Floortime

DIR/Floortime: History Founder: Dr. Stanley Greenspan, MD

Floortime is a part of a larger philosophy of DIR:Developmental, Incidental-Differences, Relationship-Based intervention.

Floortime video:http://ca.youtube.com/watch?v=esbC9KDC0dE&feature=related

Why learn about floor time?

DIR Developmental: Children’s development is

based on them meeting certaindevelopmental guidelines.

1: Self-Regulation and Interest in the World 2: Intimacy 3: Two-Way Communication 4:Complex Communication 5: Emotional 6: Emotional Thinking

DIR Individual Differences:

Specifically, motor planning & sensorysensitivities

DIR Relationship-Based: Floortime is the

centerpiece of this element

Focused on the parent-child relationship asthe center of treatment.

DIR Definition: “Floortime, a systematic way of working

with a child to help him climb the developmentalladder, is the heart of what we call the developmentalapproach to therapy. It takes the child back the firstmilestone he may have missed and begins thedevelopmental process anew. By working intensivelywith parents and therapists, the child can climb theladder of milestones, one rung at a time, to begin toacquire the skills he is missing.”

What is a developmental approach? How does it differfrom behavioral programming?

Floortime Consists of 3 parts:

Parents do Floortime with their child, creating thekinds of experiences that promote mastery of themilestones. Floortime = 20-30 minute periodwhere parents interact with their child.

All other professionals and educators use thesame principles.

Parents work on their own responses to create afamily pattern that supports the growth of allfamily members.

Goals of Floor TimeIntervention To help the child:

become more alert take more initiative become more flexible tolerate frustration sequence longer actions - plan and execute them mediate process of finding solutions communicate gesturally and verbally take pleasure in learning

Step One: OBSERVATION Both listening to and watching a child are

essential for effective observation. Facialexpressions, tone of voice, gestures, bodyposture, and word (or lack of words) are allimportant clues that help you determine howto approach the child, e.g.:

Step Two: APPROACH - OPENCIRCLES OF COMMUNICATION Once a child's mood and style have been

assessed, you can approach the child withthe appropriate words and gestures. You canopen the circle of communication with a childby acknowledging the child's emotional tone,then elaborating and building on whateverinterests the child at the moment.

Step Three: FOLLOW THECHILD'S LEAD After your initial approach, following a child's

lead simply means being a supportive playpartner who is an "assistant" to the child andallows the child to set the tone, direct theaction, and create personal dramas. Thisenhances the child's self-esteem and abilityto be assertive, and gives child a feeling that"I can have an impact on the world." As yousupport the child's play, the child benefitsfrom experiencing a sense of warmth,connectedness and being understood.

Step Four: EXTEND ANDEXPAND PLAY As you follow the child's lead, extending and

expanding a child's play themes involves makingsupportive comments about the child's play withoutbeing intrusive. This helps the child express ownideas and defines the direction of the drama. Next,asking questions to stimulate creative thinking cankeep the drama going, while helping the child clarifythe emotional themes involved, e.g.: suppose a childis crashing a car: Rather than ask critically, Why arethose cars crashing? You may respondempathetically, Those cars have so much energyand are moving fast. Are they trying to getsomewhere?

Step Five: CHILD CLOSES THECIRCLE OF COMMUNICATION As you open the circle of communication

when you approach the child, the child closesthe circle when the child builds on yourcomments and gestures with comments andgestures of own. One circle flows intoanother, and many circles may be openedand closed in quick succession as youinteract with the child. By building on eachother's ideas and gestures, the child beginsto appreciate and understand the value oftwo way communication.

Facts about Floortime The core concept of this approach: Parents

follow the child’s lead. Example of rolling cars

What does a “Circle” look like?

Child engages in abehavior

Adult approaches childand engages them

Child responds in someway

What to do if… Child perseverates? Child refuses?

Child scripts? Child moves away? Child is aggressive?

Child protests?

Join in Give them something

else that they can refuse Make up your own

script Playfully obstruct Say “no no no” to

encourage self-regulation Repairs the situation

Video Clips

http://www.youtube.com/watch?v=8LUvfWmL1kU&feature=related

http://www.youtube.com/watch?v=uqiSR4FUBG0&feature=channel

Research Basis for Floortime Indirect support from National Academy of

Science Report (2001) which stated thatservices should be tailored to the child’sneeds, and there is currently insufficientresearch on any of the treatment approachesfor treating children with autistic spectrumdisorders. It also noted that behaviorprograms were becoming moredevelopmental in their approaches.

Benefits of Floortime a. Theoretically based on where child is in

development (child-specific treatment) b. Theoretically systematic (builds on each

milestone) c. Involves parents in child’s treatment d. Sounds appealing because of the focus

on social development, which is a highpriority (often the highest) of parents.

Disadvantages of Floortimea. Not intensive enough: six-to ten 20-30

minute sessions per dayb. Does not target problem or self-

stimulatory behaviorsc. Requires parents to be therapists, and

has very high demands on what thatparent’s emotional tone should be like.

An Example of a “FloortimeFamily” We altered our lives. We took Jacob to his therapies. We

stopped watching TV. I gave up all sports. We stopped going out.We changed our diet. Rebecca began shopping at four differentstores for food: the supermarket, two different health food storesand the kosher butcher. We blew bubbles, used sign boards, andput pictures of family members, therapists and foods on ourwalls. We used brushes, lotions, vibrators and massagers. Wesprinkled vitamins in his food and bought cases of pear juice. Webought organic fruits and vegetables and sugarless lollipops. Welearned sign language. We sat through three cycles of Tomatisauditory training. We went to a nutritionist and a homeopathicphysician. We drilled into our ceiling and put up a therapeuticswing and nailed a 4 foot by 4 foot mirror into our den wall. Eachtherapist gave us a list of daily actions we were to take. Wecouldn’t keep track of everything so we made lists and charts.Massage cheeks twice a day. Blow bubbles once a day. Vibratortwice a day. Massage palate once a day. Lotion once a day.

An Example of a “FloortimeFamily” Jake’s progress was rapid and remarkable. After

less than two weeks he was more connected andhis non-verbal communication began tostrengthen… Within one month he began to engagein symbolic play. His non verbal communicationdeveloped rapidly… By the following summer hewas speaking in full sentences. Today he speaks fordays at a time. He talks from the moment he wakesup to the moment he falls asleep, as if he is makingup for lost time. He wants to know everything.

An Example of a “FloortimeFamily” Jake still does some things that one might

consider odd. When he gets excited, often inplay or while watching a movie, he shakeshis head and runs back and forth. He hums alot. You might say he has a difficult timemodulating his emotions. On the other hand,you might say that he has a wonderfulcapacity for pure, visceral joy -- a qualitymany people in our society could benefitfrom.

An Example of a “FloortimeFamily” While the academics of school seem to be

going wonderfully for Jacob, his relationshipswith his peers still seem to be a challenge.He is not quite there yet. We organize asmany play dates as we can and they seem togo fine. Friends will now stay over for 2-3hours. Because his interests are differentfrom that of his peers, not all his classmateswant to get together. Our list of available playdate partners seems limited to a small cadreof friends.

An Example of a “FloortimeFamily” Group situations are more difficult for Jacob

and generally, he finds himself on theperiphery. Kids make fun of him. He doesn’tparticipate in sports with them. They say heis different and it breaks my heart… Sportsand athletics are difficult. More often than notwe both end up angry and frustrated

An Example of a “FloortimeFamily” Floor time still provides rich, wonderful

opportunities for circles of communications.His imagination is lovely, rich and multi-layered.