Application of DIR Floortime: Sensory Integration and DIR

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Application of DIR Floortime Sensory
Integration and DIR

• Florence Tang
• Occupational Therapist
• Heep Hong Society

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The Impact of a Childs Individual Sensory
Processing and Praxis on their Ability to Relate,
to Communicate and Interact with Others

• Rosemary White, OTR/L
• (Director, Pediatric Physical and Occupational
  Therapy Services,
• Seattle, WA)

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DIR / Floortime and Sensory Processing

• A blended approach
• to the assessment and
• treatment of children diagnosed with Autistic
  Spectrum Disorder

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DIR
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The Most Important Question to Ask

• When a child is derailed is it due to
• Sensory modulation and regulation
• Praxis
• Auditory-verbal receptive processing
• Auditory-verbal expressive processing
• Visual processing
• All of the above?

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Sensory Processing

• Childs ability to process sensory information
  from systems
• Ability to maintain regulation
• IMPACTS
• How the child experiences the world, interact
  with others and learn

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Sensory Integration

• is the organizing and processing of sensory
  information from the different sensory channels
  and the ability to relate input from one channel
  to that of another in order to emit an adaptive
  response
• (Ayres 1972)

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Sensory Organization

• Sensory Modulation and Regulation
• Sensory Discrimination
• Praxis

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Assess a childs sensory organization ASK

• Sensory Modulation
• What sensory stimuli the child is
• Attending to?
• Over responding to?
• Under responding to?

(Functional Emotional Developmental Levels 1 2)
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Assess a childs sensory organization ASK

• Sensory Discrimination
• What areas of function are affected by sensory
  processing (vestibular, proprioceptive, tactile,
  visual, auditory, olfactory, gustatory)?
• (Functional Emotional Developmental Levels
  3,4,56)

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Assess a childs sensory organization ASK

• Praxis
• How is the childs planning, sequencing, motor
  execution and adaptation impacted by their
  sensory processing?
• How are their functional skills, physical and
  social, impacted by their praxis?
• (Functional Emotional Developmental
  Levels 3,4,56)

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Attention and Regulation Functional Emotional
Developmental Level 1

• Sensory Considerations
• Difficulty in sensory modulation and regulation
• Under or over responsive
• Not have efficient regulatory strategies

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Sensory Modulation Continuum (range of response)

• Failure to orient / Homeostasis / Over
  Orientation

(High Threshold)
(Low Threshold)
Poor registration Sensation seeking
Sensitivity to Stimuli- Fight or
fright Sensation avoiding- Flight or freeze

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Treatment a Dance

• Goal
• Facilitate organization
• Enable the child to self regulate, to be
  motivated and persistent in their approach to a
  task

Sensory
Affect
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Affective and Sensory Interactions Relative to
the childs Profile(Under responsive)

• Drawn into the relationship
• The caregiver is very engaging
• up regulating
• Brings meaning to the childs every action
• Interaction - vibrant

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Affective and Sensory Interactions Relative to
the childs Profile(Over responsive)

• Drawn into the relationship
• The caregiver is equally engaging,
• Their actions and voice are down regulating
• Interaction if often at a whisper, with slow,
  predictable movements
• Drawing child into a safe and secure relationship

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Techniques for(Both Under and Over responsive)

• Respond well when you are sensitive to your
  touch, movement, visual and auditory cues
• Add a sensory layer to your childs interest
  (train - rock back and forth in rhythm with him)
• Think about being in rhythm with your childs
  activity and focus of interest
• Avoid conflicting multisensory input avoid
  moving, touching and talking at the same time.

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Considerations for(Both Under and Over
responsive)

• Slow down your speech
• Child can attach their attention to key words
• Expanding the vowel in action word secure the
  attention. (looook, puuush, juuuump)

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Attention Getting

• What is the sensory stimulus that is key to the
  childs central nervous system tactile,
  auditory, visual, vestibular, olfactory?
• What does the child seek out in his self
  organizing behaviors?
• What are the childs self regulating strategies?

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Attention holding

• What is the sensory stimulus that facilitates the
  childs ability to maintain attention to an
  activity?

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Attention Releasing

• Activity too simple?
• Activity too complex?
• Activity overwhelming?
• When attention release, what sensory stimulus do
  they attach their attention to?

