Using DIRFloortime To Support Problem Solving

Editor's note: This text-based course is a transcript of the webinar, Using DIRFloortime To Support Problem Solving, presented by Lyn Bennett, OTR/L.

Learning Outcomes

• After this course, participants will be able to analyze 3 developmental components of problem-solving.
• After this course, participants will be able to compare and contrast 2 emotional responses that frequently occur in response to challenges with problem-solving.
• After this course, participants will be able to examine 2 strategies to support the development of problem-solving skills.

Introduction

I see many children struggle with problem-solving. I also see many kids that have emotional responses to the struggles that they have with problem-solving. Many have been in environments that are more structured or behavioral-based thus they have trouble with initiation and independent thinking. They can be very dependent on following directions and prompts. Today, I want to discuss some of the things to help develop these skills.

Ultimately, the problem-solving skills that we develop as children go on to help us with conflict resolution later in life. Certainly, we know there is a need for improved conflict resolution in the world today.

DIRFloortime

• Developmental and Relationship-based approach
  • DIR is the framework
    • D = Developmental
    • I = Individual Differences
    • R = Relationship

I come from a background of DIRFloortime, which is a developmental and relationship-based approach that is growing in popularity. If anybody has questions about it later, I would be happy to share some more information. Basically, if we look at problem-solving from a behavioral standpoint and how we support children, most approaches tend to fix things on the surface level. Developmental and relationship-based approaches look at what is underneath, including the issues and triggers.

Some of you may be familiar with DIRFloortime. I am going to spend some time going through what it is, and I have a couple of video examples. DIR is the framework of the model, and then Floortime is the main intervention piece. In DIR, D stands for developmental, I is individual differences, and R is the relationship.

We will look briefly at each of these. There is a whole other training that goes into it more deeply.

Functional Emotional Developmental Capacities (FEDCs)

• FEDC 1 – Regulation and Interest in the World
• FEDC 2 – Engagement and Relating
• FEDC 3 – Intentionality & Two-Way Communication
• FEDC 4 – Complex Communication & Shared Social Problem Solving
• FEDC 5 – Using Symbols and Creating Emotional Ideas
• FEDC 6 – Logical Thinking and Building Bridges Between Ideas

There are functional emotional developmental capacities or FEDCs. They go higher than this, but these are the levels that we predominantly are going to use. I typically work with children who are at those first six levels.

A child does not have to master one before going on to the next. There is a lot of ebb and flow between these levels, and hopefully, this will become a little bit clearer.

FEDC 1: Regulation and Interest in the World

Capacity one is regulation and interest in the world, and it is the basic level for all of us. If we are going to engage with other people or activities, we have to be at a functional level of regulation. We also have to be motivated to connect with what's going on in the world. This is the foundational level.

FEDC 2: Engagement and Relating

Moving on from that, once we are regulated, we can engage and relate with others. These two capacities are often talked about together. Regulation starts at day one, if not sooner in the womb when a child is co-regulated by the carers in their life. The carers see what is soothing for the child and what helps them to calm down. When they are crying, the carers determine if they are hungry, need changing, need soothing sounds, and so on. This understanding starts right at the beginning with co-regulation. As a child becomes regulated, they become engaged and connect with their caregiver with smiles, coos, and sounds.

Having said this, co-regulation develops early, but we are not regulated forever. We go up and down being regulated. Sometimes we are well-regulated, while other times we are highly aroused or under-aroused. This is an area that we continually address in therapy. When we look at the video, we will talk a little bit more about that.

FEDC 3: Intentionality & Two-Way Communication

Once you are regulated enough and engaged and connected with somebody, then the next stage that happens is two-way communication or intentionality. This level is where we get into an interaction typically between a child and an adult. It is about getting a good back-and-forth flow going. We may see a lot of short starts and stops in communication. For example, if an adult asks a child a question and the child gives an answer, and then nothing else happens, this is a short, stop-start type of thing. What we want is for the child to initiate an interaction, the adult responds, the child responds back to that, the adult responds to that, et cetera. The flow gets stronger and longer in its complexity as it goes on. 

