The DIR model, using the Floortime approach, provides a comprehensive framework for understanding and treating children with social, play, and interaction challenges. It focuses on helping children master the building blocks of relating, communicating and thinking, rather than on symptoms alone. The DIR model embraces the following concepts: Developmental capacities that integrate the most essential cognitive and affective processes; individual differences in motor, auditory, visual-spatial; and other sensory processing capacities; and Relationships that are a part of the child/caregiver and family interaction patterns. The Functional emotional assessment scale was used for analysis.
· Our first goal is to get the child into a calm alert state then the child will be alert and ready to communicate.
· When a child is prompted, the nervous system habituates but if the child decides to engage then their nervous system is firing which can be termed as intrinsic motivation
· Treat what the child is doing as purposeful and intentional and that offers pleasurable interactions with you
· The child must feel in control
· Using exaggerated body movements/facial expressions and or whisper voice.
· Using alerting but organizing strategies to increase his level of arousal, but not to overstimulate him. Body movements appear to work.
· Giving the child space to explore and not intrude in space.
· Wait, watch and wonder
Level 2: Forming Relationships and Mutual Engagement: Helping the child connect with people (typically developed by 6 months).
· Aim is to experience connection by sharing pleasure of doing something together – mutual joy
· Minimal sentences – keep around verbs such as ‘jump’, ‘climbing’ keep the language simple
· Don’t crowd the child space
· Make it fun! Make his play seem important to you
· Do not focus on numbers, letters of words unless it’s the child idea – the more we harness the child’s interests, the easier it will be to engage him in play.
· Playful obstruction – ‘spanner in the works’ depends on the relationship but it may be a purposeful response
· Purpose is to encourage ongoing interaction
· Two levels of interaction
o First is simple circles of communication, such as reciprocal nods, smiles, frowns, vocalizations
o Second is involving closing many circles as many as 40 in a row
o One circle is the child initiates; the caregiver responds and the child responds back on the same topic or activity
Floortime strategies that seemed effective to create opportunities to focus on back and forth interactions. A few guidelines could be:
· Follow the child’s lead
· Use facial expressions and be as animated as possible, can low key.
· Join the child activity rather than introduce a new one
Level 4: Two Way Purposeful Interactions with Complex Gestures and Problem Solving: helping the child to connect experiences through play in an organized way (typically developed by 18 months).
· Abstract thinking is key to most of what we do in the world. Without this ability, we are limited to the here and know
· Representational thinking is the start – its important for the start of having an idea which is ideation which is important for comprehension
· Pretend play is difficult as it requires the child to picture his own wish or desire and to link this desire to actions
· The guiding rule is always connecting your words and ideas with the child’s wishes and intent.
Floortime strategies that help pretend play:
· Add an element of make believe to the child’s favourite activities
· Rather than adding new activities, add imaginary elements to the activities he is doing.
· Start with familiar stories and help with sequencing and always one step at a time
· Ideation is the key to learn the intrinsic motivation of your child! Predictable is comforting so it’s important to slowly stretch their ideas. Using language to a minimum and giving time for the child to respond and start a new circle of communication.
· Do not fill the space with questions as this raises the performance demand and the child’s anxiety
Level 5: Elaborating Ideas, Pretend Play, and Creating Symbols: helping the child develop and express feelings and ideas (typically developed by 30 months)
· Level is important to help children cope with emotions
· Helps them attach meaning to their play and languages
· Where children play out themes of nurturance or power or aggression. This is all important to help them separate and individuate
· Even if there are themes that are difficult such as aggression, in play it is a safe place to explore this
· Symbolic play helps provide distance form real life but gives opportunity for the child to explore different roles, feelings and actions.
· Don’t over direct, follow the child’s lead
· Don’t slip into running commentary
· Don’t feel embarrassed
· Enter the child’s make believe world by being a character in his drama using words and actions
· Child must initiate play idea and through interaction, elaborate with expanding themes and ranges of emotion (closeness, assertiveness, fear, anger, jealousy, aggression)
Level 6: Building Bridges between Ideas (Logical Thinking): helping a child connect ideas and develop a logical understanding of the world (typically developed by 42 – 48 months).
· In this last stage you want to develop as rich a drama as possible with as many feelings and ideas a s possible
· To accomplish this goal you have to be even more interactive, to engage, to question and challenge what your child says and does
· Respond to the emotion that underlies your child’s comments
· This response will help heighten the meaning of the word and symbols and encourage your child to continue
· Use the child’s interest and broaden them use ’I am confused?’
· Emotion drives connection so help your child bridge his ideas. Do this with introducing conflict and challenge
· Think of attention as the persistence of an emotion – the more persistent you are the more attentive you become
· Ask open ended questions with, ‘how’ not ‘what’, ‘where’ and ‘why’ too many questions increase performance anxiety
· To become a fluent thinker your child has to learn the logic of cause and effect as any time you negotiate with your child around their needs (bedtime, more sweet, not eating his dinner), he will automatically use causal thinking
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