Doctor who pioneered "floor play time" for children with autism dies

From The New York Times:

Dr. Stanley I. Greenspan (pictured), a psychiatrist who invented an influential approach to teaching children with autism and other developmental problems by folding his lanky six-foot frame onto the floor and following their lead in vigorous play, died April 27 at a hospital in Bethesda, Md. He was 68 and lived in Bethesda.

The cause was complications of a stroke, said his wife, Nancy Thorndike Greenspan, who was co-author of several of his more than 30 books.

“Floor time,” as Dr. Greenspan called his approach, is used in special-education classrooms and clinics around the world, though it remains controversial — as do all early-intervention treatments for autism. An opposing approach that relies on strict behavioral goals and checklists has been more intensively studied and is more widely used in the United States.

Dr. Greenspan encouraged parents, teachers and therapists to get down on the floor with children, even very young ones, and engage them with gestures and words to build warm relationships and expand their world of ideas — many times a day, if necessary.

In a 2002 therapy-session video that can be seen on his Web site, he joins a mother and her distracted, barely verbal 22-month-old son on a rug strewn with toys, including a cardboard crown. After half a minute of unfocused play, Dr. Greenspan urges the mother: “Try to enter into his world a little bit more. So if he’s got the crown and he doesn’t want to put it on, you put it on. Say, ‘I’ll be the queen.’ ”

In a few moments the boy is putting the crown on his own head, his mother’s head and Dr. Greenspan’s head, and — to his mother’s surprise — using words and giggles to say what he wants.

The Harvard pediatrician and behavioral expert Dr. T. Berry Brazelton, a longtime colleague and co-author with Dr. Greenspan of “The Irreducible Needs of Children” (Perseus, 2000), said in an interview that unlike the standard behavioral approach, floor time “lets the child lead.”

“Stanley’s approach is more innovative and more sensitive,” Dr. Brazelton said, “and it’s gathering steam rapidly.”

Stanley Ira Greenspan was born June 1, 1941, in Brooklyn, and moved to Long Island as a boy. A star athlete at Long Beach High School — where he was a teammate and friendly rival of the future basketball coach Larry Brown — he overcame learning disabilities and was admitted to Harvard.

After graduating from the Yale School of Medicine in 1966, he did his residency in psychiatry at Columbia and joined the United States Public Health Service.

Floor time was part of a broader framework Dr. Greenspan developed in the 1970s and ’80s as a researcher at the National Institute of Mental Health. Studying the interactions of troubled mothers with their infants and toddlers — and videotaping and archiving the results — he came to believe that the building blocks of emotional and behavioral development were laid down much earlier than experts had thought.

“The notion of babies and young children as little adults still permeated public perception,” Dr. and Ms. Greenspan write in the introduction to their final book, “The Learning Tree: Overcoming Learning Disabilities From the Ground Up,” to be published in August by Da Capo.

Dr. Greenspan found that babies who fail to connect with their parents for whatever reason — developmental disorders, individual sensitivities like an aversion to being touched, or a parent’s inability to relate to the child — are deprived of emotional tools essential for learning and growth.

“Our emotions,” he said in an interview for “Autistic-Like: Graham’s Story,” a 2008 documentary by Erik Linthorst, “serve as the orchestra leader for getting the whole mind and brain working together.”

Floor time, he added, “is following the child’s natural interests and affect and emotions to get all this cooking.”

Dr. Greenspan founded or helped found a number of organizations devoted to early-childhood development, including the National Center for Clinical Infant Programs, now called Zero to Three, and the Interdisciplinary Council on Developmental and Learning Disorders.

Serena Wieder, a clinical psychologist who was the council’s co-founder, said Dr. Greenspan’s singular gift in dealing with little children “was to get that connection, that gleam in the eye.” Of the session with the 22-month-old boy, Dr. Wieder said the child “was watching Stanley as much as Stanley was watching him — the look, the gleam of anticipation, the two-way back and forth.”

Besides his wife, Dr. Greenspan is survived by two daughters, Elizabeth Greenspan of Boston and Sarah Greenspan of Silver Spring, Md.; and a son, Jacob, of Washington. A brother, Kenneth, also a psychiatrist, died in 1999.

Jacob Greenspan, 30, now runs a center in Bethesda for children with autism. He uses the floor-time approach, and Nancy Thorndike Greenspan said he learned about it early. In 1980, when the approach was being developed, Jacob was 9 months old. Though he had no developmental disorders, his father was eager to try the technique out.

“I was the first floor-time mom,” Ms. Greenspan said, “and he was the first floor-time kid.”