DIR Functional Emotional Developmental Levels 1-4. Griffin Doyle, PhD Lisa defaria, LCSW, BCD Monica Osgood, Executive Director Profectum Foundation

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1 DIR Functional Emotional Developmental Levels 1-4 Presentation by Senior Faculty, Profectum Foundation Griffin Doyle, PhD Lisa defaria, LCSW, BCD Monica Osgood, Executive Director Profectum Foundation Contributions from Ricki Robinson, MD, MPH, Medical Director Profectum Foundation Cindy Harrison, SLP, M.Sc Michele Ricamato, SLP, MA, CCC and Rosemary White, OTR/L PART 1 The "D" D = Development: A child s developmental profile is not solely about milestones, but rather how the "I" works together with the child s "R" to shape development. I = Individual: Children have unique physiological, neurological, psychological, communication, motor, and sensory processing differences. Together these influence the child's trajectory. R = Relationship: Parent/caretaker relationships in a child s life play a vital role in shaping development, social and emotional growth. 1 Copyright

2 FEDL's The DIR Functional Emotional Developmental Levels (FEDL) represent nine essential developmental capacities necessary in building the core foundation every child needs for optimum growth and development. By contrast, typical chronological measures often miss the interplay between developmental systems at work in the emerging growth of a child, and how interdependent they are. Weaknesses in one will influence the advancement of others. These nine core functional offer an integrative perspective on vital developmental domains, including health and well being, social emotional, communication and language, regulation, sensory-motor, visual-spatial and ultimately cognitive functioning. Assessment and treatment is multi-disciplinary and highly collaborative. 2 Nine Core Functional Social and Emotional Developmental Capacities (FEDL) Level 1: Regulation and Shared Attention 0-3 mos Level 2: Mutual Engagement 2-5 mos Level 3: Intentional 2-Way Purposeful Communication 4-10 mos Level 4: Complex Problem Solving, Sense of Self mos Level 5: Symbolic Thinking/Language/Emotions mos Level 6: Building Bridges/Abstract Thinking mos Level 7: Multi-causal and Triangular thinking Level 8: Comparative and Gray Area Thinking Level 9: Reflective Thinking/Growing Sense of Self/Stable Internal Standard Climbing the developmental ladder 3 Copyright

3 KEY FLOORTIME PRINCIPLES ACROSS ALL FED LEVELS ~ These levels build upon one another ~ Capacities at the lower levels support the development and quality of the higher levels ~ Many children demonstrate variation in their capacities across levels and developmental domains ~ Developmental gaps at any level will impact the child's ability to access and maximize growth at higher levels ~ Move up and down the ladder as needed ~ A child may develop solid capacities at a developmental level, but he or she do not "master" the level. We must attend to all levels simultaneously and where their are gaps in functional capacities, we must go back, revisit and build forward for a child to maximize their growth and true potential 4 5 Copyright

4 add levels pyramid/growth chart or add dimension of stability across levels when stressed Ricki Robinson, MD, Autism Solutions 6 PART I: DIR FUNCTIONAL EMOTIONAL DEVELOPMENT LEVELS (FEDL) 1-4 Level 1: Regulation and Shared Attention: The child is calm and focused, able to screen out distracting internal or external stimuli; available to interact and explore their world. Level 2: Mutual Engagement: The child is able to engage with trusted caregivers, demonstrating warm connections, robust engagement, trust and intimacy; sharing attention together around a meaningful experience. 7 Copyright

5 PART I: DIR FUNCTIONAL EMOTIONAL DEVELOPMENT LEVELS (FEDL) 1-4 (CONTINUED) Level 3: Intentional Two-way Purposeful Communication: The child can engage in back and forth communication with their caregiver using vocalizations, facial expressions, affect, movement, gestures, or language. Level 4: Complex Problem Solving/Sense of Self: The child has emerging ideas, all his or her own. The caregiver supports the child in executing the ideas and in resolving together natural and semi-structured problems that can occur. Circles of Communication are increasingly robust and sustained. The child's sense of self is strengthened. 8 Regulation and Shared Attention "How does the child develop the miraculous ability to attend, to be calm and be interested in the world, to desire to interact with others and to woo those around them to interact with them?" ~ Stanley Greenspan, MD Building Healthy Minds, Copyright

