How can a parent learn from autism therapy research to help their child? It can be daunting. This is especially true for psychological research on autism therapy. We have already written a parent-friendly guide for helping make sense of research on applied behavior analysis (ABA) therapies for kids with autism.
Here we have translated this research paper from the University of Ottawa in Canada by two Occupational Therapists into parent-friendly language to help parents better understand the key differences between autism therapeutic approaches. We hope parents benefit from a better understanding of this important autism therapy research on Floortime.
Autism Therapy Research Study Shows Positive Results from Greenspan Floortime Interventions for Children with Autism Spectrum Disorders
Children and toddlers with autism often face significant challenges in their social relationships at school and at home. Depending on the severity of their condition, they may have trouble communicating, making friends, or enjoying close family bonds. Different kinds of therapies are available to children who are diagnosed with autism that can help families improve their child’s social ability.
One study looked at a comparison in outcomes for children with autism between different therapeutic approaches: Greenspan Floortime and Applied Behavioral Analysis (ABA). ABA is a well-known, reputable approach where therapists typically break down behaviors into small steps that can be reinforced or rewarded. These small steps can then be combined into greater functional abilities for the child. A criticism of the ABA approach, however, is that the behavioral improvement may not take place in the real-world environment of school or home where the child needs it most. By contrast, Floortime provides intervention techniques that can be used during the child’s ordinary day by parents, caregivers, or therapists, so that the outcomes are more likely to “stick” in the real world. Also, because each child with autism has a developmental schedule that is unique, therapies work best when they can be tailored to the specific child and where they are in their own development.
This study followed one family as they used Greenspan Floortime with their child. The type of study done was called a “single-subject study,” because instead of following a cohort or a group of individuals, it follows one particular individual very closely. The measurement used as an indicator for improvement in the child was the “circles of communication” described by Dr. Stanley Greenspan, where communication is both initiated and the closed by the subject and someone else (usually a parent or caregiver, or a therapist working with the child). The number and complexity of these circles of communication was measured before, during, and after the study. This child showed a statistically significant difference in circles of communication between phases of the study, indicating that the Greenspan Floortime method is an effective therapy for children with autism.
What is the Greenspan Floortime Approach?
The Greenspan Floortime approach is an intervention technique that works at moving a child with special needs through developmental milestones by following the child’s lead during play and building on what the child does to encourage more and more effective interactions. These interactions are called “circles of communication” because they are initiated, or opened, and then go back and forth between participants until they are closed or finished.
During Floortime, the parent or caregiver goes “down on the floor” and plays with their child for 20- to 30-minute periods, encouraging him or her to interact by opening and closing as many circles of communication as possible. This intervention method is particularly interesting to occupational therapists because it takes place in the child’s own real-world environment. This eliminates the gap sometimes seen in behavioral approaches that reinforce behaviors in therapy but not in the child’s own home or school environment. Greenspan Floortime also views each child as a unique individual and approaches their situation holistically, focusing on the child’s relationships and their internal mental state. Behaviors are reinforced within a relationship instead of externally through a reward-based system.
Single-Subject Study: Who was the subject?
In this study, the subject was a boy aged three and a half years old who had been diagnosed with autism at the age of two and a half. He was recruited through an advertisement for the study that was published by the Autism Society. He had not had any previous intensive treatment, and he did not have any other conditions that would affect the study. Informed consent was obtained from his mother, and the ethics board at a local university oversaw the ethics of the study.
The boy in this study had achieved physical milestones such as crawling and walking, feeding, and toilet training within the normal time frame, but his language and play skills were delayed. He was nonverbal and only used a few spoken words to communicate. He used a picture exchange communication system (PECS) to make choices at snack time or meals. He was enrolled in a community daycare and had the support of occupational therapists and speech and language pathologists through the school. To express his needs, he was able to take an adult by the hand and indicate what he wanted, but little interaction took place during his play, and he couldn’t use toys very well.
The study began by measuring his functioning using some standardized tests like The Childhood Autism Rating Scale (CARS), which differentiates children with autism from children with other developmental delays. The test was administered by the child’s occupational therapist. Another test was The Sensory Profile, a standardized questionnaire for children aged three to 11 that looks at the child’s ability to process sensory information. A third assessment was the Functional Emotional Assessment Scale (FEAS), which attempts to determine the child’s emotional capacities in the context of family relationships. The boy and his mother were also observed with respect to Dr. Greenspan’s six developmental milestones of emotional functioning. This pre-intervention information was important because it was used to show any changes related to using the Greenspan Floortime interventions.
For this study, circles of communication were used as one variable that could be measured. They can be observed and counted, can be summarized and collected throughout the study, and can be used to show progress according to the frameworks. All the sessions in the study were videotaped and then the circles of communication were determined from viewing the videos. During the intervention phase of the study the boy’s mother was also asked to keep a journal to record his progress at home.
