Wednesday, April 19, 2023, 3:06 PM
By: Kelly Nesbitt MOT, OTR/L & Certified DIR Floortime Therapist DIR Floortime is a multidiscipl…
By: Kelly Nesbitt MOT, OTR/L & Certified DIR Floortime Therapist
DIR Floortime is a multidisciplinary, developmental treatment approach that has profoundly shaped my clinical practice as an Occupational Therapist. I have personally seen a variety of children thrive with this approach. I have been lucky enough to learn all about DIR Floortime at Easterseals. While DIR is a very complex model, I wanted to have an overview of this model that parents can refer to and start off on their journey of learning and growing with their child.
Author’s Note: I use both identity-affirming language “autistic children” and person-first language “children with autism” throughout this post, as these are two schools of thought within the autism advocacy community regarding how to refer to someone with this diagnosis. Generally, I use the language that feels most respectful to each individual family and child. As I am not someone with autism, I don’t have the lived experience to make a judgment on which school of thought is “right.”
Dr. Stanley Greenspan and Dr. Serena Wieder explain their model, DIR Floortime ®
DIR, which stands for Developmental Individual Differences Relationship Model, is the theoretical framework that works to promote the relationship between the child and parent, looking at the unique individual differences (sensory processing, motor, neurology, developmental, cognitive, and social-emotional skills) of the child and using playful, child-led strategies to support engagement and development.
All these Individual differences and the Relationship you have with your child all help catapult your child forward Developmentally. Floortime is the practice or application of DIR theory in which you literally “get down on the floor” with the child and “get into their world,” exploring their interests through affective, playful engagement in order to help them grow. The most important part of DIR Floortime is the “R,” which stands for “Relationship;” your relationship with your child drives all the development and meaning they derive from the world. DIR Floortime is, at its core, a parent coaching model.
Growing research is showing that this developmental, multidisciplinary approach is an effective treatment option for working with children with Autism Spectrum Disorders. Multiple randomized-controlled studies have been published since 2011 identifying statistically significant improvement in children with autism who used Floortime versus traditional behavioral approaches.
Your therapist will help coach you on how to use your child’s strengths and interests to accomplish your child’s goals. It aims to empower parents, who are the “experts” in their child, to trust their instincts, follow their child’s lead, and fundamentally look at the child’s capacities in a strengths-based approach. Essentially, this model looks at and bases treatment decisions around all the wonderful things a child can do and what strengths they already possess.
As an OT, I hold the core assumption that every parent and child is trying their best based on their mental, emotional, and physical capacities at that moment. This model coincides with that belief on a profound level. Since DIR Floortime is a strengths-based model that presumes competence of both the parent and child, this approach really helps me go into a session with an empathetic heart and help you use “what is going well” with your child and expand from there.
Because this approach is centered upon relationships, it’s incredibly important that all families feel comfortable with their therapist as a cheerleader and coach and are able to be vulnerable in sessions. Parenting is incredibly complex, hard, and rewarding, and your therapist rides all those ups and downs with you, not as an “expert” in DIR, but as someone who is in your and your child’s corner. Even if a session is really hard, there is always something positive that can be found together, and growth can occur from there.
I also love DIR Floortime, as it is neurodiversity-affirming. Neurodiversity-affirming practice refers to celebrating the unique diversity of neurological functioning that makes humans beautifully complex. It honors the interests and experiences of the neurodiverse child (children with Autism, ADHD, sensory processing differences, OCD, anxiety, and more). This approach assumes that children “don’t need to be fixed or cured,” just supported where they are developmentally and accepting their uniqueness; We see the child as inherently good the way they are. This model doesn’t see, as some may say, “unusual interests” in Autism but rather sees a child with a passion that can teach us more about something we may have never thought twice about.
I remember hearing an adult with Autism explain how when he was little, he always saw profound beauty in light reflecting off droplets of rain or in suncatchers on windows. He described how he would flap his hands in excitement as the droplets slid down the window or light danced through the glass and onto the floor, his body unable to contain the excitement at witnessing something so wondrous.
I wonder if, as a child, this boy may have been described as having an “unusual interest” in windows and “stereotyped behaviors” rather than someone with a unique sensory system and neurology who is having a joy-filled sensory experience. I have also heard of some Autistic advocates reporting that it must be sad that “neurotypical” people don’t get to experience the profound joy of stimming and seeing the beauty that surrounds us in everyday experiences.
