Integrating the DIR Floortime approach In MSW

DIR FLOORTIME APPROACH 13

Integratingthe DIR Floortime approach In MSW

(InstitutionalAffiliation)

DIRFloortime and Autism Spectrum Disorder (ASD)

Casestudy Seven Year old Boy diagnosed with Autism (Vincent Williams)

Thecase involves a Seven year old boy who was diagnosed with autism(ASD) condition two years ago at St. Thomas Barbados. Vincentexhibited signs of withdrawal, inattentiveness, and restlessnesssince he was three years. Unlike most young children who are activeat the age of two years, Vincent showed less interest in interactingwith other children. In addition, Vincent exhibited communicationproblem and appeared fixated. The boy’s family was supportive andmade great efforts to engage the boy in interaction. The assessmentfurther found that Vincent lacked imaginative play and problemsolving skills(Bryson, Rogers and Fombonne, 2003).

Inthis case, DIR/Floortime intervention is required to help Vincentdevelop and grow like a normal child(Greenspan, 2006).Individuals with Autism Spectrum Disorder (ASD) have three mainchallenges establishing close relationships and interaction withothers. Using symbols and emerging words with emotional intent isanother challenge for ASD victims. ASD victims are also challengedwhen exchanging emotional gestures progressively. Other problemsinvolve the sensory-processing challenge and perseveration(Francis, 2005).As such, the DIR Approach is effective in developing ASD victimsthinking, interaction and communication capabilities.

Mysocial work identity

Iam a trained Social worker with a Baccalaureate degree in Socialwork. Social work skills are important when dealing with socialissues in the society. As a social worker one meets and participatesin various social aspects aimed at helping the society address itssocial problems. My training in social work exposed me to variousskills that are applicable in various social settings. One importantskill that I learned was how to facilitate social relationships,attending the sick, helping the weak and facilitating distribution ofsocial services. To this end, I have vast experience from complex anddialogical circumstances. As such, although I was a preschoolteacher, I was able to apply DIRFloortime approach in dealing withVincent condition. My social work skills helped me assist Vincentovercome his ASD challenge thereby improving his social relationshipwith parents and peers.

Culturaland Social justice for autism condition

Inthe modern world there are great disparities and inequalities in thediagnosis and treatment of autism especially among the white andblack American children. Researchindicates that there is a significant disparity on the quality ofhealth received by racial minorities compared to non-minorities.Several factors are attributed to the racial disparity witnessedamong the black and white children with regard to treatment anddiagnosis. These factors are misdiagnosis, patrician-parentrelationship, capacity to access healthcare and biases among thehealthcare providers. In other cases, boys are likely to receivediagnosis for ASD condition than girls even when symptoms are severe.However, social economic factors and affluence have less influence onthe diagnosis and treatment of children with autism(Durkin, Maenner, Meaney, Levy, DiGuiseppi, Kirby, Pinto-Martin and Schieve, 2010).

Overviewof DIR/Foortime Approach

TheDevelopment Individual Difference Relation-based Approach (DIR) is amodel that was designed to help parents, clinicians, Social workersand educators in carrying out a comprehensive assessment anddevelopment of children affected with autism(McConachie, 2007).DIR is an intervention program that is tailored specifically to meetthe challenges and strengthen children with Autism Spectrum Disorder(ASD) (Bryson,Rogers and Fombonne, 2003).

Theoverall objective of DIR model is to build a strong foundation forsocial, intellectual and emotional capacities of the ASD persons withless focus on skills and isolated behaviors. The DIR approach isregarded as Autism therapy for its objective of lessening thedeficits of abnormal behavior associated with ASD condition on youngchildren(Stahmer, Collings and Palinkas, 2005).DIR is a relationship based developmental model based on therationale of enhancing effective interactions between child and theparents.

DIRApproach takes the scope of relationship development intervention asa family –based treatment for children with ASD (Greenspan,2006).Basically, DIR program assumes that the development of dynamicintelligence (ability to think differently, flexibly and processinformation) is essential in improving the autism victim’s qualitylife. The DIR approach was developed as a systemic interventionprogram that integrates cognitive, psychodynamic learning principles.The DIR is a holistic framework with floortime play based approach(Stahmer,Collings and Palinkas, 2005).

