Dr. Greenspan identified that Floortime is most effective when it is the integrating force behind a comprehensive holistic program and is used in many facets of life. Home, school, and therapy programs should all be working together under the same developmental social-emotional framework to establish a universal set of goals to be maintained across environments and curricula. If every adult in a child’s life helps them relate, communicate and think, then we have the beginning of a comprehensive program. Each primary caregiver’s daily participation is a must and the foundation of the program, but 20 to 30 minute daily sessions with each caregiver are the minimum and just the beginning. When dealing with challenges, disagreements, and setting boundaries and limits, we should be using the same principles and techniques as well. Using Greenspan Floortime® during daily routines and typical life experiences, like going to the grocery store, taking a bath, getting dressed, or making a snack is necessary for a comprehensive social-emotional program. Research has shown that the most successful Greenspan Floortime-based programs provide three hours or more a day (20 hours or more per week) of these fun unstructured thinking-based interactions.
Throughout the day, Greenspan Floortime® sessions should be provided in 20 to 30 minute intervals by the primary caregivers, and support team members like therapists, educators, nannies, et cetera. These sessions must be one-on-one and done in developmentally appropriate play environments to fully support the child’s social emotional growth. Capitalizing on other opportunities that present themselves throughout the day, incidental Floortime, should always be encouraged, and are not replacements for the 20-30 minute sessions. These incidental opportunities may be 2 to 5 minute moments, like when our child is getting dressed in the morning and we’re helping figure out what clothing the child wants to wear. Playing a game where we’re putting the socks on their hands and they’re correcting us within a fun and playful interaction can further support our child’s social-emotional health. These incidental opportunities are not a substitute for the 20 to 30 minute daily caregiver sessions, but instead should be seen as a growth multiplier and be done in conjunction with the discreet sessions for a stronger, more comprehensive program.
The goals during these moments and sessions are the same, playfully engage and expand the interaction. We don’t want to encourage a child to follow rigid rules and routines or memorize steps and systems. That type of teaching can lead to further rigid behavior. Consistently encouraging dynamic back and forth exchanges and expansive interactions/communications so that new interactive patterns emerge leads to sustained engagement, improved communication, and adaptability, i.e. social-emotional growth.
Greenspan Floortime® techniques must also be used during challenging moments, like when dealing with a conflict or a disagreement. When we have to say “no”, or when the child is being defiant or reactive, we must make sure we’re engaging, 2-way communicating, and expanding. At these times it may seem that the only possible response is “no”, but in order to help the child understand and feel that “no” is okay and they can handle “no”, it’s important we interact with them around their idea, feeling, or interest. First, we start by following their lead and listen, then we try to expand on what it is they want. Think of it like a negotiation, get them to put all their cards on the table first, share exactly what they want, why they want it, how they want it, where they want it, et cetera. If they can, have them create a verbal picture of what they are thinking about. Provide feedback showing you understand them, and empathize with their feelings and needs. Once you’ve heard them out, then decide on your response by either negotiating, coming up with a compromise, or setting a boundary if necessary. This type of use is most effective when the child is receiving their 20-30 daily caregiver sessions, and when these principles are being integrated at school. Make sure the child is in what’s called a thinking-based educational program. Unfortunately, learning in a compliance and memorization based educational model discourages the development of learning to create, adapt, problem, solve, and express.
The entirety of a child’s therapeutic team should support these principles. While each Occupational Therapist, Speech and Language Pathologist, and Mental Health professional may provide their interventions in slightly different ways, there should be a set of goals and principles that create an overlapping/integrating structure to pull the program together. To the outside viewer, when Dr. Greenspan’s framework is holistically and effectively integrated, the application of these different fields of intervention should look similar. A child’s foundational needs don’t change based on the therapy they are receiving. Most children with social-emotional and behavioral challenges and/or delays have needs that include building and deepening relationships, improving communication, and strengthening their thinking (problem-solving, creating, analyzing, and adapting). Developing or strengthening these core capacities occurs best when worked on holistically when a child receives the same supports, emotional and sensory, across interventions. Children need similar environments for developmentally appropriate play, genuine interest and empathy from the adult, and a focus on the process instead of the outcome during their therapeutic experiences. In addition to the social-emotional goals that are driven by the child’s Greenspan/DIR™ profile, there are also additional goals unique to each therapist and their curriculum. To juggle all these goals, therapists and educators must remember never to sacrifice the social-emotional goals of relating, communicating, and thinking in order to achieve more specific skills/goals as outlined by other curricula.
Unfortunately, without the caregivers being at the center of the child’s program by each providing an absolute minimum of one 20 to 30 minute Greenspan Floortime session a day, the effectiveness of a Greenspan Floortime® program significantly diminishes. Research has shown that it takes around 20 hours per week of training to trigger the neuroplastic reorganization of the brain, long-term learning at a neurological level. The same amount of time has been shown to be necessary for Floortime to achieve optimal outcomes. It’s important to understand that the severity of a child’s challenges do not change the neurological mechanisms that require 20 hours per week to learn something new.
20 hours per week of training is the same it takes for the brain to trigger its neuroplastic reorganization when we learn a 2nd or 3rd language, or a 1st language that’s delayed due to developmental challenges. Think about the best way for you to learn a new language. Wouldn’t it be more effective to immerse yourself in thinking and expressing yourself in that language? Speaking it a few hours a day would be less effective than doing it all the time. Whether a child is pre-verbal and learning the fundamental process of engaging and communicating, or is verbal and refining their communication becoming more conversational, both require learning a new process while activating and consistently using new/different parts of the brain. For a 3.5 year old who is not yet conversational but has language, their program may be 6 to 12 months long. A 3.5 year old child who’s learning basic gestures and a few sounds or words may have a program that lasts 2 or more years. The only difference is the duration of the program, not its intensity.
All children need equally intense Greenspan Floortime® programs to begin the process of neuroplastic reorganization. The only difference in duration is decided by how many goals they have and how developmentally delayed they are. At The Floortime Center® in Maryland, as well as The Floortime Center® in Santiago, Chile, children receiving comprehensive intensive programs, like the ones described above, are experiencing rapid and sustainable long-term growth in their social-emotional health. These changes are above and beyond what their doctors anticipated, and these outcomes are obtainable for most children if comprehensive programs can be put into place.
Learn how to apply The Greenspan Floortime Approach®. Register for the Professional or Caregiver/Parent Course at www.stanleygreenspan.com. Parents and Professionals can also receive Greenspan Floortime® Expert Tele-Coaching with additional video analysis and feedback. For in-person Greenspan Floortime® based OT, SLP, Social Group Programs, and coaching contact The Floortime Center®, www.thefloortimecenter.com.