Intensive Intervention for Autism Using the DIR Floortime Method

About the Study:

• Childern's age must be from 2 year 0 months to 4 years 0 months to qualify for the study.
• Families will receive approximately 2 hours of DIR sessions each month for a total of 1 year.
• Sessions are designed to provide therapy for your child and instruction for the parents to conduct DIR therapy at home.
• The study is a randomized control study. This means that children will be randomly selected for either an immediate or delayed (12-month waitlist) treatment group.
• Selection for immediate or delayed treatment groups is made at random. Your child has a 50% chance of being in the immediate treatment group.
• If your child has been selected for the delayed treatment group, DIR therapy will begin 12 months following the selection date. Being in the delayed treatment group does not mean that your child should not receive treatment while waiting for DIR treatment. We expect that your child will continue to receive whatever treatment s/he was receiving prior to enrolling in the study.

For more information, please contact us at 416-736-2100 Ext 20401

Frequently Asked Questions

Q: Why is this service being offered?
A: This service is being offered as part of a larger study to critically evaluate the effectiveness of intervention programs for autism. We believe that children are unique and each child has his or her own set of challenges. In short, no therapy is a cure-all. It is therefore important to critically evaluate a number of therapies for autism to determine what therapies (or components of a therapy) work best and for which children.

Q: Will my child be receiving intensive therapy for autism?
A: DIR is an intensive therapy. However, the bulk of therapy is delivered by the child's caregivers rather than by a clinician. Families meet for approximately 2 hours each week to receive coaching and instruction from DIR therapists.

Q: How will I know how to provide therapy for my child?
A: Families will recieve individual instruction in the DIR/Floortime method. Families will meet weekly with a therapist who will address the particular needs of each family.

Q: Do I have to set aside a certain number of hours each day for therapy?
A: Yes! You will need to set aside time when you can get down on the floor to work with your child. Providing DIR therapy for your child is a full-time job, though it can and should be shared among all of the child's caregivers.

Q: How does DIR differ from IBI?
A: Intensive Behavioral Intervention is a behaviorist approach to treating autism. It sets various goals designed to correct and shape behaviors through systems of rewards. DIR is a social or relationship-based approach. Rather than focussing on changing behaviors or treating symptoms, DIR aims to help the child build healthy foundations for relating and communicating.

Q: Is DIR right for my child?
A: Each child's needs are unique, and you must consider your child's needs to answer this question. DIR may be right for your child if your child has difficulties with any of the following: relating and communicating, enjoying warmth and intimacy, engaging in two-way communication with words or gestures, or using ideas creatively and logically.

Q: What exactly is the DIR intervention?
A: DIR stands for Developmental Individualized Relationship-based intervention. For more information on the intervention, please visit The Floortime Foundation web site.

Q: Are parents to blame for autism?
A: NO! Children with autism have special needs. DIR works to teach parents how to address these needs in a way that works with each child's strengths and challenges.

Q: Is DIR intervention a proven treatment method?
A: The DIR treatment studies which have been done to date are largely retrospective studies which suggest a correlation between DIR treatment and positive outcomes. Since, however, there have been no randomized controlled studies of DIR previously conducted, we do not know whether DIR is in fact effective.

Q: Who conducts the treatment?
A: Treatment is conducted by Speech Language Pathologists and Occupational Therapists who are registered with the province of Ontario. In addition, our therapists are advised and receive ongoing training from the authors of the DIR floortime method, Dr. Stanley Greenspan, MD & Dr. Serena Wieder, PhD, and a number of senior DIR faculty members.

Q: Are psychological assessments conducted?
A: We conduct a number of cognitive, behavioral and neurological tests so that we can measure changes overtime. These do not constitute "psychological assessments" and are not intended for diagnostic purposes.

Q: Do we diagnose autism?
A: We do not conduct diagnoses of our own. As part of the requirements for the study, we must be able to confirm criteria for autism using the ADOS and ADI. These tests are not perfect, so it is possible for a small percentage of children to have a valid diagnosis of autism from their physician and still not meet ADOS or ADI criteria.

Q: Can my child receive therapy while I’m on the 12-month waitlist?
A: We encourage you to seek treatment that is available in your community while on the waitlist. If your child is fortunate enough to begin receiving an intensive therapy for autism, we would ask you to withdraw from the study.

There's floortime and there's DIR Floortime.

Many clinics and clinicians are now advertising themselves as "floortime therapists" or saying that they use or encorporate "floortime" in their programmes. Anyone regardless of their qualifications or training can say they are doing "floortime". As a result "floortime" can range from a high quality social or play based therapy to what is more aptly called "ignore time" where the child is placed on the floor and told play by themselves.

Only a certified DIR therapists can call themselves a DIR Floortime therapist because DIR is a registered trademark. Floortime is not a registered or restricted word, so anyone can use it even if they have no training at all.

About DIR certification: There are three levels of training for DIR therapists: DIR B, DIR C and DIR Faculty. The DIR B certification requires successful completion of a 4-day course taught by DIR faculty members. The DIR B course is intended to give therapists an introduction to the theory and practice of DIR. On its own, it does not qualify an individual as a full-fledged DIR therapist. Following successful completion of DIR B, therapist must be supervised by a DIR faculty member for a period of 2 years during which they will also attend the DIR C training each year to present cases and demonstrate their knowledge of the theory of DIR, and their ability to practice DIR as clinicians. Completion of the DIR C certification makes a therapist a full-fledged DIR therapist. A DIR Faculty member is one who, following completion of the DIR C certification, possesses in-depth knowledge of the theory and practice arising from ample experience providing DIR therapy, and has furthermore demonstrated the ability to teach and supervise those who wish to learn DIR.

Floortime therapists in Canada: As far as we or the Floortime Foundation know, the only DIR C certified therapist in all of Canada is Cindy Harrison (who practices in Ottawa). Cindy Harrison is a speech pathologist by training and is not only DIR C certified, she is a DIR Senior Faculty member.

All of our therapists have completed the course work towards their DIR C certificates and are writing their final theses (the last requirement). In an effort to prepare our therapists for the study, they completed the DIR B certification and subsequently participated in several private and intensive DIR training workshops conducted at York University by senior DIR faculty members. These DIR faculty continue to provide both on-site and distance supervision and training to our therapists. In addition, our therapists are fortunate to benefit from consultations with Dr. Serena Wieder and Dr. Stanley Greenspan, the developers of the DIR method.