Greenspan's FLOOR TIME
An Alternative to Behaviorism
The
Developmental, Relationship-based Model for Intervention
We strongly suggest reading Dr.
Greenspan's book, The Child
With Special Needs,
for the very best information on how Floor Time works and
why it works.
Here is a short introduction to Floor Time that we have
compiled.
Background Info: Children diagnosed
with autism/PDD have severe constitutional/ regulatory
problems which cause severe problems in relating and
communications. It is presumed that such children cannot
master various maturational levels without intense
intervention. Those children with less severe physical
disorders or interactive problems are classified as having
regulatory disorders.
Greenspan classifies the
regulatory disorders into five main patterns:
1. the hypersensitive, fearful
child who tends to overreact and needs a safe, quiet
environment;
2. the hypersensitive, stubborn and defiant child who has an
enormous need to control because she is extremely
overstimulated;
3. the hyporeactive,
pain-insensitive child who may appear aggressive due to his
intense craving behavior;
4. the self-absorbed, underreactive child with low motor
tone and low activity level who needs both reality checks
and energizing; and
5. the child with motor planning problems, who is often
labeled ADHD because of her inattentive appearance.
In successfully intervening with
such a child, it is necessary to first determine where the
child is developmentally and what each particular processing
problem is contributing. Greenspan warns us not to skip
steps on the developmental ladder, and to avoid the
temptation of working above the child developmentally (e.g.
honing the so-called "splinter skills" in the absence of a
developmental context for their appropriate use). Rather
than training a child to speak a word or two on cue or to
regurgitate memorized verbal formulas, Greenspan suggests
that we first work on the child's gestural system, and let
language come in spontaneously. This is the only way to
develop speech which is responsive, cued to affect and not
to an artificial prompt.
The typical Greenspan intervention
revolves around a concept he calls "floor time" -- time
which the caregivers, generally the parents, spend entering
the child's activities and following the child's lead.
copyright © 1998-2003
Autism National Committee
What
is Floor Time?
"Floor time is a
special play time that you set aside for the child.
During this period, play is a spontaneous, unstructured
activity when you get down on the floor with the child
and try to follow his/her lead. Your initial goal is to
tune in to whatever motivates or is of interest to the
child.
"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 ...
[During floor time, children at first learn] the
pleasure of engaging with others and the satisfaction of
taking initiative, making wishes and needs known, and
getting responses. [Floor time then creates
opportunities for children] to have long dialogues,
first without words and later with them, and eventually
to imagine and think".
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".
Why Use
Floor Time?
Once a child develops
a complex sense of self he can go on to develop emotional
ideas, in particular the ability to connect his ideas and
feelings to those of others. The child at this stage,
which usually takes place around 24-30 months, can create
mental images of emotional ideas, and this ability opens up
an elaborate world of pretend play. (When this ability is
lacking in children with autism/PDD, it is sometimes said
that they lack a "Theory of Mind." In Greenspan's
developmental scheme, this represents an as-yet
unattained stage rather than an innate deficiency.)
Greenspan's view of
autism/ Pervasive Developmental Disorder (which he prefers
to call "multisystem developmental disorder") is thoroughly
developmental. He faults most interventions for zeroing in
on the initial problem area observed during diagnosis --
motor, sensory, behavioral, language, etc. -- rather than
conceiving the child's challenge in terms of a broad set of
developmental processes across all areas.
What Floor
Time Does
Reestablishing The Child's Progress On The Developmental
Ladder
The Greenspan
intervention method revolves around this concept which he
calls "floor time" -- It's time in which the caregivers,
generally the parents or therapist, spend entering the
child's activities and following the child's lead. If the
child wants to line up cars in a row or twirl a top, the
parents will join the child in his or her preferred activity
(with the intent of developing this action into an affective
interaction) rather than demanding that the child join them
in their preferred activity (a process which, at best, will
produce no more than rote action and reaction).
Starting with this
mutual, shared engagement, the parents are assisted to
draw the child into increasingly more complex interactions,
a process known as "opening and closing circles of
communication." For example, the parent may begin to take
turns with the child who is lining up his cars, until the
child begins to expect and wait for his parent's turn. Then,
the parent may "accidentally" place a car in the wrong spot,
tempting the child to open and close a circle of
communication as he corrects this appalling error.
According to Greenspan, there are six
developmental milestones. He states that appropriate emotional
experiences during each stage will help develop critical
cognitive, social emotional, language and motor skills as well
as sense of self.
