Encyclopedia of Autism Spectrum Disorders

Living Edition
| Editors: Fred R. Volkmar

The DIR Model (Developmental, Individual Difference, Relationship Based): A Parent Mediated Mental Health Approach to Autism Spectrum Disorders

  • Serena Wieder
Living reference work entry
DOI: https://doi.org/10.1007/978-1-4614-6435-8_615-3


The Developmental, Individual Difference, Relationship-Based model of intervention (DIR) provides a developmental framework for interdisciplinary assessment and parent-mediated intervention for autism spectrum and related disorders. This comprehensive model utilizes affect-based interactions and experiences tailored to individual differences to promote development. “D” refers to developmental capacities for shared attention and regulation, engagement across a wide range of emotions, two-way communication, and complex social problem solving which underlie the development of symbol formation, language, and intelligence. Intervention starts with pleasurable synchronous interactions between children and parents, the heart of relationships, which support progress. “I” refers to individual differences related to sensory reactivity and regulation, visual-spatial and auditory/language processing, and purposeful movement. Challenges in these neurobiological factors can make it...

This is a preview of subscription content, log in to check access.

References and Reading

  1. Capps, L., Sigman, M., & Mundy, P. (1994). Attachment security in children with autism. Development and Psychopathology, 6, 249–261.CrossRefGoogle Scholar
  2. Casenheiser, D. M., Shanker, S. G., & Stieben, J. (2011). Learning through interaction in children with autism: Preliminary data from a social-communication-based intervention. Autism, published online 2011.Google Scholar
  3. Casenhiser, D. M., Binns, A., McGill, F., Morderer, P., & Shanker, S. G. (2014). Measuring and supporting language function for children with autism: Evidence from a randomized control trial of a social-interaction-based therapy. Journal of Autism and Developmental Disorders, 45(3).Google Scholar
  4. Dawson, G., & Galpert, I. (1990). Mother’s use of imitative play for facilitating social responsiveness and toy play in young autistic children. Development and Psychopathology, 2, 151–162.CrossRefGoogle Scholar
  5. Gernsbacher, M. (2006). Toward a behavior of reciprocity. Journal of Developmental Processes, 1, 139–152.PubMedPubMedCentralGoogle Scholar
  6. Green, J., Charman, T., McConachie, H., Aldred, C., Slonims, V., Howlin, P., Le Couteur, A., Leadbitter, K., Hudrey, K., Byford, S., Barrett, B., Temple, K., Macdonald, W., Pickles, A., & The PACT Consortium. (2010). Parent-mediated communication-focused treatment in children with autism (PACT): A randomized controlled trial. Lancet, 375, 2152–2160.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Green, J., Wai Wan, M., Gulraud, J., Holsgrove, S., McNally, J., Slonims, V., Elsabbagh, M., Charman, T., Pickles, A., & Johnson, M. (2013). The BASIS team. Journal of Autism and Developmental Disorders, 43, 2502–2514.CrossRefPubMedGoogle Scholar
  8. Green, J., Pickles, A., Pasco, G., Bedford, R., Wai Wan, M., Elsabbagh, M., Slonims, V., Gliga, T., Jones, E., Cheung, C., Charman, T., & Johnson, M. (2017). Randomised trial of a parent-mediated intervention for infants at high risk for autism: Longitudinal outcomes to age 3 years. Journal of Child Psychology and Psychiatry, 58, 1330–1340.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Greenspan, S. (1992). Infancy and early childhood: The practice of clinical assessment and intervention with emotional and developmental challenges. Madison: International Universities Press.Google Scholar
  10. Greenspan, S. (2004). Greenspan social-emotional growth chart: A screening questionnaire for infants and young children. Bulverde: The Psychological Corporation.Google Scholar
  11. Greenspan, S. I., & Lourie, R. S. (1981). Developmental structuralist approach to the classification of adaptive and pathologic personality organization: Application to infancy and early childhood. The American Journal of Psychiatry, 138, 725–735.CrossRefPubMedGoogle Scholar
