SmartStart Developmental Learning Center

Frequently Asked Questions

What is Autistic Spectrum Disorder?

Autistic Spectrum Disorder (ASD) and other disorders of relating and communicating involve a number of different challenges. Each child, though he may share a common diagnosis with other children, has his own unique pattern of development and functioning. For example, some children are over reactive to sensations, such as touch and sound, while others are under reactive. Some children have relatively strong auditory memories, while others have relatively strong visual memories. Some children are able to sequence and plan a number of actions in a row, while others are only able to carry out one action at a time, and therefore become very fragmented in their behavior. Such processing difficulties can interfere with a child’s ability to relate, communicate and think.

In addition, children differ in their basic mastery of the foundations for relating, communicating, and thinking. Some children with autistic spectrum disorders can form relationships and engage in purposeful social interaction to a limited degree, while others are self-absorbed and aimless. Some children can attend, engage with others, and communicate with gestures, but have difficulties participating in a continuous flow of communication. These children also then have difficulties with the meaningful use of ideas and language, and in connecting ideas together for logical and reflective thinking. Other children have partial mastery of these basic foundations, but are limited in their capacity to apply these abilities to a broad range of situations. So while children may share common features that lead to a diagnosis of an autistic spectrum disorder, their underlying challenges are quite varied, which strongly suggests the need for individualizing treatment to address each child’s needs.

What causes Autism?

Current research suggests there may be many factors involved in causing autism-related disorders. A child’s risk of autism is thought to increase under the cumulative weight of various risk factors, so that a child’s genetic factors and the way in which he develops prenatally may make him more vulnerable to other factors. These factors may include infectious illnesses, toxic substances (e.g., lead, methylmercury, PCBs, organophosphates, nicotine, and endocrine disrupters such as Dioxin), and factors that trigger active autoimmunity in genetically predisposed children, such as viral infections and vaccines. Psychological or physical stress does not cause autism, but may contribute to a child’s difficulty relating and communicating. For example, a child with extreme sensitivity to sensory information such as sound, touch and light, and with significant motor planning problems, can withdraw from relationships and become repetitive and self-stimulatory in a noisy and chaotic environment.

What is DIR/Floortime?

DIR (Developmental, Individual-Difference, Relationship-Based)/Floortime model provides a comprehensive framework for understanding and supporting children’s development. It is ideally suited to children with developmental delays, including speech delays, motor delays, sensory integrative dysfunction, autism spectrum and related disorders, Downs Syndrome, cerebral palsy, as well as rare syndromes. It focuses on helping children master the building blocks of relating, communicating and thinking, rather than on symptoms alone

"D" is for Developmental.
Understanding where the child is developmentally is critical to supporting their growth and development along the functional developmental capacities identified by Drs. Greenspan and Wieder. There are six milestones that identify what every child must master for healthy emotional and intellectual growth.

· Shared Attention and Regulation
· Intimacy and Engagement
· Purposeful Two-Way Communication
· Complex Communication
· Emotional Ideas
· Emotional Thinking

For a more comprehensive examination of the Six Milestones, visit the Floortimefoundation.org website or read The Child with Special Needs (1998) by Dr. Stanley Greenspan and Dr. Serena Wieder.

"I" is for Individual-Difference.
Each child has a unique way of taking in the world - sights, sounds, touch, etc - and responding to it. The challenges associated with the child’s sensory system and the various processing issues that make up a child's individual differences may be interfering with his/her ability to grow and learn.

"R" is for Relationship-Based.
Building relationships with primary caregivers and all-important people in your child’s life are critical elements in helping a child return to a healthy developmental path. A warm related connected relationship is fundamental to children’s development.

As parents and educators we can observe where the child stands on the developmental ladder, which milestones he/she has already mastered, which need strengthening, and which still lay ahead. We can make these observations just by watching the child play, watching his/her interact with parents and others, and watching as he/she goes about her daily activities

This information, along with observations about the child’s biological challenges, will form the child’s individual profile. We can then use this profile to tailor a therapeutic model to his/her specific needs.

What is a DIR/Floortime school?

A DIR school focuses on developmental learning rather than a skill-based learning. A DIR school looks at the unique individual profile of the child, taking into account mastery of developmental milestones, individual differences in sensory processing and internal drivers. Most importantly, DIR recognizes that children must have a warm connection with all the important people in their lives, and this includes their teachers, if they are going to climb the developmental ladder. The learning environment looks and feels different; there is an intense focus on mobilizing children’s interests, supporting their unique sensory systems, and wooing children into interactive experiences.

What are the components of a DIR/Floortime program?

The 3 components of a DIR program are:

1. Floortime. Spontaneous interactions designed to mobilize the child’s developmental capacities
2. Semi-structured, problem-solving interactions
3. Sensorimotor activities designed to support improvements in motor-planning and sequencing and sensory modulation.

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Is there research demonstrating the effectiveness of DIR/Floortime?