SIX
MILESTONES
1. Self Regulation and
Interest in the World:
During this stage the manner in which infants modulate and
processes sensations is an important contributor. Children may
be either hypersensitive (too easily stimulated) or
hyposensitive (need a lot of sensory input to be stimulated).
Children's sensitivities may vary with each sense (touch, smell,
and hearing) or from day to day (sometimes hyposensitive other
times hypersensitive).
2. Intimacy:
At this stage children start to recognize sounds and sources of
speech. They begin to scan the world for familiar faces, objects
and pay attention for 30 seconds or more. This ability to be
intimate forms the basis of all future relationships and cements
motor, cognitive & language skills.
3. Two-Way
Communication:
The child first realizes his actions cause others reactions
during this phase. This is the beginning of gestural dialogues
which leads to the opening and closing of circles of
communication. The experiences of two-way communication help
children form a basic sense of intentionality. This leads to
learning fundamental emotional, cognitive and motor lessons.
4. Complex
Communication:
In this stage the child starts to link gestures into complicated
responses. The number and complexity of circles closed begins to
increase. Growing gestural dialogues become preludes to speech.
The child develops the ability to create complex gestures and to
string together a series of actions into an elaborate and
deliberate problem solving sequence. This growth in
expressiveness and complex gestures also increases creativity.
5. Emotional Ideas:
During this stage the child learns that symbols represent things
and that each symbol is an idea, an abstraction of the concrete
thing, activity or emotion with which the world is concerned.
The ability to create ideas begins which leads to pretend play.
The more the child experiments with pretend play the more
comfortable he becomes with the world of ideas.
6. Emotional Thinking:
The child begins to express feelings using words instead of
actions at this stage. The cause of their feelings becomes
linked to specific actions or events. (I.e. I am happy because I
am playing with mommy.) These links between feelings and actions
help the child to predict, think about future occurrences. The
child also starts to build bridges between play and link them
into logical sequences. The child starts to understand the
emerging concepts of space and time in a personal and emotional
way. There is also an increase in verbal communication and
problem solving skills at this time.
Conclusion:
Children achieve these milestones at different ages. Each
milestone is mastered and is a foundation for the next stage.
Greenspan discusses all of these stages in great depth in his
book, The Child with Special Needs. The book also has many
useful strategies and examples.
How Often?
"Children with special needs often
need many sessions of floor time a day. Many family members,
as well as friends, other caregivers, or students, can be a
part of your floor-time team ... For many autistic/PDD
children, especially for those with severe challenges, six
to ten 20-30 minute floor-time sessions a day is optimal.
One to two sessions a day is often not enough".
From Dr. Greenspan's The
Essential Partnership:
"Floor time is not always easy,
[your] goal is to become a good and active play partner.
If you watch parents, teachers, or even child
psychiatrists try to become play partners, we all fall
into the same pitfalls. Some of get too passive and just
watch the child. Our thoughts drift as she gets involved
in a theme that is not very compelling to us ... The
child needs your emotional presence ...
"Others of us get overly
controlling and bossy. We are all energized, wanting to
make the most of the time taken out of our busy
schedule. We start asking questions about the child's
play and helping to direct the action, stepping up the
pace whenever possible" (p.20)
- Be a play partner
... not overly controlling or overly passive. Follow
your child's lead and join in. Be careful not to ask
too many questions or to direct the action. Also, do
not step up the pace. (p.20)
- You may want to describe
what the child is communicating, especially on
an emotional level. Curiosity, assertiveness,
closeness, dependency, the human body, separation,
rejection, learning about the world are themes that
commonly characterize children's pretend play and
verbal communications. (p.20-21)
- Help your child actively
use his/her imagination. Wonder out loud what
the dog is going to do next or what you will find
behind the tree. (p.21)
- Transform the one-way
activity into a two-way one. Pretty soon,
she/he may be telling you stories, asking the
questions, or arranging the blocks into cities.
