Floortime is also Adolescent- and Adult-Led

Photo by JESHOOTS.COM on Unsplash

In March, we talked about Floortime being child-led. This week’s podcast is about how we can engage and communicate with an adolescent or adult using DIR/Floortime by following their interests, which might look quite different than how we engage a young child or someone who is younger, developmentally. A returning favourite, Dr. Gil Tippy joins us to explain this process. Dr. Tippy is an original Floortimer, having worked with Dr. Stanley Greenspan until his passing, co-authoring Respecting Autism with him, and co-founding the Rebecca School and Shrub Oak Academy, two Floortime schools in New York. He is currently in private practice in California, working on Dirty Hands Developmental Alliance, and consults around the world.

Where someone is Developmentally

When we learn about Floortime and the Functional Emotional Developmental Capacities (FEDCs), we are taught about this foundation upon which development progresses. In our podcast, Moving Up and Down Developmentally, Dr. Tippy spoke about the process of progressing developmentally within an interaction only to have the child become dysregulated, causing us to focus on attuning to the child to get that shared attention and engagement again. We tend to focus on the beginning and work our way up developmentally in one direction.

Then, in my Functional Emotional Assessment Scale (FEAS) course with Dr. Tippy a few months ago offered by the International Council on Development and Learning, Dr. Tippy gave an example of getting to engagement from the higher capacities instead of from the foundation of shared attention and regulation. It threw me for a loop! Dr. Tippy explains that it’s typical to talk about the early foundational capacities with young children because they have not mastered them yet. Floortime is about getting on the floor and playing with them. But with an older child or adult, it’s less likely that you’ll get down on the floor and push a car, train or school bus around, for instance, he says.

Following their Lead

One of the central tenets of DIR/Floortime is following the person’s lead, Dr. Tippy explains. It is often misunderstood. What it means, he says, is that, “I, as the person who is trying to support this person, have to figure out what is the person interested in. What is it they are trying to do? What is their interest at this moment?” Then, you use that to ‘hang your developmental model on in your head’ to move them up the developmental ladder. In the video Dr. Tippy showed in the class I attended, the adolescent showed up in his office with his calm, caring mother and he was reading comic books, but they were not relating.

It was clear that the adolescent liked graphic comics and books and DC Superheros. Him and his mother were not having any interactions. He wasn’t showing signs of being engaged, he wasn’t opening and closing circles of communication, Dr. Tippy couldn’t even tell if he was regulated. Since this was an older child, he wasn’t going to get on the floor, he wasn’t going to playfully obstruct to try to get those circles, so he had to go in at a level of the adolescent’s interest. His interest was the characters of the book and the plots.

Entering their World

Dr. Tippy explains that it doesn’t mean that the adolescent is always functioning further along the developmental ladder, and thinking abstractly or symbolically, or that he’s able to build logical bridges at all times. Nor, are any of us always functioning and thinking at a higher level developmentally. He did, however, have interests that could be used at those higher developmental capacities. But because he had his autism diagnosis from early on, he has had services all along and school systems tend to show a prejudice towards children with a diagnosis, Dr. Tippy adds. 

So how did Dr. Tippy enter his world and follow his lead? Dr. Tippy explains that he listened very closely. The child said something about there being a human being, Lois Lane, who works at The Daily Planet as a reporter, where Clarke Kent (who is secretly also Superman) also works as a reporter. Lois Lane is a human being and Superman is an alien raised by human beings. The adolescent thought it was interesting that Lois Lane and Superman were interested in each other and had a relationship. 

When Dr. Tippy heard that, he realized that was a level for him to begin to open and close circles and get engaged with. It is an interesting thought and might be at a higher developmental capacity, even though the child couldn’t tell Dr. Tippy reasons why he thought it was interesting. Nevertheless, he opened that window by sharing that with Dr. Tippy and made it clear he was interested and that was the ‘in’ for Dr. Tippy. It was symbolic and abstract, at a higher developmental capacity, but Dr. Tippy used that to then open and close circles of communication with him.