I think this is a wonderful way to look at neurodiversity- what can these children show us about experiencing the world with a newfound sense of wonder and excitement. How can we reframe pathologizing neurodiverse children and instead amplify their voices and experiences to learn something exciting and new?
DIR Floortime looks at a child as a human being, not a diagnosis or label, who has great ideas that should be honored.
Lucky for us all, Easterseals has many certified DIR Floortime Therapists in the Occupational Therapy, Social Work, and Speech Therapy departments! You can request a therapist who has this specialization. However, if one is not currently available at the time your child needs therapy, don’t worry! Easterseals has an environment of constant collaboration and clinical supervision, so a non-certified Floortime therapist can still provide a strengths-based, child-led approach with mentorship and consultation from a certified DIR Floortime therapist.
Easterseals provides an environment that celebrates neurodiverse children’s experiences and, through the DIR Floortime model, allows parents to help their children gain skills and grow!
If you are interested in getting started with DIR therapy for your child at Easterseals, we have many qualified therapists to guide you through the process!
Learn more here to get started.
Websites:
Profectum Parent Toolbox (this is a wealth of videos, webinars, worksheets, and educational materials to help walk parents through all aspects of this model. Available in English and Spanish)
Profectum.org and ICDL.org are the two large organizations of DIR Floortime. Both websites have a wealth of information and training opportunities for professionals and parents.
ABA vs. DIR Floortime? This is a look at these two different approaches to help you decide which is a better fit for your family
DIR Floortime Quick Fact Sheet (This link is a list of clinical research and evidence supporting this model)
Affect Autism Podcast What is it? – Affect Autism: We chose play, joy every day (this is one of my favorite podcasts about DIR Floortime, exploring a range of topics within this model)
Books about DIR Floortime and Related approaches:
Tuesday, April 11, 2023, 3:13 PM
By: Kelly Nesbitt, MOT, OTR/L One of the trickiest parts of a child’s daily routine for families is …
By: Kelly Nesbitt, MOT, OTR/L
One of the trickiest parts of a child’s daily routine for families is sleep, going to sleep, staying asleep, and finding consistency in the bedtime routine. Below are some helpful tips to make your child’s bedtime restful and not stressful.
Author’s Notes: I use both identity-affirming language, “autistic children,” and person-first language, “children with autism,” throughout this post, as these are two schools of thought within the autism advocacy community of how to refer to someone with this diagnosis. Generally, I use the language that feels most respectful to each individual family and child. As I am not someone with autism, I don’t have the lived experience to make a judgment on which school of thought is “right.”
Also falling asleep and staying asleep is a complicated process. Both environmental modifications as well as your child’s physiological processes impact sleep. Don’t be afraid to bring up sleep to your child’s pediatrician if you are worried that even with good sleep hygiene, your child is still not sleeping well.
First, ensure your child’s room is set up in an optimal sleeping environment. Physical set-up includes:
One of the biggest keys to having good sleep hygiene is having consistency every night. This means a consistent bedtime, routine, and expectations for sleep. Give yourself and your child about 30-45 minutes to start the whole bedtime routine and keep it consistent every night.
As a family, you can decide what activities are calming for your child that you can work into your routine for bedtime (taking a warm bubble bath, changing into PJs, and listening to quiet music for a few minutes before you tuck them in). It will take some trial and error to find what makes your child feel calm and sleepy.
I recommend keeping a journal or note on your phone on what time you started the bedtime routine, what activities you chose, and what time your child got to sleep. This will help you find patterns of what worked in the routine and what did not work.
This is a big one. Screen time is often very overstimulating for kids and sends signals to a child’s brain to stay awake! In fact, a review of many studies from the American Academy of Pediatrics shows that “In >90% of these studies, more screen time was associated with delayed bedtimes and shorter total sleep time among children and adolescents.” So how do we reduce screen time around bedtime?
About an hour before bed, turn off the electronics! That means tablets, iPhones, laptops, and televisions. There are parent control apps (check them out here: How to Check Screen Time on Different Devices (guidingtech.com). These apps can turn off children’s apps or even password lock the device at a certain time. It’s also recommended that children do not have access to devices in their rooms (no televisions or tablets in their rooms). You want your child to associate their bedroom as a calm space for sleep, not for sitting and watching shows. Replace screen time with reading time, unstructured playtime with their toys, or quiet music and drawing time. This hour before bed can be explained to older kids as “a time to quiet our bodies and minds.” The activities you do before bed with your child (discussed more below) should be quieter, organizing, and not high-energy activities.