  12. Greenspan, S., & Shanker, S. (2004). The first idea: How symbols, language and intelligence evolved from our primate ancestors to modern humans. Reading: Perseus Books.Google Scholar
  13. Greenspan, S., & Wieder, S. (1997). Developmental patterns and outcomes in infants and children with disorders in relating and communicating: A chart review of 200 cases of children with autistic spectrum diagnoses. The Journal of Developmental and Learning Disorders, 1, 87–141.Google Scholar
  14. Greenspan, S., & Wieder, S. (1998). The child with special needs: Encouraging intellectual and emotional growth. Reading: Perseus Books.Google Scholar
  15. Greenspan, S., & Wieder, S. (2000). Principles of clinical practice for assessment and intervention. Developmentally appropriate interactions and practices. Developmentally based approach to the evaluation process. In Interdisciplinary council on developmental and learning disorders clinical practice guidelines (pp. 261–282). Bethesda: Interdisciplinary Council on Developmental and Learning Disorders.Google Scholar
  16. Greenspan, S., & Wieder, S. (2005). Can children with autism master the core deficits and become empathetic, creative and reflective? A ten to fifteen year follow-up of a subgroup of children with autism spectrum disorders (ASD) who received a comprehensive developmental, individual-difference, relationship-based (DIR) approach. The Journal of Developmental and Learning Disorders, 9, 39–61.Google Scholar
  17. Greenspan, S., & Wieder, S. (2006). Engaging autism: The Floortime approach to helping children relate, communicate, and think. Cambridge, MA: DaCapo Press/Perseus Books.Google Scholar
  18. Greenspan, S. I., & Wieder, S. (2011). Relationship-based early intervention approach to autistic spectrum disorders: The DIR model 1068. In D. G. Amaral, G. Dawson, & D. H. Geschwind (Eds.), Autism spectrum disorders (pp. 1068–1080). New York: Oxford University Press.CrossRefGoogle Scholar
  19. Greenspan, S., Wieder, S., Lieberman, A., Nover, R., Lourie, R., & Robinson, M. (1987). Infants in multirisk families: Case studies in preventive intervention. Clinical infant reports: No. 3. New York: International Universities Press.Google Scholar
  20. Greenspan, S., DeGangi, G., & Wieder, S. (2001). The functional emotional assessment scale (FEAS) for infancy and early childhood: Clinical and research applications. Bethesda: Interdisciplinary Council on Developmental and Learning Disorders.Google Scholar
  21. Gutstein, S. (2005). Relationship development intervention: Developing a treatment program to address the unique social and emotional deficits of autism spectrum disorders. Autism Spectrum Quarterly (Winter), 8–12.Google Scholar
  22. Gutstein, S. E., & Sheely, R. K. (2002). Relationship development intervention with young children: Social and emotional developmental activities for Asperger syndrome, autism, PDD and NLD. London: Jessica Kingsley.Google Scholar
  23. Jones, E. H., Dawson, G., Kelly, J., Estes, A., & Webb, S. J. (2017). Parent-delivered early intervention in infants at risk for ASD: Effects on electrophysiological and habituation measures of social attention. Autism Research, 00, 1–12.Google Scholar
  24. Kasari, C., Freeman, S., & Paparella, T. (2006). Joint attention and symbolic play in young children with autism: A randomized controlled intervention study. Journal of Child Psychology and Psychiatry, 47, 611–620.CrossRefPubMedGoogle Scholar
  25. Kasari, C., Freeman, S. F. N., Paparella, T., & Jahromi, L. B. (2008a). Language outcome in autism: Randomized comparison of joint attention and play interventions. The Journal of Clinical Psychiatry, 76, 125–137.Google Scholar
  26. Kasari, C., Paparella, T., Freeman, S., & Jahromi, L. B. (2008b). Language outcome in autism: Randomized comparison of joint attention and play interventions. Journal of Consulting and Clinical Psychology, 76(1), 25–137.CrossRefGoogle Scholar
  27. Koegel, R. I., Koegel, L. K., Harrower, J. K., & Carter, C. M. (1999). Pivotal response intervention1: Overview of approach. Journal of the Association for Persons with Severe Handicaps, 24, 174–185.CrossRefGoogle Scholar
