Engaging Floortime (2): Greenspan on How Autism Develops

by Kristina Chew, PhD on July 18th, 2006

I will begin my review of Dr. Stanley Greenspan’s new book, Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate and Think not by reviewing the techniques of his Floortime approach, but by considering his views on “how autism develops.” Appendix B of Engaging Autism is entitled “How Autism Develops: The DIR Theory” and opens with a reference to Greenspan’s earlier work on “the development of symbol formation, language, and intelligence,” and especially to his 2004 book The first idea: how symbols, language, and intelligence evolved from our primate ancestors to modern humans, whose co-author is Stuart G. Shanker.

According to the observations we have made of a range of infants, young children, and their families (Greenspan, 1979, 1992, 2001; Greenspan and Shanker, 2004, 2006) the development of symbol formation, language, and intelligence is based on a series of critical, emotional interactions early in life. When these interactions are not mastered, these abilities do not develop. Biological factors present in autism can make it difficult for a child to participate in these interactions. We have observed that children with ASD have not fully mastered these critical early interactions (Greenspan et al., 1987; Greenspan, 1992; Greenspan and Wieder, 1998, 1999). (p. 395)

Though this is only one paragraph from Engaging Autism, these four sentences are emblematic of Greenspan’s thinking throughout the book and, indeed, behind the uses of Floortime in treating “children at risk for ASD” (p. 399). The first sentence is a general statement about the development of “symbol formation, language, and intelligence” in children—about child development—-about children in general. A certain “series [my emphasis] of critical, emotional [my emphasis] interactions early in life” are necessary for a child to “master,” and it is precisely this “mastery” of these “formative emotional interactions” that does not occur in children with ASD. Greenspan’s Floortime is an intervention designed to create “special opportunities for the necessary [my emphasis] formative emotional experiences [my emphasis].”

In other words, due to “biological factors,” an autistic child (according to Greenspan) has difficulty in acquiring these “formative” experiences, so that his development is impeded. Floortime, with its emphasis on looking at the “core psychological deficit in autism” —identified by Greenspan as an infant’s capacity to “connect emotions or intent to motor planning and sequencing and to sensations and, later to emergent symbols” (p. 397)—focuses on recreating, via those “special opportunities” (i.e., the specific techniques of Floortime), that connection between emotion and motor planning, etc., that some children do not develop “because of their unique biologies” (p. 395). Greenspan notes that these “biological factors” include a child’s genetic make-up that “may presdispose a child to autism, or create vulnerabilities to cumulative pre- and postnatal challenges such as infectious illnesses, toxic substances, and factors that can precipitate autoimmunity” (p. 396)—-Greenspan seems here to be referring to theories about the MMR vaccine, thimerasol, mercury, environmental toxins, air pollution, etc., as causes of autism.

In the next sentence in this paragraph (in a section entitled “A Multifactor, Cumulative Risk Model”), Greenspan writes:

Postnatal factors such as experiential or physical stress may also contribute to the behavioral patterns symptomatic of autism and ASD. (p. 396)

A few pages later, he writes:

When biological factors (or severe deprivation or abuse) interfere with the formation of a primary connection among the sensory system, affect, and the motor system, behavior is not strongly linked to affective qualities of sensation. Therefore, infants with this deficit evidence more aimless behavior…..(p. 399)

In addition to “biological factors,” Greenspan suggests that something in an infant’s experience may be causing “stress” on his system. The second passage quoted above provides a more specific sense of what he means by “experiential stress,” namely “severe deprivation or abuse.” It is suggested here that a child is “at risk for ASD” (p. 399) because something is lacking in those taking care of the child—the child’s parents; indeed, Greenspan suggests that the child’s caregivers may be “severely depriving” and even “abusing” a child.

Is it possible that Greenspan is suggesting that a child can be “at risk for ASD” due to improper care from the child’s parents?

If so, enfolded in Greenspan’s discussion in Appendix B of “How Autism Develops” and in his “developmental, individual-difference, relationship-based” DIR model, is more than a hint of a theory of autism that most parents have long thought outmoded and discredited, namely, the refrigerator mother theory of autism first stated by Leo Kanner and promulgated by Bruno Bettelheim.

I will continue my analysis of Engaging Autism and more of the specifics of the Floortime approach as Greenspan presents them in this book in a future post.

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