Mercury. Thimerasol. Vaccines. Heavy metals. Air pollution. Genetics. iPods: These and more have been cited as potential causes of autism; the question “what causes autism” can lead to some inflammatory (to put it mildly) debate. But one thing is clear among the proponents of the various theories of the cause of autism: The parents, and their parenting practices, are not the cause.
However, Dr. Stanley Greenspan appears to suggest precisely this in his new book Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate and Think. As I wrote yesterday in my second post reviewing Greenspan’s new book, Engaging Floortime (2): Greenspan on How Autism Develops:
In addition to “biological factors,” Greenspan suggests that something in an infant’s experience may be causing “stress” on his system. [A] passage [on p. 399] provides a more specific sense of what he means by “experiential stress,” namely “severe deprivation or abuse.” It is suggested here that a child is “at risk for ASD” (p. 399) because something is lacking in those taking care of the child—the child’s parents; indeed, Greenspan suggests that the child’s caregivers may be “severely depriving” and even “abusing” a child.
Is it possible that Greenspan is suggesting that a child can be “at risk for ASD” due to improper care from the child’s parents?
Throughout Engaging Autism, Greenspan does continually note the “unique biologies” of children with ASD, or rather in “children at risk for ASD,” for whom (as he writes),
…genetic, prenatal, and even early postnatal influences tend to express themselves in terms of differences in the way these children react to sesations, organize movement, and process and comprehand what they hear and see. (p. 130)
It is important to note Greenspan’s mention of how “early postnatal influences” in the form of “experiential or physical stress” can also lead to “the behavioral patterns symptomatic of autism and ASD” (p. 396) because it is precisely “functional emotional developmental capacities (FEDCs)” (p. 41) that Greenspan’s DIR model addresses. Without directly saying so, Greenspan suggests that parents of “children at risk for ASD” are themselves the reason for their children being “at risk.” Such parents have not been able to evoke healthy emotional development in their children who, as a result, are “at risk for ASD.” It is further suggested that such parents themselves are not in a healthy emotional state.
Thus does Greenspan refer to “Floortime as a family approach” in chapter 13. Parents are encouraged to “consider their own patterns” and specifcally their “strengths and weaknesses” (p. 164). Once these have been identified, as Greenspan writes,
…..we look at how these play out in two situations. First, we look at the characteristics in terms of the child’s progress through the developmental milestones. How do these patterns get in the way of optimal interactions?
……
The second issue to consider is how the parents’ traits play out in their relationship and in the family pattern as a whole. (p. 166)
Parents are specifically cited as “getting in the way” and “hindering” a child’s “optimal interactions,” and parents’ “traits” (an autocratic father is one example Greenspan describes) are to be analyzed and changed (p. 167). Each spouse needs “to be empathetic, not patronizing”; this is said to be “very helpful as you apply Floortime techniques with your child” (p. 169). To ensure optimal expectations for their child, parents are to “bring out the best in each other” (p. 169) in order to “be more playful” (supportive chats, back rubs, and ice cream are suggested (p. 170) ). And, in what Greenspan refers to as “Floortime for parents,” parents need to be sure to “have time alone with each other to regain the intimacy of their marriage” (p. 171). Because, as he writes,
The heart of Floortime is the warmth and nurturing that you’re conveying to your child so he will want to play with you rather than retreat into his own world. (p. 172)
Having an hour or a half-hour a couple of times a week to “come together and talk and tune into one another” (p. 172) is suggested: If your own emotions towards your spouse are not where they might be (and vice versa for your spouse), you will not be able to create the proper emotional experiences and interactions that your child is in need of, it is suggested.
If Greenspan is not outright saying that parents cause autism, he is certainly suggesting that parents contribute to a child being “at risk for ASD.” And I think that this is a theory of autism aetiology that is not only outmoded and discredited, but simply incorrect and—even more—potentially very harmful.
It is sad that we are interpreting words out of context, as an attack on our parenting. I welcome an objective person who can point out that I can change my way of touching, etc. to better match my child’s sensory needs. For example if my son likes strong squeezing not gentle stroking and cannot tell me in words he might cry uncontrollably. Sensory profiles are an important aspect of DIR/Floortime and it’s possible that we are not aware of our child’s acute sensitivities or lack of sensitivities or that we do not know how we can soothe our child’s anxious state.