FEDC 4: Complex Communication & Shared Social Problem Solving

Capacity four is where problem-solving kicks in if there is a solid foundation in capacities 1, 2, and 3. I am hesitant to give ages because everybody develops differently, but in neurotypical development, this would typically come in around toddler age levels, at 18 months or so. Communication is getting much more complex. If the child is trying to communicate with me, I look to see if the child has some other strategies to try to communicate, or do they just keep using the same thing over and over? This level brings in more gestures and facial expressions to communicate.

I was seeing a little girl who was pretty good through capacities one through three, and she was trying to tell me something. She kept saying, "Uh-ee, uh-ee, uh-ee," and I was trying but could not understand what she was saying. Obviously, she had very poor articulation, so I kept trying to prompt her to give me some other type of clue. However, she had not reached this capacity yet. There were books in the room, and I asked if she could show me a picture or use her body to show me, but she could not do it. A week or so later when she was working with her speech therapist, she pointed at the game they were doing and said, "Uh-ee." It was a game with monkeys in it.

A child who was functioning at FEDC 4 may have been able to come up with some other strategies to communicate that to me with monkey body movements, facial expressions, or by finding a picture. This is what we are looking for in complex communication and shared problem-solving. We sometimes see children, who if they want to get something, can go and do it all by themselves, but at this level, we want this problem-solving to be among two people. How do you work together to get something that you need or fix something? This is shared social problem-solving. In this presentation, we will primarily focus on one through four, but we may touch on five and six as well.

FEDC 5: Using Symbols and Creating Emotional Ideas

Five is where a child is starting to use symbols to represent things, something other than it is. They are developing abstract thinking at this stage. The first four levels are concrete in their thinking. Now, they are more abstract and are connecting more with emotional ideas, rather than tangible ideas.

At FEDC 5, this can be fairly fragmented. They may start to play imaginatively, but then, they jump all over the place. "I'm playing with this doll, and oh, there's a car over there, and wait a butterfly..." Their thoughts jump all over the place.

FEDC 6:  Logical Thinking and Building Bridges Between Ideas

When we get to FEDC 6, we are starting to see logic come in.

These are the FEDCs in a nutshell, which is a huge area. Hopefully gives enough of a framework to look at problem-solving from this perspective. This is the "D," and a huge area for us as occupational therapists.

Individual Differences

• Sensory processing
• Motor skills
• Motor planning and praxis
• Communication and language
• Health
• Family system and support
• Culture
• Trauma

When we are looking at a child's individual profile, these are some of the main areas.

We are going to look at the child's sensory processing to see how they interpret and react to all the information that is coming into their little bodies. We also want to see where their strengths and challenges are for sensory processing.

For motor skills, we want to assess postural control, bilateral coordination, and all those areas. We are also going to look at their motor planning and praxis. Do they have motor planning challenges, or is it something that is a strength for them?

We look at communication and language within the OT framework and not overstepping our boundaries. We want to know their communication strengths and challenges. Are they primarily verbal or do they use gestures or facial expressions? Assessing their communication is going to be relevant to what we are doing.

Other aspects that we want to address are their health, family supports, other support, educational support, culture, and trauma. If we are not feeling well, we are going to function very differently. How are their family and support systems? Additionally, is their educational system supportive? What is their culture, and how does that impact how they problem-solve? We also want to be aware of any trauma that would impact their interactions and problem-solving capabilities.

Once looking at all of these areas, we should have a good picture of the child and know developmentally where they are. As I mentioned, a child can move between the levels, but we can determine roughly where they may be. For example, I knew the little girl that was trying to say monkey was functioning in capacities one through three. I wanted to help her to get to four, but she was not there yet. 

Relationship

• Understanding the D and the I guides the R
  • Supports regulation
  • Fosters engagement
  • Motivates to attend and communicate
  • Creates a sense of purpose

Now that we have a picture of their individual profile, this will guide us in how we do the "R" piece, which is relationship. For example, if a child has challenges at capacity one and two with being regulated and engaged, and we know that they are very visually and auditorially sensitive, we should not approach them with a loud voice or with big gestures, as that will be overwhelming. We will need to be more soft and gentle because that is how they will connect.

Every single one of us has a style of interacting, but within that, we can change that up and down to meet the child where they are. We want to support regulation and foster engagement. It is also going to be a big motivator for them to attend and communicate. It also gives a child a sense of purpose.

