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Tammi Reynolds, BA & Mark Dombeck, Ph.D., edited by Kathryn Patricelli, MA

The floortime program, developed by Dr. Stanley Greenspan, takes a social rather than behavioral approach to autism spectrum disorder treatment. It involves working directly with children's interests, rather than simply considering those interests as a means for rewarding desired behaviors. Instead of requiring the child to engage in a structured activity, the therapist enters the child's play. Where behavioral approaches are led by the therapist, in floortime exercises, the child leads.

chlidren playing The floortime approach seeks to help children develop self- and other-awareness by helping them develop their own self- and other-concepts. These goals are achieved through a therapeutic focus designed to enhance children's emotional self-understanding, rather than their ability to communicate. According to Greenspan, when children can understand and regulate their emotions, they are able to regulate their behavior. To highlight the differences between floortime and applied behavioral analysis (ABA), behaviorist approaches do not consider children's sense of self while floor play seeks to help children to develop a sense of self.

The floortime approach involves therapists entering and joining into children's preferred play activities without making any demands. The therapist (or, ideally the children's parents) follows the child's cues and works within their interests, gradually introducing observation, parallel play and ultimately, turn taking and interaction.

There are five steps to work through. First, the therapist simply observes children at play and notes their interests and mood. Second, the therapist builds the children's interest in their chosen activities through words and gestures without disturbing the flow of their play. Third, they follow children's lead. During the fourth step, the therapist praises the children's play and quietly joins in their activity. Therapists are encouraged to have dramatic interactions with children, characterized by exaggerated facial expressions and gestures. In turn, children are rewarded and encouraged when they make a dramatic response. Therapists are also encouraged to help children navigate through everyday activities by empathetically explaining activities so that children know what to expect and what is expected of them. For example, a therapist may use verbal cues like, "my turn" to help a child wait in line at a store, thus applying the play therapy to an everyday situation. Through this process of joining and subtle reinforcement, floortime works to help the child reference other people, begin interaction and use language to indicate wants and needs. Over time, the fifth step emerges, and children start to reference their therapist, and use words and gestures to reciprocate and initiate interactions.

More information on Floortime is available at http://www.icdl.com/floortime.