Engaging Floortime (2): Greenspan on How Autism Develops
July 18, 2006 by Kristina Chew, PhD
Filed under Health
I will begin my review of Dr. Stanley Greenspan’s new book, Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate and Think not by reviewing the techniques of his Floortime approach, but by considering his views on “how autism develops.” Appendix B of Engaging Autism is entitled “How Autism Develops: The DIR Theory” and opens with a reference to Greenspan’s earlier work on “the development of symbol formation, language, and intelligence,” and especially to his 2004 book The first idea: how symbols, language, and intelligence evolved from our primate ancestors to modern humans, whose co-author is Stuart G. Shanker.
According to the observations we have made of a range of infants, young children, and their families (Greenspan, 1979, 1992, 2001; Greenspan and Shanker, 2004, 2006) the development of symbol formation, language, and intelligence is based on a series of critical, emotional interactions early in life. When these interactions are not mastered, these abilities do not develop. Biological factors present in autism can make it difficult for a child to participate in these interactions. We have observed that children with ASD have not fully mastered these critical early interactions (Greenspan et al., 1987; Greenspan, 1992; Greenspan and Wieder, 1998, 1999). (p. 395)
Though this is only one paragraph from Engaging Autism, these four sentences are emblematic of Greenspan’s thinking throughout the book and, indeed, behind the uses of Floortime in treating “children at risk for ASD” (p. 399). The first sentence is a general statement about the development of “symbol formation, language, and intelligence” in children—about child development—-about children in general. A certain “series [my emphasis] of critical, emotional [my emphasis] interactions early in life” are necessary for a child to “master,” and it is precisely this “mastery” of these “formative emotional interactions” that does not occur in children with ASD. Greenspan’s Floortime is an intervention designed to create “special opportunities for the necessary [my emphasis] formative emotional experiences [my emphasis].”
In other words, due to “biological factors,” an autistic child (according to Greenspan) has difficulty in acquiring these “formative” experiences, so that his development is impeded. Floortime, with its emphasis on looking at the “core psychological deficit in autism” —identified by Greenspan as an infant’s capacity to “connect emotions or intent to motor planning and sequencing and to sensations and, later to emergent symbols” (p. 397)—focuses on recreating, via those “special opportunities” (i.e., the specific techniques of Floortime), that connection between emotion and motor planning, etc., that some children do not develop “because of their unique biologies” (p. 395). Greenspan notes that these “biological factors” include a child’s genetic make-up that “may presdispose a child to autism, or create vulnerabilities to cumulative pre- and postnatal challenges such as infectious illnesses, toxic substances, and factors that can precipitate autoimmunity” (p. 396)—-Greenspan seems here to be referring to theories about the MMR vaccine, thimerasol, mercury, environmental toxins, air pollution, etc., as causes of autism.
In the next sentence in this paragraph (in a section entitled “A Multifactor, Cumulative Risk Model”), Greenspan writes:
Postnatal factors such as experiential or physical stress may also contribute to the behavioral patterns symptomatic of autism and ASD. (p. 396)
A few pages later, he writes:
When biological factors (or severe deprivation or abuse) interfere with the formation of a primary connection among the sensory system, affect, and the motor system, behavior is not strongly linked to affective qualities of sensation. Therefore, infants with this deficit evidence more aimless behavior…..(p. 399)
In addition to “biological factors,” Greenspan suggests that something in an infant’s experience may be causing “stress” on his system. The second passage quoted above provides a more specific sense of what he means by “experiential stress,” namely “severe deprivation or abuse.” It is suggested here that a child is “at risk for ASD” (p. 399) because something is lacking in those taking care of the child—the child’s parents; indeed, Greenspan suggests that the child’s caregivers may be “severely depriving” and even “abusing” a child.
Is it possible that Greenspan is suggesting that a child can be “at risk for ASD” due to improper care from the child’s parents?
If so, enfolded in Greenspan’s discussion in Appendix B of “How Autism Develops” and in his “developmental, individual-difference, relationship-based” DIR model, is more than a hint of a theory of autism that most parents have long thought outmoded and discredited, namely, the refrigerator mother theory of autism first stated by Leo Kanner and promulgated by Bruno Bettelheim.
I will continue my analysis of Engaging Autism and more of the specifics of the Floortime approach as Greenspan presents them in this book in a future post.
