Tuesday, August 31, 2010

What is Floortime?

Yesterday I met some lovely mums at our local ASA support group and did a training on Floortime. We had a really great time

I love talking about Floortime and Dr Greenspan for many reasons
  1. Floortime is extremely beneficial to the whole family as a whole.  DH and I have a very strong Floortime orientation and we think this has greatly helped R and us
  2. Dr Greenspan and The Floortime Foundation have made a lot of resources available for free on the web.
  3. The role of the parent is critical – I remember once reading in Kyra's ( "this mom's "post ) that "it seemed that the role of the parents is simply to cart the child from therapy to therapy and sob quietly in car" and one of the reasons why she loved RDI was because it freed her of this . For this reason ( parent having an active role rather than just the payer of the therapies ) I believe that therapies like Floortime, Sonrise.RDI, Hanen are simply great
  4. Optimism: One thing I deeply loved about the man was his fundamental optimism- his belief that there was never an end point to development and that hard work was key . I seriously detest the whole idea of all development ending at age 5 .          DrGreenspan would not care what age your child was . With Floortime you would simply look at the "developmental stage " the child was in and then think of how to move forward from there 
One of the mums brought up that she had purchased "Engaging Autism" – but had not read the whole thing through.

Now this was a very dedicated mum and I started thinking about just how difficult it is – especially in that early time to divide up our time between reading /researching and doing

So I decided to write this two pager

Even if you don't want to/don't have the resources to do a full Floortime program – you can certainly employ certain elements of Floortime

So if you have time - go read the book "Engaging Autism" go read the resources given in my sidebar

If you have no time and would rather just read two page summary read on here

Before we go on to Floortime its important to understand the basic model.

Here are the four basic assumptions of the DIR model
  • There are 6 milestones that healthy development needs to have
  • These milestones are achieved based on interaction with caregiver
  • Some children have a sensory system that does not allow them to reach these milestones
  • With the help of Floortime Structured play you can help bring the child closer to healthy development
 So first lets describe what are the six milestones

Six milestones of healthy development for a child
  1. Self Regulation &Interest in the world
    Taking in the sensory panorama that is the world while regulating your response
  2. Intimacy
    Ability to form relationships
  3. Two Way Communication
  4. Complex Communication
  5. Emotional Ideas( pretend play )
    Ability to create ideas, use of symbols example baby doll is fed by mommy doll
  6. Emotional Thinking :Ability to build bridges between ideas to make them reality-based and logical.   In stage 5  the child's idea are like islands - so a child might dress up a doll, then, seeing a crayon, scribble, then, seeing a drum, pretend to be a drummer. However a child at stage 6 of emotional thinking connects the pieces together. For example, she might have the drummer play for the dressed-up little girl and use the crayon to make invitations for the performance; or, the doll might have a tea party, call friends to invite them, prepare refreshments, set the table, and determine the seating pattern.

How does an atypical sensory system is prevent the child from achieving these milestones?

Here I most quote the brilliant Ayres

"Let us appreciate how fundamental the body is, more basic even than MOTHER" 
Here are the Seven Senses.

 I will give you some examples of how when the sensory system is not working - a child will miss developmental milestones

Its even more important to point out that a child who is overwhelmed or underwhelmed by his/her sensory system is unable to be calm and engaged. Therefore this child misses many opportunities for the interaction which is critical to development.
  • Seeing( suppose an infant sees only parts of his mother's face – never the full face – how will he build a relationship to a person who looks like a stranger each time – how will this child reach milestone 2)
  • Hearing( If the child Is hypersensitive to sound and spends their time feeling disoriented and frightened – how will he achieve any of the milestones)
  • Smelling
  • Tasting
  • Touching, plus two more
  • Proprioception ( what if the child could not feel their own skin – wouldn't this child spend all their time just trying literally not to fall apart.. how would this child learn to be calm and engaged ?)
  • Vestibular
For a minute try to be a sensory detective.

Imagine how your child experiences the world – try to see what it would be like to experience the world as a hypo sensitive child and then as a hypersensitive child

And so the sensory system delivers a double whammy to our child

Whammy One
Their body doesn't work right, so they receive and send mixed-up messages. And so they are harder to "read"
Whammy Two
Their parents have a hard time figuring out how to parent them. Yet, like all kids … but even more so …our kiddos need attunement
Another very important factor is that our own parenting is deeply influenced by our children's responses. And so we may reduce our efforts thinking that nothing works with this child .
We may think our child's reaction is rejection or bad behavior or personality. While its simply a biological response

What is Floortime?

