Tuesday, April 23, 2013

Tip Tuesday! DIR/Floortime, P.L.A.Y. Project: What's it all about?

Chevron boarder:  http://coffeekidsandcompulsivelists.blogspot.com.au/
Today I'd like to explore two other therapeutic models for working with children with ASD:  Greenspan's DIR model and Dr. Solomon's P.L.A.Y. project.

Disclaimer:  Please understand I am not an expert in either of these models but am attempting to simply share what I have learned via my own research for the sake of educational purposes ONLY.  I am not supporting one model over another, nor am I attempting to solicit any of these models.  I am not addressing research supporting or contradicting any of these models, those previously mentioned or those mentioned in future posts.  I am simply sharing information.  If you are looking for more specific information, specific research, or for a certified clinician in DIR's Floortime or P.L.A.Y Project please go to these links.

Keep in mind what you are reading today is FUNDAMENTALLY and THEORETICALLY DIFFERENT FROM APPLIED BEHAVIORAL ANALYSIS (ABA).  They are two very different theoretical camps in which these programs are based so if you read about DTT a few weeks ago, keep in mind this is COMPLETELY different, AND STILL VERY IMPORTANT FOR US TO KNOW AND USE AS APPROPRIATE!!!

Ok enough disclaimers...let's get to the meat and potatoes!

There are several similarities between these two models as the P.L.A.Y. project was created with Dr. Greenspan's input but Dr. Solomon takes it a step further as you will see.

DIR/Floortime: (Dr. Stanley Greenspan)
So first let's talk about DIR which stands for Developmental Individual Differences and Relationship model.  As you can probably see from its name, DIR focuses on the child with ASD as an individual FIRST.  Here are some core principles of DIR:

1.  DIR is a model for comprehensively evaluating and treating a child with ASD by building: "healthy foundations for social, emotional, and intellectual capacities rather than focusing on skills and isolated behaviors"(website).  

2.  Developmental: we must understand where the child is developmentally as compared to Greenspans 6 levels of developmental milestones.

  • Stage 1: Self Regulation and Interest in the World
    • How is the child understanding and interact with his world via his senses?
    • How can the child calm and self-regulation?
  • Stage 2: Engagement and Falling in Love
    • Following your child's lead no matter what his interest are.
    • Dr. Greenspan believes these interests are a window into how your child feels emotionally and how he sees the world intellectually.
    • you assume that whatever behavior your child is displaying is for a purpose and are providing him some type of pleasure.
    • Once you've met your child where he is, you can begin to pull him into your world via interaction.
  • Stage 3: Two-Way Communication
    • Opening and Closing Circles of Communication
    • Child opens circle by showing his intention/interest.
    • You build on the intentionality by giving the child what he wants or responding effectively.
    • Child closes the circle by taking what you give him
  • Stage 4: Expanding Circles of Communication To Solve Problems
    • As the child masters two way communication he can open and close more and more circles thus expanding his language development along with social communication
  • Stage 5: Creating Emotional Ideas
    • Child develops ideas via play and learns to expand upon those ideas using more words and symbolic play
    • He learns to maintain ideas and use them to meet his needs/wants
  • Stage 6:  Emotional and Logical Thinking
    • A child can express a wide range of emotions and can connect various ideas in play
    • Child begins to understand concepts of space and time
    • Begins to become fully verbal
3.  Individual:  ways each child individually responds and regulates their emotions and senses with the world around them; child may exhibit various auditory processing issues, sensory reactivity (sensory integration issues), or even motor sequencing issues (possible apraxia?).  This particular area will address these individual differences by use of various EBP (evidence based practices) for these issues.

4.  Relationships:  this program sees ASD as a "social disorder" so its a disorder in one's ability to create effective relationships.  This part of the program focuses on improving the relationships of the child's communication partners by training them to follow the child's lead and expand upon the two way communication, etc.

There is so much more to say about this model but not nearly enough space or time.  So I recommend you check out Dr. Stanley Greenspan's DIR model and particularly his explanation of developmental stages AND ideas for ways to target those stages with your children.  Good, good stuff to follow a child's lead!!!

