THE SCIENCE OF GREENSPAN FLOORTIME

   Jake Greenspan

In the early 1970s, a young child psychiatrist named Dr. Stanley Greenspan said that at birth all children have emotional experiences and emotional systems.  He believed it was these emotional experiences that drove the developmental process of each child and encouraged their interaction with the world.  He also said that it is these emotional experiences and emotional perceptions that help us organize and integrate the different parts of our brain to develop a true understanding of the world around us. Having studied under behavioral conditioning leaders such as BF Skinner and studied the works of Sigmund Freud and Jean Piaget, he determined that it was our emotions that drive and select our behavior. In 1989, he first described his Floortime approach as a way to help every child reach their maximum potential. Even though he couldn’t see what was happening in the brains of the children, he instinctively knew that he was helping to improve their neurological organization and wiring. By encouraging growth from the inside, and letting that drive behavior and thinking, he saw that his results were comprehensive and lasting. We now know from neurological research done over the last 50 years that he was right. Currently there are a number of versions of DIR and Floortime-based interventions being used by parents and professionals, but there is only one original version that Dr. Stanley Greenspan created, The Greenspan Floortime Approach®.

FLOORTIME AND NEUROPLASTIC RESEARCH IMPLICATIONS

Many behavioral approaches, like ABA, and many special needs school curricula use repetition of adult-led activities to teach a child a desired response.  These “stimulus-response” approaches focus on external observable behavior, not on what is happening on the inside of the child.  This form of conditioning can get quick, measurable results.  However, professionals have debated how comprehensive these results are and at what cost to future learning they are attained.

In 2015, researchers found that individuals with autism spectrum disorders who were taught using techniques that involved repetition showed initial gains. However, after the learning experience, they had poor generalization of that information and “automatously poor learning.”[1]

This research reports what many professionals and parents have worried about—that behavioral conditioning and teaching techniques don’t produce long-term generalized results.  As disconcerting is that the results show that these techniques can also negatively impact a child’s ability to learn in the future.  Since the behavioral techniques have been the standard for many years, this new evidence leave us asking,” What is the best teaching method for children to achieve long-term comprehensive results?”

Neuroscientist Alvaro Pascual-Leone has described our brain and the way it wires and reorganizes itself (its neuroplasticity) like the trails down a snowy hill. When we slide down, we create a path. This path is symbolic of the connections between the neurons in our brain that activate together when performing a task or when having an experience (the wiring). We can slide down and create a path, then try it again to create a second path, and a third path, and a fourth. From then on, we can be flexible in choosing which path to go down. Gradually a number of paths become deep and permanent. However, if we take the same path repeatedly, that one path can become a rut so wide and deep that ultimately no matter how hard we try to establish a new path down the hill, we can’t.  Instead we constantly get trapped in the original one. If we get trapped in a rut in our brain, the result is rigid thinking and behavior.[2]

Rigid behavior is by definition maladaptive.  Ideally we want to have many paths that are each permanent and well-defined but don’t trap us. This raises the question, should we encourage children, especially those with ASD, to take the same path over and over, that is, engage in repetitive activities for learning purposes?

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Over the last five years Dr. Greenspan’s Floortime Approach has amassed a growing body of research and support. This research has not only collected empirical data that authenticates The Greenspan Floortime Approach® clinically, but it has also shown scientifically that this approach can change and rewire how the brain is organized. This rewiring strengthens existing connections in the brain while also helps to create new ones. We see this impact from a clinical perspective when children improve their abilities to relate, communicate, and exhibit flexible and adaptive social behavior.

Scientific evidence from other neuroplasticity research supports the positive effect that Greenspan Floortime™ has on a child’s brain. When considering this evidence, it is important to understand how the brain works and wires itself.  To do this it is important to understand neuroplasticity.

It is a well-accepted scientific fact that our brain is constantly changing. It remains plastic, developing and malleable throughout most of our lives, even into late adulthood, especially when proven learning principals are applied. The neuroplastic properties of the brain ultimately lead to changes in our behavior and thinking abilities.  In this way the brain either produces more flexible (adaptive) behavior or more rigid (maladaptive) behavior.

An infant’s brain changes and grows very rapidly, which is why at younger ages we absorb certain things so quickly.  An example is language, where within the first seven years of life we have a critical phase (learning from exposure) for learning language.  Similarly with other parts of our sensory processing system, stimulation within the first few months of life promotes development.[3]  However, when the critical phase is over and the brain is no longer learning from exposure to stimulus and experiences, the brain is plastic in the sense that it can still build new connections and learn new skills and capacities under certain conditions. It is important to know the conditions for wiring the brain, particularly when tailoring a program for children who need support in helping their brains develop and grow more rapidly than they are predisposed to do, such as in cases of developmental delays.

