Pasadena Child Development Associates, Inc.
Pasadena Child Development Associates, Inc.
Articles
It is great to see new toys or ways of encouraging my son to develop new skills.
What is the DIR®/FloortimeTM Model?
The Developmental, Individual Difference, Relationship-based (DIR®/FloortimeTM) Model is a framework that helps clinicians, parents and educators conduct a comprehensive assessment and develop an intervention program tailored to the unique challenges and strengths of children with Autism Spectrum Disorders (ASD) and other developmental challenges. The objectives of the DIR®/FloortimeTM Model are to build healthy foundations for social, emotional, and intellectual capacities.
- The D (Developmental) part of the Model describes the building blocks of this foundation. This includes helping children to develop capacities to attend and remain calm and regulated, engage and relate to others, initiate and respond to all types of communication beginning with emotional and social affect based gestures, engage in shared social problem-solving and intentional behavior involving a continuous flow of interactions in a row, use ideas to communicate needs and think and play creatively, and build bridges between ideas in logical ways which lead to higher level capacities to think in multicausal, grey area and reflective ways. These developmental capacities are essential for spontaneous and empathic relationships as well as the mastery of academic skills.
Click here for the complete article: What_is_DIR-2008.doc (Word Doc),
What_is_DIR-2008.pdf (Adobe Acrobat PDF)
Social Skills Group Training using a Developmental Approach
Background and Support
Dr. Diane Cullinane
- Diplomat, American Board of Pediatrics
- Diplomat in Developmental-Behavioral Pediatrics
- Diplomat in Neurodevelopmental Disabilities
- Faculty, Interdisciplinary Council on Development and Learning Disorders
The development of social skills, specifically skills in relating to peers, is an important capacity that provides the foundations for life long success. Challenges in the development of social skills impact individual happiness and family function for many children with developmental disabilities, especially those with autism. Indeed, deficits in social behaviors are a major component of the diagnostic criteria for autism. In a survey done at Tri-counties Regional center, parents of children with autism reported that social skills were their number one concern. A detailed review of the theoretical understanding and approaches to social skills intervention is available in the report of The Committee on Educational Interventions for Children with Autism by the National Research Council (NRC). They note: "Interaction with peers is another dimension of children's social development that becomes increasingly important for children beginning at the age of 3." California regional centers have an important role in helping children with developmental disabilities in the area of socialization. Although social skills programs have existed for many years, there is a new effort to identify research support for different methodologies, particularly because policy and funding decisions are being based upon the "evidence-based" imprimatur...
Click here for the complete article:
Social-Skills-Training-Developmental-Approach.doc (Word Doc),
Social-Skills-Training-Developmental-Approach.pdf (Adobe Acrobat PDF)
Evidence-based Practice and Practice-based Evidence
"Evidence-based" has become the gold standard for determining funding. The terms evidence based medicine, treatment, guidelines, practice, models, etc are often used interchangeably. The distinctions are particularly important for the care of children with disabilities and complex medical conditions. Evidence based treatments refer to specific treatments which have been studied on specific and limited populations. These types of treatments are more amenable to study and validation because they limit variables, such as a single diagnosis, and use more easily measured outcomes. Affect, initiative, creativity, warmth, and reciprocity in complex dynamic systems are less often measured. For children with complex conditions, EBTs must be integrated into EB practice. Sackett1 defined evidence based medicine as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients."
Click here for the complete article:Evidence-based_Practice.doc (Word Doc), Evidence-based_Practice.pdf (Adobe Acrobat PDF)
What is DIR®/Floortime and Why is it "Best Clinical Practice"?
The Developmental, Individual Difference, Relationship based approach to helping children with special needs, known as DIR®, was described by Dr. Stanley Greenspan and Serena Wieder beginning in the 1980s. This approach is the culmination of years of observation and study of infants and children, done by many outstanding researchers since the 1950s. Dr. Greenspan and Serena Wieder brought together the knowledge from developmental studies, and mental health research, and recognized the critical importance of relationships and affect to learning. DIR®/Floortime is a framework for understanding child development, a philosophy that emphasizes the critical importance of relationships and affect, and a set of treatment strategies built upon those principles. DIR® is a broad and comprehensive approach which encompasses all disciplines that work with children.
