Written by Ellen Wolfson, LCSW
Picture this: A four-year-old boy, recently diagnosed with autism spectrum disorder, is sitting on the floor, carefully and methodically lining up his collection of hot wheels cars. His mom and dad are sitting on the floor, loudly calling, “Caleb, can we play too? Caleb, where will the cars go? Caleb, let’s play something else!” Caleb continues lining up the cars, not looking up, absorbed in his own world.
Now picture this: A week later, Caleb and his parents are sitting on the floor in my office, and he is absorbed in lining up my collection of toy dinosaurs. I gently coach his parents to sit quietly, observe what he is doing, then slowly move closer. Mom takes a dinosaur from the pile, which gets Caleb’s attention. She asks him, “Can I put this here?” as she places it next to his. Caleb looks up at her and nods. She takes another, and another, and the interaction continues. Then, she takes one and deliberately places it off the line. Caleb looks up and moves it back. She repeats this several times, each time Caleb making eye contact, loudly saying “No!” Mom takes another dinosaur from the pile, and this time, she gently places it on Caleb’s leg, making it jump rhythmically and making a silly sound as she does so. Caleb looks up, and slowly breaks into a smile, then as she continues, he starts to giggle. Mom pauses, Caleb says, “Again!”, and the exchange continues for several minutes.
The rest of the session builds on this joyful, reciprocal exchange of facial expressions, gestures, and most importantly, AFFECT. I use my understanding of Caleb’s developmental level, Individual differences, and primary attachments to strengthen Caleb’s capacity for attention, engagement, and reciprocity. When the session is over, Caleb’s mother is silently weeping: “This is the first time I ever heard him giggle like that.”
DIR Floortime is a model of assessment and intervention that is highly effective with any child experiencing developmental challenges. Its uniqueness is that it seeks to strengthen all areas of development from the bottom up, rather than more traditional approaches such as ABA, which work from the top down. In other words, the model uses the power of affect, or emotion, to harness and strengthen development of core deficits, such as attention, engagement, and reciprocity.
The ”D” refers to a child’s functional emotional developmental levels, which parallel infant development. For example, level 1 is self-regulation and interest in the world, level 2 is engagement in relationships, level 3 is two-way communication, level 4 is complex communication, and so forth. The “I” stands for individual differences; in other words, DIR clinicians have an in depth understanding of a child’s unique biological capacities, such as sensory and regulatory processing. It assesses the way each child takes in, regulates, responds to, and understands the world. And the “R” reflects the critical importance of the primary relationships in a child’s life, and how parents and caregivers can fuel healthy development.
If you are interested in an alternative or additional intervention to ABA, I’d love to hear from you. Call Southeast Psych Nashville at 615-373-9955 and get the ball rolling. I’d love to help you and your child with the DIR Floortime model.
