Engaging Floortime (8): Floortime and Floor-Time
I first encountered Stanley Greenspan’s work in 1999, when my husband Jim brought home a copy of his The Child with Special Needs: Encouraging Intellectual and Emotional Growth (published in 1998). The book was not (and did not purport to be) specifically about autism. After reading it, we put it aside, having gleaned a few ideas for interactive play activities from it—activities that seemed very similar to what Charlie’s speech therapist, occupational therapist, and ABA therapists integrated into their sessions between more structured teaching.
And while “Floor-Time” in the 1998 book The Child with Special Needs is now called “Floortime” in the 2006 book Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate and Think and readers can visit Floortime.org; and while the 1998 book is about “children with special needs” including autism, Down’s syndrome, cerebral palsy, and ADD, and the 2006 book is specifically about autism, much of what Greenspan says in both books is the same.
And this ought not to be surprising, as Engaging Autism is not really about autism, as I posted on Monday in Engaging Floortime (6): Don’t judge this book by its cover:
Despite Greenspan’s continual reference to autistic children’s “unique biology” and sensory processing, the view of autistic children that emerges from Engaging Autism is that such children are just like any other children inside. ASD children have “complex developmental problems” and “severe motor planning problems” (p. 4) and so
…may appear to have cognitive disabilities and to lack social skills when in fact they are limited in expressing their abilities and skills by their motor impairments. When we help children with oral motor problems communicate through sign language or other augmentative modes such as computer keyboards, we often find that they understand their world to a much more developed degree than we realized. (p. 5)
…….Indeed, Greenspan suggests that ASD is often misdiagnosed (p. 7, 20-23) and even overdiagnosed (pp. 24-25) and puts a great deal of emphasis on how many evaluators fail to take in contact the interaction between child and parent
Greenspan makes exactly these same points in the beginning of The Child with Special Needs; the main difference is that, instead of using the term “ASD,” he uses “PDD” (see p. 20) and phrases such as “autistic spectrum problems” (p. 107):
A child may be diagnosed with autism, for example, because he has difficult relating to others, when his underlying problems are actually more specific and involve difficulty processing auditory information and a severe overreactivity to sound……To protect him, the child withdraws and becomes aimless, earning the diagnosis of autism. Another child with similar biological challenges may earn a different label. (p. 21)
The use of the word “earn” here in The Child with Special Needs—as in a child “earns” an autism diagnosis—has been replaced with such phrases as a child being “at risk for ASD” or “at risk for developing ASD” in Engaging Autism; to say that a child has “earned” a diagnosis of what Greenspan calls a “devastating label” (p. 21) rather suggests that that child has been doing something to “get” (to “get the benefit of”?) the “label” of autism. Greenspan here critiques the “label” of autism in The Child with Special Needs in order to suggest that parents and the thoughtful clinician ought to look “beyond the label” and focus on the child’s individual differences” (and the phrase “individual-difference” provides the I in what Greenspan now calls his DIR model of treating autism).
Just as parents are said to “contribute” to their child’s developing autism in Engaging Autism, so in The Child with Special Needs are the parents of a special needs child asked to “observe yourselves” and consider how their own “feelings, values, expectations, behaviors, and family and cultural patterns” have influenced their interactions with their child (p. 98):
The mythology of parenting tells us that parents fall in love with their babies within the first few minutes or days. Many do, but many others don’t……. The dashed expectations brought by the recognition that a child has special needs can make bonds between parent and infant slow to develop, although sometimes it may have the opposite impact. (pp. 100-101)
As I wrote in an earlier post, Engaging Floortime (3): Floortime for Parents, Greenspan more than suggests that because of parents’ interactions, or lack of them—if the “bonds” between parent and child are “slow to develop”—their child can be “at risk for autism.” Not only does The Child with Special Needs include a chapter, “Observing Yourselves,” that asks parents to reflect on their own “ways of feeling and behaving” (p. 98); later chapters devoted to “Marital Challenges” (ch. 16) and “Family Challenges” (ch. 17) contain material highly similar to that in “Floortime as a family approach,” chapter 13 of Engaging Autism.
The similarities between Engaging Autism and The Child with Special Needs are striking. The main difference between the two books by Greenspan is the new book’s emphasis on autism—even though Engaging Autism is itself not really about autism.
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POSTED IN: Books, Education, Family, Parenting, Psychology, Treatment
13 opinions for Engaging Floortime (8): Floortime and Floor-Time
Jannalou
Jul 26, 2006 at 8:27 am
It sounds more and more exactly like Son-Rise. Except that the Options people are a tad more New-Agey about their program, and they’re a tad more cult-like in how they run their agency.
