Factors associated with parent engagement in DIR/Floortime for treatment of children with autism spectrum disorder.

BACKGROUND: The Developmental, Individual-differences, Relationship-based model (DIR/Floortime) is one of the well-known therapies for autism spectrum disorder (ASD), in which its main principle is to promote holistic development of an individual and relationships between the caregivers and children. Parental engagement is an essential element to DIR/Floortime treatment and involved with various factors. Finding those supporting factors and eliminating factors that might be an obstacle for parental engagement are essential for children with ASD to receive the full benefits of treatment. AIM: To examine the association between parents, children and provider and service factors with parental engagement in DIR/Floortime treatment. METHODS: This is a cross-sectional study of parents with children aged 2-12 years who were diagnosed with ASD. Data were collected using a parent, child, provider and service factors questionnaire. Patient Health Questionaire-9, Clinical Global Impressions-Severity and Childhood Autism Rating Scale were also used to collect data. For parent engagement in DIR/Floortime, we evaluated quality of parental engagement in DIR/Floortime and parent application of DIR/Floortime techniques at home. Finally, Clinical Global Impressions-Improvement and Functional Emotional Developmental Level were used to assess child development. RESULTS: Parents who were married, had lower income and higher knowledge of DIR/Floortime theory were more likely to have higher parent engagement (χ2=4.43, p=0.035; χ2=13.1, p<0.001 and χ2=4.06, p=0.044 respectively). Furthermore, severity of the diagnosis and the continuation of the treatment significantly correlated with parent engagement (χ2=5.83, p=0.016 and χ2=4.72, p=0.030 respectively). It was found that parents who applied the techniques for more than 1 hour/day, or had a high-quality parent engagement, significantly correlated with better improvement in child development (t=-2.03, p=0.049; t=-2.00, p=0.053, respectively). CONCLUSION: Factors associated with parents, children, and provider and service factors had a significant correlation with parent engagement in DIR/Floortime in which children whose parents had more engagement in DIR/Floortime techniques had better improvement in child development.

A one-year prospective follow-up study of a DIR/Floortime parent training intervention for pre-school children with autistic spectrum disorders.

OBJECTIVE: Determine the results of 1-year Developmental, Individual-Difference, Relationship-Based (DIR)/Floortime parent training in developmental stimulation of children with autistic spectrum disorder (ASD). MATERIAL AND METHOD: Thirty-four, two to six years old children with ASD participated. Parents were encouraged to deliver 1:1 interaction according to their child's developmental level, as they were modeled and coached. Pre-post videotapes were rated by blinded assessors. RESULTS: Thirty-one families completed the present study. The data showed that adding home-base DIR/Floortime intervention at the average 14.2 hours/week for one year could help 47% of the children to make good improvement (1.5 Functional Development Level, FDLs or more), with 23% making fair progression (1 FDL), and the last 29% making poor progression (0.5 FDL or less). There were significant increases in children's total Functional Emotional Assessment Scale (FEAS), and Functional Emotional Developmental Questionnaire (FEDQ) scores and there was significant decrease in the Childhood Autism Rating Scale (CARS) scores (p < or = 0.001). It showed that fidelity of the parents, severity of the children, and baseline developmental status might affect the outcome. CONCLUSION: Adding home-base DIR/Floortime intervention at the average 14 hours/week for one year helped 47% of children with autism to make good improvement in their development, and decreased autism's severity significantly.

A pilot randomized controlled trial of DIR/Floortime™ parent training intervention for pre-school children with autistic spectrum disorders.

This pilot study was designed to test the efficacy of adding home-based Developmental, Individual-Difference, Relationship-Based (DIR)/Floortime™ intervention to the routine care of preschool children with autistic spectrum disorder. Measures of functional emotional development and symptom severity were taken. It was found that after the parents added home-based DIR/Floortime™ intervention at an average of 15.2 hours/week for three months, the intervention group made significantly greater gains in all three measures employed in the study: Functional Emotional Assessment Scale (FEAS) (F = 5.1, p = .031), Childhood Autism Rating Scale (F = 2.1, p = .002), and the Functional Emotional Questionnaires (F = 6.8, p = .006). This study confirms the positive results obtained by a previous DIR pilot study (Solomon et al., 2007).