©David Sponder, L.E.P., BCBA, RDI CC, Floortime C1
Executive Director, Sponderworks Children’s Services

Introduction

A Floortime session is marked by the adult’s willingness and availability to follow the child’s lead and to be very responsive to her interests.  The adult uses a variety of techniques (described further below), to help the child to initiate and participate in interaction.

Very importantly, Floortime is not mere play at all.  If you are doing it right, you should be spent after the session!  That is because you must exercise an intense focus on the child and be highly responsive to everything that she does. In addition, you have to remain fully aware of what your goals are and what the child’s obstacles are. Because you are following the child’s lead, you are improvising, and that is very hard to do – at least at the beginning, or so it was for me.

Floortime is not mere play at all – it should be very apparent to the casual observer what the goal of the session is, what skills you are trying to evoke in the Learner. That means the session is very focused on a particular type of responding (even though, because this is a method that utilizes a dynamical systems-based approach, you respond to any variety of the response you are looking for).

Affect Diathesis

A major conceptual view of the prime deficit in autism Greenspan called: “Affect Diathesis,” which refers to the difficulties people with autism have in turning a thought or intention into a successful serious of actions.  An individual may want to do something, but their perceptual and motor systems can’t seem to make their plans work.  Or, they may have trouble forming intentions in the first place. This is why it can be the best thing to let the child to be the source of ideas and not just expect him to respond to directions or perform rehearsed actions on cue.

Forming an intention is an emotional skill, because it involves mobilizing interest and motivation, as well as perceptual and behavioral skills and the ability to work with others in order to be successful.  Therefore, you may start out simply helping a child do something you think he wants to or is trying to do.  But as he develops emotionally, he learns to engage others in the process.  Problem solving is something you do often do by yourself, but more often, you learn how to do it with help from others and you continue to do it by cooperating socially with others.  Social and emotional skills are actually much more important to have than mere skills orsmarts.”

The Floortime partner helps a child 1) form intentions (if the child wanders around and doesn’t seem to really operate on intentions) and/or 2) facilitates the accomplishment of the child’s intention.  The Floortime partner wants to make herself an integral partner in the child’s intentions and actions.  This “socializes” or “makes interactive” or “makes reciprocal” or “co-regulated” or whatever term you want to use – what would previously have been solitary actions and isolated systems.  The goal is “inter-dependent” rather than independent performance during a Floortime session, because the whole thing is about relating on ever more social, intimate and intersubjective levels.

DIR

DIR represents the theoretical foundations and principles in which the method is based.  DIR is based on a model of typical development that comes from years of research in infant/child development, neuroscience, developmental psychopathology and infant mental health, among others.

Floortime is the body of techniques used in therapy that are based on these foundational principles of DIR.  It is important for Floortime partners to know how to bring the child up the ladder of development and why the skill foundations at each stage are so important.  Without this, intervention can be scattered and not systematic. We have found that it is indeed true what developmental psychologists have always maintained – that when you work on skills that exceed the mental foundations the child has, you end up with rote responding. 

We also find that a child’s true emotional and cognitive developmental foundations, while they may be much younger than their chronological age, can be a taught in a way that respects their chronological age (“age-appropriateness”), and does not make them wait until they achieve mastery of foundations before they can participate in meaningful, age-appropriate activities.

Floortime techniques help you to get interactions and learning going and to maintain activities and interests for longer periods.  Basically, they allow the seizing of opportunities to provide interaction and growth that is at the heart of the technique.  Floortime techniques are used to accomplish the goals and objectives of DIR.  Below, we describe some of the more important techniques and provide suggestions for doing Floortime successfully.  We caution against however, using the techniques without understanding what the point of DIR is.  We highly recommend reading more about DIR.

Developmental

The DIR model outlines stages of “functional emotional developmental capacities,” that have to do with the current states and stages of development of the child’s intellectual/cognitive, communication, and motor functioning. The developmental aspect concerns itself with how the child integrates the skills in these domains to form intentions and action plans to accomplish them, to make sense of the world and of other people, and how all of the above and below contribute to the child’s sense of self-efficacy and personality. Before going on, we should note here that there is a great deal of overlap and no clean demarcation between the “Developmental,” “Individual Differences,” and the “Relationship” domains of the DIR model.

