Autism, PDD-NOS & Asperger's fact sheets | A guide to using Floortime as a home-based autism intervention therapy
Information on Floor Time, DIR,  Autism and Aspergers syndreome - common Autism Spectrum Disorders
 
 

HOW TO USE FLOORTIME

Parents considering using Floortime as an intervention for their child should ideally see a trained therapist in this area. However, it is acknowledged that some parents may not be able to afford intervention services, or may not be able to access them in their area. This guide explains the basics of how to use Floortime, and parents are encouraged to explore further resources and advice before commencing home-based Floortime.

 

Goals of Floortime Intervention

Floortime aims to help children on the autism spectrum to:
• become more alert
• take more initiative
• become more flexible
• tolerate frustration
•sequence longer actions - plan and execute them
• mediate process of finding solutions
• communicate gesturally and verbally
• take pleasure in learning.

 

Glossary of Floortime Terms

Closing the circle

Allowing the child to close the circle when child brings your extensions and expansions to a close.

 

Emotional thinking

The child leans to elaborate fantasies and to make connections between different ideas. (3 to 5 years)

 

Engagement

Babies coo, smile, gesture and exchange motor movements with their partners. (0 to 8 months)

 

Extending and expanding the drama

Tuning in to the child's imagination and ideas and taking them one step further through gestures and words.

 

Floortime

A warm and intimate way of relating to a child. A Floortime philosophy means engaging, respecting and getting in tune with the child in order to help the child elaborate through gestures, words, and pretend play what is on the child's mind. As a technique, Floortime is a five step process that is used to support the emotional and social development of the child.

 

Following the child's lead

Seeing the child as the director and yourself as the assistant director of the activity.

 

Observing

Noticing how the child is special and unique in style, rhythm and mood.

 

Opening the circle of communication

Turning in and following a child's special interest.

 

Shared meanings

The child begins to communicate ideas with words or pretend play. Emotional themes enter the child's play. The child uses themes not only to express wants and needs but also to expand fantasies and creativity. (18 month to 36 months)

 

Stages of relating

Stages in emotional and social development of children.

 

Two-Way communication

The child is able to have an emotional dialogue. Opening and closing circles can take place. You need to take an interest in and respond to the child, and the child responds with gestural and verbal reactions. (6 to 18 months)

 

Greenspan's Model of Stages of Relating and Communicating

Stage 1: ENGAGEMENT (Birth to 8 months)

Does the baby smile joyfully in response to vocalization and facial expression? What are the kinds of gestures the baby uses to elicit responses?
How does the baby use senses such as hearing, sight, and touch to form attachments? Is child beginning to exchange motor movements?
How would you describe baby's temperament (stable, intense, irritable, unresponsive, assertive)?

 

Stage 2: TWO-WAY COMMUNICATION (6 to 18 months)

What evidence is there that the child is reciprocating and copying your behaviors and emotions?
Does the child begin to instigate activities based on own needs and wants, rather than by imitation alone? How? Provide examples of how the child combines gestures and words to communicate.
What evidence is there that the child is beginning to understand basic emotional themes, such as whether child is being approved of, is safe and secure, or is being admired?

 

Stage 3: SHARED MEANINGS (18 to 36 months)

Provide examples of how the child is beginning to communicate ideas through words.
How does the child use pretend play to communicate emotional themes such as curiosity, independence and rejection?
Describe ways in which child makes wants, desires, and emotions know through pretend play. Describe how pretend play becomes more complex.

 

Stage 4: EMOTIONAL THINKING (3 to 5 years)

How are feelings expressed?
What evidence do you have the child realizes the relationship between feeling, behaviors, and consequences?
How would you describe the child's relationship with adults?
How does the child control impulses and stabilize moods?
How does the child interact with peers in pretend play?
Does the child help to structure and organize play themes?

 

Specific Goal Behaviors and Strategies to Attain Them

   
   
A fact sheet explaining the basics of how to use Floortime, and parents are encouraged to explore further resources and advice before commencing home-based Floortime, an intervention for autism and Asperger's syndrome
     

Goal behavior for the child

Alertness and awareness

 

Floortime activities to achieve goal

Notice something is different
Discriminating visual, auditory and other sensory information

Recognizing that they are facing an obstacle

Identifying the problem, etc.

