At AboutPlay, we favor the DIR/Floortime (Developmental, Individual-differences, Relationship-based) approach over other (more widely available) behavioral models. We have a number of reasons for this. I first want to describe Floortime a bit more, for context.
The Floortime approach was created by the late Dr. Stanley Greenspan. He felt that a key to connect with and reach children therapeutically, was literally to get down to their level and engage with them on their terms. To play and engage with their preferred activities and as they become comfortable, to help to challenge them to connect more. This model sees communication in many forms (not only language based communication), and encourages “circles” of communication. This is such an effective method, especially for non-speaking children. The communication may be gestural, and the goal is to continue to stay engaged.
The Floortime model dovetails so well with the Ayres’ Sensory Integration model that we also use at AboutPlay. Floortime acknowledges the sensory systems and sensory processing, nervous system regulation, connection, and play. We understand that play is the highest form of learning. When a child is engaged with playing with certain materials, or has interest with, they will play with it for a while, may move away from it to integrate the learning, and come back to engage with the play, expanding on their explorations; trying new things out. This type of learning is far more effective and meaningful than the punishment/reward based learning that happens daily in other forms of behavioral therapy (and schools) which many times use the play and sensory experiences as the reward or break–whereas we see play and exploration through the senses and nervous system AS the therapy.
So why do so many people still prefer to use behavioral methods? Because for the provider, it’s easier to have a plan. Because it has been what’s been done for so long, and people are reluctant to do something which requires constant engagement. There is no “dialing it in” as a therapist working with Floortime and Sensory Integration–it requires a constant engagement and assessment of whether or not the child is engaging and responding, and to be able to shift moment to moment based on what is happening in real time.
When I was a young therapist in the 90s, the first conference on autism that I attended had incredible speakers. One of my favorite panels was with adults on the spectrum, who were talking about their experiences in childhood with ABA (then known as LoVoss), and with more sensory based approaches in OT. I remember one woman stating that the behavioral methods traumatized her, while some of the sensory based interventions from OT were much more in line with what she needed in childhood (she specifically mentioned swinging and playing). I will never forget that panel; as it has shaped the way that I have chosen to work with children.
I stand by this approach now, despite what gets reimbursed, and what is widely practiced by others. I have seen firsthand the benefits of the DIR/Floortime and Ayres’ Sensory Integration play based approaches for decades. What can appear to be a quick fix with the behavioral methods can have lasting and even harmful effects on the nervous system. The behavioral methods also often encourage “splinter skills” to develop: when a skill is learned or taught without the foundational aspects of the skill. For example, we can teach children to perform a task, say, handwriting (which is a highly complex neurological skill), without addressing the foundational aspects of handwriting, handwriting may improve, but the other areas are still lacking.
Conversely, when we do address the issues (sensory processing, sensorimotor, motor, dexterity, social-emotional) from the bottom up, the higher level skills (such as academic learning, handwriting, social skills) all seem to improve in concert (versus creating the splinter skill). So many families over the years have come to us with a very specific concern (behavior, handwriting, poor sleep), and have been pleasantly surprised to see many things improve, instead of just one thing. In this sense, in my opinion and experience, the payoff with the play based models is much higher, and is in alignment with our overall philosophy of building healthy brains and experiences through sensory rich connections.
You can learn more about the DIR/Floortime approach here.
You can learn more about the Ayres’ Sensory Integration approach here.
As always, if your child is actively being seen by one of our team members, we encourage you to connect with them with any questions that you might have about this approach.
Kate Drummond, OTR/L
Kate received her degree in Occupational Therapy in January 1997 from Keuka College, New York. Kate has worked in hospitals (adult and pediatric) including Children’s Healthcare of Atlanta at Egleston, outpatient clinics, and in the natural environment. Kate started AboutPlay in 2003. She is an intuitive empath, and has always had a passion for holistic healing. She has trained in a number of holistic clinical modalities including aromatherapy, reflexology, meditation, and yoga.