Update 4/26/13:  I received an email from Nancy Greenspan today who wanted to make a few things clear.  As I am not an expert on either model I feel it is important to use Nancy's words as they were shared with me.  Nancy writes:

"...I just want to let you know that although there may be differences between the two (I am not an expert on the Play Project)  both include home visits and parental involvement. It is not a distinction between them. Stanley wrote numerous book for parents so they could do floortime on their own. He recommended to parents that if they need help, they go to a trained professional or have one come to the home. His emphasis was on having parents be the main Floortimers. He felt that children would benefit most with this type of intervention. Hope this helps."

Nancy goes on to remind all professionals that:

"Our online courses on Floortime at www.StanleyGreenspan.com have just been approve by ASHA for CEUs starting May 1."

Thank you Nancy for sharing this information with us.  It will continue to guide professionals and parents when exploring and learning about various therapeutic models and various options for their children!

P.L.A.Y. Project: (Dr. Rick Solomon)

P.L.A.Y. Project's Vision
“The vision of PLAY Project is to be a community-based, state-wide autism training and early intervention model dedicated to empowering parents and professionals to implement our intensive developmental interventions for young children (15 month to 6 yrs. old) with autism spectrum disorders in the most cost effective and efficient way.” (webinars, found on website)

The following information was taken from the 4 free webinars found on P.L.A.Y. projects website.

This model has 6 values:

1.  It is family and child centered
2.  Interventions are often in the child's natural environment (his home)
3.  It is a Parent-Empowered Model
4.  It is Relationship-Based
5.  It is Playful and fun  "When you do what a child loves, he or she will love being with you."
6.  Addresses the core deficit:  Social Impairment

P.L.A.Y. is a developmental model and is also based on Greenspans 6 developmental stages (in this model they call it FDLs).  

P.L.A.Y. projects methods focus on teaching:
1.  Contingent, reciprocal, social interactions
2.  Follow the child's lead, interests and/or intent
3.  Shared social attention
4.  Joyful relating
5.  Simple and complex nonverbal gestures
6.  Long interactive sequences (e.g. 50+) "Circles of spontaneous verbal communication"
7.  Symbolic language related to affect
8.  Intact ego functions

What are HCs and how do they help?
P.L.A.Y project attempts to help children with ASD develop FDLs 1-6 (based on Greenspand's DIR) by "training the trainer", by training the child's parents.  This model has a P.L.A.Y. trained professional (called home consultants or HC) go into the child's home one 1/2 day a month to train the parents on ways to follow the child's lead and way to create and respond to these "circles" the child is initiating.  These professionals then ask parents to spend 2 hrs a day (in 15-20 min increments) to implement the skills and techniques they have learned.  Each time the P.L.A.Y. HC will take data on the child's current skills, continue to teach and model for the parents, take video and review that with parents, etc.  These home consultants go into a child's home for 1 year (approximately 20 visits with video reviews and monthly visits) to train the parents on these skills.

This program also provided workshops and trainings outside of the home for parents IN ADDITION to their home consultations.

How does one become a HC?
HCs are usually masters level professionals (SLPs, OTs, Md., etc.).  They participate in a 4 day training course and are ready to begin home visits.  From that point they are video taped and supervised for 1 year.


So these are just two additional therapeutic models for children with ASD.  I LOVE so much that the focus is on the child's lead AND on building relationships.  I ALSO very much LOVE the idea of training parents as I truly believe parents are and can be their child's best communication partner. I have and continue to use principles of these models to help make connections and building relationships with my young clients with ASD!  In case you are wondering, there is research out that supports these developmental models with more to come according to Dr. Solomon.

I hope this gave you more information on a few other ways to reach and teach our students with ASD.

Stay tuned next week for the discussion of comparison between another therapeutic model, Son-Rise, vs. ABA.

Enjoy and happy talking!!! 

Resources:  appropriate resource links were placed within the blog post above.  Feel free to read more about each model by clicking on the links above!

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