The DIR model is a “stage model” of development. “Stage models” imply that children have to master earlier stages before they can successfully master later stages, and that each stage features unique aspects and ways of experiencing the world.  The DIR model focuses heavily on the child’s psychoemotional development. There is a general consensus in the field of neuroscience, evolutionary psychology, attachment theory, anthropology and ethology, and other fields that concern themselves with brain evolution and brain function, that the explosion of growth in size and integration of the human brain was driven mainly by needs for social cooperation and emotional intelligence. Greenspan long maintained that emotions constitute the “orchestra conductor” that organizes all of the other work of the mind’s “instruments.” We know from neuroanatomy that the so-called “emotional” or limbic parts of the brain form critical association centers that integrate information. Current research reaffirms that the emotional brain is definitely “in charge” and forms its own executive. In fact, when we think too much, we bog ourselves down and lose our “presence” in the here and now, resulting in removal in some way or another from social context.  This is the error we make when we try to try to teach social and emotional functioning through cognitive means – as lessons and rehearsed responses to cues.

The DIR model delineates a sequence of functional emotional developmental capacities that come from thousands of observations and empirical studies in the field of Infant Mental Health, Attachment, and Child Development. The following is a very brief outline of the stages:

DIR/Floortime Stages of Development

DIR/Floortime Stage I:  Shared Attention and Regulation

This has to do with the infant’s or child’s ability to be calm and interested in the world. It is about homeostasis or what some call, “homeostatic functions” (the infant’s nervous system learns to process and modulate sensation and arousal) and what is needed in order to achieve it.  In infancy, it is a given that homeostasis is not possible without the symbiotic relationship between parent (primarily the mother) and the child. It is a two-way street that depends on 1) the mother or caregiver’s abilities to provide for the sensory, biological and emotional needs of the infant, which requires the caregiver’s necessary ability to “attune” to the child’s unique signals, and; 2) the infant or child’s neurological integrity and subsequent ability to regulate sensory stimuli and arousal, as well as the infant’s ability to provide mother with coherent, “readable” signals and the ability to benefit from normal, species-specific stimulation and soothing.  In typical development, acquiring the ability for shared attention and regulation is a primary developmental task for infants between birth and three months of age.

DIR/Floortime Stage II: Engagement and Relating

Following the basic “setting up” of the nervous system for modulating and regulating sensation, the infant or child should be ready to begin engaging in simple affective relating with caregivers. This involves abilities for selectively focusing on the human face and voice in a resonant fashion, in the context of a dyad with an attuned caregiver.  As mentioned above, this is a two-way street requiring an attuned caregiver and an infant nervous system with the integrity to benefit from normal “species-specific” interactions (i.e., being touched, held, bounced and picked up, listening to voices, looking at faces, etc.).   An infant or child that is either oversensitive or undersensitive to these very characteristic human stimuli is at risk for deviation in development from there on.  In typical development this stage typically occurs between two and six months of age.

DIR/Floortime Stage III: Two-way Intentional, Affective Signaling and Communication

In line with the overlap that we expect to see in typical development, the characteristics of this particular stage occur before complete mastery of the previous stage, generally starting around three or four months. The hallmarks of this stage are “intentionality” and “contingent responding.”  Infants make sounds and movements, but very early on they have little control over them. As their nervous systems mature they begin to be able to do very simple things with their faces and their bodies intentionally.  They learn to turn and lift up their heads and to search with their eyes.  While their movements aren’t very coordinated or articulated, they can move and stop moving intentionally.Starting in the earlier stage of engagement and relating, the typically developing infant is fascinated with faces and spends a lot of her mental energy trying to make sense of all those different configurations of brow, eyes, cheeks and mouth.  She learns the associated sounds of the voice, and matches them to characteristic patterns of behavior through experience.A very important process called “mirroring” is going on at this time.  Through this process, the infant learns fundamental aspects about himself.

The circle of interaction begins with a feeling or a sensation within the infant and some sort of movement he makes in response to it.  In very early infancy, the infant has almost no control over her actions and can’t really do anything intentionally.  This is where the teaching and the shaping of the baby’s uncoordinated, unintentional actions into intentions and meaningful actions begins.

In the context of a very close dyad, the caregiver responds to these movements as if they are intentional (this can be a useful Floortime technique) – whether the actions were truly intentional or not.  The “contingent response” of the attuned caregiver is usually “congruent,” or in other words, a somewhat accurate reflection of the infant’s internal experience.