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Engagement Level 2

• Sensory Considerations
• Difficulty with mutual engagement
• Difficulty with joint attention, forming
  relationships or attachments
• Child may hyperfocus on a sensory stimulus
• Exclusion of attending to others
• Difficulty maintaining engagement in all
  emotional ranges

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Engagement Level 2 - Techniques

• Engage in Anticipatory Play
• Ensure your movement and voice are sensitive to
  the childs individual sensory profile
• Under responsive child up regulating
• Over responsive child down regulating
• Listen to the child (vocalization, words)
• Join with the child
• They know you are in sync with them

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2-way Communication Level 3

• Sensory Considerations
• Have challenges in purposeful interaction with
  gestures
• Difficulty in the area of sensory discrimination
• Simple motor planning
• May not have a clear sense of body in space
• Graded motor control can be challenge
• In turn affect sequencing and execution
• May be modulation and regulation issue

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2-way Communication Level 3 (Activities and
Handling)

• Secure childs attention
• Engage in play
• Embrace their physical actions and vocalization
  by mirroring them
• Responding to their action - every action has a
  purposeful intent for interaction
• Provide rich sensory cues to the body
• Increase awareness
• At perceptual level
• Increase the sense of confidence in what their
  body can do

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Purposeful Interaction with Problem Solving
Level 4

• Sensory Considerations
• Child has difficulties in problem solving
• Greatest difficulties with praxis
• Particularly sequencing and adaptation
• Sensory modulation, regulation and discrimination
  may also impact the child

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Purposeful Interaction with Problem Solving
Level 4(Techniques)

• Scaffold the childs success
• Well regulated
• Mutual engagement
• Use gesture to strengthen the purposeful
  interaction
• Help if problem solving is too challenging

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Functional Emotional Level 4(Techniques)

• As child moves, handling techniques
• Focus on providing physical cues to
• Increase his awareness of his base of support
• The integration of his upper and lower
  extremities
• His rotation around his body axis

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Purposeful Interaction with Problem Solving -
Level 4 (Techniques)

• If child is challenged in his desire to explore
  and master the world, may
• Subtle manipulation of environment to facilitate
  his success
• Socially
• Treatment session opportunity to engage in peer
  interaction
• Initially, therapist play the role of the peer
• Then to other peers

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Elaboration of Ideas Level 5

• Sensory Considerations
• Child has difficulties in this area
• Has greatest difficulty in praxis
• Not able to adapt and expand his plan
• Not able to project or anticipate potential
  outcomes
• The child may be rigid, hold a script
• Sensory modulation, regulation and discrimination
  may also be a concern

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Elaboration of Ideas Level 5(Techniques)

• Expand childs motor plan
• Bring in mental manipulation
• Get into imaginative piece (sofa ship child
  animal sheet magicians cloak)
• Highlight the physical
• Include props (puppets, favorite heroes, ships,
  castles)

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Building Bridges between Ideas and Emotional
Thinking Level 6

• Sensory Considerations
• Child has difficulties in building bridges
• Difficulty in praxis
• Particular ideation, sequencing and adaptation
• Difficulty in sensory modulation, regulation and
  discrimination can also impact the child

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Building Bridges between Ideas and Emotional
Thinking Level 6(Techniques)

• Use sensory environment to build bridges
• Get into the spirit of the childs imagination
• Follow the childs lead
• Embracing the full emotional range

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Functional Emotional Developmental Level
6(Techniques)

• Projected Action Sequences
• Challenge him to project what is going to happen
• (Will the cushion go down or up when you get
  on it Will the king attack from the ship or
  land How do you know)
• Challenge his choices
• Why do you want this? when he says I dont
  know, ask Why not?

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Treatment DIR / Floortime with Sensory
Processing Consideration

• Treat the whole child
• Address both AFFECT and SENSORY organization
• GOAL
• Achieve co-regulated interaction with many
  circles of communication

FUN
FUN
FUN
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References

• Berk, Laura E and Adam Winsler (1995).
  Scaffolding Childrens Learning Vygotsky and
  Early Childhood Education. The National
  Association for Education of Young Children.
• DeGangi, G.A., Porges, S.W. (1990).
  Attention/Alertness/Arousal, AOTA Self Study
  Series, Neuroscience Foundations of Human
  Performance. Rockville, MD AOTA.
• Dunn, W. (1999). Sensory Profile, Users Manual,
  the Psychological Corporation.