Rose
Jul 26, 2006 at 10:05 am
“Guilt” Greenspan, looking for parents who feel “guilty”.
I think as we become aware of the differences inherent in Autism…opportunities for opportunists like Greenspan will become less and less.
The less guilt I have, the better Ben and I get along. It leaves room for forgiveness, teasing, observation…and a whole host of human interaction that guilt destroys.
Guppy “Guilt” Greenspan will not get my cash.
Oddly…the only books I COULD read when Ben was growing up were either by people with autism or their parents. I like being real…
Kristina Chew, PhD
Jul 26, 2006 at 10:05 am
That was my sense of Son-Rise too, especially after my husband heard Raun Kauffman in New York earlier this year.
In reading Greenspan’s 1998 book and comparing it to his current work, much, if not everything, seemed the same—-except for the more prominent mention of autism.
Kristina Chew, PhD
Jul 26, 2006 at 10:05 am
That was my sense of Son-Rise too, especially after my husband heard Raun Kauffman in New York earlier this year.
In reading Greenspan’s 1998 book and comparing it to his current work, much, if not everything, seemed the same—-except for the more prominent mention of autism.
Laura Cottington
Jul 26, 2006 at 9:38 pm
I have really appreciated the reviews. Listening to the comparisons to the older book, and reflecting back to my training with Greenspan in the early 90’s, I am sensing that “parent guilt” thing. In the early 90’s I was consulting and working with Early Head Starts (the birth to 3 version of Head Start). Greenspan spoke to us and trained us in floortime, kind of like it was “up to us” early intervention people to make a difference (kind of like the parents screwed them up). Now that I think about it, he was very judgemental of the population I worked with (at risk teens who were pregnant and low income families). He stated many times that the entire success of the child will depend on the interactions of the parent and child. Almost as if, for every developmental delay we would asses, we could almost always pin it back to early parent interaction. Hmmmmmmmm…..grrrrrrrrrrr……….I wonder what it would be like to sit through his training over 10 years later, now having a child with autism? I wonder if I would feel like he was judging my early bonding time with Sam?
Thanks for making me think.
Kristina Chew, PhD
Jul 27, 2006 at 4:53 am
Laura, thank you for sharing your experience—I’d find it very interesting to attend a lecture or a workshop by him, as an autism mother. I found Alexander’s Daddy’s comments in earlier posts about seeing Greenspan on the DVD’s revealing.
When Charlie was younger, a close acquaintance who was studying for an MSW told us how she had worked with kids with autism, how their parents were drug addicts in an urban setting. I didn’t know what to say!
Micki
Oct 26, 2006 at 10:23 pm
I am so glad to have read your critique of Greenspan. My son was diagnosed with Asperger’s at the age of 4 by a qualified clinical psychologist; I have no doubt of the diagnosis, and indeed I wish I could say it was incorrect. Nevertheless, he began seeing an OT at the age of 3 for sensory regulation problems. This OT was VERY big on Greenspan and recommended I read The Child with Special Needs. They wanted me to start doing floortime at home. I found this VERY difficult; his imaginative play was almost non-existent, it was repetitive and shrill, and my stress levels were already off the walls because of behavior problems he was having at his preschool. Not to mention this was my first child, I had no idea what “sensory integration” or “visual spatial skills” or “motor planning” even were. I was scared to death. And the therapists kept telling me I needed to have “high affect” with him which I thought meant high-energy clown-like play that I did not have in me at the time. I felt like a failure. The book and therapist said I should be doing floortime for 1/2 hour twice a day. I could barely get through 10 minutes. Greenspan is a terrible writer; he takes 10 pages to say what could be said in 1 paragraph. Our OT, like Greenspan, was very “anti-label” and did not encourage me to seek other opinions or evaluations. But as a parent I NEEDED the label in order to understand my son and frankly, the autism label has entitled him to better and more rapid accomodations in the public school system. I put aside Greenspan’s book and got on the floor and just started to play with son when I could, doing things that would make him laugh and be silly, and just being a mommy. I stopped counting the “circles of communication” or worrying that I was “following his lead” or not. Frankly, I have given up on most of the “special needs” type books unless I have a specific problem to deal with, because they make me worry too much. At the end of the day, it’s all about the love anyway.
Nea
Dec 12, 2006 at 2:32 pm
Do you ever get the feeling that so much emphasis is placed on what WE parents should be doing at home while most programs fail to do what THEY should be doing for our children while they are at school? It sure would be easier for us to engage with our children at home had they been effectively taught by those who signed up for the job.
Bridgette
Jan 19, 2007 at 4:05 pm
Unfortunately, the majority of teachers are receiving poor training and/or do not have control over the structure in which they teach. They essentially are “set up to fail” the children. The tragedy of the lack of funding, poor training, and burn out that the teachers face is that the children suffer…the majority of people who “signed up for the job” of teacher did not sign up to fail children… they signed up to help kids.
