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DIR 101 for Parents and Professionals – Part 1

Cats and Dogs Teach

Their Young Video

alt

“Inside-Out” approach to a wide array of

developmental problems and educational practices.
Affectively charged relationships are essential for
development.
No two people are alike. Individual differences are
the norm not the exception.
Strength-based model

DIR 101 for Parents and Professionals 1

 Parents are the cornerstone.
A child’s interdisciplinary team and treatment plan
are formed based on the child’s individual profile.
Process is emphasized over content.
Surface behaviors and compliance are de-
emphasized.

Infants and Toddlers

Children and Adults
Schools
Communities
Families
Typical/At Risk/Developmentally Challenged

Note: This is not actually an Einstein quote, but still good ☺.

DIR 101 for Parents and Professionals 2

 Developmental (e.g. autism spectrum disorders)
Environmental/Situational (e.g. neglect/foster care)
Educational

Autism is a spectrum disorder.

Autism is everywhere.
Autism has a neurobiological basis.
Early identification and intervention is crucial.

DIR 101 for Parents and Professionals 3

 Qualitative difference in social interaction
Narrow interests- restricted and stereotypical
Nonverbal communication differences
e.g. poor/lacking gestures, eye contact, facial expressions
Verbal communication differences
e.g. delays, no conversation, odd pronoun use, stereotyped
language, repetitive, echolalia, odd pitch, intonation, rate
or rhythm, "scripting”

10

Persistent deficits in social

communication and social interaction
Restricted, repetitive patterns of
behaviors, interests or activities

11

Symptoms must be present in the

early developmental period
Symptoms cause clinically significant
impairment in social, occupational, or
other important areas of current
functioning.

12

DIR 101 for Parents and Professionals 4

 More dimensional (less categorical)
No longer a diagnosis of Asperger’s
Syndrome
Sensory difficulty now a feature – but
not primary
Social (Pragmatic) Communication
now listed
13

o The neurological profile that is

emerging suggests differences that
go beyond these domains.
o These classifications do not
account for emerging brain
research.
o There is no clear focus on “core”
and “derivative” concerns
14

Some of the ways individuals vary:

Fine and gross motor skills and challenges
Low muscle tone
Impaired motor planning
Sensory processing profiles
Health/Medical history
Immune function problems
GI problems
Regulatory profile, including difficulties with activity, mood
and attention
Expressive and receptive abilities and challenges
Visual spatial abilities and challenges
15

DIR 101 for Parents and Professionals 5

 When a parent or professional is shown in a video
clip, consider the complexities and realities involved
in the work among children, their parents and
professionals, and remember that they have
generously given permission for others to view and
discuss their actions.
When viewing a video clip, reflect on the strengths of
the practice as well as ways it might have been more
effective.

16

Remember that you are seeing only a narrow slice of a child’s,

a parent’s, and a professional’s actions. There is likely a much
larger context that, if known, could add to your understanding
of what you are seeing.
Recognize and respect cultural differences portrayed in the
video clip as they relate to language, dress, expectations,
mannerisms, and other evident characteristics.
Raise concerns and criticisms respectfully and tactfully,
remembering the challenges we all face in being effective with
children and families.

17

This baby is self-absorbed and not

attuning to his social environment
(mother).
Mother makes wonderful, gentle, sweet
overtures and he does not respond.
not engaged in the social surroundings,
hyper-focused on the computer toy

Autism at 14 months alt 18

DIR 101 for Parents and Professionals 6

 Early Onset
Most common - symptoms present before 12 to 18 months of
age

Late Onset
Seemingly typical development until around 18-24 months,
and then a regression and/or a plateau-ing of skills

19

BROAD
Therefore the label is less meaningful than often believed
to be

20

Autism was once thought to be the result of a single

cause, for example:
Genetics
Poor parenting (ice box mothers)
It is now understood that autism is likely the result of
multiple causes working cumulatively, and multiple
paths.

21

DIR 101 for Parents and Professionals 7

 Child is a “black box,” a mystery.
Compliance and easily observable skills are
emphasized.
To increase wanted behavior: reward.
To decrease unwanted behavior: punish or ignore.
Assume that bottom line improves with discrete skills.

22

Child learns to avoid the punisher.

Child performs only when extrinsic reward is
possible.
Child gains rote skills rather than abstract reasoning.
Core deficits are not improved with discrete skill
improvement.
Lack of generalization of skills.
Child is discouraged (due to being asked to do what
is impossible.)

23

Surface behavioral changes are not the end goal.

Internal changes are.
Isolated skills and compliance are de-emphasized.
Intrinsic rewards and motivation are key, starting
with finding pleasure in relationships.
Affect is emphasized at all times.

24

DIR 101 for Parents and Professionals 8

 Seek to understand core deficits rather than focusing
on outward symptoms and behaviors.
Support and increase core functions of relating,
communicating, reasoning and thinking.
Remove or bypass constitutional barriers.
(e.g. speaking slowly to a child with auditory processing
challenges; avoiding sensations a child finds aversive)

25

See child in the “big picture” of family.

Help parents choose professionals that are the best fit
for their child.
Help parents become effective advocates.
Help parents promote their child’s development
Help parents understand their child
Help parents, caregivers, teachers, and therapists
engage fully with children

26

In the beginning, it can be hard to see and measure

progress.
Emphasis is not on teaching the child skills. Emphasis is on
building the underlying fundamentals of intellectual growth
- the process of learning, which begins with the process of
relating.
For a time, the outside might not look so different, even
though changes are happening on the inside.
• Remember: Inside Out!

