DIR® Model

Quickstepz Paediatric Therapy uses the DIR®/Floortime Model as the basis of intervention when working with children and their families. The DIR® approach is a comprehensive assessment and intervention program that combines an understanding of the child’s:
  • Developmental level
  • Differences in sensory processing and
    motor planning capacities
  • Most important relationships (e.g family members)

The DIR® (Developmental, Individual-difference, Relationship-Based) Model provides a comprehensive framework for understanding and supporting the child’s development. At the heart of this approach is the role of the child’s natural emotions and interests which have been shown to be essential for learning interactions that enable the different parts of the mind and brain to work together to build strong foundations for social, emotional, and intellectual capacities rather than focusing on developing isolated skills.

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“D” is for Developmental

Understanding where the child is developmentally is essential to planning an intervention program. These six developmental milestones describe the developmental stage that every child must master for healthy social, emotional and intellectual growth. These six levels are best explained here.

Once a child is on the path to mastering these six milestones, he has the necessary basic tools for communicating, thinking and coping emotionally. The child is capable of warm and loving relationships and is able to verbally express a wide range of emotions and recover from strong emotions without losing control. He is ready to relate logically to the outside world and has an ability to use his imagination to create new ideas. He is flexible in his interactions with people and various situations and better equipped to tolerate changes and even some disappointments. 

“I” is for Individual Differences

This involves assessing and understanding the child’s sensory profile, sensory processing capacities, motor profile, motor planning/sequencing capacities that may be impacting his/her ability to grow and learn. This describes ways each child takes in, responds to and comprehends sensations such as sound and touch, and how the child moves about and interacts in his/her environment. Assessment of these individual differences helps us to plan our intervention program and guides us in how we approach and engage with the child. This is the ‘driving force’ behind the child and gives us information about what motivates them, what moves them to action, what overwhelms them, what interests them so we can work with them to achieve their goals.

Read more about Individual Difference

“R” is for Relationship-Based

Therapy places emphasis on strengthening the relationship between the child and his/her parents and family members. The DIR® approach encourages parents/family members to interact with a child in a way that helps them advance developmentally.

Dr. Stanley Greenspan writes in “The Child With Special Needs” (1998):

“Relationships are critical to a child’s development. BY engaging 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 move into the world of ideas. As together you open and close many circles of communication in a row you can help him to 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 in more meaningfully, spontaneously, flexibly, and warmly. He gains a firmer foundation for advanced cognitive skills.”

Please click on this link to look further into some of the latest research into DIR

Autism Spectrum Disorder

Autism is a complex neurobiological disorder which impairs a person’s ability to communicate and relate to others. ASD can be reliably diagnosed as early as 18 months-2 years, however current research is indicting that these first indicators of ASD are often present in the first year of life. Parents are usually the first to notice these concerns or delays. If you have concerns about your child’s development speak with your paediatrician.

Quickstepz Paeditric Therapy believes that treatment for these young children with ASD or who are at risk of ASD needs to be tailored to where the core deficits exist. i.e their social interaction and communication deficits. An intervention program is therefore tailored around these core deficits with a focus on developing the ability to connect and engage with others them having meaningful relationships.

Children attending therapy often benefit from peer or sibling sessions. In these sessions, two children are paired together for joint sessions with the therapist. The goal is for the children to learn to develop friendships/relationships with other children in a natural/spontaneous way, following DIR® principles and supporting the children to self regulate and communicate intentionally. It is not about teaching them specific ‘rules’ about what to do in social situations, but instead teaching them in the moment how to respond and how to have successful peer interactions develop a real connection with one another. DIR®/Floortime is the perfect medium to enable successful play and interactions between two children. The therapist supports the play and is seen as a mediator in the play while the children lead the direction of the play.

Sensory Processing and Developmental Disorders

In the DIR/Floortime™ Approach we look at a child’s strengths and weaknesses in their development and come to understand the child’s “Individual Differences” (the “I” in DIR). These Individual Differences include the child’s sensory profile, sensory processing capacities, regulatory capacities, motor profile, and motor planning capacities. Many children with a developmental disorder such as ASD or a developmental delay present with differences in their sensory processing. Sensory experiences include touch, movement, body awareness, sight, sound, smell, taste and pull of gravity. The process of the brain organising and interpreting this information is called Sensory Integration. This Sensory integration provides a crucial foundation for later, more complex learning and behaviour.

Sensory Processing Disorder (SPD) refers to the way the nervous system receives messages from the senses and turns them into appropriate motor or behavioural responses. Whether you are biting into an apple, reading a spelling list, learning to ride a bike, or attempting to walk up the stairs, your successful completion of the activity requires accurate processing of sensation. SPD exists when sensory signals are either not detected or don’t get organised into appropriate responses. Pioneering Occupational Therapist, Educational Psychologist, and Neuroscientist Jean Ayres, PhD, likened SPD to a neurological “traffic jam” that prevents certain parts of the brain from receiving the information needed to interpret sensory information correctly.

Sensory Processing Disorder can affect people in only one sense (for example, just touch, or just movement) or it can affect multiple senses. One particular person with SPD may be over-responsive to touch/tactile sensation and may find being touched, having their hair/nails cut or other tactile input to be unbearable. Or the child may be unable to tolerate movement and physical play (such as swings, slides, sports) like other children their age. Other children may be under-responsive to certain sensory input and they may show little or no reaction or be slow to respond to certain sensations. For example, they may seek out movement constantly, by climbing, pacing, spinning or by shaking their head side to side. In children whose sensory processing is impaired, their posture and motor skills can also be affected. They can have issues with postural control. 

Sensory-based Motor Disorder

This is where the child has trouble controlling, planning and supporting their movements in a smooth, coordinated and sequenced way. A child with a sensory-based motor disorder may present with Dyspraxia (difficulty processing sensory information to create physical, unfamiliar or sequenced movements i.e motor planning such as learning to ride a bike) or a Postural Disorder (where the child has difficulties maintaining control of their bodies in order to meet the demands of a given motor task e.g remaining in a sitting position to manipulate toys or drawing utensils).

Motor planning is the instinctive “know-how” in approaching a novel motor task, the ability to automatically make your body do what you want it to do, without having to consciously think of every step of the task. The child’s ability to accurately perceive and process sensory information from his body’s interaction with the environment is essential for motor planning. The components of motor planning include ideation, motor sequencing, motor execution and adaptability.

Therapy is enjoyable and most children will have fun participating in therapy sessions despite how hard they are working! The aim of therapy is to impact the development of how the body responds to the sensory messages it receives and how to produce meaningful responses. Therapy also aims to educate parents, caregivers, families, and teachers to allow for improved learning and participation at home and school. The therapist helps the child participate in sensory-based activities through meaningful play. This helps to activate the neural pathways and provide organisation within the central nervous to produce more regulated responses. Therapy aims to provide a neural platform that promotes the development of more complex skills by freeing up the higher cortical levels which are currently being used to process sensory information. Rather than addressing the symptoms, we are addressing the underlying causes which are essential in sustaining change. Some of the techniques used in sensory-based therapy may include:

  • Wilbarger Brushing Protocol
  • Therapeutic Listening®
  • Implementing a sensory diet through a home program
  • Environmental modifications to support a child’s sensory processing patterns (support at home and preschool)
  • Implementation of the Regulation programs (Alert/Zones of Regulation) to promote to self-regulation
  • Oral-motor programs