Developmental Interventions
Greenspan's DIR/"Floor Time"
Greenspan and others have created a developmentally based intervention for early intervention with infants and children with disabilities, titled Developmental Individual-Difference, Relationship-Based Model (DIR). This is also commonly referred to as the "Floor Time" approach (Greenspan, 1998).
Floor Time is based upon Greenspan's theories of six functional milestones necessary for a child to succeed in further learning and development. According to Greenspan (1998), these are:
- The dual ability to take an interest in the sights, sounds and sensations of the world and to calm oneself down.
- The ability to engage in relationships with other people.
- The ability to engage in two-way communication with gestures.
- The ability to create complex gestures, to string together a series of actions into an elaborate and deliberate problem-solving experience.
- The ability to create ideas.
- The ability to build bridges between ideas to make them reality-based and logical.
DIR/Floor Time includes interactive experiences, which are child directed, in a low stimulus environment, ranging from two to five hours a day. During the preschool program, DIR/Floor Time includes integration with typically developing peers. Greenspan contends that interactive play, in which the adult follows the child's lead, will encourage the child to 'want' to relate to the outside world. Furthermore, Greenspan (1998) stipulates that the program should begin as soon as the child is identified as the longer children are uncommunicative, the more difficult parents find relating to them and the more the children withdraw.
No independent, peer-reviewed, published studies of Greenspan's DIR/Floor Time's effectiveness for children with autism were identified.
RDI
Relationship Development Intervention (RDI) is a series of techniques and strategies built upon the typical developmental processes of social competence. The goal of RDI is to increase motivation and interest in social relating in individuals with autism and to provide activities and coaching to assist them to enjoy and become competent in social relationships. In a preliminary evaluation, Gutstein compared the outcomes of 17 children who received RDI with 14 children who received other programs. The participants who received RDI were reported to have demonstrated greater improvement in ADOS scores, and independent classroom functioning than the participants who received other programs. However, the methodological problems and limitations of the study are extensive and preclude any confidence being placed in the findings. Given that more comprehensively evaluated programs exist for the treatment of autism, RDI should be considered an adjunct to those other interventions which have been shown to be effective (Perry & Condillac, 2003).
*Autism Diagnostic Observation Schedule