Floor Time Basics

Bonnie Sayers

I attended an eight part training for Floor Time that was attended by other parents, service coordinators and therapists. We learned the terminology, observed videotapes of sessions with children in various phases of Floor Time, participated in play sessions and made our own videotapes for presentating to the group.

Even though a few years back we had a Floor Time assessment from another agency, I honestly did not really comprehend what Floor Time was. I was under the impression that you play on the floor with the child following their lead.

Floor Time can be done at any time of the day in any type of situation. There were examples given in the class of using it while taking a child to school and making conversation in the car. Twenty minutes is all you need to have a successful Floor Time session with your child. Many families have the siblings take part in some or all of the sessions with Therapists.

Some agencies have Floor Time sessions at their location with the option of several rooms including a gym setting. Other organizations prefer to have the Therapists come to your home or even the child's school.

An assessment can take place in one or two parts. One being at the home or the agency with an observation and parent interview with the second part being the school observation and input from teacher or aide. This is what happened with the first assessment Matthew had elsewhere. I was not too happy with the feedback the teacher and aide gave. Pros and Cons of Assessments covers the first Floor Time assessment outcome.

DIR Model means = Developmental, Individual Difference, Relationship-based approach. There are six developmental levels. These stages are:

1. Self-regulation and interest in the world (3+ months)

2. Forming relationships, attachment and engagement (intimacy) (5+ months)

3. Two-Way Communication (9+ onths)

4. Complex Communication (12-18+ months)

5. Emotional Ideas (24-30+ months)

6. Emotional Thinking (34+ months)

For the last two sessions when the participants showed their video presentations we had a handout to check off which levels the child had achieved. These forms were given to each presenter to keep.

In your Floor Time Assessment the milestones achieved thus far should be listed with explanations. Children can be at different levels at various times of the day, and they can change week to week in therapy sessions. A child could also have partial achievement in one milestone, depending on certain issues that take place where the child may need help in self regulating.

Circles of communication start at the two way communication level with the opening and closing of these dialogue circles. This is possible for children who are nonverbal. A smile and eye contact can open or close a circle of communication. There may even be a goal for how many circles of communication the child can reach in a session.

The intimacy stage is being able to engage with other people in relationships. How does the child get along with siblings, relatives, classmates, therapists, etc.

Some of the following are examples in the observation chart we were given to check off the current rating (always, sometimes, never present or loses ability under stress) and age mastered for the six levels. There was also a sensory-motor profile for tactile (sense of touch), auditory (hearing)sensation, olfactory sensation (sense of smell), visual sensation (seeing), gustoatory sensation (sense of taste), vestibular sensation (sense of balance), muscle tone (strength and balance), coordination and reflex integration.

Self Regulation - recovers from distress within 20 minutes with help from you

Intimacy - protests and grows angry when frustrated

Two-way communication - responds to your gestures

Complex communication - uses imitation to deal with and recover from stress

Emotional Ideas - multiple gestures in a row

Emotional Thinking - uses pretend play that has a logical sequence of ideas

Tactile - seems irritable when held, prefers certain textures

Auditory - puts hands over ears in noisy settings, likes to make loud noises

Olfactory - reacts defensively to smell, ignores noxious odors

Visual - appear to turn away from bright light, discriminating colors

Gustoatory - eats non edible foods (PICA), all food tastes the same

Vestibular - seems fearful in space, likes to swing, enjoys being tossed in air

Muscle Tone - Seems active or restless, tires easily, prefers to lie on floor

Coordination - accident prone, bruises easily, consistent hand dominance

Reflex - slow to walk or sit, irritable in infancy, isolating head movements

Based on my presentation many of the forms mentioned that Matthew partially mastered the first two levels. His Floor Time Assessment states the same thing. Individual Differences covers the ways a child takes in the world in sights, sounds and touch. The nine senses mentioned are found in this part of the DIR component.

My notes mentioned a great way to understand the difference between hypo and hyper. The hyper does not need more stimulation, the hypo responsive needs more stimulation. A child that has been over stimulated by swinging on the swing might get sick. This happened to Matthew a few times at his OT sessions where I saw it coming, but the Therapist had no clue she was over doing it.

A hint I made note of for two of the milestones - 5 is the Emotional Ideas, creative use of ideas. This means children that can think outside of the box. For 6 in Emotional Thinking this is those kids who can answer the why questions in detail and have higger levels of abstract thinking.

In stage 4 a child should be able to attend 30-40 circles of communication. Circles are conted per activity and not per time. A child will have more emotions at stage 4 with complex circles. They can do symbolic play

Some tips for Floor Time for parents to make note of before applying techniques with your child - be at eye level, notice the same things your child is viewing, become animated (high affect), become a fun play partner, face the child and become part of the object the chld is engaged with.

Matthew likes to lie on the bed under a blanket and shake legs on the bed. I make a game of like Simon Says and we start and stop stomping our legs in tune and he laughs a lot during this. He looks at me and smiles, opening circles of communication.

I sing songs in the car on the way to school and use his name in many of them. I say things like Yo Yo Mattie-O and repeat it several times. Matty is a silly boy, do da do da day hey! I use the high affect to keep his attention going and make the journey to school a pleasant one.

A child can take your hand and lead you to something they want and this is considered opening a circle of communication. Giving a hug or kiss is a circle of communication. If the child turns away from the conversation they have closed the circle.

The idea is to expand on what dialogue you may already have with the child and open up the lines of communication. Instead of asking how was school, get specific in your discussion. The key is to be persistent, show an interest in what they are dealing with or playing with. Explore feelings and encourage original thinking.

Floor Time can be music based or even OT based, depending on the needs of the child. The supervisor for Matthew will be an OT with the addition of Music at times per my request.

One of the handouts included a paper - Am I A Good Floor Timer? The questions to ponder are:

Do I observe the behavior, language, and gestures of the child?

Do I observe the style of relating?

Do I approach the child slowly, with respect and thoughtfulness?

How often do I let the child take the lead?

Do I let the child know through gestures, emotional tone and facial expressions that I am there for her?

Do I know when to be verbally responsive, and when it's better to quietly share a child's emotion?

Another issue that was brought up was for motor based challenges. The term crossing the mid-line was not something I had heard before. Topics in Occupational Therapy explains this phrase - " Crossing the midline, which relies on good bilateral coordination, means using part of one side of the body in the space of the other part. Some examples of crossing the midline include sitting cross-legged on the floor or drawing a horizontal line from one side of the paper to the other without switching the pencil to the other hand."

Look through assessments and reports to see if this term is ever used to describe your child and ask the Therapist their opinion. Another way to think of Floor Time is engaging in purposeful play with your child on the Autism Spectrum. During the assessment the Therapist took a book and walked around shaking it with Matthew following suit with him doing the same thing. He was quite interested to see someone doing the same thing as him in a quiet setting.

Circles of communication can be verbal, gestures, eye contact or a combination of these. A circle starts with one and closes with the other person. Motor planning is the ability to formulate the idea of an action, organize it, and then execute it. Proprioceptive is the sense of body awareness created by interpreting the information from the muscles and joints.

Receptive language - capacties involved in understanding the thoughts, feelings, desires, and needs of others. This includes the ability to interpret both verbal and nonverbal information from the muscles and joints.

Bonnie Sayers is the Autism Spectrum Disorders Editor for Bellaonline.com.