DIR-Floortime

1. Introduction

Version followed: ICDL's DIR® / DIRFloortime® as currently published by the Interdisciplinary Council on Development and Learning (ICDL): its DIR and Floortime pages, its DIR Glossary (nine FEDCs, I–IX) and its training route. Where ICDL's pages give no procedure, this guide uses the Floortime text by Stanley Greenspan adapted on stanleygreenspan.com. That site is now the home of a separately branded "Greenspan Floortime®" training run by Jake Greenspan and the Floortime Center. The two lineages share roots but certify separately. The PLAY Project (Solomon) is a different, related programme and is not covered here. [source: ICDL What is DIR; ICDL Glossary; Greenspan & Greenspan, Greenspan Floortime: What it really is]

What it is. DIR stands for the Developmental, Individual-differences, Relationship-based model, developed by Stanley Greenspan and Serena Wieder. ICDL presents DIR as a framework for understanding development across the lifespan. DIRFloortime is its applied practice, the "way to put this philosophy into action". It is not a stand-alone, manualised psychotherapy. CEBC reports that "there is not a manual" for delivering it. [source: ICDL What is DIR; ICDL Glossary; CEBC DIRFloortime]

How change is thought to happen. Development is driven by emotionally meaningful relationships. The adult follows the child's interests and emotions, tunes in to the child's individual sensory, motor and processing profile, and then playfully challenges the child into longer shared, back-and-forth interaction. The intended result is that the child's capacities for regulation, engagement, two-way communication, shared problem-solving and symbolic and reflective thinking grow from the child's own motivation, not from rewards or isolated skill drills. ICDL writes that emotion is "critical to the growth of the mind and brain". Most Floortime is done by parents and carers in everyday life, with professionals coaching them. [source: ICDL What is DIR; ICDL What is Floortime]

Stance on autism. ICDL's glossary defines neurodiversity as valuing variation, with autism as an alternative developmental path rather than a "delayed" typical one. It calls normalisation an outdated goal. ICDL also writes that helping an autistic child "is not about getting them to behave 'normal'". Neither ICDL nor this guide offers recovery or cure. Write goals as growth in the child's own capacities, never as removing autistic traits. [source: ICDL Glossary; ICDL What is Floortime; ICDL DIR and DRBI]

Evidence status, as sources give it (brief).

• ICDL calls Floortime evidence-based. It also describes DIR as a framework with "evidence-informed practices".
• The Texas Statewide Leadership for Autism Training rates DIR/Floor Time as "Emerging": more research is needed before it meets evidence-based-practice criteria.
• CEBC gives it a Scientific Rating of 3. CEBC lists one pilot RCT: Pajareya & Nopmaneejumruslers 2011, with 32 children in Thailand. Parents delivered a home programme averaging 15.2 hours a week for three months, added to routine care. The trial was small and had no follow-up.

[source: ICDL What is Floortime; ICDL DIR and DRBI; TxAutism DIR/Floor Time; CEBC DIRFloortime]

Professional frame.

• No regulated profession. DIRFloortime is not a regulated profession in itself. You practise it within your own licence: psychology, counselling, social work, MFT, OT, SLT, music therapy, education, nursing or medicine.
• Training route. ICDL training runs DIR 101 (introduction), then DIR 201/202, then DIR 203 (Advanced Certificate), then DIR 204. DIR 204 is titled "Becoming an Expert DIRFloortime Provider and Training Leader".
• DIR 204 entry requirements. Applicants need a master's or doctoral degree in an eligible field. A bachelor's degree plus 7 or more years of experience can be considered for a waiver. Criminal Justice and Applied Behaviour Analysis degrees do not qualify.
• Mentoring. One-to-one mentoring is open to professionals who have completed DIR 101 and 201.
• Do not misrepresent your training. Do not call your work "DIRFloortime" or present yourself as a DIR provider without ICDL certification. Without it, describe what you do as Floortime-informed play within your own scope [synthesis].
• Play therapy credentials are separate. Play-therapy credentials (APT/RPT in the US; BAPT or PTUK in the UK) are distinct from DIR certification. [uncertain: registration and credential routes]

[source: ICDL DIR 204 course page; ICDL DIR Institute]

Related guides: 157 Child-centred play therapy (a different, non-developmental child-led model), and 161 Theraplay and 160 Filial therapy for other parent-involving play work. [synthesis]

2. Framework

There are no fixed phases or session count. The "framework" is a developmental profile. Treatment means working continuously at the child's current capacity, while strengthening it and inviting the next one. [source: ICDL Glossary; Greenspan & Greenspan]

The FEDC ladder (ICDL numbering). Six foundation capacities, then three higher ones:

• I. Self-regulation and interest in the world
• II. Engaging and relating
• III. Intentionality and two-way communication
• IV. Complex communication and shared problem solving
• V. Using symbols and creating emotional ideas
• VI. Logical thinking and building bridges between ideas
• VII. Multiple perspectives
• VIII. Gray-area thinking
• IX. Reflective thinking and an internal standard of self

ICDL describes capacity as more fluid and non-linear than skill attainment. Expect a child to show a capacity with one partner, or when calm, but lose it under stress. [source: ICDL Glossary]

Typical work-up and format.

