Engaging Floortime (7): The “First Principle” of Floortime

by Kristina Chew, PhD on July 25th, 2006

In my previous posts on Stanley Greenspan’s new book Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate and Think, I have noted:

How Greenspan more than suggests that parents at least “contribute” to a child’s being “at risk for ASD” and even developing ASD (Engaging Floortime (2): Greenspan on How Autism Develops and Engaging Floortime (3): Floortime for Parents);
What Greenspan’s view of meltdowns and tantrums is—an expression of a child’s “free speech”—and my uncertainty as to the practical applications of his suggestions (Engaging Floortime (5): Tantrums and “free speech”);
How Engaging Autism, contary to its title, is not itself engaged with autism and not about autism (Engaging Floortime (6): Don’t judge this book by its cover).

(Greenspan has a co-author, Serena Wieder, Ph.D.; Engaging Autism is written using both the singular and plual first-person pronouns. Occasionally, in writing in the first-person, Greenspan inserts his initials in parentheses—”(SIG)”—to underscore that the “I” used in the book is him in particular.)

Today, I will consider how Greenspan describes the “first principle of the Floortime technique,” namely, following “the child’s lead, regardless of where his interest lies” (p. 70). Greenspan’s explanation of the “first principle of Floortime” begins with a (hypothetical) example of a “harsh” mother, after which he provides a narrative of himself on the floor successfully interacting with child. The first step of Floortime is not so much to follow “the child’s lead” (p. 71) as it is for parents to realize that something is at fault in their thinking about their child. Further, Greenspan’s discussion of the “first principle of Floortime” also establishes the greater understanding and ability of an expert over parents, with one expert (Greenspan himself) shown in action on the floor.

“…the ticket to engaging the child’s interest is joining him in his world,” writes Greenspan (p. 70). A parent or caregiver must follow the child’s lead (the title of this section) and join the child in the child’s interests; by doing so, a seemingly purposeless activity like rubbing a piece of cloth over and over on the floor can be transformed into a successful interaction, through the techniques of Floortime. The typical response towards a child engaged in such a floor-rubbing activity is this:

…his mother might simply say, “Stop!” in a harsh voice to scare him out of it, or pull the cloth away or try to move his face to look at her and maybe reward him for doing so with a cookie. Alternatively, the mother could think, “At least he’s finding some pleasure and relaxation in rubbing that piece of cloth; let me rub it with him for a second and see if Ii can enter his world and see how he is feeling.” Then she might put the cloth over her face and see if the child reachers for it. If he does, the mother can make a game of iot and eventually entice him to rub her arm or nose with the cloth or even search for it in her hands. Much later on she might speak for a doll who “loves pieces of cloth,” and so forth. (p. 70)

(It should be noted that it is not clear whether Greenspan has actually observed a mother thus interacting, or not, with her child, and that the scene describing her may very likely be a hypothetical example. He does note in his Introduction that “the profiles of children at the beginning of each chapter are composites of children we have treated or whose parents have contacted us with questions” (p. xiv).)

Whether the mother and child described in this passage from p. 70 are a composite drawn from actual observations, or whether the scene has been created for the sake of an example, this scene contains many details that are characteristic of Greenspan’s approach to helping autistic children in Engaging Autism. In keeping with Greenspan’s suggestion that parents are not providing appropriate emotional interactions with their children, the mother in this scene uses a “harsh voice” to “scare” her child out of rubbing the floor. She is then said to engage in two similarly “harsh” actions towards her child, pulling away the cloth and even taking hold of the child’s face to get him to “look at her” (a veiled reference to an ABA program in which a child is taught to “look at me”). Finally, the mother gives the child a “reward”—food in the form of a cookie—for looking at her (another veiled reference to ABA and its use of “reinforcement”).

