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Floortime

January 01, 1970

The floortime or Developmental, Individual-differences, Relationship-based (DIR) model is a developmental model for assessing and understanding any child's strengths and weaknesses. This model was developed by Stanley Greenspan and first outlined in 1979 in his book Intelligence and Adaptation.[1]

Introduction edit

The Developmental, Individual-difference, Relationship-based (DIR) model is the formal name for a new, comprehensive, individualized approach to assess, understand, and treat children who have developmental delays (including, but not limited to: Autism Spectrum Disorder). Focusing on the building blocks of typical development, this approach is also referred to as the "Floortime" or "DIRFloortime" approach. However, Floortime is actually a strategy within the DIR model that emphasizes the creation of emotionally meaningful learning exchanges that encourage developmental abilities.

The goal of treatment within the DIR model is to build foundations for typical development rather than to work only on the surface of symptoms and behaviors. Here, children learn to master critical abilities that may have been missed along their developmental track. For example, Autism Spectrum Disorder (ASD) has three core/primary problems: (1) establishing closeness, (2) using emerging words or symbols with emotional intent, and (3) exchanging emotional gestures in a continuous way. Secondary symptoms (perseveration, sensory-processing problems, etc.) may also exist. Thus, treatment options are based on particular underlying assumptions. The DIR model is based on the assumption that the core developmental foundations for thinking, relating, and communicating can be favorably influenced by work with children's emotions and their effects.

The DIR model was developed to tailor to each child and to involve families much more intensively than approaches have in the past. Through the DIR model, cognition, language, and social and emotional skills are learned through relationships that involve emotionally meaningful exchanges. Likewise, the model views children as being individuals who are very different and who vary in their underlying sensory processing and motor capacities. As such, all areas of child development are interconnected and work together beneficially.

Floortime Model Approach edit

The Floortime Model is a developmental intervention focusing on affection, with a fundamental assumption that emotions are the foundation of a child's development. It involves meeting a child at his or her current developmental level, and challenging them to move up the hierarchy of milestones outlined in the DIR Model. Once the child connects with the adult specific techniques are used to challenge and entice the child to move up the developmental ladder.

The DIR/Floortime Model calls for 15 hours/week of parent and clinician-conducted intervention, with the parent implementing the method in 20- to 30- minute sessions for 8–12 times per day. During each Floortime session, the child takes the lead by using pretend play and conversations. Parents and often therapists follow the child with playful positive attention while tuning into the child's interests.[2]

The DIR model is based on the idea that due to individual processing differences children with developmental delays, like ASD, do not master the early developmental milestones that are the foundations of learning. DIR outlines six core developmental stages[3] that children with ASD have often missed or not mastered:

  • Stage One: Regulation and Interest in the World: Being calm and feeling well enough to attend to a caregiver and surroundings. Have shared attention.
  • Stage Two: Engagement and Relating: Interest in another person and in the world, developing a special bond with preferred caregivers. Distinguishing inanimate objects from people.
  • Stage Three: Two way intentional communication: Simple back and forth interactions between child and caregiver. Smiles, tickles, anticipatory play.
  • Stage Four: Continuous Social Problem solving: Using gestures, interaction, babble to indicate needs, wants, pleasure, upset. Get a caregiver to help with a problem. Using pre-language skills to show intention and become a creative and dynamic problem solver.
  • Stage Five: Symbolic Play: Using words, pictures, symbols to communicate an intention, idea. Communicate ideas and thoughts, not just wants and needs.
  • Stage Six: Bridging Ideas: This stage is the foundation of logic, reasoning, emotional thinking and a sense of reality.

Most typically developing children have mastered these stages by age 4 years. However, children with ASD struggle with or have missed some of these vital developmental stages.[4]

Structure of the DIR Model and the Floortime Approach edit

The DIR Model and the Floortime Approach work in two general parts: Assessment and Intervention. Within each of these two categories, there are further steps and strategies.

