Engaging Floortime (3): Floortime for Parents
July 19, 2006 by Kristina Chew, PhD
Filed under Health
Mercury. Thimerasol. Vaccines. Heavy metals. Air pollution. Genetics. iPods: These and more have been cited as potential causes of autism; the question “what causes autism” can lead to some inflammatory (to put it mildly) debate. But one thing is clear among the proponents of the various theories of the cause of autism: The parents, and their parenting practices, are not the cause.
However, Dr. Stanley Greenspan appears to suggest precisely this in his new book Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate and Think. As I wrote yesterday in my second post reviewing Greenspan’s new book, Engaging Floortime (2): Greenspan on How Autism Develops:
In addition to “biological factors,” Greenspan suggests that something in an infant’s experience may be causing “stress” on his system. [A] passage [on p. 399] 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?
Throughout Engaging Autism, Greenspan does continually note the “unique biologies” of children with ASD, or rather in “children at risk for ASD,” for whom (as he writes),
…genetic, prenatal, and even early postnatal influences tend to express themselves in terms of differences in the way these children react to sesations, organize movement, and process and comprehand what they hear and see. (p. 130)
It is important to note Greenspan’s mention of how “early postnatal influences” in the form of “experiential or physical stress” can also lead to “the behavioral patterns symptomatic of autism and ASD” (p. 396) because it is precisely “functional emotional developmental capacities (FEDCs)” (p. 41) that Greenspan’s DIR model addresses. Without directly saying so, Greenspan suggests that parents of “children at risk for ASD” are themselves the reason for their children being “at risk.” Such parents have not been able to evoke healthy emotional development in their children who, as a result, are “at risk for ASD.” It is further suggested that such parents themselves are not in a healthy emotional state.
Thus does Greenspan refer to “Floortime as a family approach” in chapter 13. Parents are encouraged to “consider their own patterns” and specifcally their “strengths and weaknesses” (p. 164). Once these have been identified, as Greenspan writes,
…..we look at how these play out in two situations. First, we look at the characteristics in terms of the child’s progress through the developmental milestones. How do these patterns get in the way of optimal interactions?
……
The second issue to consider is how the parents’ traits play out in their relationship and in the family pattern as a whole. (p. 166)
Parents are specifically cited as “getting in the way” and “hindering” a child’s “optimal interactions,” and parents’ “traits” (an autocratic father is one example Greenspan describes) are to be analyzed and changed (p. 167). Each spouse needs “to be empathetic, not patronizing”; this is said to be “very helpful as you apply Floortime techniques with your child” (p. 169). To ensure optimal expectations for their child, parents are to “bring out the best in each other” (p. 169) in order to “be more playful” (supportive chats, back rubs, and ice cream are suggested (p. 170) ). And, in what Greenspan refers to as “Floortime for parents,” parents need to be sure to “have time alone with each other to regain the intimacy of their marriage” (p. 171). Because, as he writes,
The heart of Floortime is the warmth and nurturing that you’re conveying to your child so he will want to play with you rather than retreat into his own world. (p. 172)
Having an hour or a half-hour a couple of times a week to “come together and talk and tune into one another” (p. 172) is suggested: If your own emotions towards your spouse are not where they might be (and vice versa for your spouse), you will not be able to create the proper emotional experiences and interactions that your child is in need of, it is suggested.
If Greenspan is not outright saying that parents cause autism, he is certainly suggesting that parents contribute to a child being “at risk for ASD.” And I think that this is a theory of autism aetiology that is not only outmoded and discredited, but simply incorrect and—even more—potentially very harmful.
This is fascinating to me. I don’t know much about Floortime, except what I read in the memoir The Boy Who Loved Windows, in which the mom – through what was depicted as a frenetic, fever-pitched approach to Floortime that seemed to come at the expense of her own mental health, the health of her marriage, and the parenting of her neurotypical daughter – “cured” her son of autism. The book shook me to the core and left me with a very bad feeling about Floortime. The way she described it, it sounded like anything BUT a “family approach.” (Admittedly, I read this several years ago and may not be remembering it accurately. My own thinking has evolved a great deal since then.)