Encourage to be less passive in environment
Do not allow process to proceed in more or less automatic way

Assist child to become more critical and ready to take action to help self

It is critical to "wait" to give child chance to recognize problem and realize they must be ones to start doing something about it

Create small changes and problems to help child notice, initiate and tolerate changes
Help child to learn to cope with by solving problems and taking in more information

Have experiences which require taking as many steps as possible to solve the problem at hand and to communicate:
- who wants the problem solved

- what they want solved

- when they want it solved

- where they want it solved

- why they want it solved

- how it can be solved

- through actions, gestures and words


Do not tell or show how to do a skill e.g., "Where should we look? Did you check all the sides? Is there a tab? Let's try pulling. Does it work? Is it stuck? Do you need a tool?

Taking the initiative

Be more flexible

Longer complex actions/speech

Problem-solving abilities

Five Steps in Floortime

1 Observation

Both listening to and watching a child are essential for effective observation. Facial expressions, tone of voice, gestures, body posture, and word (or lack of words) are all important clues that help you determine how to approach the child, e.g.:

• is a child's behavior relaxed or outgoing?
• withdrawn or uncommunicative?
• bubbling with excitement?
• is the child a real go-getter?

 

2 Approach - open circles of communication

Once a child's mood and style have been assessed, you can approach the child with the appropriate words and gestures. You can open the circle of communication with a child by acknowledging the child's emotional tone, then elaborating and building on whatever interests the child at the moment.

 

3 Follow the child's lead

After your initial approach, following a child's lead simply means being a supportive play partner who is an "assistant" to the child and allows the child to set the tone, direct the action, and create personal dramas. This enhances the child's self-esteem and ability to be assertive, and gives child a feeling that "I can have an impact on the world." As you support the child's play, the child benefits from experiencing a sense of warmth, connectedness and being understood.

 

4 Extend and expand the play

As you follow the child's lead, extending and expanding a child's play themes involves making supportive comments about the child's play without being intrusive. This helps the child express own ideas and defines the direction of the drama. Next, asking questions to stimulate creative thinking can keep the drama going, while helping the child clarify the emotional themes involved, e.g.: suppose a child is crashing a car: Rather than ask critically, Why are those cars crashing? You may respond empathetically, Those cars have so much energy and are moving fast. Are they trying to get somewhere?

 

5 Child closes the circle of communication

As you open the circle of communication when you approach the child, the child closes the circle when the child builds on your comments and gestures with comments and gestures of own. One circle flows into another, and many circles may be opened and closed in quick succession as you interact with the child. By building on each other's ideas and gestures, the child begins to appreciate and understand the value of two way communication.

 

Strategies for Floortime intervention

Follow child's lead and join them - it does not matter what they do as long as they initiate the move.
Position yourself in front of the child and persist in your pursuit.
Treat what child does as intentional and purposeful - give new meanings.
Help the child do what they want to do and invest in whatever the child initiates or imitates.
Join perseverative play and do not treat avoidance or "no"as rejection.
Expand, expand, expand - keep going, play dumb, do wrong moves, do as told, interfere etc.
Do not interrupt or change the subject as long as it is interactive.
Insist on a response.

Keep it all fun - do not turn the session into a learning or teaching experience.

 

Questions to Ask Yourself if You Are a Good Floortimer

Do I use a calm voice?
Do I give gentle looks?
Is my body posture supportive?
Arm my actions non-intrusive?
Do I use encouraging gestures?
Do I demonstrate calm and supportive listening?
Am I aware of the child's rhythms and gestures?
Am I able to help the child identify play themes?
Do I expand the child's drama by staying involved with the theme and elaborating the details?
Am I able to help the child extend the drama by summarizing main ideas of play themes?
Do I observe the behavior, language, and gestures of the child?
Do I observe the child's style of relating?
Do I approach the child slowly, with respect and thoughtfulness?
How often do I allow the child to take the lead? Do I follow that lead?
Do I let the child know through gesture, facial expressions, emotional tone, and supportive body posture that I am there for the child?
Do I know when to be verbally responsive, and when it is better to quietly share a child's emotion?
Do I work to understand the emotional needs of the child?