27

DIR 101 for Parents and Professionals 9

 28
28

Selective Differences Found in Some Studies*

Increased brain volume and enhanced early growth rate

Differences in “mirror neuron” systems (Optional: Dan Siegel –
Mirror Neurons Internet Video or Alternate File)
Differences in limbic system- notably the amygdala (social
processing and affect)

*None of these are universal, but as we have learned more about the brain,
differences like these have been seen in various studies.

29

The right side of the brain (affect, rhythm,

tonality) comes “on line” before the left brain!
The sub-cortex – particularly the amygdala – is
“wired” and interconnected, early in
development through the nature of the earliest
relationships.
The baby’s brain is more sensitive to affective,
gestural and intonational cues (“musicality”)
than the words themselves!

DIR 101 for Parents and Professionals 10

 Affect and gesture are
communicative drivers-
•55%- facial expressions
•38% - vocal tone
•7% - words
31

So……………
Your facial expressions, tone of voice,
movement and gestures are more powerful
than your words! When you speak with an
infant and young child, move to their eye level
(monitoring how they “take you in”), keep a
respectful distance to be sure he/she “is in
control”, convey in all of your “body language”,
calmness, interest and willingness to “follow
the child’s lead”.

Researchers found that the amygdala was,

on average, 13 percent larger in young
children with autism, compared with control
group of children without autism. In the
study, published in a 2010 Archives of
General Psychiatry, researchers scanned
50 toddlers with autism and 33 children
without autism at age 2 and again at age 4.
The study adjusted for age, sex and IQ.

33
12/8/2015

DIR 101 for Parents and Professionals 11

 Speculation that it grows quickly in
childhood, interfering with social
processing by remaining too activated,
then shrinks or slows in growth rate as
a child ages.

12/8/2015

The new findings suggest that social fear in autism may

initially trigger a hyperactive, abnormally enlarged
amygdala, which eventually gives way to a toxic adaptation
that kills amygdala cells and shrinks the structure
The brain's fear hub likely becomes abnormally small in the
most severely socially impaired males with autism spectrum
disorders, researchers funded by the National Institutes of
Health's (NIH) National Institute of Mental Health (NIMH)
and National Institute on Child Health and Human
Development (NICHD) have discovered.

12/8/2015

In these situations, the child likely has

neurobiological vulnerabilities that
transform typical experiences into ones
which are experienced as powerful and
dangerous stimuli and which overwhelm
the child’s capacity to regulate his or her
emotions and behaviors.
Children with autism may have brain
differences that may lead them to respond
to “normal” events as if they were
dangerous or even traumatic.

DIR 101 for Parents and Professionals 12

 Dan Siegel – Helping Us Understand the Brain with a
“Hand Model of the Brain” (Mindsight, 2010)

Dan Siegel – Brain and Relationships (alt)

Dan Siegel – Hand Model of the Brain (alt)

What happens in the

amygdala DOES NOT
STAY in the amygdala!!!

38
12/8/2015

Developmental
Individual Difference
Relationship-Based

39

DIR 101 for Parents and Professionals 13

 [Link]/research
York University: Casenheiser, Shanker, and Steiben.
"Learning Through Interactions In Children With
Autism: Preliminary Data From a Social-
Communication-Based Intervention." Autism (2011).

Playing to Treat Autism York University Brain

Research: (CBC news report)

40

Solomon, R., Van Egeren, L., Mahoney, G., Quon

Huber, M., 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-
485.
Pajareya, and Nopmaneejumruslers. "A Pilot
Randomized Controlled Trial of DIRFloortime Parent
Training Intervention for Pre-school Children with
Autism Spectrum Disorders." Autism (2011).
41

Functional, emotional developmental capacities:

1. Staying Self-Regulated
2. Engaging and Falling in Love
3. Communicating Simple Intentions
4. Communicating Purposes
5. Communicating Emotional Ideas
6. Communicating Reasoning

42

DIR 101 for Parents and Professionals 14

 “To learn to interact socially, children need
to be able to focus, be calm, and actively
take in information from their experiences
with others; from what they see, hear,
smell, touch, and taste; and from the way
they move.”

From Engaging Autism, p 43

43

A child who is attentive and regulated is able to:

Remain regulated (not over or under-reacting) in response

to internal or external stimuli
Enjoy interaction without immediately withdrawing
Respond to comforting and attention
Maintain longer and longer “flows” of interaction
Begin to “woo” his caregivers with a deeper and deeper
relationship, setting the stage for baby and caregiver to “fall
in love.”

44

The synchrony between a caregiver and child may

impact the child’s ability to develop regulation. For
example:
A child who is sensitive to sound and touch may withdraw
from parents who try to cuddle or sing bouncy songs. The
parents may feel rejected or frustrated or incompetent.
A calm baby who seems uninterested in the world may not
respond to calm, mild-mannered parents. They may decide the
baby is happier by herself than with them.

45

DIR 101 for Parents and Professionals 15

 Refers to the “child’s ability to engage in
relationships, including the depth and range of
pleasure and warmth, as well as related feelings,
such as assertiveness, sadness, anger, etc. that
can be incorporated into the quality of
engagement and stability of engagement (even
under stress).”

From The Child with Special Needs, p 455

46

A child who is engaged and relating:

Recognizes special caregivers
Shows anticipation
Begins to develop gestures he can use to communicate
Laughs/smiles joyfully at caregiver; reciprocal social
smiling/cooing – initiating and responding
Is able to handle an ever-widening array of emotional
experiences and feelings and can begin to “read” the
affect of others (smiles, frowns, excitement)
Is better able to progress in areas that may be difficult,
e.g. motor planning, language, etc.