This change to limiting screen time will likely be a tough adjustment for kids, as it’s difficult to beat the immediate gratification and fun of visually stimulatory ipads, iphones and TV. But consistency is key, and kids are resilient, so they will accommodate over time. Make it a challenge for yourself, too- take a break from electronics with the kids at night and don’t get them back out until they are asleep!
Play around with what activities you try an hour before bedtime. Here are some quieter activities that can promote settling kids’ bodies for bed:
Heavy Work/Proprioceptive activities: Heavy work/proprioceptive input is compression to joints that sends calming signals to the central nervous system. Any activity that has “pushing, pulling or carrying” contains proprioceptive input. The trick with heavy work input around bedtime is selecting activities that are not going to be too active. Do these activities for about 10-30 minutes or until you notice that your child is looking tired or their body is regulated. These activities could include:
Calming Bath time: Draw a warm bath for your little one with calming bubbles if your child enjoys that. There are also some cute light-up bath toys to play with along with having the overhead lights turned down (if it’s safe to do so). Always make sure that your child is supervised when in the bathtub.
Here are some additional sensory supports that could be added to bedtime to help your child prepare their body for sleep:
You can also talk with your child’s Occupational Therapist about what other activities and sensory supports can work for your child.
Once your little one is all settled into bed, use this opportunity to connect with your child with a special routine or routine that is important to you as a family. This can be reading a bedtime story, saying prayers together, reviewing the best parts of the day, saying what you are grateful for, or singing a bedtime song.
Feeling safe and connected with their parents is a good way to bond and send them to sleep. That being said, sometimes separating from mom and dad in order to go to bed is really scary and a normal childhood fear. Having this consistent shared time can help a child feel safe and secure prior to going to bed. You can also read some separation-themed stories to help them to ease this anxiety. (Children’s Books about Separation Anxiety – Sleeping Should Be Easy)
I would be remiss not to mention that even with immaculate sleep hygiene, some autistic children still have difficulty falling asleep and maintaining sleep. There is a higher prevalence of insomnia in autistic children than in their neurotypical peers. There are some theories that gastrointestinal issues, possible sleep apnea, anxiety, restless leg syndrome, epilepsy, medication side effects and/or hormone imbalances can contribute to more sleep issues in children with autism (Wide Awake: Why children with autism struggle with sleep). It is recommended that parents who have concerns with their child with Autism’s sleep discuss this with their therapy team as well as the pediatrician. Their pediatrician may refer them for a sleep study to evaluate the quality of their sleep and what barriers contribute to them not sleeping well.
Wishing all a good and restful night!
References:
Monday, April 3, 2023, 1:40 PM
By: Valerie Heneghan, M.A. CCC-SLP/L, C/NDT As a mother of two young children, having your child eat…
By: Valerie Heneghan, M.A. CCC-SLP/L, C/NDT
As a mother of two young children, having your child eat more fruits and vegetables is always the goal. If you are like me, when my children were starting to eat solids, I could easily offer them various fruits and vegetables. They would typically take the food offered on their highchairs, explore it and even take bites of it. But as they got older, they became more selective.
There are many reasons why a child may be unwilling to try new food on any particular day. Maybe the presence of a new food made them panic, and they were never introduced again. Some children may recall a negative experience with a particular food that made them gag or throw up. Now they don’t trust any similar association with that food, such as color, shape, or specific packaging.
The good news is that it’s never too late to try new foods!
This idea may not be top of mind when you think about getting your kids to eat more fruits and vegetables, but it is critical. We need our children to be calm and ready to learn when introduced to new foods. This process starts with a trusting and nurturing relationship between the child and the caregiver.
A great place to start is being true to your word regarding food. As a parent, there is a strong temptation to sneak in vegetables in a meal. Or tell your kids it’s a fruit snack instead of these are your vitamins.
However, Trying to “sneak in” healthy foods doesn’t always lead to long-term good habits, especially with selective or “picky” eaters. Children know their foods, and if you alter it without them knowing, they will likely believe that you will do it again in the future and may reject that particular food or develop more habits that make them more selective such as watching you open the package, only eating foods when they are a specific temperature, etc. Instead, have them change foods or cook with you if they choose to and call foods by their actual name.
When possible, offer your child a secure place to eat where their pelvis is upright, and their feet are grounded into a surface. Think about an environment that is inviting to focus on a new task.
For example, limit distracting sounds, have a clear table, a predictable setting, etc.
When trying something for the first time, or food they once ate and no longer have been eating, encourage exploration and positive experiences with that new food rather than the amount of consumption. The first interaction with a new food may be smelling it, touching it with a utensil, passing it to someone else, etc. You can talk about how it looks, make funny faces with it, do actions with the food like dancing or telling jokes, etc.
