Climbing the symbolic ladder in the DIR model through floor time/interactive play
S E R E NA W I E D E R Interdisciplinary Council on Developmental and
Learning Disorders, Bethesda, USA
S TA N L E Y I . G R E E N S PAN George Washington
University Medical School,Washington, USA
A B S T R AC T The developmental, individual-difference, relationshipbased
model (DIR), a theoretical and applied framework for comprehensive
intervention, examines the functional developmental capacities
of children in the context of their unique biologically based processing
profile and their family relationships and interactive patterns. As a
functional approach, it uses the complex interactions between biology
and experience to understand behavior and articulates the developmental
capacities that provide the foundation for higher order symbolic
thinking and relating. During spontaneous ‘floor time’ play sessions,
adults follow the child’s lead utilizing affectively toned interactions
through gestures and words to move the child up the symbolic ladder
by first establishing a foundation of shared attention, engagement,
simple and complex gestures, and problem solving to usher the child
into the world of ideas and abstract thinking. This process is illustrated
by a case example of a young boy on the autism spectrum interacting
with his father during ‘floor time’ over a 3 year period.
Introduction
Play is the most important enterprise of childhood. It ushers the child into
the world of symbolic thinking where symbols and images can represent
reality. We have constructed a model of symbolic elaboration (the functional
emotional developmental model) based on an integration of affect
and cognitive theory (Greenspan, 1979; 1989; Greenspan and Shanker,
2003). By elevating feelings and impulses to the level of ideas expressed
through gestures and words, ideas and feelings can be shared and expanded
through symbolic play and conversation. The gestures encompass the affect
cues that give meaning to the words, actions, use of figures and toys (i.e.
the tone of voice, facial expression or type of movement). These affect cues
convey what is coming, what is safe, and what things mean, providing the
support necessary for regulation and taking the risk to broaden feelings and
ideas to climb the symbolic ladder. Because symbolic play provides the
distance and safety from real life and the immediacy of needs, it offers
practice to differentiate one’s own and others’ experience and feelings as
well as to differentiate from the environment in order to prepare for abstract
thinking.
Play is also the most important enterprise for children with special
needs where uneven development related to sensory processing and regulatory
challenges need not limit the potential and propensity to develop the
capacities for a symbolic life. In children with autistic spectrum disorders,
interactive play uniquely addresses the core deficits of relating and communicating
as no other approach can. Interaction is the key to facilitating
development, where long sequences of back and forth co-regulated affect
cues help the child focus, initiate and elaborate ideas. As early as 18 months
the absence of symbolic play has been identified as a critical indicator of
high risk for autism (Baron-Cohen et al., 1992). Yet, while various intervention
models include some form of play, symbolic processes are not given
the centrality necessary to reach abstract levels even though no other
activity encompasses the complexity and opportunity interactive play
provides.
Symbolic process is central to the developmental, individual-difference,
relationship-based model (DIR: Greenspan, 1992; Greenspan and Wieder,
1998; ICDL, 2000;Wieder and Greenspan, 2001). This is a theoretical and
applied framework for intervention which articulates the developmental
capacities that provide the foundation for higher order thinking and
relating.
The DIR model examines the functional developmental capacities of
children in the context of their unique biologically based processing profile
and their family relationships and interactive patterns. Three components
must be considered simultaneously in the DIR model. The ‘D’ represents
the developmental capacities (i.e. functional milestones) that emerge
during the child’s early years including: shared attention and engagement,
back and forth interactions, problem solving, creating play ideas and
abstract thinking. Through interactions during play and conversations
children expand and elaborate upon their ideas, thoughts and feelings as
well as learn to empathize with others as they put themselves in someone
else’s shoes. The ‘I’ represents individual differences in sensory motor processing
and regulation which need to be taken into account and treated to
support development (e.g. auditory or visual spatial processing deficits).
The ‘R’ represents the relationships and environment necessary to provide
the interactions through which the development of emotional, social and
cognitive capacities are nurtured, practiced and enhanced.