Nea, a high percentage of special education teachers quit within the first five years (2 years sooner than general education teachers). They realize they are not effective and they leave the profession, only to replaced by another rookie who in turn does not know what they are doing. Instead of attacking, it is better to inquire and demand a highly trained and skilled teacher. If the teacher is willing, but unskilled demand that they send that teacher to training and that they receive a coach. Also, structure is very important. Is the school supportive to the needs of your child? If they are not, you have recourse. Use that power and find a better placement for your child. That way you can build a team instead of feeling blamed and understandably,at the least, frustrated and at the most furious.
I hope that this helps.
Bosco Hui
Nov 2, 2007 at 4:49 am
Floor time is relatively new to school teachers. I have heard both Son-Rise in Option Institute and Intensive Interaction in U.K.. I would like to share my feeling that these three similar approaches are dased on interactive approach and summed up as another effective methods to facilitating the learning of autism.
Bonnie Sayers
May 11, 2008 at 8:29 pm
I had the Son-Rise book many years ago and sold it on ebay before I had the opportunity to read it. I do have their booklet and wanted to learn more about them and write on it. It is informative to read of the comparisons of both of Dr. Greenspans books. Too bad Engaging Autism is not really about EA. I might have to sell that one too. I was very impressed with the course I took at a clinic a few years back. I had the oldest kid there and people asked me why I waited so long to get therapy. I have had issues following along in his online conference as it is hard to hear him in his case examples and I would be nervous with my kid in the same room with him being videotaped.
Maybe he will retire soon and turn over his practice, etc to someone else. The place we got floortime did not call it that, it is known as SEDI, social emotional development..
kay
Jul 29, 2008 at 10:01 pm
I have personally trained with the Interdisciplinary Counsel on Developmental and Learning Disorders (ICDL), founded by Greenspan and Weider. I have read all of the books that have been discussed here, and have attended hours of lectures given by DIR Faculty. Not once have I ever had the impression that Greenspan or the ICDL group point their fingers at the parents as the cause of their child’s autism. Rather, Greenspan challenges parents to take into consideration the child’s individual differences (sensory processing profile) while that parent plays with the child in a loving, natural and developmentally supportive way. With the individual differences in mind, the parents/therapists/teachers are working to play with a child in a way that moves the child up the developmental ladder. Greenspan defines the functional developmental capacities as a way to conceptualize this developmental ladder. This play must then occur in the context of a rich and nourishing relationship. Thus you have the DIR acronym D refers to development, I individual differences and R relationship. The actual time spent playing on the floor is called Floortime.
DIR is the framework under which Floortime falls. It goes further than just using Floortime every day. When used properly it also includes semi structured activites as well as motor planning and sequencing activities. This additional time addresses issues such as visual spatial processing, gross motor coordination, visual perceptual activites, etc…. This is also planned out with the individual differences in mind.
In my opinion, Greenspan has come up with a model of treatment that pulls all therapeutic disciplines together under an extremely effective framework. Go to the ICDL website and read about current research supporting the model.
Finally, to speak to the Floortime videos and several posts regarding Dr. Greenspan’s demeanor. The purpose of the videos was to demonstrate how simply by interacting and playing with a child, parents can challenge that child to relate and communicate at increasingly higher developmental levels. The videos are also an introduction to the Floortime method. Greenspan’s role as a coach is very telling of his view on parents. He does not believe that his 20 minute Floortime session will change the child significantly. Rather, it is the parents who must learn and implement the method day in and day out in order to move the child along. This is in the beginning, very hard work for the parents, as they struggle to understand the concepts and develop a rhythm with their children. It often challenges the parents to play in ways that feels awkward to them.
Greenspan has worked a lifetime in the arena of infant and early childhood mental health and developmental disorders. He has also spent his career researching and publishing information that is being used to change the way we deliver care to this population. It is saddens me to know that this group of people has come to the belief that Greenspan faults the parents. This just is not true. Please toss these misconceptions aside and read Greenspan more thoroughly. This man has changed the way I practice, and has given me knowledge that I’ve been able to pass on to many families….and together we have moved their children “up the developmental ladder”. In my opinion, Greenspan is a genious.
Kristina Chew, PhD
Jul 30, 2008 at 12:27 am
@kay,
thanks for the detailed commentary. teaching has always worked best for my son when it has started by addressing him as an individual and started with his differences, weaknesses, and strengths.
having read some (not as many) of his books as you have, and with care, I still think there are some interesting observations being made about parents. Very best and thank you—-
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