ICDL's CEO, Dr. Guenzel, speaks at the ANISA World Autism Acceptance Day event.

DIR® iS Evidence-Based

DIRFloortime® Research, Science, and Evidence-base

DIRFloortime® Research, Science, & Evidence

DIRFloortime has the strongest research of any intervention to support its effectiveness in improving the core challenges of autism (including relating, interacting, and communicating), while also improving parent-child relationships and decreasing caregiver stress.

DIR® and DIRFloortime® Evidence-Based Quick Facts

The following is a brief sample of the evidence-base supporting DIR and DIRFloortime (Floortime). The research includes the highest levels of evidence and includes case studies, group design studies, randomized controlled trial studies, and systematic reviews. Unlike behavioral approaches which narrowly focus on specific behaviors, DIR is an interdisciplinary, individualized, whole-child, developmental approach that is broad in both its approach and its impact.

Multiple randomized-controlled studies were published since 2011 identifying statistically significant improvements for children with autism who used Floortime versus traditional behavioral approaches (Solomon, et. al., 2014; Casenheiser, Shanker & Steiben, 2011; Lal and Chhabria, 2013; Pajareya and Kopmaneejumruslers, 2011, Pajareya et. al., 2019). Most of these RCT studies also examined parental stress and found that parental stress actually decreased using DIRFloortime.

Solomon, Necheles, Ferch, and Bruckman (2007) conducted a pre-post survey of the Play and Language for Autistic Youngsters (PLAY) Project Home Consultation program. This program is a Floortime program. Results indicated statistically significant improvement in the children’s Functional Developmental Capcities and 100% of the parents reported satisfaction in participating.

The cost associated with the DIRFloortime-based weekly intervention program as described in Casenhiser et al. (2012) is approximately $5000 per child per year, which is considerably less than the estimates of therapy for most therapist-delivered programs that typically provide 20–30 weekly hours of treatment (Flanders et al., 2005; Motiwala et al., 2006).

Case studies have been effective in supporting the use of DIRFloortime with children with autism. Dionne and Martini (2011) demonstrated statistically significant improvement in communication between parent and child. Wieder and Greenspan (1997, 2005) did comprehensive case studies that spanned from 8-15 years. These studies supported the long-lasting results DIRFloortime had on individual child skills, as well as the emotional connections the families were able to develop over time using this approach.

Shamsudin et al. (2021) conducted a qualitative study examining parents of children with autism spectrum disorder’s perception on parent-implemented home-based developmental, individual-difference and relationship (DIR)/Floortime ® intervention. This study found that the use of DIRFloortime successfully improved parents’ and children with ASD’s skills and behavior and positive well-being.

In the most recent systematic review on DIRFloortime, Divya et al. (2023) concluded that Floortime is a cost-effective, completely child-led approach, which could be initiated as early as possible. If started early by healthcare professionals, it can be vital in improving social and emotional development among children. Additional systematic reviews also support the effectiveness of DIRFloortime. (Binns and Cardy, 2019; Boshoff, K. et al., 2020; Cheng, W.M. et al., 2022; Smith & Iadarola, 2015).

Not only is the research supporting Floortime expanding, there is increasing research, analysis, and reviews that are raising questions about the research on ABA and behavioral approaches. In the recent 2020 Project AIM: Autism intervention meta-analysis for studies of young children published in the American Psychological Association's Psychological Bulletin, they found that developmental approaches had stronger evidence to support effectiveness than behavioral approaches when effect size is considered. Also, in a recent report by the US Department of Defense on the TRICARE Autism Care Demonstration (this is an ABA benefit that was provided to children covered under the benefit), they reported that 76% of those that received the services had little to no change and 9% actually worsened. (TRICARE is the health insurance coverage for many in the US military and Department of Defense.)

