The research has really shown a change in how we have approached child development over the last century (See Post et al below).  The way we thought about our mental health and development used to be primarily behavioural in the 1950s and 1960s; controlling and managing the behaviours of others and ourselves for our own betterment.  It evolved to a more cognitive (thoughts) approach in the 70s and 80s. However, since the 90s, we are looking at more neuroscientific approaches (understanding how our nervous systems respond to stress) across more contexts.  In other words, we used to try to control/manage behaviour, then switched to trying to control thoughts for developmental improvements and mental health, and now we realize that it causes stress to focus on self-control, so we try to understand stress behaviours and find balance to prevent maladaptive stress behaviour patterns. We have learned how to focus on relationships and environments where development happens naturally.
The research has changed over the last 80 years, showing this shift in paradigm.  It's time for our practices to do the same! If what we are doing isn't working, we need to change not just what we do, but how we think.  We need to connect before we correct. See below for the research supporting the need for developmental, relationship-based approaches and how they proactively prevent stress behaviours from happening.  You will also see information about some key resources by Dr. Stuart Shanker who help us learn HOW to use a developmental, relationship-based framework. 
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Behavioural Vs. Developmental Approaches 

Burgess, C. C. (2023). Educator understanding of self-regulation and implications for classroom facilitation: A mixed methods study. Journal of Early Childhood Research, 21(4), 469-483. https://doi.org/10.1177/1476718X231186613
 
Burgess, C. (2019). From paper to practice: Understanding and embodiment of self-regulation in Ontario’s kindergarten classrooms. International Journal of Holistic Early Learning and Development, (1). https://ijheld.lakeheadu.ca/article/view/1615 

Broderick, A.A. (2009). Autism, ‘‘Recovery (to Normalcy),’’ and the Politics of Hope, Intellectual and Developmental Disabilities, (4), 263–281. ​

Costa, G. & Witten, M.R. (2009). Pervasive developmental disorders (Chapter 4), In B. Mowder, F. Robinson and A. Yasik (Eds.), Evidence Based Practice in Infant and Early Childhood Psychology, , Hoboken, NJ: John Wiley & Son, Publishers. 

Harris, H, Israeli, D., Minshew, N., Bonneh, Y., Heeger, D.J., Behrmann, M and Sagi, D. (2015). Perceptual learning in autism: Over-specificity and possible remedies. Nature Neuroscience. 18 (11), 1574-1576. 

Kuhn, T.S. (1962, 1970). The Structure of Scientific Revolutions. Chicago: The University of Chicago. 

National Research Council (2001). Educating children with autism. Committee on Educational Interventions for Children with Autism. Division of Behavioral and Social Sciences and Education. Washington, DC: National Academy Press. (www.nap.edu). 

Post, Y., Boyer, W., & Brett, L. (2006). A historical examination of self-regulation: Helping children now and in the future. Early Childhood Education Journal, 34(1), 5-
14. https://doi.org/10.1007/s10643-006-0107-x

Prizant, B. (2009) Treatment Options and Parent Choice: Is ABA the Only Way? Autism Spectrum Quarterly, 28-32. (www.ASQuarterly.com) 

Shonkoff, J.P. and Phillips, D.A. (Eds.). (2000) From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington, D.C. National Academy Press. 

Shanker, S. (2012). Calm, Alert, and Learning: Classroom Strategies for Self-Regulation. Canada: Pearson. 

Shanker, S. (2016). Self-Reg: How to Help Your Child (and You) Break the Stress Cycle and Successfully Engage with Life, New York: Penguin Books 

Shanker, S. & Burgess, C. (2017). Self-Reg and reframing. Reframed: The Journal of Self-Reg, 1(1), 28-39.  https://selfregulationinstitute.org/journal/journal_archives/volume_1_issue_1/#article4 

Singletary, W.M. (2015). An integrative model of autism spectrum disorder: ASD as a neurobiological disorder of experienced environmental deprivation, early life stress and allostatic overload, Neuropsychoanalysis, 17:2, 81-119, DOI: 10.1080/15294145.2015.1092334 

Smith, T. and Iadarola, S (2015) .Evidence base update for autism spectrum disorder. Journal of Clinical Child & Adolescent Psychology, 44(6), 897–922. 

