Floortime therapy is a relationship-based developmental therapy that helps autistic children reach their full communication potential. It strives to engage autistic children at their level by joining in their play.

Through floortime, children learn to engage with others and interact in a shared world. Floortime can take place in formal therapy settings as well as in nearly any other environment. As a therapist, educator, or parent, you can engage in floortime anywhere and at any time.

What Is Floortime?

Floortime is a type of therapy developed for children with autism. It is centered on building relationships with your autistic child by getting down on the floor with them and playing. Floortime encourages therapists, providers, and parents to interact with the child at the child’s level.

The child takes the lead in floortime therapy by directing play and selecting the activities and games they enjoy. Adults working with the child meet the child at their developmental level by entering their world of play. By doing so, they build on the child’s strengths and expand their circle of communication. 

The History of Floortime Therapy

This therapy is based on the DIR (developmental, individual-difference, relationship-based) intervention model that was developed by Dr. Stanley Greenspan and Dr. Serena Wieder. Dr. Greenspan is a child psychiatrist, and Dr. Wieder is a clinical psychologist. These two doctors examined the functional developmental capacities of children with autism.

Through spontaneous play that occurs during floortime sessions, adults employ gestures, words, and interactions that help to move the child up the symbolic ladder of communication. Dr. Greenspan and Dr. Wieder recognized that by creating a foundation of shared attention, engagement, and investigation, the child is brought into a world of shared ideas and problem solving.

How Floortime Works

The Interdisciplinary Council on Development and Learning explains that floortime can happen all the time and everywhere .

Children with autism require intensive intervention and will rarely initiate interaction on their own unless they need something. To encourage interaction and a shared world, floortime can occur anywhere, such as:

  • Inside the home.

  • In the backyard.

  • In a therapy office.

  • In elementary school.

  • At preschool or daycare.

  • At a playground.

  • In a supermarket. 

  • In the car.

  • In the bathtub.

Floortime can be done at any time of day and with anyone, such as parents, peers, and siblings. The key to floortime is that the people who participate in it enjoy it.

Floortime is meant to be a fun and positive communication-building experience. It shouldn’t be a source of stress for any of the involved parties.

The Goals of Floortime Therapy

According to Autism Speaks, there are six primary goals of floortime therapy. As the student achieves each goal, they experience emotional and intellectual growth . Students are encouraged to push their interactive skills by engaging with others through play.

The six milestones of floortime include:

  1. Self-regulation and interest in the world.

  2. Engagement in relationships, or intimacy. 

  3. Two-way communication.

  4. Complex communication.

  5. Emotional ideas.

  6. Emotional thinking. 

Floortime focuses on emotional development, but it also provides an opportunity to practice speech, cognitive, and motor skills while playing. 

In more formal floortime sessions, the above goals are practiced in calm, quiet environments, where sessions last from two to five hours per day. Parents and caregivers can be trained by floortime professionals for how to effectively join in the child’s play, follow their lead, and encourage their development.

Combining This Approach With ABA Therapy

Floortime and applied behavior analysis (ABA) therapy are two separate types of therapy, though they are complementary. Floortime interventions can be incorporated into an ABA program that is focused on developing the communication skills of a child.

Floortime can also be used as an alternative to ABA therapy, explains Autism Speaks. It is a relationship-based therapy with its own set of interventions and principles.

ABA is the most notable treatment approach for children and adults with autism. It is widely accepted by health care professionals as the gold standard of autism treatment . It is used in schools, homes, and treatment settings.

Like floortime, ABA encourages the development of positive behaviors and interactions. Additionally, ABA discourages negative behaviors and tracks progress through data collection.

There are many therapies that can be part of a complete treatment program for someone with autism, explains the Centers for Disease Control and Prevention (CDC). And floortime is just one these therapies.

Floortime can enhance an ABA treatment plan by providing interventions that focus on developing feelings and relationships with caregivers. It can also enhance how the child responds to sights, sounds, and smells. 

The Efficacy of Floortime

Studies have found that children with autism who regularly participate in floortime sessions over an extended period of time exhibit improved emotional development and a reduction in autistic symptoms .

In one study, children whose parents engaged in floortime activities with them an average of 15 hours per week for three months, improved significantly on all three measures used in the study: the Functional Emotional Assessment Scale (FEAS), the Childhood Autism Rating Scale (CARS), and the Functional Emotional Questionnaires.

Floortime promotes learning through interaction , which researchers have identified as a key intervention for helping children with autism. The social-communication-based approach of floortime helps to improve the social interaction skills of autistic children.

One 2011 study found that children who participated in a floortime treatment group exhibited significantly greater improvement in social interactions skills than the children in the non-treatment group. 

Cost of the Therapy

The cost of floortime therapy varies depending on the setting in which it is given. Private therapy settings are likely to be the most expensive option.

Private clinics often require initial evaluations and intake sessions, which can range from $300 to $500. One-hour coaching sessions designed to meet your child’s needs can generally cost $100 to $250. Additional consultation sessions are typically offered, though they come at an added fee.

If you have health insurance, you may be able to get the cost of floortime sessions covered. Autism Speaks explains that many private health insurance companies are required to cover autism services. 

Additionally, Medicaid must cover all treatments deemed medically necessary for children ages 21 and under . If your doctor says that floortime is medically necessary for your child, Medicaid has to cover it.

If you have questions about your insurance coverage, contact your insurance plan provider directly. They can confirm coverage of autism services and the best way to pay for the services. Some private clinics do not work directly with insurance companies, but they will provide an invoice for you to submit to your insurance provider for reimbursement.

How to Know if Floortime Is a Good Treatment Option for Your Child or Student

To help you decide if floortime is a good treatment option for your child or student, consider the following:

  • Who will be providing the therapy?

  • Where will the floortime occur?

  • Is there an initial assessment, and what does it involve?

  • How many hours of floortime per week should you expect?

  • Is training offered to parents? 

  • How is the child’s progress measured?

  • How are the treatment goals determined?

Don’t be afraid to ask as many questions as needed of the provider or instructor. If you are satisfied with the answers you receive to these questions, it might be wise to move forward with the therapy. 

Floortime may be a good treatment option for a child with autism. It’s usually used as part of a comprehensive treatment plan that also includes ABA therapy, speech therapy, and occupational therapy, as appropriate for the specific child. The progress made in floortime therapy will transfer into other therapy areas as well. Ultimately, incorporating floortime techniques into daily life can be a great opportunity for you and your child to play and bond. Throughout the process, you can help to develop your child’s communication skills to their fullest potential.

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