What is DIR? A book review of Engaging Autism

This book is not about autism. The title should be something like, A Specialized Manual for Human Development. The reason is simple: developmental interventions fill in the gaps of any person’s development.

Now you might be wondering, “What gaps?”

The more I work with people of all ages and abilities, and the more I do my own work, the more obvious it is that our relational experience database is the resource for all functioning in the world. That might seem obvious when we think about learning how and when to say “Mama” as an infant, but the reality is far wider and deeper than that!

Underneath all our physical skills, complex mental capacities, and a wide, full emotional life is the early wiring of our brains as we related to our caregivers. Chapters 1-3 of Engaging Autism provide an overview of how this development works, specifically in autism (but development follows the same track in all children).

We all know some things about children’s attachment to caregivers. What you may not know is that attachment is not easy on either side of the equation, baby or parent. On the baby’s side, the relationship must be managed with rudimentary physical abilities and eye contact. If baby’s sensory or motor systems are not up to speed for any reason, baby cannot manage her part of the relationship… Mom and Dad usually try harder…. and you have a set-up for small or large failures of development.

Stanley Greenspan’s intervention is based on gaining an understanding of how a child is functioning currently, what is missing, and how can caregivers provide those ingredients in a way the child can digest them. This combination is called DIR:

• D is for Development. Where is the child’s development uneven or stuck? Chapter 4 of Engaging Autism describes the goals of DIR/Floortime, followed by a deep dive in Chapters 5-10, exploring the developmental capacities attained by children in sequence.

• I stands for Individual differences. Every child entering a DIR/Floortime intervention is assessed in detail. An assessment, ideally by a specially trained Occupational Therapist, examines the sensitivity of each sensory system (there are 7!), the processing of each mode of sensory input, the integration of sensory information streams, the integration of these streams with motor planning and sequencing, and the use of all this information to regulate and relate to others. Chapters 11 and 12 of Engaging Autism describe some of the more common problems in detail.

• R stands for Relationships. Greenspan was a joyful therapist; his belief that children can develop if we give them what they need is the basis of DIR/Floortime’s success. He was a talented coach of parents as well. Without parents who grow in expertise with their children, any intervention ultimately will be far less helpful to the family and child. Chapters 13-18 of Engaging Autism are an empathic, direct communication to parents about how DIR will work in the home, how it will affect their relationships with the child, and what the challenges are likely to be.

Engaging Autism finishes in Chapters 22-28 by addressing aspects of parenting children with unique needs that tend to be at the forefront: scripted communication, sensory craving, hyperactivity, tasks like getting dressed, transitions, difficult behaviors, meltdowns, and social skills development, to name a few.

The book ends with some appendices that some readers will want to delve into:

• Outcome Studies

• DIR Theory

• Neurodevelopmental Disorders of Relating and Communicating.