Floortime

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.

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.[3]

Dr. Stanley Greenspan and his wife Nancy described this intervention for the first time in their 1989 book, The Essential Partnership. Floortime has since made its way into homes, clinics, schools and hospitals as an effective intervention for various types of learning and developmental challenges.

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[4] 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.[5] When these foundational abilities are strengthened through the child's lead and through meaningful play with a caregiver, children begin to climb up the developmental ladder.

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.

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.[3]

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).[18][19][20] Because of various methodological limitations, these studies were deemed to provide "weak support" to Floortime as a therapy for autism.[2] Language function in the Floortime groups did not improve beyond what was observed in the controls. No adverse effects of Floortime have been reported.[2]

• Greenspan, Stanley (2006). Engaging autism. Philadelphia: Da Capo Press. ISBN 978-0-7382-1094-0.