An Example Of Child-Centered Therapy; Some Floor-Time Strategies For Children Who Can Sustain Two-Way Communication

We discuss how children with autistic spectrum disorders may uniquely, for biological reasons, miss a critical developmental capacity, the ability to connect affect or intent to motor planning and sequencing capacities as well as symbol formation...

Processing delays do not equal a central reasoning deficit. The child's learning curve over time, rather than a cross-sectional assessment done by formal testing, is our best predictor of outcomes.

The approach discussed here is what Stanley Greenspan calls a developmental, individual-difference, relationship-based approach to intervention--also known as floor-time. The ideas of James MacDonald and others are also reflected in these pages.

The developmental, individual-difference, relationship-based model (DIR), a theoretical and applied framework for comprehensive intervention, examines the functional developmental capacities of children in the context of their unique biologically based processing profile and their family relationships and interactive patterns. As a functional approach, it uses the complex interactions between biology and experience to understand behavior and articulates the developmental capacities that provide the foundation for higher order symbolic thinking and relating. During spontaneous 'floor time' play sessions, adults follow the child's lead utilizing affectively toned interactions through gestures and words to move the child up the symbolic ladder by first establishing a foundation of shared attention, engagement, simple and complex gestures, and problem solving to usher the child into the world of ideas and abstract thinking. This process is illustrated by a case example of a young boy on the autism spectrum interacting with his father during 'floor time' over a 3 year period.

DIR engages a child at her current level of functioning, works with the unique features of her nervous system, and utilizes intensive interactive experiences that are part of ongoing relationships to enable her to master new capacities.

Difficulties with relating and intimacy are often secondary to underlying processing disturbances. Many of the children can become quite loving and caring, thoughtful and creative, suggesting a need to change the criteria for diagnosing these disorders

As a therapeutic approach, Dynamic Play Therapy uses movement, art, and interactive games to identify expressive mismatches between parents an children who have difficulties with intimacy, attachment, and emotional expression.

Overall satisfaction with PPHC was 90%. Average cost of intervention was $2500/year. The PLAY Project Home Consulting model shows promise as a cost-effective intervention for young children with autism.

Early human interaction is the starting point of all knowledge. How important it is, then, to teach a highly sensitive child to bear the often unbearable light of another person's gaze

The Greenspan intervention method revolves around a concept he calls floor time -- time which the caregivers, generally the parents, spend entering the child's activities and following the child's lead.

We have presented a model (The DIR Model) to help systematize functional understanding of processing and developmental challenges in complex developmental disorders, including ASD. We have discussed the implications of this model for assessment, intervention, and a new functionally-based approach to classification.

To help the child 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.

There are biological challenges that impact most individuals with autism. These biological challenges impact the central nervous system that includes auditory, visual, spatial and cognitive processing; motor planning and other sensory issues.

...the recent studies of ABA/discrete trial are not very encouraging in terms of the results... in the only clinical trial studies done on behavioral approaches, Tristam Smith found only 13% achieved the educational goal that Lovaas claimed for 48%... there were no differences between the intervention group and the non-intervention group's emotional and social variables.

Floor Time is a strategy to assist children develop emotionally so that they will simultaneously grow cognitively, verbally and socially. This is a very time intensive and energy sapping experience for adults to do on a daily basis.

It is proposed that skill deficits addressed through child directed and adult supported play become a standard component of early intervention practice.

In summary, current research suggests that modern developmental, relationship-based approaches to working with children with ASD and their families focus on the goal of strengthening or constructing the functional developmental capacities for relating, communicating, and thinking. To accomplish this goal, modern approaches work on creating emotionally meaningful learning interactions that are tailored to each child's and family's developmental profile.

His CV, featuring information on his publications, presentations and training, audiotapes, and biography.

Relationship-focused intervention is a general approach to developmental intervention that encourages parents to use responsive interactive strategies (e.g., take one turn and wait; follow the child's lead) during routine interactions with their children. This approach to intervention is derived from child development research reported over the past 30 years that has consistently indicated a moderate relation between the degree in which mothers engage in responsive interactions with their children and children's level of cognitive functioning, language, and socio-emotional behavior.