1. Assessment. Observation opens every evaluation and every session. Look at the child's capacities, sensory, motor and processing profile, temperament, attachment, rhythm and mood. ICDL makes the Functional Emotional Assessment Scale (FEAS) and a DIR Fidelity Scale available free. The Thai RCT also used a parent Functional Emotional Questionnaire (FEQ). Use these tools only as their manuals direct. Their items are not reproduced here. [source: ICDL Glossary; ICDL DIR Institute; CEBC]
2. Profile and plan. Map which FEDCs are solid, partial or emerging, and the child's individual differences. Then plan a team programme. ICDL says it will probably be multidisciplinary: caregiver–child interaction consultation, speech and language therapy, OT with sensory-integration training, peer play and playdates, and home and educational programmes. [source: ICDL Intervention and Treatment]
3. Formal Floortime sessions.
   • ICDL's glossary: about 20 minutes, typically 6–8 times a day.
   • TxAutism, citing Greenspan: 6–10 sessions of 20–30 minutes, for children with severe challenges.
   • The adapted Greenspan text: "20 minutes or more", a few times a day.
   • [uncertain: sources differ on dose; ICDL's figure is followed here]
4. Everyday Floortime. Use the same way of relating "anytime and anywhere": bath, car, park, meals. [source: ICDL What is Floortime]
5. Parent coaching. ICDL offers parents two formats:
   • Live virtual consultations, where families can share video of play for expert review.
   • A 3–5-day intensive at the DIR Institute (Livingston, NJ), attended with the child, with up to three virtual coaching sessions before and up to three after.
   [source: ICDL DIR Institute]
6. Monitoring. TxAutism's implementation steps:
   • Choose functional goals with the family and team.
   • Define them observably.
   • Take a baseline on at least 3 occasions over 3–5 days.
   • Monitor for at least 2 weeks across settings and people.
   • Change one variable at a time.
   This is a school-implementation overlay, not ICDL's own protocol. [source: TxAutism]

When to move up a level. No source gives formal criteria. The adapted Greenspan text says to make a partial capacity robust while introducing the next: "If they are a little purposeful, we want them to be very purposeful". Practical criteria [synthesis]: treat a capacity as ready to build on when the child shows it

• with several partners,
• in more than one setting,
• across moderate changes in arousal and mood, and
• in long unbroken chains of circles.

Drop back a level whenever the child is dysregulated. [source: Greenspan & Greenspan; synthesis]

3. Guiding principles

[source: ICDL Glossary; ICDL What is DIR; ICDL What is Floortime; Greenspan & Greenspan; synthesis where marked]

• Follow the child's lead. ICDL: "Following the child's lead means following their emotions." In practice, enter the child's chosen activity and the feeling behind it, not just the object.
• Follow, then challenge. Joining is only a step. Understanding the child's interests shows how to stretch them. Every session should include gentle challenge, not only imitation.
• Presume competence. Assume the child wants connection and can learn, whatever their neurobiology. Talk to the child, not about them, even when they are minimally speaking.
• Behaviour is meaningful. Ask why the child is doing it. ICDL says "stimming" is not its preferred term: seek the purpose, and often join in rather than redirect. Repetition is a clue to what the child enjoys and needs.
• Echolalia and scripting communicate. ICDL sees echolalia as a natural step in language development and asks you to explore what a script means. Respond to the intent behind it rather than extinguishing it.
• Regulation first. A dysregulated child is unavailable for interaction. Get to calm, alert and available, the "just right" state, before you ask for complexity.
• Tailor to individual differences.
  • Be more energetic and compelling with under-reactive children.
  • Be soothing yet engaging with over-sensitive children.
  • Mix both for mixed profiles.
  • Adapt your speech rhythm, visual supports and the motor complexity of the play.
• Respect the threshold for affect. Each child can process only a certain amount and kind of emotional intensity. Find the level that keeps this child organised.
• Sincere affect. Raise pleasure genuinely. ICDL warns against "acting" or "clowning".
• Contingency and shared timing. Match the quality, intensity and timing of your response to the child's signal. Build a shared rhythm before you build complexity.
• Circles of communication are a major objective. "Make it a major objective. Don't skip it." Track the length of back-and-forth chains, not the number of words.
• Warmth, never force. Pull the child in with pleasure. Do not grab, hold or physically force attention.
• Intrinsic motivation over rewards. Build on the child's natural interest. Rewards are not the focus.
• Development is non-linear and lifelong. Revisit lower capacities whenever needed. DIR applies to adolescents and adults too.
• Relationships drive development, and parents are central. Most Floortime happens with carers. The professional's main job is coaching the adult–child relationship.
• Self-awareness of the adult. Notice your own style: high-energy or soothing, prone to taking avoidance personally, or prone to grabbing for attention. Adjust it.
• Growth, not normalisation [synthesis from ICDL's stated position]. Goals describe the child's own capacities (for example "shares a joke with Dad"). Never use "looks less autistic" as a goal. Make no promises of recovery.

