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BASIC CONCEPTS IN FLOORTIME INTERVENTION AND THE DEVELOPMENTAL- INDIVIDUAL DIFFERENCE- RELATIONSHIP BASED (DIR) ® MODEL Presented for Cal Lutheran University.

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Presentation on theme: "BASIC CONCEPTS IN FLOORTIME INTERVENTION AND THE DEVELOPMENTAL- INDIVIDUAL DIFFERENCE- RELATIONSHIP BASED (DIR) ® MODEL Presented for Cal Lutheran University."— Presentation transcript:

1 BASIC CONCEPTS IN FLOORTIME INTERVENTION AND THE DEVELOPMENTAL- INDIVIDUAL DIFFERENCE- RELATIONSHIP BASED (DIR) ® MODEL Presented for Cal Lutheran University April 13 th, 2009 Dr. Jonine Biesman

2 STANLEY GREENSPAN, M.D. Founder of the DIR ® Approach Leading developmental theorist and interventionist Specializes in conceptualizing and working with children with special needs Degrees: Harvard, A.B., cum laude, 1962 Yale Medical School, M.D., 1966 Dr. Greenspan is a practicing child and adult psychiatrist and psychoanalyst,Clinical Professor of Psychiatry and Behavioral Sciences and Pediatrics at George Washington University Medical School; a supervising Child Psychoanalyst at Washington Psychoanalytic Institute, serves as chair of the Interdisciplinary Council on Developmental and Learning Disorders (ICDL) and co-chair of the Council on Human Development.

3 EXCERPTS FROM THE CHILD WITH SPECIAL NEEDS (Greenspan and Wieder, 1998 pp. 123, 110-111) Relationships are critical to a childs development. Through interactions, you can mobilize a childs emotions in the service of his learning. By interacting with a child in ways that can capitalize on his emotions, you can help him want to learn to attend to you, you can help him want him to learn how to engage in a dialogue; you can inspire him to take initiative, to learn about causality and logic, to act to solve problems even before he speaks and moves into the world of ideas. As together you open and close many circles of communication in a row you can help him connect his emotions and intent with his behavior (such as pointing for a toy) and eventually with his words and ideas (Give me that!). In helping him link his emotions to his behavior and his words in a purposeful way, instead of learning by rote, you enable your child to begin to relate to you and the world more meaningfully, spontaneously, flexibly, and warmly. He gains a firmer foundation for advanced cognitive skills. p. 123

4 Throughout history we have believed that emotions were subservient to thought or reason, but an emerging body of observation and neuro-scientific research suggests this view is inaccurate. Rather than being separate and subservient to thought, emotions seem to be responsible for our thoughts. Because emotions give directions to our actions and meaning to our experiences, they enable us to control our behavior, store and organize our experiences, construct new experiences, solve problems and think. The emotional component of each experience make the experience meaningful… pp.110-111

5 What is the D in DIR? The D in DIR represents social-emotional developmental milestones that are essential to intellectual growth and overall healthy development. They serve as the foundation for communicating, relating, and thinking independently within the context of the greater social world. There are nine Functional Emotional Developmental Levels: 1) Shared Attention and Regulation (begins 0-3 months) 2) Engagement and Relating (begins 2-6 months) 3) Two-way Purposeful Emotional Interactions – 2-way gesturing (begins 4-9 months) 4) Shared Social Problem-Solving (begins 9-18 months) 5) Creating Symbols and Ideas (begins 18-30 months) 6) Building Logical Bridges Between Ideas: Logical Thinking (begins 30-48 months) 7) Multi-Cause Thinking 8) Gray-Area Thinking 9) Reflective Thinking with a Sense of Self and Internal Standard

6 SOME GENERAL PRINCIPLES Affect is the glue for functional emotional development. Affect plays a central role in all learning. The child has to invest affectively. Relationships and pleasure are essential for learning to be meaningful. Emotion and motivation drive cognition and motor development. Individual differences are the norm. Children learn best through active learning and interaction (follow the childs lead to find out what is meaningful to him/her). When meaningful connections are not emphasized, a child learns to comply with external demands but lacks the internalization that leads to self-initiation, empathy, and abstract thinking. Incorporate all sensory and processing modalities.

7 SHARED ATTENTION AND REGULATION The foundation. Necessary for engaging and relating in the world. Ability to remain calm and attentive to the world in the face of multiple sensory stimuli and to self-soothe. Congruence between a caregivers approach and childs calming behaviors help the child to develop internal regulation and control of his/her behavior. Ability to achieve homeostasis Infants instinctively turn toward a pleasant or familiar voice very early on. Use pleasant sensations from others and from their environment to calm themselves. The ability to attend to others and what is going on in the world.