Hrm. Now I’m wanting to read and review a book I own by Greenspan. It’s fairly old, but it’s about how the brain develops (or something like that). I’ll see if I can find it when I get home tonight.
Carl H. Delacato—author of The Ultimate Stranger; the autistic child (Garden City, N.Y.: Doubleday, 1974). Delacato’s thesis is that autism is neuro-genic and not psycho-genic in origin. Deals almost entirely with sensory problems affecting autistic children. Topics include sensory hypersensitivity, hyposensitivity, and “white noise”, by which it refers to a kind of internal interference. ISBN: 0385010745 (paperback, 225 pages); ISBN: 0878794468 (Arena; Academic Therapy Publications, paperback, 226 pages). [autism,intro]
Delacato spoke of the similarity of aut”isms” and deaf”isms” and blind”isms”. That always stuck with me. It also explains the similarity of “cultures”.
A couple of years ago, a prominent Louisiana politician stated a belief that autism could be improved if only parents would read more to their children, implying that the lack of parental reading was behind the rising autism rate. Obviously, reading to one’s child is a wonderfully enriching experience for both parent and child, but it is not a cause of autism.
One almost expects ignorance from a politician, but it’s somewhat shocking when it comes from a reputed expert like Greenspan. I guess the “refrigerator mom” theory won’t die easily.
I wonder if the good Dr. Greenspan will offer up more $250 DVD sets on how he believes parents are to blame? I guess the old ones aren’t selling anymore, so let’s switch the theory. I bought the first set and found it interesting that he was unable to actually do his own brand of floortime. At that point, I knew this guy didn’t really understand autistic children or any children as I couldn’t see him actually be able to relate to them.
Mom-NOS, I had heard that about The Boy Who Loves Windows (I have not read it myself)—–Greenspan starts the family chapter by saying that there aren’t so much special needs kids as special needs families (this reminds me of a post on Ballastexistenz a while back critiquing that notion…..). Rose, thanks for the book and Jannalou I’m looking forward to reading your review—-and not reading enough as behind the rising autism rate, that’s a new one. AD, in what way was the doctor unable to do his own teaching methods? He writes a lot about himself getting down on the floor and makes it clear to the read that it is him and not his co-author via his initials, SIG.
I appreciate your reviewing & exposing books & articles like these! I can only say that Greenspan can not have met very many autism families like ours or the folks we know. What I dislike so much about these pervasive theories about what sorts of families produce kids with {label here} is that if you don’t fit their mould, then either your kid doesn’t really have {label} or you’re an outlier to whatever skewed statistics they’re using. I’m trying to be fair, but this sort of viewpoint really steams me up. Ultimately, everybody loses with this sort of finger-pointing, whether it subtle or not…
Kristina,
In his DVD’s, you see Greenspan as director. There are typically a mother father and child all on the floor. Greenspan sits down there with them but constantly directs the parents and what to do with the child. However, when the children approach Dr. Greenspan, you can see him tense up and become rigid as if he might be touched by the child. Greenspan didn’t ask the parents, well what type of toys does the child enjoy playing with? It was just constant direction such as “ok mommy do this, do this”, no don’t do that. It was all very weird in my opinion and about closing “circles”. Very very clinical and unnatural. If I had been there, I would have felt like I was under exam pressure. Dr. Greespan, despite being only 2 feet away from the children at any given time, didn’t personally engage them or say one word to them.
AD: Is it this DVD—13 DVDs.
Your noting how Greenspan “tenses up” is very interesting in light of the emphasis that he puts on how much he gets down on the floor and works with kids.
Kristina,
They are similar to the first 3 in the series but i believe there are 6 of them. One of Alexander’s tutors has them right now. Greenspan is a wonderful writer and I do agree with him on not letting children have any TV time, my only regret so far in raising him. However, when you watch how Greenspan interacts with the children (or more like non-interaction) and how he tries to break down “playing” into very small incremental methods, it just interupts the follow of reciprocal play and you spend more time on thinking about what your not suppose to do rather than just understanding your child and what he likes and then going with that.
The tapes present several children and their parents in segments. In the beginning of each segment is a still photo of the child along with all of his diagnosed “co-morbilities” (nothing nice about the child). Then you see about 20 minutes of “floor time” therapy. Floor time therapy seems to be more for the parents more than the child. Not all of the children are autistic. Some were diagnosed with conditions I wasn’t familiar with but they seemed quite “normal” to me.