Assessment edit

The initial step for assessment is [Screening]. The creator of the DIR Model, Stanly Greenspan, developed a measuring tool, the Greenspan Social-Emotional Growth Chart (GSEGC), to aid parents, caregivers and clinicians in this beginning step of assessment. This tool is a basic 35-item questionnaire that evaluates a child according to the social-emotional milestones he or she has met.[5] This preliminary step is a quick method to screen children for risk or diagnosis of Autism Spectrum Disorder (ASD) or Pervasive Developmental Disorder (PDD).

Following the initial screening process is conducting a [Comprehensive Functional Developmental Evaluation]. A child that has been screened with the GSEGC and displays significant developmental delay will then proceed to this step. In this process, a single clinician or clinicians of multiple disciplines (i.e. pediatrics, speech therapy, occupational therapy, psychology, etc.) must spend a significant amount of time observing a child. Specifically, the clinician(s) must be able to characterize how the degree to which a child is able to interact with others as it relates to developmental level.[6]

In the final step of Assessment an [Individual Developmental Profile] is created based on the Comprehensive Functional Developmental Evaluation[7] performed on the child. This profile is made to characterize a child's socio-emotional capacities. Through this profile, the DIR Model is able to tailor its intervention strategies uniquely to each child.[8]

Intervention edit

Once the Assessment phase is completed the Intervention period is initiated. There are four different areas that the Floortime Approach aims its interventions: 1) Home 2) Educational Programs 3) Therapies 4) Play Dates.

First, the strategies and exercises laid out in the Home Intervention are of great importance for a child. It involves three core interactions: floortime; semi-structured, problem-solving interactions; and motor, sensory, perpetual-motor, and visual-spatial physical activities.[9][unreliable medical source?] This home intervention, done primarily by the parents and family, is integral to the Floortime Approach. [10]

INTERVENTION ACTIVITY
Floortime Play with child by following their lead
Semi-structured Problem Solving Create tasks that build of the child's interests to encourage and nurture his or her problem solving skills
Motor, Sensory, and Perceptual-Motor Activities and Visual-Spatial Activities Engage child in activities that are tailored to his or her unique needs as it relates to motor, sensory, and perceptual-motor and visual-spatial activities

[11][unreliable medical source?]

Second, interventions can also be applied through Educational Programs. Just as in the Home Interventions, the three core interactions are utilized in schools. Instead of primary caregivers carrying out these interactions it will be the responsibility of the teachers, teacher assistants, or peers. As an added efficiency measure, Individualized Educational Plans (IEP) can be collaboratively created and tailored for a child by his or her primary caregivers, teachers, or clinician. The IEP is developed with the purpose of outlining the goals of improvement for a child's specific developmental needs.[12]

Another component of the DIRFloortime Model Intervention is a multi-disciplinary approach through different therapies. According to a child's Individual Developmental Profile, primary caregivers or clinicians can determine what types of therapy will benefit a child based on his or her developmental need. .[13][unreliable medical source?] Greenspan highly recommends the use of adjuvant therapies including Speech Therapy, provided by Speech Language Pathologists, and Sensory Integration Therapy, provided by Occupational Therapists.[14] As a child's primary occupation is play, Occupational Therapy is a particularly relevant field to the Floortime Method.[15]

Effectiveness edit

In 2020, Boshoff et al. concluded in their systematic review over nine studies that an increase in children's socio-emotional development is observed through various outcome measures and consistent with the focus of the model. Other areas of development have received limited focus by existing studies.[2]

The effectiveness of Floortime was examined in four randomized controlled trials in which the control group receive the usual therapies (e.g., speech therapy, occupational therapy).[16][17][18] No evidence of effectiveness has been found across the many trials that have been performed [19] Language function in the Floortime groups did not improve beyond what was observed in the controls. No adverse effects of Floortime have been reported.[20]

