Floortime Play Therapy for Children With Autism

Promote Emotional Skills With Activities

In This Article

Floortime play therapy helps children with autism build emotional connections and communication skills. Floortime is structured play therapy which can be administered by professionals, parents, or para-professionals in a huge range of settings.

Unlike behavioral therapies, Floortime is focused on helping children and teens to make emotional connections. Floortime is a low-risk, low-cost way to expand your child's emotional and social skills. You can build a stronger parent-child bond while having fun.

How to Get Started With Floortime Play
Verywell/Nusha Ashjaee

History

Floortime was developed by Drs. Stanley Greenspan and Serena Weider, and became increasingly popular during the early part of the 21st century. Both Greenspan and Weider were psychologists whose books The Child with Special Needs and Engaging Autism reached large audiences.

The theory behind Floortime was simple, but it stood in direct contrast to the more established behavioral approach best known as applied behavioral analysis.

Rather than teaching children appropriate behaviors and rewarding them to "reinforce" the lesson, Floortime engages with children through emotional connection.

Floortime is meant to entice children to interact joyfully. Through structured interaction, they build behavioral, cognitive, and social skills. At the time, this approach was philosophically distinct from any other therapeutic method. For many parents and therapists, it remains extremely appealing.

Over time, Floortime evolved into what is referred to as the Developmental, Individual Difference, Relationship-Based model of intervention (DIR), which made it possible to train practitioners and run proper research studies to determine efficacy. The result was a more robust program with trained practitioners, coaches, courses for teachers and parents, and an increasing number of studies with positive results.

In the last few decades, the ideas behind Floortime has permeated how we think about children with autism. The result: developmental approaches have evolved. More significantly, new forms of behavioral therapy such as Pivotal Response now borrow some of their methods from the Floortime philosophy.

How It Works

Floortime sessions lasting about twenty minutes can be conducted by parents, therapists, or even older siblings. Most Floortime therapists are trained as occupational therapists, though anyone can go through the training process.

Sessions can take place in an office, playground, living room, or any other location where open-ended play and interaction is possible. While sessions are often conducted by one adult with one child or teen, they can also be conducted with multiple children or adults.

A session consists of a therapist observing a child and engaging with that child in whatever he or she is doing, with the goal of "opening and closing circles of communication." A circle of communication consists of any form of action and response, whether it is verbal or non-verbal, so long as there is communicative intent.

It's important that the adult engages with the child based on the child's interests and actions, even if those actions have no obvious content or purpose.

For many young children with autism (even those who are verbal), the first step is simply to get the child's attention focused outside herself/himself and to encourage any type of engagement with another person.

Examples

One example of this is a child who is opening and closing a door with no obvious purpose. His mother hides behind the door and, when it opens, says "Boo!" The child laughs and does it again to get the same response.

Or, a child is lining up trucks on the floor. His father rolls one backward and forward, making vrooming noises. The child reaches for the truck, but his father playfully hides it under his hand. The child lifts the father's hand to get the truck and puts it back in the line.

Capacities

After multiple sessions and as the child becomes more interactive and willing to engage, the therapist can increase the complexity of the interactions, working toward specific goals described as "capacities."

  • Capacity 1: Self-Regulation and Interest in the World.
  • Capacity 2: Engaging and Relating.
  • Capacity 3: Purposeful Two-Way Communication
  • Capacity 4: Complex Communication and Shared Problem Solving
  • Capacity 5: Using Symbols and Creating Emotional Ideas
  • Capacity 6: Logical Thinking and Building Bridges between Ideas
  • Capacity 7: Multiple Perspectives 
  • Capacity 8: Gray Area Thinking 
  • Capacity 9: Reflective Thinking and an Internal Standard of Self

Originally there were only 6 capacities, but as autistic patients were able to master all of them over time, new capacities were added for older children and adults.

Depending on the child, it can take quite a while to move from one level to the next—many children jump between capacities. For example, a child might be able to pretend to feed a stuffed dog while petting it sweetly (using symbols and creating emotional ideas), but still have difficulty with purposeful communication and problem-solving.

Research

Behavioral therapies have very specific goals that are easy to measure. For instance, when asked, did the child complete a certain behavior? If so, how many times? Developmental therapies like Floortime are trickier to evaluate because each child's experience and progress is unique.

Developmental therapies have different goals from behavioral therapy, some of which are difficult to measure—some of these include joyfulness, playfulness, creativity.

Despite these difficulties, most studies of Floortime show that it is helpful. Some studies suggest that in some cases, it can be very helpful in building social communication skills and engagement. Perhaps just as significantly, Floortime is a good tool for building parent-child connections.