NEUROPLASTIC PRINCIPLES FOR FLOORTIME

1. A Fully Involved Child.     For the brain to experience lasting changes, people must be highly involved in a learning activity, i.e. pay very close attention.[4] If they are passively involved, then changes in the brain will not be as solid and will not last. In other words the neural pathways are not sufficiently deep and permanent. It is under these circumstances that we often see children who make short-term gains, but not long-term ones.  This can happen with activities where the child is only mildly interested because an adult chooses the activity and then leads or directs the child.  Letting children pick the activities and helping them stay enthusiastically engaged is a way to ensure their high level of involvement.  In The Greenspan Floortime Approach® we call this Following the Lead.
2. Integrating Information.     Researchers have coined the phrase: “neurons that fire together wire together.”[5]  With most experiences in life, especially those that involve multiple elements,we use different parts of our brain simultaneously to process and respond to that information.  For example, when communicating in a social setting we use such areas as: 1) auditory processing (understanding the sounds), 2) visual processing (watching the mouth and interpreting changing facial expressions and gestures), and 3) linking this information to the emotions the person is conveying. We integrate different types of information (motor, auditory, visual, and emotional,etc.) into a unified picture.

Neuroscientists know that when we can do this, the principle of “neurons that fire together wire together” is in place.  Performing or even thinking about a multi-element activity lets us practice using multiple areas of the brain at the same time. The brain wires itself to perform those tasks as a unit. Researchers have seen through brain imaging that even saying or hearing a word like “garlic” lights up not only the language centers of the brain but also smell and other parts.  Language is not just about words.

Conversely, “neurons that fire apart wire apart.”[6] If we practice things in isolation, we only have access to those capacities in isolation. So if we practice auditory processing (understanding language) in the absence of a rich social-emotional environment, it may be more difficult to process auditory information when in a real social relationship. This is not to say that we can’t do exercises to isolate the auditory processing, but they should be only a small part of a program that focuses on integrating all the information, especially social-emotional.

So if we want children to learn from their teacher and from their social environment, then practicing should involve them being positively involved with their social environment—not just learning from a book or a computer screen, but learning in a 3-dimensional space in a social setting. Unfortunately many interventions for children with developmental delays use isolated activities or individual skill-based activities focusing only on one area. They do not integrate many components together. Especially during skill-based activities, like fine motor work, the child’s social-emotional connection with the adult is often sacrificed for performing the activity or solving the problem.  In Greenspan Floortime™ the second step, Challenging the Child to Interact, Communicate and Think, uses integrated experiences to make sure a child can generalize and differentiate how and when to use a skill.

3. Thinking vs Memorizing.     Reinforcing the thinking process, instead of conditioning (teaching) a specific answer or response, gets faster and more complete neurological results.  By acknowledging and responding to a child’s purposeful gesture, we encourage more communication and foster an internal process. Our responses help to improve the brain’s wiring by causing the child to think and use different pathways, rather than the same one.[7]). Coming up with one’s own response, rather than using one given repetitively by someone else, achieves long-term results and a stronger internal process for use in future situations.  It helps children establish their own thinking process instead of giving them your solution (i.e. teaching to the test).
4. Working from the Ground Up.     When helping a child or even an adult to develop greater neurological wiring and progress in a skill or ability, the challenges in the activities must be designed to meet them where they aredevelopmentally. Unfortunately most teachers and therapists try to teach a specific age-appropriate expectation or skill.  A bottom-up or “Ground Up” approach emphasizes neurological development, not chronological age. For example, to rewire the motor cortex of someone who is learning to walk after suffering a brain injury, they need to learn to crawl again and cruise again first. If a child is learning to communicate verbally, they need to learn to communicate physically and gesturally prior to developing language. Starting from the ground up will make sure we are developing the comprehensive neurological wiring necessary to support future functions. This will help achieve an integrated internal thinking process and ensure initial as well as longer-term success. In Greenspan Floortime we call this Finding the “Just Right” Challenge.
5. Subtly Expanding Interactions.     Subtle changes in the challenge, starting from a point of success, are necessary to train the brain.[8] Here, we need to make sure that the challenges we provide a child progress at such a subtle rate that the change is almost imperceptible and that the child can overcome the challenges in a fun and confidence-building manner.  In Greenspan Floortime™ we call this “Expanding the Challenge”.
6. Giving the Right Kinds of Reward.     It is through the release of certain chemicals such as dopamine[9]and acetylcholine[10]that our experiences become learning experiences.  These chemicals are released based on the type of reward that we receive at the end of the experience. In turn these chemicals help solidify (remember) the learning while also fine tuning (making more efficient) what we learn from that experience. They are released from the parts of our brain that process pleasure, and it is through pleasurable experiences and rewards that researchers now know that we learn best.

