What is DIR® and Why is it Important?

The Developmental, Individual Difference, Relationship-Based model of intervention (DIR®) provides a developmental framework for interdisciplinary assessment and intervention for autism and other developmental and mental health challenges. It is a comprehensive foundation model that utilizes affect-based interactions and experiences tailored to individual needs to promote development.

The Developmental, Individual Differences, Relationship model (also known as DIR® and DIRFloortime®), developed by Drs. Stanley Greenspan and Serena Wieder, revolutionized the concept of development. It was the first model to identify the functional emotional developmental capacities that provide the foundation for lifelong learning and relating. The DIR model training was the first to relate these developmental capacities to the biological/neurological individual differences in sensory processing each person brings to the world. It identified relationships as the pivotal force that nurture and optimize development. Further, it was the first to propose a relationship based model of comprehensive intervention for autism spectrum and sensory processing disorders focusing on the core deficits of relating and communicating.

Overview of the DIR Model

Frequently children with special needs are challenged by neurobiological factors, which make it difficult to participate and enjoy early emotional interactions with their parents. These shared interactions between parent and child that are meaningful, positive and pleasurable create the foundation necessary for all development. The DIRFloortime® model supports parents in their natural and pivotal partnership with their child – promoting their development across a wide range, including regulation, joint attention, communication and language, motor skills, cognition, ideation and execution, and social problem-solving. Floortime essentially means joining the child where they are, revisiting previously missed growth opportunities and moving forward.

The DIR model has been created and informed by experts in the fields of pediatric medicine, developmental psychology, education, speech and language, occupational and physical therapies – making it the first truly integrated multi-disciplinary approach to children with an Autism Spectrum Disorder (ASD) or other special need.

Breaking Down the DIR® Model

D (Developmental) defines the fundamental capacities for joint attention and regulation, engagement across a wide range of emotions, two-way communication, and complex social problem solving. These in turn govern the development of symbol formation, language and intelligence.

I  (Individual Differences) refers to individual differences related to sensory reactivity and regulation, visual-spatial and auditory/language processing, and purposeful movement and communication.

R (Relationship) refers to relationships with caregivers that are the vehicle for affect-based developmentally appropriate interactions. Parents and families are central to this model because of their ongoing opportunities to support their child’s everyday functioning to carry out emotionally meaningful goals based on developmental levels. Cultural and environmental influences are also considered.

Intervention begins with a therapist supporting both parent and child engaging in pleasurable, developmentally appropriate, and interactions building, as well as strengthening the core relationship between caregiver and child to support developmental progress. The treating therapist typically has advanced (preferably certified) training in the DIR-FCD™ model and may come from the fields of medicine, mental health, speech and language therapies, occupational and physical therapies, special educators and early intervention providers. Parents are typically encouraged to engage in multiple DIR-FCD™ sessions daily with their child, both formally and informally.

Progress is measured in the beginning by establishing a baseline FEAS (Functional Social-Emotional Assessment Scale), with quarterly updates.

Functional Emotional Developmental Levels (D)

DIR-FCD™ intervention programs target specific goals at each level, assess and monitor using data collection and videotape sampling, and adjust goals and treatment strategies as the individual makes developmental progress. The Foundational Capacities for Development (FCD’s™) provide guidance for caregivers and professionals on how to adjust their interactions …

D  (Developmental) defines the fundamental capacities (levels) for joint attention and regulation, engagement across a wide range of emotions, two-way communication, and complex social problem solving. These in turn govern the development of symbol formation, language and intelligence. These developmental milestones build on one another and continue to evolve throughout the lifespan.

Level 1:  Shared Attention/Regulation and Interest in the World

The child’s ability to regulate his or her attention and behavior while being interested in the full range of sensations (sights, sounds, smells, their own movement patterns, etc.). The child’s ability to enter into a state of shared attention with another person. This is a child’s ability to process their environment, filter out distractions, engage with others, and attend to play or tasks (ex. pay attention in the classroom).

Level 2: Engagement/Forming Relationships

The child’s ability to engage in relationships, including the depth and range of his/her pleasure and warmth. The related feelings, such as assertiveness or sadness, can be incorporated into the quality of engagement and the stability of the child’s engagement (ex. does he/she withdraw or become aimless when under stress?).

Level 3: Two-Way, Purposeful Interactions with Gestures/Intentional Two-Way Communication

The child’s ability to enter into two-way purposeful communication. At its most basic level, this involves helping a child open and close circles of communication. This is a child’s ability to be intentional in interactions and activities. For example, a child is able to initiate with another person to keep activities going for desired objects or activities, etc.