In a January, 2020 report by the Council on Children with Disabilities, Section on Developmental and Behavioral Pediatrics of the American Academy of Pediatrics entitled "Identification, Evaluation, and, Management of Children with Autism Spectrum Disorder", they stated, "Intervention for young children also may be derived from developmental theory, which is focused on the relationship between the caregiver’s level of responsiveness and the child’s development of social communication. Through interaction with others, children learn to communicate, regulate emotions, and establish a foundation for increasingly complex thinking and social interaction. Therefore, developmental models designed to promote social development in children with ASD are focused on the relationship between the child with ASD and his or her caregiver through coaching to help increase responsiveness to the adult (ie, the interventionist or parent or caregiver) through imitating, expanding on, or joining into child-initiated play activities. This approach may address core symptoms of ASD, such as joint attention, imitation, and affective social engagement. Developmental models for intervention are focused on teaching adults to engage in nondirective interactive strategies to foster interaction and development of communication in the context of play. One such approach is known as DIRFloortime (The Developmental, Individual Differences, and Relationship-Based model)." (Hyman et. al., 2020)

In an article published in the Journal of the American Medical Association in November, 2020 entitled, “Intervention Recommendations for Children with Autism in Light of a Changing Evidence Base” they recommended that pediatricians need to consider recommending a wider range of options to parents. In regards to the changing evidence base, they reported, “There has been a recent precipitous increase in both the quantity and quality of research examining interventions for young children with autism. From 2011 to 2018, the reported number of randomized clinical trials (RCTs) of interventions for young children with autism increased from 2 to 48. To summarize this transforming evidence base, we systematically reviewed and meta-analyzed 150 reports of 130 studies, 87 of which were RCTs, which collectively reported effect sizes for 1,615 outcomes, representing 6,240 young children with autism. Several findings emerged from this research, but two are of direct relevance to pediatricians directing families to services and supports following diagnosis. First, three intervention approaches that, at present, are not commonly recommended have garnered more substantial empirical support from RCTs relative to behavioral interventions. These are naturalistic developmental behavioral interventions (NDBIs) and developmental interventions. Although distinct from one another, these interventions are alike in that they are provided in children’s natural contexts (eg, everyday interactions with caregivers) and their learning targets are guided by early developmental sequences. These attributes may make them preferable to families, since they are less likely to disrupt and separate children from family routines than more structured clinician-led interventions.” (Sandbank et. al., 2020)

The evidence is strong and building – DIRFloortime works!

Recent Research ON dirfLOORTIME

The Evidence to Support DIRloortime® Continues to Build

Establishing the evidence base behind DIR and DIRFloortime/Floortime is not as easy as in some approaches. DIR is an interdisciplinary, individualized, whole-child, developmental approach that is broad in both its approach and its impact. Unlike behavioral approaches that can simply show that a specific behavior that has been targeted to increase or decrease has changed, DIR is focused on improving the whole child in a wide range of ways. Nevertheless, the research continues to build to support DIR and the DIRFloortime approach.

Here are a few recent examples:

These recent studies offer more evidence of how effective and culturally appropriate DIRFloortime is in helping children and families around the world:

Afifah, Nursita & Hapsari, Indri. (2024). DIR/floortime: Meningkatkan komunikasi dua arah pada anak usia dini dengan gangguan spektrum autisme. Procedia : Studi Kasus dan Intervensi Psikologi. 12. 174-181. 10.22219/procedia.v12i4.34476.

Pacheco, P. M., Pacheco, M. D. S., & Molini-Avejonas, D. R. (2023). Interfaces between Biological Theory of Human Development and DIR/Floortime in the understanding and treatment of autism. European Psychiatry, 66(Suppl 1), S741–S742.

Pacheco, P. M., Piacentini, P., Pacheco, M. D. S., & Molini-Avejonas, D. R. (2023). Analysis of the individual profile of children in autism spectrum disorder (ASD) and therapeutic strategies in the DIR/Floortime model. European Psychiatry, 66(S1), S741-S741.

Romanovskiy, N. V. (2023). Dynamics of early rehabilitation care for children with autism spectrum disorder using the DIR/Floortime approach at st. Luke’s center for health and development. Russkiĭ Zhurnal Detskoĭ Nevrologii, 17(4), 33-43.

