What is Floor Time?
Floor Time is a major component of the Developmental, Individual Difference Relationship-Based model (DIR) developed by Dr. Stanley Greenspan, a psychiatrist, and Dr. Serena Weider, a psychologist. Parents and other interested individuals work with the child at his/her current developmental level to encourage higher levels of interaction by the child, with the goal of ultimately developing more spontaneous and flexible responses from the child. The focus is on underlying emotional developmental processes rather than on specific symptoms or behaviors. The sequential goals of Floor Time are the child’s development of attention and intimacy, two-way communication, the expression of ideas and feelings, and logical thought.
How does it work?
Typically developing children go through six developmental milestones which support their emotional development and relationships. Children with developmental disorders may fail to progress through these stages at any or some point, which compromises their cognitive, social-emotional, language, and motor skill development. Floor Time interactions assist the child to develop progressively more mature interactional and emotional responses so that they can respond to environment appropriately, engage in purposeful and intentional communication, develop a sense of self, begin to take another’s perspective, and engage in logical thinking.
Who can benefit from floor time ?
The intervention is typically done with children up to age 6. Any child with a developmental disability and difficulties in emotional relating can benefit, but most of the emphasis had been on children on the autism spectrum. Greenspan and Wieder
(1999) noted that children who were able to sequence actions better (motor planning) and learn to imitate were able to respond more quickly to intervention. Children with severe sequencing difficulties, who had patterns of regression, and limited imitation skills showed poorer progress.
There is little sound research to support the efficacy of Floor Time. Greenspan and Wieder (1998) reviewed the charts of 200 children they had treated with Floor Time for 2 or more years and found that 58% had a “good to outstanding” outcome, 24% had an intermediate outcome, and 17% had poorer outcomes. They note that these children were not a representative sample of children with autism spectrum disorder (Greenspan & Wieder, 1998).
Dr. Rick Solomon, at the University of Michigan, using the Greenspan model of Floor Time to treat 74 children on the autism spectrum for the P.L.A.Y. Project, found that 45.5 % made “good to very good functional developmental progress”(Solomon, 2004).
How is it implemented?
Parents, siblings, volunteers, neighbors, caregivers, students, and/or family members provide therapy at home, which is started at the lowest level of development that the child has not yet obtained. Parents are taught how to engage and respond to their child. A stage is considered mastered when the child can exhibit it even during times of high emotion. The adult gets down “on the floor” and follows the child’s lead in playing with the child at his/her current developmental level and introduces elements to engage the child at a higher level of social interaction. An attempt is made to turn whatever the child is doing (preservation, self-stimulation, aimless wandering, etc.) into an interaction.
For example, rather than trying to teach a child who is perseveratively spinning the wheels on a car to play with something else or to play with the car appropriately, it would use the child’s interests and, warmly smiling, spin the wheel in the opposite direction to get reciprocal, affective interaction gong (Greenspan & Wieder, 1999, p.151.)
The child’s unique needs are taken into account (such as difficulties in motor planning, sensory integration, auditory discrimination) in planning intervention. It is recommended that each session last for 20-30 minutes, with six to ten sessions a day. Floor Time therapy may be combined with other traditional therapies such as occupational, speech/language, physical therapies, etc.
Concerns regarding Floor Time
Very intensive treatment is recommended (up to 5 hours a day) which may be difficult for families to implement and may take time away from other needed or more effective therapies, time for siblings, and family needs. The University of Michigan
P.L.A.Y. Project states that the average cost is $2500 a year per child. There is no sound research supporting the efficacy of the Floor Time treatment.
For Further Information
Floortime Foundation: Reaching Beyond Autism. www.floortime.org
Greenspan, S. I. (1992). Infancy and early childhood: The practice of clinical assessment and intervention with emotional and developmental challenges. Madison, CT.: International Universities Press, Inc.
Greenspan, S.I., & Wieder, S. (1998). The child with special needs: Encouraging intellectual and emotional growth. Reading, MA: Perseus Books.
Greenspan, S.I., & Wieder, S. (1999). A functional developmental approach to autism spectrum disorders. The Journal of the Association for Persons with Severe Handicaps, 24, 147-161
Solomon, R. (2004). The P.L.A.Y. Project: Play and Language for Autistic Youngsters Research Abstracts (University of Michigan Play Project Home Consultation Program for Young Children with Autism) www.playproject.org/research
Wieder, S., & Greenspan, S.I.(2004). Can children with autism master the core deficits and become empathetic, creative, and reflective? www.icdl.com-publications-pdf-10-15yearfollow-up.pdf.