By: Lynn Abelson, MA, CCC-SLP, OTR
Q: What is the DIR® Model?
A: The Developmental, Individual-Differences, Relationship-based (DIR®) model, pioneered by Stanley I. Greenspan, M.D. and Serena Wieder, Ph.D, provides a framework for assessment and intervention for those with autism and other disorders of relating and communicating. It is a comprehensive, interdisciplinary approach that integrates a bio-psycho-social framework and promotes healthy foundations for social, emotional, and intellectual capacities. Rather than focusing on specific skills and isolated behaviors, DIR® focuses on improving “the whole child.” DIR® is highly individualized to the unique challenges and strengths of the child and family and focuses on family relationships. The DIR® model is typically associated with younger children, but it is also used with adolescents, adults, and senior citizens.
The “D” (developmental) part of the model describes the functional emotional developmental levels (FEDLs) that lay the foundation for learning and development across domains. The first six levels (i.e., shared attention and regulation, engagement and relating, two-way intentional communication, complex problem solving, creating symbols or ideas, and building bridges between ideas and emotional thinking) are essential for spontaneous and empathic relationships and the mastery of academic skills. The “I” (individual differences) part describes the child’s unique sensory/motor profile, including bio-medical differences and the unique way that a child takes in, comprehends, and responds to sensory input. The heart of DIR® is the “R” (relationship-based) element, which focuses on warm and trusting relationships between the child and his primary caregivers at home and school. Significant people in the child’s life are guided in tailoring their interactions so that they are “in tune” with the child’s developmental capacities and individual differences.
Q: How is DIR® Used in Assessment?
A: A hallmark of DIR’s® assessment process is ongoing collaboration between professionals and family members. A thorough background information report is a critical component of the assessment process. This report includes the family constellation, the child’s medical and developmental history and participation in educational, therapeutic, and recreational programs, and caregiver concerns and needs.
The team determines the need for additional testing (e.g., neuropsychological, biomedical, nutritional, etc.). When the assessment is completed, the team develops an individually tailored intervention program that captures and respects the child’s unique developmental profile, individual differences, and social environment (including family dynamics and cultural characteristics).
Domains Assessed as Part of DIR®
- Functional emotional developmental levels
- Sensory processing
- Motor development
- Language development
- Child-caregiver relationships
Q: What is the treatment process in DIR®?
A: DIR® is not a specific intervention approach; rather, it provides a framework for organizing specific intervention components into a comprehensive treatment program. Treatment sessions take place in the home, school, community, and/or clinic and are provided individually and in groups. Therapeutic techniques associated with the DIR® model include semi-structured activities, discipline-specific interventions, and family support/parent coaching, as well as Floortime®.
In semi-structured activities, a clinician, educator, or caregiver sets up developmentally appropriate challenges to be solved that address specific intervention goals. The environment is structured, and materials and props are provided to guide the child’s play. Discipline-specific intervention utilizes cutting-edge therapeutic strategies from one’s profession and principles from the DIR® model, as it is believed that all learning occurs through the context of a warm, nurturing relationship that involves affective, interactive exchanges.
Family training is adapted to meet the needs of the child and family and includes caregivers, siblings, and peers in treatment sessions. Home programs address mutually agreed-upon goals and are integrated into the family’s daily routines. Caregivers are provided with resources and invited to participate in all treatment sessions; some parents actively observe the professional working with their child, while others directly practice the therapeutic strategies with their child. Supportive mentoring is provided, along with opportunities to view and discuss videotapes that reflect their child’s progress.
Floortime®
While the DIR® model is often viewed as synonymous with Floortime®, it is not. Floortime® is a specific therapeutic technique for creating emotionally meaningful interactions that facilitate functional emotional development. Floortime® sessions focus on lengthening mutual attention, deepening engagement, encouraging initiative and intentionality, and developing symbolic capacities through pretend play and conversations. Floortime® is a respectful way of interacting with children, teenagers, and even adults, bringing the individual into a shared world by following his lead and harnessing his natural interests, and it need not occur on the “floor.”
Q: What are the application of DIR® in school settings?
A: In schools where the DIR® framework is the predominant educational model, DIR® is integrated into the school’s mission statement, strategic plans, curricula across domains, and ongoing staff and family training. Schools that offer both DIR® and other treatment approaches, including Applied Behavioral Analysis (ABA) methodologies, will train staff and family members in both models. Specific classrooms can be designated as using a DIR® or ABA approach. Some schools use the DIR® model to a more limited extent, in which case it may be piloted in a single classroom, infused into a specific content area (e.g., morning circle or language group), or provided to individual students through a DIR®-trained staff member or consultant via parent request and/or IEP mandates.
Q: What research supports the use of DIR®?
A: Research continues to build support for DIR®, which has been shown to be effective in improving the core challenges of autism, including relating, interacting, and communicating while decreasing caregiver stress and improving parent-child relationships. Research includes randomized controlled studies, comprehensive case studies, and pre-post surveys of Play and Language for Autistic Youngsters (P.L.A.Y.®).
Resources:
Lynn Abelson, MA, CCC-SLP, OTR is the Speech Language Pathologist and DIR Program Manager at The Phoenix Center, a private, not-for-profit school in Nutley, New Jersey.
