نوع مقاله : مقاله مروری
نویسندگان
1 گروه آموزشی کاردرمانی،دانشکده توانبخشی. دانشگاه علوم پزشکی شهید بهشتی،تهران،ایران
2 دکترای روانشناسی کودکان استثنایی، مربی گروه کاردرمانی، دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران
3 دانشکده علوم توانبخشی/دانشگاه علوم پزشکی شهید بهشتی
4 دکترای تخصصی کاردرمانی ،گروه کاردرمانی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران
چکیده
کلیدواژهها
موضوعات
عنوان مقاله [English]
نویسندگان [English]
Background and Aims: Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by persistent deficits in social communication and interaction, along with restricted, repetitive patterns of behavior. Given the multifaceted challenges experienced by children with ASD, various intervention models have been developed to target different aspects of functioning. One such approach is the Developmental, Individual-differences, Relationship-based (DIR)/Floortime model, which emphasizes emotional regulation, social interaction, and the development of functional communication through play and parent-child engagement. Despite growing interest in DIR/Floortime, the evidence base supporting its effectiveness remains scattered across studies of varying methodological rigor. This systematic review aimed to synthesize available evidence regarding the efficacy of DIR/Floortime interventions in improving social, emotional, and behavioral outcomes in children with high-functioning ASD.
Materials and Methods: This systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search of five electronic databases (Science Direct, PsycINFO, PubMed, Scopus, and Medline) was performed for studies published between 2007 and 2025. Search terms included: “DIR/Floortime,” “Floortime,” “Children with autism,” “Autism,” “ASD,” “ASDs,” and “Floortime Therapy.” In addition, reference lists of eligible studies were hand-searched to identify additional relevant articles.
Studies were included if they: (1) involved children diagnosed with ASD; (2) implemented DIR/Floortime either as the main intervention or as part of the study design; (3) measured at least one developmental, social, cognitive, or communicative outcome; (4) were published in English with full-text availability. Exclusion criteria comprised non-English articles, inaccessible full texts, non-empirical works (e.g., opinion papers, book chapters), and theoretical papers that did not report empirical data.
The screening process involved two stages. First, titles and abstracts were reviewed to exclude irrelevant studies. Subsequently, full texts of potentially eligible articles were assessed against the inclusion and exclusion criteria. Data extraction included study characteristics (authors, year, country), sample size, intervention type, study design, duration, and key outcomes. The methodological quality of included studies was evaluated using the PEDro scale, which assesses factors such as randomization, blinding, and statistical reporting.
Results: An initial search identified 40 articles, with an additional 3 articles found through hand-searching. After removing 10 duplicates, 33 studies were screened by title and abstract. Nineteen studies were eligible for full-text review, and ultimately 9 studies met all inclusion criteria and were included in the final analysis.
The included studies encompassed randomized controlled trials (RCTs), quasi-experimental designs (with or without control groups), and prospective observational studies. Sample sizes ranged from 11 to 68 participants, focusing on children aged 2 to 6 years. Studies were conducted across various countries including Iran (4 studies), Taiwan (1), Brazil (1), Thailand (2) and the United States (1), with three studies not specifying country of origin.
Interventions varied in duration from 3 months to 18 months, with an average intensity of approximately 14 to 15 hours per week in home-based or parent-mediated settings. Approaches included pure DIR/Floortime therapy, parent training programs, and hybrid models such as the PLAY Project Home Consultation (PPHC). The primary outcomes assessed were social interaction skills, emotional regulation, autism symptom severity, parent-child relationship quality, and daily living skills.
Results consistently demonstrated significant improvements across studies. Most notably, DIR/Floortime interventions were associated with:
• Enhanced social-emotional development and functional communication
• Reduction in autism symptom severity
• Improved self-regulation and adaptive behaviors
• Increased positive parent-child interactions
• Decreased stereotypical and maladaptive behaviors
Quality appraisal using the PEDro scale revealed heterogeneity in methodological rigor. Three studies (33%) were classified as high-quality (PEDro score = 5), three studies as moderate-quality (score = 3), and three studies as low-quality (score = 1–2). Common methodological limitations included absence of blinding, lack of intention-to-treat analysis, and incomplete reporting of attrition.
Conclusion: This systematic review provides evidence supporting the effectiveness of DIR/Floortime interventions in improving social, emotional, and behavioral outcomes in children with high-functioning ASD. The consistency of positive outcomes across diverse settings and study designs underscores the potential applicability and cultural generalizability of the DIR/Floortime model.
However, variability in intervention protocols, study designs, and methodological quality highlights the need for caution when interpreting the findings. Future research should prioritize high-quality RCTs with larger sample sizes, standardized intervention protocols, longer follow-up periods, and comprehensive outcome measurement to strengthen the evidence base. Additionally, emphasis on parent training and home-based implementation appears promising for sustaining long-term benefits.
کلیدواژهها [English]
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