There is currently insufficient research on any of the treatment approaches for treating children with autistic spectrum disorders. Clinical studies are needed to compare various approaches and to demonstrate the validity of DIR/Floortime. However, in one recent chart review of 200 children with complex developmental challenges, over 50% of children originally diagnosed with autistic spectrum disorders and treated intensively with DIR/Floortime approaches for four to six years have become warm, engaged and loving. These children have become active learners with highly developed abilities in the areas of verbal skills, imagination, logical and abstract thinking, as well as pleasurable peer relationships. Many of them attend mainstream schools, and often their teachers are unaware of the child’s original diagnosis. Other children, because of greater neurological challenges, make slow and steady progress. Nevertheless, even these children can become warm, loving, more connected and make more progress in their language, cognitive and social skills than previously thought possible.

What is the best program for my child … how do I know whether a behavioral model (like ABA) or DIR/Floortime is right for my child?

A common misconception about DIR is that it is just a social skills program or just focuses on social development. Another misconception is that it is not the best choice for children on the Autism Spectrum or not suited for children who are significantly delayed. This is a product of a misunderstanding of just what DIR is. DIR combines essential elements found in treatment approaches like ABA/DTT. The semi-structured component of a DIR program provides specific objective-based interactions that address the individual needs of the child. The most striking difference between DIR and ABA is in DIR’s strong advocacy that relationships are critical to a child’s development. This ensures that the individual and unique needs of your child are supported. Dr. Greenspan writes in the Child With Special Needs, (p. 123)

“Relationships are critical to a child's development. Through interactions, you can mobilize a child's emotions in the service of his learning. By interacting with a child in ways that capitalize on his emotions, you can help him want to learn how to attend to you; you can help him want to learn how to engage in a dialogue; you can inspire him to take initiative, to learn about causality and logic, to act to solve problems even before he speaks and moves into the world of ideas. As together you open and close many circles of communication in a row you can help him connect his emotions and his intent with his behavior (such as pointing for a toy) and eventually with his words and ideas ("Give me that!"). In helping him link his emotions to his behavior and his words in a purposeful way, instead of learning by rote, you enable your child to begin to relate to you and the world more meaningfully, spontaneously, flexibly, and warmly. He gains a firmer foundation for advanced cognitive skills.”

What does the research say about which methods are best for helping children with autism?

According to the National Academy of Sciences, there are no definitive studies proving any one method. There is, however, evidence for the helpfulness of a number of approaches. These include DIR/Floortime and other relationship-based models, as well as behavioral models, such as ABA or discrete trial approaches.

The Academy’s report (“Educating Children with Autism”, 2001) points out that different approaches work on different areas of functioning. DIR/Floortime works on the fundamental capacities for relating, communicating and thinking, and tends to help the child use fundamental skills capacities in a wide range of naturally occurring situations. Behavioral approaches, in contrast, tend to work on specific behaviors in very controlled settings. The Academy’s report further notes that many behavioral approaches are moving toward using more spontaneous types of learning situations, though ABA discrete trial behavioral approaches, which tend to be more structured and controlled, are generally less a part of this growing trend toward more spontaneous learning situations.

What are clearly needed are clinical trial studies comparing the different approaches. In the meantime, the Academy report emphasizes that parents need to select and tailor the model to their child’s unique qualities and needs. The DIR/Floortime model provides a framework for understanding the unique qualities of each child, regardless of his diagnosis, and for organizing a comprehensive program, including different techniques and therapies, that enables each child to climb the developmental ladder and achieve optimal growth.

Can I combine DIR/Floortime with other approaches and services?

DIR can be combined with speech therapy, occupational therapy and a good developmental school program. Combining DIR and ABA is not good for the child as they are contradictory models and much too confusing for children.

The biggest challenge I face is in dealing with my child’s behaviors. I think he needs a lot of structure and behavioral management work … is this something that a DIR/Floortime program provides?

Absolutely! Another big misconception about DIR is that it does not deal with behavior problems and how can you handle behavior problems when you are just following the child’s lead. DIR is ideally suited to work through challenging behaviors it just goes about it differently than traditional behavior therapy. DIR will look at “behavior problems” from the inside out. We want to know why is the child exhibiting the behavior, is there an underlying sensory need that the child has that is causing the behavior. Here are some examples. Is the child having difficulty initiating an interaction and is hitting to get the persons attention. Is the constant throwing of toys a child’s attempt at being naughty or rather a developmental stage the child is mastering later than expected. Does the child play too rough because he is a bully or because he has difficulty with registering input into his body and likes lots of intense squeezes and hugs? Firm limits, structure and boundaries are an essential component of all DIR programs.

The DIR/Floortime model seems to ask so much of me as a parent – how do I know if I can do it?

Just as DIR is individualized to the needs of the child, our support of parents is designed to meet the unique needs of each parent. We believe parents are the best play partners for their children, and we provide the loving training and support to get you there!

How do I know if my child is getting better?

Our teachers and therapists meet regularly with our families to update you on your child’s developmental growth. Daily notes, developmental checklists and progress reports are all important in keeping you up to date with the growth your child is making. Most importantly you will see and feel the difference in you child, as they become related and communicative.

What makes DIR speech and DIR occupational therapy different from conventional speech and occupational therapies?

