©David Sponder, Licensed Educational Psychologist
Board Certified Behavior Analyst (BCBA)
DIR/Floortime Intermediate

Emotional Engagement

We placed “attunement” at the top of the values list in DIR and Floortime. Without a strong emotional connection, and without careful attention to the child’s individual differences, progress is unlikely.

Once the Floortimer establishes a strong connection and attunement allows a child to trust in the environment (and drop their anxiety levels and defenses), intervention looks to other important aspects of development. At all times, affect and emotional development remain primary, so intervention always seeks to deepen and strengthen the child’s capacities for engagement, emotional reciprocity and intimacy.

Communication

Experience-sharingcommunication follows engagement. The purpose of experience-sharing communication is for partners to be able to communicate their subjective/internal experiences with others. The purpose of experience-sharing communication is different from imperative and instrumental forms of communication where the goal is to obtain something (a reinforcer: goods, services; information; direction) or get something done. Instrumental communication does not have to involve deep engagement at all.

DIR uses “circles of communication” as a way of measuring reciprocal back and forth turns of communication. Each partner’s turn could involve any behavior, intended or not, that can function as a “communicative act” (a behavior that carries some potential message). If the other partner responds to the act with a ‘return volley’ of communication, AND, the first partner responds to the response – we then have one circle of communication (see further explanation below). Note here that I did not mention “experience-sharing” communication as a necessary component of a circle of communication.  To clarify: Experience-sharing is a measure of the quality of emotional engagement in any circle of interaction. While the number of circles involving experience sharing is way to measure the development of emotion-based communication, we might look at other qualities of circles as specific Floortime communication objective. We might look at the frequency in which they are used for instance or; the number/amount of circles the child can volley back and forth before communicative breakdown occurs; the vocabulary and grammatical content; the amount of elaborative detail, etc.

Co-creation

Once the relationship progresses to reciprocal engagement and communication, the Floortimer seeks to expand the child’s systems: the themes, routines, and sequences of their actions that can benefit from variation, expansion and elaboration.

We prefer to look at all interventions from a systems theoretical perspective.  For our purposes here, a “system” is merely a set of steps that go together. These steps also include thoughts, feelings, as well as tangible objects that might belong to the system. Think of the system of “washing hands.” In this system, behaviors such as running the water, getting the soap, washing actions, as well as the props: the sink, the soap, etc. – belong to the “washing hands” system. The list of everyday systems that can benefit from Floortime is really only limited by the amount of time the dyad can slow down and engage meaningfully with each other.

Building on reciprocal engagement, communication and co-regulation (partners responding to each other’s responses differentially), the Floortimer focuses on “co-creation.” Technically, any variation the Floortimer is able to introduce into any routine or interaction, is something new.

The goal of every interaction should be to create something new – in Floortime and elsewhere.

The progressive energy generated in Floortime interaction comes from small changes the Floortimer introduces. The changes have to be significant enough (not necessarily large) so that the child notices, but not such that they overwhelm the child and lead to avoiding, defending or withdrawing.

“Noticing” is a response, and in certain cases, noticing might represent progress. We want more of course. We want engagement, curiosity, persistence and resilience.

Given support for arousal and sensory factors that might serve as obstacles to true engagement and pleasurable exploration, we allow the child to take the lead. The Floortimer can contrive a situation that includes “bait” and other temptations to get a system of steps going (e.g., child approaches and engages an object, activity or interaction). Alternatively, the Floortimer can try to join a system already in progress (e.g., the child is pursuing an intention of some sort; the child is in repetitive [circular, self-absorbed] activity).

Whatever the case, the thing to do is to join in somehow and get circles of interaction going. No circle of interaction is exactly alike – so variation is inherent. However, the child might have a low toleration for varying the pattern of back and forth, or the pattern of steps, or the particular manner in which partners enact the steps or whatever. The Floortimer has to be careful not to change anything too much or in the wrong way, because it might result in irreparable breakdown of circles.

Core deficits in visual and auditory tracking of the environment usually antecede this type of inflexibility – this preference for closed systems. Recall that our abilities to anticipate and predict courses of action (as we are able to predict the next few notes of a melody once we recognize it), is what allows us to adapt flexibly to changes going on in our world. Recall that we learned these mental abilities of anticipation and prediction through our experiences of being interested in how things progress. We learn how people’s emotions have predictive value of people’s next moves, and how patterns of facial, tonal, postural and other nonverbal gestures – as well as their words, contribute to our abilities to infer intentions from their actions. We also know that behavior follows intentions.

People with disorders of relating and communicating by definition have difficulty with the higher order thinking processes of inferring other’s intentions and taking into account their knowledge and propensities for the purposes of inferring their intentions and anticipating and predicting their next moves.

This is true at all ends of the spectrum to some degree or another. When one lacks the component skills of inference, anticipation and prediction, feelings of anxiety and confusion are typical when engaged in dynamic and spontaneous interaction with the world. From this stems a need for less information to cope with and more predictability. There is a need to avoid uncertainty and to cling to static ways of doing things. Indeed, we see many people on the spectrum that become upset if steps of routines change. Typical of any closed system where any change is a violation of the system’s rules, the child may object to anything new the Floortimer tries to contribute. A child may love to engage if and only if partners carry out specific roles and steps – as in a script. They consider variations of those steps as violations and do what they can to restore the static-ness of their system.

