Chapter 13 - Reuniting Development and Infant Mental Health through the DIR Model

Abstract

Development and Infant Mental Health diverged as each focused on different challenges related to autism or to infants in multirisk families experiencing adversity. Is mental health in autism overlooked? Did mental health overlook individual differences and developmental process? The DIR (Developmental, Individual-difference, Relationship-based) model integrated both perspectives and provides the framework to understand functional emotional development and individual differences where relationships provide the cornerstone for both mental health and development. DIR also pioneered parent-mediated intervention for autism. While most current treatments do not have effects that can be generalized or are long term, longer term effects are found when parents and caregivers participate in psychosocial relationship-based interventions, and they are able to carry on after intervention ends. Furthermore, preemptive research on parent-mediated intervention with high-risk infants who have siblings with autism are promising for positive treatment effects. While developmental and neuroscience research proceeds, it is important to address the current emotional development and mental health needs of children on the autism spectrum. Clinical practice shows symbolic play opens the door to understanding a child's emotional life and the developmental trajectory of emotional experience for all children. Brief symbolic play illustrations of DIR Floor Time parent–child interactions illustrate the hierarchy of symbolized emotional themes and the co-regulation needed to manage anxiety.