Clinical psychologist, Andrea Davis, returns this week to review a Floortime session of me playing bowling with my son. Dr. Davis is the founder and director of the Greenhouse Therapy Center in Pasadena, California (not “Greenwood” as I accidentally said in the podcast, oops!) where she practices the Developmental, Individual differences, Relationship-based (DIR) model. She is also an advocate with the Floortime Coalition of California. It is a thrill to have her back and to hear her observations about my son’s developmental progress.

Floortime Review with Dr. Andrea Davis

by Affect Autism

Initial Observations

Dr. Davis co-authored a User’s Guide to the DIR Model in which she describes what we do when we do Floortime. By spelling out what we do as ‘strategies’, Dr. Davis can help caregivers and practitioners new to Floortime see that how they interact has an affect on development. I’ll refer to the strategies described in her book throughout this blog post.

In this Floortime session, I followed my son’s lead by choosing an activity of interest to him (Strategy A.5 Use natural interests). He loves the cartoon PJ Masks and he loves bowling, so when he saw PJ Masks bowling pins at the store one day, he was immediately interested!

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My son also has the need to move so bowling allows us to respect his individual sensory profile (Strategy B.1 Child’s profile). I also manipulated the environment to some degree (Strategy B.5 Home design) by containing our play into the hallway so we could focus on having complex social interactions at the fourth functional developmental emotional capacity.

Dr. Davis began by emphasizing the progress she sees not only in my son’s development, but in mine as well and gives some initial examples of strategies I am naturally using from her Floortime User’s Guide–a very helpful book that can help beginners get started doing Floortime.

Dr. Davis says that we see video evidence for the efficacy of Floortime when we can view this progress over time, such as in the progression of our Floortime reviews with Dr. Davis, and the DIR lens helps us see what is profoundly fundamental to a child’s developmental growth. A key practice in the DIR model is Self-Reflection (Strategy A.10).

Dr. Davis points out that these are bowling pins that light up and flash, and what strikes her immediately is how my son is able to stay in the social world without retreating to the more mechanical world on his own with just the toys–a testament to the years we’ve spent woo-ing our son into the social world using DIR/Floortime.

Dr. Davis is looking at how he is doing in his social capacities and what am I doing in this moment to facilitate his optimal social functioning in this moment. She sees that he is functioning at the highest and most robust levels of capacity 4 which is about how we, together, are going to spend our time in a way that is pleasurable to both of us. And what jumps out if my use of Strategy 4.8, Social flow.

My son was getting excited by his own ideas and I said, “too fast!” which reminded him to slow down. I’m a stand-in for a peer, Dr. Davis says, by helping him build these social capacities so he can learn the flow of information between two people. He’s learning to remember there’s two of us together and we’re trying to track with each other how to have fun together.

I pointed out to Dr. Davis that you can also see how excited my son is to play by seeing his bouncing legs and how eager he is to throw the ball at the pins the second I am done setting them up. I suggested this demonstrates his growing ability to self-regulate. Dr. Davis said that indeed I have been able to use Strategy 4.1 Stretch interactions and Strategy 1.4 Lengthen attention. It’s about asking how do we expand the social flow and sustain it. He is clearly able to stay in the interaction despite his excitement.

I also added that although we do not see it in this video, he is now able to maintain that social back-and-forth in different emotional states, which is also part of Capacity 4. We can still sustain the back-and-forth during when he is upset, which Dr. Davis says indicates that he can receive my co-regulatory support when he is upset. I added that even when he can’t, he can come back quickly. She says that is great because that means he’s now able to participate in more experiences without having to be shielded from experiences that might make him disruptive for others.

Encouraging Social Flow 

In the beginning when he’s so excited to play, Dr. Davis says there’s a lot more support from the adult to get going. He is calling all the shots and I’m listening encouraging social flow with A.2 Be responsive, 4.2 Don’t Judge, 2.2 Gaze Tracking (watching his eyes), A.8 Embrace feelings and 2.1 Joint attention (joining him).

The essence of social skills is Strategy 2.3 Share Pleasure, the pleasure of being together: shared joy. I started to expand a tiny bit once he calmed down by suggesting my own idea, what Dr. Davis called Strategy 4.7 Genuine self, so he can get curious about my ideas too without insisting upon it and using Strategy 2.9 Use anticipation. I also quieted and slowed down to balance his excitement (B.3 Adapt yourself) and used my entire communication system by raising my arms and using my gestures, or Strategy 2.5 Emphasize affect.