At the end of each segment, Dr. Greenspan and his assistant Dr. Weider (Phd), discuss the session and critique what the child did and what the parent did. The whole thing reminded me of how Catherine Maurice describe the “holding” therapy she first tried with her child.
It’s quite obvious that Greenspan is a very intelligent man from both his books and the video’s. However, he didn’t demonstrate his own therapy, which I believe he is unable to do himself. Also, my gut tells me that he just doesn’t like these children. I’ve seen this many times with some of the psychiatry professors at UNC. They view your child as a research subject, no different than a chemist might view a bacteria strain in a petry dish. The preception you get from reading his books just doesn’t translate in the real life I saw on the video’s.
Dr. Chew describes Greenspan’s comments as “outmoded and discredited”, however, I beg to differ. I feel that he has been most courageous in bringing this issue to light again, and in such respectful language. While I understand that it is not politically correct to suggest that a parent or parents might “cause” autism, any sensitive, skilled and astute provider who has worked with the families of children with autism for any serious length of time (as I have, for 15 years) knows that who these parents are generally plays a huge role in the fact that their child has autism, and they have many emotional and personality style traits in common. This is not to categorically blame parents, it is simply to state that they are a factor. Parents and their personal issues “contribute” to the development of EVERY child, so why do the parents of children with autism feel that they are exempt from this truth? This is just as ridiculous a stance for its extremism as Bruno Bettelheim’s “refrigerator mother” theory (as referenced above, an early one with which people took umbrage for looking at the role of a parent in autism). Children with autism are my favorite clients to work with, and I believe that they are remarkable human beings. We “neurotypicals” have much to learn from them, and my own spiritual development has been deeply informed by my work with this special population. Unfortunately, most (but not all) of the parents with whom I have worked simply have not shared my view, and most importantly, have been unwilling to reflect on themselves in any meaningful way. This closed and angry parental attitude, Dr. Chew, is what is truly destructive to children with autism.
Wow, I think you totally and completely missed the point of what Kristina is saying here. In fact, your comment is rather condescending and rude (not to mention arrogant).
Greenspan’s theories are rather “messed”, for lack of a better term. His idea is that disorders are primarily caused by biological differences (which is, in my opinion, accurate) but are exacerbated by inadequate parenting styles. To be perfectly honest, that second bit is a load of crap.
I don’t deny that one’s parents have a lot to do with how one develops. My family and I were talking about this very thing at Christmas, and my brothers and I were actually asked to explain what we thought our parents did well and didn’t do so well when we were little.
My mother thinks that there wasn’t enough structure provided to us when we were small. My father thinks it was fine (”There was structure. They knew the rules, and we had set meal times.”). My brothers and I flourished in this “unstructured environment”. Perhaps more structure would have been good for us, since as it turns out I have ADHD and am having to learn to structure myself now that I am an adult, but the creative flow that lack of structure engendered cannot be given a proper value.
Your final three sentences disturb me profoundly.
I must ask, Joanne, if you are a believer in “Indigos” and “Crystals”?
Because if you are, I know that I need not waste any more of my time trying to speak sense into your perceptions of this work and Greenspan’s faulty theories.
Joanne, I really appreciate your commenting here. If I may ask, in what kind of capacity have you been working with autistic children (and I’m quite in agreement with you that they’re very great kids, indeed)? Greenspan’s references to the parents’ “contribution” to putting a child “at risk” for autism are not specifically highlighted, but introduced in the course of his descriptions of what Floortime is and why it is (he writes) effective. I was rather surprised to encounter such references while reading Engaging Autism.
I don’t think that Greenspan is the only “autism professional” whose work and treatment plan contains at least vestigial references to a Bettelheimian, “refrigerator mother” theory of autism. I have never met a parent (in my experience) who has not felt that Bettelheim’s ideas about parents causing autism were “outmoded” and “discredited”; it is from reading books like Greenspan’s and those of others that I have begun to wonder if these ideas are still out there, though not in the most obvious ways.