A note before I describe Floortime :

As the sensory system is a critical part of being ready for development you may want to incorporate a sensory diet into your child's life – the first bit of advice we got from our Flooritme psychologist was to fill R's day with SING SWIM and SING – he simply was not ready for much more.

And so this is what we did. And it really helped us.

Our Floortime sessions have infact taken place in what we call sensory areas – the bed ( much Floortime can happen with "pillow sandwich" game), the bathtub, the trampoline and the swing

Now to Floortime.

To quote Dr Greenspan( a lot of this post is directly from Dr Greenspan books and his radio shows ) 

"Floor time [is] a systematic way of working with a child to help him climb the developmental ladder ... By working intensively with parents and therapists, the child can climb the ladder of milestones, one rung at a time, to begin to acquire the skills he is missing…..

Floor time is like ordinary interaction and play in that it is spontaneous and fun. It is unlike ordinary play in that you have a developmental role. That role is to be your child's very active play partner. Your job is to follow your child's lead and play at whatever captures her interest, but to do it in a way that encourages your child to interact with you ... Your role is to be a constructive helper and, when necessary, provocateur by doing whatever it takes to turn her activity into a two-person interaction"

There are two basic principles of Floortime
The first is to follow the child's lead .

Why should we follow the child's lead ?

Because this is the window to their emotional life.

For a variety of reasons, a child may have elected to be more self-absorbed or more aimless and seemingly in his or her own world.

What will motivate them to be a part of a shared world?

Well, the first motivation is to join them in their world and show them that you can respect what they are interested in

So if the child is aimlessly wandering around the room and jumping, we wander and jump with the child.

The child then experiences a partnership in aimless wandering and jumping.

Or if a child is rubbing a spot on the floor -  we might rub a spot on the floor with them . We will see that as a child, instead of looking annoyed or looking irritated or running away from us, starts giving us some friendly looks and some warm smiles and some friendly glances. That's the beginning of that shared world.

But that is only one half of the equation; one half of this dynamic that we call Floortime. There is another half.

The Second Principle is that we join them in their world in order to pull them into a shared world in order to help them master each of their developmental milestone

This means that we are creating systematic challenges to master each level of development. It is in those systematic challenges that many of the specific techniques and strategies of Floortime come

We are always trying to broaden the child's capacities in terms of the current milestones that they have – some children can relate a little bit and be a little bit purposeful – so we are strengthening and broadening those and introducing the next one. If they can be a little purposeful, we want them to be very purposeful. If they can open and close what we call three or four circles of communication that have three and    our back-and-forth's with gestures, we want to get it to seven and eight and then to ten and then to twenty until we get 50+."

What does a Floortime Session look like ?

Before I describe a session let me define what a circle of communication is

A circle of communication is when a piece of communication ( it can be word or gesture) is given by one and then returned by the other – so for instance here is a example of circles of communication
A: Smile at B
B: acknowledges B by smiling back ( CIRCLE ONE COMPLETE )
A : Hi how are you doing
B: I am doing great ( CIRCLE TWO COMPLETE )
And so on ..

Almost all our interactions are several circles of communications in a row . However if B has autism, B would not complete the circle of communication (and soon A would give up trying )
The thing you want to see in Floortime session is many circles of communication in a row

Here is what a Floortime session looks like :
Step 1. Observe your child.
Step 2. Approach your child.
Step 3. Follow your child's lead.
Step 4. Extend and expand on your child's ideas.
Step 5. Open and close circles of communication with your child.

Click here for some youtube videos for what a session looks like ( thanks Li for the suggestion for the videos)

Some Important Floortime Strategies
  • Always Start with Observation – do not skip this step – your child is ALWAYS doing something even if they are flicking their hands in front of their eyes or staring at the fan – its important to note their mood and your mood
  • Set the Stage ; sensory comfort zone -
  • Circle of communication
  • Affect- use emotion
  • Playful Obstruction- when your child is not allowing you to join in – you can playfully obstruct them so for example if your child is rubbing a spot on the wall – you can put your hand over the spot –when your child removes your hand – you have a circle of communication !
  • Process not content – Suppose your child wants to go out in the yard – you can "play dumb" and pretend you don't know how to open – suppose your child puts your hand on the knob – play dumb again and pretend you don't know where to turn the knob – if he turns your hand to the right now you have TWO circles of communication in a row!!!
  • Never change the topic – forget appropriate play
  • Talk Less – only talk at the level that your child can speak at – gestures are fine too
  • Do less
  • Need to woo and entice the child – but not entertain the child – don't forget the second principle of Floortime
  • Floortime should be enjoyable to child
  • Deepen the plot , don't change the topic – if your child is distracted bring them back to the original topic

