To review and assess theory and research supporting DIR/Floortime™, a method proposed for treatment of young children with autism spectrum disorders (ASD).
Methods:
Published materials describing the principles of DIR/Floortime™ were evaluated. Published outcome research articles were assessed for the adequacy of their design and implementation and the extent to which their conclusions were supported.
Results:
The theoretical basis of DIR/Floortime™ appears to be generally plausible. Of the 10 outcome research articles in print, all concluding that DIR™ effectively treated ASD, five provided a comparison group, or used a randomized design, or did both. These studies failed to equalize the duration and frequency of DIR™ and the comparison treatment.
Conclusions:
DIR™ can be considered by social work practitioners as a possibility for evidence-based practice (EBP), but not as an evidence-based treatment (EBT). Further outcome research needs to concentrate not only on randomized design but on other design issues.
AddisonL. R.PiazzaC. C.PatelM. R.BachmeyerM. H.RivasK. M.MilnesS. M.OddoJ. (2012). A comparison of sensory integrative and behavioral therapies as treatment for pediatric feeding disorders. Journal of Applied Behavior Analysis, 45, 455–471.
2.
AyresA. J. (1964). Tactile functions: The relation to hyperactive and perceptual motor behavior. Perceptual and Motor Skills, 20, 288–292.
3.
AyresA. J. (1979). Sensory integration and the child. Los Angeles, CA: Western Psychological Services.
4.
BarrettB. T. (2009). A critical evaluation of the evidence supporting the practice of behavioural vision therapy. Ophthalmic and Physiologic Optics, 29, 4–25.
5.
BeaudetA. L. (2012). Preventable forms of autism. Science, 338, 342–343.
6.
BowlbyJ. (1982). Attachment. New York, NY: Basic.
7.
BrissonJ.WarreynP.SerresJ.FoussierS.Adrien-LouisJ. (2012). Motor anticipation failure in infants with autism: A retrospective analysis of feeding situations. Autism, 16, 420–429.
8.
CasenhiserD. M.ShankerS. G.StiebenJ. (2013). Learning through interaction in children with autism: Preliminary data from a social-communication-based intervention. Autism, 17, 220–241.
9.
CrockenbergS. (1992). How children learn to resolve conflicts in families. Zero to Three, 12, 11–13.
10.
CullinaneD. (2015). Evidence base for DIR/Floortime™. Retrieved fromwww.icdl.com/research
11.
DeGangiG.GreenspanS. I. (1989a). Test of sensory functions in infants. Los Angeles, CA: Western Psychological Services.
12.
DeGangiG.GreenspanS. I. (1989b). The assessment of sensory functioning in infants. Journal of Physical and Occupational Therapy in Pediatrics, 9, 21–33.
13.
DeGangiG.GreenspanS. I. (2001). Research on the FEAS: Test development, reliability, and validity studies. In GreenspanS. I.DeGangiG.WiederS. (Eds.), Functional emotional assessment scale: Clinical and research applications (pp. 167–247). Bethesda, MD: Interdisciplinary Council on Developmental and Learning Disorders.
14.
DionneM.MartiniR. (2011). Floor Time Play with a child with autism: A single-subject study. Canadian Journal of Occupational Therapy, 78, 196–203.
15.
EriksonE. (1950). Childhood and society. New York, NY: Norton.
16.
GottliebG. (1971). Ontogenesis of sensory functions in birds and mammals. In TobachE.AronsonL.ShawE. (Eds.), The biopsychology of development (pp. 67–128). New York, NY: Academic.
17.
GreenM. D. A.WachsH.DeeM. (2014). Successful optometric vision therapy with patients on the autistic spectrum: Engaging patients with visual-cognitive therapy. Optometry & Visual Performance, 2, 235–239.
18.
GreenspanS. I. (1979). Intelligence and adaptation: An integration of psychoanalytic and Piagetian developmental psychology. Psychological Issues Monographs, Nos. 47-48. New York, NY: International Universities Press.
19.
GreenspanS. I. (1992). Infancy and early childhood: The practice of clinical assessment and intervention with emotional and developmental challenges. Madison, CT: International Universities Press.
20.
GreenspanS. I. (2001). The affect diathesis hypothesis: The role of emotions in the core deficit in autism and in the development of intelligence and social skills. Journal of Developmental and Learning Disabilities, 5, 1–46.
21.
GreenspanS. I.WiederS. (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, 1–38.
22.
GreenspanS. I.WiederS. (2006). Engaging autism. New York, NY: Da Capo.
23.
HoehnT. P.BaumeisterA. A. (1994). A critique of the application of sensory integration therapy to children with learning disabilities. Journal of Learning Disabilities, 27, 338–350.
