This model was developed by Dr. Stanley Greenspan and stands out as an excellent framework for understanding the socio-emotional development of each child. The program truly empowers the parent, while validating and supporting the child's social, emotional, and physical growth. Dr. Greenspan and Dr. Serena Wieder co-authored "The Child with Special Needs" and "Engaging Autism."
- Respects the child and values the child's contributions
- Considers sensory challenges during sessions to improve length of engagement
- Establishes communicative intent as well as improves the use of language
- Is child led in terms of interests, goals are established by the team
- Parent is not the teacher, but play partner
- Loads of fun and enjoyment for the whole family
The Developmental, Individual Differences, Relationship Model (DIR®)
“The overriding, conceptual framework is a comprehensive, developmentally based model for assessment and intervention with children with special needs, rather than restricted approaches limited to selected surface behaviors and cognitive processes. For complex syndromes, in addition to exploring underlying etiological mechanisms, it is essential to work with the different functional developmental areas, including their deficits and strengths and the relationship among them.
Components of a Functional Developmental Approach
Functional emotional development capacities, which identify how the child integrates all her separate abilities (e.g., emotional, language, sensory modulation, spatial, and motor skills) to relate to the social and cognitive world in a purposeful and emotionally meaningful manner. Children with complex developmental and learning problems, including autistic spectrum disorders, often only learn skills in an isolated, unpurposeful or non-meaningful way (e.g., memorizing scripts). They tend to have a harder time integrating these different capacities meaningfully. More and more studies are identifying these capacities for shared attention, intimate relating, affective reciprocity, and the emotionally meaningful use of actions and ideas as the building blocks for logical and abstract thinking, including higher levels of empathy and reflection.
Individual differences in the functioning of the central nervous system, with a special focus on how these differences are expressed in the way a child reacts to an processes experiences, as well as how he/she plans and organizes responses. This area typically includes sensory modulation (e.g., over- or under-reactivity in each sensory modality, such as touch, sight, and sound); sensory processing (e.g. auditory [receptive language], visual/spatial, tactile, vestibular, and proprioceptive); motor planning and sequencing.
Child-caregiver interactions and family and service system patterns, particularly as they mobilize developmental progress by working with the child’s individual differences at the child’s functional developmental level. The tendency of most approaches today, is to work with isolated behaviors or processes (e.g., compliance, aggression, or matching shapes or colors), with insufficient attention paid to the child’s emotional relationship to his/her caregivers, his/her ability to engage in a continuous chain of back-and-forth affective and gestural interaction, or the capacity to generate creative idea.
A team approach to an individualized, comprehensive functional program that works with each child’s unique pattern of functional deficits and strengths and often includes, as needed, speech therapy, occupational and /or physical therapy, special education, biomedical interventions, and mental health or developmental work with the child, and child-caregiver interaction sand/or family patterns—with all team members working together.
These important areas of developmental functioning can be systematized clinically into six basic functional developmental capacities, which also have support from the normative child development literature (Greenspan, 1992; Greenspan & Lourie, 1981).
These six functional developmental capacities are:
- Shared attention and regulation
- Affective reciprocity and gestural communication
- Complex presymbolic, shared social communication and problem solving, including imitation, social referencing, and joint attention
- Symbolic and creative use of ideas, including pretending play and pragmatic language
- Logical and abstract use of ideas and thinking, including the capacity for expressing and reflecting on feelings and having insights into self and others
A review of 200 cases of children with autistic spectrum disorders demonstrated that there were individual differences (i.e., variations) in these functional developmental and processing capacities among the children, further supporting the importance of working with them in the unique configuration that characterizes a given child and family (Greenspan & Wieder, 1997). There also is considerable support (pg 19) for focusing on child-caregiver interactions and working with the family (McCollum & Hemmeter, 1998; Krauss, 1998; Turnbull & Turnbull, 1982). In addition, two other elements appear to have importance. One is employing a very intensive approach to working with children and their families. It also appears the one-on-one child-caregiver interactions, especially for children who are not yet social and interactive, is essential for significant progress (Dawson & Osterling 1997; Powers, 1992). Additionally, as children become available for social interaction, it appears that balancing adult-child one-on-one work with peer-to peer and small-group work is also quite helpful (Hoyson, Jamison, & Strain, 1984; Strain & Cordisco, 1994). The promising elements just identified can be conceptualized as part of comprehensive developmental model (Greenspan, 1992; Greenspan & Wieder, 1998, 1999) by systematizing the elements into the three broad categories describing in a previous section
These broad categories are:
D—developmental capacities that integrate the most essential cognitive and affective processes. These are the six functional developmental capacities described above
I—individual differences in motor, auditory, visual-spatial, and other sensory processing capacities.