The child was seen four times a week for 45-minute sessions at a private clinic. During these sessions, the boy’s mother participated with him. The first 30 minutes of each session were used for observation during the first phase, and intervention during the second phase of the study. The last 15 minutes of each session involved discussion with the boy’s mother, either by gathering data from her or by coaching her in the Greenspan Floortime intervention techniques.
Observation
Each time the boy was observed he was given age-appropriate toys and materials like baby dolls, toy cars and a garage, and stuffed animals. The materials were intended to provide sensory, cause-and-effect, and symbolic play opportunities.
Intervention
The second phase of the study was the intervention stage, which took place over 28 sessions or seven weeks. The intervention stage was three times the length of the observation stage, which helped the researchers see whether changes were actually occurring and were not just natural variations in behavior. During the intervention session the Greenspan Floortime techniques were taught to the boy’s mother. The therapist taught the mother different things like intentionally giving the child a different toy than he requested (what they called being “intentionally obstructive” but which most parents would call “friendly teasing”), engaging in pretend play like pretending to be asleep, and by using verbal suggestions while she played with her child. The mother was encouraged to practice different strategies to keep her son engaged, and to watch him carefully for signs that he was losing interest or that he was getting overwhelmed.
Researchers took the recorded videos of the sessions and collected data from them, putting the information into graphs and other data visualizations. Statistical analysis was performed on the data from the study. The results of the study confirmed that the boy being study had mild to moderate autism based on his standardized tests. He was essentially nonverbal and used toys inappropriately (meaning he would often throw the toys or focus very closely on some insignificant part of the toy). He frequently engaged in running or spinning that disrupted his ability to participate in daily routines. He was easily distractible when there was a lot of sensory stimulation in the environment. He liked touching people or objects but did not like the kind of touching involved in grooming activities. He was delayed in his developmental emotional milestones. His mother, on the other hand, received a “normal” score for her ability to interact with her son in a calm and sensitive manner. She tended however to use language that was too complex and to talk too much during interactions, which was getting in the way of keeping her child engaged.
The Mother’s Journal
Over the course of the study the mother kept a journal documenting the sessions she held each day—an average of three per day. She held shorter sessions on weekdays and usually they were associated with his daily routine, like taking a bath or having a meal. On weekends, she had longer sessions, up to 45 minutes, where there were more games and more circles of communication. The journal showed progress in the child’s abilities to increase the complexity of games they played and in playing them with other people in the family. The mother also noted in her journal that her son started initiating interactions with her by seeking her out or inventing new games. He still did not do very much pretend play, but his use of toys became more appropriate, like feeding a doll with a bottle, for example.
The mother also shared her personal impressions of her child’s progress in her journal. Communication between her and her child became more spontaneous, and the circles of communication became more rapid even when they were nonverbal. She was thrilled that her child was able to take part in childhood activities without becoming distressed. She noted that after the interventions, her son was able to listen to his father read a bedtime story and point out the pictures, whereas before he would rip the book out of their hands. These activities became a source of shared pleasure that they wanted to repeat. “It warms the heart,” she wrote, “to see my child with glee in his eye.”
The Effectiveness of Greenspan Floortime for Autism
The purpose of this study of one child and his family was to determine if Greenspan Floortime was an effective intervention for a child diagnosed with autism. There was a lot of variability in the data that was collected because the circles of communication being measured were often very different both in length (10 minutes versus 45 minutes) and in the increasing complexity of the interactions. Despite the variations in the data collected, however, there was a significant different in the number of interactions in the observation phase of the study compared with the intervention phase of the study. This study showed encouraging evidence that Greenspan Floortime benefits children with autism who use it as an intervention. More studies on larger groups of children and their parents would be useful as well.
Conclusion
Children diagnosed with autism benefit from early, intensive intervention programs. The Greenspan Floortime method is an intervention approach that is becoming popular and is being used by an increasing number of clinicians and parents. Few studies have been completed on this approach despite its popularity. This single-subject study was done to provide more insight on the effectiveness of the Greenspan Floortime approach and justify additional research into the use of this intervention with children who have autism spectrum disorders. This study showed that the Greenspan Floortime approach resulted in a significant increase in the numbers of interactions in the intervention phase of the study compared with the initial observation phase of the study. The mother’s journal was also helpful, because it provided a parent’s perspective on the use of Greenspan Floortime in the home. Because of the encouraging results of this preliminary study, more research on this intervention approach is called for.
More Information on Autism Therapy Research
We have a number of resources available to help parents and even professionals make sense of the growing body of autism therapy research on Greenspan Floortime. These research findings can be found within our Autism category, and, of course, to learn more about Floortime and how it helps all children, please consider one of our many courses. If you have an autism therapy research suggestion for our team, please let us know!
Learn more about Dr. Stanley Greenspan and the Greenspan Floortime approach. If you are new, we have a background and introduction to Greenspan Floortime including how it helps special needs children. We also have Greenspan Floortime training courses at Floortime U. specifically designed for parents and professionals including the Floortime Manual.