DIRFloortime

• Floortime is the intervention
  • Basic premises:
    • Attune
    • Co-regulate
    • Follow the lead/motivation
    • Expand/challenge
    • The “dance” of Floortime
    • Self-reflection

Floortime is the intervention piece. The first thing we want to do is attune to the child and recognize where the child is emotionally. We want to try to match and connect with that. If a child is feeling sad and we come in all happy and jolly, this is not being attuned to where they are. We want to match their level, and then hopefully, change up things to help them move on from that.

We want to attune and co-regulate. How do we use ourselves and the activities that we are doing to help a child stay within that functional regulation so that they can engage and problem-solve?

Following their lead is sometimes described as following the motivation. Some misconceptions are that Floortime is just doing what the child is doing by following them around with no boundaries. Instead, it is knowing the child's motivation, their interests, and joining them in order to connect. Then, we can gradually put in little challenges to help them start moving up those developmental capacities.

Additionally, there are boundaries. We are not just imitating the child, but rather, we are trying to go a little deeper. An example is seeing a child with a puzzle or blocks. They may be hitting the pieces or blocks together. We do not want to assume that this means they want to do the puzzle or stack blocks. We need to take some time to work out what they are trying to do. Do they want to do the activity or simply like the sound that that activity makes? Or, perhaps they like the feel of hitting those with their hands. This is what we want to join in on. For example, if it was the sound, rather than joining them by building blocks or putting a puzzle together, we would join them in making some sounds. We could even change the rhythm. Rhythm is a very powerful tool to use in therapy. Or, we could do something different like bang on the floor versus banging on the table. We are connecting with the child and gradually expanding.

The dance of Floortime refers to what I was saying about the FEDCs, and how we are constantly moving up and down those levels. For example, we may be working on problem-solving at capacity four, but the child starts to get dysregulated, so we move back down before we carry on with the problem-solving task. If they are dysregulated, they are not going to be able to work on that particular skill. We may then come right back up once they are regulated. We may even skip capacities two and three because we are going right back to capacity four. This is what is meant by "the dance."

Lastly, a big part of what we do is being self-reflective, particularly using our relationship in therapy. We have to be aware of ourselves so that we think about what we are doing and the implications that it has. 

What is Problem-Solving?

• Recognizing or identifying the problem
• Developing possible solutions
• Acting on or implementing a solution
• Adapting as needed
• Aligned with the stages of motor planning
  • Ideation
  • Planning
  • Execution
  • Adaptation

I looked up a definition of problem-solving and came up with these steps. The first is recognizing or identifying that there is a problem, and to qualify that, it does not need to be verbal or a statement. It may be an internal knowing that there is a problem. Next is developing some possibilities. After that, we need to act on them. We then adapt as needed.

It struck me how closely the steps of problem-solving are aligned with the basic four steps of motor planning. This goes back to Jean Ayres' basic steps. While there are more complex stages of motor planning with different steps, these are the basic four that still holds true. The steps of motor planning are ideation, which is knowing what it is that you want to try to do. This motor action is aligned with identifying the problem. Planning is thinking about how we are going to carry out this motor action, executing is carrying out the task, and adapting is changing things to still carry out the plan. If I am doing a task in a slightly different setting, can I still carry out my motor plan? There is a very strong parallel there, which I think is why as OTs, problem-solving comes naturally to us.

Problem-solving is aligned with the DIR model.

Development of Problem-Solving

• Capacity to stay regulated when challenged or frustrated
• Motivation or desire to work through a challenge
• Initiation
• Ideation
• Ability to logically plan and sequence through steps
• Ability to adapt the plan as needed
• Explore through symbolic play and emotional ideas

In order to problem solve, the child has to have the capacity to stay regulated when they are feeling challenged or frustrated. If they do not have that capacity to stay regulated, they are not going to be able to move forward with problem-solving so this is the basic capacity that they have to have.

There also has to be motivation or desire to work through a challenge. I am sure that many of you have seen a child who is not that motivated. If something is not working, they move to something else because it is not worth the effort.

If they have the desire to do a task, how do they initiate problem-solving, as again, these two things go together? They have to have the idea and the ability to logically plan and sequence through the steps that are needed.

They have to have the ability to adapt. As we get to the higher levels, like capacities five and six, they start to problem-solve more symbolically with more emotional ideas and abstract things. They may think hypothetically about what could happen.