Nonetheless, the introduction and “digestion” (integration) of change is necessary to growth at this point. As mentioned, change provides the energy for growth in development. The Floortimer, with “gentle persistence” (a favorite Floortime term), seeks to introduce change. Ideally, the Floortimer can capitalize on a moment of high spirits generated by a truly positive interest, mood or affect, because it is at those moments where flexibility is highest. Equally important, the change the Floortimer introduces is “syntonic” (in tune, harmony) with the system, rather than “dystonic” (disruptive, out of tune). Introduction of syntonic and pleasurable change can go on until the original system is no longer recognizable: that is a very valid goal sometimes. On the other hand, dystonic changes provide challenges. They can, under the right conditions and scaffolding, provide opportunities to discover or invent new understandings and new responses (see Piaget’s concept of “equilibration”).

A child’s preference for avoiding uncertainty and for static systems presents a major impediment to their development. A meta-goal of Floortime is to help a child embrace novelty and to prefer change to static repetition.

Ultimately, the goal is always to promote robust, spontaneous initiative from the child. This is the key reason why we follow the child’s [affective] lead. Some children may respond well to the Floortimer’s introduction of new variations of a play or interactive routine. If they didn’t before, they begin to look forward to, with “positive anticipation,” the new wrinkles and fun things the Floortimer introduces. However, Floortime is not entertainment – it is a way to provide opportunities to learn, discover, or strengthen skills. We don’t want to lose sight of who is supposed to be in the lead. While we want to expand the child’s systems (the objects, people and actions that are part of identifiable patterns), we want more and more of the energy for change coming from the child.

One of the most valid measures of any relationship-based intervention is the amount of work each partner contributes to keep the interaction going. Who does most of the work to keep interaction going? Who initiates most of the changes or new ideas? Who does most of the work to repair inevitable breakdowns in interaction? Who does most of the work when there are problems to solve?

Ideally, the answer should be “No one.” Interactive partners should share equivalent parts of the responsibility to keep interaction going. Floortime is a way of reaching out to a child to help them take the lead and learn the tools for keeping interaction going.

A child’s ability to come up with new themes and enact them in social interaction or play relies on their underlying abilities to form intentions and carry out organized steps, engage with others in the process and to respond flexibly to small variations. Some children may have real difficulty with this. These children tend to have the most severe issues with motor planning. They may have difficulties either thinking up variations, differences or new ideas (ideation), or enacting the steps to reach their goals, or both.

“Co-creation” implies that new ideas flow from the interaction of ideas each participant. When growth proceeds to a point where change becomes a regular feature of interaction, we encourage even more co-creation of new ideas and new themes and topics. At this point, both [all] players share the [affective] lead. The pattern of leading tends to go both back and forth and in parallel: ideas and variations come from partners in random but orderly succession, while partners continue to perform their “roles” in the interaction simultaneously.

Co-creation and problem solving involve the use of symbols, signs and other representations of experience. Words are symbols, [intentional] gestures are signals and actions are representations of thoughts and subjective experience. To collaborate and interact mutually, we must be able to trade in these media. We have to understand what these “representations” and symbols mean, and what they mean to others.

Problem-solving

The ability to carry on transactions with others enables cooperative problem solving. In Floortime, cooperative problem solving is a way to model, teach and facilitate the discovery of new skills for problem solving. The Floortimer presents challenges, playfully sabotages plans or poses a different idea – so the child has to think. We try to put the child in a position where the current way doesn’t work (e.g., “I don’t want to play trains. We always play trains.” “Uh oh, there’s no ketchup. What will we do with our French fries?”).The Floortimer’s job is to allow more room and responsibility, gradually, for the child’s efforts at solving problems.  After we’ve modeled logical thinking, we give the child latitude and the lead whenever possible, holding back as much as we can, but making sure that the child doesn’t become hopelessly stuck and frustrated. Latitude often involves opportunities to experience frustration and negative feelings – with the support of an attuned partner. The Floortimer helps the child work through the negative feelings and minor failures, empathizing and helping the child move on. This process builds resilience – the will and the motivation to take on challenges and not to avoid them.

Strengthening Regulation

Initial and ongoing assessment gives the Floortimer the sensitivity and ability to support the child’s regulation of arousal, anxiety and sensory input. Capitalizing on the plasticity of the nervous system, the child internalizes implicit, procedural memories of calming [or being calmed] from distress. Freedom from defending against stress allows interest in the world.

  • Initial and ongoing assessment helps the Floortimer provide empathic support for the child’s regulatory system
  • The Floortimer engages in ways that promote regulation of the child’s nervous system and that help him or her maintain a state of both calmness and alertness. When the child is in distress and her sympathetic nervous [alert] system is overloaded, the Floortimer provides soothing and relief from sensory impingement or other sources of distress or anxiety. In this way, the Floortimer helps decrease the child’s sympathetic nervous system activation and increase parasympathetic nervous system [calm down] activation. If the child cannot manage these processes on his or her own under normal conditions, then the child has not yet mastered the stage, and the Floortimer must provide more in the way of external support for regulation.The quality of external regulation is in large part due to the quality of the attunement of the Floortimer. The goal is to help the child learn to maintain an optimal state for learning: a combination of alert interest and low anxiety.  If the Floortimer is effective, the child’s nervous system changes and develops new set points – what we call neuroplasticity. New states of calm and interest can become traits with regular conditioning of the nervous system – especially early in development.

