my friend jacob
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My Friend Jacob. DIR/ Floortime Model. Dr Stanley Greenspan D evelopmental, I ndividual differences and R elationship-based DIR is the theory, ‘ Floortime ’ the intervention techniques. DIR/ Floortime Model. An Introduction by Dr Stanley Greenspan. D IR Model. - PowerPoint PPT PresentationTRANSCRIPT
My Friend Jacob
DIR/Floortime Model
Dr Stanley Greenspan
Developmental, Individual differences and Relationship-based
DIR is the theory, ‘Floortime’ the intervention techniques
DIR/Floortime Model
An Introduction
by
Dr Stanley Greenspan
DIR Model
Six Functional Developmental Levels1. Self regulation and shared attention (FDL 1)
2. Attachment and Engagement (FDL 2)
3. Purposeful Gestures/Two-way Communication (FDL 3)
4. Complex two-way Communication and Problem Solving (FDL 4)
5. Shared Meanings & Symbolic Play (FDL 5)
6. Logical Play and Emotional Thinking (FDL 6)
DIR Model
Six Functional Developmental Levels
1. Self regulation and shared attention (FDL 1)
birth to 3 months
Learn to focus, be calm, and take in the sights and sounds of the world.
Learn to be “with” us.
DIR Model
Six Functional Developmental Levels
1. Self regulation and shared attention (FDL 1)
birth to 3 months Focus on faces and shift attention between people and
objects
Cry to indicate discomfort, hunger, displeasure
React to sound and turn head to caregiver’s voice
DIR Model
Six Functional Developmental Levels
2. Attachment and Engagement (FDL 2)
2-4 months Develop a desire to be a part of a relationship
you see this when you see that “gleam” in
their eye and their face light when they hear your voice.
DIR Model
Six Functional Developmental Levels
2. Attachment and Engagement (FDL 2)
2-4 months Begin to respond to and engage care-givers with smiles
and cooing. This is the beginning of communicating and connecting “affect to intent”-they see you come into the room, they feel a warm fuzzy feeling and they smile.
DIR Model
Six Functional Developmental Levels
2. Attachment and Engagement (FDL 2)
2-4 months Discriminate and make vowel and consonant
sounds, synchronize sound and mouth movements with caregiver’s vocal rhythms
DIR Model
Six Functional Developmental Levels
3. Purposeful Gestures/Two-way Communication (FDL 3)
4-8 months Begin to show very intentional communication like
using gestures to get what they want.
Ex: Baby reaches up toward their care-giver when they want to be picked up, or move their bodies to show excitement.
DIR Model
Six Functional Developmental Levels
3. Purposeful Gestures/Two-way Communication (FDL 3)
4-8 months Begin to intentionally communicate by using back and
forth circles of communication and exchange(1-3).
What is a circle of communication?
Turn taking interactions
DIR Model
Six Functional Developmental Levels
3. Purposeful Gestures/Two-way Communication (FDL 3)
4-8 months Ex: Mom shows the pacifier to the baby (opening a
circle) baby sees it and reaches out and takes the pacifier(closing the circle).
DIR Model
Six Functional Developmental Levels
3. Purposeful Gestures/Two-way Communication (FDL 3)
4-8 months Gestures-facial expressions, arm and leg movements,
pointing, vocalizations
Discriminates between people
DIR Model
Six Functional Developmental Levels
3. Purposeful Gestures/Two-way Communication (FDL 3)
4-8 months Begin to understand simple play sequences like: “Peek
a Boo”, “Ring around the Rosie”.
DIR Model
Six Functional Developmental Levels
4. Complex two-way Communication and Problem Solving (FDL 4)
9-18 months Can use a back and forth interaction to solve a
problem- take mommy by the hand, lead her
to the refrigerator to get something to eat.
DIR Model
Six Functional Developmental Levels
4. Complex two-way Communication and Problem Solving (FDL 4)
9-18 months Develop verbal language-This is when they learn to talk.
Use words to express emotions
DIR Model
Six Functional Developmental Levels
4. Complex two-way Communication and Problem Solving (FDL 4)
9-18 months
Begin to see a continuous flow of interaction (3-10
circles).
DIR Model
Six Functional Developmental Levels
4. Complex two-way Communication and Problem Solving (FDL 4)
9-18 months
Learn how to control their behavior.
Follow 1 step directions like: “Go get your shoes.”