Romanovsky N.V. Evidence Base Analysis of the Effectiveness of Early Intervention Models: the DIRFloortime Model and the ESDM Model. Part 1. DIRFloortime Model. Autizm i narusheniya razvitiya = Autism and Developmental Disorders, 2023. Vol. 21, no. 4, pp. 26–33. DOI: 10.17759/autdd.2023210403. (In Russ., аbstr. in Engl.) https://psyjournals.ru/en/journals/autdd/archive/2023_n4/romanovskiy

Romanovsky, N.V., Itskovich, G., Strikha, O.E. (2022). Trialability of FEAS Structured Observation Scale on a Sample of Russian-Speaking Children. In: Arinushkina, A.A., Korobeynikov, I.A. (eds) Education of Children with Special Needs . Springer, Cham.

Mirzakhani, N., Asadzandi, S., Ahmadi, M. S., Saei, S., & Pashmdarfard, M. (2022). The effect of son-rise and floor-time programs on social interaction skills and stereotyped behaviors of children with autism spectrum disorders: A clinical trial. Cadernos Brasileiros De Terapia Ocupacional, 30, e3253.

Shamsudin, Iylia & Brown, Ted & Yu, Mong-Lin & Lentin, Primrose. (2021). Parents of children with autism spectrum disorder’s perception on parent-implemented home-based developmental, individual-difference and relationship (DIR)/Floortime ® intervention. Advances in Autism. ahead-of-print. 10.1108/AIA-05-2020-0032.

Thayer, F. & Bloomfield, B.S., (2021) An evaluation of a developmental individual differences relationship-based (DIR®)- creative arts therapies program for children with autism, The Arts in Psychotherapy,73. https://doi.org/10.1016/j.aip.2020.101752.

Itskovich, G. (2021). Therapeutic strategies for adults with ASD. building romantic and intimate relationships; starting family. Autizm i Narušenie Razvitiâ, 19(3), 15-22.

Pacheco, P., Pacheco, M., & Molini-Avejonas, D. (2021). Study of 18 months of follow up dir floortime intervention in preschool children with autism spectrum disorder (ASD). European Psychiatry, 64(S1), S503-S503. doi:10.1192/j.eurpsy.2021.1346.

Romanovskiy Nikolay, P., & Anna, A. (2020). Family and child in the DIR/Floortime approach. Психология и Психотерапия Семьи, 12(2)https://doi.org/10.24411/2587-6783-2020-10009.

Akulova, E. (2020). Implementation of the DIR model and the DIR/Floortime approach in the system of palliative care for children. Mental Health (Ciampino), 3(1), 17-20.

Binns, A. and Cardy, J.0. (2019), Developmental social pragmatic interventions for preschoolers with autism spectrum disorder: A systematic review. Autism and Developmental Language Impairments. 2019 Jan; Vol 4(1), 1-18.

Itskovich, G. (2019). DIR®-informed approach to anxiety and trauma in school age children. Mental Health (Ciampino), 2(2), 11-25.

Pajareya, K, Sutchritpongsa, S, Kongkasuwan, R. (2019) DIR/Floortime® Parent Training Intervention for Children with Developmental Disabilities: a Randomized Controlled Trial. Siriraj Medical Journal. 2019. 71(5), 331-338.

Binns, A, Hutchinson, L, and Oram Cardy, J (2018). The speech-language pathologist;s role in supporting thedevelopment of self-regulation: A review and tutorial. Journal of Communication Disorders (2018) 78, 1-17.

Sealy, J. and Glovinsky, I. P. (2016), Strengthening the Reflective Functioning Capacitiesof Parents Who have a Child with a Neurodevelopmental Disability through a Brief,Relationship-Focused Intervention. Infant Mental Health Journal. Doi: 10.1002/imhj.21557.

Casenhiser DM, Binns A, McGill F, Morderer O, Shanker SG. (2015). Measuring and supportinglanguage function for children with autism: evidence from a randomized controltrial of a social-interaction-based therapy. Journal of Autism and Developmental Disorders, 2015 Mar; 45(3):846-57.

Liao ST, Hwang YS, Chen YJ, Lee P, Chen SJ, Lin LY. (2014) Home-based DIR/FloortimeTM intervention program for preschool children with autism spectrum disorders: Preliminary findings. PhysOccupTherPediatr; 34:356–67.