Deepening Engagement

Establishing the ability to form an emotional connection with another person

  • The Floortimer relies on seduction rather than coercion. The point is to draw the child in rather than to overwhelm or turn the child off. The Floortimer makes himself more “attractive” to the child meeting the child where she is at in her development.In general, children respond best when interaction occurs mainly at their most solidly established level of mastery in development. The DIR model provides the guidelines and descriptions of characteristic interaction at each functional developmental level. Therefore, when the Floortimer meets but does not exceed this level, the child is likely to feel more understood and her natural responses reinforced rather than “corrected” or “redirected.”
  • The Floortimer speaks to the emotional brain. As in neurology and neurobiological development and as in child development overall, emotions play a central and organizing role. Emotions began their development before birth and the emotional brain is in operation whether language exists or not. Language and higher order thinking processes that use symbols are integral to the interpretation and meaning-making of events and the management of emotions later on (top-down), but all thoughts and ideas are colored in some way be emotion (bottom up). Emotion is underlying and inseparable from everything the brain (and the person) does.Development and maturation of the emotional brain is underway well ahead of symbolic thinking and language. The circuitry of the emotional brain functions differently than those involved in symbolic thinking. Emotions have their own internal representations: feelings, and their external expressions as affective displays (combinations of facial expression, posture and movement/activity level that convey emotional states), prosody (tone of voice, inflection), and nonverbal gestures> Early on – the way a person expressions emotion comes from hard-wired circuitry. These expressions are universal (e.g., anger, disgust, happiness/joy, sadness, surprise, and fear – the basic or “universal” emotions). Emotional expressions are refined, learned, and become increasingly articulated and differentiated with development. They also undergo conditioning and become automatic. Many emotional “messages” register automatically, and many emotional expressions “transmit” whether we’d like them to or not.The emotional brain connects to every other part of the brain and functions as a sort of switchboard for information coming into the senses, as well as for the organization of movement and thought. The circuitry of the brain that we refer to commonly as the “emotional brain” comprises the brain’s “regulatory” undercarriage. It includes the brainstem and basal ganglia; the hypothalamic-pituitary-adrenal (HPA) axis; the pons, medulla and (midbrain), as well as brain structures that interpret emotional information (thalamus, amygdalae, cingulate), and that interact with motor areas of the brain for action and thought (orbitofrontal and prefrontal cortex).What is important is that these parts of the brain trade on different kinds of information than does symbol-mediated thought. They respond quickly with rough representations of the world that above all make survival possible. Animals need to be able to respond to opportunities and threats as quickly as possible and without excessive deliberation that could mean death. Indeed, emotional parts of the brain process information much more quickly than the more densely wired cerebral cortex. Whereas the cerebral cortex processes words and symbols, the emotional brain understands and speaks the nonverbal “language” of the body: affective displays and tones of voice.Affective displays are largely visual and prosodic and tonal messages are largely auditory. The experienced Floortimer knows that emotional communication is the key to engagement. In order to help the child learn, the Floortimer might:
  • Therapeutically withdraw verbal language. This reduces the “load” on processing that language demands and frees up mental energy for the child to focus on the Floortimer’s nonverbal communication.
  • The Floortimer uses words sparingly in order to make them count.
  • The Floortimer slows down to emphasize each partner’s reactions and to allow time for the child to fully formulate a response before adding more input
  • The Floortimer uses proximity wisely, getting in as close as possible to maximize chances for intentional and accidental engagement, without getting so close as to make the child uncomfortable
  • The Floortimer might exaggerate emotional tones to get the child to notice them and to connect them to events, or perhaps to…
  • …mute them when they threaten to overload the child
  • The Floortimer recognizes that faces can be overstimulating at first for many children on the spectrum, and if so, does not pressure the child to “look at me.”

Encouraging Intentionality

According to the “Affect Diathesis hypothesis” of DIR, a core deficit in all disorders of relating and communicating has to do with difficulty connecting an “affect” (an intention; a wish; a goal) to a “motor plan.” That is, the person either has difficulty enacting the steps towards a goal or has difficulty coming up with goals in the first place.Children that have difficulty enacting steps towards goals need help in attaining their goals. Therefore, in cases where the attuned-enough Floortimer knows the child’s goal, the thing to do is to provide the right level of help. There’s a Goldilocks zone where helping too much leads to stagnation, and providing too little help feels misattuned and frustrating for the child.

  • The Floortimer attunes to the child’s affect and takes a facilitative role, helping the child realize her intentions.
  • The Floortimer helps just enough so there still is challenge and the satisfaction of mastery, while at the same time not so challenging as to frustrate and discourage the childChildren that have difficulty forming intentions might pace or engage in actions directed towards their own body or on an object. His or her actions appear to be circular – with no logical beginning, middle or end. If they interact with objects – it is usually only briefly, or in very restricted and repetitive ways. In some cases, the repetitive routines are complex and intricate, yet there is still no room for new goals or variations of the old ones. Indeed, the actions themselves seem to be the goal.These children need for the Floortimer to introduce some sort of dialogue into the self-directed nature of the child’s patterns, to make an organized pattern on to what seems like random movements, or to help the child turn repetitive movements into a new, co-created pattern, or, any combination of the above.
  • The Floortimer responds to actions with heightened sensitivity, turning weak intentions into goals (e.g., the child looks at a toy on the shelf that is out of reach, and will quickly turn to any other thing that is in reach. To help the child with his intentional behavior, the Floortimer might put fewer items out there to compete with the child’s weak goal preferences).
  • The Floortimer uses bait, temptations and other inducements of intentionality. The child may have extreme difficulty “just thinking of something,” but may have an easier time if the right objects or activities are close at handOther children may find it difficult to contend with external input or attempts to vary the steps they take towards goals. They know of only one way to do things and can be rigid and inflexible. These children have difficulties with keeping track of their steps. They become distracted, forget or lose their place easily. These children need help organizing their steps towards a goal.
  • The Floortimer adds subtle variations to the child’s rigid systems, showing him that there are more than one way to reach a goal
  • The Floortimer uses declarative actions and words to introduce new information without threatening the child’s rigid systems directly