DIR Model
Six Functional Developmental Levels
5. Shared Meanings & Symbolic Play (FDL 5)
18-30 months
Use their language to express themselves- They see mommy coming into the room, they get a warm fuzzy feeling, ask her for a hug and tell her “I love you!”
DIR Model
Six Functional Developmental Levels
5. Shared Meanings & Symbolic Play (FDL 5)
18-30 months
Use meaningful words and phrases in interactive pretend play with care-giver’s.
DIR Model
Six Functional Developmental Levels
5. Shared Meanings & Symbolic Play (FDL 5)
18-30 months
Language ability is growing rapidly because images acquire meaning through many more relevant emotional experiences.
Can answer “wh” questions.
DIR Model
Six Functional Developmental Levels
6. Logical Play and Emotional Thinking (FDL 6) 30-48 months
Think logically and connect ideas and experiences
Example: You ask him if he wants to go to Johnny’s or Sam’s house? He says: “Sam’s”. You say: “Why?” and he says: “Because Sam’s mom always gives us ice cream.”
DIR Model
Six Functional Developmental Levels
6. Logical Play and Emotional Thinking (FDL 6)
30-48 months Develop a logical story within symbolic play with a clear
beginning, middle, and end.
Understand time concepts and sequence of events, if I clean my room now, I can watch tv later.
DIR Model
Six Functional Developmental Levels
What do these levels look like?
DIR Model
Individual Differences
Biologically based differences in: Regulatory Capacities Motor Planning and Sequencing Abilities Receptive and Expressive Language Visual Spatial Processing
Praxis
DIR Model
Regulatory Capacities/Sensory Processing
The body’s ability to take in information from the environment through the sensory systems,
organize it, and respond appropriately to it.
For example: A baby sees mom coming into the room and the baby coos to get her attention which brings mom over. (Level 1-2)
DIR Model
Regulatory Capacities/Sensory Processing
Example: A teacher gives the instruction to complete the math worksheet, the student is able to follow the instructions and complete the assignment. (Level 4)
Example: The five year old child comes home from Kindergarten and shows her mom the dance moves she learned in music class. (Level 6)
DIR Model
Regulatory Capacities/Sensory Processing
What are the sensory systems?
What we:
See-Visual
Hear-Auditory
Touch-Tactile
Smell-Olfactory
DIR Model
Regulatory CapacitiesSensory Processing/
What are the sensory systems?
What we:
Taste-gustatory
How we experience: movement & gravity
Vestibular
Proprioceptive
DIR Model
Regulatory Capacities
When these systems work well we have: functional or “normal” sensory integration or sensory processing.
When one, two or several of these systems are not working well we have:
Sensory Processing Disorder or Sensory Integration Disorder.
DIR Model
Regulatory Capacities/Sensory Processing
1.Look at child’s response to each type of sensory information
2.Do they have typical sensitivity or is your child hyper, hypo, or mixed.
3. Does your child have a dominant reactivity?
DIR Model
Regulatory Capacities/Sensory Processing
What does hypersensitivity look like?
A heightened awareness of the sensory information
Response: Child tends to avoid that input if at all possible.
DIR Model
Regulatory Capacities/Sensory Processing
What does hyposensitivity look like?
A decreased or lack of awareness of the sensory information
Response: Child can be a seeker (craving) that input or an avoider.
DIR Model
Regulatory Capacities/Sensory Processing
What does mixed reactivity look like?
An inconsistent response to sensory information, sometimes over responsive, sometimes under responsive (difficulty with modulation)
Response: Child can be a seeker (craving) that input or an avoider and this can change from moment to moment.
DIR Model
Sensory Processing Disorders can lead to many developmental challenges that affect a child’s emotional development.
activity level may be either unusually high or low, or fluctuate between extremes
child may be in constant motion or fatigue easily
child may become impulsive, easily distractible
DIR Model
Sensory Processing Disorders can lead to many developmental challenges that affect a child’s emotional development.
show a general lack of planning
gross and/or fine motor coordination problems
speech/language delays
academic challenges
DIR Model
Regulatory Capacities/Sensory Processing
What can we do to help our children?
Be good detectives!
What’s your child’s sensory motor profile?
What sensory information helps regulate your child? What sensory information does your child crave? Like?
DIR Model
Motor Planning and Sequencing Abilities
Can a child have an idea and follow through with it?
1. Ideation-can the child develop his/her own ideas
2. Planning-can the child plan out how to accomplish the idea
3. Sequencing-can the child plan out the activity
DIR Model
Motor Planning and Sequencing Abilities
Can a child have an idea and follow through with it?