4. Intervention inventory

The items below are the procedures that ICDL and the adapted Greenspan text describe. Where a step-by-step breakdown is my own operationalisation of a principle the sources name, it is marked [synthesis]. Wieder & Greenspan (2003), Climbing the symbolic ladder, describes symbolic-level Floortime in detail, but its full text is not drawn on, so the symbolic-level items rely on ICDL's glossary [uncertain].

4.1 Observation (session-opening and continuous)

• Purpose: to read the child's emotional state, interests, sensory and motor profile, rhythm and mood before and throughout interaction. ICDL describes observation as opening every evaluation and running through every session. [source: ICDL Glossary; TxAutism]
• Steps:
  1. Sit at the child's level, a little apart, for 2–5 minutes without directing [synthesis on timing].
  2. Note what the child seeks or avoids:
     • sound, touch and movement;
     • which objects the child uses and how;
     • facial expression, body tone, vocal tone and gaze;
     • the child's arousal (under- or over-aroused).
  3. Form a hypothesis: "What is the pleasure or purpose here?"
  4. Keep observing during play. Each response the child gives updates your next move.
• Example language: to a parent, "Let's just watch for a minute. What do you think she's enjoying about the spinning lid?" (illustrative)
• Watch for: observing too long without joining. TxAutism's version treats observation as the first of five stages: observe, approach, follow the lead, extend/expand, child closes the circle. Observation is not the whole session.

4.2 Approach and joining (matching mood and style)

• Purpose: to enter the child's activity in a way the child experiences as safe and interesting. [source: TxAutism; ICDL Glossary "Following the Child's Lead"]
• Steps:
  1. Match the child's affect and tempo: quiet with a quiet child, more animated with an under-aroused one.
  2. Take a role inside the activity. For example, line up cars beside the child's line, hand over the next block, or become the "tunnel" a car goes through.
  3. With a child who is wandering, wander alongside. The adapted Greenspan text says "we wander with the child", but stay only briefly before offering a playful challenge.
• Example language: "Oh, the blue car is going fast! Mine too!", said at the child's pitch and pace (illustrative).
• Watch for: the child glancing at you, moving closer, or tolerating your object near theirs. Turning away or rising arousal mean the approach was too much. Soften it (see 4.10).

4.3 Following the child's lead

• Purpose: to let the child's intention direct the play, so the child experiences their own agency and motivation. [source: ICDL What is Floortime; ICDL Glossary; TxAutism]
• Steps:
  1. Treat whatever the child does next as an intentional move.
  2. Respond to the feeling and purpose behind it, not only to the object.
  3. Let the child change activity. Follow them, then rejoin.
• Example language: "You want the door open. OK, open!" (illustrative)
• Watch for: confusing following with passivity. ICDL pairs following with supportively expanding the child's world.

4.4 Joining repetitive or sensory-seeking activity

• Purpose: to use self-stimulatory or repetitive behaviour as a way into a shared world rather than a target for suppression. [source: ICDL Glossary "Stimming"; ICDL What is DIR; Greenspan & Greenspan]
• Steps:
  1. Identify what the repetition gives the child: visual pattern, rhythm, movement or predictability.
  2. Join by providing more of that sensation, or by becoming part of it. For example, if the child flaps, flap the scarf the child is watching; if the child opens and closes a door, make a gentle "knock-knock" game.
  3. Once the child registers you, introduce a tiny variation or an obstruction (4.5).
• Example language: "Open… close… open… knock knock!" (illustrative)
• Watch for: distress if the behaviour is regulatory. If joining raises the child's arousal, step back and let the child self-regulate. Never block a regulating behaviour simply because it looks unusual [synthesis].

