Why I Don’t Recommend Floortime

ableism, Autism, Books, Disability, Infodumping, Neurodiversity, Parenting, Writing

In many conversations about autism therapies, I’ve seen Floortime recommended as an alternative to ABA (Applied Behavioral Analysis). I’ve frequently spoken up in those conversations to caution people about Floortime, giving my elevator pitch for why I don’t recommend it. That elevator pitch/TLDR version goes something like this:

Though the real-time practice of Floortime can be a much kinder therapy with some aspects that can be beneficial to autistic children, the core concept and underlying philosophy are still highly neuronormative (holding neurotypical standards as the norm), biased against autistic development as equally valid, and include some outright harmful techniques.

I’ve long wanted to write a full blog post reviewing Floortime, because my critique is a bit nuanced and I completely understand why people would find Floortime appealing based on a cursory description of the practice. I’m also guessing that people have seen or participated in Floortime sessions that seemed innocuous at worst and maybe even wonderful at the time, because I bet a lot of people are only partially adhering to the method.

What is Floortime?

If you haven’t heard of Floortime before (also known as D.I.R./Floortime, its trademarked name), it is a therapy for children with developmental disabilities that was developed by child psychiatrist Stanley Greenspan in the 1980s and 90s. Floortime builds on play between the child and their parents or primary caregivers to strengthen the child-caregiver relationship, support the child’s emotional development, and through the method, boost the child’s overall development.

The Floortime website has a good outline of their methods in “Greenspan Floortime: What It Really Is” by Stanley Greenspan and Jake Greenspan. (Stanley passed away in 2010, and his son Jake now runs the Floortime Center; for the purposes of this post all future references to Greenspan will refer to Stanley). I will pull quotes from this article below as I dissect this method and parse out the good, the bad, and problematic.

How is Floortime Different from ABA?

Though there is much that is ableist, neuronormative and specifically anti-autistic in Greenspan’s work, I want to acknowledge that there is also a good deal of empathy and sensitivity, and that there are some concepts in Floortime worth extracting and preserving.

DIR/Floortime is commonly perceived as a kind of anti-ABA by people who are looking for a kinder alternative to ABA – and for good reason. When Greenspan was studying to become a child psychiatrist in the 1960s, he was learning mainly about behaviorism, particularly the work of BF Skinner; behaviorism reduces human behavior to little more than a set of responses to stimuli, and Skinner contributed the idea that thoughts and feelings could also be controlled via reinforcement and/or punishment. This “operant conditioning” technique was the basis for ABA.

Greenspan felt this was the wrong way to approach supporting children – he felt that the emotional life of the child was more important than their behaviors, especially in their relationship with their primary caregiver(s). So to the extent that his work is a reaction to, and counter argument against, the practice ABA it is an alternative in a real way.

Ivar Lovaas, the founder of ABA, believed that autistic children were literally not people, and that shaping their behavior by force was the way to make them into one: “One way to look at the job of helping autistic kids is to see it as a matter of constructing a person. You have the raw materials, but you have to build the person.” (Text from Psychology Today interview, 1974.) To Lovaas, the autistic child was a completely different sort of being than a typical child – something less, something incomplete.

Stanley Greenspan, by contrast, asserts that all children fundamentally have the same emotional lives and psychological needs. “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. […]The ultimate aim is to form a close relationship. It all begins with the relationship between the caregiver and the child.” (Emphases from original text.) If anything, Greenspan minimizes children’s diagnoses too much, failing to regard neurodiversity as a basic truth of being human, but certainly his views on children are far more humane than those of the founder of ABA.

Where Does Floortime Go Wrong? 

According to the Greenspans,

“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,”

I’m fine with Floortime practice through step one. And I think that in the real world, people often only take it as far as this first step. So, to the extent that people are doing Floortime incorrectly and only joining the child’s world, I approve! In fact, I’ll circle back around to highlight the positives in step one and outline the element of Floortime that we can steal or separate from the rest.

