The Developmental, Individual Difference, Relationship-based (DIR®/Floortime™) Model is a framework that helps clinicians, parents and educators conduct a comprehensive assessment and develop an intervention program tailored to the unique challenges and strengths of children with Autism Spectrum Disorders (ASD) and other developmental challenges. The objectives of the DIR®/Floortime™ Model are to build healthy foundations for social, emotional, and intellectual capacities rather than focusing on skills and isolated behaviors.
The DIR® model is based on the idea that due to individual processing differences children with ASD do not master the early developmental milestones that are the foundations of learning. DIR outlines six core developmental stages that children with ASD have often missed or not mastered:
Stage One: Regulation and Interest in the World: Being calm and feeling well enough to attend to a caregiver and surroundings. Have shared attention.
Stage Two: Engagement and Relating: Interest in another person and in the world, developing a special bond with preferred caregivers. Distinguishing inanimate objects from people.
Stage Three: Two way intentional communication: Simple back and forth interactions between child and caregiver. Smiles, tickles, anticipatory play.
Stage Four: Social Problem solving: Using gestures, interaction, babble to indicate needs, wants, pleasure, upset. Get a caregiver to help with a problem. Using pre-language skills to show intention.
Stage Five: Symbolic Play: Using words, pictures, symbols to communicate an intention, idea. Communicate ideas and thoughts, not just wants and needs.
Stage Six: Bridging Ideas: This stage is the foundation of logic, reasoning, emotional thinking and a sense of reality.
Most typically developing children have mastered these stages by age 5 years. However, children with ASD struggle with or have missed some of these vital developmental stages. When these foundational abilities are strengthened through the child's lead and through meaningful play with a caregiver, children begin to climb up the developmental ladder.
An introduction to DIR®/Floortime can be found in the book - Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think, by Stanley Greenspan, M.D. and Serena Wieder, PhD.
The SCERTS® Model is a research-based educational approach and multidisciplinary framework that directly addresses the core challenges faced by children and persons with ASD and related disabilities, and their families. SCERTS® focuses on building competence in Social Communication, Emotional Regulation and Transactional Support as the highest priorities that must be addressed in any program, and is applicable for individuals with a wide range of abilities and ages across home, school and community settings.
“SC” - Social Communication – the development of spontaneous, functional communication, emotional expression, and secure and trusting relationships with children and adults;
“ER” - Emotional Regulation - the development of the ability to maintain a well-regulated emotional state to cope with everyday stress, and to be most available for learning and interacting;
“TS” – Transactional Support – the development and implementation of supports to help partners respond to the child’s needs and interests, modify and adapt the environment, and provide tools to enhance learning (e.g., picture communication, written schedules, and sensory supports). Specific plans are also developed to provide educational and emotional support to families, and to foster teamwork among professionals.
TEACCH (Treatment and Education of Autistic and Related Communication-Handicapped Children): The TEACCH program developed in North Carolina includes an array of services such as evaluations, parent training and support groups, social and recreation groups, counseling, and supported employment. A TEACCH classroom is usually very structured, with separate, defined areas for each task, such as individual work, group activities, and play. It relies heavily on visual learning, a strength for many children with autism and PDD. The children use schedules made up of pictures and/or words to order their day and to help them move smoothly between activities.
TheraPLAY is a community based play group program offering supportive social and skill building groups for children in the Monroe County Early Intervention program. TheraPLAY groups are parent/child groups for 6-36 month old children. Group instructors from the on-site locations and therapists work together to help parents and children participate in play groups. The focus in on fun while working towards developmental goals and skills that may be transferred to the home and other natural environments.
The PROMPT© System stands for "Prompts for Restructuring Oral Muscular Phonetic Targets". It is a dynamic tactile method of treatment for motor speech disorders which is based on touch pressure, kinesthetic and proprioceptive cues. It helps to reshape individual and connected articulatory phonemes and sequences (coarticulation). The clinician helps to manually guide articulators to produce specific sounds or words that seem to be problematic. This is a hands-on approach and thus the clinician uses his/her hands to cue and stimulate articulatory movement, at the same time helping the child to limit unnecessary movements. (www.apraxia-kids.org or www.promptinstitute.com) There are four types of prompts that can be used during treatment: parameter, syllable, complex, and surface. Each of these prompts is used for different levels of support for speech systems. PROMPT takes a holistic view of the child to address all areas of need: cognitive-linguistic, physical-sensory, and social-emotional.
OMEs (Oral Motor Exercises) are non-speech activities that involve sensory stimulation to or actions of the lips, jaw, tongue, soft palate, larynx, and respiratory muscles which are intended to influence the physiologic underpinnings of the oropharyngeal mechanism and thus improve its functions. OMEs may include active muscle exercise, muscle stretching, passive exercise, and sensory stimulation.” The ASHA committee (Arvedson, et al, 2007) responsible for formulating this definition conducted an evidence-based systematic review of the effectiveness of OMEs.
Sensory integration therapy is a treatment technique that therapists can implement, and it is generally offered by specially trained occupational therapists. It involves specific sensory activities (swinging, bouncing, brushing, and more) that are intended to help the patient regulate his or her sensory response. The outcome of these activities may be better focus, improved behavior, and even lowered anxiety.