Observable Behaviors to Facing a Challenge

• Walking away or moving on to something else
• Shut down/withdrawal
• Avoidance
• Destruction
• Rigidity
• Dependence on prompts or being “rescued”

When a child has difficulty facing a challenge, these are the surface-level areas that we see. We might see them walking away or moving on to something else when it is too hard to do something.

They may go further and shut down or withdraw. This is typically when a child has some motivation to do it, but realizes they are unable. They shut down altogether and do not even try something else. They may also stick with exactly what they know and feel safe doing because it is too risky to try something else.

We also might see more destructive types of behavior. If they are building something and get frustrated, they may knock it down or break it.

We may see rigidity where a child wants things to be done in the same way all the time. Again, this is safer, and they have more control. We may see rigidity in routines trying to control what people say and do. Controlling behavior comes from anxiety and uncertainty about how to solve problems.

We also see many children who are dependent on prompts or want to be rescued. When a problem comes up, they may stand there and wait for somebody to tell them what to do or do for them. We want to foster their independence with that.

When we see these observable behaviors, what is going on underneath? If we are going to help a child work through these problem-solving stages, we need to connect with what is going on underneath. Different kids are going to react differently from one day to the next, depending on other things that are going on.

Emotional Responses to Facing a Challenge

• Frustration
• Anger
• Sadness
• Anxiety
• Confusion
• Embarrassment
• Low confidence and self-esteem

We also want to know the emotion behind the behavior we are seeing, so that we are not just putting a bandaid on the problem. It may be frustration, anger, sadness, or anxiety. It can be stressful to be in a situation where you cannot solve problems.

We may also see confusion as they are trying to work it out. We may also see embarrassment, particularly in older kids who realize that this is an area of struggle for them. They do not want other kids to see that. As a result, we may see low confidence or self-esteem.

What I would like to do next is share a video with you. I chose this video because it is far from perfect and often we learn more when there are questions or something we tried that did not quite work. 

Video 1: How to Get Water?

Ben is a little over two and a half, and he has been recently diagnosed with autism spectrum disorder. He is typically very self-absorbed and gets caught up in objects and doing things. He does not connect so much with people and is in his own world. When something does not go his way, he quickly becomes upset, cries, and becomes dysregulated. During the evaluation, his mother said that she felt like he was always walking on eggshells around him. At capacity two, he can engage if you are connecting with him in an effective way. He is interested and can engage, but his natural tendency is to be caught up with objects rather than people.

He struggles at capacity three, which is back-and-forth interaction, but he can answer his parents' questions like colors, shapes, and what sound an animal makes. His language is also a little hard to understand. He tends to answer questions as they require minimal interaction and then he is done. He can also tell you if he wants something because again it is simple and done quickly. We want him to build upon the lower capacities to support him at capacity four, which is complex communication and problem-solving.

In terms of his individual profile, he has quite a few sensory sensitivities. He struggles with vestibular and auditory input, and he's fairly sensitive to tactile stimulation. He seeks proprioceptive input and has challenges with motor planning, particularly in the ideation and adapting phases. Once he knows what he is trying to do, some of his planning is not too bad.

Strengths, from his individual profile, include being a visual learner. If you show him how to do something, he picks that up quickly. He understands more receptively than he can communicate. We want to bear in mind both of these things.

At the point he was diagnosed, the mom was about eight months pregnant. They came for their OT evaluation when she was nine months pregnant, and they started therapy when the baby was only eight days old. Thus, the family had extra stress, and Ben had to cope with many things. 

In the video, you are going to see the mom in the black dress, the Dad and baby's legs, and me. The OT assistant Lisa was videoing, and in the background, you may see an OT student who was observing.

There is a lot going on, and that is partly why I wanted to share it as it is a realistic therapy session. 

- [Ben's Dad] But if today's any reminder, it's that, a small pivot, he generally accepts pretty readily.

- [Ben's Mom] Yes, that's right.

- [Ben's Dad] A small pivot. Not a, 180 more, you know, bringing the truck to play along with, not that much of a stretch.

- [Ben's Mom] More water beads?

- Yeah.

- [Ben's Mom] This is all we have. I do not know where there are any more.

- [Lisa] I'm wondering if he's asking for water.

- [Ben's Mom] I think he said more water beads.

- [Lisa] Okay.

- [Ben's Mom] But now Miss Lisa's reminded you. More water, please. Oh, more water please. Maybe water please.

- [Lisa] Oh.