The problem, of course, is that Greenspan himself takes pains to emphasize that step one alone is NOT what Floortime is about, that it hinges on following through with steps two and three –

“Now we are talking about the real skill in doing Floortime, its real infrastructure.

2.     Pulling them into a shared world, often by challenging,
3.     Helping them master the Developmental Stages by expanding on their interest.

“We do not simply stay in their world following their actions.”

This is where Floortime goes off the rails.

[Note: I am going to use the word stimming in this section, for brevity’s sake and as a reclaimed word, with acknowledgment that many autistic people do not want to reclaim it or use it.]

“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.” (Emphasis mine)

For autistic children especially, Greenspan puts an almost tyrannical emphasis on neurotypical social skills as developmental goalposts. Where a child might simply desire a bit of solitude or be enjoying a deep absorption in a particular activity or interest, Greenspan sees “an avoidance problem.”

In his book The Child With Special Needs, which I read a few years ago, Greenspan goes into quite a bit more detail on this aspect of the Floortime philosophy. While he does not seek to extinguish stimming or “autistic behaviors” such as hand flapping, the way ABA does, he does insist that such behaviors should always be used by caregivers to initiate social play. He states unequivocally that autistic children should never be allowed to stim alone, and in fact should never be allowed to be alone for any significant period of time – they should be pulled into social interactions as much as humanly possible (possible for the caregivers, that is).

This is where my critique of Floortime may get tricky or nuanced in a way that is confusing for non-autistics who haven’t tried – or don’t even desire – to de-center neurotypical social skills in their minds. It’s not that Greenspan views autistic stimming as bad or something to crush out of the child – as Lovaas did – it’s that he can only see solitary activities as developmentally regressive.

From the Floortime website: “There are different types of ways to create “downtime” if your child has autism, notes Dr. Greenspan. “If you have a child with autism that is capable of reading a book, that’s terrific; give them regular down time. If the child is capable of doing a crossword, that’s great; give them regular downtime and then balance it through the day. If your child with autism is only capable of self-stimulatory play (self-stimming) where they’re rubbing a spot on the floor, or lining up their toys, or self-injurious activities where they’re banging their head, we want to minimize that kind of downtime because it’s destructive,” urges Dr. Greenspan.”

As an example of neurotypical bias, the above paragraph is excellent. Lumping in self injury with the pleasure of lining up one’s toys is insulting to autistic children – oversimplifying their emotional and behavioral complexity to the point of nonsense. And elevating interests like crossword puzzles or reading is nothing more than ableist, anti-autistic bigotry.

I happen to strongly agree with Greenspan that a trusting, emotionally secure relationship between an autistic child and their parent(s)/caregiver(s) is the basis of the child’s development. But unfortunately, because Greenspan is unable to imagine either  non-typical social-emotional bonding or non-typical healthy child development, his prescriptions for how to achieve a healthy parent-child relationship and how to support the child’s development are inherently anti-autistic and counterproductive.

So even though Greenspan doesn’t set out to extinguish autistic behavior intentionally like ABA does, this happens as a serious and unavoidable side effect of Floortime, because its model for “emotional healthy development” excludes most forms of autistic relating and bonding and social skills and behaviors.

To put things even more simply, solitary activities and parallel play, two pillars of autistic wellbeing, are NOT part of Floortime practice or philosophy. Parallel play is permitted only as a brief gateway to directly interactive social play. Any therapy that seeks to override normal healthy autistic activities is not a respectful, supportive therapy for autistic children.

How is Floortime sometimes similar to ABA? 

Because Greenspan’s child development model is neuronormative, at times it resembles some of the ugliest aspects of ABA therapy, which traditionally states “normalization” as a goal (ABA practitioners are now savvy enough to avoid such off-putting terminology, but that end goal is still very much baked into the cake.)

Greenspan teaches parents an array of manipulative techniques meant to “challenge” children – really what this is about, of course, is pushing them to use more neurotypical social skills to get what they want.

“Sometimes we can start the interaction by doing something to the child that we know they enjoy, especially physical activity such as a 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.”