R—relationships hat are part of child-caregiver and family interaction patterns and which provide:
Ongoing nurturing support Orchestration of the specific educational and therapeutic elements incorporated in 1 and 2 above Provisions of ongoing interactive learning opportunities geared to the child’s individual differences and current functional developmental capacities throughout most of the child’s waking hours (at an appropriate intensity) A balance between on-on-one caregiver-to child interactions and peer-to-peer interactions appropriate to the child’s individual differences and functional developmental capacitie
In the Developmental, Individual Differences, Relationships-based (DIR®) approach, functional developmental capacities, individual differences in processing capacities and relationships embedded in the child-caregiver and family patterns are utilized together in clinical decision making to create an individualized program for a given child and family.
Screening (Functional Developmental Grown Chart)
If at any time during the early years, a child experience a loss or lack of progress in developing long chains of emotional cueing—regardless of other symptoms—proceed to a full, functional developmental evaluation. Most commonly, the loss of lack of progress in enveloping a continuous flow of reciprocal emotional cueing is seen between 8 and 18 months of age.
Functional Developmental Evaluation
- Developmental history
- Observation of family patterns
- Biomedical assessment
- Review of current functioning
- Observations of child-caregiver interactions
- Reviews and/or observation of educational program and peer interactions
- Assessment of auditory processing and functional language skills
- Assessment of motor and perceptual-motor functioning
- Assessment of sensory modulation
- Assessment of sensory processing
An Essay on Autism and Theory of Mind By: Simon Baron-Cohen
“Some people (pg 1) were aware of physical things but were blind to the existence of mental things. Mindreaders (pg 2) have the capacity to imagine or represent states of mind that we or others might hold. It is our natural (pg 3) way of understanding the social environment. Our mindreading (pg 28) fills in the gaps in communication and hold the dialogue together.
The other way in which mindreading (pg 29) is held to play an essential part in successful communication is in the speaker’s monitoring the informational needs of the listener—that is, in the speaker’s judging what the listener may already know or be ignorant about, and what information he or she should supply so that the listener will be able to understand the message. The speaker must monitor whether the meaning for an utterance has been received and understood as he or she intended it to be, or whether rephrasing is required to resolve ambiguity. A final sense in which language and mindreading are intimately related rests on the idea that language functions principally as a “printout” of the contents of the mind. Mindreading (PG 30) is good for a number of important things, including social understanding, behavioral prediction, social interaction, and communication.
Stern (1985) point out that an infant’s control (pg 42) over its visual system is precociously mature, enabling the infant to make or break eye contact and thus regulate the degree of eye contact and the amount of physiological arousal that the infant can cope with at that time. Too much might be uncomfortable; too little might be under stimulating. Since what constitutes a comfortable level of arousal is likely to vary from one infant to another, it makes good sense that the infant should have its own regulatory mechanism to control this. There is mounting evidence that infants have a drive to maintain an optimal level of stimulation (Maurer 1993). Furthermore, as all parents know, infants and toddlers love to play peek-a-boo, which is all about occluding the eyes and then revealing them. This innocent little game may be quite important (Bruner 1983).
