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Thailand and
  Canada
    2011
Thailand Overview
 Thirty-two participants were enrolled in the study.
  Children were assigned to either the typical treatment
  or DIRFloortime™-supplemented treatment groups
 Intervention based on the DIRFloortime™
  intervention
 Parents added home-based DIRFloortime™
  intervention at an average of 15.2 hours/week for three
  months.
Parent Training
 The study treatment involved intervention entirely by the
  parents of children with ASD, rather than a therapist with a
  child
 Parents in the intervention group attended a one-day
  training workshop to learn about the DIRFloortime™
  model.
 Parents received a 3-hour DVD lecture taken from a
  workshop recorded by Dr. Stanley Greenspan.
 Parents were trained for 1.5 hours in a one-on-one session
  where they observed the investigator modeling the
  DIRFloortime™ techniques and were asked to
  independently demonstrate the same techniques.
Outcome Tools
 FEAS = Functional Emotional Assessment Scale
 (Greenspan et al., 2000)

 CARS = Childhood Autism Scale (Schopler et al., 1986)


 FEDQ = Functional Emotional Development
 Questionnaires (Greenspan and Greenspan, 2002).
Mean (SD) changes in standard
scores
         Control      Intervention

          (n=16)         (n=15)
 FEAS    1.9 (6.1)      7.0 (6.3)

 CARS    0.8 (1.2)      2.9 (2.0)

 FEDQ    0.8 (1.4)      7.7 (8.1)
Results
 On the FEAS the intervention group showed a gain of 7.0 points during
  the 3-month period, which was statistically significant compared to the
  gain of 1.9 points in the comparison group.

 Home-based DIRFloortime™ helped the children with autism to better
  engage, relate and communicate with their caregivers when compared
  to those who received the routine behavioral interventions.

 It was found that the 9 parents who added home-based DIRFloortime™
  intervention 10 hours per week or more made greater gains in the FEAS
  than the 6 parents who added the intervention less than 10 hours per
  week.

*Compared to the results of Solomon’s study, in which the FEAS
  increased from 38.1 to 44.6 within a 1-year period of DIRFloortime-
  based intervention, the children in the intervention group showed
  similar results within a shorter duration
Canada Overview
 Randomized controlled trial of 51 children aged 2 years
  to 4 years 11 months.
 All children were previously diagnosed with ASD
 Families in the target treatment group were given 2
  hours of therapy and coaching each week, and
  expected to spend 3 hours per day interacting with
  their child.
 Community Treatment (CT)group received a variety of
  services averaging 3.9 hours per week. After 1
  year, outcomes were measured to determine changes
  in the groups in social interaction and
  communication.
Measurements
 A modified version of the Child Behavior Rating Scale
  (Kim and Mahoney, 2004; Mahoney and Perales, 2003)
  (henceforth mCBRS) was used to rate children’s
  interactions with their parents at the beginning and 12
  months into treatment.
 The 5-point Likert-type scale is designed to track what
  Mahoney and colleagues call ‘pivotal behaviors’, (Core
 learning processes that mediate between parental
 responsiveness and developmental cognitive, linguistic and
 socio-emotional functioning).
Results
Capacity              Group          Pre Treatment   Post Treatment
                                     Scores(means)   Scores(means)
Attention to Activity Treatment      2.96            3.72
                      Standard       3.08            3.38
Involvement           Treatment      2.56            3.20
                      Standard       2.62            2.69
Compliance            Treatment      2.68            3.48
                      Standard       2.85            3.35
Initiation of Joint   Treatment      1.28            1.84
Attention
                      Standard       1.13            1.23
Enjoyment in          Treatment      3.08            3.28
Interaction
                      Standard       3.35            3.23
Results
The treatment group showed statistically significant results
 on the following capacities:

 Showed significantly greater enjoyment in interactions
  with their parents

 Were both significantly more attentive and more involved
  in interactions with their parents

 Initiated more joint attentional frames.

 That is, all but compliance.
Results
 Most children in the CT group received traditional
  behavioral interventions for autism. Behavioral
  interventions tend to emphasize teaching children to
  be compliant. Therefore, it would be expected that
  these children improve on Compliance.

 It is equally important to note that children in the
  treatment group, which did not specifically target this
  behavior, seemed to have made greater improvements
  in Compliance than the CT group, although it was not
  statistically significant at the .05 level.
Results
 Small positive changes made by the treatment group
  caregivers made a statistically significant difference in
  children’s development.
 There is an association between improvements in
  caregiver behaviors and improvements in children’s
  social-communicative functioning. The direction of
  the causality is not clear.
Reference-Thailand Study
Reference-Thailand Study

 A pilot randomized controlled trial of DIR/Floortime™ parent training intervention for
  pre-school children with autistic spectrum disorders

  Kingkaew Pajareya and Kaewta Nopmaneejumruslers
  Autism published online 13 June 2011
  The online version of this article can be found at:
  DOI: 10.1177/1362361310386502
     http://aut.sagepub.com/ Autism
     http://aut.sagepub.com/content/early/2011/06/01/1362361310386502
Reference Canada Study
    Learning Through Interaction in Children With Autism: Preliminary Data From a Social-Communication-
     Based Intervention

