From the Guidelines
DIR/Floortime is not recommended as a primary intervention for autism due to the lack of replicable evidence supporting its efficacy. The 2014 practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder published in the Journal of the American Academy of Child and Adolescent Psychiatry 1 highlights the methodological improvements and flaws in studies examining developmental, social-pragmatic models of intervention, including DIR/Floortime. While DIR/Floortime aims to develop social communication abilities through naturalistic techniques in the child's community setting, the current evidence does not support its use as a primary intervention.
Some key points to consider:
- The study notes that children with ASD are psychiatrically hospitalized at substantially higher rates than the non-ASD child population 1.
- The efficacy of DIR/Floortime intervention is unknown, and there is a lack of replicable evidence supporting its use 1.
- Other interventions, such as guided participation, Do-Watch-Listen-Say, and play organizers, have shown some evidence of improvement in social communication and generalization to other interactions 1.
In terms of alternative interventions, the study suggests that:
- Guided participation, which involves adult coaching and mediation by trained peers, may be an effective approach for infant/preschool-aged children 1.
- Social skills groups and peer network/circle of friends interventions may be beneficial for school-aged children and adolescents 1.
- Visual schedules, verbal rehearsal, and social thinking interventions may also be useful for adolescents with autism 1.
From the Research
DIR/Floortime in Autism
- DIR/Floortime is a treatment approach for autism that focuses on building relationships and improving communication skills 2, 3
- Studies have shown that DIR/Floortime can lead to significant improvements in emotional functioning, communication, and daily living skills in children with autism 2, 3
- Home-based DIR/Floortime intervention programs have been found to be effective in improving parent-child interactions and social interaction skills in children with autism 3
- DIR/Floortime is a cost-effective and child-led approach that can be initiated as early as possible, and has been found to have no adverse events for children or parents 2
Comparison with Applied Behavior Analysis (ABA)
- ABA has been supported by substantial empirical research as an effective treatment for autism 4, 5
- While ABA has been found to be effective in improving socialization, communication, and expressive language skills in children with autism, DIR/Floortime has been found to be effective in improving emotional functioning, communication, and daily living skills 2, 3, 6
- There is limited research comparing the effectiveness of DIR/Floortime and ABA, and more studies are needed to determine the relative efficacy of these approaches 6
Key Findings
- DIR/Floortime can lead to significant improvements in emotional functioning, communication, and daily living skills in children with autism 2, 3
- Home-based DIR/Floortime intervention programs can be effective in improving parent-child interactions and social interaction skills in children with autism 3
- DIR/Floortime is a cost-effective and child-led approach that can be initiated as early as possible, and has been found to have no adverse events for children or parents 2
- More research is needed to compare the effectiveness of DIR/Floortime and ABA, and to determine the relative efficacy of these approaches 6