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The Developmental, Individual Difference, Relationship-based (DIR®/Floortime™) Model is a framework that helps clinicians, parents and educators conduct a comprehensive assessment and develop an intervention program tailored to the unique challenges and strengths of children with Autism Spectrum Disorders (ASD) and other developmental challenges. The objectives of the DIR®/Floortime™ Model are to build healthy foundations for social, emotional, and intellectual capacities rather than focusing on skills and isolated behaviors. For a detailed overview, download 2 page flyer.
- The D (Developmental) part of the Model describes the building blocks of this foundation. Understanding where the child is developmentally is critical to planning a treatment program. The Six Developmental Milestones describes the developmental milestones that every child must master for healthy emotional and intellectual growth. This includes helping children to develop capacities to attend and remain calm and regulated, engage and relate to others, initiate and respond to all types of communication beginning with emotional and social affect based gestures, engage in shared social problem-solving and intentional behavior involving a continuous flow of interactions in a row, use ideas to communicate needs and think and play creatively, and build bridges between ideas in logical ways which lead to higher level capacities to think in multicausal, grey area and reflective ways. These developmental capacities are essential for spontaneous and empathic relationships as well as the mastery of academic skills.
- The I (Individual differences) part of the Model describes the unique biologically-based ways each child takes in, regulates, responds to, and comprehends sensations such as sound, touch, and the planing and sequencing of actions and ideas. Some children, for example, are very hyper responsive to touch and sound, while others are under-reactive, and still others seek out these sensations. Biological Challenges describes the various processing issues that make up a child's individual differences and that may be interfering with his ability to grow and learn
- The R (Relationship-based) part of the Model describes the learning relationships with caregivers, educators, therapists, peers, and others who tailor their affect based interactions to the child’s individual differences and developmental capacities to enable progress in mastering the essential foundations.
Central to the DIR®/Floortime™ Model is the role of the child’s natural emotions and interests which has been shown to be essential for learning interactions that enable the different parts of the mind and brain to work together and to build successively higher levels of social, emotional, and intellectual capacities. Floortime™ is a specific technique to both follow the child’s natural emotional interests (lead) and at the same time challenge the child towards greater and greater mastery of the social, emotional and intellectual capacities. With young children these playful interactions may occur on the “floor”, but go on to include conversations and interactions in other places. The DIR®/Floortime™ Model, however, is a comprehensive framework which enables clinicians, parents and educators to construct a program tailored to the child’s unique challenges and strengths. It often includes, in addition to Floortime™, various problem-solving exercises and typically involves a team approach with speech therapy, occupational therapy, educational programs, mental health (developmental-psychological) intervention and, where appropriate, augmentative and biomedical intervention. The DIR®/Floortime™ Model emphasizes the critical role of parents and other family members because of the importance of their emotional relationships with the child.
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The importance of starting early
The therapeutic program must begin as early as possible—at the first sign that something is wrong—because the more quickly the child is engaged and interactive, the more quickly she'll start learning and the fewer maladaptive behaviors she'll develop to cope with her difficulties.
Despite parents' best efforts, it is often hard to get a child into therapy. Often a parent senses something wrong, only to be pooh-poohed by relatives and sometimes even by professionals: "All babies are different. Wait and see what happens." However, children with severe disorders can't afford to wait, because months or years lost waiting will be very difficult to regain.
It typically takes eight months from the time a parent seeks help until the time intensive therapy starts. This is too long. When a child exhibits difficulties in relating or communicating, the situation should be evaluated as soon as possible. Assessment should begin within days, and intensive therapy should begin while the assessment is in progress. Only in that way can the process of decline be halted and the child spared months of lost development.
The best way to catch problems early is to have pediatricians, educators, and parents act as an early warning system. Pediatricians are in an especially strategic position; they are close to families and have the training and perspective to catch problems that parents may miss. If at each well-baby checkup pediatricians routinely examined infants for age-appropriate developmental skills, including subtle emotional, cognitive, language, sensory, and motor patterns, potentially severe disorders could be caught before they derailed a child's development. For instance, by 18 months a child should be warmly engaged and capable of initiative and two-way communication. She should also be able to use complex gestures to communicate what she wants—taking her mother's hand and leading her to the door or toy chest, or pointing, for example. Without the use of words she should be communicating with her parents, clearly understanding much of what they say to her, and communicating many of her own wishes back. If by 18 months the child can do these things, her gestural communication is developing on track and the building blocks of symbolic expression and language are present. But if she is not communicating gesturally in an age-appropriate way, the assessment and, if needed, the intervention, should begin immediately. It does not make sense to wait until she is 24 months to see if language is delayed. The child who has a circumscribed language problem that will take care of itself will be mastering these preverbal gestural communication patterns. The child who is not using gestures and behaviors to communicate needs and wishes and solve problems often is showing the signs of significant challenges.
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