In the DIR model affectively toned interactions between child and
parent, teachers or peers, be they gestural or verbal, move the child up the
symbolic ladder. A case example of one child on the autistic spectrum
moving through the first six developmental stages within the ‘D’ component
of the model will illustrate the range this concept embraces. This
example will not describe the full range of comprehensive services the
child received but focuses on ‘floor time’, the component that is spontaneous
and led by the child, where the caregiver follows the child’s lead
and promotes the continuous flow of interactions utilizing affect cues that
entice, challenge, soothe and encourage the child further. Floor time does
not mean just following the child and commenting on what he or she is
doing, but is the active process of interacting in a continuous and rapid
back and forth manner at all the levels the child is capable of, from sensorymotor
pre-verbal interactions, to problem solving, to symbolic play and
abstract conversations. The purpose is to strengthen each of those functional
developmental capacities which together form the foundation for
higher order abilities. It is important to note that some children have
language and some limited interests, but lack the interactive capacities for
mutual attention, relationships, and the back and forth affect gesturing
necessary to expand feelings and themes. These gaps derail development of
symbolic and emotional abilities.
Key elements of ‘floor time’
The key elements of ‘floor time’ are described at each developmental stage.
Stage 1: self-regulation and shared attention (interest in the world)
This initial stage focuses on harnessing all senses and motor capacities, to
help the child stay calm and regulated in order to draw him or her into
shared attention. The adult involves the child in enjoyable interactions that
include looking (look at and examine faces), hearing (focus on voices),
touching (pleasurable tickles, stroking or sharing an object or a toy) and
movement. Constructive and playfully obstructive strategies are used with
affect cues to stretch the child’s capacity.
Stage 2: engagement and relating This stage involves encouraging the
child to engage with pleasure as seen when the child brightens, smiles,
references (looks), moves, vocalizes or reaches. The idea is to encourage
growth of intimacy and ‘falling in love’. As the child develops, the relationship
is deepened to include the full range of feelings such as assertiveness,
anger or sadness that can be incorporated into the quality and stability of
the child’s engagement (e.g. does he or she withdraw or become aimless
under stress, does he/she stay connected when angry or scared?). Relationships
are continually emphasized to develop a sense of security, intimacy,
caring and empathy. Relationships also support the hard work needed to
develop motor planning, language, and positive attitudes towards all new
learning.
Stage 3: two-way intentional communication This stage involves
following the child’s lead and challenging him or her to communicate
through exchanges of gestures and emotional signals about his or her
affects (interests, needs or intentions). The adult is animated and shows
affect through tone of voice and facial expressions. This begins with a
dialogue without words through subtle facial expressions, a gleam in the
eye, and other emotional signals or gestures, and progresses to a dialogue
with problem solving words. Affect cues (signals) are used to woo and wait
for the child’s purposeful social gestures (facial expressions, making
sounds, reaching, pointing, throwing, movement, etc.) to express desires,
objections or other feelings. Reciprocity is established by challenging the
child to do things to the adult, by helping the child achieve his or her goal
and later build obstacles to add steps. A continuous flow is encouraged by
opening and closing multiple circles of communication. A circle is opened
when the child exhibits some interest or initiates a behavior – e.g. the child
looks at a toy, and the parent or caregiver follows the child’s lead by picking up
the toy and showing it to the child. The child closes the circle by reaching
for the toy, while acknowledging (looking, smiling at) the parent.
Stage 4: purposeful complex problem solving communication At this
stage the adult and child work up to a continuous flow of 30 or more back
and forth circles of communication – e.g. the child takes a parent by the
hand, walks her to the door, points to indicate that he/she wants to go out,
and perhaps vocalizes a sound or word to further signify intentions. The
adult expands the conversation by asking where the child wants to go, what
he/she needs, who else will come, what they will get, what else, how come,
etc. These conversations negotiate the most important emotional needs of
life (e.g. being close to others, exploring and being assertive, limiting
aggression, negotiating safety, etc.).
Stage 5: creating and elaborating symbols (ideas) This stage encourages
the child to relate to sensations, gestures and behaviors, to the world
of ideas which can be shared in pretend play. The adult lets the child initiate
the play idea and joins the child as a character through dramatization in
direct roles or using figures to elaborate themes and expand the range of
emotions (closeness, assertiveness, fear, anger, jealousy, aggression, etc.)
which the child can explore and express safely. When feelings and impulses
are elevated to the level of ideas, they can be expressed through words –
e.g. instead of hitting a friend, the child can say, ‘I’m mad’ without acting
out. Play provides the distance from real life and immediacy of needs to
differentiate self from others through empathic roles – e.g. the child
pretends to be a mommy, comforting her frustrated baby who broke his
toy. It is important to look out for polarizing or being dominated by one
or another feeling state (aggression and impulsivity, needy or dependent
behavior, fearful patterns, etc.). The adult engages the child in long conversations
to communicate interests, feelings, desires and objections
throughout the day.