Tsiplova, K., Ungar, W.J., Szatmari, P., Cost, K.,  Pullenayegum, E., Duku, E.,  Volden, J., Smith, I.M., Waddell, C., Zwaigenbaum, L., Bennett, T.A., Elsabbagh, M., Georgiades, S., Zaidman-Zait,A. (2023). Measuring the association between behavioural services and outcomes in young children with autism spectrum disorder,
Research in Developmental Disabilities, 132. https://doi.org/10.1016/j.ridd.2022.104392 ​

Whitman, T. (2004). The Development of Autism: A Self-Regulatory Perspective. Philadelphia: Jessica Kingsley Publishers. 

Williams, D.L. (2008). What Neuroscience Has Taught Us about Autism: Implications for Early Intervention, Zero to Three, 28(4), 11-17.

Evidence Base for Developmental Approaches

Boshoff K, Bowen H, Paton H, et al (2020). Child Development Outcomes of DIR/Floortime TM-based Programs: A Systematic Review. Canadian Journal of Occupational Therapy. 87(2):153-164. doi:10.1177/0008417419899224

Cheng, W.M., Smith, T.B., Butler, M. et al. (2022). Effects of Parent-Implemented Interventions on Outcomes of Children with Autism: A Meta-Analysis. J Autism Dev Disord. https://doi.org/10.1007/s10803-022-05688-8 

Divya, K.Y., Begum, Farzana; John, Sheeba Elizabeth; Francis, Frincy. (2023). DIR/Floor Time in Engaging Autism: A Systematic Review. Iranian Journal of Nursing and Midwifery Research 28(2):p 132-138, Mar–Apr 2023. DOI: 10.4103/ijnmr.ijnmr_272_21 

The National Clearinghouse on Autism Evidence & Practice lists Parent-Implemented Interventions such as Floortime as Evidence-Based Practices in their most recent edition of the Evidence-Based Practices for Children, Youth, and Young Adults with Autism.  

In the Project AIM: Autism intervention meta-analysis for studies of young children. Psychological Bulletin, 146(1), 1–29.https://doi.org/10.1037/bul0000215 they found that developmental approaches had stronger evidence to support effectiveness than behavioral approaches.  

The European Society for Child and Adolescent Psychiatry practice guidance for autism: a summary of evidence-based recommendations for diagnosis and treatment indicates that "At the present time, the strongest evidence for interventions for young autistic children comes from large-scale, randomised trials of developmentally based approaches designed to facilitate social communication between very young children and their parents. The main focus is on adult–child synchrony, with parents learning to respond to their child’s communicative cues in ways that encourage spontaneous communication, and create opportunities for shared attention, child initiations, and spontaneous play."

Developmental social pragmatic interventions for preschoolers with autism spectrum disorder: A systematic review
2010 Centers for Medicaid and Medicare Commissioned IMPAQ Report on Autism Services (This report preceded all of the RCT studies on Floortime and still listed Developmental Relationship-based Approaches as a level 2 emerging evidence-based intervention.)

Tristram Smith & Suzannah Iadarola (2015) Evidence Base Update for Autism Spectrum Disorder, Journal of Clinical Child & Adolescent Psychology, 44:6, 897-922

Research on Social Work Practice indicating DIRFloortime as an Evidence-Based Practice (EBP)


INTERESTING RELATED STUDIES

A study out of New York University found that the intense interests that often accompany autism in adults can not only be helpful to their self-regulation, but also in finding fulfilling career paths. Read about it HERE.

A research study calls into question the practice of defaulting to Early intensive behavioral intervention (EIBI) and more recently, the naturalist developmental behavioral intervention (NDBI) in favor of strengths-based approaches, based on the latest neuroscience autism-related research. You can see the study HERE.
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Effect of Transdisciplinary Approach in Group Therapy to Develop Social Skills for Children with Autism Spectrum Disorder
Home-based DIR/Floortime™ Intervention Program for Preschool Children with Autism Spectrum Disorders: Preliminary Findings

Research on DIRFloortime

Binns, A. and Cardy, J.0. (2019), Developmental social pragmatic interventions for preschoolers with autism spectrum disorder: A systematic review. Autism and Developmental Language Impairments. 2019 Jan; Vol 4(1), 1-18.