What type of reward gives us the greatest level of pleasure? Emotional rewards: ones we are able to receive constantly throughout the rest of our lives—a smile, a friendly look, even the feeling of self-confidence after overcoming an obstacle or achieving a goal.

The Greenspan Floortime Approach® is based on developing and deepening relationships that naturally give positive emotional rewards.  These are not external and superficial, but instead center on the feelings you have for another person.  If we become conditioned (i.e., develop the neurological habit and tendency) to expect an external reward such as an M&M, cookie, or computer time, the gains are not as strong because the rewards are not as meaningful.  We do not receive these types of rewards throughout our lives. Additionally using them in this way can make them addictive.

Another reason the positive relationship itself is the best reward is that we need to be cautious of children developing negative relationships, negative perceptions of people around them, or associations of always receiving an external reward for the activities need to perform for daily living.  Learning a skill within a negative relationship can make a child (or adult) avoid using that skill.

7. Involving Parents.     In addition to developing rigid behavior patterns, which many children are already predisposed towards, many behavioral approaches require the child to be away from parents for 20-40 hours per week, starting as early as 1.5 – to 2-years old.

We already know that spending time with a caregiver is important. Now new research sheds light specifically on its neurological importance.  In a recent study researchers from Stanford University found that: “Nonsense words produced by mother activate multiple brain systems, including reward, emotion, and face-processing centers, reflecting how widely mother’s voice is broadcast throughout a child’s brain. Importantly, this activity provides a neural fingerprint of children’s social communication abilities”.[11]  A child needs to hear mother’s voice. And we see clinically that they need to hear their father’s too!  Hearing these voices improves the processing of social information and functioning.

A mother’s involvement does even more than improve sensory processing. In 2010, a study found that girls aged 7-12 who performed stress-inducing activities that raised their cortisol levels were calmed by a hug from their mother.  “For girls who interacted with mom, their levels of oxytocin, often called the ‘love hormone,’ rose significantly, and the stress-marking cortisol washed away. This reprieve from stress was also lasting.”  The same changes in hormones were experienced by another group of girls who heard their mother’s voice over the phone. Unfortunately many behavioral approaches tell parents to ignore their child when they are experiencing stress, anger, and frustration.  How are they to learn to calm themselves?[12]

This research supports a parent-centered, therapeutic approach like The Greenspan Floortime Approach®.  Dr. Greenspan urged parents to talk to their child, especially non-verbal ones, and be physically involved.  He saw improvements in communication and self-regulation,   the areas discussed in the above research.  While some children with autism or other developmental challenges may initially have difficulty processing their parents’ voices, The Greenspan Floortime Approach® can improve a child’s responsiveness. Using fun techniques, parents become actively involved in their child’s program. With Greenspan Floortime™ parents’ voice and touch are important elements that are constantly being used for engagement and interaction and are helpful for children with behavioral challenges as well as social and communication ones.

Please note:  Some versions of Floortime (not created by Dr. Greenspan) encourage parents to verbalize minimally with their children. Except for children who are extremely sensitive to auditory stimuli, this restrictive measure is neither a principle of Dr. Greenspan’s Floortime nor obviously supported by the above research.  Given the research, a non-verbal or minimally verbal environment can be harmful to the developing child.

8. Consistency and Intensity.    Research on Floortime at York University conducted by Jim Stiebens established that about 20 hours per week of in-home Floortime was necessary to see significant clinical results.[13]  Other studies on neuroplasticity suggest that there is a mandatory amount of time to create plastic reorganization of the brain. Neuroscientist Edward Taub found that a two-week intensive training period of three-hours a day seems to begin the plastic reorganization process within the brain, a finding he continues to explore. [14]

At The Greenspan Floortime Approach® facilities, such as The Floortime Center®, strong clinical results are being achieved through intensive treatment programs that involve 3-4 hours a day for a minimum of two weeks. We see that these intense intervals jump start a child’s developmental process.  Treatment programs at The Floortime Center®, where the above neuroplastic conditions are applied within Greenspan Floortime-based services, include Greenspan Floortime™ opportunities for parents coached by Jake Greenspan or Tim Bleecker as well as opportunities for Greenspan Floortime-based approaches for occupational therapy, speech and language therapy, feeding therapy, visual-cognitive therapy, and social opportunities.