Stage 6: building bridges between symbols (ideas) This stage involves
challenging the child to connect his ideas together by seeking his opinion,
enjoying his debates, and negotiating for things he wants using logical
reasons. The adult promotes pretend play, words, and/or visual symbols to
elaborate a partially planned pretend drama (theme or idea is identified in
advance), or engage in logical conversation dealing with causal, spatial,
and/or temporal relationships between themes. Recognizing when themes
or ideas are fragmented, the child is encouraged to ‘make sense’, with a
beginning, middle and end where elements in the drama logically fit
together, motives are understood, and the child can put himself in someone
else’s shoes. The child is challenged to create connections between differentiated
feeling states – e.g. ‘I feel happy when you are proud of me!’
Relationships (contingency) between feelings, thoughts and actions are
identified. Differentiation of more subtle feelings states (e.g. lonely, sad, disappointed,
annoyed, frustrated) are expanded. This capacity is essential for
separating reality from fantasy, modulating impulses and mood, and
learning how to concentrate and plan.
Case example of a child on the autism spectrum
The first stages of intervention
Joey was diagnosed on the autistic spectrum at 30 months of age. He was
withdrawn and self-absorbed, spending his time pushing a car back and
forth lying on the floor, examining it through his peripheral gaze, shuddering
and quickly covering his ears as he heard unexpected sirens or cries.
He did not respond to his name or appear to understand what was said to
him, typically looking away. But he recognized a few songs, turned the
pages of books, and loved jumping. There were times he smiled as he
enjoyed dancing and bouncing on the bed, but he did not point or wave,
or come to his parents except to take their hands to get a cookie or toy car.
At 2 he was still silent, with just a few guttural sounds. His parents decided
not to wait any longer as they experienced their child slip away and sought
evaluation. It took nearly 6 months to put a comprehensive program in
place (ICDL, 2000).
The following sections describe the authors’ interpretations of Joey’s
progress through a series of floor time interactions over 4 years of intensive
intervention which included: (1) six daily floor time sessions, (2) four
semi-structured and sensory-motor activities, (3) intensive speech and
occupational therapies, (4) three to five playdates weekly, (5) inclusion in
a preschool and (6) various music, gym, drama and sports activities.
Joey and Dad are rolling on the floor engaged in gleeful rough house play as
Joey bounces on his dad’s tummy, waiting to be lifted up once more onto his
dad’s knees to ‘fly into the sky’. He waits breathlessly anticipating his flight
and bumpy landing, his hands trembling, but to no avail. Their gazes meet
with joint excitement and Dad asks, ‘ Are you ready Joey? Ready for take-off
sweetheart?’, his voice wooing Joey into the next step which Joey must initiate
if his intent is to keep flying, both patient and reassuring. Joey finally takes his
dad by one hand and then the other. Pulling both towards him, he blurts out,
‘Eh, eh!’ With that the engine revs up as Dad stretches the moments of their
shared gaze and joint attention until Joey tugs once more, their pleasure
mounting as the plane soars into the ‘bumpy skies’. Joey is now the captain,
signaling his wish to go higher or faster as his dad waits for him to initiate
the next move by gesture or vocalization until they reach their ‘destination’
designated by nearby photos of Nanny and Pop-Pop or Disney World towards
which Joey first reaches and then points as his dad models pointing with an
energetic, ‘Over there or over here?’
Sometimes the plane ‘crashes’ and needs to be repaired with Joey’s hammer
(fist), sometimes it needs to be refueled with kisses, and sometimes it stalls
or gets lost before Joey arrives and he is met with tight squeezes and hugs.
Their journeys stretch from moments to minutes as Dad encourages Joey to
sustain a continuous flow of gestural interactions where Joey is in charge of
each next move, solving every problem as it arises unpredictably, closing circle
after circle of communication in a co-affect regulated state until they reach
their destination.
On this joyful journey many goals are accomplished for this 30-month-old
little boy diagnosed on the autistic spectrum only 6 months earlier. The
most important was the deepening of Joey’s relationship with his dad who
acts as his ‘toy’ and makes playing with people more compelling then
pushing his cars back and forth (which he relied on earlier because of poor
motor planning and sequencing) or spinning in his craving for movement
(because of his under-reactive vestibular system). While Joey always enjoyed
rough house play with his dad, it was Dad who always threw him around
and did all the work for his passive low muscle tone little boy. Building on
this one area where he could still reach the ‘little boy he lost’, Dad learned
how to help Joey develop critical functional developmental capacities
through play with his non-verbal pre-symbolic son.