4.5 Playful obstruction

• Purpose: to create a reason for the child to initiate, signal, problem-solve or repair, while keeping the rhythm warm. ICDL defines it as adding gentle obstacles that keep rhythm and reciprocity, to invite initiation, repair or more elaborate communication. TxAutism calls it "creative obstruction". [source: ICDL Glossary; stanleygreenspan.com Playful obstruction; Greenspan & Greenspan]
• Steps (source examples):
  • Stand in the child's path so the child must go around you, or must do something to you to get by.
  • Turn a pulled toy into a gentle tug-of-war.
  • Hide a toy behind a door.
  • Put a favoured item just out of reach.
  • Wait for a signal for "more" before continuing a game.
  The adapted Greenspan text: "We want the child doing to us."
• How:
  1. Choose an obstruction the child can solve.
  2. Deliver it with a playful face and voice.
  3. Accept any communicative attempt: a look, a reach, a push or a sound.
  4. Then yield promptly.
• Example language: "Uh-oh, the car's stuck at my bridge! How can it get through?" (illustrative)
• Watch for: frustration, panic or shutdown. These mean the obstruction is too hard or too sudden. For sensitive children, the Floortime Center's guidance is a low-key approach: calm pace, quiet voice, no sudden movements, and trust before expanding. Never use force. Treat physical obstruction, tug-of-war or body-blocking as touch that needs consent and a stop signal (see 4.20).

4.6 Circles of communication (opening and closing)

• Purpose: to build continuous reciprocal interaction, the backbone of FEDCs III–IV. A circle is complete when the child opens, the adult responds, and the child closes by responding in turn. [source: ICDL Glossary; TxAutism; Greenspan & Greenspan]
• Steps:
  1. Respond to every opening the child makes. Ascribe intent where needed (see 4.9).
  2. Make your response invite a reply: a pause, a playful problem or a choice.
  3. Count the circles silently.
  4. Lengthen chains step by step. The adapted Greenspan text describes going from 3–4 exchanges toward 50 or more, and calls this the hardest part, even for children who read or do maths.
• Example language: child pushes a train toward you; adult: "Choo-choo to me?" and pushes it back slowly with a pause (illustrative).
• Watch for: adult-driven chains, where you open and close every circle yourself. Coach parents to count the circles the child closes. Progress means longer, more varied chains initiated by the child.

4.7 Expanding the interaction: choices, "playing dumb", variation

• Purpose: to stretch a stable interaction so the child must generate new ideas and solutions. [source: Greenspan & Greenspan]
• Steps:
  1. Offer a choice inside the play.
  2. "Play dumb" (the text's phrase): put the shoe on your hand, or look for the ball in the wrong place.
  3. Vary the game slightly each round, so it does not become a fixed routine.
• Example language: "Hmm, does the hat go on my foot?" (illustrative)
• Watch for: the child correcting you, laughing or adding an idea. These are signs it is working. Confusion or distress means the variation was too big.

4.8 Extending and expanding the drama (symbolic levels, FEDC V–VI)

• Purpose: to grow pretend play and emotional ideas by tuning in to the child's imagination and taking it "one step further" through gestures and words. [source: ICDL Glossary; Wieder & Greenspan 2003, uncertain]
• Steps:
  1. Join the child's play theme.
  2. Add one element that raises emotional stakes or needs a logical bridge [synthesis]: a character is hungry, or the bridge breaks.
  3. Ask open questions without intruding. TxAutism: comment encouragingly and ask questions that extend the child's ideas.
  4. Ask for reasons ("why" and "how") to support logical bridges (FEDC VI).
• Example language: "Oh no, the dinosaur is crying. What happened to him?" (illustrative)
• Watch for: the child elaborating the plot, linking ideas, or expressing a feeling through a character. Do not read play themes as evidence of real events. Play is not diagnostic of abuse (see 4.20).

4.9 Ascribing communicative intent

• Purpose: to treat subtle signals as meaningful so the child learns that signals work. ICDL notes that carers often "ascribe intent" to subtle gestures early on and act on them. [source: ICDL Glossary]
• Steps:
  1. Notice a small signal: a glance, a reach or a sound.
  2. Name and act on it as if it were deliberate.
  3. Pause, so the child can signal again.
• Example language: "You looked at the bubbles. More bubbles!" (illustrative)
• Watch for: signals becoming clearer, more frequent and better directed at you.

4.10 Contingent responding and shared timing

• Purpose: to build regulation and reciprocity through a rhythmic, matched back-and-forth. Contingency means matching quality, intensity and timing. Shared timing means sustaining rhythmic interaction, such as taking turns on a drum. [source: ICDL Glossary]
• Steps:
  1. Pick a rhythmic medium: drum, ball rolling, swing pushes or songs.
  2. Mirror the child's tempo first.
  3. Then take turns.
  4. Then make small tempo or volume changes and see if the child follows.
• Example language: "Boom… (pause)… your turn!" (illustrative)
• Watch for: the child anticipating the turn. With drums and loud toys, keep volume moderate; sound-sensitive children and close-range drumming need care [synthesis].