Click here for the complete article: What_is_DIR.doc (Word Doc),
What_is_DIR.pdf (Adobe Acrobat PDF)
Evidence Base for the DIR®/Floortime Approach
Due to the recent budget cuts in California, the 'evidence' to justify public funding for DIR®/FT programs is currently under scrutiny by regional centers in California. This article attempts to summarize the most current research evidence pertaining to the DIR®/FT approach, which will not only provide sufficient basis for a determination that DIR®/FT is evidence-based but will also present an historical view that shows that the field of intervention for children with PDD is shifting from more behavioral approaches towards more developmental models overall.
From Trailer bill: "Evidence-based practice" means a decision making process which integrates the best available scientifically rigorous research, clinical expertise, and individual's characteristics. Evidence-based practice is an approach to treatment rather than a specific treatment. Evidence-based practice promotes the collection, interpretation, integration, and continuous evaluation of valid, important, and applicable individual- or family-reported, clinically-observed, and research-supported evidence. The best available evidence, matched to infant or toddler circumstances and preferences, is applied to ensure the quality of clinical judgments and facilitates the most cost-effective care.
Click for an Adobe Acrobat PDF version of the complete article: Evidence_Base_for_the_DIR111.pdf
Mandating Autism Policy - A Closer Look at the Evidence - April 2009
A Fact Sheet for Law Makers, Parents and Health Professionals
... Informed decision-making requires a thorough review of existing research. Are claims and assertions that support one method of intervention, ABA, founded on solid, unbiased science and evidence-based research? This fact sheet reviews up to date research and autism literature to address this and other related questions. Included in the research are recent systematic reviews that provide meta-analysis of studies from the last 30 years. Systematic reviews and meta-analysis are considered the highest level of evidence among evidence based clinical guidelines.
Click here for the complete article: Autism_A-closer-look.doc (Word Doc), Autism_A-closer-look.pdf ( PDF)
DIR/Floortime and Autism Spectrum Disorders Overview
and Summary of Scientific and Public Support
... The objectives of the DIR/Floortime Model are to build the healthy foundations necessary for a child to develop social, emotional, and intellectual capacities. As stressed in the general literature that promotes healthy emotional and social development, two of the key elements to building these foundations are: spontaneous communication between children and their caregivers and nurturing relationships, that promote joyful and pleasant engagement. These two elements are basic components of the DIR/Floortime Model. Importantly, the National Research Council of the National Academy of Sciences, in their 2001 landmark report, Educating Children with Autism, called for tailoring the treatment approach to unique features of the individual child and recommended to give priority to interventions that promote functional, spontaneous communication...
Click here for the complete article:
DIR-Floortime_Overview-and-Summary.doc (Word Doc), DIR-Floortime_Overview-and-Summary.pdf ( PDF)
CDC/ICDL Collaborative Report - November 2006
Centers for Disease Control and Prevention (CDC) and the Interdisciplinary Council on Developmental and Learning Disorders (ICDL) Collaboration Report on a Framework for Early Identification and Preventive Intervention of Emotional and Developmental Challenges
Click for an Adobe Acrobat PDF version of the complete article: CDC-ICDLCollaborationReport.pdf
Finding Balance - Published Spring 2008
About the Author
Dr. Barry Prizant is the Director of Childhood Communication Services and an adjunct professor in the Center for the Study of Human Development, Brown University. Barry has more than 35 years of experience as a researcher and international consultant to children and adults with ASD. He has published more than 90 articles and chapters on childhood communication disorders and has given more than 500 seminars and workshops at national and international conferences. He also serves on the Editorial Boards of six scholarly journals. Barry is a co-author of the SCERTS Model (Prizant, Wetherby, Rubin, Laurent & Rydell, 2006 - www.SCERTS.com). In 2005, Barry received the Princeton University-Eden Foundation Career Award "for improving the quality of life for individuals with autism".
When I was invited to present a keynote address at the Southern New England Autism Speaks Luncheon for the annual Fall Walk, I thought, "How can I present a talk that is both relevant to the event, and also provides some meaningful discussion about the crucial issues faced by parents, families, practitioners, researchers, and individuals with autism - the ultimate beneficiaries of such walks?"
Then it came to me: Balance. It's the one necessary skill for participating successfully in a walk for autism, since to participate successfully one must be able to maintain appropriate posture and balance. Finding balance has also proven to be one of the great challenges faced by parents, families, practitioners, and researchers in autism, and indeed, individuals with autism. Let's reflect on this theme as we explore the issue of finding balance...