6 LEVEL 1 Regulation & Shared Attention The child's ability to be calm and alert, attentive to the information from their social (and learning) environment and available for interaction. Ability to regulate his or her attention and behavior while being interested in the full range of sensations (sights, sounds, smells, their own movement patterns, etc.) At this level a child has the capacity to enter into a state of shared attention with another person 10 CORE ACTION OF LEVEL 1 Child begins taking in his sensory environment and human interactions Caregiver and child begin to "co-regulate" as the caregiver finds the optimal level of stimulation to support the child Co-regulation lays the foundation for the child's ability to share attention in a physiological and emotional regulated state. "The Dance Begins" As primary regulation increases, so does child's ability to process experience and be available for human interaction 11 Copyright

7 CORE ACTION OF LEVEL 1 (CONTINUED) Periods of distress are more efficiently resolved. The child has fewer and less intensely, stressful moments as the caregiver learns the child s unique physiological properties The child comes to feel assured that caregiver will respond effectively to his or her primitive needs (primary attachment) As the primary attachment becomes secure, the child is more alert, available to engage and to explore his or her world 12 A-TYLER 6 WEEKS 13 Copyright

8 B-WANDER 14 What we saw in this video Levels of Functioning: The child wanders aimlessly The child does not seem to know where she is in her environment The child gets distracted by sensory input The child does not respond to people talking to her 15 Copyright

9 Mutual Engagement "How does the child learn to read other s gestures, and indicate their needs, initially through gesture and then through the use of language?" ~ Stanley Greenspan, MD Building Healthy Minds, LEVEL 2 Mutual Engagement and Relationship Formation The child must be able to engage in mutually enjoyable interactions with another for his or her relationship capacity to grow The child displays depth and range of emotions while deepening the quality of engagement Stability of engagement is determined by the ability to maintain contact even when under stress 17 Copyright

10 CORE ACTION FOR LEVEL 2 As security and regulation are maintained, the primary relationship is now fueled by their shared mutual pleasure with each other The child displays an emerging ability to link physical movement and feelings together which better enables caregiver and child to exchange affection for each other through mutual gazes, sounds, touches, and animated facial expressions The caregiver and child become more absorbed in their relationship as their shared warmth intensifies into a deeper emotional bond The child has a "gleam in the eye" as he or she becomes more robustly engaged with the caregiver The child is able to sustain engagement through a range of emotions and experiences 18 C-TYLER 5 MONTHS 19 Copyright

11 D- CASH REGISTER 20 What we saw in this video Levels of Functioning: Joining in her play elicits joint attention Physical contact, rhythm and pacing enhance the reciprocity Engagement becomes more robust as the caregiver and child share in the pleasurable experience 21 Copyright

12 Intentional Two-way Purposeful Communication "How does the child learn to read other s gestures, and indicate their needs, initially through gesture and then through the use of language?" ~ Stanley Greenspan, MD Building Healthy Minds, LEVEL 3 Intentional Two-Way Purposeful Communication Circles of Communication A child is able to communicate interactively ( back and forth ) and increasingly initiates interaction with an intention or idea he wants to express. Affect and desire are not only driving but are now organizing and enriching dyadic interaction 23 Copyright

13 LEVEL 3 Intentional Two-Way Purposeful Communication Circles of Communication Child now wants increasingly to "make something happen" when interacting with a caregiver Child is rapidly learning how certain gestures produce the response he or she desires Establishment of their own gestural "language" lays the foundation for future verbal communication The child feels empowered by the discovery that they can impact the interaction 24 CORE ACTION FOR LEVEL 3 The child now intentionally interacts with the caregiver and explores her physical world Child s ideas are better expressed and understood by caregiver due to child's sensory-motor and vocal development (more robust signaling and cues) The result then is more consistent back-and-forth circles that progressively become more paced and rhythmic 25 Copyright

14 E: LISA'S BABIES 26 F: PIZZA 27 Copyright

15 What we saw in this video Levels of Functioning: Initially in sensory, exploratory play The caregiver joins the child and treats what the child is doing as intentional The child is empowered by this and the "back-and-forth" is fueled, resulting in more robust intentionality on the part of the child 28 G: MISHA FEET 29 Copyright

16 H: JL HALLWAY 30 What we saw in this video Levels of Functioning: Initially, it was very challenging to maintain regulation and engagement The child was easily distracted by his environment As the video progresses the child acquires the ability to filter out information from his environment that he doesn't need and sustains engagement with adult Ultimately, he becomes very intentional and robustly engaged 31 Copyright

