What is Floortime Therapy for Autism: Components, Processes, Examples
Amanda Unrau CCC-SLP
August 19, 2024
Floortime therapy is a relationship-based structured play therapy that helps individuals make meaningful connections, build relationships, and improve communication. This article explains what Floortime therapy is, who it is for, what it targets, how it works, and its potential benefits.
What is Floortime Therapy?
Floortime is also known as DIR Floortime Therapy, which stands for the Developmental, Individual Difference, Relationship-Based model of intervention. It is used by a variety of professionals, including teachers, parents, child psychologists, speech therapists, occupational therapists, and mental health professionals. Floortime is often used in conjunction with or instead of ABA (Applied Behavior Analysis) for individuals with autism spectrum disorder or other developmental disorders. In Floortime, the therapist or caregiver joins the child in their play or activity and builds a relationship by interacting with them. By following the child’s lead and entering their space, the adult can build on the child’s current skills.
Core Components of Floortime Therapy
The core components of floortime therapy are represented in the DIR acronym: Developmental, Individual Difference, and Relationship-Based:
- Developmental: Children with developmental disorders may have gaps in a variety of areas, and DIR therapy for autism seeks to use individualized interventions in order to fill those gaps.
- Individual Differences: Each child has unique gifts and challenges. The DIR Floortime model focuses on recognizing and using these differences to meet each child’s individual needs.
- Relationship–Based: Since a central focus of Floortime therapy is helping children build relationships with therapists, teachers, parents, and peers, the floortime approach models nurturing relationships to promote social-emotional growth.
As an SLP, I know that recognizing each child’s unique differences is essential for creating specific goals and planning therapy sessions that are tailored to meet those goals. Identifying these differences allows for addressing any gaps in speech and language development effectively. Building rapport with the child is also a crucial step before any significant progress can be expected in therapy sessions.
Benefits of Floortime Therapy
Floortime therapy seeks to target and address several key milestones. The following are the core principles of DIR Floortime therapy.
- Self-regulation and interest in the world and others
- Engaging and relating with others and the environment
- Purposeful two-way communication
- Complex communication and shared problem-solving
- Using symbols and formulating emotional ideas
- Logical thinking and linking ideas
- Multiple perspectives
- Gray area thinking
- Reflective thinking and an internal standard of self
All of these principles help children to develop their emotional and intellectual skills. Over time, therapists guide children to participate in more challenging and complex interactions. Individuals may jump between principles and it can take time to progress to the next level. Communication, cognitive, and motor skills are not directly addressed, but they are indirectly addressed by DIR through the focus on developing emotional skills.
From my SLP perspective, it’s evident that children must develop foundational skills before advancing to higher-level abilities. For example, joint attention—where two people share their focus on the same object or person—is a critical skill that needs to be in place before a child can successfully engage in interactive play or effective communication. Conversely, gray area thinking and the use of nonliteral language are skills that typically emerge later in development.
How Does Floortime Therapy Work?
In Floortime Therapy, the parent or therapist plays with the child and interacts with them at their level, which is often on the floor. Instead of expecting the child to enter the adult’s world, the adult enters the child’s world. Caregivers who are implementing DIR Floortime therapy at home should consider the following key techniques.
Key Techniques
The key techniques used when pairing floortime and autism include the following:
- Create a supportive environment: This includes setting up a designated play area where the child feels safe and comfortable. This should be an area with interactive toys and materials that is free from other distractions. Set up a predictable routine for sessions, where floortime therapy occurs at the same time and for the same length of time.
- Following the child’s lead: The first step is to gain the child’s attention and get their focus outside of themselves in order to engage with another person. By observing the child’s interests, preferences, and actions before joining in on their play, therapists and parents can build strong connections with them by entering the child’s world and meeting them where they are. Children feel a sense of control when parents or therapists demonstrate their interest by allowing the child to take the lead and imitating their actions and vocalizations.
- Joining in and expanding on play: After the child has initiated play, the therapist or parent joins in and imitates the child, expands on the child’s ideas, or introduces new concepts or toys. Participating in these shared experiences helps the child improve their social communication and problem-solving skills.
- Using floortime interactions throughout the day: Beyond only structured therapy sessions, using floortime interactions throughout the day provides multiple benefits. It promotes continued learning and engagement, provides more opportunities for learning in natural settings, reinforces the skills learned during formal sessions, and lets caregivers keep developing emotional connections and relationships with the child. This can include morning routines, play time, during meal or snack times, and/or during bedtime routines.
- Collaborate: Communicate with therapists and professionals for support in implementing sessions at home. Be sure to keep open and regular communication in order to share observations, challenges and progress so that everyone is on the same page.
Floortime sessions typically last 20-60 minutes. This will vary based on the age, attention span, and specific needs and goals of each individual child. The frequency of these sessions will also vary, from weekly to monthly sessions.
Implementing DIR Floortime
Here are some basic steps you can take when implementing DIR Floortime Therapy:
- Set up a space with engaging toys or items, or follow the child to an activity they enjoy.
- Start small for the first session. You may want to set a time for 20 minutes.
- Observe the child and take note of what they are doing.
- Join in on their play.
- Watch and see what the child does and how they respond to your interaction.
- Continue to interact with the child for the remainder of the session.
