Autism Spectrum Disorder is characterized by a range of challenges in different areas such as social skills, speech and nonverbal communication and repetitive behaviors. The Centers for Disease Control and Prevention (CDC) estimates that 1 in every 68 American children are diagnosed with autism spectrum disorder.
We talked to Nagwa Khedr, Early Intervention Specialist, about introducing Egypt (and the whole region) to DIR Floortime. Floortime is a type of therapy based on the Developmental Individual-difference Relationship-based model (DIR). In essence, this type of therapy is based on the idea that adults can help children develop their communication using a child-led approach.
Although originally an art major and psychology minor, Nagwa was always very interested in working with children and development. She works as an early intervention specialist, at Learning Resource Center (LRC), mainly with children aged 1 to 8 years old.
For the past 3 years, Nagwa has been using the DIR Floortime approach to work with children with ASD and any developmental problems. Although the method has been around since the 70s, Nagwa is the only certified Floortime expert in Egypt and in the region.
What is Floortime?
Floortime is a play-based approach. It’s basically playing, but with a meaning and a purpose. Floortime is based on a neuroscience study that found that children with autism don’t know how to connect their sensory motion. For example, when a baby’s mother smiles at him – as a natural reflex the baby smiles back but for children with ASD even if they want to they don’t know how to make this connection.
For a child to be able to connect with his mother, we approach him emotionally. It is basically a child-led approach, where we enter the child’s world and start to challenge him and slowly bring him into our world.
At what age do you start doing Floortime?
As early as possible – we work with the child alone to build a relationship and then move on to involve the mother because it is much more important for the mother to understand the principles and learn how to carry on ‘floortime’ at home. This is crucial in order to develop a proper bond between her and her child.
What is the biggest misconception about playing?
Play or playtime is very often misunderstood or misconducted. Many parents or caretakers try to control how the child is playing – they want them to play with certain things, such as puzzles and cards and educational toys … which inevitably leads to the loss of interaction with the child. It’s much more important for the child to know that you are there and for them to be engaging with you than the kind of toy that you are using.
A lot of people underestimate the importance of play and do not see the purpose of play – their priority is usually learning and memorizing.
How often does a child need Floortime per week?
The recommendation is 20 hours of playtime a week – because this is usually not attainable; it is very important for the parents to learn how to play with their children at home even if for 10 minutes a day.
What differentiates the DIR Floortime method from all the other different approaches to autism and developmental disorders?
In other therapy approaches, it has always been that we try to change the person in front of us to do things that we (or society) consider normal. So inevitably there is no social growth for the child, he just learns a few socially accepted actions and how to follow orders without actually learning or understanding what he is doing.
In Floortime, the child leads so if the child wants to sit on the floor then I sit on the floor too. This approach is special because it is relationship based – child led to make the child feel understood and wanted instead of making them feel like they need to be changed and force certain concepts and actions onto them.
Other approaches don’t include proper playing, usually the caretaker or therapist choose the toy, how to play with it and when to play.
Can you give us examples of how Floortime can help kids develop?
Floortime can help development in many different aspects. For starters, when playing we tend to observe certain things that the child cannot yet though, for example, connect ideas. This is then reflected in his learning, you can see that he cannot bridge ideas and his thoughts are usually all over the place. Through playing, these ideas can be developed and they will eventually be reflected is his learning as well.
Floortime also helps understand kids’ interests and what they enjoy doing, which will make it easier for the parent and therapist understand how to teach them.
Can you share with us a successful case where Floortime helped a child with ASD?
I once had an autistic child whose mother was not able to sit or play with, she was not able to build a relationship with her child and so she brought him to try Floortime. After a couple of sessions, and when he got comfortable with being around me, his mother started observing the sessions and how her son was reacting to them. When she was ready she started joining us on the floor and I started coaching her on what to do. Through this process, she started figuring out a few things about her son like what he likes, what he doesn’t like, what he enjoys doing… It was a very touching case for me because in a relatively short time she was able to connect with her son and create a bond that was not previously there.