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I went to a workshop on DIR Floor Time. You may be wondering what this is and it is called the Relationship-Based Play Therapy, Individual Differentiation and Development Model for Children and Adolescents with Autism Spectrum Disorders and is also used with selective mutism. It is a non-directive therapy, very different from cognitive behavioral therapy. It is not child-centered behavioral therapy. Here, I will provide an overview of what DIR Floor Time is and its tenants. In Part II, I’ll follow up with specific interventions. You must obtain the fundamentals of this model in order to apply the interventions. The material gathered for this article was provided by Esther Hess, Ph.D., Director of the Center for the Development of the Mind. Specific trainings are available for this model and this publication and Part II do not replace the need for training. It just gives you an overview of what it is.

DIR Floor Time analyzes the developmental level of each child. There are certain milestones that children must reach before they can move to the next level of development in terms of developing relationships. For example, at three months, the baby should be able to regulate and take an interest in the world, at five months should be able to establish relationships (attachments), at nine months there should be intentional two-way communication, at thirteen months there. there must be a complex sense of the organization of the self and of the behavior, at eighteen months there must be a complex sense of the self and the elaboration of the behavior, at 24 months there must be an idea of ​​emotion and capacity for representation, and at 30 months there must be have emotional ideas and representational elaboration.

In the child with the autism spectrum, these milestones are not reached. DIR Floor time begins where the child is. The child may be five years old, but his development is like a two-year-old. Work with them at the two-year level, but recognizing their age and knowing that intellectually they may be the right age, it doesn’t necessarily delay them. The model encourages a multi-model approach and encourages evaluations and working together not only with the family, but also with the speech-language pathologist, occupational therapist, physical therapist, and educator. The evaluation is based on the findings of these disciplines. The emphasis is on checking family members, family patterns, and family needs. The family will be part of the treatment and they must be willing to participate in the sessions and practice the forms shown to them 5-6 times a day. It is a great commitment. Siblings can help too. You will also be doing observations at home.

You will work on functional development skills starting at the bottom rung, which includes focus and attention and progressing to engagement and relationship, simple two-way gestures, complex problem solving, creative use of ideas and symbols, and finally to analytical / logical thinking.

There will also be things to consider for yourself as a doctor. Do you use a calm voice? Do you give him gentle looks? Is your body posture supportive? Are your actions non-intrusive? Do you use encouraging gestures? Do you know the rhythms of the child? Are you comfortable following the child’s example? Do you know the child’s feelings? Are you talking about the DIR account? Did you observe enough? Are you using emotional cues through gestures to stay connected? Are you asking too many questions? Did you chase?

The main challenges for an interaction by the therapist are the level of comfort with the child’s issues and feelings. Do you go deep or divert? The challenges on the child’s part are avoidance, disconnection, poor communication, poor motor planning, passivity, low tone, hyperactivity, lack of symbolism, fragmentation, and anxiety. Challenges on the part of parents are taking leadership, changing themes, controlling the child’s body, relying too much on sensory motor activities, skipping cues, lacking affection, lack of synchronization, concrete, functioning below the level , function above the child’s level, are anxious and / or depressed.

Autism is a multisystemic developmental disorder. There are three types:

Pattern A-Mostly aimless and unrelated, severe motor planning difficulties, severe auditory planning difficulties, severe auditory processing, flat, unmodulated or inappropriate affect, rhythmic and self-stimulating behaviors, poor and unreactive muscle tone, hyperactive to sound and touch, too active and extremely distracted.

Intermittently B-Related Pattern, fleeting simple intentional gestures, accessible but fleeting affect, enjoys repetitive or perseverative activity with objects, very rigid and reactive to change, has mixed patterns of sensory reactivity and muscle tone, poor motor planning.

Pattern C: more consistent relationship and reactivity even when evasive and rigid, islands of warm and pleasant affection, use of simple social gestures, use of intermittent complex gestures, resist change and persistent, but allow others to join in, mixed pattern of sensory reactivity and motor planning, tends to overreact, auditory processing is less severe, uses some words in written or memorized form.

This gives you an overview of the theory behind DIR Floor Time. In Part 2, we will look at interventions so that we can have good appointments with our clients with autism spectrum disorders. You should be aware that there are specific trainings that teach this method. I’m just giving you an overview and this should not be considered a replacement for training.