Floortime/DIR is our primary therapy protocol for Billy. "Protocol" makes it sound like something instigated by Jack Bauer at CTU, but the great thing about Floortime is that it's more of a "big picture" view, inside which you can continue with speech therapy, occupational therapy, which we're also doing.

Developed by Dr. Stanley Greenspan, Floortime/DIR therapy (DIR stands for Developmental, Individual differences, Relationship-based) is all about creating moments of joy during which you communicate with your child on their level, following their lead. Rather than try to force them to perform a series of tasks, like stacking blocks or sorting objects, your goal is to get the child to connect with people, to desire to communicate. And you create that desire by following their joy.

For instance, if Billy wants to open and close doors repeatedly, rather than try to stop him from doing that, we open and close doors with him. And when he's comfortable with us playing side-by-side, we take it to the next level, creating a "playful obstruction." Dave created the "Open the latch, Daddy," game, putting his own hand on the door, and requiring Billy to ask him to release it, thereby bringing him into the moment.

A couple of great things happened as a result of adopting the Floortime mindset: We surrendered the frustrating process of trying to get him to stop opening and closing doors (which upset him and us) and we connected with our child. I was amazed at how much fun it was to open and close doors the first time those big blues eyes looked up to me and Billy smiled as if to say, "You like this too? Isn't it great?"

We want to teach him that it's more fun, fulfilling, desirable to be connected to people than it is to be lost in his own world. And over the past few months since we first read Dr. Greenspan's book, Engaging Autism, at the suggestion of our occupational therapist, Kathy Merydith at TMH, we have seen huge strides in Billy's connection to people.

He has started reaching out to other children on a regular basis, wanting to play with them, rather than by himself. Some of his social skills need a little honing, but after all, he's still just three years old.

If he runs into another room in the house, he'll call, "Mama, where are you?" In the past, I wasn't even sure if he thought about me when I wasn't there. He regular takes my hand and demands, "Play castle," meaning he wants me to come with him and play with the fort he got for Christmas. And then a few weeks ago, completely unprompted, he threw his arms around me and said, "I love you, Mama."

Now let me put up a big warning sign here: I can't say that Floortime caused my son to say "I love you." We're doing a lot of things, and also, he's getting older. One of our primary frustrations is trying to figure out what works, what doesn't, what therapy (or lack thereof) is resulting in a particular behavior, either positive or negative. Within our Floortime "big picture," Billy has speech therapy (3 times a week at school and once a week in private clinical setting), occupational therapy (once a week at school, once a week private), therapeutic listening (twice a day, 30 minutes per session), music therapy (once/week) and Kindermusik (www.kindermusik.com, therapy for the whole family!).

When I say these therapies operate within the Floortime big picture, I mean that we make sure our goal in every setting is to encourage his connection to people, create moments of joy, and develop his ability and desire to communicate.

That being said, Floortime works (at least, for us) and it works every time. I know that, because my son looks up at me, joy on his face, and makes some new gain in communication every day. Because we're doing the things he wants to do -- opening doors, playing fort, sifting dry rice through our fingers, riding the roller coaster that Nan got him for Christmas (what kid wouldn't like that?!) or simply running around the yard non-stop screaming, "He's getting away!" -- because we're following his joy, he wants to communicate. As a side note, he's almost completely stopped opening and closing doors, opting instead for more creative play.

The upside to this therapy: you can see almost immediate results, depending on the severity of your child's communication challenges and neurological issues, however subtle. Because Billy is highly functioning and very verbal (though most of his speech is repetitive), we get a lot of immediate reward and feedback from this therapy; I can imagine it would be significantly more frustrating with a non-verbal or non-responsive child. By all accounts it will still work, but the gains may be slower than what we've experienced.

More upsides: you can practice Floortime anywhere, as long as you are engaging your child, following their lead and expanding their communication; and once you learn the basic theory, you can do it yourself (essentially, it's free -- the only "training" we have at the moment is a careful reading of Dr. Greenspan's book), but it's certainly more effective if you also have an OT or other therapist skilled in Floortime who can help coach you during sessions, brainstorm new ideas, etc. Both our OT and speech therapist are Floortime-trained, and we also regularly turn to our virtual friends on the Yahoo! Floortime Group with questions and for support.

There are also a couple of great websites that offer training, online and DVD-based, message boards, documents that can help you with everything from preparing for your IEP meeting to locating a Floortime-trained professional. Floortime.org is the website of the Interdisciplinary Council on Developmental and Learning Disorders, founded by Dr. Greenspan and Dr. Serena Wieder and is really just a wealth of great information. StanleyGreenspan.com also offers courses in child development, a selection of Dr. Greenspan's books, and information on the latest research and articles published.

OK, now the downside: If you follow Dr. Greenspan's guidelines, you'll be doing eight Floortime sessions per day, 20 minutes per session. That's in addition to school, organized therapy, etc. I can't say that we hit that goal every day, or even most days. Also, you're supposed to work toward four play dates with a peer each week. We're not there yet either.

Sometimes the book can be a bit vague about how to accomplish certain goals, like how do you follow the child's lead if he keeps flitting from one activity to the next? How exactly do you know when your child is ready for more imaginative play? When it comes to these kinds of specific answers to some of the vague generalities in the book, I've always found the answer in my kid. And to his credit, Dr. Greenspan says that when in doubt, take a step back and watch your child. What is he doing? Where is his joy?

Our plan is fluid, dynamic and ever-changing. But for the first time in a long time, I feel like everyone on our team (and they're a wonderful group) is working toward a common goal. And at the center of that goal is a beautiful, intelligent and thoroughly fascinating child named Billy.