- [Ben's Mom] You want water in here?

- Yeah.

- [Ben's Mom] Should we put water in?

- Yeah.

- [Ben's Mom] Yeah. Ben, could you give me something to get the water with?

- [Ben's Dad] Godzilla.

- [Ben's Mom] What can we put the water in, Ben?

- [Lyn] Hmm? What could I use to get the water?

- [Ben's Mom] Can she put the water in this?

- Yeah.

- [Ben's Mom] No, it'll fall out. The water will go right through. Hmm. What should we put the water in?

- That one.

- [Ben's Mom] Oh, I think all the water will fall out, huh? What can we put the water in?

- [Ben's Dad] Jack's jumping in.

- [Lyn] In there, should we try? Put the water on. Is it ready? Oh no, what happened to the water? Try again?

- [Ben's Dad] Fell out?

- [Lyn] Ben, get the water. Whoop! Oh no! Gone. Should we get something else to put the water in? See what else we can find.

- [Ben's Mom] What else can we put the water in?

- [Lyn] Do we have a bucket, or a bowl? Hmm.

- [Ben's Dad] Where is something else that will hold the water? What else could hold the water?

- [Ben's Mom] What can we put the water in?

- [Lyn] This one? Okay, let's try it. Okay, let's try, can you help me?

- [Ben's Dad] Up, please.

- [Lyn] Oh, you're bringing everything, okay. Uh-oh, can I pick you up?

- [Ben] Yes.

- [Lyn] Yes? Okay, here we go. Ready? Turn the water on. Oh! Hmm. What else can we try? What else we can do? Do we have a bucket or a bowl we can put 'em in? Hmm. You can try that one.

- [Ben's Dad] What else could hold the water, Ben? What else could water go in? In there?

- [Ben's Mom] Hmm. Should we make more water, Ben?

- [Ben] Yes.

- [Ben's Mom] How can we get the water?

- [Ben's Dad] Can I pick up the water with this? Does that work?

- [Ben] Mm-mm.

- [Ben's Dad] No? Doesn't work? Hm.

- [Lyn] So it's interesting to think, you know, is he, he kind of like, he can't work it it out yet, I'm moving on to something else, or is he actually working on something here? You know, has he actually got a plan that he's working on? And I do not know what it is yet. Do you have a sense?

- [Ben's Mom] I feel like he's like, okay, we can't get water, I'm done.

- [Ben's Dad] Yeah, I'll move along.

- [Lyn] So if that's what we're thinking, then we probably will help him to actually get it.

- [Ben's Mom] Sure.

- [Lyn] So that he doesn't sort of give up on problem solving.

- [Ben's Mom] Sure. Ben, can we put water in here, and then go get more water?

- Yeah.

- [Ben's Dad] We'll go try.

- [Ben's Mom] Let's go get it. Come on. Well, let's leave that one there. Good. Wanna bring the shovel?

- Yeah.

- [Ben's Mom] Okay. Can you bring bucket?

- [Ben's Dad] Let's see if you can fill up that bucket with water.

- [Ben's Mom] Can we put water in the bucket?

- [Ben] Yeah.

- [Ben's Mom] Okay. Up. Put the bucket in the sink.

- [Ben's Mom] Yay! We got the water. Okay, can you help me, or do you want to get down first? Okay.

- [Ben] All done.

- [Ben's Mom] You want to carry it?

- [Ben] Yes.

- [Ben's Mom] Oh, careful. Mommy will carry the shovel. Use two hands. Two hands please, thank you.

- [Ben's Dad] Wow!

- [Ben's Mom] Good job, you're being so careful.

- [Ben's Dad] Now where do you want that to go?

- [Ben's Mom] Whoo!

Is there one thing that you particularly noticed? Observation and questioning is a huge part of what we do to try to understand kids. Here are some responses in the chat (from the live session):

• Hesitation
• Good regulation
• Allowed trial and error
• Allowed him to fail
• Persistence

There were many nice observations there. 

Process to Support Problem-Solving

• Identify the problem to be solved
• Formulate possible ideas for solutions
• Establish a plan to carry out ideas
• Carry out plan
• Adapt as needed

Let's review the process of problem-solving using this video as context. First of all, we need to identify the problem. In the beginning, we were not clear about the problem. We did not know whether he wanted "more water beads" or "more water, please." Everybody was problem-solving in the video. And, I do not know if the "water, please" was actually what he wanted. However, he liked that idea so we went with it. You could see it in his face that yes, that is what we were going to do even if that was not the initial one.

