Floor Time embraces Facilitated Communication

I’m not sure why I didn’t see this coming years ago—except that years ago, when I first heard of Floor Time, no one was talking publicly about FC. “Years ago” was the late 1990s, and, following the 1993 Frontline exposé Prisoners of Silence, FC had gone underground. (I had thought it had been so thoroughly debunked that was gone, gone—as in gone for good).

I first heard of Floor Time from the psychiatrist who evaluated my son for autism. Though she mentioned ABA as an alternative, she also made it clear she preferred Floor Time. (Her personal preferences played way too large a role in all this: she also told us “I don’t like labels”, which meant it took us many weeks of many visits to drag that autism diagnosis out of her).

While we waited, I did my due diligence and read the Greenspan books and Floor Time literature. In general the approach struck me as having an ever-so-subtle blame-the-parents mindset. Its basic premise is that autism parents should spend time on the floor playing with their child, and that if they do this, and if they follow their child’s lead instead of trying to control him, the child will gradually open up and become less autistic. I found myself reminded of Kanner and Bettelheim and their mid-20th-century notions that emotionally distant parents cause autism. Indeed, that association made philosophical sense: Greenspan’s work shares the same Freud-flavored psychodynamic origins as that of his predecessors—and Freudian psychoanalysis, of course, is all about uncovering the bad stuff your parents did to you back when you were little.

Also like Freudian psychoanalysis and the psychoanalytic, Refrigerator Mother theories of autism, Floor Time is not an evidence-oriented approach. The closest Greenspan has to efficacy data is a retrospective “chart review” of his cherry-picked clients. Floor Time, except when combined with more structured, substantive interventions, has not withstood the test of time.

And yet it persists. Stanley Greenspan has passed on, but his son Jake has taken over. And along with Jake Greenspan, there’s a new center with a resident Rapid Prompting Method specialist, “certified at RPM (Rapid Prompt Method) and facilitated communication” by none other than Soma Mukhopadhyay.

Why is it not surprising that Floor Time has embraced RPM—and facilitated communication more generally?

It’s not just that Floor Time isn’t an evidence-oriented approach. And it’s not just that the FT psychodynamic model of autism and the FC movement-disorder model of autism share the notion of a normal person locked inside.

Rather, the strongest connection between FT and FC stems from an aspect of FT that I found most interesting both as a linguist and as a mother eager for her son to communicate better: namely, its take on language. No explicit instruction is necessary; just talk to your kid. He understands more than you think he does. (“No, he actually understands less that I think he does”, I remember thinking). And as for the nature of the language disorder in autism, look no further than Stanley Greenspan’s Affective Diathesis Hypothesis (if you’re not evidence-based, a hypothesis is all you need):

The Affect Diathesis Hypothesis is about the connection between affect and different processing capacities. Dr. Greenspan postulated that children diagnosed on the autism spectrum could have some predisposition—due to biologically-based processing—to not connecting affect (or intent) to their motor planning and sequencing capacities and symbol formation.

I had not seen it then, but now, in this brave new world of FC redux, it’s clear as day. “Intent” is disconnected from “motor.” From here it’s one tiny step to Soma et al.

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