 

Props Needed for Floortime

Food

• plastic vegetables and fruits etc.
• plastic foods: chicken, hot dogs, eggs, bacon, french fries etc.
• plastic dishes, cups, forks, knives and spoons
• plastic or paper soup cans and boxes of foods
• plastic cooking utensils, pots, mixer, toaster etc.
• play kitchen with table and chairs

 

Transportation

• minimum of 12 match box size cars, trucks etc
• tool kit to fix cars, e.g.: screwdriver, wrench, pliers, etc.
• garage
• road signs, play road
• road construction equipment
• other forms of public transportation: airplane, boat, bus, train

 

Empathy and nurturing of others

• minimum of two dolls, one boy and one girl
• minimum of two bottles
• plastic figures of a family whose sex and number of members matches the child=s family
• plastic figures of helpers in the community: doctor, nurse, fireman, construction person, police
• doctors kit to help dolls
• tool kit to fix objects owned by dolls
• doll house for plastic family
• blankets and clothes for dolls
• play bath equipment for dolls
• play crib or bed for dolls

 

Fantasy play

• plastic animals from the jungle, zoo, water and farm
• plastic dinosaurs
• Fisher Price or Play School: farm, pirate ship, airport, school, store etc.

 

Reading

• books on a variety of topics which are age appropriate
• word signs around the room
• display of letters of alphabet and numbers 1 to 10 in room
• school desk for dolls or child to go to school

 

Aggression fantasy

• toy soldier set with military transportation (e.g.: tanks, helicopter, boat, and armored trucks) guns, tents, etc., cowboy and Indian set with horses, tents, wagons, guns, bows and arrows etc

 

Construction play

• wooden block set
• plastic block set
• tool kit for construction e.g.: saw, hammer, screwdriver etc.
• Lincoln log set
• construction equipment: truck, earth mover, etc.

 

Art play

• crayons and paper
• watercolor tempera paints, brush and paper
• finger paints and finger paint paper
• clay or Play Dough for sculpting

 

Outdoor play

• sand box, pails, shovels and other sand containers
• water play table
• gym set with slide, swings and ladder
• rubber football and/or baseballs to throw and catch
• rubber soccer ball and/or basketball to kick

 

Constructive obstruction props

• soap bubbles to be blown on child while playing to learn coping with distraction
• balloon or light ball to bounce on the drama which is occurring to create crisis
• blanket to hide the desired objects under
• rubber bands, to fix or bind things together
• tape, to fix or bind things together
• bunch of nerf balls to throw to create obstacle which needs to be attended to

 

Prop storage

keep theme related props in "shoe box" size transparent plastic containers with covers so child can see inside and select theme to play with. This will make it easier to keep play room orderly and neat when Floortime is ended. Enlist child to assist you in putting props in their respective containers.

 

some points worth remembering

Opening the symbolic door

Get engaged at any level with the child. Build on any intent, problem solving, corner or undoing. Be ready with symbolic toys available to use, and recognize and create opportunities . Cue or model symbolic actions,
be meaningful but at the same time keep it easy and fun!

 

Creating and expanding ideas

Treat objects or actions as ideas! Do not "read" or just describe things, talk to the child in role - as actor or with a figure. Build on real experiences - bridge to what would happen next and wait for the child to make the next move - then give choices or model next step.
Resist the temptation to take over and "appreciate" the child's need for control.
Try to build bridges between ideas and give reasons for your or child's actions.
Problem solve and assist in the finding of a solution, and make ideas more complex and more elaborate.

 

Constructive obstruction to extend problem solving

The child will be surprised, amused or frustrated when faced with the changes and obstacles you create for them. Approach child with a supportive attitude, sharing surprise, Oh no what happened?, What's the matter? Help child solve the problem, but wait for child to recognize the problem first and then encourage the process.
Stretch the problem as long as possible by playing dumb. Offering wrong solutions so child can check out several alternatives. Asking questions and opinions about what they want, etc. Remember: goal is not to frustrate child but to mobilize child's thinking and acting in face of something which matters personally to the child.

