DIR Floortime®: A Parent and Child Empowerment Model

By: Kelly Nesbitt MOT, OTR/L & Certified DIR Floortime Therapist

DIR Floortime is a multidisciplinary, developmental treatment approach that has profoundly shaped my clinical practice as an Occupational Therapist. I have personally seen a variety of children thrive with this approach. I have been lucky enough to learn all about DIR Floortime at Easterseals. While DIR is a very complex model, I wanted to have an overview of this model that parents can refer to and start off on their journey of learning and growing with their child.

Author’s Note: I use both identity-affirming language “autistic children” and person-first language “children with autism” throughout this post, as these are two schools of thought within the autism advocacy community regarding how to refer to someone with this diagnosis. Generally, I use the language that feels most respectful to each individual family and child. As I am not someone with autism, I don’t have the lived experience to make a judgment on which school of thought is “right.”

Dr. Stanley Greenspan and Dr. Serena Wieder explain their model, DIR Floortime ®

What is DIR Floortime?

DIR, which stands for Developmental Individual Differences Relationship Model, is the theoretical framework that works to promote the relationship between the child and parent, looking at the unique individual differences (sensory processing, motor, neurology, developmental, cognitive, and social-emotional skills) of the child and using playful, child-led strategies to support engagement and development.

All these Individual differences and the Relationship you have with your child all help catapult your child forward Developmentally. Floortime is the practice or application of DIR theory in which you literally “get down on the floor” with the child and “get into their world,” exploring their interests through affective, playful engagement in order to help them grow. The most important part of DIR Floortime is the “R,” which stands for “Relationship;” your relationship with your child drives all the development and meaning they derive from the world. DIR Floortime is, at its core, a parent coaching model.

Growing research is showing that this developmental, multidisciplinary approach is an effective treatment option for working with children with Autism Spectrum Disorders. Multiple randomized-controlled studies have been published since 2011 identifying statistically significant improvement in children with autism who used Floortime versus traditional behavioral approaches.

How Therapists Are Involved

Your therapist will help coach you on how to use your child’s strengths and interests to accomplish your child’s goals. It aims to empower parents, who are the “experts” in their child, to trust their instincts, follow their child’s lead, and fundamentally look at the child’s capacities in a strengths-based approach. Essentially, this model looks at and bases treatment decisions around all the wonderful things a child can do and what strengths they already possess.

What I love about DIR Floortime:

It Respects the Parent’s and Child’s Knowledge

As an OT, I hold the core assumption that every parent and child is trying their best based on their mental, emotional, and physical capacities at that moment. This model coincides with that belief on a profound level. Since DIR Floortime is a strengths-based model that presumes competence of both the parent and child, this approach really helps me go into a session with an empathetic heart and help you use “what is going well” with your child and expand from there.

Because this approach is centered upon relationships, it’s incredibly important that all families feel comfortable with their therapist as a cheerleader and coach and are able to be vulnerable in sessions. Parenting is incredibly complex, hard, and rewarding, and your therapist rides all those ups and downs with you, not as an “expert” in DIR, but as someone who is in your and your child’s corner. Even if a session is really hard, there is always something positive that can be found together, and growth can occur from there.

It is Neurodiversity-Affirming

I also love DIR Floortime, as it is neurodiversity-affirming. Neurodiversity-affirming practice refers to celebrating the unique diversity of neurological functioning that makes humans beautifully complex. It honors the interests and experiences of the neurodiverse child (children with Autism, ADHD, sensory processing differences, OCD, anxiety, and more). This approach assumes that children “don’t need to be fixed or cured,” just supported where they are developmentally and accepting their uniqueness; We see the child as inherently good the way they are. This model doesn’t see, as some may say, “unusual interests” in Autism but rather sees a child with a passion that can teach us more about something we may have never thought twice about.

It Encourages Interests and Doesn’t Label

I remember hearing an adult with Autism explain how when he was little, he always saw profound beauty in light reflecting off droplets of rain or in suncatchers on windows. He described how he would flap his hands in excitement as the droplets slid down the window or light danced through the glass and onto the floor, his body unable to contain the excitement at witnessing something so wondrous.

I wonder if, as a child, this boy may have been described as having an “unusual interest” in windows and “stereotyped behaviors” rather than someone with a unique sensory system and neurology who is having a joy-filled sensory experience. I have also heard of some Autistic advocates reporting that it must be sad that “neurotypical” people don’t get to experience the profound joy of stimming and seeing the beauty that surrounds us in everyday experiences.

I think this is a wonderful way to look at neurodiversity- what can these children show us about experiencing the world with a newfound sense of wonder and excitement. How can we reframe pathologizing neurodiverse children and instead amplify their voices and experiences to learn something exciting and new?

DIR Floortime looks at a child as a human being, not a diagnosis or label, who has great ideas that should be honored.

DIR Therapy at Easterseals

Lucky for us all, Easterseals has many certified DIR Floortime Therapists in the Occupational Therapy, Social Work, and Speech Therapy departments! You can request a therapist who has this specialization. However, if one is not currently available at the time your child needs therapy, don’t worry! Easterseals has an environment of constant collaboration and clinical supervision, so a non-certified Floortime therapist can still provide a strengths-based, child-led approach with mentorship and consultation from a certified DIR Floortime therapist.

Easterseals provides an environment that celebrates neurodiverse children’s experiences and, through the DIR Floortime model, allows parents to help their children gain skills and grow!

If you are interested in getting started with DIR therapy for your child at Easterseals, we have many qualified therapists to guide you through the process!

Learn more here to get started.

Where can I learn more? DIR Resources

Websites:

Profectum Parent Toolbox (this is a wealth of videos, webinars, worksheets, and educational materials to help walk parents through all aspects of this model. Available in English and Spanish)

Profectum.org and ICDL.org are the two large organizations of DIR Floortime. Both websites have a wealth of information and training opportunities for professionals and parents.

ABA vs. DIR Floortime? This is a look at these two different approaches to help you decide which is a better fit for your family

 DIR Floortime Quick Fact Sheet   (This link is a list of clinical research and evidence supporting this model)

Affect Autism Podcast What is it? – Affect Autism: We chose play, joy every day (this is one of my favorite podcasts about DIR Floortime, exploring a range of topics within this model)

Books about DIR Floortime and Related approaches:

• Brain-Body Parenting by Mona Delahooke PhD (2022)
• Beyond Behaviors by Mona Delahooke PhD (2019)
• Visual/Spatial Portals to Thinking Feeling and Movement by Serena Wieder PhD and Harry Wachs O.D. (2012)
• Engaging Autism by Stanley Greenspan, M.D. and Serena Wieder, PhD (2007)
• The First Idea: How Symbols, Language and Intelligence Evolved from Our Primate Ancestors to Modern Humans by Stanley L. Greenspan, M.D. and Stuart G. Shanker, D. Phil (2004)
• The Secure Child by Stanley Greenspan, M.D. (2001)
• The Irreducible Needs of Children by T. Berry Brazelton, M.D. and Stanley L. Greenspan, M.D. (2000)
• Building Health Minds by Stanley Greenspan, M.D. (1999)