Carlena Lowell

SEI 524 DIR/Floortime Case Study

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Carlena Lowell
DIR/Floortime Case Study
SEI 524
July 29, 2013












Carlena Lowell
SEI 524 DIR/Floortime Case Study
2

*Initials have been used to maintain confidentiality
Background Information
When we began the DIR/Floortime sessions, SM was just over thirteen months,
and at the end of the sessions she was fourteen-months-old. SM was due to be born
June 27, 2012, and was born just shy of five weeks early on May 26 in Portland, Maine.
SM was 19 inches long and weighed 4 lbs. 9 oz. when she was born; however, she
dropped to 4 lbs., 3 oz. while in the NICU. She required a feeding tube only for the first
day; from day two on, she breastfed without difficulty. She spent five days in the NICU,
and was then transferred closer to home to Pen Bay Medical Center for one day. Within
two weeks, SM was up to six pounds. BM reports the doctors in the NICU referred to
her as the rock star baby because she was able to do things many babies born at that
gestational age are generally not able to do.
SM lives in a coastal town with her mother, BM, father, RM, and three dogs,
Cammy, Nautica, and Captain. SMs paternal grandfather lives very close to the family;
both paternal and maternal grandmothers live a bit further away, but visit often. The
private wharf RM lobsters from is connected to their driveway, and BM is a stay-at-
home mother to SM. BM has a background in early childhood education, and was a
preschool teacher for Head Start prior to SMs birth. Since SMs birth, the family has
received service from Parents as Teachers, which is an affiliation of the University of
Maines Cooperative Extension. BM and RM have found this to be incredibly helpful
and informative. SM is now meeting milestones typical with her age. Her gross motor
scores from an ASQ done by their home visitor through Parents as Teachers showed a
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slight delay several months ago; however, the most recent screening showed typical
development in this area. SM still seems to have some difficulty with her gross motor
skills; however, is persistent at continuing to try even if she does show some frustration.
Analysis of the six FEDLs
This section will discuss SMs ability to function within the Functional Emotional
Developmental Levels as put forth by Stanley I. Greenspan and Serena Wieder in
Engaging Autism (2006).
Stage One: Shared Attention and Regulation
SM is at an age-appropriate level for stage one of the FEDLs. She is able to maintain a
calm demeanor and focus for more than two minutes. She is able to calm herself down,
or be comforted by another to calm down, within ten minutes of becoming upset (an
indicator of stage three). She is able to attend to things by using all of her senses; for
example, she turns to look when she hears something of interest. She also shows a
strong interest in people around her. At one point during our final Floortime session,
SM was attempting to climb up on a piece of furniture, which took about 30 seconds.
After the first two tries to get up onto it, she became frustrated with it and began to
whimper and grunt in, what seemed like, anger. However, after she finally made it up,
she was able to regulate her emotions and return to the happy state she was in before
becoming frustrated. In addition, SM was seen attending to the jack-in-the-box for more
than two minutes.

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SEI 524 DIR/Floortime Case Study
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Stage Two: Engagement and Relating
SM is also at an age-appropriate level for this stage of the FEDLs. She is able to
respond to an adults expressions appropriately. She is also able to become engaged
and maintain that engagement with an adult during play. This can be seen in the video
clip while playing the head hiding game with the lamb blanket, as well as while playing
with the cup. SM shows interest in a wide variety of things; however, she does also
show preferences for things such as favorite food, people, and toys.
Stage Three: Purposeful Emotional Interactions
This is a stage in which SM is well on her way to reaching. SM responds well to big
animation; for example, she maintained eye contact, with a smile, when we were
playing the blanket over the head game. She is able to express that she wants to
repeat things (i.e., motions, games, food) that are pleasurable to her by using her own
facial expressions, vocalizations, and gestures and movements. This was shown
through an example of her eating snack at a previous session. BM put several food
items on her high chair table. She ate all of a certain food, dropped the food she did not
want onto the floor, and then she banged the high chair and yelled to get BM to give her
more of the food she desired. SM is able to both respond to and initiate interactions
with others. In addition, she is able to show various emotional states at appropriate
times; for example, frustration when she is unable to get onto a piece of furniture, and
sadness/anxiety when BM leaves the room.