As a mother, I do understand at the end of the day, all you want is for your child to eat the dinner you prepared for them, and when they refuse it, that can be frustrating. As a child, however, I remember being served foods I had never eaten before and told I couldn’t leave the table until I ate everything on my plate. So I sat at the table trying to hide foods under other foods, sneaking little bits to the dogs under the table, any trick I could try to make it look like I complied with the rules. Trying new foods cannot be an all-or-nothing process for children. This is simply ineffective for both the child and the parent.
As an adult with that experience, I try to problem-solve how to make new food more approachable. Is it by playing a familiar game, such as playing basketball with blackberries, do we turn the celery stalk into a paintbrush? Do we offer that the food can stay on the table but doesn’t have to go on their plate until they are ready to learn more about it? Be creative and have fun with it!
Keep offering those new foods! It will likely take repeated exposure before kids are willing to try something new. Food is not wasted if not eaten because initial exposure to new foods is just as important, so children can learn more about it and increase their willingness to try it later.
5. Family Mealtime RoutinesWhenever possible, try to have family meals together where kids and adults eat the same food and can take how much they would like on their plates. This simple practice can keep exposure to new foods more consistent. Keep the conversation light and positive during mealtime (Ex: If you could be any animal at the zoo, what would you be? etc.) With a routine, kids will know what to expect. And seeing someone else eat the same food, will give them a chance to observe that it is safe to try it too. And don’t “yuck someone’s yum.” Normalize if a child decides they like a certain dip with the food or want to mix foods together.
Nearly 90% of children with special health care needs are at risk for some type of nutrition-related problem.
If you need additional support for your child’s feeding needs, our multi-disciplinary therapy team offers comprehensive support through our nutrition services, feeding clinic, speech-language feeding specialists and our fun with foods group.
To learn more about services at Easterseals DuPage & Fox Valley, call us at 630.282.2022 or email info@eastersealsdfvr.org.
Monday, January 30, 2023, 10:24 AM
By: Anne O’Dowd, Pediatric Speech-Language Pathologist, CF-SLP What does Speech Therapy Includ…
By: Anne O’Dowd, Pediatric Speech-Language Pathologist, CF-SLP
Perhaps your child or another child you know is referred to see a speech-language pathologist from their doctor. When you think about the areas a speech-language pathologist treats, it is easy to assume we work only in the areas of speech and language, as our title implies. This is a common misconception.
In fact, our field is much larger than our title offers it to be. To provide a better view of the areas we treat, below is an extensive list of our scope or service delivery areas. A speech pathologist can help a child in nine key development needs. Please note that this list is not exhaustive, not all service delivery areas are offered at Easterseals DuPage & Fox Valley, and individual speech-language pathologists can specialize in one or several areas. Areas in which we practice vary in development, some continuing to evolve (e.g., literacy) and others emerging.
Learn more about our speech services here.
Speech refers to the production of speech sounds, individually and in words. Children produce several typical speech errors that decrease over the first few years of life, resulting in adult-like speech. Intelligibility, how well an outside listener without context can understand an individual’s speech, is one quick tool we can use to measure speech development. Below are some examples of the service delivery areas we treat regarding speech:
Language refers to expressing and comprehending words through multiple modalities, including speech, writing, reading, speech-generating devices, picture symbols, and gestures. We use language for various intents, including sharing ideas and ensuring our needs are met. Below are some examples of the service delivery areas we treat regarding language:
Fluency refers to the rhythm of our speech. Typical speech is characterized by occasional disfluent moments (e.g., pauses and repetitions), although a higher frequency of these may be a cause for concern. Below are some examples of the service delivery areas we treat regarding fluency:
Voice refers to the quality, pitch, and volume of an individual’s voice. A voice disorder is present when one or more of these voice qualities are perceived as different or inappropriate for an individual’s gender, age, culture, and geographic location. Causes for variation in voice can be organic (e.g., structural changes due to aging, vocal fold paralysis) or functional (e.g., vocal fatigue). Below are some examples of the service delivery areas we treat regarding voice:
Resonance in speech refers to the production of a filtered sound, beginning at the vocal folds. The sound travels through the pharynx and oral and nasal cavity. As it passes through, it is filtered and enhanced based on the shape and/or size of an individual’s vocal tract. Below are some examples of the service delivery areas we treat regarding resonance:
Typically, when discussing the pediatric population, Auditory Habilitation instead of rehabilitation is used as rehabilitation refers to restoring a skill that was lost. Often, a young child who presents with hearing loss or is Deaf has not yet developed age-appropriate auditory skills and therefore is not restoring the skill. Below are some examples of the service delivery areas we treat regarding aural habilitation/rehabilitation:
Learn more about our audiology services here.