Opening and Closing Circles

As Dr. Tippy continued the chains of back-and-forth interactions with this older child, they moved up developmentally to the point where the discussion was abstract. They began to think about complications and did some role playing where the child had to be the next door neighbour of Superman and Dr. Tippy would play the government and the reporter. As they went back and forth, Dr. Tippy began to see the robust engagement that came from his interest and from having higher-level thinking and being supported in that higher level thinking. 

In order to get engagement with an older child, you don’t always have to do some of the tricky things that people do to get engagement when you’re with younger kids, Dr. Tippy says. When you’re with older kids or adults who have larger life experiences and have other things, Floortime–and the assessment of where a person is developmentally–has to include some of the maturational things and some of these developmental things. 

The Progression of ‘Peek-a-boo’

Dr. Tippy says it is possible to get at the same developmental capacity through using adult games and adult interests as with a child game like peek-a-boo, still opening and closing circles with the element of surprise, hiding, and anticipation that comes with peek-a-boo. It’s the early hunter-gatherer that we’re playing with. It started with following the footprints of a prey to lead you to the animal. It’s in all parts of our life, Dr. Tippy says. People instinctually play it with babies, covering their eyes then smiling.

When you’re older and playing poker, and playing Texas hold ’em and they flip the River card which changes the hand you’re holding, that’s peek-a-boo, he explains. It’s about the, “I can’t wait to see what’s about to happen and how it’s going to affect my future.” Or if you are addicted to Facebook, Instagram, or TikTok, what you’re doing when you put up a video on TikTok is waiting to see how many people are going to ‘like’ it. When you shop online, you’re searching and hoping to see something that will give you that jolt. 

There’s a million different ways to play peek-a-boo, he says. We find it endlessly entertaining, Dr. Tippy says, and adults are doing it all the time. You want to think about where the individual is developmentally, where you want to push them to developmentally, and how you will engage them, Dr. Tippy says.

Other Games for Older Children

Orienteering If you have a child with some visual-spatial struggles, you can do geocaching, which is like a treasure hunt. I asked if this was like the Pokemon game. Dr. Tippy said that no, that game is aimlessly wandering around until you bump into a Pokemon item. Dr. Tippy finds that geocaching is a hit with Dads. You’ll see on the app that there’s something hidden in the park near your house. You look at a map and begin to search logically for it, and you get to spend time outdoors. 

In schools, he has suggested using orienteering for school field trips to things like big museums. You don’t just show up and walk them around the museum showing them things. What you do is, weeks before the field trip, you get a map of the museum where you try to take the two-dimensional map and turn it into a three-dimensional notion of a building. The class can vote on what they want to see and you map out a logical way to do it. Then after two months of planning, when they arrive at the museum they have their maps in front of them, standing within the space. It’s hunting and gathering, and it’s peek-a-boo to support figuring out where you are in three-dimensional space which is such an important skill.

Noticing the Signs

Dr. Tippy says that in the planning stages of a field trip, there will be kids who will say they want to go see the Temple of Dendur at the Metropolitan Museum of Art. There will be other kids who might just say, “Flowers” and other kids who will only look up when you mention something. Dr. Tippy said you have to be a good teacher to notice that and say, “Oh, you want to see that. Ok, we will put it on the list.” You have to notice all of these communication styles. Differentiated education in a group setting is easier than people make it, he adds. You have to have a developmental perspective, not a behavioural perspective.

Using Floortime During Running Errands

Dr. Tippy suggests that if you have to get chores done, such as grocery shopping, to include the older child or adult, even though it might make it slower and less efficient. For someone who is not used to finding their way, but to simply being prompted, arriving at the store with a list of items you need and walking through figuring out where things are takes a lot. You have to think of yourself in three-dimensional space and begin to think how a designer of the supermarket thought when placing the items where they are. It’s what a European might call ‘Theory of Mind‘.

I shared that I usually just ask where things are rather than struggling to find them. He said that is a skill, too, though–to know who to ask, and that you can ask. But things in the store are grouped by what they are and how they function. For instance, at Dr. Tippy’s store, they’ve begun to put the peanut butter next to the bread. It’s someone’s thinking. So when you hand your loved one on the spectrum a list, and they say I don’t know where it is, you look at them and shrug. That’s Floortime. I suggested that Dr. Tippy make that his next For on the Floor video to follow up from his one about using maps.

