The Wonders of Floortime

A revolutionary technique, mainly for children with developmental challenges
By Brian Hayward and Cassandra Shaw

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At birth, Lucio was cortically blind. Doctors said he wouldn’t walk, his blindness couldn’t be cured, and he would unlikely live past his teens. Today, although Lucio is severely autistic, he’s a healthy, happy 13 year old with near-perfect vision. He can walk largely unassisted and is able to communicate his needs to his parents.
 
When he was 17 months his mother, based in Amsterdam, took him to a developmental educationalist who was using an increasingly popular technique with mentally and physically challenged children – to astounding effect. The technique is called DIR (the Developmental Individual difference Relationship-based model). It’s otherwise known as “Floortime” because it centres around interactions with the children, mostly on the floor in their preferred space. Despite the model being used in abundance in North America and Europe, the use of Floortime in South Africa is more isolated.
 
Breakdown
 
When American child psychiatrist Stanley Greenspan and psychologist Serena Wieder first developed the concept in the late 1980s, it sought to replace more restrictive child-development techniques with one based on celebrating each child’s uniqueness and concentrating on their quality of life.
 
“Floortime pulls together the best of OT, psychology and speech therapy,” says occupational therapist Kerry Wallace of Polka Spot Early Intervention Centre in Cape Town. Being built on three pillars (DIR: Developmental, Individual difference and Relationships), floortime is a client directed approach. The therapist assesses the child’s emotional stages of development, takes the child’s individual processing differences into consideration, and encourages involvement from those central in the child’s life, says Wallace.
 
With Floortime, children’s developmental goals are decided not by a general societal standard, but by assessing what they are capable of achieving at their level. This philosophy filters into the interaction with each child, with adults meeting them at this level. “People tend to do things to – or for – children with challenges, but what Floortime encourages is to do things with the child,” says South African-born Marius De Vos who has Master’s degrees in education and psychology and who started his own school for autistic children in Amsterdam before recently moving back to South Africa.
 
He also points out that historically, children with disabilities have suffered from the drive towards normalisation. “This method tries to find ways for children to connect with the rest of the world without taking them away from themselves,” he explains. “It’s not about saying, ‘You are nine years old, so you should be able to do this’. It’s about looking at the child and seeing what their next developmental step is and working towards that. You don’t approach children in terms of what they can’t do, but in terms of what they can do. Everybody can do something. That’s what you latch onto and where you try to meet them,” he says.
 
“Floortime is also a coaching model”, says Wallace. It includes and teaches parents, or whoever’s in the child’s world, how to work with, understand, and better deal with their child.” Other treatments are so therapist based, and especially with young children, their parents need to be involved right from the beginning. They are often the ones that get the best response from their child anyway,” she adds. Plus, if parents are involved, the model “can work anywhere for the child, and the parents’ newly found expertise can be used from different angles,” she explains.
 
Fitting in
 
The model provides a roadmap for the treatment of developmental, learning and emotional challenges and diagnoses. The widespread applicability is possible because it’s based on a theory that focuses on capacities fundamental to the development of all children. It’s also a comprehensive model with a range of interventions that can be tailored to specific underlying sensory processing, motor and learning challenges as well as family and cultural factors, says Wallace. She adds that it is an approach used in dealing with children who are anxious, have attention difficulties, language delays, learning challenges, and sensory processing, autism or Asperger’s disorders, but that it can be used for all children of all ages.
 
Wallace explains how they first “meet the family, work with them, find out their needs and formulate a way forward. Parents frequently bring their children in for speech therapy, due to language delays and that’s where the process usually starts. An OT will then work with them and shift them onto something else that fits their individual situation. It’s a very flexible process,” she says.
 
Seeing South African results
 
When De Vos returned to Port Elizabeth last year, he brought with him a physiotherapist trained in Floortime. They spent a week at the Aurora Special Needs Centre for physically and mentally challenged children, training staff in Floortime. One year later, staff members have noted significant developments in children who had previously eschewed any sort of interaction. Irma Jacobsz, a teacher at the centre for the past eight years, explains the changes in six-year-old Melanie*. “She was very into herself,” playing in front of the mirror. “For us, it was a matter of not knowing how to teach her [before being introduced to Floortime],” she says. After 15 minutes with De Vos, Melanie was interacting with him as he mimicked her behaviour. A thick jacket, which Melanie kept on no matter what – her “second skin” – was removed with relative ease as De Vos engaged with her using the Floortime principles. “There had been no attempt to deal with what the coat meant to her,” says De Vos, “so I worked with her in ways that included the coat in our interaction. When I wanted to move her arms so we could pretend to be birds together, instead of holding her hands I pulled the coat. And so she slowly accepted me as part of the experience, and I just slowly worked the coat off her.” This year, as teachers have continued using Floortime with children, Melanie has continued to improve. During a class sing-along, Melanie began interacting, holding up her hands to clap with the teacher – a remarkable action for a child with autistic traits, says Jacobsz.
 
* Name has been changed
 
Training and affiliation
 
Co-creator of the DIR Floortime method, Serena Wieder, started the Profectum Foundation, an NGO that offers online Floortime training to professionals and parents.
 
Profectum has also been establishing international affiliates throughout the world and Polka Spot’s NPO, Spotlight Trust SA, is the Profectum affiliate in South Africa. Their aim is to train people and ultimately make Floortime culturally relevant in South Africa.
 
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