References edit

  1. ^ Cullinane, MD, Diane (2016). Behavioral Challenges in Children with Autism and Other Special Needs. NYC, New York: W,W.Norton and Company. ISBN 978-0393709254.
  2. ^ a b Boshoff, Kobie; Bowen, Holly; Paton, Hazel; Cameron-Smith, Sally; Graetz, Sean; Young, Alexander; Lane, Katelyn (April 2020). "Child Development Outcomes of DIR/Floortime TM-based Programs: A Systematic Review". Canadian Journal of Occupational Therapy. 87 (2): 153–164. doi:10.1177/0008417419899224. PMID 32013566. S2CID 211022609. Retrieved 12 August 2022.
  3. ^ First Feelings: Milestones in the Emotional Development of Your Baby and Child ISBN 0140119884
  4. ^ "Autism Spectrum Disorder: Signs and Symptoms". CDCgov. Center For Disease Control. 2015-02-26. Retrieved 24 July 2016.
  5. ^ Greenspan, Stanley (2004). "Greenspan social-emotional growth chart: A screening questionnaire for infants and young children". PsychCorp.
  6. ^ . The Interdisciplinary Council on Development and Learning. The Interdisciplinary Council on Development and Learning, Inc. Archived from the original on 11 August 2016. Retrieved 24 July 2016.
  7. ^ Functional Emotional Assessment Scale by Stanley Greenspan, Georgia DeGangi, & Serena Wieder
  8. ^ Greenspan, Sidney. "Basic Course Lecture Series--Lecture 7--Comprehensive DIR Assessment" (PDF). The Greenspan Floortime Approach. Retrieved 24 July 2016.
  9. ^ . The Interdisciplinary Council on Developmental & Learning Disorders. Archived from the original on 2014-07-01. Retrieved 2014-05-31.
  10. ^ Praphatthanakunwong, Nattakit; Kiatrungrit, Komsan; Hongsanguansri, Sirichai; Nopmaneejumruslers, Kaewta (2018-10-01). "Factors associated with parent engagement in DIR/Floortime for treatment of children with autism spectrum disorder". General Psychiatry. 31 (2): e000009. doi:10.1136/gpsych-2018-000009. ISSN 2517-729X. PMC 6234967. PMID 30582122.
  11. ^ . The Interdisciplinary Council on Developmental & Learning Disorders. Archived from the original on 2014-07-01. Retrieved 2014-05-31.
  12. ^ . The Interdisciplinary Council on Developmental & Learning Disorders. Archived from the original on 2014-07-01. Retrieved 2014-05-31.
  13. ^ . The Interdisciplinary Council on Developmental & Learning Disorders. Archived from the original on 2014-07-01. Retrieved 2014-05-31.
  14. ^ Mercer, Jean (September 2017). "Examining DIR/Floortime™ as a Treatment for Children With Autism Spectrum Disorders: A Review of Research and Theory". Research on Social Work Practice. 27 (5): 625–635. doi:10.1177/1049731515583062. ISSN 1049-7315. S2CID 142604883.
  15. ^ Case-Smith, J.; Arbesman, M. (2008-07-01). "Evidence-Based Review of Interventions for Autism Used in or of Relevance to Occupational Therapy". American Journal of Occupational Therapy. 62 (4): 416–429. doi:10.5014/ajot.62.4.416. ISSN 0272-9490. PMID 18712004.
  16. ^ Pajareya K, Nopmaneejumruslers K (2011). "A pilot randomized controlled trial of DIR/Floortime™ parent training intervention for pre-school children with autistic spectrum disorders". Autism. 15 (5): 563–77. doi:10.1177/1362361310386502. PMID 21690083. S2CID 24873823.
  17. ^ Casenhiser DM, Shanker SG, Stieben J (2013). "Learning through interaction in children with autism: preliminary data from asocial-communication-based intervention". Autism. 17 (2): 220–41. doi:10.1177/1362361311422052. PMID 21949005. S2CID 37759659.
  18. ^ Solomon R, Van Egeren LA, Mahoney G, Quon Huber MS, Zimmerman P (2014). "PLAY Project Home Consultation intervention program for young children with autism spectrum disorders: a randomized controlled trial". Journal of Developmental and Behavioral Pediatrics. 35 (8): 475–85. doi:10.1097/DBP.0000000000000096. PMC 4181375. PMID 25264862.
  19. ^ "Is there science behind that dir floortime".
  20. ^ Mercer, Jean (24 May 2015). "Examining DIR/Floortime as a treatment for children with autism spectrum disorders: A Review of Research and Theory". Research on Social Work Practice. 27 (5): 625–635. doi:10.1177/1049731515583062. S2CID 142604883.