47

FEDCs 1 and 2 are clearly observed.

Even as newborns, babies have the ability to be co-
regulated by caregiver’s voice and engage in simple
back and forth interactions.
(alt)
Video: Happy Twins (alt)

Baby Reciprocity (alt)

48

DIR 101 for Parents and Professionals 16

 A child may have difficulty engaging and relating if he:
Has a sensory system that derails his ability to tune
into relevant stimuli and tune out irrelevant stimuli.
is unable to be calm and regulated (lacks adequate
mastery of FEDC 1).

49

“By about six months of age, babies begin transforming

emotions into signals for communication. For this to
happen, caregivers need to read and respond to babies’
signals and challenge the baby to read and respond to
theirs. Through these exchanges, babies begin to engage
in back and forth emotional signaling, or two-way
communication.”

From Engaging Autism, p 44

50

Caregiver
entices
• Child initiates or • Child
“opens a circle responds
of • Caregiver or “closes
communication” entices child the circle”
based on child’s to expand
• Child begins
interest a new circle

Opening Closing

51

DIR 101 for Parents and Professionals 17

 A child working at this level may:
Gesture purposefully to get what he wants (reaching,
taking, pulling, pointing, making sounds)
Play with objects while also engaging with caregiver
Respond to a caregiver’s cues; for instance, when
father offers a toy, baby takes it and puts it in a
container
Demonstrate emotions such as closeness, pleasure,
protest, fear, etc.
Recognize he causes people and things to react (Mom
coos back, block falls when he drops it)
52

In this clip a typically developing 18 month old is playing

a game of hiding and finding toys.
Look for:
Mutual attention
Shared pleasure
Non-verbal cues and responses
Rich affect and gestures
Motor planning

Video: Where’d they go? (alt) 53

A child who has not developed reciprocity or an

understanding of how to read another’s affect will
have difficulty becoming more purposeful.
A child’s ability to begin gesturing will be impeded
if he has an undeveloped or underdeveloped map of
his own body (does not have an understanding of his
body in space).

54

DIR 101 for Parents and Professionals 18

 Two and a half year old Jack was born prematurely at 25 weeks.
His challenges include relating and communicating, regulation and
sensory processing.

How might these difficulties affect his relationship with Mom?

How does Mom help Jack make meaning out of what he is doing
(i.e. help him become more intentional)?
What is mom doing that will help Jack learn to reference her?

Video: Alligator in Tunnel (alt)

55

This capacity is about learning to interact to solve

problems and about developing a sense of self.

FEDC 4 is characterized by a continuous flow of

communication: child is able to open and close many
circles, establishing a rapid back-and-forth rhythm with
caregiver using facial expressions, sounds, and gestures.

56

“For complex, problem solving social interactions to occur, the

infant needs to have an emotional desire or wish (i.e. intent
or affective interest) that indicates what he wants.”
“the child needs to connect her inner affects (intent) to
symbols to create meaningful ideas.”
“The capacity for engaging in a continuous flow of reciprocal
affective interactions enables the child to modulate mood and
behavior, functional preverbal and verbal communication, and
thinking.”

57

DIR 101 for Parents and Professionals 19

 A child working at this level will be able to:
Begin to negotiate for wants and needs
Begin to recognize emotional patterns
Play with an increasing emotional range
Imitate something new that a caregiver introduces
Sequence actions—motor planning—to execute an
idea or desire

58

Cole is a typical 10-month-old just beginning to

interact with Purposeful Social Problem Solving
Communication behaviors (FEDC 4).
His solid capacities at FEDCs 1-3 support his efforts
to get something he wants from his mom.

Video: More Crunchies (alt)

59

A child with constrictions may not easily interpret

caregivers words and gestures, making interaction
and communication confusing rather than
pleasurable.
A child with motor planning deficits may have
difficulty sequencing the sounds and movements that
are necessary for long chains of interaction.
A child with constrictions might have difficulty
remaining engaged and interactive when feeling
strong emotions. Meltdowns may occur often.
60

DIR 101 for Parents and Professionals 20

 Thomas, a 2 ½ year old with difficulty verbally
expressing himself, has a history of disengaging when
he becomes frustrated.
Note especially
o How Thomas makes multiple attempts to get his mom to
play the way he wants.
o The power of affect to organize

Video: Big Red Ball (alt)

61

Notice all the levels coming together: self regulation,

engagement, social problem-solving.

Video: Lollipop (alt)

62

“At this stage, children use pretend play to symbolize

real or imagined events such as tea parties or monster
attacks. They also now use symbols to manipulate
ideas in their minds without actually having to carry
out actions. This allows new flexibility in reasoning,
thinking and problem solving. Language and the use
of symbols become more complex from the
beginning of this stage to the end of the following
one…”

From Engaging Autism, p 48

63

DIR 101 for Parents and Professionals 21

 A child at FEDC 5 will be able to…
Understand facial expressions and other affective cues for
wide range of emotion (e.g. jealousy, disappointment)
Begin to relate to what someone else is experiencing,
responding appropriately to the feelings of others (e.g. my
friend is sad because she fell down)
Raise feelings and impulses to the level of ideas, engaging in
conversations to convey what he is thinking, feeling, wishing
Resolve conflicts in social situations
Demonstrate a sense of humor (may also begin at FEDC 4)