DIR speech and occupational therapy integrate developmental assessment and relationship-based services, the warm connected loving relationship between the therapist and the child is paramount. Further, traditional ideas about structured treatment are individualized to meet your child’s unique needs and interests. For example, our speech therapy rarely has the child seated at a table; the therapy is play-based and delivered in a naturalistic way.

What funding is available for DIR/Floortime services?

Funding for DIR services may be available for children who are regional center clients and some school districts also may fund the programs.

What is the Regional Center?

The Department of Developmental Services provides funding for persons with qualifying diagnosis or demonstration of developmental delays. These state agencies provide initial developmental screening for families who have concerns about their child’s developmental progress.

What is a certified Non-Public School?

This is a certification from the California Department of Education that allows private schools to serve children funded by the district in which they reside.

Who is Stanley Greenspan, M.D.?

Dr. Greenspan is one of the leading thinkers and researchers studying children with special needs. Below are some of his remarkable accomplishments.

Degrees:
* Harvard, A.B., cum laude, 1962
* Yale Medical School, M.D., 1966

Occupation:
Practicing Child and Adult Psychiatrist and Psychoanalyst; Clinical Professor Psychiatry and Behavioral Sciences and Pediatrics, George Washington University Medical School; Supervising Child Psychoanalyst, Washington Psychoanalytic Institute, Chair, Interdisciplinary Council on Developmental and Learning Disorders (ICDL), Co-Chair, Council on Human Development.

Professional Activities:
Researcher on the prevention and treatment of emotional and developmental disorders in infants and children; Chair, ICDL (1997-); a founder and president (1975-84) of ZERO TO THREE: National Center for Infants, Toddlers, and Families; Chairman, Diagnostic Classification Committee, ZERO TO THREE: NCITF (1988-96); Past Chief, Mental Health Study Center and Clinical Infant Development Program, National Institute of Mental Health; Past Member, Surgeon General’s Task Force on Infant Mortality; past Regional Vice President, World Association for Infant Psychiatry and Allied Disciplines. Editorial Boards (Present and Past): Clinical Infant Reports (Chair); Journal of the American Psychoanalytic Association, Journal of Preventive Psychiatry, Journal of Psychoanalytic Inquiry, Infant Mental Health Journal, Journal of Psychotherapy Practice and Research; Journal of Developmental and Learning Disorders (Chair).

Publications:
Over 100 articles and chapters. Author or editor of over 35 monographs and books. Books include Toward a Psychology of Global Interdependency (with Stuart Shanker), The Secure Child, The Four-Thirds Solution: Solving the Childcare Crisis in American Today; The Irreducible Needs of Children (co-authored with T. Berry Brazelton, M.D.), Building Healthy Minds, The Growth of the Mind, The Child with Special Needs, Developmentally Based Psychotherapy, The Challenging Child, Playground Politics: The Emotional Development of the School-Aged Child, Infancy and Early Childhood: The Practice of Clinical Assessment and Intervention with Emotional and Developmental Challenges, The Development of the Ego, Psychopathology and Adaptation in Infancy and Early Childhood, The Clinical Interview of the Child, Intelligence and Adaptation: An Integration of Psychoanalytic and Piagetian Developmental Psychology, First Feelings, The Essential Partnership. The formulations of Emotional Milestones and related strategies to facilitate emotional growth have been featured in a PBS NOVA documentary (“Life’s First Feelings”) which received the American Psychological Association’s 1986 award for Best Educational Program; the basis for a video tape entitled “Exploring First Feelings,” being shown to new mothers in over 200 hospitals; and a video tape for educators and parents entitled “Floor Time,” produced by Scholastic, Inc. Work featured in The Washington Post, Newsweek, Time Magazine, PBS NewsHour, ABC’s Nightline and on the ABC, CBS, NBC, and CNN News.

Honors:
The American Psychiatric Association’s Ittleson Prize for outstanding contributions to Child Psychiatry Research and the American Orthopsychiatric Association’s Ittleson Prize for outstanding contributions to American mental health, the only individual to receive both Ittleson awards; The Edward A. Strecker Award for outstanding contributions to American psychiatry; Distinguished Psychiatrist Lecturer Award from the Scientific Program Committee of the American Psychiatric Association; The United States Public Health Service Special Recognition Award; The Heintz Hartmann Prize and the Mary Allen Award for outstanding contributions to American psychoanalysis; Fellow of the American Psychiatric Association; Elected to the American College of Psychiatry and the American College of Psychoanalysis.

What do you mean when you say “emotion drives cognition”?

Dr. Greenspan writes in the Child With Special Needs (p. 110-111):

“Throughout history we have believed that emotions were subservient to thought or reason, but an emerging body of observation and neuro-scientific research suggests this view is inaccurate. Rather than being separate and subservient to thought, emotions seem to be responsible for our thoughts. Because emotions give direction to our actions and meaning to our experiences, they enable us to control our behavior, store and organize our experiences, construct new experiences, solve problems and think. The emotional component of each experience makes the experience meaningful …”

DIR endeavors to make each experience meaningful.