4.11 Tuning affect and input to the sensory profile

• Purpose: to make interaction processable for this nervous system. [source: Greenspan & Greenspan; ICDL Glossary "Threshold for Affect", sensory terms]
• Steps:
  • Under-reactive child: increase energy, animation, movement and contrast.
  • Over-sensitive child: soften voice and light, slow your movements and approach from the front, while staying engaging.
  • Auditory processing: keep a natural rhythm, not a monotone, and use short, repeated, sing-song phrases.
  • Visual strengths: use visual cues and props.
  • Motor planning (praxis): start with simple actions, then add steps. Support ideation, then planning, then execution.
• Example language: for an over-sensitive child, a quiet "Ready… go," with the ball rolled slowly (illustrative).
• Watch for: the "gleam", ICDL's "there you are" moment of full presence, as a sign of the right fit. Covering ears, fleeing, flat affect or escalating movement signal a mismatch.

4.12 Supporting regulation (co-regulation)

• Purpose: to restore a calm, alert, available state when the child is over- or under-aroused. [source: ICDL Glossary "Regulation", "Dysregulation", "Coping Strategies"; specific steps synthesis]
• Steps [synthesis]:
  1. Pause all demands.
  2. Lower or raise input to match the child: reduce sound and talk, or offer movement and deep-pressure activities the child has accepted before, with consent.
  3. Use a steady, warm voice and rhythm.
  4. Re-engage at a lower FEDC, such as shared attention and simple rhythm.
• Example language: "It's too much. I'm here. We can be quiet." (illustrative)
• Watch for: breathing, posture and gaze settling. Return to challenge only when the child is available again.

4.13 Responding to echolalia and scripts

• Purpose: to treat delayed echoes and scripts as communication or self-regulation and work out their meaning. [source: ICDL Glossary]
• Steps [synthesis]:
  1. Note when the script appears: during distress, joy, transitions or requests.
  2. Respond to the probable meaning.
  3. Join the script playfully, for example by taking the next line of a film scene.
  4. Then vary it.
• Example language: child: "To infinity and beyond!" (jumping off sofa); adult: "Buzz is flying! Where is he flying to?" (illustrative)
• Watch for: scripts turning into flexible, shared exchanges.

4.14 Stepping back when the child ignores you

• Purpose: to avoid escalating stimulation when the child does not respond. [source: Greenspan & Greenspan]
• Steps:
  1. Stop adding "bags of tricks" (the text's phrase).
  2. Step back and observe again.
  3. Ask how to build on what the child is already doing.
  4. Re-enter through the child's own activity (4.2–4.4).
• Example language: to a parent, "Let's stop performing for a moment. What is he doing, and how can we be part of that?" (illustrative)
• Watch for: adults escalating into noise, tickling or grabbing to win attention. The adapted text explicitly warns against forcing attention.

4.15 Working at the child's FEDC (level-targeted Floortime)

• Purpose: to aim each session at the capacity that is emerging, while consolidating the one below it. The adapted Greenspan text gives the overall progression but no per-level protocol. The per-level suggestions below are [synthesis] built on ICDL's FEDC definitions. [source: ICDL Glossary; Greenspan & Greenspan]
• Steps:
  • I (regulation and interest): sensory-matched, calming or alerting shared activities, and interest in what you offer.
  • II (engaging and relating): face-to-face pleasure, songs and peek-a-boo-style games the child seeks out.
  • III (intentionality and two-way communication): obstruction, ascribing intent, and waiting for signals.
  • IV (complex communication and shared problem solving): multi-step problems inside play, such as finding the hidden toy together or building a ramp.
  • V (symbols and emotional ideas): pretend play with feeling themes (4.8).
  • VI (logical bridges): ask why, how and what next, and link ideas to the child's reasons.
  • VII–IX (perspectives, grey-area and reflective thinking), for older and verbal clients: compare characters' views, "how much" and "sometimes" questions, and reflection on own feelings and standards.
• Example language: level VI, "Why do you think the shark wants the treasure?"; level VIII, "Was he a little bit angry or super angry?" (illustrative)
• Watch for: pitching above the child's level. Chains break and arousal rises. Drop down a level.