4. Motor execution-can the child accomplish follow through with the idea
5. Adaptation-if it doesn’t work quite the way the child thought it would can they adapt and change their plan
DIR Model
Receptive Communication
Can the child understand other’s attempts at communication?
1. Orient to sounds in the environment.
2. Tune into tone of voice, facial expressions gestures, and key words of another.
3. Engage in shared attention with care-provider
4. Switch attention from one person to another and back.
DIR Model
Receptive Communication
5. Understanding of simple words, phrases, complete sentences.
6. Understand “wh” questions including “how”.
7. Understand “what if”, “then what”, questions
8. Follows commands (simple one step, one step, two step, three step).
DIR Model
Expressive Communication
Can and How Does the Child Communicate?
1. Mirroring gestures and vocalizations with intent to communicate.
2. Intentional use of gestures, facial expressions, tone of voice and sounds to convey intentions.
DIR Model
Expressive Communication
3. Use single words
4. Use sentences meaningfully
5. Use phrases and sentences in back and forth exchanges
DIR Model
Visual Spatial Processing
Can the child use visual spatial strategies systematically to explore and discriminate desired objects?
1. Observe and focus on an object
2. Alternate gaze from object to person for joint attention.
DIR Model
Visual Spatial Processing
3. Follow another’s gaze to determine the object of attention
4. Switch visual attention back and forth between self and other
5. Differentiate important to unimportant (background) visual information.
DIR Model
Visual Spatial Processing
6. Actively search for hidden objects
7. Explore several areas of a room for hidden objects
8. Explore more than two areas of space with active visual assessment of space, shape, and materials
DIR Model
Praxis
Putting it all together
1. Initiates ideas in play with clear goals and purpose
2. Is able to associate sensory perceptions from the body, visual system, auditory system
to develop a plan
DIR Model
Praxis
3. Is able to develop the steps of the sequence
4. Is able to execute the steps and persist
5. Is able to adapt plan if it does not work or is Interfered with by another’s action
DIR Model
Relationship BasedLearning/Intervention is done in the context of
relationships through affective interactions (emotionally driven).
Focus on Relationship and Affect makes DIR/Floortime different from other developmental approaches.
Interactive relationships support development.
Floortime
Intervention or treatment technique
Child centered - meet’em where they’re at and take them where they need to go using the information gained from evaluating the D…I…R of the child.
Use playful interactions to help children move up the developmental ladder
Parent Coaching Model
DIR/Floortime Model-Assessment
D- Functional Emotional Developmental Level (FEDL’s)
I-Individual Differences
R- Relationships
Assessment-The “D”
Background Information
Greenspan Social Emotional Checklist
Functional Emotional Assessment Scale (FEAS)
Clinical Observation by a trained professional
Assessment-The “I”
Pediatric Neurologist or Developmental Pediatrician
Primary vision and hearing testing
Specific evaluations: Occupational, Speech and Physical Therapy
Educational
Assessment-The “R”
Functional Emotional Assessment Scale (FEAS)
Greenspan Social Emotional Checklist
Parent/Caregiver Report
Clinical Observation
Floortime-Basic Ideas
Follow the child’s lead!
Be with the child… OWL -observe, watch, listen Wait
Imitate Join
Floortime-Basic Ideas
Follow the child’s lead!
Make whatever they are doing interactive by: Playfully Obstructing Trying to read their intentions and helping them Narrating Making random behaviors purposeful
Floortime-Basic Ideas
Where is your child at emotionally?
What are your child’s communication skills?
Join in at the child’s
developmental level!
Floortime-Basic Ideas
What are your child’s motor skills?
What are the child’s Visual Spatial abilities?
What is the “just right’ level?
Join in at the child’s developmental level!
Floortime-Basic Ideas
Open and close circles of communication!
Take out a really fun or exciting activity or toy.
Find ways to make them laugh! Be silly!
Surprise them.
Floortime-Basic Ideas
Open and close circles of communication!Expectant Waiting!
Add a routine with a clear beginning, middle, and end to the activity.
Use “Playful Obstruction”
Floortime-Basic Ideas
Use rhythm and music
Open and close circles of communication!
Introduce simple games like: Peek a boo, Ring around the Rosie, London Bridges
Floortime-Basic Ideas
Create a play environment!
Use your child’s sensory motor profile to help you design your play area and purchase toys/equipment.
