Can DIR Floortime Help Kids With Autism Develop Communication Skills?
Is your child with autism passive or sensory seeking? Are there developmental delays? DIR Floortime therapy, an evidence-based intervention for autism, may strengthen basic communication skills and relationship skills for your child.
What is DIR Floortime?
Developmental Individual-difference Relationship-based model (DIR) Floortime was developed by the late Dr. Stanley Greenspan to help children with autism spectrum disorder (ASD) connect while using their interests and passions to develop engagement skills, symbolic thinking, increase logical thinking, and improve interaction.
During Floortime, children lead the activity with their clinician or caregiver joining in and encouraging skill development within the world and parameters the child has created. Dr. Greenspan’s approach stresses the importance of including the child’s senses, emotion, and motor skills to create a holistic approach to support the child’s development. This can be adapted to the child’s age and developmental level. As a child becomes older, Floortime becomes more conversation-based and focuses on creative thinking and exploring the child’s interests and ideas. (“About Floortime,” 2017)
The highly adaptive nature of this therapy makes it a valuable option for children at all points of the autism spectrum. Dr. Greenspan encouraged parents to observe the kind of play their child engages in best (sensory, object, symbolic, or a combination) and determine whether the child is sensitive sensory seeking, under-reactive, or passive. (“Parents: How to Learn Greenspan Floortime,” 2017) Dr. Greenspan’s website offers parents a printable Floortime manual as well as an assessment to determine a child’s sensory and regulatory profile.
Is Floortime therapy right for my child?
Floortime’s benefits largely outweigh its challenges. When Dr. Gil Tippy PsyD., clinical director and founder of the Rebecca School in NY, spoke with the University of Vermont’s publication Out Reach in 2015, he said the following about Floortime’s drawbacks and challenges:
“The primary struggle with DIR/Floortime is that somehow the general public, and those who make funding decisions, have been tricked into believing that it DIR is not scientific. Nothing could be further from the truth. DIR/Floortime, and child development, in general, have been so well documented and researched that it clearly meets criteria now to be seen as an “evidence-based practice.”
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The confusing charts and graphs of Applied Behavior Analysis look like what people believe science should look like, but it’s a trick. I would say that is DIR’s greatest challenge.” (Houskeeper, 2015)
Additionally, The Autism Resource Foundation notes that parents who practice Floortime with their children require “a lot of patience, imagination, and stamina.” They go on to say that “since there is very little in the way of a specific direction (each child is different) it can be hard to know if you’re doing it right.”
However, the benefits can be life-changing, especially when practiced by a clinician. During Floortime, a child has the opportunity to communicate and connect on his/her terms. By meeting children where they are, they are more likely to pick up language skills, express needs, and desires, and connect with their Floortime partner.
Evidence-based research supports Floortime
According to a study by K. Pajareya, MD and K. Nopmaneejumrulers, MD of Mahidol University in Bangkok, Thailand, Floortime is an effective treatment strategy for children with autism. In this study, parents conducted an average of 15.2 hours/week of at home Floortime for three months.
Floortime was used in conjunction with the child’s existing behavioral treatment. The group of children who participated is said to have made significant gains.
Pajareya and Nopmaneejumruslers noted that the children who did not show a favorable outcome in this study were affected by their families’ need for better intervention coaching and modeling to change their communication styles and encourage them to relate to the child better. The children whose parents were well trained and able to spend more time with their child made significantly better progress. (Pajareya & Nopmaneejumruslers, 2012)
Other anecdotal evidence was recorded in Physical and Occupational Therapy in Pediatrics. This study noted that Floortime conducted at home improved parent-child interaction in preschool-aged children with autism.
The families in this study completed a 10-week Floortime program averaging 109.7 hours of intervention. These children improved their emotional functioning, communication, and daily living skills. These findings were supported by the mothers of these children noticing improved parent-child interactions. (Liao, et al., 2014)
How to conduct play therapy techniques at home
Affecting Autism, a group dedicated to “educating, empowering, and supporting parents of children with developmental challenges” published an excellent guide that breaks down the basics of conducting Floortime at home based on Dr. Greenspan and Dr. Tippy’s research,
Determine your child’s sensory needs
The first step outlined is to create a comfortable environment for your child based on his/her sensory needs and preferences. As mentioned above, Dr. Greenspan’s website offers a downloadable manual to determine your child’s sensory profile. Any teachers, therapists, or other doctors in your child’s life may be able to help you determine your child’s profile.
Observe and play with sensory toys
The next step is to observe your child’s play and join in. This is referred to as “meeting your child where they are” or “following the child’s lead.” By doing this, parents can understand their child’s rhythm and preferences before joining him/her in play.
Let your child with autism know you want to play
Parents need to make sure their child knows someone is interested in playing with them. Parents must be supportive and engaged in their child’s chosen activity and show interest in all the moving parts of the play. Children who feel that the world they have created is valued and acknowledged will likely be motivated to stay engaged longer.
Participate in play therapy techniques
Be sure to include yourself in the child’s play. This may look like posing a challenge to the child and putting yourself into their play world. Entice your child to include you in his/her play. Then, use some affect to engage the child. This may take the form of any of the five senses. For example, adding sound effects or making a silly face could be engaging. If your child is comfortable with touch, this could be a useful addition to play (i.e., running a Matchbox car up his/her arm).
Keep the play routine fresh by changing sensory toys
Finally, parents need to change or add an element to the play. This will extend the play and keep the child from falling into repetitive behaviors or patterns. (“Key Take-Aways The nuts and bolts of the Floortime™ session,” 2015)
Talk to a child therapist about adding Floortime
Finding a specialist is imperative to the success of the therapy. Whether you choose to conduct Floortime at home or see a specialist to practice it with your child, a child therapist may be helpful in providing metrics to measure your child’s success and solutions to roadblocks you may hit along the way. It is important to note that for optimal success in Floortime, families have to commit to practicing it regularly for a prolonged period.
If you think this could be a helpful addition to your child’s behavioral therapies, speak to your child’s pediatrician, occupational therapist, or psychiatrist for a referral to a psychologist who specializes in Floortime. Additionally, it may be helpful to include these sessions in your child’s school day. Many schools will accommodate this request through an Individualized Education Plan.
About Floortime. (2017, March 27). Retrieved February 2018, from https://www.stanleygreenspan.com/resources/about-floortime
Parents: How to Learn Greenspan Floortime. (2017, April 07). Retrieved February 2018, from https://www.stanleygreenspan.com/node/47
Houskeeper, E. (2015, June 25). About the DIR Floortime Model for Children with Autism | UVM CDE. Retrieved February 2018, from https://learn.uvm.edu/blog-health/dir-floortime-model
Pajareya, K., MD, & Nopmaneejumruslers, K., MD. (2012). A One-Year Prospective Follow-Up Study of a DIR/Floortime™ Parent Training Intervention for Pre-School Children with Autistic Spectrum Disorders. Retrieved February 2018, from https://pdfs.semanticscholar.org/a83e/9073fcec8859ea5dfcedc4c40ed5ede49721.pdf
Liao, S. T., Hwang, Y. S., Chen, Y. J., Lee, P., Chen, S. J., & Lin, L. Y. (2014, November). Home-based DIR/Floortime intervention program for preschool children with autism spectrum disorders: preliminary findings. Retrieved February 2018, from https://www.ncbi.nlm.nih.gov/pubmed/24865120
Key Take-Aways The nuts and bolts of the Floortime™ session [PDF]. (2015, November 12). Affect Autism.