TheDIR/Floortime Philosophy

DIRis based on the philosophical idea that the emotional experience ofASD victims is essential in the treatment of ASD victims. This isenhanced by facilitating the children master functional and emotionaldevelopmental millstones. In this way, the child develops into acaring, warm, adaptable and flexible individual who is able to solveproblems independently (Stahmer,Collings and Palinkas, 2005).

WhyDIR is important and why there is a need for the intervention as itpertains to working with children with autism

Autismis a progressive disorder that requires early intervention. Earlyintervention prevents regression of social skills and communication.It is easier to provide a comprehensive treatment for infants andtoddlers than older children. DIR offers a comprehensive treatmentapproach for helping ASD toddlers develop communication and socialskills at early age without regression. DIR allows parents to engagetheir children literally at their level through floortime play. Theessence of DIR is to open up the child’s complex communication andinteraction and enhance intellectual and emotional growth.

DIRis important because it enhances good relationship between the childand the parent. DIR helps develop the child’s intimacy, selfregulation and interest in their surrounding environment. Inaddition, DIR facilitates two way communications, the development ofemotional ideas and emotional thinking of the ASD child. DIR/Floortime does not target cognitive, motor and speech skills in isolationbut addresses these areas through its focus on emotional development.

DIRis important for autism victims as it is focused on addressing thecore problems of autism social skills, emotional development andintellectual growth. By engaging the child in floortime activities,DIR helps in opening up the child’s complex ASD by encouragingback-and-forth play interactions. DIR does not automatically solveAutism problem but through sustained comprehensive floor timeactivities leads to the development of the child’s emotional andcommunication skills. In this way, DIR solves the Autism problemthrough progressive floortime activities.

TheObjectives of DIR/Floortime Approach in helping Vincent

Thefirst objective of DIRFloortime is to enhance the child interactionwith others this helps the child feel safe and calm while showingcuriosity and exploring the environment with others (Greenspan,2006).Secondly, the DIR model helps Vincent enjoy the company of others bydeveloping trust and intimacy towards the caregivers (McConachie,2007).In this way, these relationships helps Vincent achieve wider range ofemotions such as fear, disappointment, separation, anger, surprise,sadness, loneliness and jealousy among others (Francis,2005).

Thethird objective of DIR/Floortime is to engage the child inpurposeful, reciprocal and two way balanced interactions. As Vincentbegins to imitate or respond, communicate with non-verbal and verbalgestures, reciprocates emotions such as surprise, anger and sadness.DIREfloortime is also useful in enhancing the problem solvingcapacity among ASD child through sustained social interaction(McConachie,2007).Caregivers, social workers and educators achieve this by maintain theinteraction rhythm (Stahmer,Collings and Palinkas, 2005).The interaction rhythms ensure that emotional signaling andcommunications are in place and Vincent begins to use and applycognitive processes in solving problems (Greenspan,2006).For instance, a child exhibits signs of what is liked or dislikedemotionally. During this time Vincent works through his motor systemas he interacts with others and thus is able to regulate his emotionssuch as joy, surprise, disappointment and worry (Bryson,Rogers and Fombonne, 2003).

Theother objective of DIR/Floortime approach is helping Vincent becomeactive in representing his feelings, intentions and ideas throughlanguage, play, words and symbols (Greenspan,2006).These ideas come from real life engagement as learned through theDIR/floortime approach (Francis,2005).The child is able to experiment the first ideas through plays anddramas (Stahmer,Collings and Palinkas, 2005).Later, Vincent engages in fantasy plays as capacity to representtheir feelings and intentions takes shape (McConachie,2007).

Thelast objective of DIR/Floortime is helping Vincent develop logicalthinking through a combination of various ideas. As the child’sabstract reasoning takes shape, ideas become realistic and logical(Francis,2005).This helps the child develop effective comprehension of self andother people’s feelings. In this way, the ASD child began tounderstand what motivates others, feelings and predict consequencesfor their actions and those of others (McConachie,2007).At this level, the child’s mental capacity moves to abstractreasoning and the child is able to distinguish fantasy and reality,non-self from self, one feeling from the other.

Furthermore,the child is able to make distinction between space and time. As theDIR/Floortime intervention progresses and depending on the child’slevel of ASD challenge, the child may begin to exhibit higher levelsof mental, psychological and physical capacities. In addition,progress in DIR/Floortime leads to the strengthening of initialcapacities (Stahmer,Collings and Palinkas, 2005).

