What is DIR and Why is it Important?
The Developmental, Individual Difference, Relationship-Based Model of Intervention (DIR) provides a developmental framework for interdisciplinary assessment and intervention for autism spectrum and related disorders. It is a comprehensive foundation model that utilizes affect-based interactions and experiences tailored to individual needs to promote development.
The Developmental, Individual Differences, Relationship Model (also known as the DIR Model), developed by Stanley Greenspan and Serena Wieder, revolutionized the concept of development. It was the first model to identify the functional emotional developmental capacities that provide the foundation for lifelong learning and relating. The DIR Floortime model training was the first to relate these developmental capacities to the biological/neurological individual differences in sensory processing each person brings to the world. It identified relationships as the pivotal force that nurture and optimize development. Further, it was the first to propose a relationship based model of comprehensive intervention for autism spectrum and sensory processing disorders focusing on the core deficits of relating and communicating.
Overview of the DIR Floortime Model Training
Frequently children with special needs are challenged by neurobiological factors, which make it difficult to participate and enjoy early emotional interactions with their parents. These shared interactions between parent and child that are meaningful, positive and pleasurable create the foundation necessary for all development. The DIR Floortime model training supports parents in their natural and pivotal partnership with their child – promoting their development across a wide range, including regulation, joint attention, communication and language, motor skills, cognition, ideation and execution, and social problem-solving. The “Floortime Model” essentially means joining the child where they are, revisiting previously missed growth opportunities and moving forward.
The DIR Floortime Model Training has been created and informed by experts in the fields of pediatric medicine, developmental psychology, education, speech and language, occupational and physical therapies – making it the first truly integrated multi-disciplinary approach to children with an Autism Spectrum Disorder (ASD) or other special need.
Breaking down the DIR Floortime model training:
D (Developmental) defines the fundamental capacities for joint attention and regulation, engagement across a wide range of emotions, two-way communication, and complex social problem solving. These in turn govern the development of symbol formation, language and intelligence.
I (Individual Differences) refers to individual differences related to sensory reactivity and regulation, visual-spatial and auditory/language processing, and purposeful movement.
R (Relationship) refers to relationships with caregivers that are the vehicle for affect-based developmentally appropriate interactions. Parents and families are central to this model because of their ongoing opportunities to support their child’s everyday functioning to carry out emotionally meaningful goals based on developmental levels. Cultural and environmental influences are also considered.
Intervention begins with a therapist supporting both parent and child engaging in pleasurable, developmentally appropriate, and interactions building, as well as strengthening the core relationship between caregiver and child to support developmental progress. The treating therapist typically has advanced (preferably certified) training in the DIR Floortime model training and may come from the fields of medicine, mental health, speech and language therapies, occupational and physical therapies, special educators and early intervention providers. Parents are typically encouraged to engage in multiple DIR Floortime model training sessions daily with their child, both formally and informally.
Progress is measured in the beginning by establishing a baseline FEAS (“Functional Social-Emotional Assessment Scale”), with quarterly updates.
Functional Emotional Developmental Levels (FEDL)
Level 1: Shared Attention/Regulation and Interest in the World
Level 2: Engagement/Forming Relationships
Level 3: Two-Way, Purposeful Interactions with Gestures/Intentional Two-Way Communication
Level 4: Two-Way, Purposeful Problem-Solving Interactions/Development of Complex Sense of Self
Level 5: Elaborating Ideas/Representational Capacity and Elaboration of Symbolic Thinking
Level 6: Building Bridges Between Ideas/Emotional Thinking
Level 7: Multi-Cause, Comparative, and Triangular Thinking (Grade School Children)
Level 8: Emotionally Differentiated Gray-Area Thinking (Grade School Children)
Level 9: Intermittent Reflective Thinking, a Stable Sense of Self, and an Internal Standard (Grade School Children)
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Highlights Through the Years
The DIR Floortime model training started with the Clinical Infant Development Program, an NIMH clinical research study initiated by Stanley Greenspan in the 1970’s. This program was based at the Mental Health Study Center in Prince George’s County, where Serena Wieder joined in 1978 as the Clinical and Research Director.
Greenspan and Wieder’s work discovered the need for a humanistic model based on typical development in the context of the family and relationships. This was around the same time Lovaas started ABA. Autism was still rare with an incidence of 1/10,000 and certainly a mystery in 1979 when it became recognized in the Diagnostic and Statistical Manual (DSM).
Through the 80’s and 90’s Greenspan and Wieder developed the DIR Floortime model training that offered children with autism, PDD, and other emotional and developmental disorders, and their families, an emotional and relationship based intervention to establish the foundations for a meaningful future. They worked with many other professionals concerned with early development and psychopathology in theory and in practice. They presented and published extensively both individually and together.
Some of their joint publications include The Child with Special Needs, Engaging Autism, Infant and Child Mental Health, and Diagnostic Manual for Infants & Children.