Floortime

Stanley Greenspan is a Clinical Professor of Psychiatry, Behavioural Science and Pediatrics and a practicing Child Psychiatrist. Greenspan developed DIR aka Floortime, a unique therapy approach for working with children with special needs, which has been significantly successful with children diagnosed with autism, a neurological disorder that deeply affects the child’s ability to communicate effectively with their environment.

According to Greenspan’s theory, there are six preliminary developmental milestones, which underline all human intelligence and interactions with the world: language, communication, turn taking and other social, emotional and cognitive skills. The six milestones are:
1) The child’s ability to be interested in the sensation from the world as well as calm him/herself down.
2) The ability to engage in relationships with other people
3) The ability to engage in two-way communication
4) The ability to create complex gesture, to tie together a series of actions into an elaborate and deliberate problem-solving sequence
5) The ability to create ideas
6) The ability to build briges between ideas to make them reality-based and logical
(Greenspan and Wieder, 1998).

The Floortime approach is designed to help children that for some reason (i.e. their particular structure of the brain, etc.) did not develop one or more of those six milestones.
Floortime helps the child go back to the missing milestone and re-build it, so that more advanced and complex skills will be built upon.

The philosophy of Floortime is very unique and it is very humanistic in nature. It stems from deep respect for the child, and tries to use the child’s strengths and areas of interest in order to build upon new skills and to challenge the child. Also, it is most important to note that Floortime tries to bring out and nourish the internal motivation of the child in the areas of speech and communication. Rather than “teach” the child how to communicate, the parent/therapist/caregiver leads them to find their own internal motivation, from which stems the will and drive to communicate with us.

Another principal extremely important in Floortime is that children learn much better through activities that involve a relatively high level of emotional excitement, especially positive one. Actions such as raising our voice to a vivid, dramatized and high-pitched sound, making broad gestures, or engaging in a pleasant physical ativities are some examples of how we can bring the child’s system to a level of excitement that is optimal for their learning. The child will be more inclined to pay attention, engage in the activity, and as a result – close more circles of communication, and even increase output of language. When we follow the child’s lead, there is more chance the activity will end up being “high energy” and stimulating, and engaging for the child, since it is the child’s interest to begin with.

By following the lead of the child, the parents, caregivers and therapists try to increase circles of communication with the child. The focus is on how many circles the child closes, rather than the actual means of communication (the child can communicate with their actions as well as vocalizations, etc.; In some cases even “avoidance” is communication – if it is a response to a communication circle that was initiated by the caregiver). By responding to the child’s actions and acknowledging
his/her interest, we help the child step out of their “shell” and engage in the world outside them. It is essentially like inviting ourselves to their world, reach out to them, and than pull them out to be interested in the world around them.

According to Greenspan (1998), following these principals can change the structure of the brain of children that otherwise were known to “lack” the ability or the will to communicate. Floortime can be adapted to different needs and levels of communication.

Recommended reading:
The Child With Special Needs: Encouraging Intellectual and Emotional Growth by Stanley I. Greenspan and Serena Wieder. This book covers not only the basics of Floortime, but also brings case studies of both children and their families, including the families' coping styles with the child's condition.