64

Pretend play includes:

Using symbols to stand for things
Projecting own thoughts and feelings onto characters
Elaborating on ideas through extended pretend play
sequences
Expressing ideas that often convey emotion
A growing range of emotional themes, including
closeness, dependency, assertiveness, and humor

65

Expands experiences and understanding

Pretend play offers a safe arena to practice and
experiment with real-life feelings, abilities, ideas,
relationships, situations, etc.
Vital precursor to the ability to think abstractly
Pretend play uses symbols that become more elaborate as
child “climbs the symbolic ladder”

66

DIR 101 for Parents and Professionals 22

 Nurturance and dependency
Pleasure and excitement
Curiosity
Power and assertiveness
Anger and aggression
Limit setting (containing feelings - aggressive feelings,
excited feelings, yearning feelings)
Fears and anxieties
Love, empathy, and concern for others
Control

*The Child with Special Needs, pp. 206-208 67

A child with constrictions may not use his emotions

effectively to organize his thoughts and behavior. He
may appear overly literal or fact-based (emotions
seemingly absent).
A child who is not comfortable with a range of
emotions may become fearful and anxious in pretend
play (emotions are disorganizing), or play may be
limited to a few comfortable scenarios.

68

The benefits of pretend play extend to older children

and teenagers, but the approach needs to age-
appropriate. For example:
o Rather than getting on the floor with figurines and toys, an
adolescent might participate in a small drama or
improvisational group.
o An adolescent’s interest in music, art, movies, etc. might be
the starting point for a Floortime session (that may no
longer be on the floor).
o Role-playing sessions with a therapist can provide some of
the pretend play practice that leads to logical, “gray area”
thinking.
69

DIR 101 for Parents and Professionals 23

 Alex is a 3-year-old boy whose challenges include
auditory processing.
With his dad’s help, he is able to engage in simple
pretend play.

Video: More Coffee (alt) and Video: More Coffee (Coaching) (alt)

70

Belle is a typically developing 23 month old who is

very interested in the idea of the puppy pulling ears
and having his ears pulled, and that it hurts.

Watch as Belle’s mom allows Belle to be the director

of the drama.
What functional emotional capacities can you
identify?

Video: Directing the Drama (alt)

71

Where FEDC 5 is about generating and

communicating emotional ideas, FEDC 6 is about
building bridges between emotional ideas.
“Logical thinking leads to new skills such as
debating, math, and scientific reasoning. Children can
now invent things, such as a new game, and play
games with rules.” (Engaging Autism, p 49)

72

DIR 101 for Parents and Professionals 24

 A child at FEDC 6 will be able to…
Reflect on his own feelings
Ask and answer “Wh” style questions (who, what,
where, when, why, and how)
Give opinions and reasons for her feelings and actions
Use logic and abstract thinking
Debate, negotiate, and express choices
Hold a sustained sense of self and others

73

Pretend play at FEDC 6 includes:

Logical and emotional connections (don’t have to be
realistic)
Time and space concepts
More elaborate, complex dramas with identifiable
topics
Full range of emotional themes, including conflict,
loneliness, aggression, frustration and morality

74

A child who is unable to build bridges between ideas

may be repetitive and mechanical, or may appear
fragmented in his play.
A child with constrictions may not be able to see the
abstraction and logic behind ideas.
A child with constrictions might have difficulty
understanding the concepts of temporality and
spatiality (time and space).

75

DIR 101 for Parents and Professionals 25

 Luke and Anthony (about 11 years old) orchestrate a
pretend drama to keep a family of animals safe from a
gorilla gang.
Notice how they employ negotiation, elaboration,
reasoning and multiple points of view.

Video: Gorilla King (alt)

76

FEDC 7 - Multiple perspectives

o Child moves from simple logical thinking to triangular
logical thinking
FEDC 8 - Gray area thinking
o Child becomes able to see the world in relativistic terms
rather than all this or all that.
FEDC 9 - Internal standard of self
o Child begins to be able to compare daily experiences
against an internal standard.

77

This five year old girl uses capacities up to and

beyond FEDC 6
Notice especially:
o Bridging of ideas
o Self-reflection
o Sequencing
o High affect that organizes her thoughts
o Multiple perspectives
o Internal Standard of Self

Video: Job before Marriage (alt)

Video: Comedian (alt) 78

DIR 101 for Parents and Professionals 26

 Each child has a unique capacity to take in,
integrate, manage, and react to sensory input from
the environment, from others, and from his or her
own body.
No two children are alike in their expression of
autism or other challenges of relating and
communicating.
No treatment is “one size fits all.” Multiple
techniques and therapies are called for.

79

Health
Sensory/Motor Processing
Auditory Processing
Visual Processing
Support systems
Family/Therapists/Community Resources

80

Chronic illness, reduced immune function

Allergies
Ear Infections
Gastro-Intestinal Problems
Chronic Antibiotic Use

81

DIR 101 for Parents and Professionals 27

 Olfactory (sense of smell) Each sensory system
Visual (sense of sight) has a protective
Auditory (sense of hearing) function as well as a
Gustatory (sense of taste) discriminative
Tactile (sense of touch) function
Each system may be
Vestibular System (sense of hyper or hypo
balance) sensitive, or typical
Proprioceptive System
(feeling of muscles, tendons
and joints)
82

Plan and execute purposeful movement in space.

Develop perception of our selves and our
environment.
Develop discrimination and control of our
movements.
Develop and maintain an optimal arousal level.

