Evidence-based practice” refers to a decision-making process that best combines scientifically rigorous research, clinical expertise, and the characteristics of the individual. Evidence-based practice is an approach to treatment rather than a specific treatment. Evidence-based practice promotes the collection, interpretation, integration, and ongoing evaluation of valid, significant, and applicable self- or family-reported, clinically observed, and research-supported evidence. Best evidence is applied to ensure the quality of clinical decisions and facilitate the most cost-effective care.
A starting point for measuring the effectiveness of an intervention is to identify the factors to be measured. This is a major challenge in developmental disorders. 'Behavior' approaches consider environmental influences on observable behavior and encourage or discourage target behaviors by altering the antecedents and consequences of that behavior. Recently, there has been a focus on measuring spontaneous interactions and generalization of skills, which has presented new challenges in measurement.
In contrast, developmental programs target core capacities or “core deficits” as the focus of intervention, with improvements in complex changes in interactive behavioral patterns. That is, developmental approaches focus on the relationship between the child and the caregiver and address the child's functional capacities. Developmental interventions rely on the child's sense of pleasure inherent in shared emotional experiences to increase the spontaneous flow of affective communication and achieve increasingly complex levels of interaction.
Behavioral approaches emphasize targeted behavior and its generalization.
>Developmental Approaches:
• Joint Attention
• Ability to establish warm, sincere and trusting relationships
• Using purposeful actions and social togetherness (being in a constantly responsive position ability to initiate communication; spontaneous-spontaneous communication
• The ability to participate in reciprocal (two-way, reciprocal) interactions in different emotional situations
• (co-regulation), reading and responding to the child's signals. Being attuned to the emotions of others crying
• Creativity
• Thinking logically about the motivations and perspectives of others
• Developing one's own intrinsic values
These developmental measures, PDB / It is closer to the diagnostic criteria for autism than criteria often used in older research, such as IQ, early academic skills, and behavioral responses.
Developmental models focus on individual differences and the extent to which intervention depends on the child's individual profile and parent-specific characteristics. emphasizes the need to adapt it to the characteristics of child interaction.
Research is challenging due to both the complexity of the factors measured and the wide variety of individual differences in the population. When considering the evidence for DIR/Floortime, it is important to understand the challenges in examining a complex model and to consider the long wait on the effectiveness of various aspects of the developmental framework.
Approaches that use behavioral principles use external motivation tools on the grounds that children with autism do not have the motivation to participate in social interaction or learn. The DIR/Floortime approach has established that all children will show purpose and initiative and seek close social relationships when provided with interactions that respect their interests and are tailored to their individual differences.
Historically, behaviorist approaches have not focused on relationships or individual differences. But this has been changing recently.
Evidence continues to support parent-mediated intervention as effective in treating children with autism. When the literature, which included only randomized controlled trials, was reviewed, it was found that there was a positive change in parent-child interaction, an increase in parental synchronization and a decrease in children's understanding of language and the severity of autism features.
Psychodynamic therapy, case-by-case perspective. It is a form of “holistic therapy” or therapy that focuses holistically on the aspect. Alternative “problem-based” therapies, such as cognitive behavioral therapy, aim to reduce or eliminate symptoms rather than exploring the in-depth needs, wants, and desires of the case (McLeod, 2014). This means that there is a difference between the goals and techniques among therapies. and turn into significant differences in terms of general approach.
Psychodynamic therapy involves the interpretation of mental and emotional processes rather than focusing on behavior
According to Shedler, in 2010, many studies and meta-analysis
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Experimental evidence supports the effectiveness of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies actively promoted as 'empirically supported' and 'evidence-based'. ”
Defines 7 features of psychodynamic therapy:
1. Focusing on affect and expression of emotions
2. Exploring attempts to avoid distressing thoughts and feelings
3. Identifying recurring themes and patterns
4. Discussing past experiences (developmental focus)
5. Focus on interpersonal relationships
6. Focus on the therapeutic relationship
7. Exploration of fantasy life
The American Psychological Association [19] strongly recommends the inclusion of clinical expertise and judgment in the practical application of evidence-based psychotherapies. Even evidence-based psychotherapies (therapist-centered, like CBT, not case-centered because there are too many variables and cannot be controlled for scientific study) should not be practiced as usual. Therapies that lack flexibility do more harm than good.
