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What is DIR/Floortime therapy? A complete guide for neurodiverse families

DIR Floortime Therapy: A complete guide for parents

Updated: August 4, 2023 · 8 Minute Read

Lindsay Teitelbaum, M.S. CCC-SLP, Owner Spirited Play Labs

Reviewed by:

Lindsay Teitelbaum, M.S. CCC-SLP, Owner Spirited Play Labs


  • DIR/Floortime is a popular type of play therapy where strong relationships are built between children and their parents (or children and their therapists) through play.
  • A DIR/Floortime therapist or teacher creates activities and guides your family on how to best support your child’s development.
  • The latest research shows many benefits to DIR/Floortime therapy. It might not be covered by insurance since some consider it an experimental therapy.
  • Some families consider DIR/Floortime a good alternative to ABA because it’s child-led. Others choose to do both ABA and DIR/Floortime.
  • DIR/Floortime can be an affordable option for therapy because parents spend more time coaching instead of relying on therapists providing direct care.

What is DIR/Floortime therapy?

DIR/Floortime (also known as floortime or DIRFloortime®) is a play and relationship-building therapy for autistic and neurodivergent children. Floortime is also helpful for people with a traumatic background. As the name suggests, the parent or therapist plays with the child on the floor.


DIR/Floortime therapy is designed to help parents build stronger relationships with their child in a playful and engaging environment. DIR/Floortime is based on the idea that a child’s development is affected by their environment, relationships, and interactions. This therapy is used to help children develop their social, emotional, cognitive, and communicative skills.


Who can do DIR/Floortime?

One unique aspect of DIR/Floortime is that anyone can get certified and trained. Parents and caregivers play an important role in DIR/Floortime because they are responsible for providing a supportive and encouraging environment for their child to explore.


Many parents work with developmental health professionals like occupational therapists, speech therapists, and psychologists who have the DIR/Floortime certification. Therapists and teachers who are certified in DIR/Floortime can help create activities and provide guidance on how to best support your child’s development.


Can DIR/Floortime be used with other therapies?

It has become more common! While some families try DIR/Floortime on its own, it can be done in combination with other therapies, such as occupational therapy, speech therapy, and applied behavior analysis (ABA) therapy. Many families enjoy incorporating exercises from DIR/Floortime with other therapies. Many therapists and providers like to include DIR/Floortime’s play and child-led approach into their practices.


What’s the difference between DIR/Floortime and ABA?


DIR/Floortime is exclusively child-led. ABA is usually therapist-led. They are both usually in a play-based format, but ABA may also be in a more formal setting, such as sitting at a desk. DIR/Floortime focuses on building relationships. ABA focuses on changing behavior.


Insurance usually covers ABA more than DIR/Floortime. The nature of ABA is to collect data which then allows them to prove to insurance its effectiveness. DIR/Floortime research has been ongoing for 32 years. Since floortime is a developmental therapy, there is less data collection and more qualitative information. With the lack of data collection insurance needs, it’s harder to “prove” it’s effective like ABA. Because insurance is less likely to cover DIR/Floortime, ABA therapy tends to be more commonly used.


Is DIR/Floortime effective for kids with autism and other developmental differences?

Some research supports DIR/Floortime as a practical approach for improving the unique, individualized challenges autistic children experience. One 2013 study found improvements in turn-taking, communication, and cause-and-effect understanding.5 More research is needed to solidify DIR/Floortime as an evidence-based practice. However, many families report a positive experience.


Where does DIR/Floortime happen?

Your home or a playground are popular options for DIR/Floortime. Here are a few options for you to consider:


  • DIR/Floortime often happens in a family’s home and in the community. This can include in a child’s bedroom, in the basement, backyard, playground, or even in the grocery store.
  • Some DIR/Floortime programs are in a clinical setting (e.g., a therapist’s office, clinic with a big playground). Your child might also have the opportunity to play with other neurodivergent children in a small group setting.
  • Virtual DIR/Floortime is also popular since its focus is on parent and child interactions. Your therapist or teacher will share exercises for you both to do and provide you with coaching.


How long does DIR/Floortime therapy last?

One DIR/Floortime session usually lasts 20 minutes at a time. Many families do multiple 20-minute sessions each day doing DIR/Floortime activities. The intention is for learning (and play) to become embedded into a family’s daily routines and activities. In DIR/Floortime, everything becomes a learning opportunity by finding the balance between following a child’s lead and challenging them to acquire new skills.


Families can spend a few months to several years working with a trained DIR/Floortime professional. Parents are encouraged to continue DIR/Floortime exercises after therapy has ended until children are young adults. DIR/Floortime can continue into adulthood, though it often looks different than it does with young children.


Is DIR/Floortime therapy affordable?

Unlike many other types of care for children diagnosed with autism, DIR/Floortime is typically not covered by insurance or Medicaid. This is primarily due to insurance considering DIR/Floortime an experimental treatment. There are exceptions: states like New Jersey and Minnesota have started covering services. Check with your insurance and ask if DIR/Floortime is covered under your plan.


While you are likely to pay out of pocket, many families consider DIR/Floortime an affordable option for therapy. Instead of a medical practitioner providing direct care, parents and caregivers receive coaching and learn how to care for their children. Parents attend training sessions and use techniques with their child in their home, making it more cost-effective. A DIR/Floortime 16-week training program can start around $900.


How do I find a qualified DIR/Floortime provider?

If you’re considering DIR/Floortime therapy for your child, check with your insurance provider to identify whether it is a covered service. Beaming Health is also building a directory of DIR/Floortime providers and other top-rated local autism experts covered by your insurance.


What else do I need to consider before starting DIR/Floortime with a therapist?

Once you find a therapist or certified professional you want to work with, here are a few things you need to know:


  • There will be an evaluation. You’ll answer questions about your child and work with the therapist to identify your child’s strengths and needs. A DIR/Floortime evaluation can last anywhere between 1 and 4 hours.
  • You’ll set your family’s goals. Many children who start DIR/Floortime therapy begin at one of the earlier milestones, such as self-regulation. However, each child’s care plan and goals are unique.
  • Expect parent training (also known as coaching) sessions early on. DIR/Floortime therapy starts with professional coaching such as a psychologist training the caregiver on individualized procedures and objectives. You’ll learn helpful activities to do at home.
  • Your relationship will grow stronger during the caregiver-child sessions. DIR/Floortime therapy often happens at home with the parent and child. The DIR/Floortime professional will sometimes oversee a few sessions. During these sessions, you will get on the floor with the child, directly engaged in play or other preferred activities. Parents and professionals work on engaging with the child in a way that enhances learning through natural motivation.


DIR/Floortime is meant to bring more fun and joy into your family’s life. It can help your child to reach their full potential and lead a more fulfilling life.

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Article References

  1. Phase 2 (2015). National Autism Center at May Institute.
  2. Treatment Intervention Advisory Committee. Wisconsin Department of Health Services. Published December 30, 2020. Accessed December 19, 2022. 
  3. What is the PLAY Project. Intervening Early. Accessed December 19, 2022.
  4. ​​What is floortime? Home of DIRFloortime® (Floortime). Accessed December 25, 2022. 
  5. Mercer J. Examining DIR/FloortimeTM as a Treatment for Children With Autism Spectrum Disorders. Research on Social Work Practice. 2015;27(5):625-635. doi:10.1177/1049731515583062
  6. Pajareya K. DIR/Floortime® Parent Training Intervention for Children with Developmental Disabilities: a Randomized Controlled Trial. Siriraj Medical Journal. 2019;71(5):331-338. doi:10.33192/smj.2019.51