It is quite late tonight and I will have much more to say later, but one of the most interesting
things here is that the TREMENDOUS defensiveness
of the mere suggestion (put aside the tomes of accurate, clinical research and outcomes over the last many decades), that the parents have any responsibility in actually co-structuring the child’s emotional signalling/emotional development which in fact structures a great deal of the brain’s circuitry (neurological wiring). The lack of connectivity, for example, between the amygadla and para amygadla and the prefrontal and frontal cortex (emotional centers and the executive motor-planning/motor-sequencing functions has been shown to be strongly mediated (re-connected) by increased co-affect cuing. However, it is and will continue to be much safer for others to blame the infamous gene(s).
Thanks so much for your comments, Mr. Samuels; I much appreciate your critique.
From my personal experience, I believe Dr. Greenspan may be right about the interconnectedness of the biologically based deficit and environmental programming. When my 15 month old daughter regressed quite suddenly and became extremely disengaged, we were able to reengage her again quite rapidly using Floortime. When I looked back over the weeks of her regression, I realized that I had been actually been engaging her very little. This was because she seemed so happy in her repetitive, perseverative play (which should have tipped me off anyway), that she didn’t need much attention. Now I by no means suggest that I “caused” her autism. But if she was biologically wired (or wiring) to prefer solitary activity and avoid social interaction, then I did nothing to outcompete that natural tendency. And so I wonder now if I had been more alert to her differences during that period and engaged her more consistently/intensively, I might have been able to prevent the autistic features emerging. I don’t know, but it seems at a stage when the brain is so plastic, environmental reinforcement for development of social and communication abilities must have a big role in determining the outcome, whatever the underlying genetic/biological framework.
I’m glad that this string of posts has been resurrected because I wasn’t reading Autism Vox back in 2006 (didn’t get my daughter’s diagnosis until almost the end of that year). It’s a new angle on Greenspan for me, and an important one since we’re soon going to be starting a Greenspan-influenced, relationship-based intensive program with our daughter in the next few months.
I’m thinking right now of some of the techniques I’ve already learned for communication interactions, via the Hanen program and some work with Jim McDonald’s Communicating Partners. For me, learning about more effective patterns of interaction has definitely involved some level of critique of some of the patterns that parents often naturally fall into — for example, breaking ourselves of the habit of barraging our daughter with questions, or demanding “Say ‘banana,’ sweetie. Say ‘banana.’ C’mon, can you say ‘banana’?” or even just throwing too many words at her. My older daughter responded fine to an outpouring of words and requests; my younger daughter does not.
Seems to me that it ought to be possible to tell parents that they can learn to improve their interactions with their child, and that some communication and affect is more helpful than others, without arriving at the conclusion that the parents have somehow caused autism by using the wrong interactions or emphases. I didn’t pick up the blame-the-parents vibe at all from my first reading of Engaging Autism (admittedly over a year ago now), and I still don’t think I quite hear it in the Family Approach quotes you cite from Ch. 13. What I hear is “you can do this better,” rather than “it’s your fault for not doing it right in the first place.”
I’ll be on the lookout for those biases now, but I do think that relationship-based intensive therapy is going to be an excellent match for our kiddo, and that our whole family has a lot to learn about how to best help her.
Hopefully, the attacks on Dr. Greenspan’s view’s of parenting children on the autism spectrum do not mean that Floor Time is a useless therapy. Countless thousands of children with ASDs receive Floor Time therapy every day through Regional Centers, OTs or PTs in clinics, hospitals, public and non-public schools as a Best Practice basis of intervention.
Hi everyone.
I am an occupational therapist who has worked with children on the autism spectrum for two decades. I must say that the families I currently work with and who I have worked with in the past have been warm and nurturing. I have never thought there was any connection with the diagnosis of autism and the family dynamic. Clearly there are extreme situations of deprivation and abuse that can result in autistic like behaviors however these are extreme examples.
Kudo’s and blessings to these amazing families who give so much to these special children.
My 3 year old (my fifth out of six children] was recently diagnosed with autism. Because I see progress with my own version of floortime, I cannot help but wonder if my son did suffer some lack of interaction/warm engagement as a baby. On the other hand, he definately received the most attention and adoration from all of my children who are all typical loving happily developing children.