1) The document summarizes outcomes from 200 cases of children with autism who received treatment using the DIR/Floortime model over an 8-year period. 58% showed good to outstanding outcomes, 25% showed medium outcomes, and 17% showed ongoing difficulties. 2) A closer look at 20 children with good outcomes found they scored similarly to typically developing peers on assessments of emotional, social, and intellectual functioning, unlike a group with continuing challenges. 3) The DIR/Floortime intervention was associated with higher adaptive skills in communication, socialization, and daily living compared to age levels for a sample of 15 children.

1. The DIR Model
Outcome Studies
Summary

2. 200 Cases of Children
• All children were seen for consultation or
treatment by Dr. Greenspan over an 8
year period.
• All children were evaluated on the autism
spectrum by 2 or 3 other evaluation teams
• All children were treated in accordance
with the comprehensive DIR Model
described in the book Engaging Autism

3. Developmental Patterns
Presenting Patterns
• 5% - no affective engagement
• 31% - only intermittent engagement
• Engagement • 40% - intermittent engagement and some
reciprocity
• 24% - intermittent engagement and
reciprocity and islands
• of symbolic capacity
• 100% - lacking long chains of reciprocal
interactions
• Auditory Processing Problems • 100%
• Motor Planning Dysfunction • 100%
• Reactivity to Sensation • 39% - Underreactive
• 19% - Hyperreactive
• 36% - Mixed
• *Journal of Developmental and Learning Disorders, 1997

4. DIR–Floortime Intervention
Outcomes
All Degrees of Implementation of
Recommended Program
N=200
• Good to Outstanding 58%
• Medium 25%
• Ongoing Difficulties 17%

5. Looking more closely at 20 children in the
good to
outstanding outcome group
• In 1997 Greenspan & Wieder used the Functional
Emotional Assessment Scale (FEAS. Greenspan,
DeGangi, & Wieder, 2001),
– a reliable and validated instrument which measures
emotional, social, and intellectual functioning
• Compared these 20 children to an age and
socioeconomic status-matched group of peers with no
history of developmental challenges, as well as a group
of children with ASD who had continuing challenges.
• They found there were no differences between the
DIR/Floortime intervention group and the “typical” peer
comparison group in terms of emotional, social, and
intellectual functioning, but significant differences with
the group that had continuing difficulties.
• They also assessed the group of twenty with the
Vineland Adaptive Behavior Scale,( Sparrow, Balla, &

6. FEAS Outcomes
N Mean FEAS Range
• DIR/Floortime 3 74.8 70-76
Intervention Group
• Normal Comparison 5 74.9 65-76
Group
• Continuing Significant
12 23.7 <20-40
Difficulties

7. Vineland Outcomes
Sample of Children with Good to Outstanding
Outcomes
N=15
• Higher than age
levels in • 93%
communication
• Higher than age • 87%
levels in socialization
• Higher than age • 53%
levels in daily living
skills

8. Recommended Books
Engaging Autism: Using the Floortime Approach to Help Children Relate,
Communicate, and Think, by Stanley I. Greenspan, M.D. & Serena Wieder,
Ph.D., 2006. Perseus Books, 800-242-7737.
The Child With Special Needs. by Stanley I. Greenspan, M.D. & Serena
Wieder, Ph.D., 1997. Perseus Books, 800-242-7737.
The Challenging Child. by Stanley I. Greenspan, M.D., 1995. Perseus Books.
The First Idea: How Symbols, Language and Intelligence Evolved from Our
Primate Ancestors to Modern Humans. By Stanley I. Greenspan, M.D. and
Stuart Shanker, Phil.D. 2004. Perseus Books, 800-242-7737.
Floor Time Techniques and the DIR Model for Children and Families with
Special Needs: Training Videotape Series. with Stanley I. Greenspan, M.D.
and Serena Wieder, Ph.D., 2001, a series of 13 videotapes available from ICDL,
301-656-2667.
Reaserch Support for a Comprehensive Developmental Approach to Autistic
Spectrum Disorders and Other Developmental and Learning Disorders: The
Developmental, Individual Difference, Relationship-Based Model. Stanley I.
Greenspan MD. Can be found at http://www.icdl.com - (301-656-2667)
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