@Andy,
Thanks for sharing your thoughts. A careful reading of many of Greenspan’s works reveals similar views about how parents “contribute” to a child “becoming” autistic (he also notes such views in The Special Needs Child).
Larry commented that children have been cured of autism by using Floortime. This is news to me. I thought it would be helpful to draw my son into more purposeful play instead of shredding papers or stomping feet or slapping walls with palms of hands, etc. Although some of it is sensory based and I ordered two DVDs today to help with that and taking the sensory conference now as well as the Stanley Greenspan online course.
I have Engaging Autism and yet to read it and have read some of Special Needs child, but not that much to get this sense of it yet. Interesting take and now I am going to have to find time to read many books and less computer time.
“Larry commented that children have been cured of autism by using Floortime. This is news to me.”
——-
Autism is listed in the DSM of mental disorders. According to Freud, all personality is a mental disorder. It’s the price we pay for living in civilization. We are all on the autistic spectrum. The cutoff, therefore, between mental illness and mental health is necessarily arbitrary. My favorite cutoff is Freud’s who defined mental health as the psychological ability to work and love. Accordingly, lots of autistics have been *cured* of autism.
Freud … who betrayed his patients by ultimately deciding they were lying about being abused and instead he invented an entire ‘theory’ around it, as a way to subvert the reality. It was actually malpractice on his part. But, I’m not the the mood much to go round-n-round with you again larry, so never mind.
You are not in the mood because I will cream you for such childish ignorance, whoever you are. People like you are the ones who caused the idiot witchhunts in the eighties and nineties, like the McMartin Preschool case and the Ramona case. Everybody went around like you scorning Freud for abandoning his seduction theory of neurosis. They all believed neurosis is caused by the sexual abuse of children. Therefore, if your child was neurotic or autistic, it must be because the father raped them!
Hundreds of perfectly innocent people were jailed for incest all because of ideologues like you–again, whoever you are.
People like me? Do you know the numbers of children who are abused? Are you denying that Freud’s patient was abused, as she revealed during analysis? I said nothing about McMartin and I don’t know of Ramona. There’s a great book about psychoanalysis and sexual abuse that I just finished reading, that supplies historical stats for the numbers of children sexually abused and some great insights regarding psychoanalytic theory in helping those who have been sexually abused. I’m sorry but Freud was remiss. I’ll post the link for the book tomorrow. BTW, I’ve talked to you for well over a year on this board and another. It’s not at all childish to call Freud out on this. He made a mistake — plain and simple.
He was a man; he was flawed. Please think twice before you call someone an ideologue. And I’m not in the mood to debate this with you because I might have been one of those kids Freud would have dismissed. Goodnight larry.
Bonnie:
A very popular book called The Boy Who Loved Windows by Patricia Stacey definitely portrays Floortime as a cure. The reader is essential told that Walker, the author’s child, has been ridded of autism through his mother’s backbreaking work. Actually, it’s more correct to say that she supposedly prevents autism from ever showing up. It’s an interesting book and well-written, but pretty outdated. For instance, it mentions that secretin has shown promise.
Anyway, I have always found it odd that there haven’t been more updates on the child in the book. I did see that Patricia Stacey wrote an article recently in O Magazine where she described herself as being mother to a child with special needs. So maybe talk of a cure was premature.
“He was a man; he was flawed. Please think twice before you call someone an ideologue. And I’m not in the mood to debate this with you because I might have been one of those kids Freud would have dismissed. Goodnight larry.”
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Oh Freud was flawed sure enough. But not in this regard. Books like you just read are a dime a dozen, written by people who never read Freud or who deliberately lie. The book that started the eighties witch hunt was written by Jeffrey Masson, a psychoanalyst who had a grudge against Anna Freud. (read the customer reviews for this stinker:
http://www.amazon.com/Assault-Truth-Freuds-Suppression-Seduction/dp/0345452798/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1210608884&sr=1-1).
I think the case of the memory of an actual child abuse you mention was reported by Masson in this book as something Freud himself wrote in a letter to William Fleiss. It involved a girl who remembered a childhood incident where her brother entered her bedroom at night and kissed her feet. Regardless of whether that’s the case you have in mind, it’s a good example of how people lie about or are ignorant of Freud’s theories.