We formulated possible ideas about how to get more water. We need to think about his individual profile and what his mom and dad were doing. They both went for one of his strengths. Mom used a verbal strategy of trying to explain to him why something would not work as she knows he has good receptive language. Dad, on the other hand, went for the visual. I do not know if you noticed, but he was bouncing the baby in one of the containers that would have been able to collect water to try to prompt Ben to use it. Both of these strategies were above him. For instance, he could not grasp Mom's explanation of the water coming through. He also did not quite connect with his Dad's visual. However, these are nice examples of trying to use the kid's strengths to generate ideas. One of Ben's problems is that he does not have ideas himself so they were trying to prompt him.

We then had a plan for carrying out the idea that I wanted him to experience. We attempted to carry out the plan and adapted as needed as he could not come up with something else. I would say this is where I went a step too far with the tray with the beads because it did not make sense to him why I did not put it under the tap. In my mind, I was trying to challenge him a little bit more, but I went a little too far in that. This is a perfect example of how sometimes things work, and sometimes they do not. This does not mean that we cannot come back to it.

Foundations for Supporting Problem-Solving

• Understand the child’s individual profile
  • Challenges
  • Strengths
• Be aware of the child’s developmental level
• Be aware of your own responses, any emotions that  make you feel uncomfortable, and how you typically react to these
• Don’t rush to “fix it” for the child, support them to do it

Some of the foundations for supporting problem-solving include understanding the child's individual profile and the challenges that they have, but also recognizing strengths. We want to use their strengths as I mentioned in the review of the video. We also want to be aware of their developmental level. Each one of us at one point in the video presented him with something that was a little too challenging for him, but when we came down to his level, he was able to connect.

Another foundation is that we need to be aware of our own responses like what makes us feel uncomfortable and how we react. If we see a sad child, do we feel uncomfortable and want to make that feeling go away? If we see a child being destructive, how do we respond to that? Can we work with them, or do we start setting rigid, controlling boundaries due to our anxiety? Having said that, we do not want things to get broken so we do need to set boundaries, but we might find we get too rigid with it.

Another big foundation for supporting problem-solving is not rushing to fix things for the child. We want to support them to be able to do it, not do it for them. 

Functional Emotional Developmental Capacities (FEDCs)

Let's look at each of the capacities, and some of the strategies we might use for each.

Strategies at FEDC 1 & 2

• Constantly observe regulation and scaffold support accordingly
• Affectively acknowledge the problem – attune to the child
• Encourage exploration and creativity
• Affectively respond to ideas

At capacities one and two, we want to constantly observe regulation and put in scaffolding to support that accordingly. As most of you saw, Ben was well-regulated throughout the session. Although when we took the tray with the water beads to the water and came back, he had given up at that point. He was like, "This is not working," and he started to pull into himself at that point. He was not dysregulated, but he was starting to move to a point of low regulation, where he was not going to be engaged and connected. We want to watch out for these episodes, bearing in mind that regulation is not just about getting too high, but it is also about going too low and becoming withdrawn. We want to watch their regulation and put in the supports to keep that going.

We want to affectively acknowledge the problem. This fits in with what I was saying about attuning to a child. We try to identify the underlying emotion that we were seeing. Is the child frustrated? Are they feeling despondent? What are we seeing? We want to acknowledge that we understand them as it is so meaningful, and it supports them to move forward. Saying "It's okay, we can fix it," or "That doesn't matter, we can do another one," affectively dismisses the child's feelings. Instead, we want to think about how the kid is feeling and name it but also do it in an emotional way. For example, if a child is trying to put something together and I can see they are getting frustrated, I am not going to say, "I can see you're frustrated." If someone says that to me, it makes me even more frustrated. I am going to pick up on that feeling, and say something along the lines of, "Oh no, it just won't work." I am affectively connecting with that feeling. A child's trying to do something, and they are feeling sad because it is not working. This communicates to the child that we get what is behind it for them. This is a small change you can make in your practice that is going to be so helpful for the kids.

We want to encourage them to explore and be creative, and we want to effectively respond to their ideas. If they want to try something, our affect of being interested, excited, and motivated, is going to help them to stay regulated, connected, and engaged.