Click for an Adobe Acrobat PDF version of the complete article: Prizant-FindingBalanceSpring08.pdf
On Recovery - Published Summer 2008
About 18 months ago, I attended a national conference on autism in Providence, Rhode Island. One of the keynote speakers was a well-known researcher who gave an eloquent presentation about the dangerous effects of toxins on child health and development. She made a clear and convincing argument about the importance of funding research to examine the relationships between toxins and chemicals in our environment and foods, and the increase in neurodevelopmental disorders such as autism. Sprinkled throughout her presentation were comments that implied that we are at the precipice of being able to "reverse the course of autism"; "resolve the toxic influences that cause autism"; and yes, "recover children from autism". Knowing that approximately one-half of the audience of 800 was comprised of parents, I immediately began to reflect on what they were likely taking away from this presentation, and my discomfort increased. There was a strong implication that nutritional and biomedical interventions were the only hope for the future...
Click for an Adobe Acrobat PDF version of the complete article: Prizant-OnRecoverySummer08.pdf
Parent-Professional Relationships: It's a Matter of Trust - Published Fall 2008
After three decades of supporting individuals with autism and their families, I've come to the firm conclusion that a trusting relationship between parents and professionals may be the most important factor in helping families navigate through the often stormy seas of raising a child with ASD. There is one simple rule: Trust must be earned; it is not bestowed lightly.
In my career, I've had the opportunity to observe education and healthcare professionals interacting with parents in schools, hospitals and university clinics, in activities ranging from diagnostic evaluations and informal encounters, to meetings of all shapes and sizes from the preschool years through the transition to adult services. I've listened in disbelief to the "war stories" shared by parents about the additional stress they've experienced due to the behavior of professionals. Many "problems" I am asked to address in school consultations are directly or indirectly grounded in less-than-harmonious parent-professional relationships...
Click for an Adobe Acrobat PDF version of the complete article: Prizant-ItsAmatterOfTrustFall08.pdf
Treatment Options and Parent Choice:
An Individualized Approach to Intervention - Published Winter 2008
Choices about educational and treatment approaches may be among the most important, yet anxiety-arousing decisions made by parents of children with autism. A few decades ago, the limited amount of information and number of choices available for supporting children with autism were sources of great frustration for parents. Today, the myriad educational and treatment approaches, and claims of success associated with some of them - most often made by those most invested in those approaches - are sources of overwhelming confusion for many parents.
Today, especially in the United States, parents are deluged with an overwhelming amount of information about treatments, both biomedical and educational. Given the competitive nature and commercialism of our culture, we have come to expect the "selling" of approaches; however, unlike buying a new brand of toothpaste, the choices that parents make have significant long-term consequences for both the child and the family...
Click for an Adobe Acrobat PDF version of the complete article: Prizant-TreatmentOptionsWinter08.pdf
Treatment Options and Parent Choice:
Is ABA the Only Way? - Published Spring 2009
As noted in part one of this three-part series, educational and treatment approaches for children with ASD tend to be limited with respect to family-centered practice, and there is a dire need to move practice in this direction. In this discussion, we will consider a very popular and influential category of treatment approaches - applied behavior analysis - given that it is illustrative of an intervention technique that is often promoted in a manner that violates principles of family-centered philosophy and practice. More specifically, a subgroup of professionals in applied behavior analysis (ABA) has espoused an "ABA only" approach for children with ASD, and makes recommendations conveying this restrictive message to families and agencies serving children. Claims that "our approach works and others do not" is heard primarily from some leading proponents of ABA, and rarely if ever heard from proponents of other available treatment and educational approaches, or from independent sources. I regularly speak to many experienced professionals and parents who have become increasingly concerned about these statements, since they convey inaccurate information to families that is not supported by current research and practice. When this occurs it can result in confusion for families and mistrust of professionals, thereby undermining the critically important parent-professional partnership. Furthermore, it can also result in limited treatment options for parents to consider, as parents are often told that they have no need to look further, and no need to educate themselves about the range of approaches available. In my consulting practice, I hear repeatedly from parents of older children that in the early years they were led to believe that ABA was the only credible approach that was available, and that they wish they had been exposed to, and educated about the broader range of intervention practices for children with ASD...
Click for an Adobe Acrobat PDF version of the complete article: Prizant-IsABAtheOnlyWaySpring09.pdf