Among the manipulations he recommends is “playing dumb,” to push the child to use more neurotypical social communication:

“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.”

And of course, a central tenet of Floortime – step three – is to use the child’s interests to push them to “master the developmental stages,” which of course means neurotypical stages. ABA may exploit a child’s interests in harsher ways, but they share this common practice of using those interests as levers, as manipulative tools to employ in the work of teaching an autistic child to imitate neurotypical social skills better.

“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.”

This advice of playing dumb and manipulating the child to “expand” their communication is one that he emphasizes as especially important for autistic children, whom he says have the most difficulty in sustaining long chains of social interactions. This too is neuronormative in that it devalues the autistic child’s natural communicative abilities and needs – to get their message across in a minimum of words or gestures, to simplify social interactions and conserve their own resources.

But even worse, I feel that it sadly undermines the stated goal of building a trusting relationship between the parent and child. Intentionally frustrating a child does not build trust – quite the opposite. And I believe Greenspan greatly underestimates the ability of young autistic children to pick up on when they’re being manipulated, when a parent is “playing dumb,” and when a parent is essentially pretending to play and enter the child’s world while barely concealing a hidden agenda to push their “development.”

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.

“Greenspan Floortime is for all the time.”

What do children learn when they are constantly being pushed to do more and more? That they are never quite good enough in their parent’s eyes.

Ask Me How I Know

 

Though I still feel some shame admitting it, I take a hard line against Floortime now because I know from personal experience the harm it can do. A few years ago, on the advice of an occupational therapist, I not only read one of Greenspan’s books, I paid almost $100 for one of his online courses. (Please please do not fall for this tremendous ripoff, which consists of a series of poorly produced videos covering material that you can learn easily for free elsewhere.)

I tried doing Floortime at home with my son, but not for long, because even though he was only about 3 or 4 years old at the time, he very quickly caught on to my scheme and stopped playing with me altogether. It took considerable time to rebuild the trust he lost in me when I tried approaching every opportunity to play with him as a therapy session – and worse, he hardly had a chance to play by himself with me popping in to intrude several times a day!

And that’s not even touching how intensely draining it was for me as an autistic person to attempt to be socially engaged all the livelong day. If I couldn’t stand it and I’m an adult who had had 30+ years experience pretending to be neurotypical, I can hardly imagine how unbearable Floortime is for an autistic child!

What Can We Borrow and Steal from Floortime?

However, as mentioned above, I do feel that there are some positive, beneficial elements of Floortime that can be extracted and preserved.

All parents of autistic children would do well to focus on building up their relationships with their children – establishing and reinforcing trust, connection, and emotional security. If parents of newly diagnosed/identified autistic children feel confused or overwhelmed by questions and information, I think they would do quite well to make that relationship with their child a sort of lighthouse in their family life. If a parent feels completely unsure of how to proceed with issues of therapy and education and so on, I think it would serve them well to hit pause on all of that and just concentrate on making sure their child is able to trust them and be safe in their care.

If I could be Floortime Noncompliant and disobey Greenspan’s instructions to follow through with steps two and three, I could endorse Floortime Step One as a therapeutic practice for parents of autistic children. At some points in his books and videos, Stanley Greenspan is almost poetic in the way he urges neurotypical parents to join their child’s activities, describing the way what might appear at first to be “nothing” is almost surely something to the child.

The end goal of using a child’s interests to further the therapy agenda is wrong, but the way of getting there can and should be an end in itself: join in, if your child is agreeable to it. Not all the time, not against their will, but slowing down and trying to see what they see, hear what they hear, feel what they feel, appreciate what they love, is worth it. If you’re neurotypical perhaps you’ll never fully understand what’s so captivating and beautiful about the fringe along a blanket’s end, the spinning of a ceiling fan, but when you try, your child sees that what matters to them… matters. It’s not silly or bad or nothing. And that is such an important cornerstone of a trusting relationship with your child. Especially for autistic people, who love what we love so deeply, having our interests validated by people we care about is one of the best, most fundamental supports we can receive.