The Theory-of-Mind Mechanism (ToMM)
ToMM (pg 52) is a system for inferring the full range of mental states from behavior— that is, for employing a “theory of mind.” The first thing that is still needed is a way of representing the set of epistemic mental states (which include pretending, thinking knowing, believing, imagining, dreaming, guessing, and deceiving). The second is a way of tying together all these mental-state concepts (the volitional, the perceptual, and the epistemic) into a coherent understanding of how mental states and actions are related. Regarding ToMM’s first function of representing epistemic mental states, Leslie’s suggestion (Leslie and Thaiss 1992; Leslie and Roth 1993) is that ToMM processes representations of propositional attitudes of the form. Around the age (pg 54) of 18-24 months (Leslie 1987; Dunn and Dale 1984) the mental state “pretend” is probably one of the first epistemic mental states that young children come to understand. Second, from 36 to 48 months, children show evidence of understanding additional epistemic states, such as “knowing,” and demonstrate that they understand the principle that “seeing leads to knowing” (Pratt and Bryant 1990)”Baron-Cohen, S. (1999). Mindblindness: An essay on autism and theory of mind. Cambridge, Massachusetts: MIT press
Watch this for recent research developments in DIR/Floortime in Canada
"Testimonial for the Meltdown Recipe Workshop"
I attended the Meltdown Recipe workshop in December 2014 in my professional capacity as an Occupational Therapist. I was however pleasantly surprised to find that in the end, I benefitted personally tremendously from the workshop. My daughter was two and a half years old at the time I went to the workshop and I was quite at my wits-end, as all the usual methods of handling her tantrums and meltdowns were highly unsuccessful! Maude’s meltdown recipe came at just the right time for us and I started implementing it immediately.
It is working so well for her, she loves her “Nessie” (little nest) and although it was quite labour intensive initially to implement this new method, it works extremely well. As Maude explained, it is not possible to reason with her in those moments when she “flips her lid” and she needs to gain self-control when that happens. It was so amazing to see how she was often able to pull herself together on her own, after a few months of implementing the Meltdown recipe. Needless to say, these are still “flipped lid moments” but those moments are less, shorter and the best of all is that she doesn’t resist going to her “Nessie” at all, she actually helps to pack out what she needs, while still crying!
I have recommended the Meltdown recipe to so many of my clients and can highly recommend it as an effective tool for any Therapist or parent.
Belinda von Wielligh – Occupational Therapist, Mother of 6 and 3 year old.
"Still amazes us to see his progression"
I just wanted to send you a note letting you both know that Eric and I think of you often, and to let you know how well Alec is doing.
Alec is doing so well. He is in kindergarten at Concord and has the help of a paraprofessional in class. He really likes school and has adjusted well. Academically he really excels and is getting along well with the other kids. We recently had an event which highlighted how much he has improved.
Three years ago my niece had her bat mitzvah. We wanted to take pictures in the reception room. Even though there were no people in the room, we could not get Alec into the room, which was big and overwhelming. This Saturday night my nephew had his bar mitzvah. Alec wore his first suit (2 years ago he would not even wear a shirt with buttons) and looked so handsome. Not only did we get him in the room, but he danced all night! He danced with Eric and I, his aunts, cousins, grandparents and anyone who wanted to dance.
Alec communicates really well these days. He teases his sister and torments her, just like a typical brother. He also loves her. He has a sense of humor and is funny.
While we always believed, and continue to believe, that Alec has unlimited potential, it still amazes us to see his progression into this fabulous, loving, smart young man. Every day he does something to make us proud. Both of you, as well as others at Total Approach, helped so much with his growth. You also taught us how to be better parents to a child with special needs. We are forever grateful to you. Thank you.
Have a wonderful Thanksgiving.
Marla – November, 2009
Letter to Maude
We have decided with great difficulty to have Taite start services closer to our home which will also be less costly for us. We have been so happy with the progress Taite has made at Total Approach and we thank you for all you have done for her.
I will never forget when I first called you in July 2005, it was just prior to Taite's second birthday. At that time we had received some floortime coaching from someone who was not a good match for our family. During our initial telephone conversation, you said "we want to bring out all the love your little one has to offer." Do you say that to everyone? You should. Those words were so encouraging to me, it is just what I needed to hear. And they have resonated since.