4.16 Adult self-reflection on relational style

• Purpose: to help parents and clinicians see how their own temperament shapes the interaction. [source: Greenspan & Greenspan; ICDL Glossary "Attunement"]
• Steps:
  1. After a session or a reviewed video, ask the adult:
     • Am I naturally high-energy or soothing?
     • Do I take avoidance personally?
     • Do I grab for attention?
  2. Agree one adjustment for the next session [synthesis].
• Example language: "When she turned away, what went through your mind? What did your body want to do?" (illustrative)
• Watch for: guilt and self-blame. Frame the discussion as noticing, not judging.

4.17 Parent-mediated coaching (live and video review)

• Purpose: to make the parent the main Floortime partner, since most Floortime happens with carers. ICDL offers virtual consultations in which families share video of their interactions for review, and intensives with hands-on coaching. [source: ICDL What is Floortime; ICDL DIR Institute; CEBC (parent-delivered home programme in the RCT)]
• Steps (coaching cycle, [synthesis] structure):
  1. Set goals. Agree one or two FEDC-based goals with the parent, worded as growth (for example "longer back-and-forth with Mum during bath time").
  2. Observe. Watch 5–10 minutes of live play, or a parent-recorded clip, with the parent's consent and the child's assent.
  3. Name strengths first. Point to specific moments: a circle the child closed, a gleam.
  4. Pick one strategy (for example waiting, or playful obstruction). Model it briefly with the child, then hand back.
  5. Coach in the moment with brief, quiet prompts, or afterwards on video.
  6. Plan home practice. Agree short Floortime sessions the family can actually manage, plus everyday moments (4.18).
  7. Review progress next time against the goal, by counting circles or noting new capacities.
• Example language: "Right there, you waited and she reached for your hand. That was a whole circle. Try waiting just that long again." (illustrative)
• Watch for:
  • parent overload, given ICDL's frequency;
  • the parent becoming directive or quizzing;
  • the clinician taking over the play.
  Keep video consent, storage and deletion explicit and in writing [synthesis].

4.18 Everyday Floortime (routines as practice)

• Purpose: to apply the Floortime way of relating "anytime and anywhere", for example bath time, the car or the park, and so add interaction without extra sessions. [source: ICDL What is Floortime; Greenspan & Greenspan "for all the time"]
• Steps [synthesis]:
  1. With the parent, list 3–4 daily routines.
  2. Choose one Floortime move for each: a playful "oops" while dressing, a waiting pause at the bath tap, a song-turn in the car.
  3. Review what happened at the next coaching session.
• Example language: "Shoes on… on your head? No? Where then?" (illustrative)
• Watch for: routines becoming rushed tests. Keep them light.

4.19 Functional-emotional assessment and progress monitoring

• Purpose: to profile capacities and track change. ICDL makes the FEAS and a DIR Fidelity Scale available free. The Thai RCT used the FEAS, the CARS and a parent FEQ. [source: ICDL DIR Institute; CEBC]
• Steps:
  1. Obtain the instruments from ICDL and train in them. Their items are not reproduced here.
  2. Video a baseline play sample.
  3. Score it as the manual directs, and repeat at agreed intervals.
  4. For school or home goals, TxAutism suggests a baseline on 3 or more occasions over 3–5 days, then 2 or more weeks of monitoring across people and settings.
• Example language: to a parent, "I'll film ten minutes of you two playing now and again in three months, so we can both see what's changed." (illustrative)
• Watch for: treating scores as diagnoses. FEAS profiles describe functional capacities and do not diagnose autism or other disorders. The validity and reliability of these tools were not reported in the sources [uncertain]. Use the fidelity scale on your own sessions too.

4.20 Consent, assent, touch and safeguarding inside play [synthesis, required practice frame]

• Purpose: Floortime involves floor play, body-based games (tug-of-war, swinging, roughhousing, deep pressure) and home video. These need explicit consent and child-protection safeguards. The sources do not give a procedure, so this section is general good practice.
• Steps:
  1. Consent. Get written informed consent from those with parental responsibility for:
     • the approach;
     • touch and sensory games;
     • video recording, storage and sharing;
     • information sharing with the team.
  2. Assent.
     • With the parent, identify how the child signals "yes", "more", "stop" and "too much": words, signs, AAC, pushing away, turning, vocalising.
     • Honour any stop signal at once, including non-speaking ones.
     • Re-check assent whenever play changes in intensity.
  3. Touch.
     • Use only touch the child seeks or accepts, preferably with the parent present.
     • Never genital or sexual touch. Never restraint as a technique. Never hold a child to force eye contact or attention.
     • Ask before tactile or deep-pressure input, especially with tactile defensiveness, a trauma history or cultural norms around touch.
  4. Materials and space.
     • Keep small parts away from children who mouth objects (choking).
     • Check allergies before food-based or messy sensory play.
     • Use mats and supervision for swings, trampolines and climbing.
     • Keep volume moderate with drums and noisy toys.
     • Clean toys between clients.
  5. Safeguarding.
     • Know your local child-protection procedures and who your safeguarding lead is.
     • Mandatory-reporting duties vary by jurisdiction and profession. Check your own (for example US state law, UK statutory guidance such as Working Together, Australian state schemes).
     • Disabled children face raised risk of abuse and may disclose through behaviour. Record observations factually.
     • Never treat play themes, drawings or behaviour as evidence of abuse. Refer concerns through the proper channels.
  6. Home visits. Follow lone-working policy and agree in advance which adult stays present.
• Example language: to the child, "Tug again? … You let go, so we stop."; to the parent, "Show me how he tells you 'stop'. That's our signal too." (illustrative)
• Watch for: compliance mistaken for assent, such as a child who freezes or goes limp. Treat that as "stop".