 

Opportunities for Doing Floortime with Child

To assist child to solve problems and handle changes identify opportunities in the child's daily life which present a "stage" for problem solving and change accepting "dramas". Brainstorm how you could utilize the following opportunities:
• all thing you routinely do for child
• all the things child expects or waits for you to do
• all the things child already expects to do for self
• all the things child desires or expects to have or go to
• daily challenges.

 

Home-Based Opportunities for Floortime

Dressing and undressing: giving child choices about what to wear or not or what to take off first, is following the child's lead.


Mealtime: chose one meal a time with enough time - talk may focus around food preparation, different foods being served, which foods are particularly enjoyable or any topic relating to the child's life.
Car time: engage child in a relaxed conversation in which child takes the lead, or sing-along for which child chooses songs


Coming and going time: plan to have at least a little time to get child settled on arrival to a classroom or in switching and transitioning from one activity to another by reading a short story, visit pet in classroom or at home, or look at special toy in classroom or at home. Show child support through your interest and warm clear good-bye if leaving in classroom. On picking child up from classroom give the child a chance to tell you something important about the day while you are still in the school setting.


Bath time: Bath toys are wonderful props as they float, get dunked, and come into contact with each other. The water is a great opportunity for play. The child will naturally relax in the water.
book time: Read the book with the child on your lap or next to you on a chair or bed. As you read, be aware of responses and questions that you can extend. (If the child is totally absorbed, however, it is best to continue reading and simply enjoy the sense of shared interest)


Bedtime: Bedtime is often accompanied by a ritual, but is also a moment to feel close and loving. Children sometimes share important thoughts and feelings during the last moments before falling asleep. Although you will not want to rev-up the child up prior to sleeping, you can respond with empathy and stay close until the child is calm and feels safe enough to sleep.

 

Every day activities as problem solving for child

• chair not close to table, in the child's spot, when meal time arrives
• bottle not open when you are trying to pour juice
• bathtub empty of water when you tell child it is time to take a bath
• shoes hidden from usual resting place
• changing the shelf locations of favorite books, tapes etc.
• putting two socks on same foot
• putting shirt on feet
• give child adult shoes instead of their own
• use rubber band to hold together a spoon and fork when giving child tool for eating
• being sure cup is upside down when offering child a drink
• put markers in a new container which child has not yet learned to open
• mix puzzle pieces of two or three puzzles together.

 

Strategies for Engagement and Two-way Communication

Give child seemingly random actions new meanings by responding to them as if they were purposeful.
Use sensory-motor play -- bouncing, tickling, swinging, and so on -- to elicit pleasure.
Use sensory toys in cause-and-effect ways: hide a toy, then make it magically reappear; drop a belled toy so that child will hear the jingle; bring a tickle feather closer, closer, closer until finally you tickle child with it.
Play infant games, such as peek, I'm going to get you, and patty cake.
Play verbal Ping Pong with child, responding to every sound or word the child makes and continue the ping pong match to expand the number of circles closed.
Pursue pleasure over other behaviors and do not interrupt any pleasurable experience.
Use gestures, tone of voice, and body language to accentuate the emotion in what you say and do.
Try to be as accepting of child's anger and protests as you are of child's more positive emotions.
Help child deal with anxiety (separation, getting hurt, aggression, loss, fear, and so on) by using gestures and problem solving.

 

Strategies for Helping Child Build a Symbolic World

Identify real-life experiences child knows and enjoys and have toys and props available to play out those experiences. Respond to the child's real desires through pretend actions

Allow the child to discover what is real and what is a toy (e.g., if child tries to go down a toy slide, encourage child to go on; if child tries to put on doll's clothes, do not tell it doesn't fit; if the child puts foot in pretend pool, ask if he or she is cold).


If child is thirsty, offer an empty cup or invite to tea party. If child is hungry, open cardboard-box refrigerator and offer some food, pretend to cook, or ask if the child will got to the pretend market with you to get things. If child want to leave, give pretend keys or a toy car. If child lies down on floor or couch, get a blanket or pillow, turn off the lights, and sing a lullaby.

 

Encourage role playing with dress-up props, use puppets - the child may prefer to be the actor before using symbolic figures. Use specific set of figures/dolls to represent family members and identify other figures with familiar names.