Strategies at FEDC 3 & 4

• Narrate to clarify the problem
• Support child to work out what to do – don’t do it for them
• If needed, make suggestions or give ideas, but observe child’s response and follow their lead
• Engage in a shared process of trial, error, and discovery
• Give open-ended options for help
• Make plan and consider possible outcomes
• Try an idea, even if you can see it won’t work out
• Allow “failure”
• Experiment with adaptation

Capacities three and four are where we are getting into back-and-forth communication and problem-solving. There may be some narration to clarify the problem at this stage. "Oh, it won't work. I can see you are  trying so hard." We are saying what the problem is and supporting the child to work out what to do, but not doing it for them. 

It is easy to slip and do it for a kid. One of the common things I see in therapy is that when a child is struggling with something, we say, "Do you need help?" The child replies, "Help," and then we do it for them. It may be fine to do so at certain times, but for the most part, it does not help the kid to learn. It helps them to move through the situation, but it also gives them the impression that we can do it better than they can. Instead, we can say, "Sure, I'll help you. Let's see what we can do."

If a child has difficulty coming up with ideas, it is absolutely fine for us to give them ideas, like in the Ben example. We can give ideas, but then we want to pull back and watch to see what the child does with that idea. When we have an idea for solving a problem, we probably have the next few steps in our minds, but the kid may go in a different way. It may be a perfectly valid way to go, so we want to watch for that.

We want to work together making errors and giving open-ended options for help. We want to ensure that the child can choose what kind of help they want from us. As we are through capacity four, and they are able to sequence things, we want to get more into making a plan and considering possible outcomes.

However, at this level, their thinking is still pretty concrete. We want them to try something, even if we know it will not work out. We need to allow for failure because that is how kids learn. This is partly why I wanted to show you a video that was not perfect. Kids also need to learn how to cope with failure to have the desire to move forward through it.

The last area is experimenting with adaptation. You are working on a problem and attempting to do things differently to see what works.

Strategies at FEDC 5 & 6

• Earliest stage to ask “why questions”
• Earliest stage to discuss abstract or hypothetical outcomes
• Engage in symbolic play to explore problem-solving and conflict resolution
• Connect emotional and behavioral responses to challenge
• Support awareness of the emotional responses of others

At five and six, this is the earliest stage that we can ask the "why" questions. Often with problem-solving, people get into that quite early on, which requires some abstract thinking. Try to avoid the why questions until we get to know if the child has some symbolic play and abstract ideas.

This is also the earliest stage where we can discuss abstract hypothetical outcomes, or what might happen.

We can engage in symbolic play to explore problem-solving and conflict resolution. As children get into imaginative play, they do not necessarily have to work on the problem. Instead, they might work it out through the context of play. This is very valid and helps develop that capacity to be able to work out a problem in your head, without having to physically do it.

As we get through this level, we can also help the child with more connection and awareness of their own emotional and behavioral responses to challenges. It can help them to see when something is not working and how they feel inside so that they can start to learn to regulate themselves through that.

We also, at this stage, are going to get more into being aware of the emotional responses of other people. In the early stages, it is about their own responses. Whereas at this stage, they may start being more aware of how somebody else has reacted to something going on.

This is another video of a couple of kids at those higher levels. These are children at capacity four. If you have been to my motor planning class, you may have seen this, but this one never grows old. These are two boys in kindergarten who both want to go first.

Video 2: Who Goes First?

- So let's see, now who is going to go first?

- I.

- Oh my goodness, what do I do? You both said you wanted to go first.

- No, I. I going go.

- Well I tell you what. I do not know, you two talk to each other. See who's going to go first.

- Oh, me.

- [Matthew] Me.

- Ask each other. How you going to do it?

- I'm going be it.

- But Matthew wants to be it, too.

- Yeah. How we, we can sit a pile, and we can put a piece on top.

- Well we gotta work out who's going to throw the dice first. How we going to work that out?

- I'm going throw the dice.

- Yeah, but you both want to, I do not know what to do.

- I think I do.

- I do.

- You think you do, and you think you do. Hm. What should we do? How do we decide?

- I do it.

- I'm going do it. Oh.

- [Lyn] What?

- I want this. I want to do it.

- You want to go first, and Matthew wants to go first. Only one person can go first. Oh you have an idea?