Shu-Ting Liao, Yea-Shwu Hwang, Yung-Jung Chen, Peichin Lee, Shin-Jaw Chen & Ling-Yi Lin (2014) Home-based DIR/Floortime™ Intervention Program for Preschool Children with Autism Spectrum Disorders: Preliminary Findings, Physical & Occupational Therapy In Pediatrics, 34:4, 356-367, DOI: 10.3109/01942638.2014.918074.

Solomon, R., Van Egeren, L., Mahoney, G., Quon Huber, M., Zimmerman, P. (2014). PLAY Project Home Consultation Intervention Program for Young Children With Autism Spectrum Disorders: A Randomized Controlled Trial. Journal of Developmental and Behavioral Pediatrics, 35(8), 475-485. http://www.playproject.org/assets/PLAY_Project_Home_Consultation_Intervention.1.pdf

Mok, J.W.S. and Chung, K.H. (2014). Application ofDIR/Floortime Model in the Psychiatric Service for Very Young Children with Autism in Hong Kong. Hong Kong Journal of Mental Health. 2014, 40(1), 23-30.

Guiot, G, Meini, C, and Sindelar, M.T. (2012). Autismo e musica: il modello Floortime nei disturbi della comunicazione e della relazione. Difficoltà di apprendimento. 17(3), 103-113.

Casenhiser D.M., Shanker, S., Stieben J. (2011). Learning Through Interaction in Children with Autism: Preliminary Data from a Social-Communication-Based Intervention. Autism, published online September 26, 2011.

Christian, G (2011). A Person-Centered Approach to Problem Behavior: Using DIR®/Floortime with Adults Who Have Severe Developmental Delays. The NADD Bulletin, 2011, March/April, 14(2), 21-31.

Dionne M, Martini R. Floor Time play with a child with autism: A single-subject study. Revue canadienne d'ergotherapie, juin 2011, 78(3).

Pajareya K, Kopmaneejumruslers K. A pilot randomized controlled trial of DIR/Floortime parent training intervention for pre-school children with autistic spectrum disorders. Autism, published online before print, June 13, 2011.

Recent Relevant Evidence Based Practice Reviews

Binns, A. V., & Oram Cardy, J. (2019). Developmental social pragmatic interventions for preschoolers with autism spectrum disorder: A systematic review. Autism & Developmental Language Impairments, 4. https://doi.org/10.1177/2396941518824497 (Original work published 2019)

Boshoff K, Bowen H, Paton H, et al (2020). Child Development Outcomes of DIR/Floortime TM-based Programs: A Systematic Review. Canadian Journal of Occupational Therapy. 87(2):153-164. doi:10.1177/0008417419899224.

Cheng, W.M., Smith, T.B., Butler, M. et al. (2022). Effects of Parent-Implemented Interventions on Outcomes of Children with Autism: A Meta-Analysis. J Autism Dev Disord. https://doi.org/10.1007/s10803-022-05688-8

Divya, K.Y., Begum, Farzana; John, Sheeba Elizabeth; Francis, Frincy. (2023). DIR/Floor Time in Engaging Autism: A Systematic Review. Iranian Journal of Nursing and Midwifery Research 28(2):p 132-138, Mar–Apr 2023. DOI: 10.4103/ijnmr.ijnmr_272_21 \.

Mercer, J. (2017). Examining DIR/Floortime as a Treatment for Children with Autism Spectrum Disorders: A Review of Research and Theory. Research on Social Work Practice, 27(5), 625–635.

Sandbank, M., Bottema-Beutel, K., Crowley, S., Cassidy, M., Dunham, K., Feldman, J. I., Crank, J., Albarran, S. A., Raj, S., Mahbub, P., & Woynaroski, T. G. (2020). Project AIM: Autism intervention meta-analysis for studies of young children. Psychological Bulletin, 146(1), 1–29. https://doi.org/10.1037/bul0000215.