Speech-language pathologists also provide services for individuals with Cognitive-Communication Disorders. In the pediatric population, the most common etiologies for cognitive-communication disorders are autism spectrum disorder, cerebral palsy, developmental delay, and traumatic brain injury. Below are some examples of the service delivery areas we treat regarding cognitive communication:
Feeding and swallowing refer to how individuals transport food and drink from their environment into their bodies. Speech-language pathologists are involved in the parts of this process that involve the mouth, pharynx, and esophagus. We collaborate with other specialists, such as nutritionists, occupational therapists, and gastroenterologists, to meet each child’s individual feeding and swallowing needs. Below are some examples of the service delivery areas we treat regarding feeding and swallowing:
Learn more about our feeding clinic here.
Augmentative and Assistive Communication (AAC) includes all forms of communication that are used to supplement or replace oral speech to express thoughts, needs, wants and ideas. AAC allows children to communicate more easily and, in doing so, reduces frustrations for the individual and his or her family. There are several forms of AAC ranging from light tech to high tech. Below are some examples of the service delivery areas we provide in AT services:
If you are concerned about your child’s language or other development, take our free online developmental screening tool for children birth to age five. The Ages and Stages Questionnaire (ASQ) will showcase your child’s developmental milestones while uncovering any potential delays. Learn more at askeasterseals.com.
To learn more about Speech Language services at Easterseals DuPage & Fox Valley, click here or call us at 630.282.2022.
Wednesday, January 18, 2023, 2:12 PM
by: Theresa Forthofer, President & CEO This past summer, Easterseals DuPage & Fox Valley suc…
by: Theresa Forthofer, President & CEO
This past summer, Easterseals DuPage & Fox Valley successfully completed the Commission on Accreditation of Rehabilitation Facilities (CARF) re-accreditation process. As a highly respected and recognized third-party organization, CARF performs rigorous evaluations of service-based providers seeking accreditation. We are honored to be one of very few freestanding pediatric outpatient facilities in the area with CARF accreditation.
Their audits ensure that top service providers are easily recognized by the public when looking for providers who follow internationally accepted standards. We are proud to say that for more than 40 years, Easterseals DuPage & Fox Valley has achieved the highest possible recognition from CARF, acknowledging our commitment to quality services and continual improvement.
“This achievement is an indication of our organization’s consistent dedication and commitment to improving health equity in our communities” said Theresa Forthofer, President & CEO of Easterseals DuPage & Fox Valley. “Our CARF accreditation signifies that each child is receiving state-of-the-art services from our collaborative team of experts.”
Among the observations made by CARF in its survey of Easterseals DuPage & Fox Valley at our three center locations (pictured below, left to right, Villa Park, Naperville, and Elgin):
As a pediatric specialty program, we are required to demonstrate compliance with over 1800 standards. Prior to the two-day survey, the survey team reviews clinical documentation samples, outcome and compliance reports, and thousands of policies. During the survey, the team interviewed Center Leadership, Key Process Owners, Medical Advisory Board members, funders, and most important, clients and families.
CARF uses the ASPIRE to Excellence Quality Framework to guide their survey. Their framework operates on a continuous improvement model which “provides a logical, action-oriented approach to ensure that organizational purpose, planning, and activity result in the desired outcomes.
The entire CARF survey lasts two days, but accredited centers such as ours must demonstrate we have upheld standards over the last three years, as surveys are conducted every three years.
Easterseals DuPage & Fox Valley is a CARF accredited outpatient rehabilitation center with comprehensive services including occupational, physical and speech-language therapies, mental health, assistive technology, medical nutrition, audiology, autism services and inclusive childcare. With 80 therapists and professional staff specialized in early intervention, and further certified in Neuro-Developmental Treatment (NDT), Developmental, Individual-differences, & Relationship-based (DIR/Floortime) methods, Sequential Oral Sensory Approach, Sensory Integration and Praxis Test, feeding, motor, speech and sensory areas of specialties. Additionally Easterseals has a medical advisory board and affiliations with local hospitals and medical partners through our vision, orthotics, mobility, seating and diagnostic clinics. Learn more at https://www.easterseals.com/dfv/programs-and-services/.
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