By Maureen Dinsmore, M.A., MT-BC, MusicWorx Staff

I’ve had the privilege of working with individuals with intellectual and developmental challenges, with an emphasis on persons with autism spectrum disorder (ASD), for over fifteen years. These amazing people have forever inspired me to tailor my approach to best serve their needs.

While pursuing undergraduate studies for music therapy, I worked as a behavioral therapist with a child with Down Syndrome and ASD. Meltdowns, tantrums, and self-injurious behaviors were a frequent occurrence and raised many questions concerning how to approach the child during these stressful moments. The more I observed and interacted with the child, the more I understood that these behaviors lay deeper than mere defiance or attention-seeking; the child was frustrated and didn’t have the means to communicate his feelings or cope. I learned that there was a crucial need to address his psychosocial needs and development, specifically emotion regulation (ER).

When heightened emotions occurred, I intuitively felt a need to address it, but was unsure how. I found this domain to be one of the most challenging, yet intriguing. Despite having communication and language impairments and difficulties employing adaptive ER strategies, they were able to reveal their emotion through active music-making and, with guidance, modulate their emotions.

During my graduate studies thesis research, I interviewed music therapists across the country and learned that by using a relationship-based framework and taking into consideration each individual’s interests, motivations, sensitivities, and capacities, our role as music therapists is to coach person during times of dysregulation. Once regulated, we can mentor them to help move up the developmental ladder. Hence, the DIR®/Floortime™ is a model that does just this!

What is DIR®/Floortime™?

A Human Development Model for all individuals with and without challenges used across one’s lifespan.

DIR®

The DIR® Model was developed by Dr. Stanley Greenspan and is a comprehensive framework which enables clinicians, parents and educators to construct a program tailored to the person’s unique challenges and strengths.

Floortime™

Floortime™’s particular technique is considered the cornerstone and the engine that drives the DIR®/Floortime™ Model and the developmental process.

1. Following the child’s lead
2. Joining the child’s world and pull them into a shared world in order to help them master each of their Functional Emotional Developmental Capacities.

DIR® and Floortime™ Combined

Together, this model identifies where a person is functioning within the framework of six specific levels of typical social-emotional developmental milestones (Greenspan & Wieder, 2005). These levels create the developmental ladder.

Research and Evidence

DIR®/Floortime™ has the strongest research of any intervention to support its effectiveness in improving the core challenges of autism including relating, interacting, and communicating while decreasing caregiver stress and improving parent-child relationships.  Eighteen randomized control studies support DIR®/Floortime™’s efficacy

• The Interdisciplinary Council on Development and Learning, Inc.
  • The CDC and ICDL Collaboration Report on a Framework for Early Identification and Preventative Intervention of Emotional and Developmental Challenges.

Research has shown Effective for those with Autism Spectrum Disorder (ASD)

• Joint Attention: Casenhiser et al., 2013; Ingersoll et al., 2006
• Imitation: Ingersoll & Gergans 2007; Ingersoll et al., 2007; Ingersoll et al., 2006; Ingersoll 2010
• Language: Casenhiser et al., 2015;  Ingersoll et al., 2006; Whalen et al., 2006
• Communication: *Casenhiser, Shanker & Steiben, 2011; *Casenhiser et al., 2015
• Social-Emotional: Carpente, 2016; Dionne & Martini, 2011; *Lal and Chhabria, 2013; Mahoney & Peroles, 2004, *Pajareya & Kopmaneejumruslers, 2011; Sealy & Glovinsky, 2016; *Solomon, et al., 2014

* Indicates Randomized Control Trial

Why DIR®/Floortime™?

1. The approach is process-oriented to work on foundational capacities.
2. Generalization! Studies have shown that there are limitations to behavioral interventions that are therapist-led and driven in two crucial areas:
   1. Gains made were not generalized to new settings or maintained over time (Harris et al. 2015; Ingersoll et al., 2007; Paul, 2008; Schreibman & Koegel 2005)
   2. Lack of spontaneity and overdependence on prompts (Ingersoll, 2008; Schreibman & Koegel, 2005; Schriebman et al., 2015)
   3. Behavioral approaches are respected and targeting skills for outcomes are a first step; however, there is a need to go beyond: first do a task, then get a reward. DIR®/Floortime™ focuses on the person’s intrinsic want and motivation to connect with others and move up the developmental ladder.
3. Targets Core Features of ASD
   1. Social interaction
   2. Peer relationships
   3. Seeking to share enjoyment, interests, or achievements with others
   4. Social-emotional reciprocity
   5. The ability to initiate and/or sustain a conversation

Children with ASD have a biologically-based difficulty in connecting emotion to the emerging ability to plan and sequence their actions. Using the DIR®/Floortime™ approach, these complex interactions are guided by need, interest, or emotion (affect).  Intention and meaning is necessary to move up the developmental ladder. When overly structured and repetitive, the person may rely on memory rather than learning and practicing the skill.

How does Music Therapy Relate to DIR®/Floortime™?

Music Therapy Improvisation Techniques

These are used to heighten engagement with the person through musical-affect and reciprocal interactions (Carpente, 2011).

• Grounding
• Reflecting
• Enhancing
• Mirroring
• Imitating
• Synchronization
• Dialoguing

Musical Emotional Levels

• Musical attention
• Musical affect: client has an emotional response to musical play
• Musical adaptation: Parallel play
• Musical engagement: Parallel/Interactive play
• Musical interrelatedness: Interactive play

Dr. John Carpente (2012) described the shared similarities of DIR®/Floortime™ and Improvisational Music Therapy:

• Following the child’s emotional lead
• Action-based and non-directive approach
• Musical responses and reactions
• Idiosyncratic behaviors respected
• Affective interactions
• Relationship-based

How do we measure if this is effective?

Carpente (2016) investigated the effectiveness of the Music Therapy – DIR®/Floortime™ framework using the Functional Emotional Assessment Scale (FEAS) (Greenspan & Wieder, 2001). He measured social communication capabilities according to the six developmental milestones as the course of experiences occurred across three phases:

1. Following the child’s music-emotional lead
2. Two-way purposeful musical-play
3. Affect synchrony in musical play

Functional emotional level on the FEAS indicated that Music Therapy – DIR®/Floortime™ results were consistent with evidence from other studies (Edgerton, 1994; Kim, Wigram, & Gold, 2008, 2009; Nordoff & Robbins, 2007; Thompson, McFerran, & Gold, 2013), showing its effectiveness for improving social communication skills in children with ASD.

The Foundational Piece

The DIR®/Floortime™ approach provides a framework that looks at the whole person and their support systems to reveal and illuminate each person’s strengths.

For more information, please reach out and speak with one of our music therapists.  We look forward to being on your family’s team!

858-888-0399

ICDL FAQ’s:http://www.icdl.com/dir

ICDL Resources: http://www.icdl.com/education/selfstudy