Written by Esther B. Hess, Ph.D. First published Feb. 10, 2010.
Summit Professional Education Instructor – View Upcoming DIR/Floortime Seminars

February is the month when many of us celebrate the possibilities of romance with Valentine’s Day. It comes as no surprise then that our older adolescent and young adult population with developmental delays such as Asperger’s Disorder has similar yearnings as they begin to become aware of the need for companionship. The question is how do you clinically support this hormonal need and simultaneously encourage developmental growth?

Asperger’s Disorder is what many developmental experts believe to be the highest form of functioning within the autism spectrum and is characterized by the severe inability of the impacted individual to comprehend social nuances while at the same time having the capacity for great academic intelligence. Older teenagers and young adults with Asperger’s Disorder need more support than their neuro-typically developing peers, because despite potentially brilliant I.Q.’s often their chronological age does not match their developmental age.

DIR/Floortime is an affect driven, developmental/relational approach towards the treatment of Asperger’s Disorder and takes into consideration an individual’s developmental age (the D of DIR), underlying individual neurological differences that might be impeding development (the I of this treatment model) and the individual’s relationship with the world and how to use that relationship (the R of DIR) to move that individual forward. The basic tenant of Floortime is to ‘follow the lead’ of the individual that you are working with (their area of initial interest and motivation) and then expand on that interest.

As mentioned, many older teens and young adults appear much younger in both their overall appearance and behavior (D). They characteristically are challenged in regard to good hygiene because of underlying sensory regulatory issues (I). Adolescents with developmental delays can be tactilely defensive and reluctant to wash their bodies, shampoo their hair, use deodorant/cologne and/or shave on a regular basis. While these individuals may not necessarily be bothered by their bodily odors, using Floortime (i.e., his/her motivation to date) can be an impetus for emphasizing the  importance of keeping oneself clean and neat and how by doing so you will make a good impression (R).

Keeping in mind individual neurological differences, clinicians working with this population can offer additional support, by helping to create visual schedules that can be placed in the bathroom that chart how often this individual needs to take care of his/her personal needs. Many teens and young adults with developmental delays are visual learners and get very organized once they have a clearer ‘map’ of social expectations.

Dating and safe sex practices can be addressed through role- play and concrete visual demonstrations. Working with your impacted teen/young adult, you can create a step by step guide for the date, giving an opportunity to practice and improve on issues such as appropriate boundaries, limiting perseverative talk and learning how to share in mutual interests thus expanding on what are typically very limited social skills. The advantage of practicing with a supportive clinician is that the information you will share, will in all likelihood be far more appropriate and accurate then the direction that might be received from watching over sexualized sitcoms or dramas on TV. You might also want to guide the direction of the date by suggesting a Floortime strategy of using the individual’s interest as a theme. For example, if your client likes animals, suggest that a great date can be done by escorting someone to the zoo. Likewise, if someone is interested intensely in trains there are many cities which have wonderful museums with permanent locomotive exhibits.

Undoubtedly, there will be many bumps and bruises along the social journey of our older teens and young adults with developmental challenges. While we certainly can’t nor should we even try to protect from all of life’s hard knocks, it’s actually o.k. to offer some Floortime tips as a steadying hand along the way.

Written by Esther B. Hess, Ph.D.
Summit Professional Education Instructor – View Upcoming DIR/Floortime Seminars

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