Here is what I would like you all to do after you read this

Read this again tomorrow and first try to see where your child is at developmental milestone wise

Then try to do a 10 minute Floortime Session

In my next post I will give some examples of a Floortime Session 


ICDL FLoortime Training 2008

Sensory Organisation Training by Rosemary White - 2008

The Child with Special needs, Engaging Autism , Dr Stanley Greenspan

www.icdl.com, Dr Greenspan Radio Transcript


Floortime Guide – for parents by parents


Floortime Training ICDL 2008 Rebecca Shahmoon Shanok, LCSW, PhD,New York City.Lisa de Faria, MSW, LCSW, BCDMonterey, CA


mamafog said...

I really like this post, you give a great description and the links are helpful. Floortime really helps me feel like I know what to do, you know what I mean? Engaging Autism is like “the manual”, I wish there were even more books available.

Kim said...

Awesome, Awesome post! Love all this info. It seemed all I read was ABA, ABA, ABA when the Roc was diagnosed. I finally read a little about Floortime much later and realized that the "play sessions" I was doing with the Roc were very similar to Floortime.

Li said...

Great post! It might also be helpful to link to YouTube videos of Floortime sessions. I believe that Dr. Greenspan posted examples. In fact...going to look right now...

Here we go: http://www.youtube.com/user/dirfloortime

Floortime Lite Mama said...

Darlings - so Glad you liked the post - I know its long - but I really thought I could not have a blog with Floortime in its name and not talk about what it actually was
Plus many folks borrow Engaging Autism from the library and then returns it - unread - because - in the early days when words like "proprioception" motorplanning - are still unknown - its a hard read
Thanks Li - I added the videos - great suggestions

Anonymous said...

You live up to the name of your blog, K. And you honor Dr. Greenspan with this post. And children will be blessed by their parents after reading your words.

Thank you.


Annah said...

Parenting is one of those beautiful things that just terrifies me.

Lynn said...

It's been so long since I read "Engaging Autism"...thanks for the refresher course! I need to remind myself that it is still valuable even though Audrey is older and her play skills have improved so much since I first read the book.

Oh, and I see you credit Lisa de Faria....she was our Floortime consultant when we lived in Northern Cali!!! She was so unbelievably AWESOME!!!! I was so sad when we moved and had to stop seeing her.

Anonymous said...

Thank you for writing this post!! I've bookmarked it so I can come back to it. I've bought Engaging Autism and LOVE what I've read so far and what I've tried. I've learned so much, but as you've said I'm one of those who has never been able to actually finish the book! Thank you again for writing this in a way that moms whose brains are already overloaded can make easy sense of it!!!

Thanks for your sweet comments on my blog the other day. I miss you as well! I'll catch up on the last few posts I missed soon. I really hope to be "back" soon. It feels so good to have this past hour or so to read, research and just connect to everything again!

Mia @ Finding Balance said...

I truly enjoyed this. It educated me more on what floortime is...I never had a clear picture. Thank you.

Anonymous said...

Great Post. I really liked the part where you talk about the "Whammys". I have to say, if you can get great coaching it really helps. Those folks, the people who are well trained and can coach, are few and far between in the DIR/Floortime world, but they can help parents to really carry on Dr. Greenspan's vision for his intervention. I am the Clinical Director at the Rebecca School in Manhattan, and have a clinical practice on Long Island, and in both places I focus on helping parents, siblings, caregivers and anyone working with the child to do the good, joyful work they are capable of.
Keep up the great blog!
Gil Tippy http://drgiltippy.wordpress.com

Anonymous said...

www.floortimelitemama.com is wonderful. There's always all of the ideal info in the ideas of my fingers. Thanks and keep up the excellent work!

Unknown said...

This was really interesting and helpful. Communication is so important, I like the hands-on therapeutic approach.

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