  28. Lewis, J. D., Evans, A.C., Pruitt, J.R., Botteron, K.N., McKinstry, R.C., Zwaigenbaum, L., Estes, A., Collins, D.L., Kostopoulos, P., Gerig, G., Dager, S.R., Paterson, S., Schultz, R.T., Styner, M.A., Hazlett, H.C., Piven, J., for The Infant Brain Imaging Study Network (2017). The emergence of network inefficiencies in infants with autism spectrum disorders. Brain Psychiatry, 82, 176–185.Google Scholar
  29. Lord, C., & McGee, J. (2001). Educating children with autism. Washington, DC: National Research Council National Academy Press.Google Scholar
  30. Mahoney, G., & Perales, F. (2005). A comparison of the impact of relationship-focused intervention on young children with pervasive developmental disorders and other disabilities. Journal of Developmental and Behavioral Pediatrics, 26, 77–85.CrossRefPubMedGoogle Scholar
  31. Miller, L. J., Coll, J. R., & Schoen, S. A. (2007). A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder. American Journal of Occupational Therapy, 61, 228–238.CrossRefPubMedGoogle Scholar
  32. Mostofsky, S., Dubai, P., Jerath, V., Jansiewicz, E., Goldberg, M., & Denckla, M. (2006). Developmental dyspraxia is not limited to imitation in children with autism spectrum disorders. Journal of International Neuropsychological Society, 12, 314–326.CrossRefGoogle Scholar
  33. Mostofsky, S. H., Burgess, M. P., & Gidley Larson, J. C. (2007). Increased motor cortex white mater volume predicts motor impairment in autism. Brain, 130, 2117–2122.CrossRefPubMedGoogle Scholar
  34. Mundy, P., Sigman, M., & Kasari, C. (1990). A longitudinal study of joint attention and language development in autistic children. Journal of Autism and Developmental Disorders, 20, 115–128.CrossRefPubMedGoogle Scholar
  35. Oppenheim, D. (2009). Maternal insightfulness and resolution of diagnosis are associated with secure attachment in preschoolers with autism spectrum disorders. Child Development, 80, 519–527.CrossRefPubMedGoogle Scholar
  36. Pfeiffer, B. A., Koenig, K., Kinnealey, M., Sheppard, M., & Henderson, L. (2011). Research scholars initiative – effectiveness of sensory integration interventions in children with autism spectrum disorders: A pilot study. American Journal of Occupational Therapy, 65, 76–85.CrossRefPubMedPubMedCentralGoogle Scholar
  37. Pickles, A., Le Couteur, A., Leadbitter, K., Salomne, E., Cole-Fletcher, R., Tobin, H., Gammer, I., Lowry, J., Vamvakas, G., Byford, S., Aldred, C., Slonims, V., McConachie, H., Howlin, P., Parr, J., Charman, T., & Green, J. (2016). Parent-mediated social communication therapy for young children (PACT): Long term follow up of a randomized controlled trial. Parent mediated communication-focused treatment. Lancet, 388, 2501–2508.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Prizant, B., Wetherby, A., Rubin, E., & Laurent, A. (2003). The SCERTS model: A transactional, family-centered approach to enhancing communication and socioemotional abilities of children with autism spectrum disorder. Infants and Young Children, 16, 296–316.CrossRefGoogle Scholar
  39. Profectum Parent Toolbox, 2017. www.Profectum.org.
  40. Rogers, S. J., & Dawson, G. (2010). Early start Denver model for young children with autism. New York: Guilford.Google Scholar
  41. Rogers, S., Herbison, J., Lewis, H., Pantone, J., & Reis, K. (1986). An approach for enhancing the symbolic, communicative, and interpersonal functioning of young children with autism and severe emotional handicaps. Journal of the Division for Early Childhood, 10, 135–148.CrossRefGoogle Scholar
  42. Rogers, S. J., Ozonoff, S., & Maslin-Cole, C. (1993). Developmental aspects of attachment behavior in young children with pervasive developmental disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 1274–1282.CrossRefPubMedGoogle Scholar
  43. Schreibman, L., & Koegel, R. L. (2005). Training for parents of children with autism: Pivotal responses, generalization, and individualization of intervention. In E. D. Hibbs & P. S. Jensen (Eds.), Psychosocial treatment for child and adolescent disorders: Empirically based strategies for clinical practice (pp. 605–631). Washington, DC: American Psychological Association.Google Scholar