8 ENGAGEMENT Falling in love!!!!! -Wooing -Intimacy -Enjoying the presence of another -Mutually enjoyable shared experiences such as smiles and gazing -Warm mutual feelings -Helping the child to experience a range of feelings while staying engaged and related -Building trust -The foundation for long-lasting relationships -Insure that your movements and voice are sensitive to the childs individual sensory profile so that you can woo them and they can woo you – always be affective but for the under-responsive child be up-regulating and for the over- responsive child be down-regulating. -Rosemary White, OT

9 TWO-WAY COMMUNICATION Use of gestures to communicate – pointing, reaching to be picked up, purposeful noises, responding to people talking by making sounds, faces, initiating gestures (wiggling, gurgling), back and forth affective signaling to convey intentions, reading body posture and facial expression Mommy smiles, baby smiles back; Daddy rolls the ball, baby happily rolls it back. Dialogue without words. First sense of cause and effect and establishing a sense of self, separate from the caretaker. My intents and actions create results. Foundation for more sophisticated communication Beginning of opening and closing circles of communication – help the child use affect and emotion to communicate intent, wishes, and needs (use of hands, face, body)

10 COMPLEX COMMUNICATION AND SHARED PROBLEM-SOLVING Organizing behavior to solve problems Continuous flow of affective interactions with people for shared social problem-solving (e.g., may take caregiver by the hand, lead to the refrigerator, bang on door, point to or say milk – sequencing of actions) Beginning to communicate ideas through words. Development of a more complex sense of self Stretch out exchanges for as long as possible. Dont be too compliant and facilitative. Shared problem-solving is an essential skill for functioning with peers, in school, and beyond. Insure the problem-solving is in an interaction

11 IDEAS AND SYMBOLIC PLAY oBeginnings of fantasy play and the child representing the world in which he/she lives, the conflicts faced, through play or symbolism oExploring a range of feelings and themes (good guys, bad guys) oMaking sense of a complex world oIncreased use of language to indicate wishes and interests oFunctional use of ideas (Me hungry, Juice please; feeding dollies, racing cars) oRepresentational capacity, forming mental pictures to form ideas about wants and needs o Ability to use imagination oExperience the idea of an emotion oSymbols are necessary to express thoughts and feelings and to resolve conflicts oWhen we look at symbolic development were looking at emotional development. Symbols provide clues into the childs emotional world. oThe goal is to elevate all feelings and impulses to the level of ideas and express them through words and play instead of acting out behavior

12 BUILDING LOGICAL BRIDGES BETWEEN IDEAS Stringing together a logical sequence of ideas. Moving toward more reality-based thinking Providing explanations: Why? Linking ideas and feelings to begin to form a logical understanding of the world The child learns to differentiate what is inside him from the outside world, to understand himself and his world better. Running dialogue, linking of the childs action and ideas with your own Closing of a multitude of symbolic circles, interaction of ideas Be even more interactive, engage, question, challenge, collaborate, talk about – but let the child take the initiative Combine action, words, and affect! Thinking conceptually, reflecting on motives, making predictions

13 THE IMPORTANCE OF APPRECIATING INDIVIDUAL DIFFERENCES KNOW THE CHILDS INDIVIDUAL PROFILE. NO TWO CHILDREN ARE ALIKE IMPORTANT AREAS TO ASSESS ARE LANGUAGE (EXPRESSIVE AND RECEPTIVE), SENSORY PROCESSING, REACTIVITY, AND MODULATION, VISUAL SPATIAL PROCESSING, AUDITORY PROCESSING, MOTOR PLANNING (PRAXIS), PROPRIOCEPTIVE, AND VESTIBLAR SENSES – THESE AREAS CAN CHALLENGE PROCESSING AND REGULATION OTHER AREAS ARE TEMPERAMENT, FRUSTRATION TOLERANCE, COGNITIVE ABILITIES, EXECUTIVE FUNCTIONING, ATTENTION, PERSONALITY TRAITS, BEHAVIOR UNDERSTAND THE CHILD ACROSS SETTING MODIFY THE ENVIRONMENT. REMOVE THE ENVIRONMENT FROM THE CHILD; NOT THE CHILD FROM THE ENVIRONMENT MODIFY THE WAY IN WHICH YOU INTERACT WITH EACH CHILD.

14 RELATIONSHIPS ARE THE CORE ESSENTIAL LIFE LINE Relationships organize the childs experience and support all domains of development Rich synchronicity that occurs between child and parent in typical development Flooded with positive emotional energy to glue to parent Holding image of parent when play peek-a- boo, baby can remain regulated with just the image of mommy Evidence of dormant mirror neurons (fire in the prefrontal cortex when we see someone doing an action we have performed) in individuals with autism Maintaining and sustaining co-regulated interactions FEAS – an assessment instrument designed to assess a childs functional emotional and social capacities in the context of the relationship with the caregiver

15 RELATIONSHIPS (CONT.) Essential to consider family dynamics, parenting styles, family stress, patterns of interaction, capacity to woo and engage Assess parents priorities and conceptualizations Understand parents own experiences and feelings regarding play Parents capacity for handling aggression and other difficult behaviors Parents view of their child once diagnosed Available support for the family system including siblings Genetic propensities Can not underscore the need for AFFECT in the family. Affective interactions help the child regulate around sensory experiences, to draw meaning, helps the brain to create connections between different developmental domains (e.g., motor, cognitive, visual-spatial)

16 SOME RESOURCES ICDL.COM STANLEYGREENSPAN.COM COPING.ORG CELEBRATE THE CHILDREN.ORG Books by Stanley Greenspan, Serena Wieder, and other contributors: The Child with Special Needs Engaging Autism The Challenging Child ICDL- DMIC (Diagnostic Manual for Infancy and Early Childhood) Psychodynamic Diagnostic Manual (PDM) Clinical Practice Guidelines The Out of Sync Child (Kranowitz) The Boy Who Loved Windows (Stacey) The Developing Mind (Siegel)


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