Level 4: Two-Way, Purposeful Problem-Solving Interactions/Development of Complex Sense of Self

The ability to string together many circles of communication and problem solving into a larger pattern (ten or twenty). This is necessary for negotiating many of the most important emotional needs in life (being close to others, exploring and being assertive, limiting aggression, negotiation safety, etc.). This is the stage where the child begins to develop a sense of self/self-esteem/independence (“I did it!” or “Look what I did!”), using affect, gestures and words, if verbal.

Level 5: Elaborating Ideas/Representational Capacity and Elaboration of Symbolic Thinking

The child’s ability to create mental representations. The ability to do pretend play or use words, phrases or sentences to convey some emotional intention (“What is that?,” ”Look at this fish!,” or “I’m angry!,” etc.). The child begins to have his own ideas and share them with the people around him. This is the ability to share ideas with others and represent ideas and real life through play or activities.

Level 6: Building Bridges Between Ideas/Emotional Thinking

The child’s ability to make connections between different internal representations or emotional ideas (“I’m mad because you’re mean.”). This capacity is a foundation for higher level thinking, problem solving and such capacities as separating fantasy from reality, modulating impulses and mood, and learning to concentrate and plan.

Level 7: Multi-Cause, Comparative, and Triangular Thinking (Grade School Children)

The child is able to explore multiple reasons for a feeling, comparing feelings, and understanding triadic interactions among feeling states (ex. “I feel left out when Susie likes Janet better than me.”). Finding an indirect road to problem solve (ex. “John wants to be Sara’s friend.”). He sees that Tom is Sara’s friend, so John becomes Tom’s friend. This type of thinking is more expansive and even a little manipulative. He learns to “work the crowd” to satisfy his social needs. During this stage the child becomes more interested in his/her body and sexual relations. These feelings may cause the child to be fearful. Nurture him/her through these fears and help them to understand their feelings. It is a good sign when a child becomes manipulative in a triangular way. When understanding the three-person system, the child becomes interested in all facets in their world: sex, death, where did I come from? etc.

Level 8: Emotionally Differentiated Gray-Area Thinking (Grade School Children)

Shades and gradations among different feeling states, the ability to describe degrees of feelings about anger, love, excitement, disappointment, etc. (ex. “I feel a little annoyed.”). The child begins to know where they fall on the social ladder. They begin to define themselves by how accepted they are by their peer group. He/she begins to see the “shades of gray” and becomes a better problem solver. He/she can also see consequences of their behavior. The child is able to give you a range of emotions (ex. “I’m a little mad, very mad, etc.” or “I’m the best, Jo is second best, and John is the worst.”).

Level 9: Intermittent Reflective Thinking, a Stable Sense of Self, and an Internal Standard (Grade School Children)

Reflecting on feelings in a relationship to an internalized sense of self (“It’s not like me to feel so angry.” or “I shouldn’t feel this jealous.”). The child begins to internalize values and develops a greater sense of self that can’t be broken down by lack of acceptance by a peer group (ex. “Sally was mean to me because she was having a bad day, but I am still a good person.”).

The Foundational Capacities for Development (FCD™) Model is Profectum’s Approach to Integration

Cuong Do, Dr. Serena Wieder, Monica Osgood and the Profectum Faculty

Developmental problems need developmental solutions. Drs. Greenspan and Wieder developed an integrated bio-psycho-social framework to profile typical development, which became a guide for assessment and interventions for individuals with special needs. The Developmental, Individual Difference, Relationship based model (DIR® / DIRFloortime®) identifies the functional emotional developmental milestones that integrate emotional and intellectual development. Not only do interventions have to be tailored to the unique profile of the child but depend on relationships as the vehicle for learning and affect to engage and give meaning to experiences. This framework provides the anchor for a comprehensive intervention approach that changes as the child grows.

What If ? ! …

  • despite all intensive efforts, development does not progress at a steady rate?
  • the child and caregiver learn how to co-regulate and engage, but have trouble progressing for there?
  • the child’s sensory system results in the child experiencing the world as an unpredictable and scary place?
  • the child’s motor system is so disorganized that he or she cannot express their ideas and intentions, even when they know what they want to do.
  • the intervention program and daily interactions fall into a rut that don’t promote development at the child’s specific developmental level?

The Foundational Capacities for Development (FCD’s™) provide the construct for adapting experiences, strategies and intervention programs to allow each individual to realize his or her developmental potential!

This often starts with the adults in an individual’s life adapting their responses to foster feelings of  …

Comfort

  • Environmental
    • Physical
    • Sensory Experience
  • Emotional State
    • Trust
    • Predictability
    • Passions
    • Judgement Free Zone

Competency

  • Expectations
    • Accomplishment
    • Purpose

Confidence

  • In SELF
  • In Environments
  • In Activities/ Situations/Demands
  • With People

Control

  • I can make something happen, or not
  • I can be an EQUAL contributor to interactions/situations
  • I am in control of myself

Communication

  • Reliable
  • Functional
  • Powerful
  • Expresses who you are!

