The Continuous Flow is part of Dr. Greenspan’s 4th social-emotional milestone and is the most important capacity within all of the milestones in his Greenspan/DIR™ Model.   The capacity for engaging in a continuous flow of reciprocal affective interactions enables the child to modulate (understand and consistently and proportionately respond to) sensory and emotional experiences.  This positively supports the development of,

  • mood and behavior,
  • meaningful preverbal and verbal communication, and
  • thinking (creativity, adaptability and problem-solving).

It also enables flexible attention within the environment because the child gets feedback from what he sees and hears and, based on that feedback, can decide to explore further, or not. This requires using our visual-spatial, auditory, and motor systems together because when we are involved in a meaningful continuous social interaction, we are more able to stay focused on the most important element in the room, our caregivers face, and ignore and filter out distractible visual-motor stimuli.  Using these systems together allows us to achieve long chains of reciprocal interactions while purposefully exploring the environment.  Social-emotional interaction is absent during most traditional sensory integration activities. Sensory-motor activities in sensory gyms and sensory OT clinics involving only modulating the sensory experience are limited in their effectiveness.

In facilitating back-and-forth interaction with people and the environment, the capacity for reciprocal interaction also facilitates associative learning. Associative learning means building up a reservoir of related experiences, thoughts, feelings, and behaviors which give range and depth to one’s personality, inner life, and adaptive responses.  This ‘learning’ is necessary for healthy social-emotional growth. Without it children can develop feelings, thinking, and behavior patterns that are rigid and mechanical, as are often seen in autistic spectrum disorders.

Reciprocal affective interactions, social problem-solving interactions, and the use of meaningful symbols to interact/communicate are necessary for healthy social-emotional development.  These are the unique capacities that distinguish individuals with autism from individuals without autism. For example, long chains/patterns of back and forth social interaction depend on emotion/affect guiding this social behavior. Sustained ‘shared attention’, which includes social referencing and shared problem-solving, also depends on emotion/affect guiding social interaction and behavior. The capacities for empathy and theory of mind depend on the ability to understand both one’s own emotional states or feelings while also understanding another person’s emotional states and feelings.  If we can do both of these things, then we can project ourselves into the other person’s mindset. This complex emotional and cognitive task begins with the ability to exchange emotional/affective signals with another person.  Through these exchanges, we are able to understand our own intent and emotionally sense the other person’s intent through a sense of “self” in interaction with another. Similarly, higher-level abstract thinking skills, such as making inferences, depend on the ability to generate new ideas from our own past experiences.

The continuous flow is achieved once you hit around twenty circles in a row, ideally more.  This is called a continuous flow of back-and-forth communication because once a child can do twenty-plus circles with you where they are taking the initiative and being assertive, not just reacting to your tickle or your sounds or your movements, then they can keep the interaction/activity going as long as they want.  To encourage shared social problem solving and getting a continuous flow of back-and-forth communication, the adult needs to create extra steps during Greenspan FloortimeⓇ play, as well as during daily routines.

For example, if a child is moving a car, then you can playfully block it with your hand.  You can say, “The car won’t move, what should we do?” You can create barriers or obstacles, even with another car. You can pretend to be a policeman blocking the way where the child has to knock the policeman down or go around the policeman. It’s important you are more animated in your voice than normal. Every time your child begins drifting into their own world, begins self-absorbing a little bit, you have to accentuate the liveliness in your voice, become more animated, become more compelling, more interesting. Pretend you’re giving a lecture, and the people in the first row are beginning to fall asleep, or you’re telling a joke at a party. You begin increasing your affect. Your voice is more enthusiastic. It doesn’t have to get louder. It just becomes more compelling, more expectant, and that’s the first step of drawing a child back in.

When Dr. Greenspan completed his initial research as the Director of NIMH Mental Health Study Center and the Clinical Infant Development Program, he identified that pre-verbal exchanges between the caregiver and child are more than just a milestone of development most of us go through. He also identified that higher level communication develops from these necessary co-regulated pre-verbal exchanges.  He found that this meaningful interactive process was the driving force in a child’s development of self-regulation, communication, social skills, and adaptability.  His research then led him to founding and being the first president of Zero to Three: The National Center for Infants, Toddlers and Families and developing The Greenspan Floortime Approach®.  

As early as the 1960’s, theorists and researchers have identified similar developmental processes driving healthy social emotional growth in infants.  While they didn’t fully understand the significance of these co-regulated interactions, Dr. Greenspan’s work pulled it all together with his development of his Greenspan/DIR Model , Even today, new research is shedding light on these processes (Read more…).


Enormous advances were made in developmental psycholinguistics when knowledge about the pragmatics of communication, how people try to influence others with words and communicative gestures, was applied to pre-speech communication between infants and their caregivers (Austin, 1962). By this view of communication, the infant’s growing use of language requires first that the infant become competent at influencing their caregivers through the communication of his or her emotional and motivational states (Bruner, 1975). 

Caregiver-child interaction during the first few months of the child’s life – the reciprocal and turn taking interchange of looks, expressions and vocalizations – is a proto-dialogue or preverbal conversation (Bretherton & Bates, 1979; Stern, 1977). Caregiver and child alternate “utterances”, vocalizations, gestures and facial expressions in what are called proto-conversations (Stevenson et al., 1986). Caregivers attribute meaning to the utterances, gestures and actions of infants and respond according to inferred meanings and the baby’s intentions. The caregiver might ask if the baby is tired when she observes the child becoming fretful, and she might try to settle the child to sleep. 

This early interaction predisposes the child to language acquisition by sensitizing the infant to a sound system, to the referential requirements of speech or what is being talked about, and to communication objectives such as getting the other person to understand what one wants (Bruner & Sherwood, 1983). Prelinguistic communication first fulfills these functions in the interactions between caregivers and infants. According to Halliday (1975), in these interactions the child learns how to convey meanings to others long before she speaks. Although the precursors to language are extremely complex, in these ways early social interactions play a central role in language development (Bruner, 1983; Nelson, 1973). 

The preceding three strains of theory and research, (object relations, social mediation, and psycholinguistics) indicate the importance of early interactions to emotional, social, cognitive and language development.

Help your child Relate, Communicate and Think by learning how to APPLY The Greenspan Floortime Approach®.  Register for the Professional or Caregiver/Parent Course at Parents and Professionals can also receive Greenspan Floortime® Expert Tele-Coaching with additional video analysis and feedback.   For in-person Greenspan Floortime® based OT, SLP, Social Group Programs, and coaching contact The Floortime Center®,  

*Understand how Dr. Greenspan’s Greenspan Floortime® is different from ICDL’s DIR®Floortime.