Floortime Therapy: Does It Really Work?

Floortime is the common term used to describe the Developmental, Individual-differences, Relationship-based (DIR) model used by psychiatrist Dr. Stanley Greenspan in an attempt to provide a unique therapy experience for children diagnosed with a wide array of developmental issues, delays and conditions. ‘Floortime’  describes the method used by parents or caregivers to reach out to the child on his or her level, engaging them down on the floor where children spend most of their playtime. DIR was first outlined in Dr. Greenspan’s 1979 book titled, “Intelligence and Adaptation.”

Dr. Greenspan, along with other researchers and in particular, clinical psychologist Dr. Serena Wieder, PhD, conducted a series of studies of the effect of DIR or Floortime on patients throughout the years, concluding that Floortime was beneficial to their patients. By focusing on the parent-child connection which is so strong in many children affected with developmental issues, Greenspan believed that the child’s natural curiosity and creativity could be readily attracted and captured.

One study in particular occurred in 2003, when Dr. Greenspan and Dr. Weider studied a particular patient named Joey, who was diagnosed with autism spectrum disorder or ASD. Joey and his father participated in Floortime therapy 6 times each day over a period of 3 years and showed continuous improvement. Other studies were conducted independently of Dr. Greenspan in the US, Canada and Thailand, that also supported the benefits of Floortime, particularly in reducing the core symptoms of ASD.

How Does Floortime Work?
The idea behind Floortime or DIR is that autism and other developmental disorders are a direct result of the brain’s effect on a child’s senses, relationships and other experience in the world. DIR assumes that a child’s actions are purposeful no matter how unusual or different, and invites the parent or caregiver to follow along, mimicking the same behavior as a means of coaxing interaction to develop communication with the child. Other child-led learning methods have proven to be effective and there are many who see improvement in children who participate in this type of play-based therapy.

In addition to other more proven exercises, some schools have begun to incorporate Floortime into their overall strategy with preschool-aged children as a means of improving emotional and social development. Studies have shown that Floortime works well in conjunction with other behavioral programs such as Verbal Behavior or Applied Behavior Analysis. Families are encouraged to utilize Floortime as an at-home treatment of extended therapy, particularly for affected preschoolers or even toddlers.

According to Greenspan’s research, there are 6 unique milestones of development that are important for encouraging intellectual and emotional growth in a child with development issues. The goals of DIR/Floortime are to help the child achieve these developmental milestones:

  • Stage #1 – Regulation/Interest
    Helping the child to self-regulate behavior in order to give full attention to a person or the child’s surroundings.
  • Stage #2 – Relating/Engagement
    Encouraging interest in a person or the child’s surroundings to develop a bond and learn how to distinguish inanimate objects from people.
  • Stage #3 – Intentional Communication
    Learning how to have a two-way interaction or communication between the parent or caregiver and the child.
  • Stage #4 – Social Problem-solving
    Utilizes pre-language skills to encourage problem-solving, creativity and interaction through the use of babbling, gestures, expressions and more.
  • Stage #5 – Symbolic Playtime
    Communicating ideas or intentions through the use of symbols, pictures or words.
  • Stage #6 – Bridging Ideas
    Establishing a sense of reality and encouraging basic reasoning, logic and emotional thinking patterns to bring all of these ideas and intentions together.

DIR/Floortime challenges the child to increase their developmental milestones through intentional play-therapy in a calm and comfortable setting. Most of these therapy sessions last between two and four hours, following the child’s lead in an attempt to create a connection between the caregiver and the child. Floortime and variations of these techniques are used today by parents, caregivers, specialists, hospitals, schools and other developmental experts.

The Verdict?
While there are many parents and professionals who strongly support the use of DIR/Floortime, there are relatively few independent studies that have been completed that support its effectiveness on children with ASD or other developmental disorders. A single-subject study was recently conducted (Case-Smith & Arbesman, 2008; National Research Council) using a child who had been diagnosed with autism. The results were encouraging, particularly the journal provided by the child’s mother throughout the analysis, but so far have only prompted researchers to determine that further testing was needed to draw a complete conclusion as to its effectiveness.

For those of you who have tried Floortime therapy we would love to hear from you.  What has been your experience so far to include results?  How did your child react to this form of therapy?  Did you find it easy to follow and adapt too?  Thanks for sharing!

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