83

The nervous system shuffles incoming information

and prepares for responses.
Incoming information must be registered,
discriminated, categorized, and judged.
The nervous system must react quickly and
appropriately, including: Fight or Flight.
If sensory registration is problematic, Fight or Flight
may be exhibited too often. Also moodiness, over-
reactivity will often show.

84

DIR 101 for Parents and Professionals 28

 How the sensory system reacts to stimulation
A person’s sensory threshold is the level at which
their nervous system responds to stimulation.
Thresholds vary person to person and sensory system
to system. The concept of sensory threshold helps us
understand how individual children register sensation.

85

Regulation refers to “the capacity to control the

nature and the intensity of one’s responses, by
regulating levels of arousal, attention, affect and
action.

(Dunn, 2007; Williamson and Anzalone, 2001) 86

Arousal – the ability to maintain alertness and

transition between different cycles such as sleep and
wakefulness. Influenced by child’s perceptions and
interpretations of sensory input.
Attention – the ability to focus selectively on an
object or task.
Action – the ability to engage in adaptive, goal
directed behavior. (Anzalone, 1993)
Affect – the emotional component of behavior.

87
Williamson and Anzalone, 2001

DIR 101 for Parents and Professionals 29

 Locate the source of a sound, and distinguish salient
from background sounds
Attend to sounds
Fuse sounds together to form a word
Decode/remember what is heard and draw meaning
from it
Understand the rules and meanings of language
(semantics)

88

Make quick eye movements to keep things in focus

when the body moves
Converge and accommodate: keep moving objects in
focus in focus
Coordinate sight and other senses
Recall/mentally manipulate
Recognize familiar faces, body language and facial
expressions
Create a “mental map” of physical surroundings

89

adaptability
execution
initiation

ideation

Feedback, feed forward,

grading, timing sequencing

90

DIR 101 for Parents and Professionals 30

 Cultural Values
Intergenerational Pressure
Social Support
Family history (e.g. neglect, abuse, trauma history)
Coping Skills
Emotional availability or reactivity
Grief (shock, denial, guilt)
Coping patterns
Goodness of fit (e.g. play favorites)

91

Need to control/protect
Warmth versus authority
Desire for more or less information
Internal family teamwork
Communication styles
Division of labor
Emotional support
Ability to problem-solve

92

Knowledge
Therapeutic Orientation
“Chemistry”

93

DIR 101 for Parents and Professionals 31

 Communities vary in their availability of resources,
the type of resources, and the overall amount of
support offered to families.

94

Affect is a core concept of DIRFloortime

Affectively charged relationships are essential for
development
Pleasurable affect, attuned to the child’s individual
differences, is emphasized at all times.

95

Affective interactions help the child

regulate around sensory experiences.
Affective interactions and experiences
allow the child to draw meaning from
sensory events.

Rosemary White, 2009; Beth Osten, 2006.

96

DIR 101 for Parents and Professionals 32

 Emotional experiences are perceived as sensation.
Each sensation registered by the child gives rise to
an affect.
This dual coding of experience is the key to
understanding how emotions organize intellectual
capacity and create a sense of self.

Dr. Jerry Lindquist [Link]/[Link]

97

Affect creates the desire to work through

difficult/frustrating learning areas.
Affective interactions can provide the motivation to
stay calm while thinking.
Affective interactions help the mind create
connections between different developmental
domains, like memory, motor, cognitive, visual-
spatial etc. *

*Rosemary White, 2009; Beth Osten, 2006.

98

Affect creates the desire to work on difficult motor

skills.
Affective ideas can motivate creation and execution
of plans.
Affective interactions can provide the motivation to
stay calm while moving.
Affective drives the development of functional
adaptive responses.*

*Rosemary White, 2009; Beth Osten, 2006.

99

DIR 101 for Parents and Professionals 33

 3 ½ year old Grayson has challenges that include
sensory under-reactivity, auditory processing and
motor challenges that impact his “D.”
In this clip, we see these constrictions causing him to
appear unrelated and self-absorbed.

Video: Self-absorption (alt)

100

A Child’s View of Sensory Processing

What are some of the strengths and challenges Dale displays?

How might Dales’s sensory profile get in his way?
How could teachers/professionals use the understanding of his
sensory profile?
Without an understanding of his sensory profile, how might others
reaction to Dale? How might he feel himself without the self
awareness and understanding from others?

Video: A Child’s View of Sensory Processing (alt)

101

What we have covered so far

The D (Functional Emotional Developmental Capacity)

tells you where to start.
The I (Individual Difference) tells you what to avoid and
what to depend on as you play and interact.

And with knowledge of the D and the I, you forge the R.

102

DIR 101 for Parents and Professionals 34

 Infant research tells us that emotion and relationship
are essential to healthy development.
Many important social-emotional milestones happen
in a child’s first year of life.
Positive, relationship-building interaction is
characterized by warmth, engagement and security,
and involves exchanges that are reciprocal,
pleasurable, emotionally meaningful, and co-
regulated.

103

Relationship:
Draws child into shared world
Motivates child to attend and communicate
Supports self-regulation
Creates sense of purpose
Strengthens spatial skills
Creates foundation for learning math concepts and
reading comprehension

From Engaging Autism, Chapter 6: Fostering Attention and Engagement, page 65-77
104

So what happens to a relationship when all affect is

removed and responses from one partner are muted or
absent?