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Stage Four: Long Chains of Back-and-Forth Emotional Signaling and Shared Problem-
Solving
This is a level in which SM abilities are emerging. She is able to close ten circles of
communication, as seen in the blanket over the head game. We also achieved this by
reading several books throughout the sessions. By viewing the section of the video
when SM and I are playing with the jack-in-the-box, one can see that her problem
solving skills are emerging. These skills are coming through particularly in games such
as find the hidden toy. She is also able to imitate behaviors with intention in simple
forms. I did present an empty cup in an effort to model pretend play. We went back
and forth with the cup three times each. It seemed as though SM was imitating me by
holding the cup to her mouth, rather than actually pretending to drink from it. She then
made a game of throwing it!
Individual Differences
Although SM was born at 35 weeks gestation, within a short amount of time she
developed to the point of reaching age appropriate milestones in many areas of
development. SM is able to aptly regulate sensations as they come in. At birth, SM had
hearing screenings done, and passed all of them. Her auditory processing and
language skills seem to be developing at a typical rate. SMs expressive language skills
are emerging; this can be seen through various vocalizations of a range of speech
sounds. Throughout the videos she can be heard saying ah, de, he, mm, ya, etc.; she
seemed to make more vocalizations in the second video than in the first. BM said that it
is typical for her to make many vocalizations throughout the day, and that she is now
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saying dada with intent. She also has particular noises she makes to convey that she
is happy, as well as when she is frustrated. SMs displays age-appropriate receptive
language skills, particularly when looking at books with adults.
An area of development that has been a bit difficult for SM is gross motor. On
the nine month ASQ (as done by the Parents as Teachers home visitor), SMs gross
motor score was below average. BM noted it took her longer to roll over than what is
typically observed. However, when the 13 month ASQ was done she had made gains
in this area and her score reflected that of typical development. SM has not yet
crawled; rather, she is able to scoot in a sitting position using her legs and one arm for
support. She is able to control her speed to a point when executing the scoot. SMs
motor planning abilities are somewhat affected by her gross motor skills. She is able to
hear sounds, and is easily interested in things; however, sometimes she has difficulty
manipulating her body to reach the desired outcome in the most efficient way. For
example, several times throughout our sessions she wanted to get up on furniture,
which she is able to do, but if she was not positioned just right it became difficult for her,
which resulted in slight frustration. In addition, she sometimes needed to pause to
correct her positioning to be able to get from one point to another. For example, in the
second video, I put the jack-in-the-box behind my back and she crawled over my leg to
go find it. Once she got over my leg she was in crawling position; however, stopped to
arrange her body into a sitting position to be able to scoot over to the toy.
SMs visual-spatial processing skills are evolving. She is able to visually follow
another persons gaze. A wonderful example of this is in both videos when I address
the camera in the beginning. She realized my attention was somewhere else, and
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turned to see what I was attending to. She seems to have a solid sense of her body as
it moves through space. She is able to manipulate her body in the scooting fashion in
order to get to something she desires across the room. She is able to look for objects
when she sees them hidden. She avidly experiments with objects; for example,
throwing balls, dropping food off her high chair, turning pages of a book, and finding
simply hidden toys. As SM is young, her visual-spatial skills will need practice for years
to come. At one point when we were playing on the chaise lounge, a toy dropped off
the end of it. She slowly went to the edge, and then was content just to slide of the end
in a heap, seemingly not understanding that she may have gotten hurt if she went face
first into the floor of the furniture; I was able to catch her to break the fall.
Reflection
Since I have conducted these DIR/Floortime sessions, and watched the videos
repeatedly, I have identified certain skills that I would look for and encourage with SM. I
think there are many opportunities I could create through Floortime that I missed in
these sessions because I am still learning the details of this model. A skill I would like
to encourage more of is SMs language. As I wrote this case study and watched the
two videos, at one point I looked specifically at SMs receptive language skills. It is my
feeling that I should do more to encourage these skills. It seemed as though SM was
