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Running Head: DIR Floortime Therapy DIR Floortime Therapy
| Content Provider | Semantic Scholar |
|---|---|
| Author | Matheson, Rebecca Greenspan, Stanley I. |
| Copyright Year | 2016 |
| Abstract | DIR Floortime Therapy is a social pragmatic approach used to help children with autism develop stronger verbal and social skills. Dr. Stanley Greenspan determined there were six milestones all children must master in order to develop appropriate language and social skills. DIR Floortime Therapy engages with the child through play in order to create a naturalistic environment that helps children achieve these milestones. While the approach is not evidence based, several studies have been conducted using DIR Floortime Therapy to strengthen language and social skills in young children with autism. The majority of these studies found a greater increase in the participants’ language and social skills. The study that did not find an increase in language, did see greater joint attention and enjoyment in social interactions. These two factors are predictors of language which possibly points to the assumption that with a longer period of DIR Floortime Therapy, these children would eventually improve their language skills. Moreover, while DIR Floortime is not evidence-based, the Early Start Denver Model, whose foundation is based on DIR Floortime, was deemed evidence-based. This model targets mostly toddlers in hopes that intensive early intervention of this therapy could significantly decrease autism symptoms, enabling these children to progress socially and verbally at a similar rate to their typically developing peers. Perhaps with further research DIR Floortime therapy will be found as an evidence-based practice to increase positive social interactions and language skills in young children diagnosed with autism. DIR Floortime Therapy 2 Overview of DIR Floortime Therapy The strategies used to instruct children with developmental delays, especially autism spectrum disorder fall into two categories: behavioral and social-pragmatic. While the two approaches are different, their foundations share key characteristics: early intensive intervention, strategic direction, and structured programs. ABA (applied behavior analysis) is the most common behavioral approach used for individuals with autism. Under this approach, behavior is shaped through operant learning (modifying behavior through reinforcement) (Prizant & Wetherby, 1998). The most common method of intervention using a social-pragmatic approach is DIR Floortime Therapy, developed by psychiatrist Stanley Greenspan. He figured that by creating an intervention based on developing relationships, he could teach children with developmental delays socialization skills, improve language, develop joint attention, and decrease repetitive movements (Solomon, Necheles, Ferch, & Bruckman, 2007). He determined that there are six milestones all children must master for healthy emotional and intellectual growth: “self-regulation and interest in the world; forming relationships, attachment and engagement; two-way, purposeful communication; behavioral organization, problem solving and internalization; representational capacity; and representational differentiation” (Solomon et al., 2007, p. 11). He hypothesized that children would be more likely to reach their emotional and intellectual potential if instruction started at their developmental level and then teachers used the children’s strengths to better their skills. Through this type of teaching and as the children mature emotionally and intellectually, their communication skills would increase as well (Greenspan & Wieder, 2006). So while DIR Floortime therapy can be used to teach typically and atypically developing children since it simply uses the children’s strengths and interest to stimulate their emotions and intellect, it became a popular technique to instruct children with emotional DIR Floortime Therapy 3 disabilities, mental health challenges, developmental delays, and autism spectrum disorder (Haan, n.d.). DIR Floortime was created based on the DIR model (Developmental, Individualdifferences, and Relationship-based) which illustrates child development and helps adults understand how to support growing children (Haan, n.d.). Since DIR Floortime bases its foundation on starting at the child’s level and building on his/her strengths, the approach has the adult physically work with the child at his/her level—the floor. Then instead of having the mentor initiate the interaction, the mentor enters the child’s play. So the child determines the framework of the therapy, and the adult uses these activities to strengthen communication. Typically parents and therapists appreciate DIR Floortime therapy because it can be done in the child’s natural environment and embedded in the daily routine. So through training, parents can implement the therapy with their children which not only decreases the cost of therapy, but also strengthens the parent-child relationship. The first step of the intervention is to engage the child using their interests in order to bring them into “our world.” A way this can be done