Floortime: A Breakthrough on Autism Treatment

An Interview with Dr. Stanley Greenspan on the New "Floortime" Approach

Autism and the spectrum of disorders associated with it is now believed to affect one in every 166 children. It's one of the most common developmental disorders in the United States.

By Alison O'Leary Murray

The sixfold increase in autism spectrum diagnoses over the past 12 years has parents and educators understandably worried: What's the best way to care for and educate children with this developmental and communication disorder, and what is the best we can expect for them during their adult years?

Stanley Greenspan, MD

"We have been able to help all children. In one subgroup, we helped to such a degree that they became fully verbal, very bright, creative and empathetic. They did better than our wildest expectations."

- Stanley Greenspan, M.D.
Co-creator of DIR Floortime therapy for autism

Enter Stanley Greenspan, M.D., a child psychiatrist with decades of experience, ranging from his leadership posts at the National Institute of Mental Health to his current position as clinical professor of psychiatry and pediatrics at George Washington University Medical School.

A world-renowned expert in child development, Greenspan and clinical psychologist Serena Wieder, Ph.D., have created a new approach to treating autism, called "DIR Floortime" - the "DIR" standing for "developmental, individual differences, relationship-based approach." Their book, Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think (A Merloyd Lawrence Book), explains the therapy in detail.

Greenspan calls DIR Floortime a "breakthrough" approach. He claims that the therapy can actually prevent a child from becoming fully autistic. We recently spoke with Greenspan about his innovative techniques.

You've publicized the DIR Floortime approach as therapy that can prevent autism. Is that true?

Yes, I believe we can prevent it. I believe we have done that in many cases. But we have to be careful. We say we can prevent a child from becoming fully autistic. We still have to do a definitive study and show that we can reduce the rates by using these approaches. But certainly, in every case we've worked with so far, we have helped the child to do better than they would have done; their autism is less severe.

How does this therapy work?

Floortime focuses on foundation-building, rather than concrete tasks of the sort that are often used in therapies. We use the child's natural emotional interactions as an entry point into the child's world, rather than trying to get the child to do what we want.

The idea is to get a continuous flow of back-and-forth interaction going between the child and parent or therapist, using gestures, perhaps, or facial expressions. Therapists often pursue cognitive tasks such as matching shapes, but you need to move that from sensory to cognitive. They become wedded to the task rather than the process. It's subtle, but so pivotal.

[The therapy is] profound in the effect it has on children and their relationships with therapists and their parents, and the effect it has on their growth.

If you're trying to get a child to sort shapes and he gets up to go out the door, what can you do? If you stand in his way, he may point to show he wants to go out the door. That starts an exchange, a back-and-forth interaction. Soon, you teach him that he has to sort the shapes before he can go out the door, like a bus driver taking a fare. It profoundly changes everything therapists do with the child and how they teach.

How long have you been developing the DIR Floortime approach?

This started even before I began working with children with autism, about 30 years ago. At the National Institute of Mental Health, I studied babies and children, [including] some children with pre-autistic features, and developed an understanding of the foundations for healthy development, which became this theory and the framework of emotional and social development and how that can orchestrate all other development.

Is DIR Floortime helpful for every child on the autism spectrum?

Yes. We have been able to help all children. In one subgroup, we helped to such a degree that they became fully verbal, very bright, creative and empathetic. They did better than our wildest expectations. Others made more modest progress, but they still made progress. And for others, it made their symptoms less severe. We haven't encountered any children who haven't been helped to some degree; they've all improved considerably in relation to where their starting point was.

Your book's discussion of Floortime as centered on the child's emotional development seems to create a big role for families in using this therapy.

Yes. It makes families feel better because they can become more involved. There are a lot of other therapeutic approaches that only allow minimal involvement by the parents. There's a lot that parents can pick up on their own from this book, and our Web site [], and training classes that are held every April in the Washington, D.C., area. Many parents write to me about the things they are doing differently with their children as a result of my books, and they tell me what effect it's had.

Want to Learn More?

The DIR Floortime approach is the brainchild of renowned child-development expert Stanley Greenspan, M.D., and clinical psychologist Serena Wieder, Ph.D.

To educate and promote the therapy, Wieder founded the Floortime Foundation, a Maryland-based organization dedicated to promoting the treatment of children with developmental and communication disorders, such as autism and pervasive developmental disorder (PDD). The foundation also trains clinicians and others in the DIR Floortime approach. Its aim is to provide early and adequate treatment of children with these disorders.

The foundation's Web site,, offers more information about the treatment approach and DVDs that help parents use the approach to supplement the DIR Floortime treatment their children are receiving from professionals. There's also a link to the foundation's live, Web-based, weekly radio program on autism and the DIR Floortime approach.

Alison O'Leary Murray is former editor for United Parenting Publications.

More Resources:

Understanding Autism

Other Disorders in the Autistic Spectrum