Psychodynamic therapy is a “holistic therapy” or form of therapy that focuses holistically on the case's perspective. Alternative “problem-based” therapies, such as cognitive behavioral therapy, aim to reduce or eliminate symptoms rather than exploring the in-depth needs, wants, and desires of the case (McLeod, 2014). This translates into significant differences between therapies in terms of goals, techniques and general approach.
Psychodynamic therapy involves the interpretation of mental and emotional processes rather than focusing on behavior
This is what I am telling you. Although not relevant to children with autism, it provides the basic framework for a psychodynamic approach that is the root of developmental approaches to treatment with children. “The goals of psychodynamic therapy include reducing symptoms, but the study goes beyond that. Successful treatment is simple ce should not only alleviate symptoms but also promote the positive availability of psychological capacities and resources. ”
A key distinction of measurement for research outcomes is that developmental approaches enhance developmental capacities rather than simply changing specific skills or behaviors, reciprocity, and that these changes enhance social participation. However, it is more difficult to measure the consequences of change in functional capacity.
DIR / Floortime has a solid empirical evidence base and is widely used for children of all ages and abilities. Behavioral approaches are not superior to developmental approaches in functional outcomes.
Evidence-based practice means that the clinician can use a full range of information, including clinical expertise and the family's individual values and preferences, in addition to published research.
The United States National Standards Project (NSP) periodically publishes reports evaluating behavioral or educational treatments used in the field of autism. However, D.I.R Floortime is basically neither a behavioral nor an educational method as mentioned above. therefore, it is evaluated with different scales in a classification to which it does not belong.
The National Standards Project (NSP) divides interventions into treatment categories. ‘Developmental and Relationship-based treatment (DRBT) and “Social communication intervention”
In NSP, the strength of the evidence is based in part on the amount of research articles in each category, so that the grouping of interventions becomes a critical factor in the final rating. NSP Phase 1 (2009), which reviewed articles through 2007, has a category of interventions called “Developmental Relationships-based treatment (DRBT).” Seven articles were included in the DRBT group and were rated as “promising.” However, “Social-communication intervention” emerges in a category where 2 studies (Salt, 2002 and Aldred 2004) can easily be considered DRBT. There will probably be different ratings in different groupings.
In 2015, a new category under the name 'Parent education package' is opened in NSP phase 2 and floortim Since e meets both parent therapy and the above categories, a separate title is created for it and the phrase 'no evidence yet' appears because the article is insufficient.
A review by Smith and Iadarola, 2015, dated February 2014 Contains as many articles. These divide interventions into larger treatment families, such as ABA and developmental social-pragmatics (DSP). In their review, “developmental, social pragmatic interventions” were rated as “probably effective” by parents and “probably effective” by teachers.
In 2015, Mercer developed a new approach to social work for the treatment of children with ASD, specifically DIR/Floortime. Published a review about. “DIR is one of the Developmental Social Pragmatic (DSP) treatments for ASD,” he said. He thinks that DIR/Floortime is a logical treatment and concludes: “The foundations of DIR/Floortime make sense because it is compatible with theories about early child development.” In assessing the effectiveness of DIR/Floortime, “even relatively weak evidence for DIR indicates that it is part of evidence-based practice.” “Given the general factors that DIR/Floortime shares with other child psychotherapies, it is likely as effective a treatment for ASD as other developmental social pragmatic treatments.”
One of the principles of developmental relationship-based interventions is that the intervention follows the child's leadership and is child-centered. Dunst et al. (2012) reported a meta-analysis of 24 studies on the impact of incorporating the child's interest into intervention. They conclude that “intervention practices based on the child's interests were effective in increasing socialization and reducing problem behaviors.”
In summary, D.I.R floortime is based on psychodynamic therapy, as well as language development-sensory development. It is a valid method with scientific evidence that can be used with children with special needs, as it is an approach that is informed by motor theories and cares about the child-family relationship.
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