(Stanley Greenspan MD Inc. does not support DIRFloortime or its licensor ICDL)
Before we get into what Following a Child’s Lead is and why it is so important, let’s discuss what it IS NOT.
IT IS NOT,
- Waiting and Observing while a child wanders or self-involves in a toy.
- Following a child around commenting on what they are doing.
- Playing with a child without using language.
- Letting a child pick a toy or activity and then teaching them a skill or an adult led outcome.
Ove the years I’ve seen many therapists and parents who have been told that these are elements of Following a Child’s lead, unfortunately, that is wrong! If you want to get the results that Dr. Greenspan was able to achieve with the families he worked with, you have to first start by understanding his definitions of Floortime, or as we call it now Greenspan Floortime®.
When Dr. Greenspan first discussed the idea of ‘Following the Child’s Lead’, his main focus was helping a child and a parent connect, i.e. build and deepen their relationship. He wanted to encourage parents to join their child’s world, not force them into ours. By identifying, joining, and sharing their child’s interests and needs, they could establish a shared world. Originally, he had discussed this as a method for all parents to connect with their children, not simply as a technique for children with special needs. He found that by teaching parents to join their child’s world, show an interest in their child by showing an interest in what their child is doing, and truly become part of that activity and that experience, the child, in turn, was more interested in the parent. They were more able to listen to the parent, process what the parent was doing, and respond to the parent in purposeful and adaptive ways. In the beginning, Floortime was about following the child’s lead at its most basic level. However, as Dr. Greenspan’s work was identified as being more and more effective at supporting and helping children with developmental challenges, like those on the autism spectrum and with autism spectrum disorders, ‘following the lead’ continued to evolve and become more complex in its application. As Dr. Greenspan began to see and understand how all children with developmental delays, like ASD, had unique and often sensitive nervous systems, he realized a deeper understanding of each child’s needs would be necessary to truly connect with them.
Children on the autism spectrum and autistic individuals unfortunately don’t always show an interest in the outside world, and we cannot and should not force them to. However, if you believe it is important for all human beings to have relationships (and it is), then our goal should be to connect with them and support their voluntary development of meaningful relationships, on their terms. To do this, the best thing to do is to get interested in them and in their world, and not to force them into ours. Whether they like bouncing, spinning, running, animals, cars, etc. we need to become part of that world with them. However, when a child engages in self-involved activities (like hyper focusing on pictures, cars, figurines, etc.), self-stimulatory behavior, or is hyperactive, then we have to understand why they are engaging in this activity and do our best to support that child’s emotional and sensory needs (oftentimes outside of that activity).
For many children these activities can calm them and appear to be meaningful, they seemingly need to engage in this behavior. However, these ‘needs’ if addressed in a self-involved and rigid/repetitive manner can get in the way of building and maintaining relationships. While the child’s chosen behavior may satisfy them temporarily, it continues to be needed and when the child cannot access that behavior then they can experience a tremendous amount of stress, leading to meltdowns, tantrums, and aggression.
In the last 19 years of practicing The Greenspan Floortime Approach®, The Floortime Center® has seen that children almost always prefers to calm and regulate off of the warm caring adaptive adult vs the self-involved sensory experience when ‘Following the Child’s Lead’ is correctly applied.
- Figure out why a child is engaging is a certain activity.
- Identify their sensory and emotional needs.
- Join and support them in a socially engaging manner.
Children who establish this preference begin to seek out the comfort of nurturing adults/peers, which will hopefully always be available. By supporting a child’s sensory and emotional systems you are “following the child’s lead”, or as we sometimes say at the center, “following the child’s need”. This is done by proving affect, through language and gestures, and sensory stimulation to the vestibular, proprioceptive, and tactile systems, while also limiting exposure/access to overstimulating/self-involving environments and stimulus. Most children on the autism spectrum don’t know how to fully regulate their own systems, and often find solutions that lead to isolation and/or self-stimulation due to consistent exposure to stress at school and in other environments. These temporary solutions can lead to self-involvement, fragmentation, seeking, or avoiding.
If we observe and wait or follow them around the room commenting on what they are doing, then we are waiting for a child with known communication difficulties to show us what they want. Instead, we need to interpret their needs based on a full psychodynamic understanding of their individual profile. That information will inform how we set up the physical environment that will facilitate regulation, and how we can join them. Certainly, when we get to know a child for the first time, we should be more gentile and gradual with our involvement. At times that may mean briefly waiting and observing because we are being sensitive to a more reactive/sensitive child’s profile, but that is only necessary some of the time in certain situations. Waiting and Observing is not a consistent part of Following the Child’s Lead, and if you watch videos of Dr. Greenspan coaching parents, you will never see him recommend this.
To become part of a child’s world you have to join them both physically and verbally. We tell parents to “Do Something and Say Something”. Most children are more comfortable or only able to communicate with their bodies, i.e. physically. Making sure they see us participating in what they are doing physically is communicating to them that we are here to join you, we are interested in you and what you are doing, and we respect your choice. This means getting on the floor and playing with your own car, standing next to the slide and putting your arms across it, or putting your hand on the swing ropes while they are climbing in. However, to make sure the child knows you are there to have fun and play (necessary elements of Greenspan Floortime®), you have to use language to express affect and intent. Affect is our outward expression of inner emotional states, and it is shared through our words, vocal tones, gestures, and facial expressions. We tell most parents and professionals to verbally express your actions and make sur you are using changes in tone to express anticipation of a coming action. You want the child to hear and see the words in action. Afterall, how can a child learn to process language receptively and expressively if they don’t hear it in an emotionally meaningful context. Some “Floortime” SLP’s say don’t talk because the child has auditory processing difficulties. That is incorrect and potentially detrimental to their progress. Parents, caregivers, and professionals should talk by making statements and occasionally asking questions, but do it in a warm, slow, and calm manner that the child is interested and able to process. Using phrases like, “IIIII’mmm comingggggg… to tickle you!” usually gets a smile if it is using just prior to gentle tickles. The child first hears the words and then associates the action, the sensation, and the emotional experience all together. If it’s done in a gradual manner and the child enjoys it, they usually want more. We had dozens of children say their first words, or word approximations, around these sensory games. This doesn’t mean that we should be talking the entire time. We need to pause and allow the child to respond, just like we do in an adult conversation. Think about the pattern/rhythm you ideally establish with another person; you say one or two things and then you let them respond. The same is true when using these techniques with children, but their response will likely be gestural/non-verbal and sometimes subtle.