Greenspan’s first suggestion to this hypothetical mother is for her to change her thinking, to seeing the floor-rubbing as “pleasure and relaxation” for the child and to considering joining her child on the floor to see how he feels about rubbing the floor. His next suggestion is again directed to the mother, who is to put the cloth (dust and all) on her face and “see if the child reaches for it” (which would, technically, be difficult if the mother has a cloth over her face). Greenspan than issues a warning to the mother or caregiver not to offer the child something that she is interested in, as this may well result in the child “[retreating] into her own world, feeling the caregiver isn’t interested in what she cares about” (pp. 70-71). That is, the mother who does not follow her child’s lead is ignoring her own child’s interests. As a parallel example, Greenspan offers the example of what we adults do “when we want to engage a new acquaintance at a cocktail party” (p. 71)—-an example which seems rather out of place in explaining how to start teaching an autistic child.

At this point in his discussion of the “first principle of Floortime,” Greenspan inserts himself to show how he starts with a child’s interest (floor-rubbing) and turns this into the child “at least acknowledging my presence and relating to me a little bit, though not yet with much pleasure” (p. 71). Greenspan describes himself (using his initials, SIG) getting on the floor beside a floor-rubbing child and getting a child to rub his (SIG)’s hand instead. The child rubs the floor, Greenspan rubs a spot by the child’s hand, the child moves his hand; Greenspan “very gradually” moves his hand a bit more in the child’s direction and:

I watched his face: he looked a little puzzled and actually gave me a little look—it was the first time he had looked at me—as if asking, “What are you doing?” As he moved his hand away again, I moved my hand ever so slowly toward his, and when I was about to move my hand under his, he uttered, “Uhnnnn uhnnnn uhnnnn!” ……

I pulled my hand back a little as though to acknowledge his annoyance and show him that I respected his purpose gesture. He seemed to take some satisfaction in that; he kept rubbing his spot, and his voice texture changed slightly to a more rhythmic “unnn, unnn, unnn.” I joined in with some rhythmic sounds of my own and rubbed next to him for another few second. (p. 71)

Greenspan threads his description of his effective interaction with the child with kindly terms; he talks about “games” and being “playful” and working “gradually”; he emphasizes his own patience and gentleness, versus the “harsh” cookie-rewarding mother in his earlier example. Greenspan describes how he continues to move his hand closer while making “rhythmic sounds,” “each time a little more playfully with a little more of a smile on my face” (p. 72). After the fifth try, the child touches his hand; by the eighth, he rubs Greenspan’s hand, which is placed over the child’s “favorite spot” (p. 72). Next, Greenspan describes how he gets “a little game going” in which the child “wanted to rub my hand rather than his spot and I would move it away and then move it back toward him” (p. 72). In the child’s second session with Greenspan, the game continues and “I [SIG] got some little smiles” (p. 72).

The chapter closes with Greenspan noting “one of the biggest obstacles to engaging children,” namely “the parents’ feeling that the child doesn’t want to engage with them—rejects them—-” (p. 77). Greenspan refers again to himself by way of contrast:

However, I (SIG) have never worked with a child who didn’t, at least after a while, enjoy the human world more than the inanimate one…..
……

So, if you the caregiver find youself getting annoyed that the child is “rejecting” you, take a break for a few minutes to regroup; then try to be sillier and fun loving as you persist in your task of getting between the child and what she is trying to do so. Try to become the plaything in the child’s life…….This simple engagement is the first step in falling in love…… (p. 77)

Again, Greenspan addresses his advice to the parents. While seeming to be compassionate towards frustrated, worried parents (”take a break for a few minutes to regroup”), Greenspan is rather quite critical. Parents are consistently described in negative language (”harsh”; “annoyed”); they must be advised to be silly, fun, and playful, in order to promote proper engagement with their child, “that first step in falling in love.” This last phrase is vague: Is Greenspan suggesting that it is via Floortime that a child will (finally) fall in love with the parents? Or, is the implication that, by properly engaging their child, the parents will (finally) “fall in love”—will love—their own child?

And that, parents of autistic children, do not love their own children?

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Engaging Floortime (7): The “First Principle” of Floortime

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