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Occupational Therapy Tips:
An Integrated Approach to Occupational Therapy for Children with SPD and their Families: Combining Sensory Integration and the DIR®/Floortime™ Model

Juliana Padilla, MOT, OTR/L, STAR Center

This article is the first of a two part series on Occupational Therapy using Sensory Integration and the DIR®/Floortime™ Model for children with Sensory Processing Disorder (SPD). The first article offers a rationale for the use of the DIR®/Floortime™ Model and provides a comparison of the two approaches. The second article in this series will review some basic principles of the DIR®/Floortime™ approach.

For most children healthy physical, emotional, and mental development occurs naturally in day-to-day interactions with the environment and in their relationship with caregivers and peers. For children with SPD, this natural and typically developing process is often distorted, unpredictable, and contributes to a complex set of challenges for these children and their families. However, while SPD interferes with a child’s ability to gain developmentally appropriate skills, and participate in academic and play activities required for learning, equally important is the impact on a child’s ability to form meaningful and healthy relationships with both adults and other children. Parents seek out occupational therapists trained in sensory integration theory to help attain a better understanding of their children’s difficulties. Our role is to address the specific sensory processing issue as well as all of the developmental skills needed for success in daily life.

The goals most often expressed by parents of children with SPD are for

  • Regulated interactions
  • Good social skills and
  • Healthy self-esteem

The question for OTs is how best to achieve this result for children and families.

Ghostly play with therapist and mom

The DIR®/Floortime™ Model is a powerful approach to accomplish not only these three goals but also to provide a structure to support the treatment of children with SPD and their families. DIR®/Floortime™ stands for Developmental, Individual Difference, Relationship-based Model. DIR® focuses on building relationships and meaningful interactions as a foundation for the development of social, emotional, and intellectual capacities rather than focusing on the development of isolated skills and behaviors.

The DIR®/Floortime™ Model is designed to tap the child’s natural emotions and interests while at the same time challenge the child’s competence in higher level social, emotional and intellectual activities. This is accomplished through playful interactions with therapist, family members and peers. .

Child playing hide and seek with dad and sister

For those of you familiar with Sensory Integration, is it beginning to sound somewhat similar?

The DIR®/Floortime™ Model is a perfect complement to Sensory Integration Theory and Treatment. A. Jean Ayres taught us that in order to have adaptive responses the child must experience therapeutic interventions that are meaningful, purposeful and successful. The DIR®/Floortime™ Model contributes by putting relationship at the forefront; helping therapists, parents and all other caregivers use ‘relationship’ to foster adaptive responses in challenged areas of development. When our relationships are reliable, predictable, and consistent, the child has a foundation from which to learn new skills.

Treatment that uses the DIR®/Floortime™ approach along with Sensory Integration, teaches parents strategies to increase the child’s attention and development/learning through the recognition and awareness of 1) sensory experiences that impact regulation, 2) affective states that occur during interactions and 3) the “just right zone” for play. Parents learn to recognize when and how to use sensory and physical activity and language to engage their child and help their child problem solve and elaborate ideas. In this way, parents become aware of their child’s intention in play and what is motivating. This is essential for children to be able to engage in play with others and in more structured learning settings.

The following chart is designed to assist the clinician in how to combine sensory integration theory and practices with the DIR®/Floortime™ approach. Four main areas of child development are highlighted: sensory, motor, cognitive and social emotional. For each area, an example of sensory integration practice is compared to the corresponding DIR®/Floortime™ principles. Notice the similarity and complementary aspects of the interventions.

Developmental Area

Sensory integration theory

DIR®/Floortime™ Principles

Sensory development

  • Multiple sensory opportunities, emphasizing tactile, proprioceptive and vestibular systems
  • Help the child use sensory information adaptively
  • Provide sensory input to attain appropriate level of arousal
  • Read the child’s cues about how they are using sensory information from the environment
  • Attend to sensory needs

Motor organization
(development)

  • Create challenges that are “just right”
  • Facilitate ideation – capacity to expand play theme and ideas, ability to use objects in novel ways
  •  Perform novel movements and activities
  •  Insure success
  • Active participation increases motivation and insures physical activity
  • Encourage MOTOR-PLANNING
  • Don’t do for the child what he can do for himself. Give the child time and help him to “Do it all by HIMSELF!
  • Support pride in being independent

Cognitive development

  • Enriched environments with enhanced sensory, motor, cognitive and social opportunities
  • Therapist facilitates interaction, supports organization and level of arousal
  • Child directed, therapist guided
  • Tap child’s inner drive

 

  • Encourage the child to problem solve and THINK for himself.
  • Cognitive effort facilitates child to think, organize himself and make adaptations
  • Follow the child’s lead
  • Try to discern the child’s intent
  • Encourage the child to be creative and have ORIGINAL IDEAS
  • Encourage the child to give reasons behind their ideas, expand and negotiate
  • Give multiple choice if needed

 

Social emotional development

  • Scaffold activities so the child feels safe and stays regulated
  • Facilitate self-regulation
  • Emotionally supported by therapist
  • Insure safety
  • Encourage the child to share his/her EMOTIONS
  • A trusting relationship must be the foundation for all interactions
  • Make your relationship reliable, consistent, and predictable

Look for part two of this article in our next issue of Sensation. We will provide additional tips on how use the DIR/Floortime Model.




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