We were fortunate to find you and got so much out of your approach towards floortime coaching. We would meet monthly in your office to watch our tapes and you'd tell us how we underestimate ourselves and give us good advice on improving our skills. Now, we feel like experts.
And then coming in and meeting Angela and all the joy she expressed towards working with Taite. She and MaryBeth would joke and "fight" over who would get to work with Taite. Of course, Angela scooped her right up! Angela's enthusiasm for her work and interest in Taite and our family showed. MaryBeth would show her "jealously" in the hallway, but later she too got her chance to work with Taite.
Tears come to my eyes as I write these words and think of leaving. Please understand that the decision does not come easily.
Beth and Brad Daniels – April 2009
Our son, Dean was diagnosed with PDD (an Autistic Spectrum Disorder) at eighteen months of age. Initially, we were devastated. We didn't know anything about the disorder or what interventions we could use to help our son. The thing that was so disturbing to us was how Dean seemed to not know how to play. He would do the same things over and over again, like spinning or lining things up. He also did not play with other children and he didn't have any interest in doing so. Fortunately for us, we found out about A Total Approach very early on.
We started with Occupational Therapy initially. It was there that we learned about DIR®/Floortime™ therapy. We started having individual sessions with Dean and training sessions for us(Dean's parents and our team members) This intervention has been a crucial component to Dean's program.
The staff at ATA have been phenomenal in their attentiveness to Dean and to our family and staff in coaching us how to work with Dean at home. Over the last year, we completed three loops of Tomatis and also started Speech therapy there as well. Dean is making great strides! He has come such a long way with his play skills and interaction with peers. We truly cannot say enough about ATA.
Kim and Dan York ¨C July 2006
When I first met Maude she was speaking at an autism support group meeting. This particular discussion was on DIR®/Floortime™. Her enthusiasm and love for children was apparent through her talk. At the end of the meeting I could not refrain from telling Maude how you can tell that she truly loves and believes in her work.
That was three years ago. From that moment on Maude and her highly skilled staff has been a part of our families life. Our two sons (6 and 4 years old boys) have grown with the A Total Approach Family.
They have been evaluated through comprehensive sensory evaluations. With the results from these evaluations we have been able to design a sensory diet and meet all of their sensory needs. They have attended hours of occupational therapy to help them with issues such as low tone, fine motor skills and postural stability. All terms which were foreign to us prior to becoming part of this world.
Through DIR®/Floortime™ my husband I have been able to engage our children in play like we have never before. They too have grown emotionally with this technique. Our oldest son has reached the higher levels of the milestones while our younger son continues to work hard with "his Nancy" to attain the higher levels. Although I was skeptical we tried listening therapy. I have to say it WORKS! And I am as skeptical as they come. It's amazing how our sensory system affects our whole being.
This summer our older son participated in Tomatis. We have seen an increase in our son's conversation, a decrease in rigidity and a willingness to be more flexible. At the end of the third loop (after not riding a bicycle all summer due to a broken wrist) our son jumped on his two-wheel bike. He had not practiced riding the two-wheeler since the beginning of the summer. He took off without anybody's help and has been riding ever since.
We hold each and every therapist at A Total Approach with deep respect. And we feel they will take care of our children as if they were their own. We fully trust them. To sum it up you know you are in a wonderful place when your children can't wait to get there and do not want to leave once they are done!
Read what one of the therapist’s Maude mentors has to say:
Hi hope you are well. I have been taking flying leaps and using the floortime technique with many of my children. Especially the very anxious. rigid ones - oh my word. Last friday i had a treatment session of note with some little boy who is developmentally delayed and has lots of instability within his hands and body. By the end of the session we had covered number, colour, shape and he was building food out of playdough and putting pegs into the playdough and then using a spoon to move the pegs.We even had an oven involved that he had built out of blocks. All things he has really struggled with in the past. All self directed , the items just "happend" to be around and i went with him enthusiastically. He was sitting wonderfully by the end with great symmetry and we both had had fun.