Binns, A, Hutchinson, L, and Oram Cardy, J (2018). The speech-language pathologist;s role in supporting thedevelopment of self-regulation: A review and tutorial. Journal of Communication Disorders (2018)  78, 1-17.

Casenhiser D.M., Shanker, S., Stieben J. Learning Through Interaction in Children with Autism: Preliminary Data from a Social-Communication-Based Intervention. Autism, published online September 26, 2011.

Casenhiser DM, Binns A, McGill F, Morderer O, Shanker SG. (2015). Measuring and supportinglanguage function for children with autism: evidence from a randomized controltrial of a social-interaction-based therapy. Journal of Autism and Developmental Disorders, 2015 Mar; 45(3):846-57

Christian, G (2011). A Person-Centered Approach to Problem Behavior: Using DIR®/Floortime with Adults Who Have Severe Developmental Delays. The NADD Bulletin, 2011, March/April, 14(2), 21-31.

Dionne M, Martini R. Floor Time play with a child with autism: A single-subject study. Revue canadienne d'ergotherapie, juin 2011, 78(3).

Guiot, G, Meini, C, and Sindelar, M.T. (2012). Autismo e musica: il modello Floortime nei disturbi della comunicazione e della relazione. Difficoltà di apprendimento. 17(3), 103-113.

Mok, J.W.S. and Chung, K.H. (2014). Application ofDIR/Floortime Model in the Psychiatric Service for Very Young Children with Autism in Hong Kong. Hong Kong Journal of Mental Health. 2014, 40(1), 23-30.

Pacheco, P., Pacheco, M., & Molini-Avejonas, D. (2021). Study of 18 months of follow up dir floortime intervention in preschool children with autism spectrum disorder (ASD). European Psychiatry, 64(S1), S503-S503. doi:10.1192/j.eurpsy.2021.1346

Pajareya K, Kopmaneejumruslers K. A pilot randomized controlled trial of DIR/Floortime parent training intervention for pre-school children with autistic spectrum disorders. Autism, published online before print, June 13, 2011.

Pajareya, K, Sutchritpongsa, S, Kongkasuwan, R. (2019) DIR/Floortime® Parent Training Intervention for Children with Developmental Disabilities: a Randomized Controlled Trial. Siriraj Medical Journal. 2019. 71(5), 331-338. 

Romanovsky, N.V., Itskovich, G., Strikha, O.E. (2022). Trialability of FEAS Structured Observation Scale on a Sample of Russian-Speaking Children. In: Arinushkina, A.A., Korobeynikov, I.A. (eds) Education of Children with Special Needs . Springer, Cham.

Sealy, J. and Glovinsky, I. P. (2016), Strengthening the Reflective Functioning Capacitiesof Parents Who have a Child with a Neurodevelopmental Disability through a Brief,Relationship-Focused Intervention. Infant Mental Health Journal. Doi: 10.1002/imhj.21557.

Sandbank, M., Bottema-Beutel, K., Crowley, S., Cassidy, M., Dunham, K., Feldman, J. I., Crank, J., Albarran, S. A., Raj, S., Mahbub, P., & Woynaroski, T. G. (2020). Project AIM: Autism intervention meta-analysis for studies of young children. Psychological Bulletin, 146(1), 1–29. https://doi.org/10.1037/bul0000215

Shamsudin, I. D., Brown, T., Yu, M. L., & Lentin, P. (2021). Parents of children with autism spectrum disorder’s perception on parent-implemented home-based developmental, individual-difference and relationship (DIR)/Floortime® intervention. Advances in Autism, 7(4), 294-310. https://doi.org/10.1108/AIA-05-2020-0032

Solomon, R., Van Egeren, L., Mahoney, G., Quon Huber, M., Zimmerman, P. (2014). PLAY Project Home Consultation Intervention Program for Young Children With Autism Spectrum Disorders: A Randomized Controlled Trial. Journal of Developmental and Behavioral Pediatrics, 35(8), 475-485. http://www.playproject.org/assets/PLAY_Project_Home_Consultation_Intervention.1.pdf

Thayer, F. & Bloomfield, B.S., (2021) An evaluation of a developmental individual differences relationship-based (DIR®)- creative arts therapies program for children with autism, The Arts in Psychotherapy,73. https://doi.org/10.1016/j.aip.2020.101752.