EstablishingCircles of Communication

A circle of communication is a unit of dialogue between interactive partners.  It is a convenient unit for measuring the reciprocal back and forth of relating and communicating.A “circle of communication” is really like the beginning circle of a coil. It “opens” or starts with one partner (the first partner) making an intentional communication bid to the other.  (The “communication bid” is merely an act of some sort that has communicative value: it could be a gesture, a movement, a word or a silence – as long as the intention is to communicate).  The other partner then responds in some way to the bid, extending the circle.  The first partner responds to the response and “closes” the circle.

Partner 1 opens the circle (communicates to Partner 2)
Partner 2 responds to Partner 1
Partner 1 responds to Partner 2’s response
Partner 2 responds to Partner 1’s response to the response
Partner 2 responds to Partner 2’s response to the response to the response…
…and so forth and so on.

Or like this…

From the ICDL Website

We like to think of …dialogues as opening and closing circles of communication. When a child reaches out—with a look, for example—he opens the circle. When the parent responds—by looking back—he builds on the child’s action. When the child in turn responds to the parent—by smiling, vocalizing, reaching, or even turning away—he is closing the circle.  When the parent responds to the child’s response—by holding out a toy, by saying, “Don’t you want to play?,” by echoing the child’s vocalization—and the child responds with another gesture (a look, a smile, or hand movement) they have opened and closed another circle.”

The following is a story from a father, Dr. Joshua Feder (Child Psychiatrist), describing his first forays into Floortime with his son Matt (Leslie is Matt’s mother)…

Leslie works every minute to join Matthew in whatever he is doing and build on it with him, “closing those damn circles.” Matt is so attached to Thomas the Tank Engine toys that he carries a bag of them down the aisle while ring bearer at his aunt’s wedding. The circles work. Matthew is more “with” us. I cautiously intrude on him, picking up one of the little engines he’s lined up and amiably offering it back, or rolling one out of place for him to circle back, so to speak, and get it in line again. Over and over, always a tiny bit differently, playful in my motions, trying ever so gently to liven up his serious demeanor. When I hesitate a moment, getting ready to mischievously pluck one more, he looks my way and I think I see a twinkle in his eye. He knows it’s a game. He is looking at me, naturally looking at me. This is so different from behavioral intervention. I didn’t tell him to look at me. I’m not instructing him how to play. This is Floortime. It’s about his idea and how we make it into a shared moment. I’m melting. And, impossibly, he comes back for more.”

Dr. Feder was fortunate enough to work Drs. Greenspan and Weider and is now part of the ICDL faculty. You can read the full article and read more about Floortime by visiting his website: www.Circlestretch.com.

The number of circles that a child can complete with a partner is one way of knowing how things are going.

We want long chains of social interaction, which is almost unique to Floortime. Most intervention therapies for children with disorders of relating and communicating feature a “start/stop” format, where the Therapist “elicits” some form of speech or language from the child and the child then receives some form of reward for communicating. There is little emphasis on long chains of continuous interaction, and few techniques developed to support them.

I maintain that it is just as important to look at the nature and content of the circles as well as the amount of them, but the number of successive (unbroken) circles can be a reasonably valid way of looking at durations of engagement. What we are really looking for is truly robust communication, where the child shows strong intention to communicate. A very good sign of the robustness of communication is something called “communicative repair.”  Communicative repair is something we all do whenever there is a breakdown in communication. Breakdowns in communication are common and expected in every interaction. Pauses, gaps, misunderstandings, incomplete messages, missed context, etc. are all forms of communicative breakdown. The “communicative repair” could involve rephrasing, adding more information or clarification, using different words, adding gestures, “showing” (“show me”) or demonstrating something nonverbally, among other devices. Of course, the children that come to us for help often have great difficulty when others don’t understand what they are trying to communicate. They might become stuck and frustrated, give up, or they might have no ability to come up with another way of communicating their message – so they simply repeat. There are effective and evidence based techniques we can use to model and teach communication repair skills (see Language Techniques used at SCS).

