See VIDEO BLOG created on November 8, 2016

In the last two blogs we talked about starting to implement a DIR/Floortime® for your child by first determining their individual sensory profile, and then by determining their developmental level using a basic checklist. This week we will talk about the nuts and bolts of starting the Floortime™ session. Please review the Introduction to Floortime™ blog for a refresher as well.

The Set Up
Eventually when you are comfortable with the principles of the Floortime™ session, you can do Floortime™ anywhere and everywhere. To begin, though, let’s start with planning to hold the session in a preferred area at your home where your child is comfortable.
Depending on your child’s sensory profile, you might want this to be a place with minimal visual, auditory and other distractions. This will allow you the best chances of engaging your child and keeping their attention.
Have a few items on hand that your child might enjoy playing with. Avoid toys with batteries that entertain your child such as toys with buttons to press that make noises. Simple items such as balls, pillows, blankets, balloons, or bubbles are good.
Example:
  • In today’s blog photo the therapist chose the patio area for the session which had minimal visual and other distractions and it was a beautiful summer day.
  • Our son loves “accidents” such as spilled water so the therapist used a highly motivating activity of a simple green bin with water in it, knowing our son would be motivated to spill the water.
TIP: The goal is to keep the child in the same activity for as long as possible, rather than moving from one activity to another because we want the continuous flow of gesturing and “checking in” that neurotypical children have. This is very difficult to achieve if you are moving from activity to activity.
1st: Follow the Child’s Lead
OBSERVE AND JOIN: To start your session you will first want to be the observer. Note what your child is doing and simply join your child in what they want to do.
Do not ask your child questions. Do not direct your child’s play or suggest to them what to do. Do not physically move or help your child do something. Just observe and follow their lead to join them in their play.
Some children are non verbal and have seemingly purposeless behaviours while others might engage in meaningful play and/or be verbal. Either way, we want to participate in what is motivating for them.
With more repetitive behaviour, this is more or less imitating what the child is doing with the intention of getting the child to notice that you are doing what they are doing.
In more purposeful play, it is about engaging in an activity the child enjoys so (s)he is motivated to stay with the activity.
Dr. Greenspan always said that you want to treat every behaviour as purposeful.
Examples:
  • If the child is simply rocking back and forth, or picking at a spot on the floor, then you assume that is a motivating activity for the child and do the same thing beside him/her.
  • If they are moving a car back and forth or spinning the wheels, you join them with your own car and start by imitating what they are doing beside them.
  • If they whack a balloon across the room, you grab a balloon and whack it back. If they jump on a big pillow, you jump on another pillow.
  • If they want to build a tower the knock it down, then you help them build a tower.
  • In our example in today’s blog photo, the therapist followed our son’s lead when he wanted to put water in the green bin and spill it. She helped him get the bin out,  put water in it, and then in the photo is about to spill the water.
TIP: You also want to always USE AFFECT to engage the child. Use sound effects, facial expressions, intonations, exaggerated gestures or body movements and the like to invite your child into a shared world.
2nd: Present a Challenge
INSERT YOURSELF: You want to take joining the child a step further by inserting yourself into the child’s world and getting him/her to include you in what (s)he is doing.

PLAYFUL OBSTRUCTION: A technique called playful obstruction is a way to playfully entice the child to interact with you–even if it only lasts for a single moment before they go back to continuing to ignore you. You have to start somewhere.

Playful obstruction is getting in the way of what your child is independently doing so they have no choice but to acknowledge you.

PLAY DUMB: A great way to prolong every interaction is by playing dumb. Dr. Gil Tippy likes to say that he hopes to hear from his students one day how they thought he was so dumb! So what is this about?

Dr. Tippy says it’s like having your foot on the gas pedal and brake at the same time. You stop and look puzzled and wait for the child to initiate what to do next.

You don’t want to play dumb to the point of your child getting frustrated and moving on to a new activity, but neither do you want to just do all the steps for him/her.

