DIRFloortime® Evidence Base Summary
DIRFloortime® is an evidence-based model with a growing body of research including four randomized control trial (RCT) studies since 2011 (Casenhiser, Shanker, & Stiben, 2011; Lal & Chhabria, 2013; Pajareya & Nopmaneejumruslers, 2011; Solomon et al., 2014) two pre-post studies (Liao et al., 2014; Solomon, Necheles, Ferch, & Bruckman, 2007), and a single subject study (Dionne & Martini, 2011) offering support for it's efficacy. Findings include improvements in joint attention and social reciprocity and in parents' abilities to read their children's cues, follow their lead, and obtain reciprocal social exchanges (Casenheiser, Shanker, & Stiben, 2011). Casenheiser et. al. (2014) found that children receiving DIR® based treatment outperformed children in a control group on measures of functional language development. In the Solomon et al. (2014) study not only were improvements in social interaction found but also in autistic symptomatology and autism diagnostic category.
The recent research findings validate earlier case study research (Greenspan & Wieder, 1997, 2005) that suggested the promise of the DIR® model. The efficacy of developmental, relationship-based intervention has also been documented in numerous studies of other similar approaches (e.g., Aldred, Green, & Adams, 2004; Ingersoll, Brooke, Dvortcsak, Whalen, & Sikora 2005; Kasari, Gulsrud, Wong, Kwan, & Locke 2010; Kasari, Paparella, Freeman, & Jahromi, 2008; Landa, Holman, O’Neill, & Stuart 2011; Mahoney & Perales, 2005; Siller, Hutman, & Sigman, 2013). A recent (Sandbank et al., 2019) meta-analysis of research studies across seven different intervention types (behavioral, developmental, naturalistic developmental behavioral (NDBI), TEACCH, sensory-based, animal assisted, and technology-based) found that when study quality indicators were taken into account and only high quality RCT studies were considered, evidence of positive impact was only found for developmental (including the aforementioned DIR RCT studies) and NDBI studies (which incorporate a developmental component).
For a more in-depth review of the evidence base:
The recent research findings validate earlier case study research (Greenspan & Wieder, 1997, 2005) that suggested the promise of the DIR® model. The efficacy of developmental, relationship-based intervention has also been documented in numerous studies of other similar approaches (e.g., Aldred, Green, & Adams, 2004; Ingersoll, Brooke, Dvortcsak, Whalen, & Sikora 2005; Kasari, Gulsrud, Wong, Kwan, & Locke 2010; Kasari, Paparella, Freeman, & Jahromi, 2008; Landa, Holman, O’Neill, & Stuart 2011; Mahoney & Perales, 2005; Siller, Hutman, & Sigman, 2013). A recent (Sandbank et al., 2019) meta-analysis of research studies across seven different intervention types (behavioral, developmental, naturalistic developmental behavioral (NDBI), TEACCH, sensory-based, animal assisted, and technology-based) found that when study quality indicators were taken into account and only high quality RCT studies were considered, evidence of positive impact was only found for developmental (including the aforementioned DIR RCT studies) and NDBI studies (which incorporate a developmental component).
For a more in-depth review of the evidence base:
| evidence_base_for_dir_2015.doc |
References
Aldred, C., Green, J., & Adams, C. (2004). A new social communication intervention for children with autism: Pilot randomized controlled treatment study suggesting effectiveness. Journal of Child Psychology and Psychiatry, 45, 1420–1430.
Casenhiser, D, Binns, A., McGill, F., Morderer. O. & Shanker, S. (2014 ePub). Measuring and supporting language function for children with autism: Evidence from a randomized control trial of a social-interaction based therapy.
Casenhiser, D. M., Shanker, S. G., & Stiben, J. (2013). Learning through interaction in children with autism: Preliminary data from a social-communication-based intervention. Autism, 17(2), 220-241.
Dionne, M., & Martini, R. (2011). Floor Time Play with a child with autism: A single-subject study. Canadian Journal of Occupational Therapy, 78(3), 196-208.
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 of children with autistic spectrum diagnoses. Journal of Developmental and Learning Disorders, 1, 87-141.
Greenspan, S.I., & Wieder, S. (2005). Can Children with Autism Master the Core Deficits and Become Empathetic, Creative and Reflective? 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. The Journal of Developmental and Learning Disorders, 9, 39‐61.
Ingersoll, B., Dvortcsak, A., Whalen, C., & Sikora, D. (2005). The effects of a developmental, social-pragmatic language intervention on rate of expressive language production in young children with autistic spectrum disorders. Focus on Autism and Other Developmental Disorders 20(4), 213-222.
Kasari, C., Gulsrud, A.C., Wong, C., Kwon, S., & Locke, J. (2010). Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. Journal of Autism and Developmental Disorders, 40(9), 1045–1056.
Kasari, C., Paparella, T., Freeman, S., & Jahromi, L.B. (2008). Language outcome in autism: Randomized comparison of joint attention and play interventions. Journal of Consulting and Clinical Psychology, 76(1), 125-137.
Lal, R., & Chhabria, R. (2013). Early intervention of autism: A case for Floor Time approach. Recent Advances in Autism Spectrum Disorders, I. http://dx.doi.org/10.5772/54378
Landa, R.J., Holman, K.C., O’Neill, A.H., & Stuart, E.A. (2011). Intervention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder: A randomized controlled trial. Journal of Child Psychology and Psychiatry, 52(1), 13-21.
Liao, S.; Hwang, Y; Chen, Y.; Lee, P.; Chen, S & YiLin. (2014). Home-based DIR/Floortime intervention program for preschoolers with autism spectrum disorders: Preliminary findings. Physical and Occupational Therapy in Pediatrics. Early online: 1-12.
Mahoney, G., & Perales, F. (2005). Relationship-focused early intervention with pervasive developmental disorders and other disabilities: A comparative study. Developmental and Behavioral Pediatrics, 26, 77-85.
Pajareya, K., & Nopmaneejumruslers, K. (2011). A pilot randomized trial of DIR/Floortime™ parent training intervention for pre-school children with autistic spectrum disorders. Autism, 15(5), 563-577.
Sandbank, M., Bottema-Beutel, K., Crowley, S., Cassidy, M., Dunham, K., Feldman, J. I., Crank. J., Albarran, S. J., Raj, S., Mahbub, P., & Woynaroski, T. G. (2019). Project AIM: Autism intervention Meta-Analysis for Studies of Young Children. Psychological Bulletin.
Siller, M; Hutman, T & Sigman, M. (2013). A parent-mediated intervention to increase responsive parental behaviors and child communication in children with ASD: A randomized, clinical trial. Journal of Autism and Developmental Disorders. 43(3), 540-550.
Solomon, R. J., Necheles, J., Ferch, C., & Bruckman, D. (2007). Pilot study of a parent training program for young children with autism: The PLAY Project Home Consultation program. Autism, 11(3), 205.
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.