    • The Floortimer uses techniques of behavioral shaping and reinforcement to encourage and strengthen communication (i.e. responding to successive approximations). This may include responding to non-communicative acts as if they were communication
    • The Floortimer never forgets the primacy of nonverbal and emotional forms of communication
    • The Floortime uses declarative language and declarative actions predominantly in order to encourage communication responses. The Floortimer uses open-ended questions rather than closed-ended questions
    • The Floortimer uses Intensive Language Input, developmentally appropriate language, over-articulation; sabotage and delay strategies, clōz strategies and other developmental language stimulation tools (see Language Techniques used at SCS)
    • The Floortimer uses continued attention and conversation as “reinforcers” for using communication – rather than praise for communicating

Establishing and elaborating patterns and themes

The trait of “…restricted repetitive and stereotyped patterns of behavior, interests and activities” is a defining feature of the autism diagnosis. The problem exists in almost all cases involving disorders of relating and communicating, and the behaviors associated with it are among the most common targets for treatment.We take a systems theoretical perspective on the issue of restricted and repetitive patterns of thinking and/or behavior. Restricted and repetitive patterns of thinking are essentially closed systems in that they restrict new information or input, see changes or additions as violations to be corrected or eliminated, and tend to exist for the perpetuation of the system. From a neurological perspective, we also understand that the problem stems from underlying issues with motor planning and sequencing.

The best practice in intervening with closed systems is to add new information or “open up” the system. The Floortimer might encounter mild to serious resistance to this effort because the system has value to the child. If the repetitive nature of the actions is tightly circular (e.g., single or short sequences of behavior repeated over and over in succession), there is probably some sort of regulatory benefit such as increasing alertness or dissipating excess energy or anxiety. In the vast majority of cases, the predictability and control afforded by these systems is [self-] reinforcing.

Peripheral v. Fundamental Variations

We know that if we try to add too much change or the wrong kinds of changes into the system, the system will reject them. That is, if the change we introduce is averse to the child in some way, the likely responses will be the breakdown of reciprocity and circles of interaction, and possible withdrawal, avoidance or hostile behavior from the child. This is where the concept of peripheral v. fundamental changes can be helpful.A peripheral change occurs to parts of the system that are not threatening or central to the system.  Most of the system is preserved. Changes don’t seriously disrupt the flow or pattern, but change it in some small way nonetheless.

Stevie loved to turn the lights on and off. Adults could get Stevie to stop temporarily if they redirected him, but he returned to the light switch whenever he had a chance. The behavior seemed intractable. Stevie obviously derived some sort of pleasure out of engaging in the pattern. A lot of the time, he seemed driven somehow to do it. Regardless, the behavior did nothing to advance his development. In fact, it functioned as a developmental time-out (a source of developmental stagnation).

The Therapist approached Stevie while he tuned the light on and off. Despite her effort to be non-threatening, Stevie ran from her, perhaps fearing that he would be in trouble for the behavior, or that she might ask him to do something he preferred much less.

The Therapist decided to do a “declarative action” to draw him back in. She turned the light on an off, on and off… This brought Stevie right back. The Therapist had to encourage Stevie to go ahead. He did. She made a funny noise when he turned the light on and another when he turned it off, “bewp, bawp; bewp, bawp; bewp, bawp…” He smiled and continued. This was a very peripheral variation, because it didn’t really require any adjustment on Stevie’s part. He could have gone on, ignoring the Therapist, and if that happened, then the variation wouldn’t have accomplished anything. After a few turns, Stevie was looking at the Therapist in anticipation of the noises – as if the switch was now operating the Therapist.  When she paused – he looked and waited, (he turned on the light, she didn’t say anything, and he looked to see what was going on with her).

Technically, these were circles: 1. he turned on the light, 2. she made a noise, 3. he looked; he turned on the light, she made a noise, he looked; and so forth and so on. Her noises became an integral part of this system. However, these circles weren’t very reciprocal because he could have easily gone on without her. The Therapist wasn’t a vital part of the loop, and perhaps not as reinforcing as the thrill of flicking the light switch.

Always looking for something deeper, something more shared, the Therapist held up her hand after he turned the light on. “Up high,” she said, and Stevie ‘high-fived’ her. He turned the light off, “Down low,” Stevie ‘low-fived’ her. Now the system was: [light on, “high five,” light off, “down low,” light on, “hip bump to the right, light off, hip bump to the left]. Fairly soon, the extremely static ‘light on and off’ routine began to resemble a dance, and eventually, the light was no longer part of the dance.

This is an example of adding peripheral variations and incrementally opening up a static system until the original system was no longer recognizable. It is also an example of how to make an essentially self-directed static system into something interactive and dynamic (i.e. changing) and fun.

Fundamental variations change the system abruptly. In Floortime, even larger changes should remain consistent with the child’s affect (lead). Looking at Stevie’s system, a fundamental change might seek to preserve the “cause and effect” theme of his play. Children go through a “stage” of simple cause and effect type play in typical development. Children explore what happens when they act on things such as when they knock over blocks or explore push-button operated toys. Based on what we know from typical development, it could’ve been easy to entice Stevie to join the Therapist in other types of cause and effect play, with perhaps the same results.

A related problem is one of impoverishment of ideas in play. The child’s play might not be as extremely circular, static and self-absorbed, but it nonetheless lacks spontaneity, new ideas, or openness to input from others. In such cases, the Floortimer adds new twists that take the “story” of the play in a new direction. For instance, a little boy’s play might consist mainly of making his characters fight each other. There’s little or no story – just the fight. It might be very easy to join this play, but it seems difficult to expand. In such a case, it might be intuitive for an adult to want to pacify the play and to try to use the opportunity to introduce themes of empathy. Good luck! The problem with that strategy is that is not syntonic with the theme of aggression underlying the play. In such a case, it might be more syntonic to join together to fight other bad guys; to get hurt and ask for a doctor (and the boy can play the doctor), or to change weapons.

Many children are capable of more sophisticated play than the examples above, but their play still lacks thematic content.

