The DIR model is an all-inclusive model of treatment for children with emotional and developmental problems and particularly for those on the Autism spectrum. Treatment plans that are designed according to this model aim to teach children how to interact with others, communicate in a meaningful way, and develop a high level of cognitive functionality.
This model is based on Greenspan’s developmental theory, which associates a child’s development with the ability to processes sensory information, regulate behavior and sustain considerable social interaction. A treatment plan built on the DIR blueprint is comprehensive and encompasses all the caregivers and other individuals who are in constant contact with the child: therapists, family members, teachers, and assistants.
DIR is an acronym for the three elements of childhood development:
1. Developmental – In a healthy child there is synchronized progress in the various aspects of human development including: motor, cognitive, language, emotional and social skills. Greenspan and Wieder outlined a developmental ladder which identifies six core developmental stages:
- Stage 1: Absorbing and taking interest in the world
- Stage 2: Engaging and relating to other people
- Stage 3: Two-way communication
- Stage 4: Social problem solving
- Stage 5: Symbolic/imaginative play
- Stage 6: Bridging ideas in logical sequence
In normal childhood development, there is gradual transition between the stages.
2. Individual differences – This facet relates to the individual differences that exist in each child, based on his/her biological and environmental factors. Each child has a different way in which he absorbs, processes, and reacts to stimuli. The ability to absorb, process and respond to stimuli is a vital prerequisite to proper functioning and lays the foundation for sensory, motor and cognitive development. This is why much emphasis is placed on the individual sensory pattern of each child.
3. Relationship – how a child interacts with his environment. The ruling assumption is that emotions and social interactions that are meaningful to a child will serve as the blueprint for his cognitive, language, emotional and social development. Emotional interactive experiences can actually affect a physical change in the structure of the brain. Relating properly to a child’s needs, feelings and areas of interest helps him achieve better performance in behavioral, communicative and reasoning skills. This element refers to a child’s ability to initiate interpersonal communication with his therapists, teachers, and others in his environment. A suitable treatment plan is designed based upon the things that interest the child as well as activities that he engages in.
The DIR Model highlights emotion as a central and critical component of development, positing that emotion, ambition and inner motivation are the fuel of the human engine.
When working with a child in therapy or engaging him in any activity, it’s always important to keep in mind each facet of the DIR prism: his current developmental stage (D), his individual profile (I) and his relationship with his environment (R).
The Floor Time Technique
Floor Time is a form of intervention for children with developmental delays or autistic disorders. This approach involves meeting a child on his/her current developmental level and building upon a particular set of strengths in order to help him climb the developmental ladder. Floor time is a therapy technique as well as a philosophical approach that can be carried out in any location or situation. In this child-focused technique, the parent or therapist follows the child’s lead, and through playful positive attention and by tuning into the child’s interests, encourages creativity, motivation and problem solving.
A Case in Point from Mrs. S. Hirsh’s Classroom
Batya is a six year old girl who suffers from moderate mental impairment and communication problems. At the beginning of the school year, she was observed as being a loner, living inside her own bubble, without making any connections to the world around her. She observed people in her environment as mere objects and had obvious sensory disturbances. She didn’t cooperate with her therapists, left the classroom at every opportunity and almost never expressed herself and her wants.
Over the course of the year, she received therapy twice a day, based on the DIR model. Mrs. S. Krul, her speech therapist, describes her progress that resulted from therapy:
Batya showed marked improvement in interpersonal communication. Whereas in the past, she used to avoid learning, therapy, and communication, today – when she sees the speech therapist, she runs over to her and asks to go along with her for a lesson. She communicates with other people, displays initiative and grasps interactive situations. During a recent therapy session, she took out a picture board from the drawer (on her own accord) and pointed to a picture of a book, asking the therapist to read her a story – an achievement that seemed like a far-off dream at the beginning of the year… The DIR model also helped advance her communication skills to the problem-solving level. When Batya and her teacher came to a room that was locked, her teacher turned to her and asked what to do. Batya immediately went upstairs and asked the secretary for the key to the room!
And what does Batya’s family say? After a few months of therapy, Batya’s mother reported emotionally to Seeach Sod’s staff that the day before, upon coming home from preschool, Batya had hugged her mother – for the very first time!
It’s quite evident that the DIR model was the key that unlocked the door to Batya’s inner character. By entering her world and engaging her in playful activities, her therapists were able to significantly improve her functionality, Baruch Hashem.