If my child needs compression to help him cope with a situation, which may be challenging and upsetting to him and I touch him very gently, which causes him to cry, that doesn’t mean that I am a poor parent. It just means that I am not reading my child’s needs. I am certain that all of us do things which are good for us but may be hurtful to our spouses and children, without awareness at that time. That is human. I welcome an objective observer to help me read my child’s specific sensory needs so that I can consciously change my behaviors, which, are not good or bad, though may be aversive to my child’s sensitivities. Dr. Greenspan and Floortime therapists act as coaches to parents and are sought after for this skill. How i wish that I had an observer to coach me when my children were younger.
My 3 year old (my fifth out of six children] was recently diagnosed with autism. Because I see progress with my own version of floortime, I cannot help but wonder if my son did suffer some lack of interaction/warm engagement as a baby. On the other hand, he definately received the most attention and adoration from all of my children who are all typical loving happily developing children.
Hi everyone.
I am an occupational therapist who has worked with children on the autism spectrum for two decades. I must say that the families I currently work with and who I have worked with in the past have been warm and nurturing. I have never thought there was any connection with the diagnosis of autism and the family dynamic. Clearly there are extreme situations of deprivation and abuse that can result in autistic like behaviors however these are extreme examples.
Kudo’s and blessings to these amazing families who give so much to these special children.
Hopefully, the attacks on Dr. Greenspan’s view’s of parenting children on the autism spectrum do not mean that Floor Time is a useless therapy. Countless thousands of children with ASDs receive Floor Time therapy every day through Regional Centers, OTs or PTs in clinics, hospitals, public and non-public schools as a Best Practice basis of intervention.
I’m glad that this string of posts has been resurrected because I wasn’t reading Autism Vox back in 2006 (didn’t get my daughter’s diagnosis until almost the end of that year). It’s a new angle on Greenspan for me, and an important one since we’re soon going to be starting a Greenspan-influenced, relationship-based intensive program with our daughter in the next few months.
I’m thinking right now of some of the techniques I’ve already learned for communication interactions, via the Hanen program and some work with Jim McDonald’s Communicating Partners. For me, learning about more effective patterns of interaction has definitely involved some level of critique of some of the patterns that parents often naturally fall into — for example, breaking ourselves of the habit of barraging our daughter with questions, or demanding “Say ‘banana,’ sweetie. Say ‘banana.’ C’mon, can you say ‘banana’?” or even just throwing too many words at her. My older daughter responded fine to an outpouring of words and requests; my younger daughter does not.
Seems to me that it ought to be possible to tell parents that they can learn to improve their interactions with their child, and that some communication and affect is more helpful than others, without arriving at the conclusion that the parents have somehow caused autism by using the wrong interactions or emphases. I didn’t pick up the blame-the-parents vibe at all from my first reading of Engaging Autism (admittedly over a year ago now), and I still don’t think I quite hear it in the Family Approach quotes you cite from Ch. 13. What I hear is “you can do this better,” rather than “it’s your fault for not doing it right in the first place.”
I’ll be on the lookout for those biases now, but I do think that relationship-based intensive therapy is going to be an excellent match for our kiddo, and that our whole family has a lot to learn about how to best help her.
From my personal experience, I believe Dr. Greenspan may be right about the interconnectedness of the biologically based deficit and environmental programming. When my 15 month old daughter regressed quite suddenly and became extremely disengaged, we were able to reengage her again quite rapidly using Floortime. When I looked back over the weeks of her regression, I realized that I had been actually been engaging her very little. This was because she seemed so happy in her repetitive, perseverative play (which should have tipped me off anyway), that she didn’t need much attention. Now I by no means suggest that I “caused” her autism. But if she was biologically wired (or wiring) to prefer solitary activity and avoid social interaction, then I did nothing to outcompete that natural tendency. And so I wonder now if I had been more alert to her differences during that period and engaged her more consistently/intensively, I might have been able to prevent the autistic features emerging. I don’t know, but it seems at a stage when the brain is so plastic, environmental reinforcement for development of social and communication abilities must have a big role in determining the outcome, whatever the underlying genetic/biological framework.
Thanks so much for your comments, Mr. Samuels; I much appreciate your critique.