Nine-year-old Maya’s play appeared normal at first glance. She voiced out conversations between her dolls and they did things that real people do. But Maya’s play lacked thematic development to a degree that is quite noticeable to her neurotypical peers and they quickly lose patience with her. Here is what Maya’s play sounded like:

Maya’s doll: “Let’s go the mall.”
Therapist’s doll: “OK. Here I come.”
Maya’s doll: (Maya picks up a motorcycle). “Here’s my motorcycle. Hop on.”
Therapist’s doll: “OK. Where are we going?”
Maya’s doll: “To a party. Vroom, vroom. Here we are.”
Therapist’s doll: “This is a nice party. Let’s dance.”

With support for expansion of her themes, we can extend Maya’s play in the following manner…

Maya’s doll: “Let’s go the mall.”
Therapist’s doll: “OK. Here I come.”
Maya’s doll: (Maya picks up a motorcycle). “Here’s my motorcycle. Hop on.”
Therapist’s doll: “Wait. I need some shoes. Let’s go in the shoe store.”
Maya’s doll: “OK.
Therapist’s doll: “Ooh – look at those red shoes. They’re so pretty.”

Maya: “I got red shoes. Wanna see them?”

At this point, Maya breaks the conceit of the current play and goes to her closet to retrieve her red shoes. She shows her shoes to the Therapist and then puts them on. Maya seems to have lost track of the thread of the play, and is now absorbed in dressing up. She’s speaking in her own voice now, rather than in the doll’s voice. According to Maya’s mother, this sort of jumping around and self-referencing is what turns her peers off.

As a side note, it is very normal for children’s play to evolve into unknown directions and new threads that take the players far from where they started. This is an integral part of the joy of co-creative play. Play is like conversation and this dynamic feature of conversation and play is not only normal – it is essential. Neurotypically developing children at Maya’s age want something new; something different, each time they play. However, Maya’s play is so scattered and her themes so underdeveloped, that there’s very little room for joining in a meaningful way. Fortunately, with a little bit of help, Maya can learn to stick with and expand themes a bit longer…

Maya: “I got red shoes. Wanna see them?”
Therapist: “Those are really cute. Do you have any in my size?”

Maya goes to her closet, gets another pair of her shoes, and hands them to the Therapist. Maya’s forgotten about the dolls. At this point, the Therapist could go along without the dolls and engage Maya in circles along this new variation of the shopping theme…

Maya: “Here’s some black ones.”
Therapist: “Those are nice. Let me try them on. Ooh, these will look pretty with my black dress. Now we can go to the party.”

Here’s another way we could’ve expanded the play…

Maya: “I got red shoes. Wanna see them?”
Therapist: “Those are really cute. Do you have any in my size?
Maya: “Here’s some black ones.”
Therapist: “Oh those are too big for me. My feet are very small. [Therapist points to her doll] Can I look at some of those? [Therapist points to the bin where Maya keeps her doll accessories].

    • The Floortimer adds peripheral and fundamental elaborations and variations of the child’s themes that are syntonic with the child’s affect (intentions and feelings)
    • The Floortimer helps the child to become organized and to stay organized (these children are often described as aimless; distractible; impulsive; inattentive)
    • The Floortimer  introduces related themes and thematic content and in this way helps the child build bridges between ideas (Milestone 4)

Expanding Symbolic and Logical Thinking

Skills for solving problems arise out of the need to solve problems.DIR and Floortime emerged at a time when researchers in infant development were studying how infants learn foundational social interaction skills. They discovered that infant/mother dyads engage in patterns of back and forth that have high degrees of predictability and regularity to them. They found that whether mothers knew it or not, they automatically adjusted their interactive style to match their baby’s proclivities. The babies came to expect responses to their actions that they could make sense of and be able to form reciprocal responses.

In a famous set of so-called, “still-face” experiments (Tronick), researchers instructed mothers to interact as they naturally would for a few minutes. Healthy mother/infant dyads engaged in easygoing and mutually pleasurable reciprocal emotional interactions – what Floortimers call circles of interaction. Mothers stayed within or at the edge of their child’s capacity to respond, which meant a mix of regular and easy to anticipate moves, along with enough novelty to keep things interesting.

As the dyad became comfortable in their interactive “groove,” researchers then instructed the mothers to hold their face still and emotionless. The mothers sat their looking at their babies with flat, expressionless faces. The attunement and responsiveness stopped suddenly.

At this point, a very predictable response in the babies occurred. They quickly noticed the change from responsiveness to flatness in their mother’s face. At first, they appear confused. Then you see the babies doing things that they’ve done before – things that worked in the past. When these actions don’t work, the infant becomes stressed and panicky. Nothing changes the expression on the mother’s face, and the baby becomes increasingly scared and desperate. Finally, the infant gives up in depression and sadness.

Once the instruction is given and the mother’s face comes alive again, the infant is OK. Researchers originally developed the “still face paradigm” to study what happens to infants of depressed mothers – mothers whose faces can really be flat and emotionless. They observed the same desperate and then discouraged and depressed reactions in those children; hence, the still-face experimental procedure was born.

In their analysis – they used a systems theoretical approach. The interactions the babies were used to made up a system of actions and responses in both directions that included a high degree of regularity and as mentioned, enough spontaneity and variety to keep the system dynamic (read: novel and interesting).