Mutual attention and engagement were enhanced through affect cuing
to get Joey to initiate what he wanted and communicate this to his dad,
who wooed but waited for Joey to make the first move, knowing what Joey’s
intent or desire was. Their mutual pleasure deepened their relationship and
affection, expressed in deliberate smiles, hugs and kisses. By waiting and
being playfully obstructive, Dad was able to get Joey to elaborate on getting
more of a ride and also to woo him into more complex gestures, where
Joey not only had to tug at his hands but look, pull, figure out if the next
step or solution to the problem was to bang his hammer or give a kiss or
point to where he wanted to go, identifying the purpose of his flight. On
this two-way street, Joey became a better problem solver. Dad then challenged
him to find more complex solutions as they maintained a continuous
flow of interactions and Joey learned to get off the plane and get the
gas truck, or tool kit, or other passengers who could get on board (his
favorite teddy bear and figures). He developed more complex gestures as
he learned to ‘close his seat belt, pull up the throttle, and listen for the count
down (5, 4, 3, 2, 1)’ etc., until he could first point and then say ‘up’ and
‘go’. He mastered a sequence of actions (motor planning) necessary to take
his trip through interactions.
This was a bumpy ride that first just met his proprioceptive and vestibular
needs through rough house play where Dad ‘recaptured’ his son, ushered
Joey into the symbolic world. The countless times his parents had pointed
to the airplanes rumbling in the sky (which Joey was very sensitive to),
and the plane trips they had taken to visit his grandparents, prepared Joey
for the symbolization which now accompanied their lengthier and lengthier
interactions. Choosing symbols and actions which had personal
meaning based on experience, coupled with strengthened capacities for
mutual attention, engagement, communication and problem solving,
prepared Joey for the symbolic world.
Six to 18 months later
Six months later Joey and Dad continued to play on the floor (floor time),
but this time family figures were boarding a small airplane as Joey called
out ‘All aboard’ and told ‘Mommy, on!’, ‘Daddy, on!’, ‘Ready, set, go [to]
Nanny!’ His family figures had driven up to the airplane on a bus,
transferred their luggage, and were ready to board. Joey was still the captain
as Dad spoke for the various figures. Enveloped by strengthened basic
developmental capacities for shared attention, engagement, reciprocal communication
and problem solving Joey went on to develop some verbal
language and motor planning to now express his ideas through symbolic
play. His love of airplane rides readily expanded to symbolizing many other
aspects of his real life experience as he pretended to be ‘Pilot Joe’ or ‘Chef
Joey’ serving various foods (some of which he did not eat in real life!) at
picnics and dinners. He was also a good daddy, giving his babies baths and
putting them to bed with his personal rituals. He was the doctor, the teacher
and the traffic controller, eager to ‘play’ at any time with his parents, sister,
therapists and playdates. His language propelled forward in his eagerness
to express his ideas with words, built on the strong gestural communication
and comprehension aided by the use of toys, another language he could
‘see’ as he listened and talked. He practiced the words, embedded with rich
meanings and affect cues, provided during the interactive play. His excitement
and impulsiveness was co-regulated through affect cues signaling
caution, moderation or action. The elaboration of play and ideas with toys
relies on expanding interaction and communication, as well as motor
planning abilities which allow the child to plan and execute his ideas. He
was encouraged to develop ideas or stories with a beginning, a middle and
an end which had a point or mission.
Soon Joey entered the world of symbolic solutions and magical thinking
as his emotional range expanded and he moved from safe dependency
themes, feeding, fixing and ‘in control’ of the world through symbolic role
play and use of figures and toys related to reality, to the new emotional
themes lurking in the shadows as he encountered meat eating dinosaurs
ready to pounce on the plant eaters, jealous queens with spells and potions,
mean stepmothers or sea witches impeding romance, brother lions fighting
for a kingdom, hungry alligators ticking as they waited for mean pirates,
and noble kings ready for the rescue. Now baskets became cages and jails,
rubber bands bound the enemies, and Nerf swords were ready for battle so
romantic weddings could go on. When all else failed or fears were too high,
a magic wand could come to the rescue. To be sure, the ‘good guys’ almost
always won. Time and space had no bounds!
During this stage Joey became very anxious as he struggled to understand
what was real and what was fantasy, as well as to grasp his emerging
range of new complex emotions related to competition, jealousy, power,
loss, aggression, death, justice and morality which he would encounter in
the next few years. Again it was lots and lots of symbolic play and reflective
conversations which would give him the opportunity to safely explore
these emotions, their meanings, and the alternative solutions they posed.