Otheradditional goals of DIR/floortime include developing the ASD child’scapacity for multi-causal thinking. Multi-causal thinking helps theASD child have multiple feelings at the same time (Greenspan,2006).Developing the child’s ability to think at different intensitiesand emotional response is another goal of DIR/floortime approach.Lastly, DIR/floortime should help the ASD child develop capacity toreflect on their feelings, reflects and develop their own personalvalues (Francis,2005).

Explainingthe basic concepts in DIR/Floortime Approach

‘D’Developmental

Thisis the building block of the model foundation. The concept of‘Development’ is based on assessing the area where the ASD childis developmentally challenged. This assessment helps in planning atreatment approach that facilitates development. Development focuseson six milestones whose focus is enhancing the attainment of healthyintellectual and emotional growth (Stahmer,Collings and Palinkas, 2005).This involves helping the child develop capacity to regulate theiremotional and mental faculty when relating with others (Greenspan,2006).In particular, the development helps the child remain calm, engagewith others, initiate and respond to all forms of communication suchas emotions and gestures (McConachie,2007).In addition, the child develops ability for problem solving, thinkinglogically and in reflective ways.

‘I’Individual

Inthe DIR/floortime approach ‘I’ represents the unique biologicalaspect of each child. Each child is unique on how they regulate,respond, comprehend, plan and respond to sequence of actions andideas (Greenspan,2006).For instance, some children are highly responsive to sound and touchwhile others are under responsive to sensations. The term‘Individual differences’ refers to various ways each child isunique in ability to learn and grow(McConachie, 2007).Furthermore, the ‘I’ concept relates to individualized strategiesused for each child.

DIR/floortimeassumption in is that it is important to recognize the particularinterests of each child, motor skills, sensory response, visualability and verbal communication capacity. In addition, the conceptof ‘individualized difference’ assumes that each child hasdifferent cognitive and fuctional skills that need to be tailored forthe well being of the child. This calls for individualizedintervention measures that address speech, language, occupational,physical, visual and cognitive aspects of ASD children.

‘R’Relationships

Thispart of DIR/Floortime model explains how caregivers, Social workersand educators establish learning relationships. The goal ofrelationship development is the basis of ASD child development(Greenspan,2006).Relationships are established through interactions in this case,interactions between parents, caregivers and educators (McConachie,2007).Relationships are channels through which ASD children learn anddevelop. Social workers should focus on creating affectiveinteractions as a way of developing ASD victim responsiveness inrelationships. The aim is to enhance the child’s relationship withparents, teachers and others (Stahmer,Collings and Palinkas, 2005).

DIR/Floortime

Theterm floor time literally means being on the floor with the ASDchild. “Floortime’ also refers to the aspect of joining anotherperson in any circumstance for emotional experience attunement andrhythmical interactions. The objective of ‘floortime’ is toenhance interaction flow that in turn help individuals communicate,relate and solve problems and develop capacity to learn (Greenspan,2006).DIR/Floortime utilizes floor play semi-structured activities topromote relationship development goals (McConachie,2007).The main objectives of floortime is to enhance the child developinterests in playing with others and challenge the child to broadentheir ideas and interests. In addition, floortime helps infacilitating continuous flow of interaction that in turn develops theASD child capacity(Greenspan, 2007).

DIRFloortimeModel Approach

DIRFloortimeis a family approach since the entire family is affected by theuneven development of the child. Children with ASD are rigid andsuffer from frustrations of coping with their condition (Greenspan,2007).Family members may also exhibit the same rigidity due to trauma andlack of understanding on how ASD person is assisted to develop fullyas a normal adult. Ideally, the family should serve as the firstsolution to ASD individual by been flexible and open in effort tooffset the child’s rigidity (Greenspan,2007).However, when the family members exhibit the same rigidity, thisworsens the condition limiting opportunities for remedy (McConachie,2007).

Usingthe DIRFloortime helps the parent, caregivers, educators and otherfamily members to reflect on their behavioral patterns and adoptbeneficial actions. The main goals of DIRFloortime are two prongedto bring the child to the shared world and follow the child’s lead(Greenspan,2006).Following the child means taking important cues from the child tounderstand his/her emotional needs. After this, the other familyremembers can join the child making him/her feel closer (Stahmer,Collings and Palinkas, 2005).