4.21 Coordinating the comprehensive programme

• Purpose: to fit Floortime into the child's wider support, which ICDL expects to be multidisciplinary: speech and oral-motor therapy, OT trained in sensory integration, PT, education or inclusion support, interactive play therapy, and regular peer playdates. [source: ICDL Intervention and Treatment]
• Steps:
  1. Share the child's DIR profile with the team, with consent.
  2. Agree common relational principles across settings.
  3. Set up peer play with one well-matched peer, supported by an adult [synthesis on format].
  4. Review the plan with the family regularly.
• Example language: to the OT, "He organises best after swinging. Could we start Floortime right after your sessions?" (illustrative)
• Watch for: contradictory approaches across settings (for example one adult following the lead while another drills compliance). Discuss these openly with the family. ICDL's parent page acknowledges behavioural techniques may help early with attention and imitation, but cautions against relying on them alone.

5. Handling problems

The sources address avoidance, repetitive behaviour, sensory mismatch and the adult's style. Most other guidance here is [synthesis] and is marked as such.

• Child avoids, wanders or ignores you.
  • Do not force or escalate.
  • Step back, observe, and re-enter through the child's own activity. Wander with the child briefly, then add a simple playful challenge, such as standing in their path.
  • [source: Greenspan & Greenspan]
• Child stuck in one repetitive activity.
  • Treat it as a clue to pleasure or regulation.
  • Join it, then add the smallest possible variation or obstruction.
  • If the repetition is calming the child, let it run and work on shared attention alongside it.
  • [source: ICDL Glossary; Greenspan & Greenspan; last point synthesis]
• Child over-aroused or overwhelmed (meltdown, flight, covering ears).
  1. Stop all demands.
  2. Reduce input: less talk, light and noise.
  3. Offer the regulating input the child has accepted before.
  4. Re-engage later, at FEDC I–II.
  Afterwards, review the session for triggers: noise, too-fast obstruction, touch. Lower intensity next time. [synthesis, grounded in ICDL's regulation definitions]
• Child under-aroused or flat. Increase energy, movement and contrast. Try alerting activities the child enjoys, such as swinging, if they are safe and the child assents. [source: Greenspan & Greenspan; activity choice synthesis]
• Hitting, biting or throwing (not addressed in the sources) [synthesis]:
  • Keep everyone safe first. Move breakables, step out of reach, and use a calm voice.
  • Treat the behaviour as communication of distress, over-arousal or a blocked intention.
  • Reduce the challenge that preceded it.
  • Do not use restraint as a technique. Follow your service's policy on safe physical intervention for emergencies only.
  • Refer for medical review if self-injury is new or escalating, since pain or illness can drive it.
• Playful obstruction triggers anger or panic. The obstruction was too hard, too sudden or felt like teasing. Yield at once, repair warmly ("Oops, too much, here you go", illustrative), and offer an easier version. [synthesis on the ICDL definition, which requires rhythm and reciprocity to be kept]
• Parent non-adherence (cannot manage 6–8 sessions a day).
  • ICDL's frequency is demanding.
  • Negotiate what the family can realistically fit in.
  • Lean on everyday Floortime in routines.
  • Share sessions among carers, siblings and grandparents.
  • Never frame the shortfall as the parent's failure.
  • [source: ICDL Glossary; ICDL What is Floortime; negotiation synthesis]
• Parent too directive (quizzing, testing, teaching colours). On video, show the moments where waiting worked. Coach one change at a time: "comment, don't question", or the 3-second wait. [synthesis]
• Parent takes avoidance personally, or grieves. Use the self-reflection in 4.16. Acknowledge that adjusting expectations is a process. Offer or refer for parent support, or for their own therapy if there is depression or anxiety. [source: Greenspan & Greenspan for the self-reflection; rest synthesis]
• Parent hopes for recovery or "normal" behaviour. Be clear that Floortime aims at the child's growth in their own way, not cure or normalisation, as ICDL's own pages state. Re-word goals as relational capacities. Give honest evidence information: emerging or limited evidence, one small pilot RCT. [source: ICDL What is Floortime; ICDL DIR and DRBI; TxAutism; CEBC]
• Rupture with the parent (feels judged on video, disagrees with the approach). Name it. Return to their goals. Let them choose which clips are reviewed. Put strengths first. [synthesis]
• Conflicting programmes (for example an intensive behavioural programme in parallel). Respect the family's choice. Coordinate goals and language across providers. Flag any practice that conflicts with the child's assent or wellbeing. [synthesis; ICDL acknowledges behavioural techniques can play a limited early role]
• Neurodiversity-affirming concerns. ICDL acknowledges that some autistic adults experienced interventions as aiming to make them "normal". It prefers supporting growth in each person's own way of being.
  • Possible tension [synthesis]: any developmental ladder can be applied as a normative yardstick.
  • Counter this by asking for the child's preferences, keeping regulating behaviours, accepting AAC and non-speaking communication as full communication, and seeking autistic perspectives in service design.
  • External autistic-led critiques of Floortime specifically are not covered in the sources [uncertain].
  • [source: ICDL DIR and DRBI; ICDL Glossary]
• Older, verbal or adolescent clients. Shift to FEDC VII–IX work: conversations about interests, perspectives, grey-area feelings and reflection. Keep the child-led, affect-rich stance. Replace floor play with shared activities the young person chooses. Increase the young person's own consent role as their capacity grows. [source: ICDL Glossary for VII–IX; application synthesis]
• Cultural fit (floor play, eye contact, adult–child play norms). Adapt the setting and play forms to family norms. Never require eye contact. Shared attention can be side by side. [synthesis]
• Telehealth. Coach the parent live while the clinician stays off-camera or on-screen. Use recorded clips. Check privacy and consent for video. [source: ICDL DIR Institute for virtual consultations; method synthesis]
• Disclosure or concern about harm during sessions. Stay calm, listen, and do not lead or interrogate. Record the child's words and behaviour factually. Follow local safeguarding procedure and your jurisdiction's mandatory-reporting law. Do not use play content as evidence. [synthesis]
• No progress after an agreed period. Re-profile with the FEAS or video. Check sensory and medical contributors: hearing, vision, sleep, pain, seizures. Look at the fidelity of home practice. Consider team changes, for example adding OT or SLT. [source: ICDL DIR Institute for FEAS and fidelity tools; rest synthesis]