Freud believed that ALL neurosis is due to trauma. He started out assuming that children are innocent of sexuality and are thus incapable of sexual fantasies. When he discovered memories of sexual abuse in ALL his patients, he assumed that their neuroses was due to traumatic sexual abuse–rape. The recovered memory of the tender foot kissing incident, however, was hardly traumatic. There is no way Freud would have ever considered this pertinent to his seduction theory. If anything, it would have contributed to his decision to scrap the theory and finally accept the fact that infants do, in fact, have strong sexual fantasies, and that PROHIBITION of sexuality–masturbation, public nudity, goosing, etc– from people they depend on for love is the source of the trauma which caused the neurosis.
Anyway, Freud never, EVER wrote anywhere in his twenty-three volumes of collected work that children never suffer from traumatic sexual abuse, or that such a trauma would not cause neurosis. You can check this yourself. If your book is to be credible, there has to be footnotes citing Freud’s work for the outrageous claims being made against him. Freud’s collected works can be found in any university library or for sale in paperback.
http://www.amazon.com/Standard-Complete-Psychological-Works-Sigmund/dp/0393011283/ref=sr_1_8?ie=UTF8&s=books&qid=1210609508&sr=1-8
You can follow the footnote references to Freud, and you will discover that the supposed facts reported in your book are either lies or distortions, or deliberately taken out of context with the intent to deceive. I have gone through this routine myself with many anti-Freud books, and so far I am batting a thousand. They are all liars. Susan Forward’s book, “Betrayal of Innocence” was a good example. She was oh-so-condescending in reporting that Freud believed woman are inherently masochistic. What she didn’t bother to mention was that Freud believed all living substance is inherently masochistic! Then there was some fool who reported that Freud believed primitive tribesmen were something less than human. When you look up the actual reference in Freud’s “Totem and Taboo,” however, you will find that Freud was actually saying just exactly the opposite. In order to emphasize his point, however, he had simply exaggerated the primitive native’s miserable existence.
So, if you want to argue, that’s fine. You obviously know me well enough. I love to argue. I think it’s fun. However, I refuse to indulge you any further in this until you take the trouble to check your sources like I suggested.
Thanks for the info about the book. Turns out I have that one also. I have purchsed way too many books and never get around to reading many. I stopped reading stories on autism that turned out to be about personal agendas and cures and focues on therapy type books. Looks like I am going to get that book out as well.
I will have to do a series on floor time after I finish the online conference and read some books. I am focusing more now on sensory processing disorder and ways to help my sensory seeking kid who is smacking the walls all over the house and knocking things down and very tactile as well.
It’s nothing to do with Masson nor Forward, larry and everything to do with actual psychoanalysis helping those who were actually sexually abused in their youth — which is what Freud should have focused on when given the opportunity. Period.
Here’s the the link for the book:
http://books.google.com/books?id=Mxn-Xro7m1MC&printsec=frontcover&sig=m9KBj6InHPRDPX0G8eat4K0L0NA
Well there’s no shortage of ideas of what causes autism or cures autism.
Does Dr. Greenspan have other/newer controlled outcome data than the case review paper of the 90’s? Just curious.
We tried some floortime, but Eleanor lacked some prerequisites even for that. I tend to think of the stages as a graduated curriculum of social interaction and executive functioning.
He read rather sternly, but I think to blame parents would be off the mark; to say that we don’t necessarily know the most appropriate means for interacting with a child with atypical reciprocation skills doesn’t seem out of bounds.
“indeed, Greenspan suggests that the child’s caregivers may be “severely depriving” and even “abusing” a child.”
I think you misunderstood. Children with severe reactive attachment disorder (particularly instutionalized kids) often meet criteria for autism, but unlike truly autistic kids the features disappear when they enter a more suitable environment. I think what Greenspan is saying is that due to a biological abnormality, autistic kids have the same attachment problems in a good home as NT kids have when severely deprived/abused.
“The only viable explanation for the aetiology of autism in this case of Rett Syndrome is that the autism is preceded by the misery of the illness. In other words, the autism is caused by TRAUMA.”
You sure are prejudiced. Being disabled is not that traumatic for a baby, unless they’re actually in pain (there is no evidence that Rett Syndrome is painful).
I have to say, if you wanted to emulate Freud, you certainly have succeeded. You twist reality to fit your theories in a classically Freudian manner, and generate untestable theories as a result.