Examples:
  • If the child grabs a ball and throws it just to grab it and try to throw it again, you want to fetch it first and say “my turn!” and then toss it to him/her.
  • If (s)he reaches for a desired toy, you might playfully grab it and hold it on your head for him/her to come get.
  • If (s)he is running in circles, you might jump in front of him/her so (s)he has to move around you.
  • In our example in today’s blog photo, the therapist is waiting on cues from our son about what to do because he is motivated to spill the water. She played dumb through the entire process, and she used affect to entice our son in each step in the process.
  • First, they needed water. She waited and “played dumb” until my son initiated going to the sink. She stopped there and “played dumb” until my son initiated turning on the tap.
TIP: RECIPROCITY is an important aspect of Floortime™. Reciprocity means we are about equal participants in the interaction rather than one of us doing more than the other. If the child gives you a glance, gesture, or a word, you respond with about the same amount rather than using a lot of words. In neurotypical children this is seemless as they glance at the other for cues before proceeding, gesture with the other, and exchange words while always checking in that the other person is "in it" with them. This is our goal.
3rd: Expanding the Interaction
Whenever we would try to do a Floortime™ session with our son, we could join him and follow his lead and even challenge him, but then what? We would lose him as his attention was diverted elsewhere.
This can be the most frustrating part of Floortime™ and many parents find this the most challenging piece.

Since one of our main goals in Floortime™ is to get a good chain of affective reciprocal interactions going with the child: a good back-and-forth interaction–verbal and/or non-verbal, we need to find a way to prolong every step in our interaction.

So once we join and challenge the child, the next step is to add a new element into the play. This will prevent repetition in the play which can push the child back into his/her own world.
By adding or changing one thing about the play, we aim to continue to capture the child’s interest in being with us in our shared world. We are still following their interest, but expanding it just enough to keep it from being repetitive to get prolonged interactions with the child.

When a child seems stuck, Dr. Greenspan would offer two choices to move the process along: the right choice first and a silly choice second (since many kids will just repeat the last thing they heard).

Each step in prolonging the interaction promotes another circle of communication, or back-and-forth interaction.

In summary, we want the session to be practice for the child in looking to us for affective cues (which is our facial expressions, vocal intonations, etc.) and having a good, continuous flow of balanced back-and-forth of gestures, glances, or words on the same topic or within the same activity (rather than jumping from activity to activity aimlessly).

Examples:
In the example where the child reaches for a desired toy and you playfully grab it and hold it on your head for him/her to come get, you can expand this idea by putting it behind you the next time, and then under your leg the third time.
If you are knocking down a tower with your hands, you might do that for a few times and then change it to body bumping into the tower, and after that, use a ball to knock down the tower.
In our example with the green bin, if playing dumb was losing our son’s attention, the therapist may have asked our son “bin in the sink or on my head?” If he replied “head” then she would oblige and put the bin on her head. He would protest because he really wants to put water in it.
So she would repeat the question again until he realized it’s the sink where they would fill the bin with water and either say “sink” or point to the sink.
Back to our photo, once outside she could continue to expand the interaction by holding the bin up high until he initiated an interaction to spill it. She would prolong it by saying things like “bin over here or over there?” “up high or down low?”
She could have first spilled all the water, then spilled a tiny bit of water, changed the container that was used for spilling the water, or even had our son help to grab and tilt the bin to spill the water.

"3 ways to Expand Play with Cars" from our friends at PEEK-A-BOOST PLAY

CLICK HERE

For a much better description than I could ever provide, please listen to Dr. Greenspan himself talk about how to do Floortime™

LISTEN HERE

This is all nice and good… but… WHAT IF?

  • What if my child won’t stop crying or having a tantrum?
  • What if my child appears to ignore me no matter what I try?
  • What if my child just wants to repeat the same thing over and over?
  • What if what my child wants to do is be violent or do something dangerous?

Ahhh…

Next week we will talk about the interaction of the Floortime™ session with the “D” (developmental level), the “I” (individual profile), and the “R” (the relationship with you).

Until next week… here’s to affecting autism!

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