DIR/Floortime In-Home Coaching Supports Families

Affect Autism: We chose play, joy every day

Photo by Gustavo Fring

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What is Floortime?

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This Week’s Guest

Kerri Ciskowski is a DIR-Expert Occupational Therapist in central New Jersey who does in-home support through her service Therapy Keeper for families who are typically raising autistic kids. She is a happily married mother of 3 boys age 12, 10 and almost 8. Today we’re talking about in-home DIR/Floortime coaching which supports parents in unpacking ‘behaviours’ and finding connection and joy with their neurodivergent children.

This Week’s Topic

Parents learning about Floortime often say that they understand the theory, but are still unsure about how to handle their children’s ‘behaviours’. There is no ‘prescription’ in Floortime, though, as each child and family are so unique. We discuss how you can figure out what to do in a great follow-up to the recent podcasts on Intentionality, FEDC 4, and FEDC 4 into 5.

DIR/Floortime In-Home Coaching Supports Families

by Affect Autism

https://affectautism.com/wp-content/uploads/2024/09/2024-09-13.mp3

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Bonus Insights

DIR Parent Network click HERE

D = Developmental

I = Individual differences

R = Relationship-based

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Setting the Stage

I set up a scenario that a family comes to Kerri’s service and she has to figure out how to support them. Kerri, I presume will be talking about that Floortime mindset where we look for the ‘why’ behind the behaviour, avoiding ‘teaching’ and ‘directing’, and looking at the sensory processing and individual profile of the child. Kerri says that what’s important when she meets a family is that she wants to set the stage before she even visits the home because it’s different than anything else they’ve experienced.

Kerri lets the family know that if the child is super interested in her when she arrives, and she establishes a great connection, she will run with it in the moment. She lets the parents know that they are a part of that process and if they have any questions, to write them all down because they’ll process it afterwards. The DIR model puts the child and family in the center. She’s never going to tell you what you need to do nor ask your child to perform. What she’s after–what families are always after–is the connection and the joy. This sets the stage for what the initial interactions are about, she assures us.

Appreciating Trauma

A lot of families are coming with so much trauma, including a lot of ‘icky’ experiences, Kerri says. She always wants it to look and feel like an environment where everyone is heard and loved. While this is typical for the Floortime community, Kerri continues, so few outside of it have experienced this. So when Kerri talks about the ‘I’, she wonders what that parent individually needs to have the capacity to even see the magic that’s unfolding in front of them.

The experience of trauma is as wide the individual differences can be, Kerri explains. I shared with Kerri how my son had a massive seizure and another 12 hours later, ending up in emergency, connected to so many contraptions that I didn’t know if he was going to die or if we’d be going home the next day. He was there for 3 weeks, then in a rehabilitation hospital for 3 more months. There, I saw children with very complex disabilities and felt guilty for feeling sad about what happened to my son.

It took me about four years to get over that post-traumatic stress without feeling guilty for feeling sad. I eventually realized that my son had many sensory differences from birth, and was born autistic. He is just like me. We have the same personality. Other parents face traumatic experiences with children who are banging their head or melting down a lot, and parents don’t know what to do to support them. Some children run off when in public, and sometimes you may lose your child, as discussed in this past podcast.

Meeting Families Where They’re At

Kerri concurs that when we realize that our child is not like other children we are overwhelmed. I shared that many find themselves in a behavioural setting like I did at the rehabilitation hospital where my 2-year-old was being strapped in a chair being asked to do menial tasks, and I hated it. It drove me to find Floortime.

Kerri says that Floortimers do an amazing job of holding space for this reality with parents. It’s such a big part of the story, she says. She loves working in homes to see the dynamics between the family members. It’s so organic in that way, she says. She prioritizes the individual profile, and often the conflicting profiles among family members, and she uses the word ‘trauma’ very carefully in a sensitive way, being sure not to project it on anyone.

Kerri and her team recently created two documents in Canva for families: Potential Triggers for a Parent of a Neurodivergent Child and Potential Triggers for a Neurodivergent Child which have both been very helpful for families to see because many people process things more visually. At Therapy Keeper, they are always meeting families where they’re at, but I asked what that looks like?

