Developmentally-based Individual-difference Relationship-based intervention (DIR)/Floor Time

Description: Also called Greenspan Method or DIR, in Floor Time, the adult aims to engage the child with autism spectrum disorder (ASD) by following his/her lead during play activities that capture the child’s interest. The adult seeks to extend or elaborate on the child’s activities. For example, if the child wants to line up cars in a row, the parent or service provider may playfully intrude in this activity (e.g., moving one of the cars or blocking a car and asking where it’s going). Floor Time is usually provided by parents under the direction of psychologists. However, it may be an intervention strategy used by professionals in other disciplines such as speech therapy or special education.

Research Summary: To date there are no studies with strong experimental designs evaluating whether or not DIR intervention is effective. Two large studies have recently evaluated DIR; however, substantial methodological limitations preclude drawing any conclusions regarding the effectiveness of this method.

Recommendations: An important area for future research is to evaluate DIR in studies with strong experimental designs. Professionals should present DIR as untested and encourage families who are considering this intervention to evaluate it carefully.

Selected References:

Selected scientific studies:

Solomon, R., Van Egeren, L. A., Mahoney, G., Huber, M. S. Q., & 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. doi: 10.1097/DBP.0000000000000096

Casenhiser, D. M., Shanker, S. G., & Stieben, J. (2011). Learning through interaction in children with autism: Preliminary data from a social-communication based intervention. Autism. DOI: 10.1177/1362361311422052

Pajayera, K., & Nopmaneejumruslers, K. (2011). A pilot randomized controlled trial of DIR/Floortime™ parent training intervention for pre-school children with autistic spectrum disorders. Autism. DOI: 10.1177/1362361310386502

Systematic reviews of scientific studies:

Zane, T., Weiss, M.J., Dunlop, K. and Southwick, J. Relationship-Based Therapies for Autism Spectrum Disorders. In R. M. Foxx & J. A. Mulick (Eds.) (2016). Controversial Therapies for Autism and Intellectual Disabilities: Fads, Fashion and Science in Professional Practice. (pp. 357-371). New York, NY: Routledge.

Myers, S. M., & Johnson, C. P. (2007). Management of Children With Autism Spectrum Disorders. Pediatrics, 120, 1162-1182.

Related article:

Pilot study of a parent training program for young children with autism: The PLAY project home consultation program