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Which Developmental Therapy for Autism is Best? RDI or Floortime?

By Edited Jul 9, 2016 1 2

Which Developmental Therapy for Autism is Best?

Impaired emotional and social functioning affect all autistic individuals regardless of where they fall on the autism spectrum. These deficits influence the quality of life and joy that comes from interacting with others. While many people with autism can learn to function in society by taking turns, using better eye contact, accepting the word “no,” or running other life skills programs, memorized scripts rather than an emotional connection with people are at the heart of these activities.

Dr. Steven E. Gutstein, founder of the Relationship Development Intervention (RDI) program, and Dr. Stanley Greenspan, creator of the Developmental Individual-Difference, Relationship-Based Model (DIR/Floortime), believe that connecting with others at the emotional level enables children with autism to develop in ways that memorized interaction cannot, but their methods and approaches are different.

While RDI focuses on helping autistic children develop brain functions that didn’t mature properly as an infant, Floortime seeks to pull the child out of his current, inner personal world and into a shared connection with others. These developmental programs are both effective, but which therapy for autism is best? Like all treatments for autism, the answer depends upon a child’s individual deficits, sensory issues, developmental level, and degree to which they have shut themselves off from the outside world.

DIR/Floortime Model is the More Popular Option

All autism treatments and therapies are expensive, but many school districts will provide therapy for deficits that interfere with learning and schoolwork. The most common therapies funded by school systems are:

  • speech and language therapy
  • occupational therapy for sensory issues
  • physical therapy for fine-motor control problems
  • behavior therapy
  • social skills therapy

School Systems Fund Basic Autism Therapies

Dietary interventions and reaching autistic children at the emotional level generally do not qualify for school funding. Mostly, that’s because there’s little scientific research to back up the results. Schools zero in on scientifically proven methods, which leave most developmental therapies up to the parents.

The DIR/Floortime model comes highly recommended, but like most popular autism therapies, it relies heavily on anecdotal evidence to demonstrate the improved communication and closer relationship that develops between a parent and a child. Parents who have implemented the RDI program also show improved communication and parent-child relationships, yet parents recommend it less often. Why is that?

Relationship Development Intervention Imitates Typical Child Development

Early intervention for children with autism helps improve many of their social, behavior, and developmental issues. However, after working with autistic children for over 20 years, Dr. Gutstein saw little in the way of real improvement. Although utilizing typical behavior therapies like Applied Behavior Analysis (ABA) did improve appropriate responses, he noticed that ABA worked only if the autistic individual followed memorized scripts. When placed in a situation where others didn’t follow along, or they didn’t respond as expected, autistic children had no skills to help them improvise. In addition, they were not happy.

After studying the development pattern of typical children and comparing those patterns to the autistic kids he worked with, Dr. Gutstein noticed they were missing many developmental steps that typical infants experience at birth. As a result, he designed infant-like activities that helped children with autism learn to pay attention to what was going on around them. He then taught parents to use those same awareness-generating activities at home.

In the following video, Dr. Gutstein outlines the fundamentals of his RDI program:

Dr. Gutstein Speaks About Relationship Development Intervention (RDI)

Placing the child in a strict, sensory-clean environment where nothing can distract them or interfere with their sensory integration, and setting a parent up to take control of the session, RDI returns autistic children to the last developmental level they’ve mastered. Once they’ve returned to that level, they are encouraged to move forward by imitating the same development path of a typical child.

To achieve permanent benefits, however, similar circumstances must also be set up at home. That’s why many parents do not recommend RDI. They find the program time consuming, costly, and too much work. However, the results of Dr. Gutstein’s program for those parents who have chosen to go that extra mile cannot be argued with. It definitely works, as the following video clearly demonstrates.

Before and After RDI: A Success Story

DIR/Floortime Improves Communication

Dr. Greenspan believes autistic children need to address six basic developmental capacities. However, these functions can be engaged in and mobilized spontaneously. They don’t have to be implemented one at a time. Rather than parents leading infant activities in hopes of developing the portion of the child’s brain that never matured appropriately as in RDI, he teaches parents to imitate what their autistic child is currently doing.

Whether that is sitting at the dining room table and drawing, lying on the floor spinning the wheels of their favorite truck, or flipping the lights on and off in the hallway, DIR/Floortime seeks to enter the world of autistic children by first joining them.

