Reaching an Autistic Teenager

Did you see this latest article in the NYTimes?
Reaching an Autistic Teenager
The article describes D.I.R./Floortime (D.I.R. stands for developmental, individual differences, relationship-based approach.) Have any of you come across this technique?
The method seems to be involve relating to students on a direct emotional level, responding to students interests and concerns. The article contrasts D.I.R. with ABA and never really addresses how the two could work together.
I was left thinking that what they are recommending is what I see good teachers and interventionists do on a daily basis – that is – not relying solely on behavioral strategies but also responding to students in a personal, connecting way. I’m glad someone has articulated why this is important, it is pulling back the curtain on what effective teachers do instinctively.
One confounding part of the article is a connection to Autism and Attention Deficit Disorder which the author seems to assume and passes over much too quickly.
Can any of you help sort any of this out?
TomJ

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2 Responses to Reaching an Autistic Teenager

  1. DIR/Floortime sounds good. Unfortunately, there is very little empirical evidence that it actually results in gains for autistic children as summarized in two credible reviews, the MADSEC (Maine) Autism Task Force Report and the AAP Management of Children with Autism Spectrum Disorders:


    MADSEC Autism Task Force Report, page 6:

    • Without scientific evaluation of any kind:
    Greenspan’s DIR/”Floor Time,” Son-Rise.

    MADSEC Autism Task Force Report, page 43:

    Discussion

    There have been no peer-reviewed, published studies of Greenspan’s DIR/Floor Time’s
    effectiveness for children with autism.

    Conclusions

    There have been no peer-reviewed, published studies of Greenspan’s DIR/Floor Time’s
    effectiveness for children with autism. Researchers should consider investigation using research protocols. Professionals considering Greenspan’s Floor Time should portray the method as without peer-reviewed scientific evaluation, and should disclose this status to key decision makers influencing the child’s intervention.

    The American Academy of Pediatrics reviewed autism interventions in Management of Children with Autism Spectrum Disorders(2007) and stated, at page 5, with respect to RID that:

    Relationship-focused early intervention models include Greenspan and Wieder’s developmental, individual-difference, relationship-based (DIR) model,55 Gutstein and Sheely’s relationship-development intervention (RDI),56 and the responsive-teaching (RT) curriculum developed by Mahoney et al.57,58 The DIR approach focuses on (1) “floor-time” play sessions and other strategies that are purported to enhance relationships and emotional and social interactions to facilitate emotional and cognitive growth and development and (2) therapies to remediate “biologically based processing capacities,” such as auditory processing and language, motor planning and sequencing, sensory modulation, and visual-spatial processing. Published evidence of the efficacy of the DIR model is limited to an unblinded review of case records (with significant methodologic flaws, including inadequate documentation of the intervention, comparison to a suboptimal control group, and lack of documentation of treatment integrity and how outcomes were assessed by informal procedures55) and a descriptive follow-up study of a small subset (8%) of the original group of patients.59″

  2. Kaja Weeks says:

    As many approaches as there are to autism intervention, so too are there varying critical reviews from respected sources. Note the American Academy of Science (NAS) Committee on Educational Interventions for Children with Autism stated that there is research support for a number of approaches, including DIR/Floortime and behavioral interventions, but that there are no proven “relationships between any particular intervention and children’s progress” and “no adequate comparisons of different comprehensive treatment.” The study also noted that “studies have reported that naturalistic approaches are more effective than traditional discrete trial at leading to generalization of language gains to natural contexts.”

    Autism and its interventions are clearly complex entities that defy easy analysis. In pursuing only the currently fashionable quest for perfect, case-closed empiricism, we may well miss out on what more dynamic approaches such as DIR/Floortime offer. Increasingly, critical questions ARE being answered, by the way. Check out the ICDL website http://www.icdl.com to look at publications and research in progress, including a very rigorous study through the Milton and Ethel Harris Research Initiative at York University, Canada, “Assessing Behavioral and Neurophysiological Outcomes of Intensive DIR Intervention for Children with Autism.”

    Tom, you are right in your intuition about good teachers and interventionists having their work grow from the perspective of “a personal, connecting way.” DIR is based on the premise of unique, individual differences, and the “connecting way” is through affect, which fuels all our developmental capacities (including emotional, cognitive, social). This is an approach that can be applied across the life-span with “typically-developing” individuals as well as those with developmental challenges.

    Understanding why autism was probably connected in the article to attention-deficit can be more clearly understood by looking at the frame of what Greenspan terms “functional developmental capacities,” of which the state of regulated attention is first; it’s bedrock! None of us can get far without sustaining that. Yet as we know, in autism, neurological impairments derail so often, that sustained attention is often hard-won.

    I hope this helps a little in answering some of your questions. It sounds like your insights, questions and curiosity could lead to some interesting new reading! Best of luck.

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