DIRFloortimemilestone approaches that would be applied in Vincent’s case are

Milestoneonethis milestone involves developing the self control and selfregulation of the child. The focus here is developing a ‘sharedattention’ through interacting and learning socially.

Milestonetwo:in this stage, the child is taught how to relate and engage withothers through language. The goal is to help the child internalizethe process of engagement and interacting with others (McConachie,2007).For instance, the child should be able to process and internalizemeaning and cognitively understand language.

Milestonethree atthis stage, Vincent should be able to hold a two way communication,interpret communication signals (Greenspan,2006). However, for this to materialize the Social worker must first readand respond to the child’s signals as a way of eliciting andenhancing the child develop effective two way communication andinteraction.

Milestonefour instage four Vincent should be able to solve problem, form sense, moodand regulation(Diggle and McConachie, 2003).For instance, the child can request for food, drink or ask questions.In this milestone Vincent should be able to interpret variousemotions and engage in reciprocal interactions.

Milestonefiveat this stage Vincent should be able to create symbols and ideas.This extends to making meaningful meaning of words, symbols andpictures.

Milestonesixthis involves ability to think emotionally, have sense of reality andlogic. Vincent should be able to create new understanding of realityand connect ideas logically. The floortime should help Vincentdevelop capacity to recognize other’s ideas and behaviors.

Milestoneseven atthis stage Vincent should exhibit multi-causal and triangularthinking especially distinguishing different emotions.

Milestoneeight thisis the stage where the child should portray emotionallydifferentiated thinking ‘gray thinking or abstract thinking.’Vincent should be able to think in varying degrees, have regulatedfeelings of events or situations.

Milestoneninethis is the level where the child should portray reflective thinkingand has capacity to form self perspective in more complex emotionalsituations (McConachie,2007).

Workingwith Children that have Autism Disorder

Ihave never worked with this population of autism, but worked as apreschool teacher and noticed some significant social, communicationand intellectual problems with some children. While some childrenwere quick to learn, playful and active, other children exhibitedrestlessness, wireless interactive and were slow learners. Inparticular, Vincent (case study) exhibited more abnormal social,intellectual and communication problems. At first I thought the childwas not used to new environment or that the child was sick. I did notrealize this problem until I talked to the parents to confirm thecondition.

Myanalyses were confirmed by the parents that the children exhibitedthe same conditions at home. This revelation prompted me to deviceways of helping Vincent overcome his problems and enhance his socialinteraction with parents and peers. As a social worker, I had learnedvarious skills of helping ASD victims. I thus developed a DIRfloortime intervention to help the child regain his normal sociallife. This intervention approach involved applying the floortimeactivities to develop the child emotional and communication skills.After one year Vincent was able to actively interact, communicate andexpress emotions just like other children. The DIRFloortime strategywas continued to allow Vincent attain normal intellectual, emotionaland social skills.

References

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DiggleTT J, McConachie HH R. (2003). “Parent-mediated early interventionfor young children with autism spectrum disorder.” CochraneDatabase of Systematic Reviews.( 2)

FrancisK. (2005). “Autisminterventions: a critical update[PDF].” DevMed Child Neurol,47(7):493–9.

GreenspanStanley. (2007). “DIR and the DIRFloortime Approach.” Retrievedfrom http://www.icdl.com/DIR

Greenspan,Stanley (2006). Engagingautism.Philadelphia: Da Capo Press.

MaureenS. Durkin , Matthew J. Maenner, F. John Meaney, Susan E. Levy,Carolyn DiGuiseppi, Joyce S. Nicholas, Russell S. Kirby, Jennifer A.Pinto-Martin and Laura A. Schieve. (2010). “SocioeconomicInequality in the Prevalence of Autism Spectrum Disorder: Evidencefrom a U.S. Cross-Sectional Study.” Retrieved fromhttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0011551

McConachieH, Diggle T. (2007). “Parent implemented early intervention foryoung children with autism spectrum disorder: a systematic review.”JEval Clin Pract.13(1):120–9

StahmerAC, Collings NM, Palinkas LA (2005). “Earlyintervention practices for children with autism: descriptions fromcommunity providers.”FocusAutism Other Dev Disabl.20(2):66–79.