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There are three types of developmentally appropriate interactions and practices that need to be part of the child's daily routine at home:
1. Floortime™, spontaneous interactions during which the caregiver follows the child's lead and helps her elaborate
2. Semistructured, problem-solving interactions, during which specific learning objectives are worked on through the creation of dynamic challenges that the child wants to solve.
3. Motor, sensory, perceptual-motor, and visual-spatial physical activities to strengthen important processing foundations.
This page describes each of the three types of developmentally appropriate interactions in more detail. For an illustrative synopsis of the DIR
® based Home Program components recommended by ICDL, click here. The content of this page is based on chapter 12 of the ICDL Clinical Practice Guidelines, written by Stanley I. Greenspan, M.D., and Serena Wieder, Ph.D.The PDF document for this chapter is available for download at the end of this page.
Floortime™ sessions focus on having caregivers follow the child's lead to encourage the child's initiative and purposeful behavior, deepening engagement, lengthening mutual attention, and developing symbolic capacities. The length of the sessions will depend on how long it takes the child to "warm up" and become fully engaged as well as how long it takes the child to create and expand on new gestures and/or ideas. Daily opportunities for 6 to 8 or more sessions lasting between 20 and 45 minutes each often recommended.
There are several basic principles of Floortime™
- Follow the child's lead
- Join in at the child's developmental level and build on her natural interests.
- Open and close circles of communications
- Create a play environment with rattles, balls, dolls, action figures, cars, trucks, schools, etc. that will provide a vehicle for the child's natural interests and facilitate opening and closing circles of communication.
- Extend the circles of communication.
- Interact constructively to help the child reach his own goals.
- Interact playfully, but obstructively, as needed
- Broaden the child's range of interactive experience:
- Broaden the thematic and/or emotional range.
- Enjoy and engage in play dealing with the different themes of life: closeness and dependency; assertiveness, initiative, and curiosity; aggression and limit-setting: and pleasure and excitement.
- Challenge the child to engage in neglected or avoided types of interactions
- Broaden the range of processing and motor capacities used in interactions.
- Engage the child with sound and/or words, vision, touch, and movement
- Challenge the child to employ underused or avoided processing capacities
- Tailor your interactions to the child's individual differences in auditory processing, visual-spatial processing, motor planning and sequencing, and sensory modulation.
- Profile the child's individual differences, based on observation and history.
- Work with the individual differences. Utilize natural strengths for interaction, gradually remediate vulnerabilities. Be extra soothing for the sensory-overreactive child and/or extra compelling and animated for the sensory-underreactive child.
- Simultaneously attempt to mobilize the six functional developmental levels (attention, engagement, gestures, complex, preverbal problem-solving, using ideas, and connecting ideas for thinking) Younger children or children with developmental challenges will master the later levels as they develop.
Semistructured problem solving involves a shared agenda, where the caregiver can teach a child something new by setting up challenges for the child to solve. The challenges can be structured learning activities that are meaningful and relevant to the child's experiences, or they can be spontaneous challenges, such as when the child has to solve a problem or confront something different in his environment to get something he desires. The caregiver can create a new problem-solving challenge whenever it becomes evident the child may want something. Because problem-solving interactions involve creating challenges that motivate a child, semistructured problem solving is similar to following the child's lead, which builds on child's interests and motivations. In problem-solving interactions, however, the caregiver helps to create these interests and motivations.
The amount of time spent on semi-structured problem solving will vary depending on the developmental level of the child, how purposeful he is, and specific areas of need, such as the need to increase gestural communication, language and concepts, or motor planning. Semi-structured problem-solving interactions may occur from 3 to 6 times a day, for 15 minutes or more each times. Those children requiring more semistructure may have as many as five to eight sessions a day.
Problem solving interactions can occur during daily routines, with enough time allowed for extended interactions.
For children who are unable to imitate, more structured learning and behavioral approaches (such as TEACCH, Discrete Trial. and special educations) can be implemented to teach imitation, motor planning, and problem-solving patterns. Once a child can imitate and problem solve, dynamic challenges should be used to teach new skills.
These activities are geared to the child's individual differences and regulatory patterns. They build basic processing capacities and provide the support that helps children become engaged, attentive, and regulated during interactions with others. For example, children who are underreactive and have low muscle tone will benefit from proprioceptive activities (e.g. jumping on the trampoline) or vestibular activities (e.g. swinging) to increase arousal, attention, and intentionality. Other children need calming and organizing activities, which build awareness of their bodies in space, require bilateral movements, and reduce tactile defensiveness.
To understand a child's regulatory profile and organize a home program, it is useful to organize specific recommendations from all therapists working with these processing areas. These activities can be used to help a child get ready for Floortime™ and semistructured activities, reorganize, and increase arousal or calm down and focus, as well as to strengthen the child's basic processing abilities.
The amount of time children should participate in these activities depends on their individual needs, but usually involves from 3 or more hours of 15 to 20 minute sessions interspersed throughout the day. For children at early developmental levels who need to become more fully engaged and purposeful, these activities may occur very frequently because they are "fun" and increase the children's pleasurable interactions with others. These activities also increase communication because children can be taught to gesture or use picture communication to indicate what they want (e.g. more or less, slower or faster). These activities can also be used for problem-solving interactions and sequencing (e.g. obstacle courses and other motor-planning activities).
It is also important for all involved to recognize the considerable demands of a developmentally appropriate, home-based program. Other family members and people (e.g. graduate students and volunteers) should be trained in methods and principles of Floortime™ and be scheduled in to help implement the program.
To read the complete text of chapter 12 "Developmentally Appropriate Interactions and Practices" from ICDL Clinical Practice Guidelines click here
To purchase the ICDL Clinical Practice Guidelines click here
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