     Devin M. Casenhiser, Stuart G. Shanker and Jim Stieben
     Autism published online 26 September 2011
     The online version of this article can be found at:
     http://aut.sagepub.com/content/early/2011/09/20/1362361311422052

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Tgfa studies 3

  • 1. Thailand and Canada 2011
  • 2. Thailand Overview  Thirty-two participants were enrolled in the study. Children were assigned to either the typical treatment or DIRFloortime™-supplemented treatment groups  Intervention based on the DIRFloortime™ intervention  Parents added home-based DIRFloortime™ intervention at an average of 15.2 hours/week for three months.
  • 3. Parent Training  The study treatment involved intervention entirely by the parents of children with ASD, rather than a therapist with a child  Parents in the intervention group attended a one-day training workshop to learn about the DIRFloortime™ model.  Parents received a 3-hour DVD lecture taken from a workshop recorded by Dr. Stanley Greenspan.  Parents were trained for 1.5 hours in a one-on-one session where they observed the investigator modeling the DIRFloortime™ techniques and were asked to independently demonstrate the same techniques.
  • 4. Outcome Tools  FEAS = Functional Emotional Assessment Scale (Greenspan et al., 2000)  CARS = Childhood Autism Scale (Schopler et al., 1986)  FEDQ = Functional Emotional Development Questionnaires (Greenspan and Greenspan, 2002).
  • 5. Mean (SD) changes in standard scores Control Intervention (n=16) (n=15)  FEAS 1.9 (6.1) 7.0 (6.3)  CARS 0.8 (1.2) 2.9 (2.0)  FEDQ 0.8 (1.4) 7.7 (8.1)
  • 6. Results  On the FEAS the intervention group showed a gain of 7.0 points during the 3-month period, which was statistically significant compared to the gain of 1.9 points in the comparison group.  Home-based DIRFloortime™ helped the children with autism to better engage, relate and communicate with their caregivers when compared to those who received the routine behavioral interventions.  It was found that the 9 parents who added home-based DIRFloortime™ intervention 10 hours per week or more made greater gains in the FEAS than the 6 parents who added the intervention less than 10 hours per week. *Compared to the results of Solomon’s study, in which the FEAS increased from 38.1 to 44.6 within a 1-year period of DIRFloortime- based intervention, the children in the intervention group showed similar results within a shorter duration
  • 7. Canada Overview  Randomized controlled trial of 51 children aged 2 years to 4 years 11 months.  All children were previously diagnosed with ASD  Families in the target treatment group were given 2 hours of therapy and coaching each week, and expected to spend 3 hours per day interacting with their child.  Community Treatment (CT)group received a variety of services averaging 3.9 hours per week. After 1 year, outcomes were measured to determine changes in the groups in social interaction and communication.
  • 8. Measurements  A modified version of the Child Behavior Rating Scale (Kim and Mahoney, 2004; Mahoney and Perales, 2003) (henceforth mCBRS) was used to rate children’s interactions with their parents at the beginning and 12 months into treatment.  The 5-point Likert-type scale is designed to track what Mahoney and colleagues call ‘pivotal behaviors’, (Core learning processes that mediate between parental responsiveness and developmental cognitive, linguistic and socio-emotional functioning).
  • 9. Results Capacity Group Pre Treatment Post Treatment Scores(means) Scores(means) Attention to Activity Treatment 2.96 3.72 Standard 3.08 3.38 Involvement Treatment 2.56 3.20 Standard 2.62 2.69 Compliance Treatment 2.68 3.48 Standard 2.85 3.35 Initiation of Joint Treatment 1.28 1.84 Attention Standard 1.13 1.23 Enjoyment in Treatment 3.08 3.28 Interaction Standard 3.35 3.23
  • 10. Results The treatment group showed statistically significant results on the following capacities:  Showed significantly greater enjoyment in interactions with their parents  Were both significantly more attentive and more involved in interactions with their parents  Initiated more joint attentional frames.  That is, all but compliance.
  • 11. Results  Most children in the CT group received traditional behavioral interventions for autism. Behavioral interventions tend to emphasize teaching children to be compliant. Therefore, it would be expected that these children improve on Compliance.  It is equally important to note that children in the treatment group, which did not specifically target this behavior, seemed to have made greater improvements in Compliance than the CT group, although it was not statistically significant at the .05 level.
  • 12. Results  Small positive changes made by the treatment group caregivers made a statistically significant difference in children’s development.  There is an association between improvements in caregiver behaviors and improvements in children’s social-communicative functioning. The direction of the causality is not clear.
  • 13. Reference-Thailand Study Reference-Thailand Study  A pilot randomized controlled trial of DIR/Floortime™ parent training intervention for pre-school children with autistic spectrum disorders  Kingkaew Pajareya and Kaewta Nopmaneejumruslers Autism published online 13 June 2011 The online version of this article can be found at: DOI: 10.1177/1362361310386502 http://aut.sagepub.com/ Autism http://aut.sagepub.com/content/early/2011/06/01/1362361310386502 Reference Canada Study  Learning Through Interaction in Children With Autism: Preliminary Data From a Social-Communication- Based Intervention  Devin M. Casenhiser, Stuart G. Shanker and Jim Stieben Autism published online 26 September 2011 The online version of this article can be found at: http://aut.sagepub.com/content/early/2011/09/20/1362361311422052