Application of DIR

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Application of DIR Floortime Bridge between
DIR and Language Training

• LI Lai-ching, ST, Heep Hong Society
• Angela Tsoi, ST, Hong Kong Christian Service

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Bridge between DIR and Language Training

• 1/ The DIR model and language development
• 2/ Affect-Based Language Curriculum (ABLC)

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1/ The DIR model and language development
Sherri Cawn, M.A., CCC-SLP Cindy Harrison, M.Sci.
Functional Emotional Development Stages
Language Development
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Functional emotional stage Age reference Communication/ Language development
1. Attention and regulation 0-3 months Co-regulation and communication
2. Engages in relationships 3-6 months Back-and-forth exchange
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Functional emotional stage Age reference Communication /Language development
3. Two way, purposeful interaction with gestures 7-9 months Open and close circles An active partner More comprehension More vocalization
4. Purposeful problem solving interaction 9-18 months Sharing meanings in gesture and words Use of gestures (e.g. pointing) First word
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Functional emotional stage Age reference Communication /Language development
5. Elaborating ideas 24-36 months Use of abstract representational systems Symbolic play development - play out intentions Word combination - increased utterance length and content
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Functional emotional stage Age reference Communication /Language development
6. Building bridges between ideas 36-48 months Sequences of symbolic actions Conversation skills
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Affect and Language development

• Affect is more critical for many elements of
  language acquisition and use than has been
  traditionally realized. (Greenspan and Lewis,
  2005, p.3)
• The more you interact with affective gesturing
  the more differentiated your interactions are.
  The better it will be when words and sentences
  appear.
• Affect gesturing ? pointing ? complex
  gestures/causality

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Social Communication
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A DIR/Speech Therapist

• Engaging and interactive
• Believes that product is less important than
  process
• Understands that expressive language is not
  always the goal
• Focuses on gestures as an important part of
  treatment - More than words

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A DIR/Speech Therapist

• Understands the link between emotional
  development, speech and language, and regulation
• Utilizes floortime/play based intervention
• Recognizes individual differences!!!

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2/ Affect-Based Language Curriculum (ABLC)

• Background of ABLC
• Authors Stanley I. Greenspan, MD Diane Lewis,
  MA, CCC/SLP
• A curriculum for speech therapy
• Integrate AFFECT and LANGUAGE together

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• Hypothesis
• Affect and engagement are fuel to drive the
  development of language
• Create heightened affect states
• Utilize affect and engagement with pleasurable
  back-and-forth reciprocal interactions as the
  foundation for the development of imitation,
  pragmatics, and receptive and expressive
  language (Greenspan and Lewis, 2005, p.3)

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Greenspan and Lewis (2005) p.5
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D2 36-48 monthsD1 24-36 monthsC 16-24
monthsB 9-16 monthsA 0-9 months
Core areas
Co-regulated reciprocal interaction
Expressive Language
Receptive Language

• Engagement

Pragmatics
Imitation
Levels





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ABLC - Subject selection

• Child VS Adult
• Best to apply during childhood
• For clients functioning at about 0-48 months
• Apply on clients with special needs
• Autistic Spectrum Disorders
• Mental Retardation
• Seizure Disorders

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ABLC - Implementation

• Assessment
• Using checklist as a screening

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ABLC - Implementation

• Treatment
• Using schedule on recommendation of combination
  of treatment
• Sensory Preparation - Systematic Instruction
• Applied Floor Time - Oral-motor
  program
• AAC
• Using systematic instruction tracking form for
  goals setting and recording

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ABLCExamples on skills targeted

• Level A

Engagement Engage and shares attention with the adult and /or objects used by the caregiver for 10 seconds Take the initiative to vocalize to get your attention
Imitation Responds to the adults sound with sounds of his or her own Imitates the adults facial expression
Receptive Responds to a sound that is not visible Appears to listen to the speaker
Expressive Smiles responsively with an adult Responds vocally when called by an adult
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ABLCFrequency and schedule

• Depending on childrens developmental needs and
  overall program
• Minimum of 1-1.5 hours each day on ABLC and other
  recommended program
• For children at lower level
• ?sensory preparation, oral-motor and floor time
• ?systematic instruction and applied floor time