Give symbolic meaning to objects as you play: hen child climbs to top of the sofa, pretend child is climbing a tall mountain, or when child slides down the slide at the playground, pretend the child is sliding into the ocean and watch out for the fish. Substitute one object for another when props are needed. Pretend that the ball is a cake or the spoon is a birthday candle. Resume use of gestures for props along with toy objects and substitutes. As you play, help child elaborate on personal intentions.

 

When a problem crops up during play, create symbolic solutions.
Get the doctor kit when the doll falls so child can help the hurt doll, tool kit for broken car etc.
Acknowledge child's disappointment and encourage empathy.
Get involved in the drama. Be a player and take on a role with your figure.
Talk directly to the dolls rather than questioning child about what is happening or narrating
Both help the child and be your own player.


Talk as an ally (perhaps whispering), but also have your figure oppose or challenge child's ideas.
Insert obstacles into the play. (e.g.: make your bus block the road. Then speaking as a character, challenge child to respond. If necessary, get increasingly urgent (whispering to child to encourage to deal with the problem, offer help if needed by becoming an ally).
Use symbolic figures child knows and loves, such as Barney, Disney or Sesame Street characters, to generate symbolic play. Reenact familiar scenes or songs, create new ideas, and notice characters and themes child may be avoiding or fear. Use play to help child understand and master ideas/themes which may have been frightening. Work on fantasy and reality.


Let child be the director. Child's play need not be realistic (child may still be a magical thinker) but encourage logical thinking. Focus on process as you play; which character to be, what props are needed when ideas have changed, what the problem is, when to end the idea, etc. Identify the beginning, middle and end.
As you play, match your tone of voice to the situation. Pretend to cry when character is hurt, cheer loudly when your character is happy, speak in rough or spooky tones when you are playing the bad guy. Remember, drama, drama, drama to give child affect cues.


Reflect on the ideas and feelings in the story both while playing and later on as you would with other real life experiences. Discuss child's abstract themes such as good guy/bad guy, separation/loss, and various emotions such as closeness, fear, jealousy, anger, bossy, competition, etc. Remember symbolic play and conversation is the safe way to practice, reenact, understand and master the full range of emotional ideas and experiences.

 

Strategies to Develop Abstract Thinking

Follow child's lead, build on child's ideas. Challenge child to create new ideas in pretend play. Practice and expand rapid back and forth interactions and conversations (gesturally and verbally). Carry on logical conversations all the time (e.g.: while driving, at meals, during baths etc.) Content does not have to be realistic.
Encourage understanding of fantasy-reality. The child will use toys as real objects for self as if real (e.g.: puts feet in play pool, tries to go down toy slide, tries on doll clothes, etc.) or may prefer to start with role play and puppets. Encourage use of toys in pretend fashion and recognize fears and avoidance of certain feelings, themes and characters. During play and conversations get beginning, middle and end of story or idea - identify problem to be solved, motives and feelings - accept all feelings and encourage empathy. Select books to read that have themes, motives and problems to solve - discuss alternative outcomes, feelings.


Encourage abstract thinking by asking "why" questions and asking for opinions. Compare and contrast different points of view and reflect on feelings - come back to experiences again later. Avoid rote, fragmented, academic questions


Be creative: if child puts foot in pretend pool, ask if it's cold. If child is thirsty, offer an empty cup or invite child to a tea party. If child is hungry, open toy refrigerator and offer some food, pretend to cook, or ask if child will go to pretend market with you to get things to eat. Encourage role playing with dress-up props, use puppets - child may prefer to be the actor before the child uses symbolic figures. Use a specific set of figures/dolls to represent family members and identify other figures with familiar names. Get involved in the drama. Be a player and take on a role with your own figure. Talk directly to the dolls rather than questioning child about what is happening or narrating.

 

Strategies to Develop Motor Planning Abilities

Encourage "undoing" such as moving objects that have been lined up or positioned in a desired way. Put puzzle piece in wrong place or bury desired object(s) under other toys and very different objects. Hide a desired object from the place where child last put it etc. and provide destinations for actions - treat as intentional and symbolic. Some other examples:

• child throws - catch it in basket
• child taps - bring over drums (can be plate, plastic toy, sticks etc)

• child rolls car - bring over garage, crash into it, block with figure
• child reaches for hand - play give me five, variations, dance.