Wondering Together

If she has a mother who comes in with a fair amount of trauma and a child who is being triggered by something, Kerri looks at the ‘R’ (the Relationship) and the ‘I’ (Individual differences) of the Mom and why she’s feeling what she’s feeling, then separately looks at the child’s experience, the child’s individual differences and for patterns that often occur in autism, and then figures out in real time what’s happening.

If a Mom is saying, “Let’s go brush our teeth” and the child is in the middle of an activity, the child didn’t know they had to brush their teeth, they’re a Gestalt Language Processor (GLP), they don’t like brushing their teeth in the first place, or maybe their expressive language is very robust and they want to negotiate why they shouldn’t have to brush their teeth, this demand that the mother is putting on the child will not go well. It might be her childhood experience. She might be flooding the child with questions.

Kerri would say, “Here are the things that I’m wondering…” She says that her responsibility is to the family, wondering with them, about them, about the child, and getting the parents’ wheels turning as to why things might be falling apart. Kerri says that what might seem simple to a Floortime practitioner might be mind blowing to some parents, such as them asking a lot of questions when the child is dysregulated.

Kerri uses a lot of video footage in her practice without it feeling ‘icky’ or without parents feeling put on the spot. She also uses a lot of home cameras where behaviours might happen, such as during meal times, then they can go back and analyze it later. That shift–something that might feel so foreign to a family, yet is a standard tool for Floortimers who see it so clearly–might be something a parent has yet to see. When you make those simple shifts, Kerri emphasizes, it makes such a huge difference.

Without wanting to sound like a saleman, Kerri has literally seen this shift transform families. She tells people as one Mom to another Mom, whether you engage in her services or not, she needs you to know about Floortime!

Setting up for Success

I provided an example of what I do at home with my child who is verbal. We build structures into the day so every day is as predictable as possible. We get up, eat breakfast, go to school, come home, ‘relax’ on the iPad while I prepare dinner, eat dinner, play boardgame, have a bath, read a few books and then go to sleep. I shared that many families use visual schedules to show their child what’s happening which can help during transitions.

Kerri says that predictability affords a child the capacity for something else. They have a certain energy or battery capacity for the day. We’re making their day so predictable to reserve their capacity to problem solve things that come up that will challenge them, Kerri explains. Kerri aims to set a family up for success and finds that she can often see where minor shifts can help a family, such as the predictable routine.

Schedules are critical components. But she’s also looking at how they handle transitions and she’s looking at the profiles of the parents. Many parents struggle with their child not wanting to leave their screen to come upstairs to brush their teeth, for example. Her team recently did a social media post on double standards that helps the parent take the child’s perspective.

Kerri asks parents if they’re watching TV would they want to stop watching mid-show? She also thinks about parents being on autopilot, always in a go-go-go mode. Often families have something planned out in their head, but haven’t conveyed that to their child, she explains. In the brushing teeth example, she says, the plan wasn’t shared with the child, and the mother had beautiful reflections about it afterwards.

Parents’ plans aren’t transparent. She encourages them to share them in a clear and kind manner. Floortime is relationship-based. There’s nothing more than having solid relationships, including your relationship with yourself, Kerri says. She likes to help parents with having a schedule, visuals, and doing a lot of reflection about how transitions are being managed every day. Kerri created a document of 20 different transitions that parents may not even think of that she used with one client (some of which are documented here).

People moving into your space is a transition, for example. A child might find someone coming into their space to be very disruptive. Kerri continues that in standardized testing, the number one executive functioning challenge that comes up is shifting from one activity to another.

Kerri looks at all of the intricacies–which is what Floortime is, she adds–wondering about it together, and helping a family move away from the medical model, cookie cutter version of things. She instead gets them to think about where their child is getting caught up and struggling.

Kerri aims to figure out why parents are showing up the way they show up and what experiences brought them to where they are. She helps parents hold space for not judging that and empowering them. She says that we can all make a conscious decision to how we show up for ourselves and to others.

Tips for Parents

I asked Kerri that I can still hear parents asking, “What if I shared the plan with my child and they just won’t go along with it?” Kerri asks if it is a child who is aversive to demands (i.e., a PDA profile, aka Pathological Demand Avoidance, aka Pervasive Drive for Autonomy)? Kerri says that that can be an entire different case, but try to infuse a bit of humor, which can be hard at the end of the day as a parent.