At the end of these intensive periods, not only have the children significantly strengthened their relating, thinking and communicating, but the parents have received a good foundation for doing Greenspan Floortime at home.  Families can then maintain a level of Greenspan Floortime throughout daily life and revisit The Floortime Center® for another intensive program a number of months down the road.

CONCLUSION

In 2006, the consulting firm Accenture studied 251 of its executives to determine what made them successful. It concluded that although intelligence is an important factor, it is not the main one.  The key predictor is emotions: more specifically, “interpersonal competence, self-awareness and social awareness — all elements of emotional intelligence.”[15]

This conclusion makes eminent sense. In a seminal monograph in 1979[16], Dr. Greenspan described how emotions are the foundation of intelligence, to the skepticism of some of his colleagues.  And almost 40 years later they still are. They continue to be the basis for the Greenspan Floortime Approach, which he described in the monograph.

One of the most important emotional capacities associated with emotional intelligence is empathy.  Empathy— the emotional connection between human beings that gives an understanding of others’ feelings—is critical for a fully participating in life. The basis of empathy is flexible behavior.[17] Since all children need to develop empathy, especially those with developmental challenges like ASD, it is important that we encourage flexible and adaptable behavior versus rigid and repetitive behavior.

Using the principles of neuroplasticity within an approach like The Greenspan Floortime Approach® lets all children achieve flexible adaptable behavior, empathy, and improvements in communication and thinking. Knowing how adaptable the brain is proves that these are all realistic goals for children with developmental challenges and behavior difficulties. Simply teaching them a new behavior is insignificant when compared to what these children can truly achieve through an approach that is aligned with optimal neuroplastic development.

[1]Harris H, Israeli D, Minshew N, et al., “Perceptual learning in autism: over-specificity and possible remedies”,Nature Neuroscience, 2015 Nov;18(11):1574-6.

[2] Pascual-Leone, A, described in Doidge N, The Brain that Changes Itself, Penguin Books, New York, 2007, pp.208-9.

[3] Hubel D and Wiesel T, described in Doidge N, The Brain that Changes Itself, Penguin Books, New York, 2007, pp.51-52.

[4] Merzenich M, described in Doidge N, The Brain that Changes Itself, Penguin Books, New York, 2007, p 68.

[5] Hebb D, described in Doidge N, The Brain that Changes Itself, Penguin Books, New York, 2007, p 63.

[6] Hebb D, described in Doidge N, The Brain that Changes Itself, Penguin Books, New York, 2007, p 63

[7] Taub E, Hebb D, described in Doidge N, The Brain that Changes Itself, Penguin Books, New York, 2007, p 143

[8] FastForWord program.

[9] Berridge K and Robinson TE, “Nature of Dopamine’s role in reward”, Brain Research Reviews 1998 Dec 28 (3), 309-69.

[10] Hasselmo ME, “The role of acetylcholine in learning and memory”, Current Opinion in Neurobiology 2006 Dec 16 (6), 710-15.

[11] Abrams DA, Chen T, Odriozola P et al., “Neural circuits underlying Mother’s voice perception predict social communication abilities in children”, Proceedings of the National Academy of Science, 2016 May 31;113(22):6295-300.

[12] Seltzer LJ, Ziegler TE, Pollak SD, “Social vocalizations can release oxytocin in humans”, Proceedings of the Royal Society B, 12 May 2010.

[13] Stieben J, unpublished research, reported in CBC program on DIR Floortime in Canada.

[14] Taub E, described in Doidge N, The Brain that Changes Itself, Penguin Books, New York, 2007, p 149.

[15]http://business.financialpost.com/executive/careers/the-biggest-predictor-of-career-success-not-skills-or-education-but-emotional-intelligence

[16] Greenspan, SI, Intelligence and Adaptation: An Integration of Psychoanalytic and Piagetian Developmental Psychology, IUP, New York, 1979.

[17] Eslinger PJ, Neurological and Neuropsychological Bases of Empathy. European Neurology 1998;39:193-199,