is by having the adult simply copy the child’s actions. For example, if the child is banging a lego on the floor, the mentor might join the individual by tapping a toy on the floor as well. Then the adult might engage the child a little more by giving the child another lego, or providing some commentary to add language. The same technique can be applied to older children as well, but perhaps instead of banging a lego on the floor, the older child might be interested in building train tracks. So in order to enter that child’s world, the adult might suggest adding a drawbridge to the track so the child’s play is being expanded, but it is still based on the individual’s interest (Autism Speaks, 2016). DIR Floortime Therapy 4 DIR Floortime Experiments In a study done by Michigan University, Solomon et al. (2007) determined the effectiveness of the PLAY Model (Play and Language for Autistic Youngsters). This project’s framework was based on the DIR Floortime model, to study whether a social-pragmatic approach can improve the functioning skills of children with autism. The children chosen for the experiment had to be older than eighteen months but less than six years of age. They also had to have a diagnosis of autism, pervasive developmental disorder not otherwise specified (PDDNOS), or Asperger syndrome. They also could not have a severe medical disability. The children had to live within 60 miles of a home consultant, and receiving no other type of intensive therapy. Overall, 68 children were chosen to participate in the study. Ten had severe autism, twenty-two had moderate autism, eighteen had mild autism, fourteen had PDD-NOS, and three were diagnosed with Asperger syndrome (Solomon et al., 2007). Consultants worked with the families once a month for 3-4 hours, training the parents how to provide the therapy. The parents also received a one-day training that discussed the PLAY Project and DIR Floortime model. The parents were taught these skills in order to provide therapy to their child for at least 15 hours a week, through either structured play periods or embedded into the daily routine. The parents were required to record the number of hours their child received therapy per week (Solomon et al., 2007). To determine the effectiveness of the PLAY Project, the participants were given the Functional Emotional Assessment Scale (FEAS) before and after the intervention was provided. The FEAS determined the functional level of the child based on Greenspan’s six developmental levels. Overall, 45.5% of the participants scored “good” to “very good” functional developmental progress. The consultants also used clinical ratings to determine the functional DIR Floortime Therapy 5 development level of these children. It was found that 52% of the children made very good clinical progress, and 14% made good progress. While it was not statistically significant, researchers discovered that the more hours during the week a child received therapy, the higher the outcome scores were for that child. After therapy the parents were given the opportunity to rate their satisfaction with the PLAY Project. From the 68 families who participated, 74% completed the satisfaction survey. Seventy percent were very satisfied with the PLAY Project, 10% were satisfied, and 20% were somewhat satisfied. No family, however, was unsatisfied with their child’s progress using the intervention. Another important aspect of this project was the cost. While the typical therapies for autism (Applied Behavior Analysis, Pivotal Response Therapy, Verbal Behavior Therapy) cost between $25,000-$60,000 a year, the PLAY Project only costs $2,500 a year. This extreme difference might be a deciding factor for many families (Solomon et al., 2007). While the experiment did appear successful in strengthening the participants’ functional skills, there were some limitations to the study. For instance, there was no control group used in the experiment, so it was impossible to claim that the changes seen in the children’s pre and post FEAS scores were directly caused by the PLAY Project interventions. Also since it was found that the more hours of intervention a child received, the higher the functional developmental scores were, this possibly indicates that parent involvement and time was more important than the actual therapy. The researchers agreed that further studies need to be done to determine if the DIR Floortime framework is an effective strategy to use with children with autism. However, the strong results from this pilot study highly suggests that the DIR Floortime framework is successful in increasing the functional levels of children with autism (Solomon et al., 2007). DIR Floortime Therapy 6 Another study by Casenhiser, Shanker, and Stieben (2011) used the DIR Floortime framework to compare social and communication skills of young children with autism. They used the Milton and Ethel Harris Research Initiative treatment program [MEHRIT] (an intervention based on the DIR principles) |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://www.lynchburg.edu/wp-content/uploads/volume-13-2016/Matheson-Rebecca-DIR-Floortime-Therapy.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