17 Complex Problem Solving, Sense of Self "How does the child develop the ability to think and plan how to interact with their world and to solve physical problems to achieve their goals?" ~ Stanley Greenspan, MD Building Healthy Minds, Complex Problem Solving, Sense of Self "The ability to express herself through complex gestural conversations builds a child s motor and motor planning skills. To convey wishes and intentions, she must first organize her behavior into logical sequences and she must learn to read the sequences of others. As her ability to use and enjoy the world grows, so grows her ability to grasp the world cognitively." ~Stanley Greenspan, MD & Serena Wieder, PhD, Engaging Autism, Copyright

18 Level 4 Complex Problem Solving, Sense of Self The child is able to sustain more complex back and forth interactions with an emerging ability to have their own ideas, particularly around simple problem solving interactions with his or her caregiver. Child's maturing motor planning & sequencing contributes to maintaining continuous flow of " circles of communication" With this success, the child's sense of self is being strengthened by more complex realizations of one's own ideas and emerging abilities to flexibly solve problems 34 CORE ACTION OF LEVEL 4 Child actively contributes more to lengthy joint activities Child keenly seeks to transform his or her more complex, unfolding ideas into action. In efforts to "make it happen", he or she contends with simple problems, planning, and testing solutions Improved motor planning and visual-spatial capacities allow the child to adapt his or her plan as needed to keep interactions going or to obtain a desired goal 35 Copyright

19 CORE ACTION OF LEVEL 4 (CONTINUED) The child is more flexible and able to accept new ideas and sustain regulation and engagement Child now adds a new dimension to sense of self. The child is able to navigate, solve problems, adjust, and thereby feel more autonomous. Shaping self internally now defined by clearer feelings and ideas that child can transform into plans and actions. The mind, emotions, and body are becoming more coordinated 36 I: "POPCORN" 37 Copyright

20 What we saw in this video Levels of Functioning: The child uses two-way communication through gestures and some words The highly affective play allows the child to stay organized around the play The child is demonstrating budding capacity to engage in two-way problem solving in the context of the interaction 38 J-JUSTIN AND ZACK 39 Copyright

21 What we saw in this video Levels of Functioning: Initially the child is at a basic level of intentionality with support and modeling As the caregivers begin to expand the challenge, the child responds and is able to organize longer and more complex patterns of interaction The highly affective and supportive experience allows the child to move from ideation with execution This successful experience that allowed the child to feel his intentions were realized, further developing his sense of self 40 KEY FLOORTIME PRINCIPLES ACROSS ALL FED LEVELS ~ Promote Regulation & Mutual Engagement ~ No matter where a child s highest level and functional capacities may be, we must always start by supporting the child in achieving a wellregulated state of arousal, able to attend, focus and thus available for social interaction and learning ~ Aim for Synchronization ~ Engage with the child (and family!) where they are in their growth process, not where you wish they would be. Identify this child/family s level to synchronize mind, body, motivation/affect & communication/language through engagement 41 Copyright

22 Thank you We want to thank Serena Wieder, PhD and the late Stanley Greenspan, MD for pioneering this model and deeply enriching our understanding of child development, the child with special needs and the importance of relationship. We would also like to thank the DIR faculty for their multi-disciplinary contributions to the model and recognize that these contributions are reflected in what the model is today. Finally, sincere gratitude to all the families who have taught us so much and allowed us to share some of their precious moments in this presentation! 42 References Greenspan MD., S., Lewis, N. (2000). Building Healthy Minds: The Six Experiences That Create Intelligence And Emotional Growth In Babies And Young Children. Cambridge, MA: De Capo Press. Greenspan MD., S., Wieder PhD., S.. (2006). Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think. Cambridge, MA: De Capo Press. Greenspan, S., Wieder, S. (2003). Infant & Early Childhood Mental Health: A Comprehensive Developmental Approach to Assessment and Intervention. Zero to Three. Greenspan MD., S., Wieder PhD., S.. (1998). The Child With Special Needs: Encouraging Intellectual and Emotional Growth. Reading, MA: Perseus Books. Robinson MD., R. (2011). Autism Solutions: How to Create a Healthy and Meaningful Life for Your Child. Ontario, Canada: Harlequin. The Interdisciplinary Council on Developmental and Learning Disorders. (2000). Clinical Practice Guidelines: Redefining the Standards of Care for Infants, Children and Families with Special Needs. Bethesda, MD: ICDL. Some videos were supplied by Celebrate the Children School, NJ~ 43 Copyright