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 

Sources 

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

http://www.polyxo.com/floortime/buildingplaypartnerships.html

Floortime Guide – for parents by parents

www.floortimerepository.com

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

Tuesday, August 17, 2010

Little bits of August


Here are some of the bits of this past month that I want to save and remember

Cabin

We are slowly settling into the cabin .

Most of the heavy lifting has been done .

Here is DH and me moving our bar – this is solid wood and it literally ( well not literally ) killed us to move this !


DH and I really love the cabin

On Sunday mornings we wake up to sunlight instead of the clock which feels most natural


What adds to our joy R is mad for the cabin and asks for "New cabin New house" all the time !

The name of our cabin used to be "Life is good".

Here is a picture of the first cup of tea I made and drank here and I want to remember this moment always


I love looking at the woods.


Sometimes drinking coffee and reading a book ( this last weekend was "Death of a Cad ")

Sometimes just staring at this



I think of all the dramas that have played out in these forests and how all of it passes .

I am reminded of the fact of my temporariness and the temporariness of all my woes and worries and I find it deeply comforting

We end up going every Saturday afternoon to be enveloped in the calm of these trees and leave the world behind

Theft

We were robbed

I left our garage door open for a little bit to let a bat out.

Someone came in and stole my wallet, GPS and DH's power tools

Our county police was super efficient and came in and took fingerprints etc but we have had no luck in recovering anything

I don't mind the things much at all – DH cancelled the cards immediately and the other things we can do without/replace

The worst thing is that my sense of safety in our neighborhood is forever gone .

I can no longer tell the story of how its easy to leave your house unlocked or your car out

The end of summer and the start of real life

 I have often mentioned how depressed I get when summer ends and school starts again

This year R is to get a mixture of Special Ed and regular ed.

I like his Special Ed teacher very much

Regular Ed feels scary as it has 17 kids and I don't think they get Autism




Changing the home therapy program

We are also thinking that it may be time to modify the mix of what R gets

DH has talked about this for the past couple of months and I am really seeing the wisdom of what he is saying – he is such a smart guy and has his own mind

We are not sure that ABA is the right thing for him anymore

I think one has to keep evolving the home program to the needs of the child

Yesterday I was talking to E about this and I told her how a program with discrete trial things like

"Dora is ….. ( and he has to fill in "a girl )" is not optimal on so many levels

First of all once he knows the answer there is no benefit in repeating it 20 more times

You could debate back that it helps with compliance

And I would say to that – that I am not trying to apply for the position of "least troublesome inhabitant of group home" but for R to live independently

The second thing that is wrong with a program like that is that its an open ended statement that should not have one right answer – example it could end with

"pretty", "Spanish", "a child", "a singer", "a dancer", "a friend of Boots "

What do you want then ? E asks patiently when I had climb off my soapbox

I want him to be able to answer questions like "what is your name" ? I reply

And then one day ..I want him to ask that question of someone...

Spontaneous and unprompted

Learning to Pretend

Pretend play has been just a great add to the summer program

The other day DH had to drop R off at my office so he could get a blood test and R found a wooden puzzle piece where he pointed to the bottom of the shape  and said

"is a trapezoid" ( which it is but I had to look it up )


Of course I am impressed that my 5 year old knows what a trapezoid is

But here is the really cool part .

He then put it on his head – pretended it was a crown and said – "King "



Yes you are R, Yes you are !

Tuesday, August 10, 2010

Beautiful Blogger award

Lynn Hudoba- the hilarious – has given me these two awards ( heartily recommend her blog as she will make put a smile on your face  )






Here are 7 things about me

#1 Scarlet
I am mad for clothes – I have 3 closets at home- one of which is a walk in and one of which is entirely devoted to saris . this is my favorite color and about half my clothes are in this color

#2 I am very interested in people – especially what makes they think about - and I will listen to pretty much anyone who looks chatty - which is why I love reading all the blogs I do

#3 Screen guilt

I feel very guilty about all the TV/computer I let the kid watch - greenspan says parents should spend 3- 4  hours each day doing Floortime with their kids and denounces TV as a very passive form of entertainment


#4 the love of my life is my opposite

DH and I are a real team –we each do things that the other is hopeless -(  I often joke that I fell in love with DH because of his sense of direction and there is truth in that.

It still makes my heart skip a beat when I see him read a map or back into a tough parking spot- while I still cannot reverse if someone is looking and have no idea of roads

One of the reasons why we work as a team is because  we are opposites in many ways . My way of a fun time is to curl  up with a nice book - DH's?  well his way of fun is to make  clay oven to smoke meat in -


#5 The woods
 Watching the sunlight stream through the woods from my front porch with a cup of coffee may be my favorite thing in the world


#6 If I had three magic wishes - one of them would most certainly be getting all the chores done in a flash of light - I like a clean house and homemade food and hate all the time that is wasted accomplishing this

#7 I know the kid has Autism apraxia spd and all that jazz but I secretly think DH and I won the kid lottery !
Passing this on to  7 of you though I love soooo many of my friends here

Links have been added

Kim of the RocChronicles

Thursday, August 5, 2010

On Hopeful Parents : The truth about my life

I am over at Hopeful Parents today
My first ever Guest post
If you have a minute to read my post or visit that lovely website go here

Full post here as some of the links for Hopeful Parents don't work anymore

Almost everyone I know has been wonderful with the news of R’s Autism

In fact, I often say we meet a nicer type of people in the special needs worlds and encounter  a nicer side of people in the typical world

But on a rare occasion,  I get to experience a brand of sympathy that I find especially hurtful

The kind that assumes my life is all doom and gloom
I know you are just putting on a brave face.. I dont know how you do it”  a friend told me when I told them I was okay in the early days of finding out , “I know you can’t really  be okay .. its okay to mourn… you can tell me like it really is ”

Its as though the new rules, for my life as the mother of a special needs child, are to develop a gritty forbearance.

A sort of shouldering-my-burden with a  make-lemonade-when-life-hands-you-lemons strength

As though I don’t have the permission to be happy and proud any more

But it’s not like that

Its not gloom and doom  at all

For R is a child of endless charm.

A dream come true, as I tell him everyday

And I am a very lucky mother

(Its a lot of work but  work does not preclude joy)

In the sisterhood of special needs mamas that tell our stories in our blogs, we have been talking about authenticity lately

A need to tell the whole story

Not just the good bits

Also the bad bits

Its as though we are saying – here is all the detritus, all the rotten stuff- now that you know this whole complete story of me – do you still love me?

This has made me reflect on the way I tell my story

Do I pick only the shiny, pretty  bits and pieces of my story?

Do I gloss over the hard bits?

I don’t think so

 I really do experience my life in the way I talk about it

But the truth is that there are many true stories about the same thing

All truths are only versions

For everybody says it like it is

Like it is to them

So I speak my truth, the complete truth and nothing but the truth

When I tell you that life is good

And I am okay

Floortime Lite Mama

On my life as the mother of an adorable 5 year old with Autism and Apraxia