24.
HyattK. J.StevensonJ.CarterM. (2009). A review of three controversial educational practices: Perceptual motor programs, sensory integration, and tinted lenses. Education and Treatment of Children, 32, 313–342.
25.
JernbergA. (1979). Theraplay: A new treatment using structured play for problem children and their families. San Francisco, CA: Jossey-Bass.
26.
KaganJ. (1984). The nature of the child. New York, NY: Basic.
27.
KiddC.PiantadosiS. T.AslinR. N. (2012). The Goldilocks effect in infant auditory attention. Child Development, 85, 1795–1804.
28.
KurtzL. A. (2008). Understanding controversial therapies for children with autism, Attention Deficit Disorder, and other learning disabilities. London, England: Jessica Kingsley.
LindenM. (2013). How to define, find, and classify side effects in psychotherapy: From unwanted events to adverse treatment reactions. Clinical Psychology and Psychotherapy, 20, 286–296.
31.
LovaasO. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9.
32.
MaglioneM.GansD.DasL.TimbieJ.KasaniC. (2012). Nonmedical interventions for children with ASD: Recommended guidelines and further research needs. Pediatrics, 130, S169–S178.
33.
MahoneyG.PeraqlesF. (2005). Relationship focused early intervention with children with pervasive developmental disorders and other disabilities: A comparative study. Journal of Developmental and Behavioral Pediatrics, 26, 77–85.
34.
MercerJ. (2014). Alternative psychotherapies. Lanham, MD: Rowman & Littlefield.
35.
MorganL. J.RubinE.ColemanJ. J.FrymarkT.WangB. P.CannonL. J. (2014). Impact of social communication interventions on infants and toddlers with or at-risk for autism: A systematic review. Focus on Autism and Other Developmental Disabilities, 29, 246–256.
36.
PajarayaK.NopmaneejumruslersK. (2011). A pilot randomized controlled trial of DIR/Floortime™ parent training intervention for pre-school children with autistic spectrum disorders. Autism, 15, 563–577.
37.
PortalesA. W.PorgesS. W.GreenspanS. I. (1990). Parenthood and the difficult child (abstract). Infant Behavior and Development, 13, 573.
RosenG. M.DavisonG. C. (2003). Psychology should list empirically supported principles of change (ESPs) and not credential trademarked therapies or other treatment packages. Behavior Modification, 27, 300–312.
40.
SaltJ.SellarsV.ShemiltJ. C.BoydS.CoulsonT.McCoolS. (2001). The Scottish Centre for Autism preschool treatment programme: I. A developmental approach to early intervention. Autism, 5, 362–373.
41.
SaltJ.ShemiltJ.SellarsV.BoydS.CoulsonT.McCoolS. (2002). The Scottish Centre for Autism preschool treatment programme. II. The results of a controlled treatment outcome study. Autism, 6, 33–46.
42.
SolomonR.NechelesJ.FerchC.BruckmanD. (2007). Pilot study of apparent training program for young children with autism. Autism, 11, 205–224.
43.
SolomonR.van EgerenL. A.MahoneyG.HuberM. S. Q.ZimmermanP. (2014). PLAY Project Home Consultation intervention for young children with autism spectrum disorders: A randomized controlled trial. Journal of Developmental and Behavioral Pediatrics, 35, 475–485.
44.
SmithT.GroenA. D.WynnJ. W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal of Mental Retardation, 105, 269–285.
45.
SmithT.MruzekD. W.MozingoD. (2005). Sensory integrative therapy. In JacobsonJ. W.FoxxR. M.MulickJ. A. (Eds.), Controversial therapies for developmental disabilities (pp. 331–350). Mahwah, NJ: Lawrence Erlbaum.
VygotskyL. S. (1978). Mind in society. Cambridge, MA: Harvard University Press.
48.
WiederS.GreenspanS. I. (2003). Climbing the symbolic ladder in the DIR model through floor time/interactive play. Autism, 7, 425–435.
49.
WiederS.GreenspanS. I. (2005). Can children with autism master the core deficits and become empathetic, creative, and reflective?Journal of Developmental and Learning Disorders, 9, 1–29.
50.
WiederS.WachsH. (2012). Visual/spatial portals to thinking, feeling, and movement: Advancing competencies and emotional development in children with learning and autism spectrum disorders. Mendham, NJ: Profectum.
51.
YarrowL.McQuistenS.MacTurkR. H.McCarthyM. E.KleinR. P.VietzeP. M. (1983). Assessment of mastery motivation during the first year of life: Contemporaneous and cross-age relationships. Developmental Psychology, 19, 159–171.