Further reading edit

January 01, 1970
floortime, this, article, multiple, issues, please, help, improve, discuss, these, issues, talk, page, learn, when, remove, these, template, messages, this, article, present, fringe, theories, without, giving, appropriate, weight, mainstream, view, explaining,. This article has multiple issues Please help improve it or discuss these issues on the talk page Learn how and when to remove these template messages This article may present fringe theories without giving appropriate weight to the mainstream view and explaining the responses to the fringe theories Please help improve it or discuss the issue on the talk page December 2023 Learn how and when to remove this message This article includes a list of general references but it lacks sufficient corresponding inline citations Please help to improve this article by introducing more precise citations May 2011 Learn how and when to remove this message This article needs more reliable medical references for verification or relies too heavily on primary sources Please review the contents of the article and add the appropriate references if you can Unsourced or poorly sourced material may be challenged and removed Find sources Floortime news newspapers books scholar JSTOR November 2017 Learn how and when to remove this message The floortime or Developmental Individual differences Relationship based DIR model is a developmental model for assessing and understanding any child s strengths and weaknesses This model was developed by Stanley Greenspan and first outlined in 1979 in his book Intelligence and Adaptation 1 Contents 1 Introduction 2 Floortime Model Approach 3 Structure of the DIR Model and the Floortime Approach 3 1 Assessment 3 2 Intervention 4 Effectiveness 5 References 6 Further readingIntroduction editThe Developmental Individual difference Relationship based DIR model is the formal name for a new comprehensive individualized approach to assess understand and treat children who have developmental delays including but not limited to Autism Spectrum Disorder Focusing on the building blocks of typical development this approach is also referred to as the Floortime or DIRFloortime approach However Floortime is actually a strategy within the DIR model that emphasizes the creation of emotionally meaningful learning exchanges that encourage developmental abilities The goal of treatment within the DIR model is to build foundations for typical development rather than to work only on the surface of symptoms and behaviors Here children learn to master critical abilities that may have been missed along their developmental track For example Autism Spectrum Disorder ASD has three core primary problems 1 establishing closeness 2 using emerging words or symbols with emotional intent and 3 exchanging emotional gestures in a continuous way Secondary symptoms perseveration sensory processing problems etc may also exist Thus treatment options are based on particular underlying assumptions The DIR model is based on the assumption that the core developmental foundations for thinking relating and communicating can be favorably influenced by work with children s emotions and their effects The DIR model was developed to tailor to each child and to involve families much more intensively than approaches have in the past Through the DIR model cognition language and social and emotional skills are learned through relationships that involve emotionally meaningful exchanges Likewise the model views children as being individuals who are very different and who vary in their underlying sensory processing and motor capacities As such all areas of child development are interconnected and work together beneficially Floortime Model Approach editThe Floortime Model is a developmental intervention focusing on affection with a fundamental assumption that emotions are the foundation of a child s development It involves meeting a child at his or her current developmental level and challenging them to move up the hierarchy of milestones outlined in the DIR Model Once the child connects with the adult specific techniques are used to challenge and entice the child to move up the developmental ladder The DIR Floortime Model calls for 15 hours week of parent and clinician conducted intervention with the parent implementing the method in 20 to 30 minute sessions for 8 12 times per day During each Floortime session the child takes the lead by using pretend play and conversations Parents and often therapists follow the child with playful positive attention while tuning into the child s interests 2 The DIR model is based on the idea that due to individual processing differences children with developmental delays like ASD do not master the early developmental milestones that are the foundations of learning DIR outlines six core developmental stages 3 that children with ASD have often missed or not mastered Stage One Regulation and Interest in the World Being