GREENSPAN FLOORTIME: WHAT IT REALLY IS

Stanley I. Greenspan, M.D. and

Jake Greenspan (The Floortime Center)

Greenspan Floortime[1] is at the heart of a comprehensive program to benefit children at risk for developmental challenges including autistic spectrum disorders. It has two dimensions, both of which help children master their developmental stages.

   One is: A specific technique where for 20 or more minutes you get down on the floor with little Johnny or Susie a few times a day.

   And the other is: A general philosophy that informs all the interactions with the child because all interactions have to incorporate the features of Floortime as well as the particular goals of that interaction, be it speech therapy or occupational therapy or a special set of educational goals. 

 The ultimate goals of Floortime are for us first to join the child in their world and second, gradually interest them in ours. Through this experience they can learn how to: 1) focus and attend, 2) relate with real warmth, 3) be purposeful and take initiative, and 4) have a back-and-forth communication with us through gestures and eventually through words. We can then help them learn how to: 5) problem solve and sequence so they are involved in a continuing interaction with their environment and the people in it, and 6) create ideas and use them logically until they have high degrees of reflective thinking, empathy and an understanding the world. One day, if they can evaluate their own feelings, you might hear them say, “Gee, I’m angrier than I should be today.”

 Not every child is capable of achieving the highest level of reflective thinking, but most children are capable of moving up the developmental ladder.  And we have found a significant subgroup that is capable of reaching the highest levels regardless of the original diagnosis.

 Floortime has three steps for reaching these goals, and they all need to work together for Floortime to be successful. They are:

1.     Following the child's lead and joining the child’s world,
2.     Pulling them into a shared world, often by challenging,
3.     Helping them master the Developmental Stages by expanding on their interest.

Step 1. Following the child’s lead

The best known step of Floortime is following the child’s lead,or in other words, harnessing the child’s natural interests.  Why do we follow the child’s lead?  We know that in our own education we had to learn things that we didn’t want to. We neither studied nor acted however we wanted. So why does Floortime take its clue and cue from the child? 

 Because a child’s interests (their lead) are the window into their emotional life. 

 Through these interests we get a picture of what is enjoyable and pleasurable for that child.  Let’s say that a child is staring off at a fan. Or rubbing a spot on the floor over and over again. Or opening and closing a door repetitively. It may be easy to say that it’s because he or she has this or that disorder. But if we start with the essential question:  “Why is little Johnny or Susie doing that,” we may have a different reaction.

 Little Johnnie and Susie are human beings.  They may have a disorder or a set of problems, but they are not the disorder or set of problems.  They are human beings with real feelings and real desires and real wishes.  Sometimes they can’t tell us about them, so we have to figure it out. We have to read their behavior to see what gives them pleasure. And we start by following their lead and using it to engage them. With this first step we join them in their world and show them that we respect what they are interested in.The ultimate aim is to form a close relationship. It all begins with the relationship between the caregiver and the child.

 So if the child aimlessly wanders around the room, we wander with the child.  The child then experiences a partnership in aimless wandering.  Or we might rub a spot on the floor with them. If a child is moving a truck, we may move a truck with them.  This is only the first step, just the beginning—and a very short-lived beginning at that. We want the child to share their world with us—to let us in—not just tolerate our presence. Two things can happen now. Sometimes the child responds to our participation and looks at us, gestures to us, engages with us in whatever is going on. Once the child  interacts with us—that is, they have let us into their world—it’s time to move on to step 2 of Floortime. Here, following the lead may only last for seconds or a few minutes. We do not simply stay in their world following their actions.

 But engagement and acceptance of us as partners are not always the case. Sometimes, as we try to get involved, the child keeps changing what they are doing or completely ignoring us. How do we follow their lead and join their world if they won’t invite us in? Do we follow the aimless activity on and on? If we intervene, how is that following the lead? Aren’t these opposites? 

 Parents say, “Well, I don’t know what to do. I’ve tried my bags of tricks and nothing works.”  Maybe they brought out the child’s favorite book or toy or began a favorite activity. These ‘tricks’ may help the child calm down or focus—and sometimes that is needed—but they may not get them engaged with us because the child didn’t choose them. So it’s best to stick to what the child is doing and don’t feel pressured to do so much to the child.  When you feel stuck, take a step back, relax, and observe.  Ask yourself, “How do I build on what little Johnny or Susie is doing?  How do I build on their pleasures?”  If the answer is, “Well, they aren’t doing anything really,” look again. If they are walking or banging or just wandering, they are doing something.  If your copying them doesn’t encourage them to involve you, how can you build on their interest and get into their world? The answer is: You need to challenge.

 Floortime’s second step ‘challenge’ can be used in two different ways. One is to start the initial interaction with a child when they are ignoring you. The other is to expand the interaction once you have their attention. In this case, it’s to solve the avoidance problem.

