Monday, October 20, 2008

New York Times' Slanted Article On DIR/Floortime and Autism

The New York Times has published in its print and online editions a lengthy piece by Melissa Fay Greene promoting DIR/Floortime. The article acknowledges to some extent the value of ABA as an autism intervention but implies that ABA is outdated and that DIR/Floortime is a new modern improved form of autism intervention. The usual cliches about ABA being rote learning are trotted out along with the positive buzzwords used to promote DIR/Floortime "relationship", "respectful of the child". The article indicates that experts do not endorse any one method.

What the article does not do is mention the fact that there is no empirical evidence to support the effectiveness of DIR/Floortime as an autism intervention. The MADSEC Autism Task Force Report (2000 rev. ed.) described DIR Flootime as without scientific evaluation of any kind.

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

The article also fails to indicate the value of ABA as an autism intervention and the large body of evidence supporting its effectiveness:

MADSEC (2000)

Conclusions

There is a wealth of validated and peer-reviewed studies supporting the efficacy of ABA
methods to improve and sustain socially significant behaviors in every domain, in individuals
with autism. Importantly, results reported include “meaningful” outcomes such as increased
social skills, communication skills academic performance, and overall cognitive functioning.
These reflect clinically-significant quality of life improvements. While studies varied as to the
magnitude of gains, all have demonstrated long term retention of gains made.

Other major contributions of ABA to the education and treatment of individuals with autism
include:

• a large number of empirically-based systematic instruction methods that lead to the
acquisition of skills, and to the decrease/elimination of aberrant behaviors;
• a technology for systematically evaluating the efficacy of interventions intended to affect
individual learning and behavior; and
• substantial cost/benefit.

Over 30 years of rigorous research and peer review of applied behavior analysis’ effectiveness
for individuals with autism demonstrate ABA has been objectively substantiated as effective
based upon the scope and quality of science. Professionals considering applied behavior
analysis should portray the method as objectively substantiated as effective. Methods of applied behavior analysis should be considered to evaluate the effectiveness of any intervention used to help individuals with autism. Researchers should continue to vigorously investigate behavioral intervention as the most promising area of research and treatment benefitting individuals with autism known today. Early interventionists should leverage early autism diagnosis with the proven efficacy of intensive ABA for optimal outcome and long-term cost benefit.


American Academy of Pediatrics (2007)


The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology21,25,27,28 and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings.29–40 Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.31–40

The New York Times is still a news source of great influence. When it is using that influence in promoting interventions for children with autism, a neurological disorder, it should do its homework and present an accurate and credible review of the professional literature. Simply offering a guest column to a promoter of an intervention lacking in empirical verification of its effectiveness does a disservice to autistic children whose decision makers, family or public, could be misled by the NYT and its weighty reputation.

6 comments:

Anonymous said...

FYI --- Melissa Faye Greene is a friend of the parent that was profiled in the New York Times article. Their typical children attend(ed?) the same exclusive private school in Atlanta. The wife of the headmaster for said school is also Floortime practitioner in the same practice as the parent in the article. It's a mutual support society of earnest but unscientific friends who happen to inhabit places on influence.

Anonymous said...

FYI - Melissa Faye Greene and the parent who started the school profiled in the NY Times article have typically developing children who attend(ed?) the same exclusive private school in Atlanta. The plot thickens when you know that the wife of the founder of that school is in the same Floortime practice with the parent who started the school. At best, it's a mutually supportive society of well meaning but unscientifically motivated friends.

The latest fad may be Floortime, but I strongly agree with you that it's harmful for parents of newly diagnosed children to have it offhandedly dismissed when in fact it's the evidence based treatment. Here in Atlanta parents will pejoratively refer to behavior intervention as "top down". It's scary.

Anonymous said...

FYI - Melissa Faye Greene and the parent who started the school profiled in the NY Times article have typically developing children who attend(ed?)the same exclusive private school in Atlanta. In addition the wife of the founder of that school is in the same Floortime practice with the parent who started the school. At best, it's a mutual admiration society of well meaning but unscientifically motivated friends.

I agree with you that it's a harmful and biased to
dismiss an evidence based treatment like ABA for faddish treatment plans like Floortime and sensory integration therapy.

Anonymous said...

sorry, can't agree with you. It is unfortunate that the NB Government has thrown all our money into only the ABA approach excluding other "proven" treatments. Go and listen to Greenspan in DC, read Engaging Autism (or take the amazing online course they offer www.stanleygreenspan.com ) Then you will see the beauty and effectiveness of the relation based DIR treatment approach and the true respect for the children we work with! It is time that we in NB expand our minds and look at more humanistic treatments and outcomes...wait..isn't that where we are trying to lead our children??

Autism Reality NB said...

Anonymous 11:00

The NB Government did not "throw" money into ABA. It provided funding for evidence based interventions for treating autism. Only ABA, as reviewed by the US Surgeon General, the NYSDOH, the Maine Autism Task Force Report (MADSEC), the NYSDOH, the Association for Science in Autism Treatment and more recently the American Academy of Pediatrics Mangement of Children with Autism Spectrum Disorders (2007) has been found to be "Proven", evidence based, or scientifically validated. NONE of these credible reviews have found empirical evidence to support the effectiveness of Floortime or any of the other interventions which you believe are "proven".

The government of NB provides funding for evidence based intervention. Attacking ABA which has such strong evidence including a study release this week, does not help prove that other interventions are scientifically validated, evidence based or "proven".

Anonymous said...

Dear Mr. Doherty, although this is an old blog entry, thanks for your article. Our practice in Berlin, Germany works primarily with ABA. Of course, we hear some rumblings about DIR Floortime and are quite sceptical due to lack of peer reviewed journal papers on the treatment method. Unfortunately, the level of hype coming from overseas can often influence desperate parents. Best Regards, Marc L.