Early in 2004, a mother wrote into the autism-teaching-L discussion list and asked this question:

I just joined this group. I also just finished reading "The Boy Who Loved Windows" where I learned about floortime. My son turns 3 tomorrow, so my question is: Is it too late to start this with him? I'm so sad that I didn't start this sooner. We've been following ABA and speech therapy since April '03. I'm not very happy with the results so far.

Here is my response:

Often, age three is the earliest that many children are first diagnosed with autism or autism-spectrum disorders. Consequently, I would guess that your child is actually a fair bit younger than many at the start of therapy.

However, the average age of children at the commencement of a therapy really tells us little about whether or not it is right for your child to start this particular intervention at this particular time. Let's pursue an answer to your question in a bit more depth by deconstructing Floortime.

Floortime is also known as "developmental, individual-difference, relationship-based" therapy. A clearer answer might emerge if we consider each of these three elements in turn.

Developmental

Floortime is based on the natural development of emotion and human interaction in children. It assumes six milestones of typical emotional and communicative development and attempts, through intensive play and interaction, to guide children through each of these stages.

Because Floortime assumes a natural developmental sequence, it can be used (in theory) with individuals at any point along that continuum. If you've a six-year-old who has not yet passed the first milestone (self-regulation and interest in the world), you begin by building interactions to help with that skill. If you've a three-year-old who is at the third milestone (two-way communication), that would be your starting point.

Individual-difference

Floortime is an approach that respects the child and his unique interests, abilities, weaknesses, sensory system, and interaction/social patterns. It is not a cookie-cutter, cook-book type approach; listing sequences of isolated behaviors to be mastered. It assumes no prerequisites and the content, course, and approach should be tailored individually for each child.

This aspect of Floortime, like its developmental basis, is independent of age. If an approach is grounded in a fundamental respect for the child, if it is flexible and responsive to his needs and changing interests, then it should matter very little how old that child is.

Relationship-based

Floortime is not primarily about speech, imitation, syntax, or any of the other myriad skills and behaviors that many try to teach in isolation. At it's heart, Floortime is about building relationships. These relationships, then, provide a meaningful context within which those skills and behaviors make sense and which allows for countless natural opportunities for practice and teaching.

This is a fundamental concept to Floortime, and worth repeating. Floortime is about building relationships.

At the risk of sounding a bit melodramatic, I would ask you, then, "Is it ever too late to start building a relationship with your son?"

An Ageless Therapy?

There is nothing inherent in Floortime that expects or prefers a specific age at the outset of therapy. I would argue that Floortime is a good technique to use at just about any time with children, with special needs or otherwise.

This isn't to say, however, that there may not be limiting factors to its efficacy. As when considering most techniques targeting early childhood, we should be mindful of the brain's high degree of plasticity in the first few years of life. Any quality interactions will be more beneficial during these early years. But three is hardly over-the-hill where brain plasticity is concerned (and again, is likely the average age for outset of most therapies). And a more plastic brain, while helpful, is not a requirement to learn new skills and behaviors.

Similarly, older children may be more likely to have found and maintained attitudes and behaviors (avoidance, aggression, etc.) that, while they work splendidly for the child, may be at cross purposes to the goals of Floortime. Floortime is designed to provide more nurturing and socially accepted replacements for these behaviors, true, but they may be easier to teach to a child who has not been using them successfully for several years.

Depending on the philosophy and attitude of parents and other caregivers, Floortime may have a ceiling. It is an intervention based on play and playful interactions. Though I would hope it is not commonly the case, for some parents there may be an age at which they no longer feel it is appropriate to be "playing" with their child. My preference is that such a decision be made with the needs and interests of the child in mind. This may be opposed to the feelings of some about "age-appropriateness," but that, too often, is a demarcation bandied about arbitrarily and with little thought.

I would strongly urge you to consider starting with Floortime with your son. It can be a wonderful addition to your lives.

Your Floortime sessions can be in addition to whatever ABA-based techniques you are currently using, or can replace them, of course, if that is your choice. I would encourage you to continue speech therapy for your son, however. If you like, find a therapist who is familiar with Floortime so you could be doing similar things at home and in therapy, or bring your current therapist on-board with the Floortime program you are beginning. If you can find a quality, qualified, and caring SLP, they'd be an asset to any team.