 A child is wandering around the room paying us no attention regardless of what we do. So how do we get their attention? We introduce a challenge, using their movement to create a simple game. That is, we get in front of the child so that the child has to go around us to continue to avoid us. He looks at us to check out how to get past and we look back. It’s a cat-and-mouse game and the first little moment of interaction. Even if fleeting, he has let us in. A big grin and positive emotion from us—and importantly letting him get past us—lets him discover the fun in interacting. Soon he may even smile back as we keep up the game and he bests us by getting around us.

 Our ultimate goal for entering their shared world is to bring them into ours and to support them in becoming empathetic, creative, logical, reflective individuals.  We don’t want to pull them in screaming and yelling.  We want to pull them in with warmth and pleasure.  We want the child to want to be in a shared world. ‘Wanting’ is the key. When following the lead, we need to be sensitive to the child. (More about that later.) With a fun challenge we will see that instead of looking annoyed or running away, the child starts giving us friendly glances and warm smiles and letting us in. 

 Floortime is not simply following the child’s lead.

 Step 2. Challenging them to connect to a shared world so they can master each of their Developmental stages.

What will motivate a child to be a part of a shared world?  Is it as simple as running around and jumping with the child or playing on the floor with building blocks?  Or is it as simple as being silly and making funny noises with them or playing copy-cat games with them?  In other words, how does “following their lead” actually mobilize a child to master the critical developmental milestones, the fundamentals of relating, communicating, and thinking?

 The goal is to follow the child’s lead on the one hand but then create opportunities and challenges that bring them into a share world where they can master the developmental stages.  That is the “dialectic,” the two opposite polarities of Floortime:  joining the child in his rhythms, joining the child in his pleasure, but harnessing them to bring the child into a shared world, and a shared world where they then master each of their functional emotional milestones.  That means creating systematic challenges to expand their abilities and master each level of development.  It is in these systematic challenges that many of the specific techniques and strategies of Floortime come in.  Now we are talking about the real skill in doing Floortime, its real infrastructure. 

 Let’s say a child has a favorite car that he loves to bang on the floor. We bang our car next to him; he looks at us and giggles but no more. Playfully we reach for it a couple of times and retreat as he protects his car. Next we can grasp it, making sure he is holding it, so we have a tug-of-war game that he wins. After much playful back-and-forth, we take his car and ‘hide’ it outside the door, showing him where and closing the door. Now he bangs on the door, and we say, “Can we help you?  Can we help you?”  Being really motivated to get that car, he takes our hand and puts it on the doorknob to open the door. Over a few weeks, we expand the interaction, and he begins to say “Op, op, op” and eventually “Open” so he can get that toy. Through following the child’s interest and then challenging, we have mobilized not only attention, engagement, and purposeful action, but also problem solving and even the beginning use of words.  We call this type of challenge strategy “playful obstruction.” We don’t want to do to the child.  We want the child doing to us.  We challenge the child to do something to us rather than us do to the child.

 Sometimes we can start the interaction by doing something to the child that we know they enjoy, especially physical activity such asa little tickle game or a horsey ride.  Children love to get on daddy’s shoulders and move a lot.  But then how do we get the child to do to us?  As soon as he is up on our shoulders, he has to gesture or make a sound to show us that he wants the horse to move more or he wants the airplane to go again.  We challenge the child to take initiative.  If we give the child a backrub, he can show us where he likes to have his back rubbed or whether he wants his tummy or arms rubbed.  If we are playing a finger game or toe game – which foot he wants rubbed or which toes on which foot – he can show us by wiggling or moving that foot a little bit.  So we are always challenging the child to take the initiative to do to us rather than us do to him.  The key is to harness the child’s initiative. 

 Step 3: Expanding the interaction

Let’s say the child is now in our world and wants to engage with us. He moves a truck back-and-forth, and we open our hands to make a tunnel.  He looks at that, gives us a big smile, and moves the car into our tunnel.  Now we have shared attention, engagement, purposeful action, and some problem solving: real thinking. Words, “truck, truck, move,” often follow soon. But there’s more to be done. We begin to give his choices, expanding the play:  “Do you want to move it into the tunnel or the house?”  He goes, “Ha, ho” indicating “house” and points.  We ‘play dumb’—another type of challenge—and ask if he wants the truck in the house or on our head. He laughs and points to the house again.

 Once we get the interaction cooking, a back-and-forth where we get attention, engagement, and purposeful communication, then the whole question is, and this is the biggest missing piece that I see and the hardest part for both professional colleagues and parents, other caregivers, and educators, is how to get a continuous flow of communication.  In other words, children usually communicate once they can be purposeful with gestures – a smile, a nod, arm gestures, body posture – as well as, hopefully and eventually, use words.  But the hardest thing for children, particularly children with developmental challenges including autism, is how to make that a continuous flow: going from a few interactions where they use a single word or gesture to 50 or 100 back-and-forth interactions in a row so you two are having a real conversation. 

