Factors associated with parent engagement in DIR/Floortime for treatment of children with autism spectrum disorder

Nattakit Praphatthanakunwong; Komsan Kiatrungrit; Sirichai Hongsanguansri; Kaewta Nopmaneejumruslers

doi:10.1136/gpsych-2018-000009

Factors associated with parent engagement in DIR/Floortime for treatment of children with autism spectrum disorder

Gen Psychiatr. 2018 Oct 31;31(2):e000009. doi: 10.1136/gpsych-2018-000009. eCollection 2018.

Authors

Nattakit Praphatthanakunwong¹, Komsan Kiatrungrit², Sirichai Hongsanguansri², Kaewta Nopmaneejumruslers³

Affiliations

¹ Joint curriculum program by Faculty of Medicine Ramathibodi Hospital, Faculty of Medicine Siriraj Hospital and National Institute for Child and Family Development, Mahidol University, Nakhon Pathom, Thailand.
² Psychiatric Department, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
³ National Institute for Child and Family Development, Mahidol University, Nakhon Pathom, Thailand.

Abstract

Background: The Developmental, Individual-differences, Relationship-based model (DIR/Floortime) is one of the well-known therapies for autism spectrum disorder (ASD), in which its main principle is to promote holistic development of an individual and relationships between the caregivers and children. Parental engagement is an essential element to DIR/Floortime treatment and involved with various factors. Finding those supporting factors and eliminating factors that might be an obstacle for parental engagement are essential for children with ASD to receive the full benefits of treatment.

Aim: To examine the association between parents, children and provider and service factors with parental engagement in DIR/Floortime treatment.

Methods: This is a cross-sectional study of parents with children aged 2-12 years who were diagnosed with ASD. Data were collected using a parent, child, provider and service factors questionnaire. Patient Health Questionaire-9, Clinical Global Impressions-Severity and Childhood Autism Rating Scale were also used to collect data. For parent engagement in DIR/Floortime, we evaluated quality of parental engagement in DIR/Floortime and parent application of DIR/Floortime techniques at home. Finally, Clinical Global Impressions-Improvement and Functional Emotional Developmental Level were used to assess child development.

Results: Parents who were married, had lower income and higher knowledge of DIR/Floortime theory were more likely to have higher parent engagement (χ²=4.43, p=0.035; χ²=13.1, p<0.001 and χ²=4.06, p=0.044 respectively). Furthermore, severity of the diagnosis and the continuation of the treatment significantly correlated with parent engagement (χ²=5.83, p=0.016 and χ²=4.72, p=0.030 respectively). It was found that parents who applied the techniques for more than 1 hour/day, or had a high-quality parent engagement, significantly correlated with better improvement in child development (t=-2.03, p=0.049; t=-2.00, p=0.053, respectively).

Conclusion: Factors associated with parents, children, and provider and service factors had a significant correlation with parent engagement in DIR/Floortime in which children whose parents had more engagement in DIR/Floortime techniques had better improvement in child development.

Keywords: DIR; autism spectrum disorder; floortime; parent engagement.