The DIR/Floortime Approach

Emotional Engagement Occurs When Parents First Follow

It is by imitating what autistic children love to do the most that they find the power to take control of the situation. However, imitation is only the first step. Once engagement has been entered into successfully, the parent then does something that deliberately initiates communication.

While Dr. Gutstein believes the universal need of feeling joy comes from the intimacy of sharing experiences with others, Dr. Greenspan believes autistic children find joy in what they do or possess. Floortime protocol instructs parents to gently provoke the child through doing things, or saying something that makes it necessary for the child to gesture or speak. The hope is that better communication at home will lead to a desire to communicate with those outside of the family circle.

In the following video, Dr. Greenspan gives an introduction to his DIR/Floortime Approach:

Dr. Greenspan's Introduction to His Floortime Method

Floortime sessions can be structured or unstructured, staged or unstaged. They can easily be adapted to a family’s current lifestyle and schedule. Out of all of the autism therapies available today, many parents consider Floortime to be the least intrusive on family life, since it merges well with other therapies and fits many living conditions. However, Floortime isn’t always the best choice for the child.

Which is Best? Development Relationship Intervention or Floortime?

Sorting through autism therapies is time consuming, but not impossible, as no single therapy is the best choice for every child. While some programs appear more popular than others, the autism spectrum leaves plenty of room to make individualized choices. What’s best for one particular child won’t be a good fit for another.

Floortime is the Most Popular Play Therapy for Autism

The most popular play therapy is DIR/Floortime, probably because many parents feel it is less expensive than RDI. In addition, most parents of autistic children desire better communication, improved behavior patterns, reduced stimming, and a happier child, which the Floortime plan gives them.

Others many find Floortime difficult to implement. While it easily slips into their current lifestyle, many autistic children have turned so far inward that parents find it difficult to connect with them. Some children refuse to accept outsiders joining them in their inner world, and that includes their parents. For these particular children, returning to the beginning of child development and working with them at that particular level brings better results.

The good news is that books and other reading materials on both developmental programs are readily available today. Parents can easily implement the principles of either program (or a combination of the two) without the help of a trained specialist. In fact, RDI has books that go into detail about appropriate activities and games for each development step, as well as ideas for older children.

How to Choose the Best Developmental Program

Both DIR/Floortime and RDI offer training classes and individualized help for parents you prefer one-on-one training, in addition to their books and other materials, but RDI does recommend professional counseling once the child reaches the point where parents need to select a well-matched playmate.

Since both programs make their teaching materials available without having to enroll and pay for their professional advice and help, the best way to choose the right program is by giving both therapies a trial run. That way parents can see which plan the child responds to best: a clutter-free, sensory-free environment that starts over, or a more lenient plan that focuses on creating an emotional attachment by allowing the child to be in charge.



May 14, 2014 4:03am
I would agree that a trial run is a great way to select a therapy that suits a family best. Some facilities do offer a program that gives an introduction to a number of different tools and approaches (augmented communication, OT with weighted vests, PECS, floortime, music therapy, etc.) This is a great way to learn the basics of each approach and see what helps your family most.
May 22, 2014 11:46am
A facility that offers an introduction to a variety of choices would be an excellent way to do it I would think. Originally, this article was two articles that I was contracted to write for the website Health Mango, but when Panda hit, the owner decided he couldn't afford any more therapy articles, so I tried to combine them into something that was more helpful than either alone.
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  1. SE Gutstein, AF Burgess, K Montfort "Evaluation of the relationship development intervention program." Autism. 11 (2007): 397-411.
  2. Steven E. Gutstein Autism Aspergers: Solving the Relationship Puzzle: A New Developmental Program that Opens the Door to Lifelong Social and Emotional Growth. Arlington: Future Horizons, Inc., 2000.
  3. Stanley I. Greenspan and Serena Wieder Infant and Early Childhood Mental Health: A Comprehensive Developmental Approach to Assessment and Intervention. Washington DC: American Psychiatric Association, 2006.
  4. Steven E. Gutstein The RDI Book: Forging New Pathways for Autism, Asperger’s and PDD with the Relationship Development Intervention Program. Houston: Connections Center Pub, 2009.

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