Joey’s floor time partners all followed the same principles: let Joey
initiate the idea, follow his lead, be a ‘player’ (not interviewer), do not
change topics, help him elaborate by challenging him to solve the problems
at hand (of which some occurred incidentally and others were opportunities
created by you), provide new language to encourage conversation,
not ask questions he already knew the answers to but get him to think, get
him to predict what you will do through signals and cues, keep the back
and forth pace rapid, and use affect cuing to provide challenges and continuous
flow as long as possible. It was also at this time the stage was set
up for the development of abstract thinking through reflective conversations
where Joey was encouraged to give his opinions, figure out what he
and others were feeling, empathize, and determine what was right and
wrong, safe and dangerous.
Three years later
As he turned 6, Joey was contemplating motives as he discussed different
strategies to capture the ‘dark side’! He no longer automatically arrived in
space ready to win. He even negotiated with Dad who would be on which
side as he now planned his play and debated what was possible. Their conversations
were now rich with why questions and discussions of feelings
and motives as Joey embarked on his journey into abstract thinking and
increased empathy. Dad asked questions that required Joey to anticipate how
he would feel in certain situations as well as how someone else would feel.
He asked Joey his opinions about choices and to compare and contrast
experiences. Dad also realized Joey had missed a lot of incidental learning
during the years that auditory and language processing difficulties impeded
picking up information about the world around him. The combination of
these efforts through daily conversations and floor time play started to move
Joey towards more abstract thinking. The world was becoming less black
and white.
He applied these emerging capacities to his interactions with peers as
he realized some days his friends would be nice to him and other days not.
Running with the crowd was now easy as he had learned to join social
games on his numerous playdates, enjoying chase, ‘capture the flag’, and
even soccer. On the floor, he and his friends engaged in superhero battles
and tigers were no longer kitty cats. He joined the ‘Justice League’ as he
borrowed the power of different superhero roles to compensate for his
growing realization he was only a little kid after all in a world full of rules
and many bosses loomed above him. He discovered the other ‘darker’ side
of emotions as he encountered characters consumed with jealousy, competition,
and lust for power.With his parents, he turned to his fears, sorrow,
loss and disappointment, and need for compassion and support as he
expanded his emotional range. After a tough day he brought his daily
struggles to floor time, reenacting his conflicts and confusion. After a victorious
day he brought his success to floor time to analyze what was fair
and loyal, as well as to empathize with others. As he experienced defeat or
disappointment, it was only in play he could experiment with negative
emotions and aggression without getting in trouble.Without play symbols
he was at risk for acting out his newer emotions and conflicts. During floor
time he prepared for the next day’s encounters.
Symbolic play and conversations were now the opportunity to work out
real life dilemmas whereas before he used it to imagine, fulfill wishes,
practice roles, and enjoy the magic he conjured. Now, entering school
years, ‘saying so no longer made it so’, as he grasped reality and reflected
on the experience of others. He was now prepared to go onto the next
stages of emotional development.
Conclusion
Not every child progresses at the same rate as Joey during 4 years of intensive
intervention, central to which were the daily floor time interactions.
But every child with developmental challenges must have the affective
interactions necessary to develop each functional milestone. More than 6
months were necessary just to build the foundations for higher level
problem solving and symbolic process. Whether playful rough housing or
tickle games, or gleeful chase and hide and seek, the foundation was established
for pleasurable relating and communicating through interaction.
Joey’s progress represents the stages of symbolic play and thinking essential
for later life, stages traversed through affect based interactions as each
stage emerged. This is evident when toys become symbolic ideas and words
convey emotions, empathy and logical and abstract thinking.
Joey progressed continuously during the course of a comprehensive
intervention program addressing his specific processing difficulties, and
rooted in building interactive relationships, enabling him to climb the
symbolic ladder. We believe that floor time was central to his progress
in that it helped him build the structure necessary for each successive
achievement. A single child’s progress cannot, of course, prove the efficacy
of an intervention. Neverthess, our observations suggest that play provided
the lifeline for Joey’s development. It set the foundation for abstract
thinking needed for comprehension of literature and history, as well as
logical thinking related to time, space and numbers. When symbols can
stand in for reality, there is the opportunity to experiment, practice, comprehend,
communicate, empathize, develop theory of mind, and become
logical and abstract through the interactions inherent in relationships, the
essence of life.
Follow-up studies indicate many children initially diagnosed on the
autism spectrum can achieve the developmental capacities necessary for
relating and learning as Joey did following appropriate interventions
(Greenspan and Wieder, 1997b; ICDL, 2002).
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