The document summarizes two studies on interventions for children with autism. The Thailand study involved 32 children who received either typical treatment or DIRFloortime supplemented treatment for 3 months. Parents in the intervention group added 15 hours per week of DIRFloortime. Children in this group showed greater improvements on assessment scales compared to typical treatment. The Canada study was a randomized controlled trial of 51 children who received either DIRFloortime therapy and coaching or community treatment. Children in the DIRFloortime group showed significantly greater improvements in social interaction capacities like attention, involvement, and joint attention.

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