The Developmental, Individual Difference, Relationship-Based Model (DIR) is an approach used for young children with autistic spectrum disorders (Greenspan & Wieder, 1999). The interventions derived from this model are anchored in the understanding of each child's unique profile of functional development capacities, enabling parents and professionals to construct an intervention plan geared to these individual characteristics. This study examined the change in autistic symptomatology and functioning in preschoolers participating in a DIR school program. The purpose was to examine the impact of DIR treatment on the children as well as to clarify associations between aspects of autistic symptomatology and functioning, which may be pertinent to future intervention and treatment planning. The participants were 13 three to five year olds diagnosed with an autistic spectrum disorder who attended a full day preschool program that utilizes the DIR approach. Nine children were studied for one year (two time points) and four children were studied for two years (four time points). Time sampling procedures were used to measure change across the following dimensions: autistic symptomatology, social-emotional functioning, adaptive behavior, stereotypic behavior, sensory reactivity, and parent stress.
Significant differences across one year were found for autistic symptomatology, stereotypic behavior, sensory seeking behaviors, and adaptive behavior. Parent stress was not found to change significantly, with 64% of parents still scoring in the clinical range after one year. Moreover, autistic symptomatology, stereotypic behavior, social-emotional functioning, and sensory-seeking behaviors evidenced the greatest change after two years in contrast with shorter intervals of time. It was found that as self-regulation and interest in the world and two-way purposeful communication increase, sensory-seeking behaviors significantly decreased. This supports the hypothesis that as the children became more interested in their surroundings and better attuned to others, their need for sensory-seeking behaviors decreased. Significant relationships were found between social-emotional functioning and overall autistic symptomatology, stereotypic behavior, and adaptive behavior, implicating the importance of addressing social-emotional deficits. While higher social-emotional functioning remained strongly associated with lower autistic symptomatology and higher adaptive behavior, it did not change in accordance with other abilities over one year. Consequently, social-emotional functioning appears to change gradually and slowly, indicating a need for intensive, long-term treatment. A positive association between sensory reactivity and autistic symptomatology, as measured through the course of intervention, was not supported.
An important implication of this study is the pattern of findings that as children with autism become less withdrawn and more responsive to their environment, their need for engaging in stereotypes decreases and they, in turn, seek out regulation from their environment, which is demonstrated by an increase in sensation-seeking behaviors. However, as the children gain the ability to relate, sensory-based behaviors were found to decrease, implicating that these social interactions meet their regulatory needs. Limitations, clinical implications, and future research suggestions are discussed.