For instance, the baby feels a gas bubble and grimaces, and the mother (usually without even realizing it) shows a concerned look on her face and says empathically, “Ooh.”  In another moment, the baby feels some sort of delight and smiles and wiggles, and the mother – again without really thinking about it, smiles and coos.  The mother imitates the baby’s affect and therefore functions as a mirror for him.

Now a child of this age would not recognize himself in a real mirror, but he is beginning to notice that there are consistencies between his felt experience at the moment, and characteristic patterns he sees on his mother’s face.  The equation amounts to this: she looks like how I feel.

Affective Signals as “Action Predispositions”

At this very early stage of life, the infant gets a very important education about affect, or, the emotional display of a feeling through facial expressions, the sound of the voice, and body postures among other features.Another connection, or contingency (a cause and effect relationship), has to do with the function of affect and emotion as a signal.  In animal behavior, emotions and emotional displays (affects) function as signals of likely behavior or “action predispositions.”  For instance, when a dog growls, it signals to others a hostile predisposition and that approach would likely be followed by aggression or attack.  Conversely, when a dog wags his tail, he displays an action predisposition that his likely next behaviors will be friendly and that approach is welcomed.In animals, emotional displays (affects) fall into two broad categories: “approach” or “avoid.”  In human beings, these two broad categories are exquisitely multifaceted and nuanced, but at this stage, the infant is learning the basics.Now let’s think about the infant that avoids the face – that is either understimulated or overstimulated by it, or that has visual-spatial processing issues that make it difficult for the infant to discover regularity in facial patterns of affect. This child is not making connections between facial expressions and the actions that typically follow them – so there is less predictability in the world.  Generally, our faces are pretty good indicators of what we are likely to do or how we are likely to react, although as we get older, we can mask or control our affects and not reveal everything that we feel.  Young children have not mastered that, so what you see is what you get. The point here is that a child that is not actively studying facial expressions and sounds of voice etc., and the actions that match them, is not learning to read other people’s intentions; is not learning to predict people’s behavior, and can start down the path of atypical or autistic development.  They can become uncomfortable around people and spontaneity.

DIR/Floortime Stage IV: Long Chains of Co-regulated Emotional Signaling and Shared Social Problem Solving

The most important aspect of this stage is that the child is learning to rely on interdependent relationships in order to solve problems.Young human infants are perhaps the most vulnerable infants in the animal kingdom. They can only exist in symbiosis (and I am not sure that that ever really ceases to be the case throughout the lifespan).  Emotionally healthy individuals rely in healthy and balanced ways on loved ones, friends, colleagues and other social relationships to manage their feelings and get their needs met.But human infants in particular are unique in their lack of survival skills.  One of the most, if not the most viable problem-solving strategy for a young child is to get help from a more capable individual, and to recognize who those capable and caring individuals are.In the prior stage, the infant learns “contingency,” that is, that her actions can produce changes in the actions of others. One of the most important types of actions an infant can make is to signal distress, which should result in the summoning of help.In very early infancy, the infant is not ambulatory and has little control over her arms and legs. Caregivers have to come to her.  She signals and they come.But as she gets older and wants to explore the world, and she can sit up, move around, and handle things, she develops evermore sophisticated ways of engaging others in problem solving.  She holds her hands up in the air to signal that she wants to be picked up.  She holds up an object so that she can share her experience by “showing it” to someone and looking for their reaction.  As she develops more sophisticated motor planning ability and ambulation, she can now travel to the caregiver. When she needs or wants something, she no longer has to wait for someone to come to her.Infants at this stage now also have the developmental equipment to do much more elaborated and variegated experimentation on the world.  Not only are they fascinated with the physical properties of objects and what their bodies can do, they also perform experiments on the peoplearound them.  They experiment with what gets other people’s attention, what makes them happy or what makes them angry.  They may not fully appreciate the effects they have on other people, say, when they go through their experimentation with biting others or dumping their plate off the highchair, but they do appreciate the cause and effect and they continue to experiment.Longer and longer chains of interaction become a part of this scenario. Children don’t just do things once in their experimentation. They do them over and over and they try little variations (many happen by accident) and they study the effects of these little variations in longer chains of interaction with objects and with other people. Because our brains are the result of filling a “social-cooperation” niche, naturally, the social experimentationis a primary fascination and the most important developmental task of this period.According to DIR, this stage is readily observable between nine and 18 months of age – but really, does it ever end? I think it continues for the rest of the lifespan, and like any other biological or systems phenomenon the tendency is towards greater integration and greater differentiation at the same time. So as we get older, we try old things on new systems (integration) and  we try old systems on new things (differentiation).  Or is it the other way around?  I guess that’s the point.