Smith, T., & Iadarola, S. (2015). Evidence Base Update for Autism Spectrum Disorder. Journal of Clinical Child & Adolescent Psychology, 44(6), 897–922. https://doi.org/10.1080/15374416.2015.1077448

The National Clearinghouse on Autism Evidence & Practice lists Parent-Implemented Interventions such as Floortime as Evidence-Based Practices in their most recent edition of the Evidence-Based Practices for Children, Youth, and Young Adults with Autism.

The European Society for Child and Adolescent Psychiatry practice guidance for autism: a summary of evidence-based recommendations for diagnosis and treatment indicates that "At the present time, the strongest evidence for interventions for young autistic children comes from large-scale, randomised trials of developmentally based approaches designed to facilitate social communication between very young children and their parents. The main focus is on adult–child synchrony, with parents learning to respond to their child’s communicative cues in ways that encourage spontaneous communication, and create opportunities for shared attention, child initiations, and spontaneous play."

2010 Centers for Medicaid and Medicare Commissioned IMPAQ Report on Autism Services (This report preceded all of the RCT studies on Floortime and still listed Developmental Relationship-based Approaches as a level 2 emerging evidence-based intervention.)

INTERESTING RELATED STUDIES

A study out of New York University found that the intense interests that often accompany autism in adults can not only be helpful to their self-regulation, but also in finding fulfilling career paths. Read about it HERE.

A research study calls into question the practice of defaulting to Early intensive behavioral intervention (EIBI) and more recently, the naturalist developmental behavioral intervention (NDBI) in favor of strengths-based approaches, based on the latest neuroscience autism-related research. You can see the study HERE.

Effect of Transdisciplinary Approach in Group Therapy to Develop Social Skills for Children with Autism Spectrum Disorder

Other DIR Related Research

Affleck, G., et al. (2001). Promise of relationship-focused early intervention in developmental disabilities. Journal of Special Education, 16, 413-430.

Brown, J. A., &; Woods, J. J. (2015). Effects of a triadic parent-implemented home-based communication intervention for toddlers. Journal of Early Intervention, 37(1), 44–68. doi: 10.1177/1053815115589350.

Deb, S., Retzer, A., Roy, M., Acharya, R., Limbu, B., & Roy, A. (2020). The effectiveness of parent training for children with autism spectrum disorder: A systematic review and meta-analyses. BMC Psychiatry, 20(1), 583-583.

Deniz E., Francis G., Torgerson C., Toseeb U. Parent-mediated play-based interventions to improve social communication and language skills of preschool autistic children: A systematic review and meta-analysis protocol. PLoS One. 2022 Aug 15;17(8):e0270153. doi: 10.1371/journal.pone.0270153. PMID: 35969530; PMCID: PMC9377609.

Dijkstra-de Neijs, L., Tisseur, C., Kluwen, L. A., van Berckelaer-Onnes, I. A., Swaab, H., & Ester, W. A. (2023). Effectivity of play-based interventions in children with autism spectrum disorder and their parents: A systematic review. Journal of Autism and Developmental Disorders, 53(4), 1588-1617.

Dominguez, G., Dominguez, J., Stieben, J. & Shanker, S. (2013), The Imaginary part of coherency in autism: Differences in cortical functional connectivity in preschool children, PLOS ONE.

Factor, R. S., Ollendick, T. H., Cooper, L. D., Dunsmore, J. C., Rea, H. M., & Scarpa, A. (2019). All in the family: A systematic review of the effect of caregiver-administered autism spectrum disorder interventions on family functioning and relationships. Clinical Child and Family Psychology Review, 22(4), 433-457.

Gernsbacher M.A., (2006). Toward a behavior of reciprocity. Journal of Developmental Processes, 1, 139-152. http://psych.wisc.edu/lang/pdf/gernsbacher_reciprocity.pdf

Gernsbacher has shown that intervention can change the way parents interact to increase reciprocity and that these changes are correlated with changes in social engagement and in language.

Harris, K. I. (2022). Through a child's eyes: Using floor play to connect with children and families. YC Young Children, 77(2), 36-42.

