Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think, by Stanley Greenspan and Serena Wieder, is a guidebook and near-instructional manual on the DIR/Floortime method of therapy.
I'm typically cautious to the point of pessimistic skepticism when reading about specific therapies and how they're supposed to "improve" autistic people. This is possibly because Applied Behavioral Analysis (ABA) is the biggest of these therapies, and it is all-too-often abusive. But I'd heard good things about the Floortime method, so despite this book being 400+ pages, I gave it a read.
I was not disappointed. While the book is dense and not written in a way that's easily accessible to a frazzled parent, the approach it's trying to communicate is excellent.
Unlike ABA, which typically just tries to elbow autistic people into "normal behavior" via bribery, Floortime instructs parents and caregivers to enter the autistic person's world. Instead of invalidating our experiences and existences in pursuit of some imagined norm, the aim is to develop connection, warmth, stability, and then, communication and reasoning skills.
Floortime recognizes the autistic person as a person. Perhaps a person with difficulties, sensory or biological or emotional, but a person deserving of kindness, care, and attention. A person with autonomy and feelings, regardless of what level of apparent functioning they've reached.
Floortime also refuses to assume a limit on how far an autistic person can develop. It lays out the developmental steps for communication and reasoning, but then says on page 125: "Never assume a ceiling on a child's abilities. Always assume you can get to one more level, and after that, one more level."
The writers are aware that people may have limits, and may only be able to develop to a certain point, but they prefer to err on the side of assuming competence and assuming potential rather than possibly limit a person's growth and development. Since that kind of assumed limitation is so common and crippling, and people with limited speech are so typically ignored, this philosophy is what all people should strive for.
It doesn't pretend the process will be easy, nor does it ignore biological, sensory, and processing differences. These have their own chapters devoted to them, and while I could wish for much more to be said on the subject, it's a bit outside the scope of the book.
I can't stress enough how unusual Floortime's philosophy is. Or how badly it's needed. This is the therapy that should have been subsidized by insurance companies, not ABA. Rather than teaching robotic compliance, it teaches proactive communication, self-regulation, and connection. It recognizes that humans, all humans, are social and desire positive relationships with others.
It makes me wish, in all honesty, I'd had the opportunity to benefit from this therapy. As an autistic adult who is markedly leery about behavioral therapies, that's probably the highest compliment I can give.
I could probably continue showering Floortime and its creators in compliments and appreciation for some time, but there are some other things that should be said.
First, Floortime is not a "follow directions, receive child with improved functioning" sort of deal. It's a significantly effortful, complicated, time-intensive method, which is why it took them 400 pages or so to explain it. It requires you spend at least 15 minutes per session with the autistic person, and suggests 8 sessions a day. As such, it is not a therapy that is easily practicable by every parent in the current world. Single parents, or even two parents near or under the poverty line, may have difficulty finding the time and energy for the sessions.
The authors specifically state that interventions and therapy need to be built on a stable base: a healthy, safe environment with adequate food, shelter, and medical care (pg. 255). In an ideal world, that would be true of every family. In reality, it is not.
Money worries can strain spouse relationships, and communication issues may exist beyond the actual autistic person. Family relationships in a household with an autistic person can be significantly unhealthy. If the autistic person is to develop in a healthy way, family counseling may be required. And of course, not all families can afford counseling.
Second, this book is not the most approachable for a busy parent. The style of writing seems more akin to scientific writing than it does to plainspeak. The word choice isn't overly elaborate, thankfully, but I found the writing dense and difficult to digest in large chunks. The authors do not get to the point quickly or efficiently. This is maybe understandable since they're trying to convey a philosophy and a state of mind, rather than simple facts or bullet points.
Finally, like basically every other "here's this method to help autistic people!" guide, this book is geared towards helping children. Most references in the book speak about developmental levels and abilities typically involved in childhood, and the book stresses beginning Floortime as soon as possible.
However, Floortime can also be used with adults, and chapters 17 and 18 specifically talk about how that can be done. They also share the results of a few cases where it has been done, and the positive results that followed. So while I'd personally appreciate more emphasis on it never being too late to start, the authors didn't entirely miss this point.
I'm typically cautious to the point of pessimistic skepticism when reading about specific therapies and how they're supposed to "improve" autistic people. This is possibly because Applied Behavioral Analysis (ABA) is the biggest of these therapies, and it is all-too-often abusive. But I'd heard good things about the Floortime method, so despite this book being 400+ pages, I gave it a read.