  44. Seida, J., Ospina, M., Karkhaneh, M., Hartling, L., Smith, V., & Clark, B. (2009). Systematic reviews of psychosocial interventions for autism: An umbrella review. Developmental Medicine and Child Neurology, 51, 95–104.CrossRefPubMedGoogle Scholar
  45. Siegel, D. (2001). Toward an interpersonal neurobiology of the developing mind: Attachment, “mindsight,” and neural integration. Infant Mental Health Journal, 22, 67–94.CrossRefGoogle Scholar
  46. Siller, M., & Sigman, M. (2002). The behavior of parents of children with autism predict the subsequent development of their children’s communication. Journal of Autism and Developmental Disorders, 32, 77–89.CrossRefPubMedGoogle Scholar
  47. Solomon, R., Necheles, J., Ferch, D., & Bruckman, D. (2007). Pilot study of a parent training program for young children with autism: The P.L.A.Y. project home consultation model. Autism: The International Journal of Research and Practice, 11, 205–224.CrossRefGoogle Scholar
  48. Solomon, R., Van Egeren, L. A., 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.CrossRefPubMedPubMedCentralGoogle Scholar
  49. Spreckley, M., & Boyd, R. (2009). Efficacy of applied behavioral intervention in preschool children with autism for improving cognitive, language, and adaptive behavior: A systematic review and meta-analysis. Journal of Pediatrics, 154, 338–344.CrossRefPubMedGoogle Scholar
  50. Torres, E. B., Smith, B., Mistry, S., Brinckner, M., & Whyatt, C. (2016). Neonatal diagnostics: Toward dynamic growth charts of Neuromotor control. Journal Frontiers in Pediatrics, 4, Article 21.Google Scholar
  51. Vismara, L., & Rogers, S. J. (2009). Can one hour per week of therapy lead to lasting changes in children with autism? Autism, 13(1), 93–115.CrossRefPubMedGoogle Scholar
  52. Wallace, K. S., & Rogers, S. J. (2010). Intervening in infancy: Implications for autism spectrum disorders. Journal of Child Psychology and Psychiatry, 51(12), 1300–1320.CrossRefPubMedPubMedCentralGoogle Scholar
  53. Wetherby, A. M., Prizant, B. M., & Hutchinson, T. (1998). Communicative, social-affective and symbolic profiles of young children with autism and pervasive developmental disorders. American Journal of Speech-Language Pathology, 7, 79–91.CrossRefGoogle Scholar
  54. Wieder, S. (1996). Climbing the "symbolic ladder": Assessing young children's symbolic and representational capacities through observation of free play interaction. In S. Meisels & E. Fenichel (Eds.), New visions for the developmental assessment of infants and young children (pp. 267–287). Washington, DC: Zero to Three.Google Scholar
  55. Wieder, S. (2011). DIR: Developmental, individual-difference, relationship-based model: A dynamic model for the 21st century. In D. Zager, M. Wehmeyer, & R. Simpson (Eds.), Research-based principles and practices for educating students with autism (pp. 82–98). New York: Routledge/Taylor & Francis.Google Scholar
  56. Wieder, S., & Greenspan, S. (2001). The DIR (developmental, individual-difference, relationship-based) approach to assessment and intervention planning. Zero to Three, 21, 11–19.Google Scholar
  57. Wieder, S., & Greenspan, S. (2003). Climbing the symbolic ladder in the DIR model through floortime/interactive play. Autism, 7, 425–436.CrossRefPubMedGoogle Scholar
  58. Wieder, S., & Wachs, H. (2012). Visual spatial portals to thinking, feeling and movement: Advancing competencies and emotional development in children with learning and autism spectrum disorders. Mendham: Profectum Foundation.Google Scholar
  59. Williams, D. L., & Minshew, N. J. (2007). Understanding autism and related disorders: What has imaging taught us? Neuroimaging Clinics of North America, 17(IV), 495–509.CrossRefPubMedPubMedCentralGoogle Scholar
  60. Zwaigenbaum, L., Bryson, S., Lord, C., Rogers, S., Carter, A., Carver, L., et al. (2009). Clinical assessment and management of toddlers with suspected autism spectrum disorder: Insights from studies of high-risk infants. Pediatrics, 123, 1383–1391.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media LLC 2018

Authors and Affiliations

  1. 1.Profectum FoundationMendhamUSA