One study, for example, concludes that children made strides in "emotional function, communication, and daily living skills." The mothers of the children noticed these changes as well, along with improvement in "parent-child interactions."

Pros and Cons

Floortime can be a terrific tool for building skills and emotional connections. It is not, however, the right choice for everyone. If you're considering Floortime, consider these pros and cons.

Pros of Floortime

  • Parents can become Floortime therapists with little training

  • Useful for relationship-building

  • It's portable—you can do Floortime play almost anywhere

  • Helps kids develop meaningful human interaction

  • Very safe activity

Cons of Floortime

  • Not likely to be sufficient without behavioral therapy for moderate to severe autism

  • Few schools are willing to implement Floortime

  • Rarely paid for by insurance (hiring therapist can be pricey)

  • Takes time, patience, and energy to implement

In terms of the pros, Floortime therapy is great for getting the whole family involved, and it has a lot of potential emotional benefits. You can do it almost anywhere—in the car, in the bathtub, or while tucking your child into bed.

On the other hand, cons of Floortime include the fact that it may need to be supplemented with behavior therapy—floortime may not be sufficient on its own. Few schools are willing to implement Floortime as well because ABA (applied behavior analysis) is considered the "gold standard" in autism treatment.

Get Started

If you are interested in trying Floortime with your child on the autism spectrum, you can start by visiting the ICDL website and reading up on the subject. Consider purchasing a few books and watching videos that will provide useful models to get you started.

If you happen to live in an area where Floortime therapists are available (usually metropolitan areas), you may want to work with a therapist to get started. Once you feel comfortable, set up space you'll use for your initial Floortime sessions. This can be a playroom, bedroom, or office.

How to Get Started With Floortime Play

  • Find a space in which you and your child are comfortable
  • If possible, videotape your first Floortime session
  • Set a timer for 20 minutes
  • Observe what your child is doing and then join him/her
  • Be patient

Make sure your space is stocked with toys or objects that are fun and interactive. You might want to videotape (or have someone tape) your first few sessions so you can see what methods worked and what didn't. Twenty minutes for a first session is a good guideline for timing.

Remember, your goal is communication—the goal is not to teach your child special skills or games, or to encourage her to come to you.

Oftentimes, "playful obstruction" (stopping your child from what he is doing in a playful manner) is a good way to get his attention and have him interact with you.

Most important is patience. While it may be difficult getting started, you and your child need to build trust—this takes time. Eventually, your Floortime sessions may become the best part of your (and your child's) day!

Find a Therapist

You can find a Floortime therapist through the ICDL online directory or through a Google search. Even if you intend to provide Floortime therapy yourself, it can be very helpful to work with an expert as you get started. Therapists can:

  • provide help in setting goals for your child.
  • help you structure a program that will meet your child's particular needs.
  • review videos or observe you as you interact with your child to provide suggestions or guidance.
  • model techniques that may be helpful.
  • suggest ways to help your child move forward.
  • help you to troubleshoot if you run into roadblocks or challenges (as you almost certainly will from time to time).

In addition, Floortime therapists are sometimes able to help you advocate for Floortime services in the school setting, find an appropriate private school, or help you to find support groups or like-minded families in the area.

A Word From Verywell

Floortime, like other developmental therapies, is just one of several approaches that can help your child build skills, make connections, and develop emotionally. Even if you decide that Floortime is a good option for you and your child, it's also a good idea to explore additional therapies. It's a good idea to put together a therapeutic schedule that includes speech and social skills therapies, both of which address core symptoms of autism. Many families will also find ways to combine developmental and behavioral therapies. This can be an ideal to provide a well-rounded program for your child.

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Article Sources

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  • Christian, G (2011). A Person-Centered Approach to Problem Behavior: Using DIR®/Floortime with Adults Who Have Severe Developmental Delays. The NADD Bulletin, 14(2), 21-31.

  • Liao S-T, Hwang Y-S, Chen Y-J, Lee P, Chen S-J, Lin L-Y. Home-based DIR/Floortime™ Intervention Program for Preschool Children with Autism Spectrum Disorders: Preliminary Findings. Physical & Occupational Therapy In Pediatrics. 2014;34(4):356-367. doi:10.3109/01942638.2014.918074

  • Solomon, R., Van Egeren, L., Mahoney, G., Quon Huber, M., Zimmerman, P. (2014). PLAY Project Home Consultation Intervention Program for Young Children With Autism Spectrum Disorders: A Randomized Controlled Trial. Journal of Developmental and Behavioral Pediatrics, 35(8), 475-485.