 My advice is very, very simple:  Make it a major objective.  Don’t skip it.  With the child who wants to go out the door, we make it into a 10-step interaction rather than one.  “Well, mommy can’t open the door. Get daddy.”  The child pulls on daddy, and daddy has a hard time too.  “Can you show me? Do I turn or pull the knob?” and the child shows you.  The child can make a sound to make the door open and so forth, until you get 10 circles of communication rather than one of simply opening the door.

 We need to expand circles of communication—often by playing dumb—to get a continuous flow where the child takes the initiative, where it isn’t just us doing to/for them. And continuous flow is not just repeating the same action over and over.  We always need to vary what we do. That challenges the child to expand his ideas and come up with new solutions, often within the same basic scenario or game. 

 Once the child has words, it’s the same thing: can we get a lot of back-and-forth use of words?  Once a child is logical, can we get many logical circles of communication?  I see many, many children who read and do math.  They can use whole, long sentences but can’t have a long back-and-forth conversation. That becomes the hard part.  That is often the missing piece in many children’s development: getting the continuous flow going. 

 So when doing Floortime, I’m asking you to always think about its two poles – following the child’s lead and challenging them to master new milestones.  We are always trying to broaden the child’s capacities in terms of their current milestones — strengthening and broadening those and introducing the next one.  If they are a little purposeful, we want them to be very purposeful.  If they can open and close three or four circles of communication (back-and-forth’s with gestures or words) we want to get it to seven and eight and then to ten and twenty until we get 50 or more.  If they have a few words, we want to extend back-and-forth conversations to get a continuous flow.

  Individual Differences

To engage in these Floortime interactions, following the child’s lead on the one hand and on the other challenging the child to master each of their new milestones, we have to do something very, very important—we have to tune into their individual processing differences!  If a child is under-reactive to touch and sound, we have to be very energetic to pull the child into a shared world.  If a child is over-sensitive to touch and sound where they hold their ears and get overwhelmed easily, we have to be extra soothing while still being compelling.  Many children have mixtures of over- and under-reactivity so we have to be soothing and energizing and compelling. For instance, if they are under-reactive but sensitive to sound, we use a soft but compelling voice, whispering, “Here!  Here!”

 We have to pay attention to their auditory processing and language abilities.  We don’t want to simplify by slowing down the cadence of our words or speaking in monotones (or not speak at all!) because they process words slowly and need help to tune in. Instead we keep a normal rhythm because that is more pleasurable and easier for a child to digest. We can use simple phrases and repeat them.  If we are saying “open the door,” it’s not in a monotone voice, “ooopen, ooopen,” but in a sing-song voice, “Open door?  Open?” and showing the child.  It’s with energy and rhythm but with simple phrases. With visual spatial processing, some children have good visual memory but can’t see the forest for the trees. They are not yet good visual problem solvers. We can use lots of visual cues in their visual memory skills to help them share our world.  Many children have motor planning and sequencing problems.  Here we start with simple actions and go to more complex action patterns. 

 We have to tune into the child’s individual differences in order to challenge them to master their different levels. 

  Our Emotional World

We also need to pay attention to ourselves as caregivers, as families, as family members, as therapists.  What are our natural strengths and weaknesses?  What do we do easily?  What is hard? Are we a high energy person and great for kids who are under-reactive and need lots of energizing and wooing, but we have a hard time soothing?  Or are we great soothers and very good with hyper-sensitive children who need a lot of calmness, but we have a hard time energizing up for the child who is under-reactive?  Do we take the child’s avoidance as a personal rejection and shut down and not try as hard?  Or does the child’s avoidance make us intrusive, not paying attention to his pleasure but grabbing him and forcing him to pay attention to us rather than wooing him into a relationship? So we have to think about our own personalities and family patterns, and as therapists, our therapeutic skills and strategies. Which kind of child is easier or harder for us?  When we ask these difficult questions, we can fine tune our strategies to meet the child’s individual differences and create the most beneficial learning interactions.  Then we know how we have to stretch to work with a particular child as we enter their world and tailor our interactions to their nervous system.  

 In summary, Floortime involves a polarity or dialectic between following the child’s lead, entering his world and pulling him into our world, and challenging him to master each of the developmental stages. It means paying attention to the child’s individual differences in terms of processing sounds, sights, and movements and modulating sensations as well as paying attention to the family patterns and to our own personalities. It means getting into a continuous flow.

 That is the heart of Floortime. And that is why Floortime is not just a technique where several times a day we spend 20 minutes or more with a child at home. It is also a philosophy for school interactions and for interactions in the store or car. 

 Greenspan Floortime is for all the time.

©The Greenspan Floortime Approach® 2017