The therapy used in a York University study is a slightly adapted version of DIR/Floortime. DIR (which stands for Developmental, Individual difference, Relationship-based) is a comprehensive, multi-faceted therapy tailored to each child. Much of the difficulty children with autism have with social interaction is often due to the trouble they have processing sensory input. Therapists at The Milton & Ethel Harris Research Initiative at York worked with parents to figure out what their child’s main developmental and sensory issues are (for example, over-sensitivity to light, sight, sounds or textures), and then to find ways to reduce those stressors so each child spent less time in the stressed state that interferes with his inability to interact.
A case study For six-year-old Asif Bhurgri*, the big sensory issues were visual. “When Asif first came to therapy, he seemed really interested in people because he would walk right up to you and stare at you,” says speech-language pathologist Fay McGill. “But it didn’t go beyond staring. He might be staring at your nose or your chin, but it wasn’t interactive. We eventually realized there were too many things going on for him visually, so focusing intently on one thing was his way of coping.”
Tailoring to his needs Therapists thought Asif might cope better in a smaller room with less visual stimulation. “We did our first therapy sessions in the waiting room with most of the furniture taken out, and very few toys,” McGill recalls. Reducing Asif’s sensory stressors meant he didn’t have to put all of his energy into coping, which therapists say is the purpose of “autistic” symptoms like repetitive behaviours such as lining up toys or spinning objects, withdrawing and avoiding social contact. “That made it possible for him to focus on his mom,” McGill explains.
But Asif still had to learn social interaction because he’d spent his whole life avoiding it. That’s where Floortime comes in. It’s a sort of play therapy in which therapists and parents follow the child’s natural interests to create opportunities for interactive play. “He started doing this movement that he’d seen in Bollywood movies, swaying from side to side with his hands clasped in front of him,” says McGill. “His mom and I joined in by doing a similar movement and giving him animated facial expressions to show him we were enjoying it.”
The idea is to enable kids like Asif to participate in and learn from social interactions that come more naturally to other kids.
One key to success is understanding how to interact with each child in a way that he can handle. “We learned to approach Asif less directly,” says his mom, Niya. “You have to join with him rather than directing him or forcing him, as we had been trying to do.”
*Name changed by request
A version of this article appeared in our September 2012 issue with the headline “More about DIR/Floortime,” p. 116.