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Book Review: Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think by Stanely I. Greenspan, M.D. and Serena Wieder, Ph.D

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This review of Engaging Autism is written for any person interested in autism. Its main intent, however, is to speak directly to a parent (caregiver) who may be dealing with a child with the disorder. In this review, I refer to a child with the disability as “her” and “daughter.” Early in the book's chapters, authors Greenspan and Wieder warn that the presence of one symptom should never lead to a diagnosis of autism. Engaging Autism lists these three problem areas as indicative of the disorder.

  1. The first problem you may notice is your child’s inability to establish closeness and affection when relating to you and others. You may notice she does not turn meaningfully to greet you. Her general body motions appear uncoordinated and random for her age – purposeless. You get the unmistakable gut feeling that she shows little or no affection in spite of your best attempts to show her intimacy and warmth.
  2. The second problem you might notice is her failure to communicate with gestures and expressions of <bremotion. Engaging Autism believes your child may feel pleasure and sense affection; still she is unable to express this feeling. To add to her problem, you may be more hesitant to respond to her, thus reducing the chain of social and emotional exchanges necessary for her to develop a sense of self.
  3. A third area where your child may languish would be expressive language. You may find that although she has begun to use basic words, she may use them without showing longing or emotion. When she does vocalize, it may be the same words repeated over and over as if memorized with little or no feeling involved.

In Engaging Autism, floor-time refers to three actions you, and everyone who deals with your daughter, must be encouraged to take, in order to help her develop to her full potential. The actions must be taken as often as possible and should include other family members, neighborhood children, relatives, teachers etc.

1. Floor-time means you begin a sequence of two-way communication with your daughter at her own developmental level. It may not involve talking.
2. Floor-time means you start a communication sequence by following your daughter’s lead regardless of what she is doing.
3. Floor-time means challenging your daughter to respond verbally or with some other kind of cue: a grin, a smile, an emotional change on her face – any noticeable reaction.

It can be extremely frustrating for you trying to engage your daughter if she is staring off into space or is engaged in obsessive stimming behavior. But before any real communication can begin, you must first engage her.

Floor-time could involve getting down on the floor with her many times a day. It could be a sequence of communication at any time, hopefully many more times than not: while you and she are showering and/or bathing; while going shopping together; while playing inside and outside the home with peers; while you attend some classes at school with her, until both teacher and aide (if available) can use the same sequencing system you use.

The key to begin communicative behavior is to place your body physically where your daughter is focused (called floor-time regardless of place), you follow her lead, and challenge her to respond. The following few paragraphs contain an example of floor-time as I, the reviewer of Engaging Autism, understand it:

If your daughter is staring off to one side of the room or out a window or at a wall, it is necessary for you to go to that spot and be seen by her. It is important that you don’t stand in front of her and demand her attention nor would you turn her head to force her to look directly at you. No, you must start where she is focused.

If you now jiggle her favorite doll (any toy), you might challenge her, “How can we play with this doll now?” If she responds, “Play,” or “Me Play” (just an example), then a communication circle — you-daughter-you — has happened.

Suppose you challenge again, “What can we play?” she might just answer, “Play here,” or “Play now!” Holding the doll, you would then approach your daughter in her line of vision and attempt to keep communication going by repeatedly challenging her with simple questions, hopefully to add more layers to your circle of communication. As you develop this engaging, you’ll want to try to ask questions which require more than a “Yes” or “No” response.

Another example of floor-time by this reviewer: Suppose you want to take your daughter outside to play. She is sitting at a table rubbing the same spot over and over. There is no possibility of eye contact because she stares downward, vacantly. You place your hand beside hers so that her hand now slides alongside yours. If she utters anything and you answer, a communication circle has started. If she doesn’t respond, you push your hand slightly against hers to move it a tiny bit. This is a challenge. Back off if you suspect a meltdown is coming.

She may respond; she may not. If you keep challenging by moving against her hand, she may eventually look up and make eye contact, or even smile – another response. Now you might challenge her again with words, “Let's put our fingers on a toy we can take outside?” or you might just begin to play some kind of finger game. The book describes several.

Engaging Autism would readily agree that it is not always easy to start a communication circle, but RESPONSIVE communication is your main objective. The longer – the better; the more circles of communication you can build – the more helpful your floor-time will be in helping your daughter learn to relate, communicate, and think.

This is not to say there will never be lapses, or tantrums, or days of complete frustration on your part. After taking a break — a few minutes, an hour, the rest of the day — the most critical thing to remember is: keep trying! Don’t give up.

What I have described here are only two imaginary examples of floor-time approaches to engage your daughter in communication circles with you at a relatively low level. But Engaging Autism describes a multitude of ways to engage her at every level of development from infancy through her schooling years.

It suggests ways you can work with your daughter’s teachers so that at school and at home, the same floor-time approach provides her with a wrap-around interactive environment. It even discusses successful ways to toilet train. Finally, the book explains how you can help playmates interact and accept her, by literally joining in their play and showing them how to interrelate.

After some 30 years working with exceptional children in the Pittsburgh Public School System, this reviewer feels that floor-time as described in Engaging Autism is a genuinely unique way of helping a child with autism to communicate and relate to others in a meaningful and satisfying way. There are many approaches out there, but I think a lot will be ventured and a lot gained using floor-time.

Engaging Autism is a must read for parents, caregivers, teachers, physicians, psychologists and psychiatrists who have been frustrated in their attempts to help young and older children with autism. Its methods will give all of them more than just a ray of hope.

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