Use your child’s interests as a guide
Floortime-Basic Ideas
Create a play environment!
Think about what has been successful in the past and slightly vary the toys, equipment, or activities.
Floortime-Basic Ideas
Extend the circles of communication!
Theme and Variation. Do something different with the same activity or change the activity slightly.
Add a different sensory component to the activity.
Floortime-Basic Ideas
Extend the circles of communication!
Stop doing what you always do and wait for them to do ask for help or see if they can do it on their own and then celebrate the moment with them!
Floortime-Basic Ideas
Extend the circles of communication!
Be a actor in their play-yourself, using a puppet or stuffed animal, or using a favorite character.
Floortime-Basic Ideas
Broaden the child’s range of interactive experience.
Allow/introduce a wide variety of play activities and emotions
Include pretend/symbolic play when the child is ready.
Floortime-Basic Ideas
Broaden the child’s range of interactive experience.
Why is Symbolic Play Important?:
Safe way to practice, re-enact, understand and master full range of emotional ideas,
experiences and feelings.
Floortime-Basic Ideas
Broaden the child’s range of interactive experience.
Why is Symbolic Play Important?: Allows flexibility in reasoning, thinking, and
problem solving leading to abstract thinking and differentiation of sense of self and
others.
Floortime-Basic Ideas
Broaden the child’s range of interactive experience.
Symbolic Play Themes: Earliest symbols-Blankie, Teddy Bear, Barney,
Sesame Street, Dora, Farms, Dinosaurs and dragons, etc.
Floortime-Basic Ideas
Broaden the child’s range of interactive experience.
Symbolic Play Themes: Symbolizing-comfort, reassurance, real life learning and feelings, explore and think, safety and danger
Floortime-Basic Ideas
Broaden the child’s range of interactive experience.
Symbolic Play Themes:
Fairy Tales and feelings-Goodnight Moon, Goldilocks, 3 Little Pigs, Billy Goats Gruff, Cordoroy
Floortime-Basic Ideas
Broaden the child’s range of interactive experience. Symbolic Play Themes:
Symbolizing-separation, getting lost, disappointment, rescue and safety, fear and danger, joy, anger, sadness, good and bad guys
Floortime-Basic Ideas
Broaden the child’s range of interactive experience.
More advanced symbols-Pirates, Knights and Kings, Princesses, Wizards, Superheroes, Witches, Joker, Dracula
Floortime-Basic Ideas
Broaden the child’s range of interactive experience.
Symbolizing- good and bad guys, more complicated and rich themes, discriminating between real and imaginary
Floortime-Basic Ideas
Tailor interactions to the child’s individual differences in sensory processing and modulation.
Go to their “comfort zone”
Use your child’s sensory motor profile to support your child’s regulation
Floortime-Basic Ideas
Tailor interactions to the child’s individual differences in sensory processing and modulation.
Use your child’s interests to guide you in play.
Floortime-Basic Ideas
Simultaneously attempt to mobilize the six functional emotional developmental levels!
Be in the moment and let your child guide you!
Have fun!
DIR Framework (Greenspan)
Children’s Therapy Unit
We offer this model within our interventions-O.T., P.T., S. T., and Psychology and have been for the last 11 years.
DIR Framework (Greenspan)
Children’s Therapy Unit
Recently, we started a new program called the PLAY Project which uses the DIR/Floortime Model as an intensive developmental intervention for children with autism in the home.
Case Studies
DIR/Floortime
Where Can I Learn More?
The Child with Special Needs: Encouraging Intellectual and Emotional Growth
by Dr Stanley Greenspan and Serena Weider, PhD
DIR/Floortime
Where Can I Learn More?
Engaging Autism: Using the Floor TimeApproach to help Children Relate,
Communicate, and Think by
Dr Stanley Greenspan and Serena Weider, PhD
DIR/Floortime
Where Can I Learn More?
Autism Solutions: How to Create a Healthy and Meaningful Life for Your Child
by Ricki G. Robinson, MD
DIR/Floortime
Where Can I Learn More? Websites:
www.icdl.com (Interdisciplinary Council on Developmental and Learning Disorders
www.playproject.org
www.profectum.org
www.stanleygreenspan.com
DIR/Floortime
Dawn Heino, O.T.R./L
Pediatric Occupational Therapist
PLAY Project Home Consultant
(253) 697-5200
DIR/Floortime
Never underestimate the Power of
Play!