Create problems to solve that require multiple steps. Examples include:

• put desired objects in boxes to open, untie, remove tape or rubber band
• pretend object needs to be fixed using tools, tape, rubber bands, Band-Aids (symbolic)
• create obstacles to child getting around or restore to correct position
• hold book to read upside down and/or backwards
• offer pens/markers which do not work
• sit in child's special place
• get to where the child is running first
• hide object child desires in one hand or the other so that the child can choose
• when child seeks your hand, put your hands on your head or in your pocket
• put socks on child's hands instead of feet
• give child your shoes to put on
• make desired toy/object a moving target (move from place to place).

 

Be playful and supportive as you encourage and expand these interaction. Change environment frequently to encourage flexibility, create problems and expand discussion. Move expected objects (change drawer content, change content in baskets) and rearrange furniture and create problems (child find chair upside down, or is told to sit down when chair is across the room). Hang up pictures from magazines at eye level and change frequently.


Play interactive song-hand games such as Itsy bitsy spider, one potato two potato, slap my hand
sailor went to sea, sea, sea etc. Play Treasure Hunt and use maps (use visual and verbal cues).

 

Activities that are good for building on motor planning abilities include:

• Play games

• social playground/party games
• board games (cognitively challenging)
• cooking
• drama
• arts and craft activities

• athletic activities • individual sports e.g. tennis, roller skating, shooting baskets, ice skating etc
• group sports e.g. soccer, baseball, basketball etc
• gymnastics
• Tae Kwon Do.

 

READING LIST and ONLINE RESOURCES on Floortime

For more information about Floortime and other Greenspan Early Intervention concepts contact:

http://www.stanleygreenspan.com/
http://www.icdl.com/
The Interdisciplinary Council on Developmental & Learning Disorders, 4938 Hampden Lane, Suite 800, Bethesda, Maryland 20814, or call 301-656-2667
THE CHILD WITH SPECIAL NEEDS: ENCOURAGING INTELLECTUAL AND EMOTIONAL GROWTH. Stanley I. Greenspan, M.D. and Serena Wieder, Ph.D., Addison Wesley: (1998, Reading, MA). The most recent, comprehensive, and parent oriented discussion of the use of Floortime with children with special needs.
INFANCY AND EARLY CHILDHOOD - THE PRACTICE OF CLINICAL ASSESSMENT AND INTERVENTION WITH EMOTIONAL AND DEVELOPMENTAL CHALLENGES, Stanley I. Greenspan, M.D., International Universities Press, Inc.(1997, 3rd Printing Madison, WI). The comprehensive coverage of the whole range of Behavioral, Sensory Spectrum Disorders which is addressed to clinicians. The FEAS scales used in this program were developed from material contained in this book.
THE CHALLENGING CHILD - UNDERSTANDING, RAISING, AND ENJOYING THE FIVE "DIFFICULT" TYPES OF CHILDREN. Addison Wesley (1995, Reading, MA).
THE CLINICAL INTERVIEW OF THE CHILD. Co-authored with: Nancy Thorndike Greenspan, American Psychiatric Press, Inc. (1991, Washington).
DEVELOPMENTALLY BASED PSYCHOTHERAPY. International Universities Press, Inc. (1997, Madison, WI)
FIRST FEELINGS - MILESTONES IN THE EMOTIONAL DEVELOPMENT OF YOUR BABY AND CHILD. Co-authored with Nancy Thorndike Greenspan, Penguin Books, (1985, NY).
THE GROWTH OF THE MIND - AND THE ENDANGERED ORIGINS Of INTELLIGENCE. Addison Wesley (1997, Reading, MA).

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Many thanks for permission to reproduce information from Coping.org, a Public Service of James J. Messina, Ph.D. & Constance M. Messina, Ph.D., Email: jjmess@tampabay.rr.com ©1999-2007 James J. Messina, Ph.D. & Constance Messina, Ph.D. This material may be reproduced for your personal, educational, or noncommercial use as long as you credit the original authors and website.