- Oh Matthew can roll it, and I do the spinning of this.

- Oh, so your idea, Matthew throws the dice, and what do you do?

- Just spinning this thing.

- You spin it, and then... Okay, then Matthew puts the piece on. Okay, so then, whose turn will it be next?

- And me.

- Then it will be your turn.

- And be your turn.

- Would you like me to play as well, or just you two boys?

- You.

- You think so too?

- Yeah.

- All right. They are so darn cute, those boys.

In summary, I keep coming back to what the problem is. I am not going to solve it for them, but I also want them to stay engaged and connected, to keep the problem-solving going. They are both regulated and engaged and are in capacity four.

It is so hard sometimes not to do it for them. It is very typical to say, "Hey, you went first last time. You can go first this time," but you can see that the boy, Loki, standing up was moving into, "Okay, I can come up with some options here." Whereas Matthew, who was sitting down, was not coming up with anything else, other than "I want to go first."

Summary

The last couple of slides are references and additional resources. If you are interested in more information about DIRFloortime, there are some wonderful classes. I also listed a few books that cover some of those areas including, "Engaging Autism," "Behavior Challenges," "Beyond Behaviors," and "The Whole Brain Child." 

Please contact me if you want more information.

Questions and Answers

How do you get the parents to stay in the background and not tell them the solution immediately?

It is a process. Part of the wonderful thing about DIRFloortime is that it is a model for coaching parents because they are the most important people in the kids' life. The first video was a series of sessions where I was coaching the parents. They were not in the background but were actively involved. We want them to understand their child's profile, how they do things, and what is important to them. We want them to understand that if they keep asking their kids questions, they are not going to get the flow going.

How would you go about engaging kids whose special interests are musical toys, where they push the buttons and hold them to their faces or ears?

You want to know if it is the sound or the visual that is important. Try to connect with what they are doing, maybe offering them something else that they like doing to change it up a bit. You also want to try to shift them from total focus on the object to you. If you share in the joy of it, then it can be appealing and it entices them to connect with you.

What if a child is highly self-directed? How do you redirect a child without frustrating them?

I guess that depends on what self-directed means. Whatever it is they are doing, you are trying to join with them, rather than take it away from them. You are shifting their perspective. It is not about blocking them from being very self-directed, it is connecting with them. 

Are these goals you are monitoring?

If problem-solving is a relevant goal for a child, then absolutely, we will make it a goal, and how they are doing with that.

Is there an upper age that is appropriate for DIRFloortime? 

No. It came out of infant mental health, and it was largely used with children on the autism spectrum. Now, it is used everywhere in every walk of life and at all ages. It becomes a way of life. You can interact with everybody in your life with that model in mind because it helps with problem-solving and reduces conflict.

If a child gets dysregulated, do you take a complete break from problem-solving and do what is needed to regulate?

Yes, and then come back to it. We do not want them to have a sense of failure so we regulate them first.

References

Cahill, S. M., & Beisbier, S. (2020). Occupational therapy practice guidelines for children and youth ages 5-21 years. Am J Occup Ther, 74(4), 7404397010p1–7404397010p48. https://doi.org/10.5014/ajot.2020.744001

Grinon, S., Waldman-Levi, A., & Olson, L. (2019). The power of a play partner: Assessing the influence of parent behavior on young children's playfulness in joint play. Am J Occup Ther, 73(4_Supplement_1), 7311500005p1. doi: https://doi.org/10.5014/ajot.2019.73S1-PO1005

Montroy, J. J., Bowles, R. P., Skibbe, L. E., McClelland, M. M., & Morrison, F. J. (2016). The development of self-regulation across early childhood. Developmental psychology, 52(11), 1744–1762. https://doi.org/10.1037/dev0000159

Pajareya, K. (2019). DIR/Floortime® parent training intervention for children with developmental disabilities: A randomized controlled trial. Siriraj Medical Journal, 71. 331-338. 10.33192/Smj.2019.51.

Sandbank, M., Bottema-Beutel, K., Crowley, S., Cassidy, M., Dunham, K., Feldman, J. I., Crank, J., Albarran, S. A., Raj, S., Mahbub, P., & Woynaroski, T. G. (2020). Project AIM: Autism intervention meta-analysis for studies of young children. Psychological Bulletin, 146(1), 1–29. https://doi.org/10.1037/bul0000215