What is DIR /Floortime? Developmental - children progress through stages toward ability to think and communicate flexibly in the world Individual Difference - each child has an unique set of biologically based strengthens, challenges, and sensitivities Relationship Based - Development progresses directly from relationships with other people Floortime - Affectively rich play to match child s individual differences and stimulate developmental growth Focusing on Interactions in Relationship Information in the brain is organized by the brain areas that process emotion. Development progresses through emotional interaction with other people. The relationship between the child and her caregivers drives this process by motivating the child and organizing the brain. This is called interactive regulation. In neurotypical children and caregivers this process unfolds naturally. It is primarily modulated through non-conscious emotional communication and usually goes unnoticed. When a child has neurodevelopmental challenges, their individual differences can derail this natural process. Understanding the child s unique profile allows parents and professionals to match their interactions with the child to the child s unique profile. Maximizing the interactive match to the child s profile supports interactive regulation in the child s relationships and opens pathways for developmental progression. Relationships, Emotions, and Learning Greenspan, 1999, p. 67 Thousands and thousands of interactions help the baby exercise all of her senses and motor skills together while experiencing a growing range of emotions with you. These emotions provide a kind of glue that helps the baby organize all of her various experiences. Greenspan, 1999, p. 67 Your baby is learning that shared feelings of joy, as well as annoyance, are part of a special human relationship that is quite different from the world of inanimate physical objects. Greenspan, 1999, p. 56 Your baby s first lessons in being logical, or understanding that she can make something happen, arise out of the way you interact with her. Human learning relies on emotion in relationships to make meaning of experiences throughout our lifetime. Without a meaningful context learning is 1
rote, the child will rely on structure for regulation, and reflective thinking capacities will not develop. Communication, sense of identity & purpose, understanding symbols, and thinking rely on the emotion and meaning at the core of every experience. Pulling it all together: emotions, the body, and intention Many neuroscientists and psychotherapists alike have come to understand the body as the organ of our emotions and intentions. It is through this pathway of: o emotions > body > intention o that we get almost all of our social comprehension, that our communication and language develop, and that we regulate and organize our behavior. Thus, we must learn to use our relationships with our children to match their profile and build confidence in their bodies! Building Confidence in the Body Attend to the 7 non-verbal cues for interactive regulation o Eye contact o Facial expression o Body posture o Gestures o Vocal tone o Timing of response o Intensity of response Respond to your child s nonverbal communication Building Confidence in the Body Use body-based fun interactions, engaging around the child s emotions and intentions to join your child s state of mind and get the interactive regulation of body, emotion, and communication Focus on movement > get the interaction going by getting your bodies moving Greenspan: Go for the gleam in the eye. Stimulate your child s body to match his/her needs for arousal regulation Use yourself, your love for your child, and YOUR BODY 2
Building a comprehensive intervention program Evaluation(s) Developmental Profile Home, School, and Clinic(s) Floortime, Floortime, Floortime Incorporating support throughout each day based on the developmental profile including: o Perceptual-motor supports o Visual-spatial supports o Auditory processing supports o Cognitive and comprehension supports o Use mutual support between developmental components to support the child s integrated functioning Building a Team Occupational Therapy o Sensory Integration trained and experienced o Motor Planning through affective engagement Speech Therapy o Developmental: builds precursors to language first and throughout o Assesses and develops goals for form, function, and usage! Education Team and Therapies Biomedical Supports Family Supports 3
1: Shared Attention & Regulation This first, most foundational level of development, involves the capacity to attend to multisensory experiences in relation to a caregiver and organize a calm, regulated state. As this level emerges a child/person takes an interest in watching, listening to, and following the movements of a loved one. They also use caregiver interactions to calm themselves when they become upset. Although the basic foundation for this level is generally observable between birth and three months, development of these capacities continues for years as the person s threshold for arousal increases, tolerance of and/or interest in emotional and sensory stimulation increases, and ability for self-control matures. 2: Mutual Engagement & Intimacy Once basic capacity for shared attention and regulation develops, the child/person can process and use multisensory information to engage in and develop relationships. The earliest signals of this capacity are in the first social smiles and pleasurable interactions. As this second foundational level emerges the child can regulate interactions with an ever-expanding depth and range of emotions including assertiveness and sadness. 