Dr. Davis emphasizes the Don’t Judge Strategy 4.2. She explains that some parents find it difficult to not correct their children’s way of expressing themselves if it looks a bit different, but if we did that we would completely lose the social flow. So we have to keep in mind what is most important which is the developmental progress first. We can leave alone the other behaviours that might be disruptive or odd because we want the focus to be on developmental progress.

On Disruptive Behaviours

I provided Dr. Davis with a couple of examples of how I manage behaviours in public. She suggested Strategy X.7 Preview which is about  providing my son with expectations where we verbalize what to expect before going out somewhere. We want him to adjust to these expectations and to internalize them. “We will talk quietly so other people can enjoy the trains” might be an example which might work better than an in-the-moment cue and remind which is less effective because he’s so excited.

When I talked about my son drinking the water at the splash pad and mentioned that we do some of the previewing, we discuss rules. She mentioned that Strategy X.8 Post rules is about agreeing on, posting, and enforcing rules because without a consequence a rule is just a wish. It’s about gently telling him the rule, empathizing with him, and explaining why. When he can do the mantra “Don’t drink the water” she suggests trying to add “or else“, but third, helping him to understand why.

Dr. Greenspan used to say break it down, so she suggested perhaps we can ask if he can go 2 minutes without drinking the water. After that 2 minutes regroup, celebrate and do the happy dance, acknowledging that he did it, then ask if you should try for another 2 minutes or go home? She says to do an outing just to work on that goal alone. Make it a reachable challenge to have a success because that’s how he will learn.

Working on his impulse control might be a priority now. We want him thinking about making the rules, what would help me remember the rules, and thinking about it. Involve him, she says. We heard similar suggestions from Jake Greenspan last time around food choices as well.

Expanding the Play and Presenting a Challenge

Around the 46-minute mark, Dr. Davis notes that I gently suggest, “Do you think you can set them up now?” to encourage a change or expansion in the play. I wasn’t insisting, but instead invited him by suggesting it. Dr. Davis says it’s pretty natural for me to let him direct the game and not insert my own ideas, but for many of us at the beginning we are inserting our own ideas which is disrupting the flow. So I did set the stage by joining him in all of his ideas then brought him back to the main activity.

I told Dr. Davis that I do need to start challenging him a bit more in play because he is really ready. Once you have this robust back-and-forth at the 4th capacity, it’s time. She suggested we can aim to do this in our next Floortime review session. In the meantime, she pointed out that when my son brought up having more pins, I was able to avoid a challenging situation by granting his wish in fantasy saying that it would be nice to have more pins. She pointed out that it helped him stay regulated and added that you could take it a step further by asking, “What would we do if we had 10 pins?”

Where I did try to create some challenge was more about teaching some math. Dr. Davis said I was scaffolding by using some rhythm and auditory support to help him count objects as opposed to him just counting without matching the numbers to the objects. In self-reflecting, I realized I was trying to come up with a challenge for him and that was what came to mind. In addition, my son would stray off topic as he remembered events and Dr. Davis pointed out that I was supporting him by sharing his mutual gaze with our faces are connected and having an anticipatory stance, showing him I’m interested. He is so eager to share these ideas with me, which is the core to a social relationship, Dr. Davis says. At this point, he is ready for a challenge and I ask him if I can take a turn.

I brought up that Canadian psychologist Dr. Neufeld says, “Collect before you direct” and Dr. Davis offered that Dan Siegel and Tina Bryson say, “Connect before you re-direct” which is in line with Floortime’s moving up developmentally concept. In our video, I finally challenge my son when I’m taking a turn by waiting and not rolling the ball right away as he’s telling me to take a turn over and over. Dr. Davis says this might feel uncomfortable for me, but it’s great because there is constant frustration with peers. Building up that stress tolerance is an essential part of navigating the social world.

Rather than giving up, Dr. Davis points out that my son got more flexible and tried some different ways to get me to roll the ball. He also got to feel a bit of mini-frustration, which helped with his stress tolerance. I challenged him by changing up how I was bowling and not being predictable. Dr. Davis says this is practice for handling the distress of not knowing what your friend will do. She also brings up the Relationship: that I have that delight and love for him, so I can get the furthest with him. The love and delight is the support to allow the challenge. When we can see through their eyes what’s fun and funny to them, we can remember how being a kid felt like and realize how fun it is to share joy with another.

Thank you to Dr. Davis for taking the time out of her busy schedule to review this Floortime session for us, offering her observations and guidance. If you enjoyed this post please consider sharing it on Facebook or Twitter and if you have any constructive feedback, related experiences, or comments or questions, please feel free to type them into the Comments section below.

Until next time… here’s to affecting autism through playful interactions!

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