When working with children with autism and other developmental disorders, it is important to meet the child where they are before supporting and teaching them the skills needed to progress. In addition, it is essential to provide opportunities to allow for carryover of skills in natural settings outside of structured therapy sessions. This leads to sustained learning and use of learned skills and improved progress.
DIR Floortime Therapy Examples
Floortime sessions can be conducted anywhere and at any time throughout the day. For example, parents or caregivers can engage in a session during bathtime. If the child starts splashing the water and vocalizing, the parent can begin to splash also. The parent can then introduce a new action in order to extend the interaction, such as pouring water with their hand. The child may look or continue to repeat their own action. They may also touch the parent’s hand to indicate that they want the parent to pour water again. This or another similar interaction can be repeated during every bathtime.
Another time to incorporate floortime therapy is when the child is participating in a play or leisure activity of their choice. If a child is opening and closing a door repeatedly, the caregiver can stand on the other side of the door so that the child sees them each time they open it. Once the child notices the parent, the parent can add some words, such as “peekaboo!” or “There you are!” The parent can also model a surprised face or another emotion. If the child enjoys the interaction, they will repeat this action to see the caregiver respond the same way.
The goal is to enter the child’s world and follow their lead, while introducing new concepts, materials, words, etc. The goal is not to teach them specific skills or games, but to get the child’s attention and encourage them to engage with another person.
Research and Evidence of Floortime Therapy
Floortime was created by child psychiatrists Stanley Greenspan, M.D. and Serena Wieder, PhD in 1979. It is difficult to evaluate the effectiveness of developmental therapies such as Floortime because the goals are more subjective and not easy to measure. For example, how do you gather data on and measure playfulness and creativity?
However challenging it may be to evaluate the effectiveness of Floortime, studies have shown that it is a helpful therapy approach. A study conducted by Dr. Greenspan and Dr. Weider in 2003 showed that a child with autism spectrum disorder who participated in six daily Floortime sessions with his father over the course of 3 years demonstrated continuous improvement in his skills over that time.
A pilot study conducted in 2007 of children whose parents added an average of 15.2 hours per week of Floortime therapy for three months demonstrated significant improvement in the three measures tracked in the study: Functional Emotional Assessment Scale (FEAS), Childhood Autism Rating Scale, and the Functional Emotional Questionnaires.
A systematic review published in 2023 indicated that Floortime therapy improved communication, emotional expression, and daily living skills. Interactions between the child and their parents or caregivers improved as well.
Using Forbrain with Floortime Therapy
Forbrain is a brain training device that stimulates the brain’s natural auditory feedback loop when worn by the user. It helps individuals hear and process their own sounds louder and more clearly. It is a great educational tool for children with autism since it can help them stay more focused.
Floortime therapy, autism, and Forbrain can all be combined. When the child wears the Forbrain device, they will be able to better hear themselves and the adult or peer they are working with during that Floortime session. This will help the child be more attentive, stay present during the interaction, and regulate their energy and mood to better suit the situation. Some children may exhibit increased vocalizations if they like the way their voice sounds while wearing Forbrain. These improvements can carry over into Floortime sessions or other interactions when the child is not wearing Forbrain.
A great time to use Forbrain during Floortime is during activities where the child tends to be more vocal or interactive. For example, the child can wear Forbrain when engaging in vocal play, singing songs, reading books, or playing social games.
Final Words
DIR therapy for autism can help children improve their social emotional skills and build relationships. These benefits can also lead to improvements in other skill areas. Since Floortime therapy sessions can be conducted by therapists as well as family members such as parents, siblings, or other family members, it is a great way to facilitate carryover of skills once the Floortime approach is introduced and taught by a professional. Please seek professional advice if you think Floortime therapy could benefit your child, client, or student.
References
Autism Speaks. (Accessed 2024, July 27). Floortime. https://www.autismspeaks.org/dir-floortime
Divya, KY, Begum, Farzana, John, Sheeba Elizabeth, & Francis, Frincy. (2023). DIR/Floor Time in Engaging Autism: A Systematic Review. Iranian Journal of Nursing and Midwifery Research, 28(2). Read here
Hollander, Alan. (2024, July 16). Floortime Therapy: Ultimate Guide. BridgeCare ABA Therapy. https://www.bridgecareaba.com/blog/floortime-therapy
ICDL. (Accessed 2024, July 27). What is Floortime? The International Council On Development and Learning, Inc. https://www.icdl.com/floortime
Pajareya, Kingkaew, & Nopmaneejumruslers, Kaewta. (2011, June 13). A Pilot Randomized Controlled Trial of DIR/Floortime Parent Training Intervention for Pre-School Children with Autistic Spectrum Disorders. Sage Journals, 15(5). https://doi.org/10.1177/1362361310386502
Rudy, Lisa Jo. (2023, July 28). Floortime Play Therapy for Children with Autism: Promote Emotional Skills with Activities. VeryWell Health. https://www.verywellhealth.com/floortime-play-therapy-overview-4582061
The Treetop ABA Therapy. (2024, July 17). DIR/Floortime Model: A Complete Guide. The Treetop ABA Therapy.
https://www.thetreetop.com/aba-therapy/dir-floortime-model
Wieder, Serena, & Greenspan, Stanley. (2003, December). Climbing the Symbolic Ladder in the DIR Model Through Floor Time/Interactive Play. Sage Journals, 7(4). https://doi.org/10.1177/1362361303007004008
Amanda Unrau
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