Friday, March 13, 2009

More on DIR®/Floortime™: A Conversation

Many parents are interested in using the DIR®/Floortime™ model with their children on the autism spectrum. One of the benefits of this treatment is that parents can be trained and work directly with their children. Today I'm talking with Lynette DiLuzio, MS, CCC-SLP, and a DIR Certificate Candidate - Level III. Lynette is also the director of The Creekside School in San Jose, a small private school for students, age 5 to 9, with autism.
Patricia Robinson: Lynette, can you explain a bit about DIR®/Floortime™ and your experience with it?
Lynette DiLuzio: As a speech-language pathologist, I came to Floortime as a young clinician.  It seemed simple and very natural to me -- follow the child's lead, be playful, try to get the child to connect.  The more I practiced it and the more I studied Floortime I realized just how intricate and holistic the method truly is.  It was kind of like starting at the bottom of a pyramid and working to climb all the way to the top.  But once I got there, there was an inverted pyramid and I had a lot more climbing to do!!  Thank goodness the journey has always been fun!
Floortime is one element of the larger model -- DIR, which stands for the Developmental, Individual difference, Relationship-based Model.  Similarly, DTT is one element of ABA - to make a comparison.  As a DIR Clinician, I am able to assess both the child AND the family's needs within the model.  DIR helps me know how to use my skills as a speech-language pathologist to meet a child's needs in all areas (with help of the family and other specialists on the team) while helping the child integrate skills and reach their highest potential socially, emotionally, physically, and academically.  I can do this using Floortime as well as any other method that can benefit that particular child's specific need (which can borrow and/or include anything from TEACCH methods, behavioral intervention, visual supports, sensory integration, technology, etc.).  All of that happens within the constructs of the family unit through relationships.
Patricia Robinson: Lynette, can you share some of your experiences with using DIR®/Floortime™ with your students?
Lynette DiLuzio: I'd love to!  One recent event was with an 8 year old boy with whom I've been working since he was 3.  This guy is non-verbal and struggles with significant dysregulation and motor issues.  Over the last several years, he has learned strategies that help him self-regulate though he often depends on the adults around him to give him the input he needs.  He uses a combination of PECS, some words, and phrases he has memorized from books and songs to communicate.  We were in class participating in a sensory/art activity and he was becoming dysregulated, which for him used to lead to aggressive episodes.  We were able to stay connected using Floortime around the activity in which we were involved because I provided the deep pressure/sensory input he needed at that moment.  As the activity got harder, I anticipated we would have to give up on finishing the activity.  At this point, he reached into his PECS books and requested "walk" - typical reaction, so I thought.  He had another idea -- he got his backpack (which is weighted so when he goes for a walk it often gives him the needed support to stay regulated), put it on, took me by the hand, and went back to the activity!  I was so proud of him!!
Another instance was with a 6 year-old boy.  He is also non-verbal and has motor processing issues that really prevent him from using his body in ways that he wants to.  He came into class pretty low arousal -- for him meaning that he wasn't looking at anyone, didn't acknowledge people in the room, and simply entered and sat on a bench looking at something out of the corner of his eye. I was coaching our Occupational Therapist during this session. She was able to address his low arousal by getting on his level (physically) and wooing him in with her high affect.  She began giving him a horsey ride around the classroom.  As he was brought up to a higher arousal level, she would move further away from him.  He began using gestures and vocalizations to call her back and request another horsey ride.  She, using high affect and simplified language, would ask "Oh, you want another horsey ride?"  He began to nod in reply as a "yes".  This was a first!!  Throughout the session through the use of Floortime, she was able to keep him well-regulated while increasing the demand on his communication.  He was having so much fun he began using all kinds of gestures, vocalizations, and even some words.

Patricia Robinson
: Do you have any suggestions for how parents can keep progressing with their Floortime experience at home?
Lynette DiLuzio: Many parents often try to fit in eight 20-minute sessions a day.  These can be incorporated throughout the regular course of your time at home.  It's important for parents to remember that Floortime is anytime - when you're putting away the groceries, giving your child a bath, sorting the laundry.  Also, there is no "bad" Floortime...there is only better Floortime.  The most successful Floortime parents are those who remember to take a break, refresh, and ensure they are taken care of so they can be fully charged to play!
Patricia Robinson: How can parents learn more about DIR®/Floortime™? Where can they find trained experts to work with their families? How much parent training is necessary for parents to start using this approach?
Lynette DiLuzio: Parents can find DIR trained and certified practitioners by visiting www.icdl.com and clicking the "Find DIR Professionals" link.  Parents can learn more about Floortime by clicking the "DIR/Floortime Model" or "Getting Started" links on the same site.  There is also information regarding the online courses available through the ICDL as well as area trainings.  We just had our first parent training event at The Creekside School on February 28th.  We will be scheduling more trainings and conducting parent training groups in the near future.  Please visit our website at www.creeksideschool.org and click the "Events" page.
Parents are always the best expert when it comes to their own children.  That is all the training they need to get started.  Don't be afraid to be silly, get messy, and have a good time.  The rest can be learned through practice with the support of the rest of the team, by reading one of the resources (also listed on the ICDL website), attending a conference, or contacting a Floortime practitioner.
Patricia Robinson: Thanks for the information, Lynette!