not directly responding to my words at some points, but rather was motivated to come to
me for a reason other than my words. For example, at the start of the first video I said,
Lets move over here so we dont fall on the table. I had her doggie in my hand and
she moved toward me, but it seemed not to be because I said, Lets move, it seemed
to be because of the dog. Also, in the second video, I was trying to woo her back in and
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said, Come over here!, but I had Clara raccoon, and again it seemed like that was the
motivating factor, rather than her responding to my words. In future play sessions I plan
to be more purposeful in encouraging both her receptive and expressive language.
In my notes from the ASHA DIR/Floortime video, I wrote drama, drama, drama
and extend, extend, extend. I feel as though my ability to engage SM is strong
because of the drama effect. In general, I am a fairly dramatic person with my voice,
my facial expressions, and my affect, which enables me to easily engage a child.
However, I feel less confident about my ability to maintain the engagement and the
extend aspect of DIR/Floortime. During our sessions, I often felt I was unsure of how
to expand our play to maintain interest, as well as try to create problems to solve that
were in SMs zone of proximal development. Another struggle for me was completely
following SMs lead. I feel have a strong beginning to mastering this skill; however, I did
note times when I was leading the play. Examples of me following SMs lead are the
ball play and opening and closing the wipe box (both in the first video). Examples of me
leading the play are me presenting the jack-in-the-box and pretending to drink from an
empty cup (both in the second video). As I am reflecting on this, it seems as though in
the second video I was focused on trying to encourage problem solving and pretend
play so much so that I felt the need to lead her into each, rather than embedding them
into her play.
A strategy I used with SM was waiting, which is key to use in the DIR/Floortime
model. This can be seen in particular when we were playing with the jack-in-the-box.
Although I was able to wait for her on several occasions, this is a skill I would like to
improve on, and use with more intentionality, as I use the model in the future. For
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problem solving strategies, I used hiding toys as a technique quite a bit. She was most
often able to find things I hid; therefore, I feel she is able to move on to solving problem
that may be a bit more difficult. At a few points this technique did not work (not featured
in the video). She would watch me hide something, and I would prompt her to find, but
she seemed uninterested in finding it; this could be an indication she is ready to move
on to slightly harder problem solving. As discussed earlier, this is also something I am
aware I could facilitate better in the future. Another strategy I used was playful
obstruction, which can be seen with the wipe case in the first video. We had many
circles of communication involving the box of wipes, many more than what were shown
in the video. When SM and I played with the lamb blanket over our heads, this was a
form of peek-a-boo that encouraged many circles of communication, which applied to
both FEDL three and four. Throughout our sessions, I used animation as a strategy to
engage and maintain SMs interest in our play. Repetition is also a strategy I used, but
would like to see myself use it more the future.
The DIR/Floortime sessions had with SM were an incredible learning tool, and
fun for both of us. Not only was I able to implement skills I learned through reading and
the in person class, but I was able to analyze them, and then go back and focus on
certain areas that were identified through watching the first video. The reflection group
we attended several weeks ago was a wonderful way to learn more about identifying the
different levels. I was able to take time to look at what I did, as well as what other
people did that I might like to try. I felt confident after analyzing my first session to go
back and try again with new ideas and goals. After reflecting on the sessions, I feel
more comfortable in what needs to be done and how to go about doing it while adhering
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to the tenants of the model. These DIR/Floortime sessions, along with the readings, the
reflection group, and this case study have been an incredible introduction to the
DIR/Floortime model. This is a model, when implemented correctly, can be of great
benefit for those involved.














Carlena Lowell
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References
Cawn, Sherri (author). (n.d.). Comprehensive assessment and intervention using the
DIR/Floortime model [Motion picture]. (Available from the American Speech-
Language-Hearing Association, 2200 Research Boulevard, Rockville, MD
20850-3289).
Greenspan, S.I. & Wieder, S. (2006). Engaging autism. Philadelphia, PA: Da Capo
Press.