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Where I Am: Home | Interventions | List | Dir Method And Autism

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DIR Method and Autism

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Ranking :

Type(s) : Behavioural

Other Names :

• Developmental Individual Difference Relationship-Based Model
• Floortime
• Floor Time
• Greenspan method

Introduction

The DIR method focuses on helping children to master the building blocks of relating, communicating and thinking, rather than on the symptoms of autism alone.

The main way in which this is achieved is through a series of ‘Floortime’ exercises in which the carer takes an active, developmental role in spontaneous and fun activities that are directed by the child’s interests and actions.

Opinion

There is limited evidence as to whether the DIR method is beneficial to children with autism spectrum disorders. Because of this we cannot recommend its use, although further large scale, high quality research into this intervention might be warranted.

Further information

Please see the Advanced version of this page for more information about this intervention, including relevant research studies and details of how we ranked these.

Disclaimer

Please read our Disclaimer about this intervention.

Audience

DIR was designed for infants, toddlers and preschoolers with autistic spectrum disorders – including autism or Asperger syndrome –
but it can also be used with older children.

Applicable Age Ranges

Aims

‘The goal of treatment is to help the child master the healthy emotional milestones that were missed in his early development and that are critical to learning. Building these foundations helps children overcome their symptoms more effectively than simply trying to change the symptoms alone.’ (Floortime Foundation, 2004).

Claims

The Floortime Foundation claims that

‘... in one recent chart review of 200 children with complex developmental challenges, over 50% of children originally diagnosed with autistic spectrum disorders and treated intensively with DIR/Floortime approaches for four to six years have become warm, engaged and loving. These children have become active learners with highly developed abilities in the areas of verbal skills, imagination, logical and abstract thinking, as well as pleasurable peer relationships. Many of them attend mainstream schools, and often their teachers are unaware of the child’s original diagnosis. Other children, because of greater neurological challenges, make slow and steady progress. Nevertheless, even these children can become warm, loving, more connected and make more progress in their language, cognitive and social skills than previously thought possible.’ (Floortime Foundation, 2004)

Detail

The DIR method allows carers to use a wide range of techniques and other interventions – such as speech and language therapy – alongside the core element of ‘Floortime’.

‘Floortime’ is a series of interactive exercises that are designed to help the child master key developmental milestones. As the name suggests, most of the exercises take place on the floor.

The carer follows the child’s lead and plays at whatever captures his interest but does so in way that encourages the child to interact with the carer. The role of the carer is to be a constructive helper and, when necessary, provocateur by doing whatever it takes to turn the child’s activity into a two-person interaction.

For example, if the child wants to roll cars, the carer rolls cars with him, offering him a faster car or a competitive race or, if necessary, crashing his car with the carer’s – whatever it takes to create an interaction.

By creating these interactions, over and over again, the carer builds on and develops the child’s interests and capabilities until the child is enticed into the world of ideas and logical thinking.

Who does what?

‘Parents do Floortime with their child, creating the kinds of experiences that promote mastery of the milestones.

‘Professionals, such as speech, occupational, and physical therapists, special educators and psychotherapists, work with the child using techniques informed by DIR/Floortime principles to deal with the child’s specific challenges and facilitate development.

‘Parents work on their own responses and styles of relating to their child with regard to the different developmental milestones in order to tailor their interactions with their child in a way that optimally supports emotional and intellectual growth.’ (Floortime Foundation, 2004).

The Floortime exercises

The exercises are based around five key steps.

• Step 1. Observation

The partner listens to and watches the child to determine how best to approach him or her.

• Step 2. Approach – open circles of communication

The partner approaches the child using appropriate words and gestures based on his or her mood and communication/behaviour style.

• Step 3. Follow the child’s lead

The child establishes the tone, guides the activity and creates ‘personal dramas.’ This helps the child experience feelings of warmth, connectedness and being understood by the partner.

• Step 4. Extend and expand play

The partner makes encouraging comments about the child’s play. This helps the child to express ideas and emotions.

• Step 5. Child closes the circle of communication

The child makes comments and gestures of his or her own.

Time

The length and frequency of the treatment will depend on the specific needs of the child.

Most children get three to five hours of intensive treatment, which is provided in 20-30 minute sessions throughout the day.

Children with more severe and challenging problems may get eight to ten 20 to 30 -minute sessions during the day.

Involvement

The DIR method is an extremely intensive intervention which requires an enormous commitment of time and energy on the part of parents and other carers. It may also require input from a variety of professionals.

The core elements of the intervention, the floor-time exercises, are delivered by the parents or carers.

Other elements, such as speech or occupational therapy, may be delivered by professionals or appropriately trained informal carers.

The exact amount of time required by each of these groups will depend on the needs of the individual with autism.

Costs

The study by Solomon (2007) suggested that the average cost of this intervention is ₤1,250/$2,500 a year, although it is likely that the exact costs will depend on the specific needs of the individual child and the level of service provided by the Floortime Foundation/Interdisciplinary Council on Developmental and Learning Disorders and/or the clinician approved by these organisations.

Credentials

The main providers of the DIR method are the parents and other informal carers who undertake the Floortime exercises. They do not need any formal qualifications, although most will have studied the materials published by the Floortime Foundation or attended one or more of their courses.

The other providers may include a range of professionals, such as speech or occupational therapists who will have a range of different credentials and qualifications.

The Floortime Foundation website also provides details of approved clinicians who can provide assistance with the DIR method within the USA and some other countries.

Availability

In theory, any parent or carer can implement the DIR method for themselves, once they have bought and read relevant training materials or attended relevant training courses provided by the Floortime Foundation.

The Floortime Foundation website also provides details of approved clinicians who can provide Floortime within the USA and some other countries.

Hazards

There are no known hazards for the DIR method.

Contraindications

There are no known contraindications for the DIR method.

History

The DIR method was developed by Stanley Greenspan and Serena Wieder from the school of Psychiatry and Pediatrics at George Washington University Medical School during the 1990s.

Greenspan and Wieder went on to found and run two organisations in 2003 to promote the DIR model. The Interdisciplinary Council on Developmental & Learning Disorders provides educational programs and training materials to professionals. The Floortime Foundation provides outreach and training for parents and other non-professionals.

Issues

Links

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