Because every child, family system and environment is unique, modifications and adaptations to intervention goals and programs must also be flexible to recognize and support the individual needs of each individual at various stages of development.

For over 40 years, the DIR® model has changed the lives of thousands of families and professionals caring for individuals with special needs. Over the last two decades we have learned, and research supports, that the complex sensory and motor systems of people with autism and other challenges in relating and communicating require a dynamic, not static, approach to intervention.  The DIR model provides a clear guide for development based on the Functional Emotional Developmental Levels (FEDL’S) also know as the “D” in DIR®. We know that relationships, the “R,” are our strongest mechanism for promoting developmental progress. We also respect that other factors play a role in the child and caregiver’s ability to deepen the quality their relationship to support some areas of development.  Some of these factors include:

Culture

  • Socio-economic environment
  • Safe and stable home and community
  • Relationship patterns with caregivers, siblings and peers
  • Individual Sensory and Motor profiles

Finally, our model has always recognized the need to tailor intervention strategies to each child’s individual sensory and motor profile, the “I.”  This component of the model is the least obvious to assess and often, the severity of how the individual profile impacts a person’s ability to act on, and communicate his or her intentions is highly underestimated.  We also understand how differences in the sensory and motor systems interfere with a person’s availability to successfully engage in meaningful interactions and experiences needed to attain developmental progress.

Thanks to our beautiful relationships with thousands of families, insights shared with us from the children and adults we work with, and ongoing, cutting-edge research, we have a much more accurate understanding of how all individuals can develop the Foundational Capacities for Development (FCD’s™) that are needed to allow each person to maximize progress through the FEDL’s.  These capacities are:

We created the FCD model to provide guidance for adapting the child’s experience to provide the emotional foundations needed to maximize progress through the FEDL’s at different stages throughout the lifespan. This may include integrating principles and strategies from a range of intervention approaches in order to tailor intervention programs to support each individual’s unique sensory and motor systems, ability to connect, communicate, learn and be independent. The FCD’s™ complement the DIRFloortime® framework by defining critical elements and experiences, which further enable children to climb the developmental levels.  These capacities are dynamic and change as the individual grows, progresses through the developmental levels and experiences build memories, comprehension and contribute to one’s sense of self.

Semi-structured and structured activities designed to foster feelings of COMFORT, COMPETENCE, CONFIDENCE, CONTROL AND COMMUNICATION = The reduction of stress and abilities realized!

Setting up successful interactions = CONFIDENCE!

Development is Never Straightforward …

Neither is intervention. Despite research advances made in the last decade, attempts to translate these into best practice(s) face many challenges and obstacles. While early identification now has some reliable tools and clinical trials are underway in early intervention, it is not yet possible to capture the complexity of autism spectrum disorders and the variability in how different children respond to different interventions, especially as children grow older and become adolescents or adults and outcomes vary so widely. Identifying the potential capacities of each person and guiding their development to realize this potential is the most important goal we have.

Most importantly, in a dynamic intervention model, every child is viewed as having an inner world with feelings and desires and experiences that they cannot always express but can let us know about in different ways. The feelings, insights, and experiences of parents must also be considered; providers and caregivers need to reflect on the complexity of the child’s development and functioning, as well as their own feelings to best support the child’s development.

Since we are very far from knowing which interventions will benefit which person in this diverse disorder, we must rely on extensive clinical experience and developmental models to guide best practice. Two key principles are relevant.

  • First, intervention models must address the unique characteristics of each child and the families and systems they are part of.
  • Second, individuals develop across the lifespan and can continue to advance if (or when?) provided with foundational capacities for development to support learning and functioning.

In the last century development began to take on various meanings. For some, it was the behavioral and regulatory aspect of growth. For others, it involved a progression of skills to support functioning and competence and for still others, the essence was an emotional and thoughtful life with relationships at the center. Development encompasses all of these meanings.

Foundational Capacities for Development (FCD™) Model Explained

At Profectum, we believe development advances when experience captures the child’s affects and interests and activates new learning, gets organized through interactions, and gets integrated into the child’s repertoire of thinking, feeling and functioning. These experiences build the foundational capacities for development that carry through one’s lifespan (“Foundational Capacities for Development” or FCD™). They are integrative capacities that go beyond specific sensory motor processing and environmental challenges, as they are more fundamental, dynamic, interactive and underlie how, and to what degree they effectively integrate experience to advance development.