Hess, E. B. (2015). DIR®/Floortime™: A Developmental/Relational play therapy approach toward the treatment of children with developmental delays, including autism spectrum disorder (ASD) and sensory processing challenges. In K. J. O'Connor, C. E. Schaefer & L. D. Braverman (Eds.), Handbook of play therapy (pp. 357-379). John Wiley & Sons, Inc.

Jurek, L., Leadbitter, K., Falissard, B., Colin, C., Touzet, S., & Geoffray, M. (2023). Parental experience of parent-mediated intervention for children with ASD: A systematic review and qualitative evidence synthesis. Autism: The International Journal of Research and Practice, 27(3), 47-666.

Kasari et al. 2008 used a randomized, controlled trial looking at joint attention and symbolic play in 58 children with autism. Results indicate that expressive language gains were greater for treatment groups that used developmental approaches compared with the control group that was based only on behavioral principles.

Kasari, Connie; Paparella, Tanya; Freeman, Stephanny; Jahromi, Laudan B. “Language outcome in autism: Randomized comparison of joint attention and play interventions.” Journal of Consulting and Clinical Psychology. Vol. 76(1), Feb 2008, 125-137.

Kim, J. and Mahoney, G. (2005). The effects of relationship focused intervention on Korean parents and their young children with disabilities. Research in Developmental Disabilities, 26, 117-130.

Kurzrok, J., McBride, E., & Grossman, R. B. (2021). Autism-specific parenting self-efficacy: An examination of the role of parent-reported intervention involvement, satisfaction with intervention-related training, and caregiver burden. Autism, 25(5), 1395-1408.

Leadbitter, K., Macdonald, W., Taylor, C., & Buckle, K. L. (2020). Parent perceptions of participation in aparent-mediated communication-focused intervention with their young child with autism spectrumdisorder. Autism, 24(8), 2129–2141.

Liu, X., & Schertz, H. H. (2022). Parents Outcomes of Parent-Mediated Intervention for Toddlers With Autism. Topics in Early Childhood Special Education, 42(3), 259–268.

Mahoney, G., and F. Perales. (2004). “Relationship-focused early intervention with children with pervasive developmental disorders and other disabilities: a comparative study.” Journal of Developmental & Behavioral Pediatrics 26, 77-85.

Mahoney, G., & Perales, F. (2003). Using relationship-focused intervention to enhance the Social—Emotional functioning of young children with autism spectrum disorders. Topics in Early Childhood Special Education, 23(2), 74-86.

Minishew, N.J. and Williams, D.L. (2008) Brain behavior connections in autism. In K.D. Buron and P. Wolfberg (Eds.), Educating learners on the autism spectrum: Translating theory into meaningful practice. Shawnee, K.S.: Autism Asperger Publishing Co.

Dr. Nancy Minishew presented neurological findings regarding the differences in persons with and without autism, and suggested that affect-based interventions are critical to address the underlying neurological core deficits in autism.

Nevill R. E., Lecavalier L., Stratis E. A. (2018). Meta-analysis of parent-mediated interventions for young children with autism spectrum disorder. Autism, 22(2), 84–98.

Oono I. P., Honey E. J., McConachie H. (2013). Parent-mediated early intervention for young children with autism spectrum disorders (ASD). Evidence-Based Child Health: A Cochrane Review Journal, 8(6), 2380–2479.

Praphatthanakunwong, N., Kiatrungrit, K., Hongsanguansri, S., & Nopmaneejumruslers, K. (2018). Factors associated with parent engagement in DIR/Floortime for treatment of children with autism spectrum disorder. Shanghai Archives of Psychiatry, 31(2), 82–90.

Rai, S., & Rahman, S. (2022). Autism spectrum disorder and interventions. Indian Journal of Positive Psychology, 13(4), 428-431.

Rust, K. L., & Thanasiu, P. L. (2019). Parent-mediated, play-based counseling interventions: Use of affective engagement to treat autism spectrum disorder in young children. Journal of Mental Health Counseling, 41(3), 189-202.

Seo, J., France, K., McLay, L., & Waddington, H. (2022). Parents’ perceptions of coaching and low-intensity therapy for young children on the autism spectrum. Advances in Neurodevelopmental Disorders, 6(1), 65-75.