Importantly, researchers discovered that like dynamic systems, each behavioral variant required some sort of appraisal from the partner and some related counter move.  The predictable and regular parts that kept going formed what they call in ‘systems’ parlance, “homeostasis.” At the moment of variance, the system becomes temporarily out of sync – broken if you will, and one or both partners will do something to “restore” the system.  The efforts to return the system to homeostasis are called allostatic moves. Dynamic systems move in and out of “homeostasis” (regularity) and “allostasis,” (moves or changes made to return to homeostasis). The researchers pointed out that it was in the moments when the system was in allostasis, that the infant experimented and developed new adaptive skills, and that this mechanism was the primary mechanism for learning relating and communicating skills.

Homeostasis and allostasis, equilibrium and disequilibrium

Each of the above terms describe similar processes that drive adaptation (learning). Almost all teaching methods involve the introduction of a little therapeutic confusion, a state of not knowing, in which teaching and experience generate new skills driven by intentional allostasis or therapeutically breaking regular systems. Our goal as Floortimers or teachers is to create healthy allostasis – the kind in which the child can manage to develop new skills and that won’t cause “allostatic load” or too big, too fast or too much change that becomes overwhelming and counterproductive.

The DIR model of development outlines different types of logical problem solving at each of its stages. In a very real way, “problem-solving” is equivalent to goal pursuit, which is why “problem-solving” isn’t something you work on in one stage, master and then move on.

The primary function of any brain is to convert sensory information into some kind of motor response. Converting sensory information into motor responses is the one problem the brain deals with, but healthy human brains do it in millions of different ways on many levels.

Human brains convert sensory information (input) into multiple layers of meaning going from simple sensation to abstract thinking and symbol use. Human brains look for and find relevant “reference points” in a complex and noisy world, compare it to what goes on inside in terms of feelings and the current state of the goal, and sequence out thoughts and actions to achieve what can be very complex and long-term goals. Human brains can keep their goals in their minds “on line” in working memory while they deal with numerous other demands and distractions, and they can make use of a wide range of prior experiences (memory) as internal reference points for problem solving. Therefore, no matter what stage of functional emotional development the child is working on, there are related problems to solve.

Problem Solving as Goal Pursuit

We note that disorders of relating and communicating, on a neurological level, result from difficulties with being able to form intentions (affects) and coordinating an action [motor] plan to achieve it. This is what Greenspan called the Affect Diathesis Hypothesis (affect ≈ intent or goal; diathesis ≈ stress or increased vulnerability to damage from stress).

To connect affects (intentions) to responses (action or motor plans), the sensory systems must interpret the internal and external world accurately and provide the motor or output systems with continuously updated information as the body moves through space. The motor or output systems also involve coordinating attention, which is responsible for subordinate goals of choosing what to pay attention to and what to ignore, what channels to open and focus with, and which ones to shift to the background, etc. To respond, we have to be able to use the most up-to-the-moment sensory information and then to sequence out actions in a coherent manner that takes us towards the goal.

At the earlier stages (DIR: Stage 1: Regulation and Interest in the World), “problems” have to do with the child’s ability to regulate his or her arousal, alertness and attention.  The Floortimer helps the child deal with any sensory (registering and modulating, processing and perceiving), emotional, or motor planning issues that prevent the child from staying calm, taking in and pursuing information from the world, and sharing attention with other people.

At later stages, the problems can range from maintain simple reciprocal emotional and social exchanges with others, learning to learn from physically exploring objects and watching others (imitation), etc. And as a child progresses through the stages, the “problems to solve” become increasingly more complex in terms of input (discriminating complex and dynamic patterns; making inferences and “reading intentions” and perspective in others’ behavior, etc.), as well as output (multiple layers of sequential actions to think about, plan, remember and perform).

As we equate problem solving with goal pursuit, we also note that to live in a dynamic world, it requires efficient and accurate enough mental processing facility to adapt one’s actions and possibly one’s goals “on the fly.” Mental energy must flow efficiently and synchronously through multiple layers and channels of sensory, emotional and motor processes occurring in parallel, as well as in sequence (motor steps include moving one’s attention around, searching and rearranging the contents of one’s mind as in thinking, etc.).

The Floortimer’s gifts to the child are multiple opportunities to solve problems. We call these “challenges.” The Floortimer calibrates challenges within the child’s “capacities” to pull them together.  These capacities define the particular stage of DIR in which the child functions and the types of challenges the child must develop new skills to master.

2-year-old Jeremy was working on learning to explore different textures – calmly. He recoils when he touches sand, mud, clay, playdough, paper, and many foods and avoids them warily. If he gets wet or dirty, he can explode in distress until someone washes it off his skin and changes his clothes.  This “individual difference,” is something commonly called, “tactile defensiveness,” which is a type of oversensitivity to many common textures. Jeremy didn’t mind touching his toys, because they were made of plastic, wood, metal and other hard, smooth surfaces. Further, Jeremy’s aversion to sand, dirt, water and other common textures found in play areas for young children began to be an obstacle to social play.

Jeremy’s continued avoidance of tactile exploration could have a serious and cumulatively arresting effect on his cognitive development. His aversion to textures found in play areas could lead to arresting effects on Jeremy’s social development as well. 

