Saturday, May 9, 2009

DIR MODEL: DR. Stanley Greenspan


THIS IS A RESPONSE FOR A TEACHER WITH A DIFFICULT CHILD - SUMMARY OF THE DIR MODEL FOR INTERVENTION. IF YOU WOULD LIKE THE ENTIRE RESPONSE PLEASE FEEL FREE TO POST A COMMENT OR EMAIL. crdconsulting@bigpond.com


It sounds like he is quite a challenge. My approach is not to tell you what to do but to offer you a process that may be helpful in determining your course of intervention. Since I do not know the process you have undertaken so far I will present some information as a precursor to a comprehensive intervention.
The DIR model may be appropriate for this child. DIR stands for Developmental, Individual, Relationship model. The D stands for the developmental functional capacities of the child which I will explain to you. The “I” stands for Individual differences such as motor planning, auditory processing etc... and the “R” stands for the Learning relationships the child has access to, parents, teachers, siblings.
The first thing that needs to be investigated is his Functional Emotional Capacities in relation to his development and his individual needs.

There are 9 stages of Emotional development that need to be addressed: Through observation and interaction a reasonable prediction of his level can be attained. The key here is to observe him to bring out the best in him. So in the classroom at this point probably would not be appropriate.

Do you have a guidance officer or a behaviour specialist that can carry out observations as the child is in play with his caregiver?? Is there someone that does home visits that can observe the interaction between the caregiver and the child if the caregiver is prompted to initiate play activities with the child?

1. FUNCTIONAL EMOTIONAL DEVELOPMENTAL CAPACITIES: The core capacities that integrate all areas of functioning into one milestone. Affect is the “team leader” that orchestrates the mental team or mental health of the child. Does the child integrate appropriately his abilities (emotional, language, spatial, sensory modulation, motor skills and planning) to relate to the world in a purposeful and emotionally meaningful way?

The child requires a comprehensive assessment that focuses on where the child is having difficulty but also where the child is excelling (I will explain further). The assessment will determine if the basic foundations for development are present in the child in order to move them from one level to the next. The core capacities progress through the following stages:

1. Stage 1: Shared attention and regulation (purposeful movement, sensory affect motor pattern links sensation coming in with the coordinated motor pattern, experienced based – without pleasurable affect there is no purposeful looking, listening, etc...
2. Stage 2: Engagement: Special interest in the human world, warm smiles and interactions with caregivers, broadening of emotional range, emerging attachments and relationships.
3. Stage 3: Affective reciprocity and gestural communication: Learns cause and effect, social reciprocity, responds to emotional signals, self-regulation, purposeful communication.
4. Stage 4: Complex presymbolic, shared social communication and problem solving, including imitation, social referencing, and joint attention. Increased ability to utilize circles of communication, back and forth communication, sense of self forming, interacting with environment and getting feedback, learning to operate in terms of patterns, forms the ability to have a symbolic world, fixed perceptions and actions are separated and replaced by problem solving, creates images that are multi-sensory and acquires meaning of symbols through many different interactions.
5. Stage 5: Symbolic and creative use of ideas: Use of symbols in pretend play, meaningful use of language, learns new words in problem solving, full engagement through back and forth communication and emotional investment.
6. Stage 6: Logical and abstract use of ideas and thinking, including the capacity for expressing and reflecting on feelings and having insights into self and others.
7. Stage 7-9: Higher level critical thinking, comparative thinking, and internal sense of self.

As you can see the progress through these stages does not necessarily happen according to a chronological age as your student may not have passed through the initial stage of shared attention and regulation and he is in grade 3. The assessment then determines the stage he is functioning in and the intervention targets those core capacities that can move him along the developmental stages.

2. INDIVIDUAL PROCESSING DIFFICULTIES
How does the child comprehend what he sees, hears, smells etc....The ability of the child to process the sensations that are coming in to the central nervous system. Some examples of individual differences could be: over sensory, under sensitive, auditory/visual processing, tactile, motor planning and sequencing. Are there biological factors that may influence the child’s ability to progress typically through the functional emotional capacities?

3. RELATIONSHIPS
Learning relationships are those relationships where experiences the child has, leads them through the core functional emotional capacities. These relationships are caregiver, teacher, sibling, therapist etc... The learning relationships should be tailored to meet the child at their functional emotional level. Critical foundations may be missing if the child is not met at their level because “the thinking capacity” comes from back and forth emotional signalling and meaningful use of language. The first academic skill is to think not necessarily how to spell or do math tasks. The first foundation for academic work is social and emotional capacities that force thinking. It may not be beneficial at this time for your student to focus on literacy and numeracy but on the ability to engage and interact experiencing pleasurable affect rather than negative.



1.SEMI-STRUCTURED PROBLEM SOLVING INTERACTIONS INVOLVING COGNITIVE, LANGUAGE, SOCIAL AND EMOTIONAL SKILLS:
•If child is able to imitate and use complex problem solving gestures, then semi-structured learning should focus on dynamic problem solving interactions orchestrated by the educator to enable the child to master specific cognitive, social or educational goals
•If child is not yet able to imitate and use complex problem solving gestures, consider more structured exercises to teach specific cognitive, language and social and emotional skills. The initial goal should be mastery of gestural problem-solving interactions and complex imitation
•A cognitive curriculum should involve pragmatic conversations groups, cooperative learning and social stories

2.SPONTANEOUS DEVELOPMENTALLY APPROPRIATE INTERACTIONS MOBILIZING THE SIX FUNCTIONAL EMOTIONAL CAPACITIES
•Includes social interactions with teachers and peers, social games and play dates with “expert peers” ( peers that can function appropriately around the child)

3.MOTOR SENSORY AND VISUAL- SPATIAL ACTIVITIES
•Often recommended: three or more 20 minute sessions per day.
•Sensory integration occupational therapy exercises such as running, jumping, and spinning.
•Perceptual-motor exercises eg. Looking/doing games such as throwing, catching, kicking, tracking
•Visual spatial problem solving such as hide and seek, treasure hunt, flashlight games
•Once child can answer “why” questions consider adding visual – spatial thinking activities
•Once child is pre-academic work, consider adding pre-academic conceptual reasoning, reading and math exercises.

The point is to implement a comprehensive intervention program that involves the areas that I have discussed. The engagement of the student creates an environment where he feels he is competent and can master the tasks he is given. If he feels safe and secure and receives some pleasure in his accomplishments he will probably be willing to exert an effort to continue to achieve the pleasurable affect. The family relationships as you have mentioned are not stable and would eventually hinder the emotional development of this child. A holistic intervention is required to help this family and child attain his greatest potential. If your school is not ready to intervene in this capacity it may be a very difficult process as this child continues down the negative pathway and never develop emotionally. My suggestion to you as well would be to try to develop a relationship with this child before he comes to your class and to remember not to take his non-compliance personally. Find out his strengths, likes, passions, and try to engage him through those things. Use your personality to bring him into an environment where he actually feels that he is competent and happy. I know, not an easy task but remember at the end of the day you can only do what you can do with the resources you have. I hope this helps. If you need more information the DIR/Floortime Model was developed by Dr. Stanley Greenspan and there are many more activities in the book “Engaging Autism”. I know your student is probably not autistic but this approach can be utilized for all children with special needs.

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