Shahi, Y., Arjmandnia, A. A., Arjmandnia, A. A., & Ghavami, F. (2022). The effectiveness of a music-based developmental relation therapy program on the promotion of the mother-child relationship of children with an autistic spectrum disorder. Ravānshināsī-i Afrād-i istis̠nāyī (Online), 12(47), 1-32.

Shanker, S (2012) Calm Alert and Learning: Classroom Strategies for Self-Regulation. New York: Pearson.

Shanker, S (2013) Emotion regulation through the ages. In T. Racine & A. Foolen (eds.), Moving Ourselves.

Shanker, S and J Stieben (2009), ‘The Roots of Mindblindness’, in Ivan Leudar (ed.), Against Theory of Mind. London, Palgrave Macmillan.

Shanker, S & Casenhiser, D (2013), Reducing the Effort in Effortful Control. In The Role and use of Conceptual Analysis in Psychology, T. Racine & K Slaney (Eds.). Palgrave.

Sigman, M., Siller, M. (2003). The origin of language: Evidence from longitudinal research in autism. Journal of Developmental and Learning Disorders, 7 1-14.

Williams, D.I. (2008). What neuroscience has taught us about autism. Zero to Three. 11-17

Behavioral Services Just don't work Well

The above heading is a provocative statement, but it is not just an opinion. Many have been saying this for years and more and more studies and reviews are supporting the statement. Click here for a recent research study examining outcomes when using behavioral interventions with preschoolers.

Here is a Very Compelling Podcast About the Latest Research on Autism

Effect_Size_Matters.mp3

Click here to go to the Carlat Report website to listen to the podcast.

DIRFloortime Research Forum

Click here to join

(When you request access, please provide a detailed reason for your request. All requests without any reason provided will be refused. Thank you.)

In Floortime, we seek to maximize the number of "circles of communication" during the Floortime process. This back-and-forth communication helps the brain develop. Check out this study:

Evidence-Base for DIRFloortime: A White Paper. This is a comprehensive paper examining the research base for DIR by Dr. Diane Cullinane. It includes many of the studies cited on this page plus a chronological perspective on the development of the research. If you are interested in the research, this is a great resource.

research on the DIR-based assessment tools:

Functional Emotional Assessment Scale (FEAS)

Greenspan Social-Emotional Growth Chart

Functional Emotional Assessment Scale

The Functional Emotional Assessment Scale by Stanley Greenspan, Georgia DeGangi, & Serena Wieder enables clinicians, educators, and researchers to observe and measure emotional and social functioning in infants, young children, and their families. Historically, the complexity of emotional functioning has been difficult to measure and assess. The FEAS meets this longstanding need of the field. The FEAS conceptualizes, operationalizes, and measures in a reliable and valid manner:

The full range of emotional functioning of infants, young children, and their families.
Naturally occurring emotional interactions between infants, children, and caregivers in a variety of settings, including home and school.
Both easily observable emotional behaviors and the subtle, more difficult to measure, deeper levels of emotional functioning.

Click here to read more on the FEAS development

Purchase the Book and Score Sheets

Download the Book and Score Sheets (FREE):

Recent Research on the FEAS

Even More...

Developmental Patterns and Outcomes in Infants and Children with Disorders in Relating and Communicating: A Chart Review of 200 Cases of Children with Autistic Spectrum Diagnoses by Stanley I. Greenspan, M.D., & Serena Wieder, Ph.D.

Charts of 200 children who were diagnosed with autistic spectrum disorder were reviewed. The goal of the review was to reveal patterns in presenting symptoms, underlying processing difficulties, early development and response to intervention in order to generate hypotheses for future studies. The chart review suggests that a number of children with autistic spectrum diagnoses are, with an appropriate intervention program, capable of empathy, affective reciprocity, creative thinking, and healthy peer relationships; that an intervention approach that focuses on individual differences, developmental level, and affective interaction may be especially promising; and that there are different underlying processing patterns with a difficulty in connecting affect and sequencing capacities as a possible common denominator. It also suggests that there is an early marker, the difficulty in engaging in complex purposeful gestural communication, and that contrary to traditional beliefs, a significant number of children may have relatively better functioning in the first year with a regression in the second and third years. This review also suggest that difficulties with relating and intimacy are often secondary to underlying processing disturbances. Many children can become quite loving and caring, thoughtful, and creative, suggesting a need to change the criteria for diagnosing these disorders. To read the complete article please click here.