105

DIR 101 for Parents and Professionals 35

 Baby tries everything she can to get Mom back: smiles,
points, puts both hands up to say “what’s going on?!”,
screeches.
When Mom doesn’t respond, even in a brief window,
Baby experiences extreme stress.

Video: Still Face (alt)

106

Where
Affect is the
conductor
Think of an leading the
orchestra… way!

107

What does affect do to change the quality of the

relationship?
How does Mom keep the “I” in mind as she plays
with him?
What is the role of the “R”?

Video: Related (Tickle) (alt)

108

DIR 101 for Parents and Professionals 36

 DIR recognizes parents (primary caregiver) as the most
important players in a child’s therapy.

The parent-child relationship is critical to all of the

child’s developmental leaps.

DIR asks: How can this relationship be strengthened and

supported?

DIR is an empowering model for parents – building upon

their strengths
109

Child and family (immediate and extended)

Therapist(s) and Child
Therapist(s), parents and other team members
Parents are viewed as advocates and partners. Professionals and
parents learn from each other.
Therapists can model effective strategies and support parents’
bond with child.
Relationship is the foundation of all work of all team members.
Child and Peers
As the child gets older, supporting the child’s development in
dyads or small groups is also important.

110

Autistic Like: Graham’s Story

Enhancing the Potential in Children
From Emotion to Comprehension
Jacob Barnett

[Link]/videos

111

DIR 101 for Parents and Professionals 37

 
DIR 101 for Parents and Professionals – Part 2

The D and the I tell you how to work on the R

The D tells you where to start…
The I tells you what to emphasize or strategically avoid
with this child who has this unique profile…
A strong R is essential for progress in the D and the I
Remember the fundamental things that happen through
relationship!

113

“Children with special needs require a tremendous

amount of practice in linking their intent or emotions to
their behavior and then their words. Like a right-handed
person learning to throw a curve ball with her left hand,
they need to practice the skill over and over to master
it.”*

DIR stresses intensive, early intervention with positive,

emotional attachments between a child and his parents at
the center.

*The Child with Special Needs

114

DIR 101 for Parents and Professionals 38

 Floortime
Semi-Structured activities
Structured/Targeted Intervention (multi-disciplinary,
based on profile)
Biomedical interventions
Family support

*ICDL Clinical Guidelines

115

Affective interactions help the child regulate around

sensory experiences.
Affective interactions and experiences allow the
child to draw meaning from sensory events.
Affect helps the mind create connections between
different developmental domains, like memory,
motor, cognitive, visual spatial, etc.
Affect drives the development of functional
adaptive responses.

Rosemary White, 2009; Beth Osten, 2006.

116

Affect cuing underlies all communication.

Affect cueing is the expression of one’s
intentions and emotional state, through subtle
vocal and motor acts – and, simultaneously, the
ability to read the vocal and motor cues given by
the other as to his/her state and intentions.

117

DIR 101 for Parents and Professionals 39

 A specific intervention…
numerous intensive, one-on-one sessions of deliberate play, each
lasting 20-30 minutes or more

that embodies a relationship-centered philosophy.

encapsulates particular principles and ways of being with a
child to maintain engagement and foster development; a manner
or mode of interacting with a child in a given activity.

118

Generally 6-8 session per day recommended.

20+ continuous, undisturbed minutes per session,
preferably in the home in a space free of
interruptions.
As parents and professionals begin to understand
Floortime as both a strategy and a philosophy,
hundreds of micro moments and experiences lead to
“floortime all the time and everywhere.”

*Engaging Autism
119

Developmental - Supports growth of social,

emotional and intellectual capacities (FEDCs).
Individual-difference -Tailors to how the child
takes-in, responds to and understands sensations and
movements (sensory-motor profile)
Relationship-based - Uses affect charged
interactions within relationships as the engine of
development.

120

DIR 101 for Parents and Professionals 40

 Initial goal: mastery of gestural, problem-solving and complex
imitation. May need structured exercises to work on:
o Motor planning and sequencing
o Visual spatial processing
o Affective gesturing
Once the initial goal is achieved, the focus of semi-structured
learning is dynamic problem-solving interactions

*ICDL Clinical Practice Guidelines

121

Occupational therapy
Speech therapy
Physical therapy

122

Medication
Dietary supplementation
Speical diets
Immune function support

123

DIR 101 for Parents and Professionals 41

 What the professional offers is extensive knowledge
about children in general
What the parent offers is unbeatable knowledge about
one particular child
These two combine to:
Deepen their relationship with their child
Help parents see strengths/challenge areas
Help parents advocate for their child
Help parents find the support they need

124

Symbolic:
Toy telephone,
Large baby doll, bottle,
Toy cars, toy boat,
Plastic tableware, cups and plates

Sensory, Sensory -Motor:

Use yourself (e.g. peek a boo)
Bubbles, balloons, pinwheels
Feathers, scarves
Plastic porcupine and other textured balls,
Furry animal puppets,
Paint brush, heavy musical toy with balls on spokes
Toys that child needs adult to operate such as swings
Big therapy ball, small peanut ball

125

Symbolic:
Transportation - cars, trucks, trains, garage
Food play- Pretend food, pretend stove, puppets,
Empathy toys - dolls, bottles, family figures, doctor kit, tool kit, doll house
Fantasy Play -animals, dinosaurs, play school
Communications -phones, chalk board, books
Aggression/Fantasy -soldiers, ninja turtles
Construction- blocks, Legos
Constructive- balls, bubbles, paper, blanket
Sensory, Sensory – Motor:
Outdoor Play - sand, water, swings/slides
Indoor Play – therapy ball, indoor swing, floor spinner, bean bag chairs,
Crash mats
Art/Sensory- paint, crayons, play dough, etc.
126

DIR 101 for Parents and Professionals 42

 Attune to child’s affect
Co-regulate
Follow the child’s motivation
Move up and down the ladder with the child
Maintain continuous circles of communication
Expand and challenge when appropriate
Remember self-reflection

127

Watch, observe, and simply “be with” the child.