DIR/Floortime Stage V: Creating symbols or Ideas

One of the unique aspects of the way we do Functional Analysis of Behavior, is that we do a motor plan analysis and we look at the connection between growing abilities to ambulate or travel, and the developmental capacities one needs and has or doesn’t have in order to make that work.Let me explain. As the young child develops the ability to walk and turn corners, then the mother or caregiver is now out of sight. Walking begins to happen at around one year of age. I don’t think that it is a coincidence that that is when children begin to understand and use symbols.  Infants that age may not be able to form words per se, but they understand names for things and they are usually using proto-words (e.g., “ba-ba” for bottle) and specific gestures (arms in the air) that symbolize ideas (pick me up).So why would walking and the development of symbols go together?  Well for one thing, symbols are a way of representing events in the mind as memories (really just specific configurations of neural circuits) and that can be reactivated as “recall.”  In the absence of the physical presence of mother, the infant can now call upon his memory of herand her previous location to reassure himself that their connection is not broken if he turns a corner.Another important function of symbols is for communication. Words and gestures form packets of information that can be transmitted from one brain to another. This would also be necessary when one partner experiences an event outside the experience of another. The infant can now communicate about experiences to people who weren’t there.  As the child gets older, symbols allow sharing of experience from the past and references to the future that allow so-called experience sharing through mental time travel.The simplest versions of this emerge much earlier than 18 months. But the full fruition of symbolic thinking is evident when the child starts to pretend.  The diagnostic manual of DIR: “The Diagnostic Manual for Infancy and Early Childhood” or “DMIC” (published by the Interdisciplinary Council on Developmental and Learning Disorders or the “ICDL“) indicates that this stage is most evident in typically developing children starting between 18 and 30 months of age.

DIR/Floortime Stage VI: Building Bridges Between Ideas or Logical Thinking

Prior to this stage, the child may begin to pretend and talk at a furious rate, but their ideas jump around and they make a lot of assumptions about what you know.  They assume that if they know something youmust know it as well. They don’t really have much ability to understand other people’s perspective.At this point, they may have become fairly adept at seeing the cause and effect between events, such as the way their behavior might cause a reaction in a parent or on some other object.  And they have developed a fairly impressive ability to predict the consequences of their behavior when they do something that they have done before.  They are also growing an ability to make predictions in contextually similar situations.This particular stage is about developing perspective and Theory of Mind.  Children begin to realize that the listener has needs.  They are beginning to appreciate “why” things happen and subsequently develop better abilities to make the connections between cause and effect and relate their ideas to others.  This is the advent of what developmental psychologists call “pre-logical thinking,” because it doesn’t really include testable conclusions.  The child still sees connections between events and deduces causes by following the action.  At the beginning of this stage, when you ask a child, “Where does the sun go at night?” the child at the younger and would simply remark about what he sees without giving any explanation why (e.g., “It goes down behind the house.”).  As the child develops pre-logical thinking, she begins to look for explanations, but she is still likely to be fooled by her perceptions and her own limited experience and gives an answer such as, “It goes to sleep.”  If she’s never seen the sun rise, she might assume that “Mommy wakes up the sun.”  But at least there is a bridge between the effects and the causes.Another aspect of the “building bridges” has to do with the number of steps and the length of sequences you can observe in their narratives and in their pretend play. Instead of just pretending that a little car is a representation of a real car and rolling it around on a track, the car now goes places, picks up people and goes other places and does several things in a a logical sequence.  Narratives begin to have a beginning, a middle, and an end.

Note: There is a great deal of overlap between the domains of DIR. There is no real need for clean demarcation, as there is no such thing in development or in these aspects of human beings writ large.  Therefore, the Floortime techniques we associate with a particular domain of DIR could easily apply to any of the other of its domains.

So…. Would you like to try Floortime.  In this next article, we give you Useful Floortime Techniques for the ‘D’ the ‘I’ and the ‘R’ of DIR.

 



[1] The theoretical model and pedigree for Floortime are found elsewhere in these materials

[2] A list of “Communicative Temptations” is found elsewhere in these materials.