I was not disappointed. While the book is dense and not written in a way that's easily accessible to a frazzled parent, the approach it's trying to communicate is excellent.
Unlike ABA, which typically just tries to elbow autistic people into "normal behavior" via bribery, Floortime instructs parents and caregivers to enter the autistic person's world. Instead of invalidating our experiences and existences in pursuit of some imagined norm, the aim is to develop connection, warmth, stability, and then, communication and reasoning skills.
Floortime recognizes the autistic person as a person. Perhaps a person with difficulties, sensory or biological or emotional, but a person deserving of kindness, care, and attention. A person with autonomy and feelings, regardless of what level of apparent functioning they've reached.
Floortime also refuses to assume a limit on how far an autistic person can develop. It lays out the developmental steps for communication and reasoning, but then says on page 125: "Never assume a ceiling on a child's abilities. Always assume you can get to one more level, and after that, one more level."
The writers are aware that people may have limits, and may only be able to develop to a certain point, but they prefer to err on the side of assuming competence and assuming potential rather than possibly limit a person's growth and development. Since that kind of assumed limitation is so common and crippling, and people with limited speech are so typically ignored, this philosophy is what all people should strive for.
It doesn't pretend the process will be easy, nor does it ignore biological, sensory, and processing differences. These have their own chapters devoted to them, and while I could wish for much more to be said on the subject, it's a bit outside the scope of the book.
I can't stress enough how unusual Floortime's philosophy is. Or how badly it's needed. This is the therapy that should have been subsidized by insurance companies, not ABA. Rather than teaching robotic compliance, it teaches proactive communication, self-regulation, and connection. It recognizes that humans, all humans, are social and desire positive relationships with others.
It makes me wish, in all honesty, I'd had the opportunity to benefit from this therapy. As an autistic adult who is markedly leery about behavioral therapies, that's probably the highest compliment I can give.
I could probably continue showering Floortime and its creators in compliments and appreciation for some time, but there are some other things that should be said.
First, Floortime is not a "follow directions, receive child with improved functioning" sort of deal. It's a significantly effortful, complicated, time-intensive method, which is why it took them 400 pages or so to explain it. It requires you spend at least 15 minutes per session with the autistic person, and suggests 8 sessions a day. As such, it is not a therapy that is easily practicable by every parent in the current world. Single parents, or even two parents near or under the poverty line, may have difficulty finding the time and energy for the sessions.
The authors specifically state that interventions and therapy need to be built on a stable base: a healthy, safe environment with adequate food, shelter, and medical care (pg. 255). In an ideal world, that would be true of every family. In reality, it is not.
Money worries can strain spouse relationships, and communication issues may exist beyond the actual autistic person. Family relationships in a household with an autistic person can be significantly unhealthy. If the autistic person is to develop in a healthy way, family counseling may be required. And of course, not all families can afford counseling.
Second, this book is not the most approachable for a busy parent. The style of writing seems more akin to scientific writing than it does to plainspeak. The word choice isn't overly elaborate, thankfully, but I found the writing dense and difficult to digest in large chunks. The authors do not get to the point quickly or efficiently. This is maybe understandable since they're trying to convey a philosophy and a state of mind, rather than simple facts or bullet points.
Finally, like basically every other "here's this method to help autistic people!" guide, this book is geared towards helping children. Most references in the book speak about developmental levels and abilities typically involved in childhood, and the book stresses beginning Floortime as soon as possible.
However, Floortime can also be used with adults, and chapters 17 and 18 specifically talk about how that can be done. They also share the results of a few cases where it has been done, and the positive results that followed. So while I'd personally appreciate more emphasis on it never being too late to start, the authors didn't entirely miss this point.
Read This Book If
You're a parent, professional, or caretaker for an autistic child, adolescent, or adult. If you're looking for a therapy to help your loved one connect with the world and improve their communication, this is it. Seriously. I can't recommend the method highly enough. The book itself may be a slow read, but the ideas are sound, and even backed up with research at the end of the book.
Wow, this sounds cool! I love that the authors recognize the actually human needs of autistics. I mean, this should be obvious, but with ABA etc. it for sure isn't. It also reminds me of a video I recently saw on the Dutch Center for Consultation and Expertise's website in which a young adult wiht profound intellectual disability and sensory processing issues was helped by his support staff doing "attachment time" with him. This man was diagnosed with attachment d isorder, not autism, but it does speak to me re the often unsafe environments that autistics grow up in with ABA etc.
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