Be aware of the child’s functional developmental
capacities.
Empathize with the child.
Respond to the child’s affect shifts, by shifting your
body language and affect cues, etc. Let the child
know you’re “present” with them.

128

Cues are critical for following the child’s lead, co-

regulating and providing appropriate challenges for
an optimal interactive experience.
Cues must be recognized, understood and responded
to.
The adult may need to shift affect cues to help the
child modulate his/her affect.

129

DIR 101 for Parents and Professionals 43

 Check-in and read cues to assess the child’s level of affect and
arousal level.
Use rich and varied communication: gestures, facial
expressions, sounds, touch, and verbalization.
Attend to the child’s general sensory profile as well as his
current emotional state.
Tailor interactions to child’s individual differences.
Up or down regulate the child by using affect or sensory motor
actions/activities.
Maintain connection and shared attention to ultimately get the
child to the optimum arousal level.

130

Start with what he is interested in.

Use “rich” affect to get something cooking.
Include gesture, voice and movement.
Enrich communication with rhythms, tone of voice, tempo
and relating style.
Maintain shared attention.
Allow the child to be the play director.
Pursue the child’s feelings, expanding the emotional range.
Repeatedly wonder “How can I turn what he is naturally doing
into interactive and dynamic play?”

131

Move focus of interaction up and down the

ladder as needed to maintain engagement in a
shared world.

Start where the child leads you.

Move up the developmental ladder whenever
possible.
Move down when you lose regulation, attention,
engagement.
Continue to follow the child’s motivation.

132

DIR 101 for Parents and Professionals 44

 Maintain co-regulation.
Open and close circles of communication, extending
the series around one theme when possible.
Keep back and forth verbal and non-verbal exchanges
going constantly (goal is 20+ circles).
Try to create rapid back and forth (be sure to provide
appropriate response time).
Remain flexible and in the moment.
Repair communication as needed.

133

Within the play, provide developmentally appropriate

challenges.
Expand and integrate emotional content: life themes,
types/styles of interaction, sensations (all modalities),
motor requirements/movement and processing capacities.
Engage multiple levels of FEDCs simultaneously, moving
up and down “the ladder” according to child’s responses.
Capitalize on child’s strengths while gradually working
on challenges. Remain non-coercive.
EXPERIMENT! Be creative! Stay playful! Remember the
RELATIONSHIP is what gets things cooking!
134

Notice what you are thinking and feeling

Show compassion for yourself
Stay present and in the moment
Ask yourself what gets you “hijacked” and out of the
present moment

135

DIR 101 for Parents and Professionals 45

 Four and a half year old Cole can be warmly engaged
and creative, but has challenges with auditory
processing, self-absorption and a tendency to be
repetitive in his play.

What does Cole find motivating?

How would you describe Mom’s and Cole’s affect?
What is it that makes it easier for Cole to stay engaged with
Mom? What makes it harder?
Where do we see the best continuous flow?
Video: Bear and Elephant (alt)
136

Establish the foundation of shared attention,

engagement and reciprocal interactions – you are the
first “toy!”

Follow child’s lead – Join in at the child’s

developmental level and build on her natural
interests.

137

Poor Attachment & Engagement

Disconnected
No mutual joy
Withdrawn
Avoidant
Poor Arousal and Modulation
Irritable/Overexcited
Distractible
Sensory Craving

138

DIR 101 for Parents and Professionals 46

 Five year old Danny has sensory regulation, sensory
processing and motor planning challenges that create
constrictions at all developmental levels.
In this clip we see constrictions at FEDC 1 and 2 that
cause Danny to be disregulated, anxious, and
unrelated.

Video: Overwhelmed (alt)

139

Why was Danny having a difficult time interacting?

What helped Danny start to interact?
How might you have supported Danny?
In what area(s) might Mom or Dad need support?
What would you focus on during future Floortime
sessions?

140

Pursue activities that promote optimal arousal and

regulation.
Create an inviting environment.
Join perseverative play – make it interactive.
Imitate.
Help child with activities/interests.
Connect subject matter to an interest.

The Child with Special Needs

141

DIR 101 for Parents and Professionals 47

 Be sensitive to child’s mood, where he is at that
moment.
Return to FEDCs 1 and 2 when child is not able to
work at the higher levels.

Video: Overwhelmed (coaching) (alt)

142

Facilitate a continuous flow of back and forth

affective gesturing at all times both during the
foundation building levels and symbolic play.
Child must initiate and maintain his or her end of
the continuous flow!

The Child with Special Needs

143

Child may:
Not reach to be picked up
Not “hug back”
Ignore request/be unresponsive
Not share interests with others
Have poor recognition of body language

The Child with Special Needs

144

DIR 101 for Parents and Professionals 48

 Gary is a twenty-two month old with constrictions at
FEDCs 1-3 that can cause him to be distractible and
somewhat unrelated in his play.

Video: Easily Distracted (alt)

145

What is Gary interested in?

How might you have helped Gary become more
engaged?
How would you help Gary attend to an activity
longer?
In what areas might Gary’s mom need support?