calm and feeling well enough to attend to a caregiver and surroundings Have shared attention Stage Two Engagement and Relating Interest in another person and in the world developing a special bond with preferred caregivers Distinguishing inanimate objects from people Stage Three Two way intentional communication Simple back and forth interactions between child and caregiver Smiles tickles anticipatory play Stage Four Continuous Social Problem solving Using gestures interaction babble to indicate needs wants pleasure upset Get a caregiver to help with a problem Using pre language skills to show intention and become a creative and dynamic problem solver Stage Five Symbolic Play Using words pictures symbols to communicate an intention idea Communicate ideas and thoughts not just wants and needs Stage Six Bridging Ideas This stage is the foundation of logic reasoning emotional thinking and a sense of reality Most typically developing children have mastered these stages by age 4 years However children with ASD struggle with or have missed some of these vital developmental stages 4 Structure of the DIR Model and the Floortime Approach editThe DIR Model and the Floortime Approach work in two general parts Assessment and Intervention Within each of these two categories there are further steps and strategies Assessment edit The initial step for assessment is Screening The creator of the DIR Model Stanly Greenspan developed a measuring tool the Greenspan Social Emotional Growth Chart GSEGC to aid parents caregivers and clinicians in this beginning step of assessment This tool is a basic 35 item questionnaire that evaluates a child according to the social emotional milestones he or she has met 5 This preliminary step is a quick method to screen children for risk or diagnosis of Autism Spectrum Disorder ASD or Pervasive Developmental Disorder PDD Following the initial screening process is conducting a Comprehensive Functional Developmental Evaluation A child that has been screened with the GSEGC and displays significant developmental delay will then proceed to this step In this process a single clinician or clinicians of multiple disciplines i e pediatrics speech therapy occupational therapy psychology etc must spend a significant amount of time observing a child Specifically the clinician s must be able to characterize how the degree to which a child is able to interact with others as it relates to developmental level 6 In the final step of Assessment an Individual Developmental Profile is created based on the Comprehensive Functional Developmental Evaluation 7 performed on the child This profile is made to characterize a child s socio emotional capacities Through this profile the DIR Model is able to tailor its intervention strategies uniquely to each child 8 Intervention edit Once the Assessment phase is completed the Intervention period is initiated There are four different areas that the Floortime Approach aims its interventions 1 Home 2 Educational Programs 3 Therapies 4 Play Dates First the strategies and exercises laid out in the Home Intervention are of great importance for a child It involves three core interactions floortime semi structured problem solving interactions and motor sensory perpetual motor and visual spatial physical activities 9 unreliable medical source This home intervention done primarily by the parents and family is integral to the Floortime Approach 10 INTERVENTION ACTIVITY Floortime Play with child by following their lead Semi structured Problem Solving Create tasks that build of the child s interests to encourage and nurture his or her problem solving skills Motor Sensory and Perceptual Motor Activities and Visual Spatial Activities Engage child in activities that are tailored to his or her unique needs as it relates to motor sensory and perceptual motor and visual spatial activities 11 unreliable medical source Second interventions can also be applied through Educational Programs Just as in the Home Interventions the three core interactions are utilized in schools Instead of primary caregivers carrying out these interactions it will be the responsibility of the teachers teacher assistants or peers As an added efficiency measure Individualized Educational Plans IEP can be collaboratively created and tailored for a child by his or her primary caregivers teachers or clinician The IEP is developed with the purpose of outlining the goals of improvement for a child s specific developmental needs 12 Another component of the DIRFloortime Model Intervention is a multi disciplinary approach through different therapies According to a child s Individual Developmental Profile primary caregivers or clinicians can determine what types of therapy will benefit a child based on his or her developmental need 13 unreliable medical source Greenspan highly recommends the use of adjuvant therapies including Speech Therapy provided by Speech Language Pathologists and Sensory Integration Therapy provided