  • The Floortimer arranges to have motivating activities that somehow require the child to develop new skills or means to master
  • The Floortimer has the DIR model as a guide in which to choose the right types of challenges at each level. Taking into account the child’s individual differences in capacity, the Floortimer calibrates challenges so that the child will persist and find solutions (new skills, new understandings)

Jeremy liked water balloons, as long as we allowed him to maintain his boundaries and no one pushed him too fast. The Floortimer filed a bucket with small water balloons that Jeremy could throw.  “Throwing,” a common fascination for young children, explores distance and coordination of his muscles, and he’s learning a bit about what happens when a water balloon hits the grass, or a tree, or the sidewalk, or Daddy’s foot. This kind of exploration touched on the edge of Jeremy’s tolerance for water.  The water balloon activity was very attractive. Jeremy wanted to do it, but he had a problem. He would have to deal with water. This seemed safe enough to him, and he could remain in a pleasantly excited as well as calm and alert [arousal] state to grow and learn.

  • The Floortimer used the titration principle to introduce textures that progressed carefully from the least to most difficult for her to tolerate.

Inevitably, the splash of the water balloon led to a few drops on his skin. Jeremy didn’t seem to mind when it came to water balloons. If Dad wiped off his feet, Jeremy would return immediately to the games.

As it turns out, the backyard had some amazing things lying around. A little experimentation led Dad to pick up the hose. The hose had a sprayer on the end that turned out to be absolutely fascinating to his son. Dad made sure that he was close enough to get Jeremy’s attention, but not too close that the water would scare him.  He turned the sprayer to the “jet” setting and pointed it at the sidewalk. Jeremy noticed the splash. He squealed and jumped with delight. Dad pointed the hose at other things and showed Jeremy what happens when a jet stream hits various surfaces (that were safely away).

  • The Floortimer set up a pattern of regular actions to build a sense of anticipation and mastery.

Dad said, “On!” and turned on the sprayer. Jeremy squealed as long as the stream flew. Dad pointed it up in the air. While the sight of the jet stream dispersing into the air was indeed thrilling, it was a little much for Jeremy when a bit of drizzle fell on him, so he ran away a few steps and looked back.  Once Dad pointed the sprayer at the tree, he came right back.

Then Dad abruptly announced, “Off!” and turned off the sprayer.  Dad announced, “On!” and turned on the sprayer. He let it go for a few seconds; splashing different things, and then dramatically announced, “Off!” and turned off the sprayer.  Now Dad waited just a little bit longer when the sprayer was off. Father and son connected electrically in this moment. Jeremy eagerly awaited the next step (this is called, “positive anticipation,” which can be the most important aspect of the calm, alert state because that is when a person’s mental capacities are most concentrated and able to learn). Dad repeated the pattern, “milking it” each time by teasing Jeremy by waiting just a little longer. Jeremy used whatever communication he could muster when that sprayer was off! Jeremy started to command, “On!” if Dad left it off too long. Fairly soon into this regular pattern, Jeremy began to say, “On!” as soon as Dad turned the sprayer off.

At this point, Jeremy learned how to use communication to get Dad to turn on the hose. That is a good example of learning to solve a problem in and of itself. There are always other problems to solve.

Another very different type of person, Ralph, a teenaged boy, is working on Stage 6 (Emotional Thinking, Logic, and a Sense of Reality).

Ralph has difficulty sharing his experience with others because he tends to jump from one idea to another.  He doesn’t really link his ideas together in a way that flows like narrative. Therefore, his expressive communication lacks cause-and-effect; lacks description of how one thing led to another, and; lacks references to the sequence or time events occurred – so the listener doesn’t know which order the events occurred.

Ralph is aware of all of his [personal and unfortunately still private] reference points when he talks to people, but it does not occur to him that he needs to share them with the listener. Inside of his mind, there is probably some sort of idea that connects his narratives, but we’ll never know it because there is no real flow or unfolding of his utterances. For this reason, listening to him share his experience can be frustrating to both the speaker and listener. In this case, The Floortimer feigns misunderstanding (what Floortimer’s like to call, “acting dumb”). He says, “Wait a minute, how did you guys get to the park?

  • The Floortimer scaffolds the gaps in both Ralph’s stories and in his nascent skills, helping the boy include the “bridges between the ideas” in the interaction.

From the examples above, you can see that a Floortimer looks for ways to introduce instances of goal pursuit and problem solving into the session where the child must apply some means of action or thought or communicating and relating to achieve his or her goal.  If he doesn’t have a way (which is the point), he’ll have to use the tools he has so far. Applying his [known/mastered] skills and devices in the face of something that isn’t responding as expected, will generate some sort of variation – even if by accident. The Floortimer may have to scaffold the child’s efforts, but we’re hoping that he or she will stumble upon, discover or devise some new means and learn something new in the process. This is a very powerful form of learning because the learning involves achieving a personal goal – what the brain seems “designed” to do. We know that when this kind of motivation applies to the learning situation (i.e., the person is in a position of having to figure out the solution to a problem that he or she wants or needs to solve), retention and generalization are most likely. Very importantly, the reason that retention and generalization are more likely is that natural, mastery-motivation is the reinforcing process.

At this point, we strongly note that in terms of solving, a child’s best available problem-solving strategy is to enlist the aid of a parent.  Enlisting the aid of a parent is a challenge in and of itself – it requires sharing experience in ways that both can understand.  The more elaborated a child’s skills at communication are, the better equipped he is to communicate his point efficiently and clearly. The less elaborated the child’s skills are, the more the adult must scaffold the child’s communication, or they are forced to guess what the child is trying to communicate.