(p.21)
- Just being there is
worthwhile as dramatic play. Your gestures -
pointing, smiling, frowning, and vocalizing ideas -
all add an interactive component and complexity and
depth to the play. When your child becomes
repetitive, he needs more, not less, floor time and
more, not less, patience. (p.21)
- The children are the coaches;
you are an active partner, always trying to
expand the activity further than they would on
their own but without taking charge. (p.21)
- Express empathy for
emotional themes. If the child is expressing a
theme of anger and aggression, you don't interfere
by saying "Why is he so mad? Why doesn't he behave
nicely?" Instead you say, "Gee, he really wants to
bomb those bad guys. He's going to destroy them in a
hundred different ways. He must have a good reason
for that." You acknowledge the range of anger and
the fact that there must be a good reason. Your
empathy will enable your child to feel you are on
his side rather than a proponent of your own agenda.
(Your acknowledgment does not imply approval.
Recognizing a child's "pretend" agenda will
strengthen your ability to set relevant limits on
his aggressive behavior at a later point in time.)
(p.21-22)
- Foster your child's ability
to express a range of emotions, a balance of
feelings. Alongside your acknowledgment of
"negative" feelings may come your child's
introduction of the opposite theme. Dependency,
love, and concern will spontaneously emerge
alongside aggression. (p.22) Help your child explore
the reasons for his/the teddy bear's feelings, e.g.,
"you must have good reasons for being so mad" (p.
23).
- Contribute to a sense of
mutual pleasure. Be animated, silly, involved,
joyous, as well as explore aggression in an
imaginative way. Share his smile or pout. Human
relationships can be characterized by a quality of
connectedness that allows for a great range of
feeling and exploration. (p.22)
- Help your child elaborate
on the theme of his play. For example, your
child may explain that "the bear is mad." In
response, you might ask, "very mad?" ... ("Yes.")
and then follow with "What does he want to do?"
("Put you in the ocean and make sure the pieces
never come back together again.") then comment
"Sounds like a big anger." ("It is.") (p.22)
- Help your child amplify
each side of a theme that involves conflict.
Explore the ways both sides behave and feel. For
example, if the play theme is "the cat hates the
dog, but the dog insists on playing with the cat,"
it may relate to a child's insistence on playing
with the one person in his class who is mean and
rejecting. You can learn about the 100 ways the cat
shows his hate for the dog, and discuss how the dog
must play with anyone he wants to irrespective of
the cat's feelings. (p.23)
- You want to respond to your
child's overall emotional tone. So, part of your
role is to make comments that help you
understand the play more and help the child
elaborate more. You could say, "Oh! What will
the pig do when the hurricane comes? How does he
feel?" Or better yet, you could just comment on his
drama, "Oh, the pig sees the hurricane coming."
These are questions or comments that may help the
child elaborate his feelings and add one more piece
to his play. You are expanding his drama just a
little, by summarizing the action and by empathizing
with the child's interest. (p.28).
- Goal 1:
- Encouraging attention and
intimacy. Beginning with the
ability to feel calm, focused, and intimate
... Maintaining mutual attention and
engagement. Your goal is to help your child
tune in to you and enjoy your presence.
(This goal contributes to milestones 1 and
2.)
- Goal 2:
- Two-way communication.
Next you will help your child learn to open
and close circles of communication, at first
with subtle facial expressions and a gleam
in the eye, a dialogue without words ...
Your task is to encourage a dialogue, to
help your child use his affects or emotions,
hands, face, and body to communicate wishes,
needs, and intentions. Over time, you try to
help your child open and close many circles
of communication in a complex,
problem-solving dialogue. (This achievement
correlates with milestones 3 and 4).
- Goal 3:
- Encouraging the expression and
use of feelings and ideas ... Your
goal is to encourage dramas and
make-believe, through which your child can
express her needs, wishes, and feelings, and
gradually to help her express these in
words. (This goal corresponds with milestone
5.)
- Goal 4:
- Logical thought.
Finally, you can help your child link his
ideas and feelings to come to a logical
understanding of the world. Your goal is to
encourage him to connect his thoughts in
logical ways. (This ability corresponds to
milestone 6.)"
Who
Is Stanley Greenspan, MD?
-
Clinical Professor of
Psychiatry, Behavioral Sciences and Pediatrics at
George Washington University Medical School
-
Supervising Child
Psychoanalyst at the Washington Psychoanalytic
Institute
-
Chairman of the
Interdisciplinary Council on Developmental and
Learning Disorders
-
Founder and former
president of Zero To Three: National Center for
Infants, Toddlers and Families
-
Former Director of
the National Institute of Mental Health's Clinical
Infant Development program
-
Recipient of the
American Psychiatric Association's highest award for
child psychiatry research
-
Practicing child
psychiatrist
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