She suggests giving autonomy to the child by asking things with tons of affect like, “Should we fly to the bathroom sink or march like soldiers?” Always gear this to the child’s interests so if they’re into sharks, ask, “Should be go like a hammerhead shark or fly like a great white?” Some kids might like a race to the bathroom, but it might trigger others. The child might prefer using one bathroom versus another. Think of what will peak their interest.

It might be sequencing that helps, Kerri continues. You might have to say that first we’ll brush teeth and then race cars to the bedroom. If kids are interested in books, she’ll suggest social stories. In a social story, she’ll start with a positive thing, then the experience of the child’s experience, such as “I might feel frustrated“. Next, you give them options like, “If I feel frustrated when mom asks me to brush my teeth, I can…”

I shared that Dr. Karen Levine said that the part where the child is scared is always left out of typical social stories! Educator Jackie Bartell always says we have to set the expectation, for example, “We have to brush our teeth.” In social story, Kerri says that what it’s doing is giving meaning to the social experience. Having meaning behind why the expectation is important then they might be more willing to do it.

You could also watch YouTube videos of what you want your child to be able to do. Dr. Karen Levine suggested doing this with my son around clipping his toenails, and he absolutely loved the video and asked to watch it repeatedly. Kerri asks who is the favourite aunt or uncle? Get a picture of them brushing their teeth, she said. I said you could also brush teeth together with your siblings or parents. Kerri said they also use dolls and brush their teeth.

Regarding giving agency, Kerri says that if they like the cartoon Paw Patrol, get them a Paw Patrol toothbrush. Also, beware of the flavours in case they don’t like mint, Kerri adds. The message here is to stay hopeful, Kerri encourages parents. Stay curious and you will find something that works. Sit in the space of “I’m going to figure it out“, she urges.

What to do about Screentime

Parents continually share that they struggle to get their child off the screen. Kerri first tries to understand the family’s opinion around technology. Some say it’s ok and it’s regulating, so there’s no limit. Other families see that the more screentime the child has, they have less opportunities for play and their instinct as parents is to get the child off the device. Kerri wonders how polarized it is between the different caregivers and wonders about what that looks like.

Research supports the claim that screens are wildly addictive, Kerri adds, and quotes Dr. Stuart Shanker who says that you can’t have self-control if you don’t have self regulation. She says that also Dr. Stanley Greenspan talked about the developing mind pointing out the importance of whether or not the child has the capacity to easily move away from a screen. Kerri reframes what that could feel like for a child.

For some kids, she explains, it’s a certain amount of time they’re allowed to use their screen. For some, the limit is one show. For others, it’s the type of show. A YouTube clip has a new screen cut every two to five seconds, but if you can find a show that stays with a plot, maybe that’s a better fit and can make for an easier transition away from it. Maybe you only make screentime available on the big television so the parent has control of the remote, she suggests.

Kerri has worked with bridging where she’ll have a picture to colour from the show they watch so when it ends she’ll stick with the content of what they watched by transitioning to colouring the picture. You can also use a step-away process where first a sound or a timer goes off, then you lose the picture. Next, you lose the sound. She says that you have to know your child and be willing to try things.

What is a brilliant game-changer strategy for one child can cause another child to melt down, Kerri emphasizes. Doubling down on outdoor time is an underutilized strategy, as well. Get out in nature with the sun on you, moving your body, away from constant stimulation inside walls with a lot of sounds and music. Sometimes our kids need to experience that. Kerri adds that if a child starts to understand what it feels like to be outside on a trampoline, on a scooter on a nature walk, or in the pool, and those neurochemicals start to feel really good, they might be more willing to put the screen down.

I also suggested making the screen a shared experience where you’re watching a show together and connecting around it, when you have time, but once you’re in the meltdown or struggle, it’s too hard to figure it out. Kerri likes the idea of stepping back and reflecting on it and how to make changes going forward. I’ve also heard that when a child has visual-spatial challenges, sometimes screentime can make it worse because we want them to see things in three dimensions, interactively in movement.