DIRFloortime and Autism Spectrum Disorders: Overview and Summary of Scientific and Public Support

(An older 2010 overview, but some good information and links still...)

The Developmental, Individual Difference, Relationship-based (DIR/Floortime) Model is a developmental, interdisciplinary framework that enables clinicians, parents and educators to construct a comprehensive assessment and intervention program based on the child’s and family’s unique developmental profile. It enables the individual working with the child to enter the child’s world, bring the child into a shared world, and then interact with the child in ways that build the foundations for social, emotional, and intellectual development. The profile includes understanding the child’s emotional, social, and intellectual level; individual differences in motor, sensory, and language functioning; and the existing caregiver, child and family functioning and interaction patterns.

Built on years of research in developmental psychology that underscores the importance of early relationships and family functioning, DIR Floortime also integrates research contributions from various disciplines, such as speech and language pathology, occupational therapy, social work, and marriage and family therapy. Neuroscience research lends further support to developmental interventions. Early relationships and reciprocal interactions between infants and caregivers appear vital for the creation of healthy brain development, including for example wiring the pre-frontal cortex. These diverse contributions provide a rich structure so that clinicians can understand the child and family’s unique profile. This understanding is crucial for implementing a comprehensive assessment and intervention program for children with autism spectrum disorder (ASD) as well as related special needs conditions. View this 2010 article.

Guidelines for Early Identification, Screening, and Clinical Management of Children With Autism Spectrum Disorders by Stanley I. Greenspan, MD, T. Berry Brazelton, MD, José Cordero, MD, MPH, Richard Solomon, MD, MPH, FAAP, Margaret L. Bauman, MD, FAANP, Ricki Robinson, MD, MPH, FAAP, Stuart Shanker, DPhil and Cecilia Breinbauer, MD, MPH

National Academy of Sciences Report, "Excerpts from Engaging Autism Using the Floortime Approach to Help Children Relate, Communicate, and Think" by Stanley I. Greenspan, M.D., Serena Wieder, Ph.D. A Merloyd Lawrence Book Da Capo Lifelong Books A Member of the Perseus Books Group

The National Academy of Sciences (NAS), in its report“ Educating Children with Autism” (National Academy of Sciences, Committee on Educational Interventions for Children with Autism, NRC, 2001), states that there is research support for a number of approaches, including DIR/Floortime and behavioral interventions, but that there are no proven “relationships between any particular intervention and children’s progress” (page 5) and “no adequate comparisons of different comprehensive treatments” (page 8). The report concludes that effective interventions vary depending on an individual child’s and family’s needs. The NAS analysis further indicates that behavioral interventions are moving toward naturalistic, spontaneous types of learning situations that follow the child’s interests, and note that “studies have reported that naturalistic approaches are more effective than traditional discrete trial at leading to generalization of language gains to natural contexts: (Koegel, Camarata, Valdez Menchaca, and Koegel, 1998; McGee, Krantz, and McClannahan, 1985). To read the rest complete article please click here.

A Ten to Fifteen Year Follow-Up of a Subgroup of Children with Autism Spectrum Disorders (ASD) Who Received a Comprehensive Developmental, Individual-Difference, Relationship-Based (DIR) Approach By Dr. Stanley I. Greenspan & Dr. Serena Wieder

A follow-up study of 16 children diagnosed with an autistic spectrum disorder (ASD) revealed that with the DIRFloortime approach, a subgroup of children with ASD can become empathetic, creative, and reflective, with healthy peer relationships and solid academic skills. This suggests that some children with ASD can overcome challenges and reach levels of development formerly thought unattainable with a family-oriented approach that focuses on the building blocks of relating, communicating, and thinking. To read the complete article please click here