Families often come to DIR/Floortime to build healthy foundations for social, emotional, and intellectual capacities rather than focusing on skills and isolated behaviors after a diagnosis of Autism Spectrum Disorder (ASD). The Developmental, Individual differences, Relationship-based (DIR) Model outlines six basic core functional emotional developmental capacities that are foundational in human development.
To date, though, there has been no comprehensive assessment process that describes an individual’s Developmental capacities (D), Individual differences (I), and Relationships (R) to foster a holistic view of how to move forward.
This week we welcome back occupational therapist and DIR Expert Training Leader, Maude Le Roux, to discuss her new comprehensive, innovative assessment process.
For the first time, A Total Approach in Glen Mills, Pennsylvania has all of the core pieces of a diagnosis on the Autism Spectrum included in one assessment process for a holistic view of the child. Please enjoy the video blog interview with Maude about the new Functional Developmental Autism Assessment Protocol!
Occupational Function and The Whole Picture
As an occupational therapist, Maude’s drive is occupational function: whether it’s leisure activity, school function (reading, math, writing), socialization, or relationship-building. Whatever would impede those levels occupational function is what she’d be interested in looking at. Many assessments are out there, but they don’t always give you the full total picture.
There is a drive to look at behaviour in an intervention plan, but looking at behaviour to drive the model was not what Greenspan wanted. Rather, we want to respect all behaviour and look at the why behind the behaviour. To chase the “why”, Maude’s team looked at individual instruments and Greenspan’s six core functional emotional developmental capacities in the standardized Functional Emotional Assessment Scale (FEAS), which is currently being revised.
Maude says that in the FEAS assessment, though, which is very research focused, there were still pieces they needed to add in the capacities and individual differences to make the whole profile happen. So with the new assessment, her team looked at pieces from the Childhood Autism Rating Scale (CARS) to determine where the child is on the autism spectrum, and then re-designed the evaluation in terms of the six core Greenspan capacities.
The Six Core Capacities
They took those six capacities and added some questions within each level. They also added standardized assessments within each level. For capacity 1, shared attention and regulation, they used some sensory assessments. In the 2nd, engagement, they added some joint attention pieces. In the 3rd, two-way emotional communication, they used language assessments, Praxis and motor planning pieces that would inhibit this third level.
In capacity 4, social problem-solving , they added theory of mind testing that can help them to understand what the child’s capacity is for social perspective taking and if they can pair their verbal and nonverbal gestures together. In capacity 5, symbolic thinking, they added other emotional processing measurements such as Heart Drawing by Dr. Arthur Becker-Weidman which can be done with children with very minimal fine-motor skill to give them idea of what their concept is of some symbolic, emotional pieces that might come up.
They also have videos of the caregivers playing with the child to see the different capacities in play. Then at capacity 6, logical thinking, they have added executive functioning tests. So in all of the capacity levels you can get the individual differences that go within each. Finally, they end the assessment with the Relationship piece using the Parenting Stress Index to see how the parent profile is coping with what’s happening and what we need to do to support in that arena to get a holistic family view.
Individual Profile over Diagnosis
As an occupational therapist, Maude does not diagnose, but she loves working on profiles because a profile tells her so much more than the diagnosis. It gives her the nuances about who the child is. She does not want to change the child. She just wants to make life easier for the child, and when she begins to understand the nuances in the profile, she knows where to begin.
The new Diagnostic and Statistical Manual (DSM) includes sensory processing as a criteria for a diagnosis of Autism Spectrum Disorder. Maude has seen many children come to her with a diagnosis of ASD when they are really only SPD, or Sensory Processing Disorder. Now she can see which child really has autism versus sensory processing disorder when they do the new evaluation.
“This assessment is about celebrating our individual differences. Let’s accept each other for who we are.” – Maude Le Roux
Developing Theory of Mind
For Maude, the distinction between SPD and ASD is central coherence and theory of mind, and she discusses each. Central coherence is whether they can they learn something in this environment and generalize it somewhere else, and theory of mind is whether or not they can take the perspective of another person.
I have to have a sense of myself and have a body awareness, which has a different physical feel than the child next to me, and know that there’s a separation between us, and that they’re a separate entity. Children who have trouble knowing I, me, you, yours can’t get it until they have a sense of “I”. If the sense of self doesn’t develop then it’s hard to develop theory of mind. That’s why the core capacities are so important.
In Maude’s vast travels and experience, she hasn’t found any other program other than DIR/Floortime that truly encapsulates what it is to work with theory of mind. Kids who have theory of mind issues linger much longer in the levels and that does not happen with SPD. Knowing makes a big difference in how she intervenes. There’s no cookie cutter recipe here. Your child is unique. There is no real one size fits all.
What the family gets after the two-hour long assessment is a summary of each capacity and what’s impeding each level. This gives the parents a picture of their journey and a road map to follow. Parents find it so much easier to comprehend the process. The parents are walking away with not just a diagnosis anymore, but how the child has come to be, regardless of diagnosis or not. We give them a place to start that makes sense to them.
It is so important to have an assessment that can drive the decision-making to save the parents time and money in order to direct your attention and energy in the space where you can go. We’ve become a society that wants to see a quicker fix and the product. We get rewarded for what we produce, but we forget that in order to produce we have to have the process. If we give the child process, the product will always be there.
We have to find a way to validate the process because in that validation lies that intrinsic motivation to want to try again. But if the only way I get validated is to deliver a product there’s a disconnect between my understanding, where I’m going with it, and how I achieve it. I’m doing something only to please someone else. This assessment helps to lead us to the appropriate process.