Monday, March 29, 2010

Floortime: A Promising Model of Autism Therapy

I just read a story in the New York Times Magazine about autistic teenagers that was very profound to me. In all the years I have been researching autism, it seems I am still able to be surprised and amazed by new information once in a while; I thought I had read everything there was worth reading on it!

The article can be found at

The NYT article was about floortime and a school for ASD teens. Floortime is a theory pioneered by Stanley Greenspan that says you should connect with an autistic person on the level they're at, using their interests and abilities to create a relationship. Once you create a relationship, this connection will enable them to better able to connect to, be a part of and interact with the world. I really like that theory.

It addresses the relational deficits in autism, which are of course some of the prime deficits in the disorder.

From the article:

"What does this have to do with autism? A child born at risk of an A.S.D. has cognitive and sensitivity issues that inhibit engagement. Pleasures enjoyed by a typical baby can upset him: a mother’s face seems too close, so the infant cranes away; the father’s tickles may produce fear reflexes rather than laughter. Meanwhile the sunlight is burning his eyes, the diaper scrapes his skin and the baby begins avoiding interaction with people at the cost of normal brain development.

I begin to picture the brain metaphorically as a tangled ball of Christmas lights. When you plug it in, there are strands that light up perfectly and there are dark zones where a single burned-out bulb has caused a line to go out. If the bulb for Exchanging-Smiles-With-Mother doesn’t light up, then Empathy won’t be kindled farther along the strand, or Playfulness, or Theory of Mind (the insight that other people have different thoughts from yours). The electrical current won’t reach the social-skill set, the communication skills, creativity, humor or
abstract thinking.

According to the D.I.R. perspective, emotion is the power source that lights up the neural switchboard. D.I.R./Floortime’s goal is to connect autistic students with other people as a way of fueling their cognitive potential and giving them access to their own feelings, desires and insights. The latest findings in the field of neuroplasticity support D.I.R.’s faith in the capacity of the human brain to recoup and to compensate for injury and illness. “Early intervention is optimal,” Dr. Greenspan told me, “but it’s never too late. The areas of the brain that
regulate emotions, that sequence ideas and actions and that influence abstract thinking keep growing into a person’s 50s and 60s.” "

This is a theory that makes a great deal of sense to me. People with autism have relational deficits not only because their brain is hard wired that way, but because of the way their brain is wired, they miss out on early opportunities for connection and learning emotional regulation due to their sensory issues. This is not the fault of the parents; it is merely the fault of the way the person's brain works. When a child does not learn emotional concepts when they are young, they have a much harder time understanding them later on.

That is why a relational, emotional approach to working with autism seems so important. Help a person with autism work through their feelings, help them problem solve step by step, help them learn how to ask other people for help and interact with others in a meaningful way, and you are giving them the skills they need to succeed in life.

This brings me to the most profound quote in the article; really, you need to read the whole thing to grasp the context, but I tried to summarize it above. This paragraph sums up basically everything I have been trying to articulate in four years, everything I believe to be at the root of most of my problems or the problems of most people with autism, and it stuns me that something can still do that four years later.

"“If we can keep Ty engaged with us, it means that he is harnessing and organizing his energies in order to interact,” Nelson told me later. “By keeping him connected, we won’t let him be kidnapped by random fragmented thoughts. If you aren’t engaged with other people, then you are completely at the mercy of your own regulatory system. Think about a
situation where you were overcome with distress and how being able to tell someone helped you avoid becoming uncontrollably distraught.”

That is so profound to me because it speaks to an absolute truth. If you have nothing but yourself to turn to, you really are at the mercy of whatever coping system your brain has developed to deal with problems: some good and some definitely not. You can get lost in a problem and become considerably distressed over it, left to your own devices. But if you have someone to walk you through the problem, redirect you, someone who you feel a connection to, that feeling of emotional connection will probably override most of the distressed and despairing feelings and bring a sense of calm; and the other person's helping you to problem solve will ground you and remind you to look at the problem in perspective, in a reasonable way.

More than anything else, it is the emotional connection that seems to be missing with people in autism. People who are not autistic probably know - or perhaps they don't since they know no other reality - how much a sense of connection to others has helped mute some problems in their life and generally made them feel more confident and secure in their ability to handle life's problems. People with autism, however, generally know nothing but their own feelings and emotions, and find it extremely hard to feel a sense of connection to others, especially an emotional one. This lack of connection leaves them floundering and can cause many to regress into many of the inappropriate behaviors often seen in autism.

So what to do about this? Well, the article explains how one school is doing it; but basically, it seems, people need to just try to reach the person with autism at the level they are at, understand the way their brain works, and try to reach them and connect with them on a level they will understand. That is obviously a simplistic way of looking at it, and the real answer would be far more complex, and more research needs to be done on this matter, but that is a good start.

Does anyone have any experiences with or thoughts on this model of autism therapy?

1 comment:

  1. We are using the DIR approach with our son who is 2 years old and it has been very helpful.