146

Use simple language

Make affect inviting/enticing
Insist on a response
Show anticipation
Make 'big' gestures
Be very animated

147

DIR 101 for Parents and Professionals 49

 In this clip, we see that while Gary has some
constrictions at FEDCs 1-3, he also has strengths:
good regulation and attention
the ability to be engaged and related
the ability to gesture, communicate and solve problems.

Video: Easily Distracted (Coaching) (alt)

Video: Crown (Engaged) (alt)

148

Child uses complex problem solving strategies that

include long series of circles and social, nonsocial,
verbal and nonverbal means.
All the while, the child continues to stay in contact
even when upset or frustrated.

149

Child may:
Quickly lose interest in activities
Frequently shift attention
Seem to forget the goal
Experience quick frustration if goal isn't attained
Have motor planning difficulties

150

DIR 101 for Parents and Professionals 50

 Use affect to keep the child motivated.
Use Playful obstruction/Undoing.
Plan out a strategy together.
Work out a 'Plan B' together when 'Plan A' fails.
Accept a wide range of emotions.
Set up treasure hunts/play hide and seek.

151

What challenges with Curt do you observe?

What techniques does Dad use in the Floortime
session?

Video: Improved Engagement (alt)

152

What ideas do you think Curt is having?

How would you describe his affect?
How could you join with Curt if you were playing
with him?
What ideas might you try to get his arousal up?
In what areas might Dad need support?

153

DIR 101 for Parents and Professionals 51

 “Thanks to abstract thinking we are able to imagine,
to understand others, to conceptualize things that
aren't right in front of us;… Without the ability to
think abstractly we are limited to the here and now;
you cannot plan, we can only react.”

Child with Special Needs

154

Mechanical/rigid play
Lack of fantasy play
Reduced/absent symbol use
Poor tolerance for some emotions

155

Use abstract concepts in play.

Respond symbolically/in character.
Make characters with big attitudes.
Stay with emotional themes.

The Child with Special Needs 156

DIR 101 for Parents and Professionals 52

 In this clip, Spencer is able to answer a variety of
“wh” questions when talking about scary things.
What do Dr. Greenspan and Mom do to help him tolerate
and explore these scary feelings?

Video: Talking about Scary Things (alt)

157

What were Spencer’s ideas?

What was upsetting to Spencer?
What are Mom’s ideas?
How might you have supported Spencer?
In what areas might Mom need support?

158

Expand range of themes and emotions: dependency,

separation, bodily injury, fears, anger,
disappointment, sadness, joy, surprise, jealousy,
rivalry, competition, aggression, power, revenge,
friendship, loyalty, mortality, justice, morality.

The Child with Special Needs 159

DIR 101 for Parents and Professionals 53

 Disjointed ramblings
Many unorganized thoughts
Conversations that are not logical
Inability to connect ideas
Inability to understand the motivations of others

160

Five and a half year old Grace has sensory, motor

planning and visual-spatial challenges and
constrictions at the lower levels that cause her to be
overly concrete and rigid.

Video: Wolves (alt)

161

How would you describe the action in this clip?

What were Grace’s ideas?
What were Mom’s ideas?
In what areas might Grace need support? How might
you do that?
In what areas might Mom need support?

162

DIR 101 for Parents and Professionals 54

 Ask open-ended/ “w” questions.
Converse about big ideas and how they relate
to him. (e.g. fairness, justice).
Help connect ideas.
Understand gradations of feelings.

The Child with Special Needs 163

What “Wh” questions is Grace able to answer?

What are Grace’s ideas?

Video: Wolves (Coaching) (alt)

Video: Creating Ideas (alt)

164

Star Wars
Organization of thought by emotion (“Watch out for Darth Vader!”)
Multiple points of view

Video: Star Wars (alt)

165

DIR 101 for Parents and Professionals 55

 Stay relaxed and calm.
Be aware of co-regulation.
Be aware of individual differences.
Be aware of joint attention.
Make play pleasurable and fun.
Go for continuous flow.

166

Caroline has many challenges including severe motor

planning challenges, low muscle tone, auditory,
visual-spatial and language challenges.

Video: Greater Challenges (Coaching) (alt)

Video: Mom Inserts Herself (alt)

Video: Fence (alt)

167

Push for higher levels whenever you can.

Challenge the child to think and elaborate.
Ask abstract questions.

168

DIR 101 for Parents and Professionals 56

 Move up and down “ladder” as necessary.
Keep going for more and more circles.
Remember: Words-Action-Affect.
Ask 'interesting' (not rote/labeling) questions.
Go for connection rather than good behavior.
Help child tolerate/'stay with' a wide range of affects.
Stay empathetic.

169

Why is it so important to stay in “destructive mode”

with Spencer?

Video: Destructive Mode (alt)

170

Cole and Mom play Three Little Pigs

What is working well here?
What developmental capacities do you observe?
What constrictions can you identify?
How might Mom push for higher levels when playing a
favorite story?

Video: Little Pigs (alt)

171

DIR 101 for Parents and Professionals 57

 Ghosts and Alligators
Think about the clip “Little Pigs” seen earlier. How is this
clip different?
What additional capacities do you observe?
What is the “magic moment”? Why is it so important?

Video: Ghost and Alligator (alt)

172

Have fun!

173

[Link] for information on conferences and

training opportunities

174

DIR 101 for Parents and Professionals 58

 1941 -2010

Whose work
touched the lives of
countless children
and families

175

DIR 101 for Parents and Professionals 59