Developmental Growth

Dr. Tippy explained how more and more states are providing self-directed money to adults on the spectrum and hire individuals to work with them. Dr. Tippy works with support staff by helping them understand how the client wants to get food to cook for dinner, or how to help them use the bus system. He shows them how to turn that into good developmental support. He recalls the only argument him and Dr. Greenspan had and it was around how individuals on the spectrum were often trained how to do things like deliver paper towels, or to use the bus by giving so much money to the driver, etc.

This didn’t lead to developmental growth, only memorization. When the bus was late or when the subways suddenly weren’t operating in NYC, this left the person with nowhere to go. Learning how to tackle a transportation system is Floortime, Dr. Tippy says. Dr. Greenspan and him agreed when they called it ‘Taking Floortime to the larger Ecological Context’ and worked on adding the thinking aspect to it. The last chapter in Respecting Autism is about the application of this. 

We are All Always Developing, if we Chose to

I gave the example of how challenging I find navigating the grocery or hardware stores which comes so easily to my husband, yet how I really enjoyed navigating the complex subway system the first time I went to Paris, France. Dr. Tippy gave the example of how he grew up in the Northeast before Google maps were created and now living in California he doesn’t know his way around as well because he’s only relied on technology. He also gave an example of an autistic adult he worked with who found it impossible to leave her house to get a job after graduating from college.

He gave a task. If she wanted a slice of pizza, he had her drive to the pizza restaurant by only taking left turns. It made her think and plan. Then this 21-year-old ended up having to do the shopping for her family. She went from being someone who wouldn’t leave the house to someone who is employed and has been promoted in a very competitive, cool job. It was all Floortime taken to the larger ecological context with the support of an adult by thinking more abstractly and more symbolically. She can now take on the world in a more flexible way and has saved up money to buy an apartment and is interested in dating.

The Relationship

I gave another example of seeing a family repeatedly at model train shows we went to and never having heard their autistic child speak. At one show I was explaining to the caregiver that after the show, we were grabbing dinner then going to see the Christmas train display at the nearby mall, then heading to the train club’s open house close by. The autistic boy turned to me, looked me right in the eye, and asked, “Where’s the place with the Christmas train?” I smiled and exclaimed, “Wow! He talks!” then explained the plan to him. It was an example for me of what Dr. Tippy is talking about when you come at a higher developmental capacity around a chlid’s interest to get engagement.

I also shared that sometimes when my son gets stuck on something and is dysregulated and frustrated, instead of co-regulating by mirroring his expressions of feelings I can suggest something about Mario Kart, his current interest, and he snaps right out of being dysregulated, and is immediately in a back-and-forth exchange with me. I asked Dr. Tippy if this is just me distracting him. Dr. Tippy responds that you don’t always have to regulate someone sensorially. You can regulate them by taking a real interest in their interests, i.e., following their lead. So he doesn’t think it’s distraction, but love, interest, and a real relationship.

I ended with another example of how after the lockdown, my son’s school has taken more precautions. Upon their return, my son was having a harder time separating from me outside at the entrance. It would take five to fifteen minutes of co-regulating before he’d feel secure and confident enough to go inside. But after the most recent lockdown, my son had a new therapist meet him at drop off and all she did was hold up a laminated card of Mario Kart characters, and he walked right in, all excited to pick which character they would draw on the board.

Dr. Tippy says that it’s skillful to know who you’re working with and what their interests are. He adds that eventually that therapist will not want to have the card, and simply through the power of her being, their relationship, and her caring, she will just show up. My son will see that there’s someone he cares about and who cares about him and who actually knows him, and then he will separate on his own, and the Mario Kart card won’t always be necessary. Because this therapist was new, they didn’t know each other. Now they have formed a relationship, so this is a good next step to aim for.

Thank you to Dr. Gil Tippy for sharing his Floortime expertise with us about adolescents and adults, which is a topic I’m asked about so frequently. If you enjoyed and found it useful and helpful, please do share it on Facebook or Twitter and feel free to share relevant experiences, questions, or comments in the Comments section below. Stay tuned next week for veteran Occupational Therapist, Robbie Levy, who will discuss the importance of movement–in a Floortime way–during the pandemic!

Until next week, here’s to affecting autism through playful interactions!