3: Two-Way Purposeful Communication This level of development involves using pre-verbal gestures and vocalizations to let caregivers know intentions and desires. This capacity typically begins more than a year before verbal communication as the child organizes interactions, develops ideas and intentionally, and can open and close several circles of communication around his/her ideas and intentions. For example a little girl may open a circle, then close two more when she looks at her water bottle, then points when mom looks puzzled, then points again and grunts when mom picks up the water bottle with a questioning look. The earliest examples of this capacity are commonly raising hands to be picked up or pushing away unwanted food or toys. 4: Shared Social Problem Solving This preverbal level of development involves much more consistent, social, reciprocal communication using gestures, vocalizations, and possibly some words or signs. In playful sensorimotor contexts it involves a continuous flow of back-and-forth communication. In other contexts it is reflected by 10-15 circles of problem solving communication, such as when a child pulls their parent by the hand to the door and puts their hand on the doorknob to go outside. As this level emerges, a child/person will begin to use a variety of strategies to communicate their needs and wishes. Their sense of initiative increases along with a sense of competence. Eventually increasing independence informs the earliest sense of personal identity. 5a: Representational Communication This level marks the beginning of verbal development as the child/person develops the ability to create mental representations through words, phrases, and/or pretend play. This transition from the direct action mode to the reflective understanding mode allows children to express their feelings with symbols (either words or play ideas) rather than acting out feelings behaviorally. Ideas may not be logically connected at this level, but the ideas are symbolically connected to the child/person s emotions and intentions. As this level emerges pretend play extends beyond concrete, semi-realistic play with toys (feeding a doll with a toy spoon), to play with emotional ideas initiated by the child/person (doll enjoys eating toy ice cream). Language also extends beyond memorized words or labeling of objects to represent the child/person s relationships with objects, feelings, and ideas (e.g. child points out dog to communicate his excitement or fear). 4
5b: Representational Elaboration At this level the mental representations expand as the child/person uses more language, more complex phrases, expresses feelings (child says me mad when she does not get her favorite candy), plays out sequences, and develops play themes related to an increasing number of intentions, wishes, and feelings. 6a: Representational Differentiation & Logical Thinking This level of development is marked by the beginning of the child/person s ability to differentiate between their own feelings and the feelings of other people. As this level emerges they begin to make connections between ideas and understand cause-and-effect sequences. This is the foundation of higher levels of thinking, reality testing, understanding temporal and spatial relationships, developing concentration, and modulating impulses and mood. This developmental level is reflected in the capacity to close symbolic circles of communication in pretend play, as well as, reality based conversations and the ability to connect two or more emotional ideas in either pretend play or reality based conversations (e.g. train crashes, then needs to get fixed before it works again or the doll is going to ride the truck then the truck gets stuck in the mud and doll cannot go to destination). 6b: Emotional Thinking This level of development is critical as children/people move into social relationships with peers and begin early forms of abstract thinking. The child who can differentiate between their own feelings and the feelings of others (representational differentiation) can now become aware of the difference between their relationship with external reality and their internal subjective experience of fantasy and imagination. This differentiation allows the child to think about subjective emotional experience, apply this thinking to external real life situations, and switch back-and-forth between fantasy and reality. As this level emerges a child/person can connect many emotional ideas logically in pretend play using concepts of causality, time, and space. 7, 8, & 9: Reflective Thinking Reflective thinking emerges at a different pace for each child and is typically present by early adolescence. As reflective thinking emerges, a child/person will develop the ability to understand multiple causes and reflect on a variety of possibilities for other s behavior. The child who has developed multicausal thinking may begin to reflect on the relative importance of different feelings and events and be able to say I m only a little mad. Finally, reflective thinking should develop to include the capacity to judge experience based on an internal standard of experience. A person capable of reflective thinking can think in more than one frame of reference at the same time and compare perspective. Thus, they may say, I was angrier than usual or It may be okay for them, but I don t like it for myself. 5
Processing Registration Modulation Organization of Processing Planning Organization of Execution Auditory N/A N/A Verbal Visual Spatial N/A N/A Visual Tactile Vestibular Balance Proprioceptive Movement Affective Smell/Taste N/A N/A Processing Score Key: P (poor) BT (below typical range) AT (above typical range) RS (relative strength) RW (relative weakness) UN (unclear) NO (not observed) ** (core constriction) Reactivity (mark all that apply) Auditory Verbal Visual Spatial Visual Tactile Vestibular Balance Proprioceptive Movement Affective Smell/Taste Terrified Avoidant Cautious Seeking Strong, Satiable Craving Insatiable Craving 6
Motor Development Floor Skills & Ground Interaction Strength: Core, Limb, Hands. Feet Balance & Walking Skills Range of Movement Motor Skills & Fluidity 0 1 2 3 4 5 Scoring Key: 0 not at level 1 beginning to emerge 2 very immature 3 immature 4 immature for age 5 mature for age Motor Planning Number of Steps Type of Service Needed When Derails Derailment Frequency Ideas Sequences Execution 7
Caregiver-Child Interaction Patterns Fully supported Minor interference Moderate interference Major interference Comforting child Appropriate stimulation to interest child Pleasurably engages child Reads and responds to child s emotional signals Tends to encourage child 8