Sources

Sources:

• ICDL: What is DIR?
• ICDL: What is Floortime?
• ICDL: DIR Glossary
• ICDL: DIR Institute
• ICDL: Intervention and Treatment (parents)
• ICDL: DIR and DRBI
• ICDL: DIR 204 Becoming an Expert DIRFloortime course registration
• Greenspan, S. I. & Greenspan, J.: Greenspan Floortime: What it really is (adapted from an earlier version by Stanley Greenspan)
• Greenspan, J.: Engaging with a sensitive child: playful obstruction
• CEBC: DIRFloortime® programme profile
• Texas Statewide Leadership for Autism Training: DIR/Floor Time
• Wieder & Greenspan 2003, GWU Health Sciences Research Commons record (no full text)
• Engaging Autism, library catalogue record (Université de Nantes)

Books and papers cited:

• Greenspan, S. I., & Wieder, S. (2006). Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think. Da Capo Lifelong Books, Cambridge, MA. Catalogue record; text not drawn on [uncertain].
• Wieder, S., & Greenspan, S. I. (2003). Climbing the symbolic ladder in the DIR model through floor time/interactive play. Autism, 7(4), 425–435. Record; full text not drawn on [uncertain].
• Greenspan, S. I., Wieder, S., & Simon, R. (1998). The Child with Special Needs: Encouraging Intellectual and Emotional Growth. Addison-Wesley. Cited from the TxAutism reference list; not drawn on [uncertain].
• Greenspan, S. I., & Wieder, S. (1997). Developmental patterns and outcomes in infants and children with disorders in relating and communicating: a chart review of 200 cases. Journal of Developmental and Learning Disorders, 1(1), 87–141. Cited from TxAutism; not drawn on [uncertain].
• Pajareya, K., & Nopmaneejumruslers, K. (2011). A pilot randomized controlled trial of DIR/Floortime parent training intervention for pre-school children with autistic spectrum disorders. Autism, 15(5), 563–577. Details as reported by CEBC and TxAutism; paper not drawn on.