Floortime

What is Floortime?

Floortime is a relationship-based therapy for children with autism. The intervention is called Floortime because the parent gets down on the floor with the child to play and interact with the child at their level.

Floortime is an alternative to ABA and is sometimes used in combination with ABA therapies.

The goal is for adults to help children expand their “circles of communication.” They meet the child at their developmental level and build on their strengths.

Therapists and parents engage children through the activities each child enjoys. They enter the child's games. They follow the child's lead.

Six Key Milestones of Floortime

Floortime aims to help the child reach six key milestones that contribute to emotional and intellectual growth:

  • Self-regulation and interest in the world
  • Intimacy, or engagement in relationships
  • Two-way communication
  • Complex communication
  • Emotional ideas
  • Emotional thinking

Therapists teach parents how to direct their children into more and more complex interactions. This process, called “opening and closing circles of communication,” is central to the Floortime approach.

Floortime does not work on speech, motor or cognitive skills in isolation. It addresses these areas through its focus on emotional development.

Overall, this method encourages children with autism to push themselves to their full potential. It develops “who they are,” rather than “what their diagnosis says.”

How does Floortime work?

Floortime takes place in a calm environment. This can be at home or in a professional setting.

Therapy sessions range from two to five hours a day. They include training for parents and caregivers as well as interaction with the child.

During a session, the parent or provider joins in the child’s activities and follows the child’s lead. The parent or provider then engages the child in increasingly complex interactions.

Floortime encourages inclusion with typically developing peers when used in a preschool setting.

Sessions emphasize back-and-forth play. This builds the foundation for shared attention, engagement and problem solving. Parents and therapists help the child maintain focus to sharpen interactions and abstract, logical thinking.

EXAMPLE:

If the child is tapping a toy truck, the parent might tap a toy car in the same way. The parent might then put the car in front of the child’s truck or add language to the game. This encourages the child to respond and interact.

As children grow, therapists and parents match the strategies with their child’s developing interests. They encourage higher levels of interaction.

For example, instead of playing with toy trucks, parents can engage with model airplanes or even ideas and academic fields of special interest to their child.

Families are encouraged to use Floortime principals in their day-to-day lives.

What is the history of Floortime?

Floortime was created by child psychiatrists Stanley Greenspan, M.D. and Serena Wieder, PhD. It is based on the Developmental Individual-difference Relationship-based model (DIR). Dr. Greenspan developed the DIR model as therapy for children with a variety of developmental delays and issues in the 1980s.

Who provides Floortime services?

Different types of professionals seek special training in Floortime techniques, including:

  • Child psychologists
  • Special education teachers
  • Speech therapists
  • Occupational therapists

Parents and caregivers can also learn Floortime techniques through workshops, books and websites.

What is the evidence that Floortime works?

In a 2003 study, Dr. Greenspan and Dr. Weider studied Joey, a child on the autism spectrum who spent three years engaging in Floortime with his father. Over that time, Joey enjoyed six daily Floortime sessions. He continuously improved, and the two scientists concluded that Floortime helped Joey progress.

In 2007, a pilot study conducted by independent researchers likewise showed benefit for children with autism. Two other 2011 studies—one conducted in Thailand and one in Canada—further supported Floortime as significantly improving emotional development and reducing autism’s core symptoms.

Is Floortime covered by insurance?

Sometimes. Many types of private health insurance are required to cover services for autism. This depends on what kind of insurance you have, and what state you live in.

All Medicaid plans must cover treatments that are medically necessary for children under the age of 21. If a doctor recommends Floortime and says it is medically necessary for your child, Medicaid must cover the cost.

Some young children receive Floortime through their Early Intervention program. Early intervention is offered in each state to children under age 3 who are not growing and developing at the same rate as others. These services are free or low-cost based on your family income. 

Please see our insurance resources for more information about insurance and coverage for autism services. 

You can also contact the Autism Response Team if you have difficulty obtaining coverage, or need additional help.

Where do I find a Floortime provider? 

Autism Speaks Directory

ICDL Floortime Directory

What questions should I ask?

The following questions can help you learn more about Floortime before you begin. It can also help you learn whether a particular therapist is a good fit for your family:

  1. Who will be working directly with my child?
  2. How many years have you been working with people with autism?
  3. Where will services be provided?
  4. What does the initial assessment involve?
  5. What type of insurance do you accept? Will my insurance cover your services?
  6. Do you have a waiting list? 
  7. How many hours of therapy per week?
  8. How long are therapy sessions?
  9. What training do you offer for parents?
  10. How are goals determined? Can clients and parents provide input?
  11. What does a typical program look like?
  12. How do you measure progress?
  13. What progress should we expect? 

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