Being Prepared

Our brains are very nuanced, Kerri says, so let’s refer to the Floortime concept of attunement and look to our child’s cues to attune to them to figure out what feels like you’re moving in the right direction. And just like a child uses scripts, parents have to have their scripts, too, Kerri says, like a bank of things to say in that heated moment.

Your child might have a hard time to do some things spontaneous. Kerri has a Commonly Used Phrases document that parents can put on their phone and inside their kitchen cabinet or where they keep their glasses, to have it handy when you need to use it. These are things parents can say instead of asking a lot of questions, Kerri shares.

Kerri likes to talk about a sensory lifestyle where families are prepared, knowing the things everyone’s body needs to stay regulated. Kerri has tools to up- or down-regulate. To down-regulated an overstimulated child, she suggests reducing your pacing, anchoring yourself in space, and lowering your volume.

I shared that for transitions my son’s preschool had a soothing song “Tidy up… tidy up… everybody tidy up, let’s go” clapping to the slow rhythm that helped keep the children regulated. Kerri says that we always want to start the transition saying something the child likes in a calming way in the regulation and pacing in a way that works for your child.

Non Speaking Children

I asked Kerri how she works with families who have non speaking children who may have apraxia of speech and motor challenges. Kerri will demonstrate herself how to be with the child to take the pressure off of the parents for a moment. She wants to show how you get that shared social engagement and connection in a way that you presume competence and build beautiful reciprocity–a fundamental thing in early communication.

Kerri says that some families said to her that she came in and didn’t bombard them with a million questions and just connected with their child so they got to see her do it in real time. This is one of the best ways she says that they can support a family. She also notices another theme that comes up when a child isn’t talking. The family stops talking back, especially if there’s a verbal sibling. There’s not an intentional ignoring happening, but it ends up being that the non speaking child is ignored.

Kerri says that you have to think about creating opportunities for communication. Build reciprocity even if there isn’t a verbal output. I shared that the podcast on Preverbal Affective Signalling I did and the podcast on nurturing intentionality might be helpful where we discussed how holding that space with your child to see what the child does is so important, versus feeling the pressure to do something. Kerri stresses that a child can get used to nobody responding them so give up trying. Keep persisting and trying.

Floortime is about Shared joy

Kerri says that you are the toy for your child, and there are some toys that change the chemistry between you, such as blowing up a balloon or spinning toys. Sometimes having a ‘thing’ helps when parents say the child isn’t responding or initiating and they are stuck. The toy isn’t the answer, but it might be the spark, Kerri explains. When the parent sees the interaction, it ignites a bit of hope and less defeat and you can build from there.

When parents aren’t using a Floortime lens, they’re looking at things differently. I talk about looking at the strengths in the We chose play documentary. We were in the Hanen program and I’m blowing up a balloon and letting it go. My son had these beautiful strengths in his early Functional Emotional Developmental Capacities (FEDCs), but I didn’t have the DIR lens yet and only saw what he wasn’t doing. Since discovering Floortime, I’ve watched these FEDCs bloom in my son.

Look at your child’s strengths. Kerri often tells families to measure backwards. For families who really need to see that evidence, you can then see that in November the child wasn’t doing x, y, and z, but in July they are. They wouldn’t have believed it back in November. It’s powerful in the reflective process to look at how far you’ve come. You always want your child to be seen, heard, and loved at their fullest potential. It’s ok to want more, but celebrate where you are at.

Kerri's Resources

• Potential Triggers for a Neurodivergent Child
• Potential Triggers for a Parent of a Neurodivergent Child
• Commonly Used Phrases
• Resource on Double Standards
• Resource on Common Mistakes for Transitions
• Therapy Keeper Instagram account

This week’s PRACTICE TIP:

This week let’s think about the points Kerri shared with us and reflect on minor shifts we could make to help our connection with our child.

For example: Are you sometimes in too much of a rush and directing your child when your child has ‘behaviour’? Let’s think about how we can slow down, share our plan, use a visual schedule, and/or incorporate something your child likes into the transition using fun affect.

Thank you to Kerri for sharing her resources and telling us how she works with families in such great detail. Please visit her blog, her fabulous Instagram page, and resources at her website. I hope you found it as helpful as I did and will consider sharing this post on social media.

Until next time, here’s to choosing play and experiencing joy everyday!