by Occupational Therapists 14 As a child s primary occupation is play Occupational Therapy is a particularly relevant field to the Floortime Method 15 Effectiveness editIn 2020 Boshoff et al concluded in their systematic review over nine studies that an increase in children s socio emotional development is observed through various outcome measures and consistent with the focus of the model Other areas of development have received limited focus by existing studies 2 The effectiveness of Floortime was examined in four randomized controlled trials in which the control group receive the usual therapies e g speech therapy occupational therapy 16 17 18 No evidence of effectiveness has been found across the many trials that have been performed 19 Language function in the Floortime groups did not improve beyond what was observed in the controls No adverse effects of Floortime have been reported 20 References edit Cullinane MD Diane 2016 Behavioral Challenges in Children with Autism and Other Special Needs NYC New York W W Norton and Company ISBN 978 0393709254 a b Boshoff Kobie Bowen Holly Paton Hazel Cameron Smith Sally Graetz Sean Young Alexander Lane Katelyn April 2020 Child Development Outcomes of DIR Floortime TM based Programs A Systematic Review Canadian Journal of Occupational Therapy 87 2 153 164 doi 10 1177 0008417419899224 PMID 32013566 S2CID 211022609 Retrieved 12 August 2022 First Feelings Milestones in the Emotional Development of Your Baby and Child ISBN 0140119884 Autism Spectrum Disorder Signs and Symptoms CDCgov Center For Disease Control 2015 02 26 Retrieved 24 July 2016 Greenspan Stanley 2004 Greenspan social emotional growth chart A screening questionnaire for infants and young children PsychCorp Guidelines for a Comprehensive DIR Program The Interdisciplinary Council on Development and Learning The Interdisciplinary Council on Development and Learning Inc Archived from the original on 11 August 2016 Retrieved 24 July 2016 Functional Emotional Assessment Scale by Stanley Greenspan Georgia DeGangi amp Serena Wieder Greenspan Sidney Basic Course Lecture Series Lecture 7 Comprehensive DIR Assessment PDF The Greenspan Floortime Approach Retrieved 24 July 2016 Home Interventions The Interdisciplinary Council on Developmental amp Learning Disorders Archived from the original on 2014 07 01 Retrieved 2014 05 31 Praphatthanakunwong Nattakit Kiatrungrit Komsan Hongsanguansri Sirichai Nopmaneejumruslers Kaewta 2018 10 01 Factors associated with parent engagement in DIR Floortime for treatment of children with autism spectrum disorder General Psychiatry 31 2 e000009 doi 10 1136 gpsych 2018 000009 ISSN 2517 729X PMC 6234967 PMID 30582122 Interventions The Interdisciplinary Council on Developmental amp Learning Disorders Archived from the original on 2014 07 01 Retrieved 2014 05 31 Educational Interventions The Interdisciplinary Council on Developmental amp Learning Disorders Archived from the original on 2014 07 01 Retrieved 2014 05 31 Therapies The Interdisciplinary Council on Developmental amp Learning Disorders Archived from the original on 2014 07 01 Retrieved 2014 05 31 Mercer Jean September 2017 Examining DIR Floortime as a Treatment for Children With Autism Spectrum Disorders A Review of Research and Theory Research on Social Work Practice 27 5 625 635 doi 10 1177 1049731515583062 ISSN 1049 7315 S2CID 142604883 Case Smith J Arbesman M 2008 07 01 Evidence Based Review of Interventions for Autism Used in or of Relevance to Occupational Therapy American Journal of Occupational Therapy 62 4 416 429 doi 10 5014 ajot 62 4 416 ISSN 0272 9490 PMID 18712004 Pajareya K Nopmaneejumruslers K 2011 A pilot randomized controlled trial of DIR Floortime parent training intervention for pre school children with autistic spectrum disorders Autism 15 5 563 77 doi 10 1177 1362361310386502 PMID 21690083 S2CID 24873823 Casenhiser DM Shanker SG Stieben J 2013 Learning through interaction in children with autism preliminary data from asocial communication based intervention Autism 17 2 220 41 doi 10 1177 1362361311422052 PMID 21949005 S2CID 37759659 Solomon R Van Egeren LA Mahoney G Quon Huber MS Zimmerman P 2014 PLAY Project Home Consultation intervention program for young children with autism spectrum disorders a randomized controlled trial Journal of Developmental and Behavioral Pediatrics 35 8 475 85 doi 10 1097 DBP 0000000000000096 PMC 4181375 PMID 25264862 Is there science behind that dir floortime Mercer Jean 24 May 2015 Examining DIR Floortime as a treatment for children with autism spectrum disorders A Review of Research and Theory Research on Social Work Practice 27 5 625 635 doi 10 1177 1049731515583062 S2CID 142604883 Further reading editGreenspan Stanley 2006 Engaging autism Philadelphia Da Capo Press ISBN 978 0 7382 1094 0 Retrieved from https en wikipedia org w index php title Floortime amp oldid 1219172578, wikipedia, wiki, book, books, library,

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