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The "Floortime" Treatment for Autism

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Updated October 07, 2008


What Is The Floortime Treatment for Autism?

The following is drawn from the transcript of a web radio program presented through the www.floortime.org website. The original show aired in spring, 2006. Thanks to Dr. Greenspan for answering my questions about Floortime and the DIR (Developmental, Individual-Difference, Relationship-Based)therapeutic method.

Question from autism.about.com:

What makes the kind of play that you do with your child when you are doing Floortime play different from typical play with a child that a parent would ordinarily do?

Answer from Dr. Stanley Greenspan:

Dr. Greenspan: The question is, “What makes Floortime play different from typical play?” What makes it different is that the parent is working and the child is having fun. Over time, the parent or the therapist will have fun too, but you are challenging the child to do really six things at once, so the highest level the child can, he or she may not be capable of all six initially, but eventually we want to get them there.

You are challenging the child by following their interest and their lead, so it’s like play, if they are interested in dollies or if they are interested in a truck, or if they are interested in aimlessly wandering around the room, you are taking the lead from them, and then you are using their interest to get their focus and attention, to get them engaged, and to get two-way communication going – opening and closing circles of back-and-forth interaction where they are taking initiative. You are trying to get as many of these in a row as possible. Then you are trying to also engage the child in what we call shared social problem solving, where the child is taking you to the door, showing you where the toy is, taking you to the refrigerator, etc. Then you are trying to help the child, if they can, speak, use ideas, and tell you what they want, what they want to do, or speak for the dolly and you speak for the other dolly. Then you are trying to help the child connect ideas together, like your dolly might say, “Gee, why should we build a house?” or “Why should we feed the baby?” and hopefully you will get an answer, if your child is at that level.

Now not all children will be at all the levels. While you are doing this, you are also profiling and tuning in to your child’s nervous system. Some children are over reactive to touch and sound so your voice is extra soothing. Some children are under reactive and need extra energy in your voice to get their attention, so you energize up. For the child who is aimlessly avoiding and walks away from you every time you come near them, you are getting “playfully obstructive” – you may get in front of them and play a cat-and-mouse game so they have to scoot around you, or build a little fence around them with your hands and then they have to duck under the fence or say “open” to get away from the fence.

So basically, Floortime is a special kind of play where you are harnessing all these abilities of the child by tailoring your relationship to the child’s nervous system, and having fun because you are following the child’s leads and interests. Then when the child looks at you or giggles or talks to you, it’s meaningful. It’s not contrived, it’s not forced, and it’s not a rote skill. That’s what makes Floortime special. That’s why we call the model the “DIR Model” – because the “D” part means we focus in on whether the child needs more work on engagement or two-way communication, the “I” is focusing in on their individual ways of their biologically based ways of dealing with sensations like being over or under reactive, and the “R” is learning relationships that are tailored to their nervous system, and meet them where they are at their developmental level. So that’s what makes it a special kind of play.

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