Once you understand the child’s interests, their communication abilities, their sensory and emotional regulatory system using the Greenspan/DIR™ Model, then following the child’s lead should happen as soon as a child walks into a room. When a child walks into a familiar space, if they go over to the ladder connected to the bunk bed, we go over with them. We don’t stand back and watch to see what they do. We follow them and we join them, and we try to see why they are interested in that bunk bed. Many children like to climb, so we are there to support their climbing. We might try to climb after them or have a big stuffed animal climb up next. The decisions we make are based on the types of play that are most developmentally appropriate; sensory play, object-based play, or symbolic play. (See the Greenspan Floortime® Parent/Caregiver Training Program for more information on types of play)
When they’re standing at eye level on the bunk bed, how do we connect with them? How do we truly join their world? If they’re up there, how do we become part of that world up there? We’re not just standing back and observing. Just today, a little boy at The Floortime Center® did something very similar where he climbed up on a platform. His speech language pathologist went over there with him, stood in front of the edge of the platform so he couldn’t just jump off into the foam pit. His initial preference was to do his own thing in a more self-involved manner by climbing and jumping on his own. Instead, his SLP became part of the experience by standing there in front of him with her hands open, palms facing the ceiling, stretched out in front of her as if she was there to join him, help him, or be there as a safety net for him. It didn’t really matter why she was there, as long as she was there to join him in a shared world. Sure enough, the little boy slowly walked into her arms and wanted to be dropped down into the foam pit. The little boy and the therapist, who had just met that day, began to build their relationship, and what ensued was a beautiful 10 minutes of laying in the foam pit, getting some tickles and smiles, and then going back up on the platform and repeating it in a different but similar manner. The second time the therapist did that, she didn’t just put him in the foam pit as he did the first time. She stood closer to the edge of the platform, and he nudged her back and then got into her arms. The third time she spun around in a circle, and he gave her a big smile, and gave her a hug, then they fell in the foam pit together.
The therapist made subtle changes during the experience and gave the child a little bit more sensory input. From her Greenspan Floortime® training she knew that this little boy was up on that platform to be up high, jump, and crash because he was in search of sensory stimulation. He enjoyed the feeling of movement and being up high, which are types of vestibular stimulus (so is spinning around). She added a little element to help address his sensory needs and show him that she can be there to be an even larger part of his shared world. As this interaction continued, she wasn’t teaching him to spin, she wasn’t directing him to spin, all she did was naturally expand the exchange by adding one subtle element. She Followed his Need and his Lead. If he didn’t like it or want it, she was prepared to immediately stop at the first sign of changes in his affect. She pays close attention to respect his response. If necessary, she puts him down, and there’s no more spins. The way she did it, she spun him slowly, she looked at his eyes and his face the whole time, and she made sure this was something he was enjoying and wanted. If he had looked uncertain or scared, she would’ve stopped and respected that communication.
As you can see from this example, following a child’s lead means,
- Making sure the environment is developmentally appropriate, has developmentally appropriate toys, and doesn’t have toys that lead to self-involvement or rigid/repetitive behavior.
- Following the child, and showing interest in them and in their interest
- Joining the child (physically and verbally)
- Supporting/satisfying the child’s needs (emotional and sensory)
- Helping them accomplish their goal, and helping them do it even better than they might be able to do it themselves
- Responding to their subtle cues and gestures, as well as overt communication
The same process is used if the child is rolling a car on the floor. The adult gets on the floor near them and rolls their own car near the child’s car. If the child takes your car, then you get another or ask to see theirs. While doing this you are explaining your actions and making statements with enthusiasm and anticipation about where your car is about to go. For example, “Here goes my car! 1……,2……….,3……………….(pause to see if the child looks, smiles, or responds in other ways and then)…..roll!” Remember the goal of Greenspan Floortime is dynamic interaction, not the play scenario or our imposed rules of sharing and taking turns. If the child is ignoring you, then you need to make sure that they are in the right environment and that their sensory/emotional needs are being met. Using the whole room can be helpful. Crawl over to the other side and say, “I’m going to roll over here!” Just because you are doing something slightly differently, you are still following their lead. Remember not to teach. You are not trying to get them to be more complex with their play scenario by bringing in advanced ideas like driving your car to a store, unless they show an interest in pretend/fantasy ideation. Focus on what the child is actually doing with the toy, not what you want them to do. The next step in Greenspan Floortime® is to Challenge and Expand, and sometimes you do this simultaneously while following their lead.
To learn how to apply The Greenspan Floortime Approach®. Register for the Professional or Caregiver/Parent Course at http://www.stanleygreenspan.com. Parents and Professionals can also receive Greenspan Floortime® Expert tele-coaching with video analysis and feedback.
For in-person Greenspan Floortime® based OT, SLP, Social Group Programs, and coaching contact The Floortime Center®, www.thefloortimecenter.com.