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Research Supporting Relationship-focused, Developmentally appropriate, Social Communication Play-based Interventions

Research strongly suggests that child-centered, relationship-based intervention is very effective in helping young children with autism spectrum disorders (ASD) gain language and social skills. Below is a list of supporting research evidence for relationship, developmental, and play-based interventions.

 Beurkens NM, Hobson JA, Hobson RP. (2013) Autism severity and qualities of parent-child relations. J Autism Dev Disord.  Jan;43(1):168-78. 

Gutstein, S. E., Burgess, A. F., & Montfort, K. (2007). Evaluation of the relationship development intervention program. Autism11(5), 397-411. ABSTRACT: This study is the second in a series evaluating the effectiveness of Relationship Development Intervention (RDI) to address unique deficits inherent in autism spectrum disorders. RDI is a parent-based, cognitive-developmental approach, in which primary caregivers are trained to provide daily opportunities for successful functioning in increasingly challenging dynamic systems. This study reviewed the progress of 16 children who participated in RDI between 2000 and 2005. Changes in the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R), flexibility, and school placement were compared prior to treatment and at a minimum 30 month follow-up period. While all children met ADOS/ADI-R criteria for autism prior to treatment, no child met criteria at follow-up. Similar positive results were found in relation to flexibility and educational placement. Generalizability of current findings is limited by the lack of a control or comparison group, constraints on age and IQ of treated children, parent self-selection, and parent education conducted through a single clinic setting. Link to article:

Gutstein, S. (2004). The effectiveness of Relationship Development Intervention in remediating core deficits of autism-spectrum children. Journal of Developmental and Behavioral Pediatrics25(5), 375.

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,

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

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.

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

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.

Casenhiser D, Shanker SG, Stieben J. (2011) Learning Through Social Interactions in Children with Autism: Preliminary Data from a Social-Communications-Based Intervention. Autism 26 Sept: 1-22.

Dawson, G., Rogers, S., et al. (2010) RCT of an Intervention for Toddlers with Autism: The Early Start Denver Model. Pediatrics, 125(1).

Green, J., Charman, T., McConachie, H. et al Parent-mediated communication-focused treatment in children with autism (PACT): a randomized controlled trial. Lancet Online May 21, 2010.

Greenspan, S.I., and Wieder, S. “Developmental Patterns and Outcomes in Infants and Children with Disorders in Relating and Communication: A Chart Review of 200 Cases of Children with Autistic Spectrum Disorders”.  The Journal of Developmental and Learning Disorders, Volume 1, No. 1 (1997b):87-141.

Ingersoll, Brooke, A. Dvortcsak, C. Whalen, and D. Sikora. (2005) “The Effects of a Developmental, Social-Pragmatic Language Intervention on Rate of Expressive Language Production in Young Children With Autistic Spectrum Disorders.” Focus of Autism and Other Developmental Disorders 20(4), 213-222.

Kasari C, Gulsrud AC, Wong C, Kwon S and Locke J (2010) Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. Journal of Autism and Developmental Disorders40(9): 1045–1056.

Kasari, C., Paparella, T., Freeman, S., & Jahromi, L.B. (2008). Language outcome in autism: randomized comparison of joint attention and play interventions. Journal of Consulting and Clinical Psychology, 76(1), 125-137.

Landa, R.J., Holman, K.C., O’Neill, A.H., Stuart, E.A. (2011) Intevention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder: a randomized controlled trial. Journal of Child Psychology and Psychiatry. 52:1, pp 13-21.

Krebs Seida, J., Ospina, M., Karkhaneh, M., Hartling, L., Smith, V., Clark, B. (2009).

Systemic reviews of psychosocial interventions for autism: An umbrella review, Developmental Medicine & Child Neurology, 51: 95-104.

Mahoney G and Perales F (2003) Using relationship-focused intervention to enhance the social emotional functioning of young children with autism spectrum disorders. Topics in Early Childhood Special Education 23(2): 74–86.

Mahoney, G., and F. Perales. (2005) “Relationship-focused early intervention with children with pervasive developmental disorders and other disabilities: a comparative study.” Journal of Developmental & Behavioral Pediatrics 26(2): 77-85.

McConachie H., V. Randle, D. Hammal, and A. Le Couteur. “A controlled trial of a training course for parents of children with suspected autism spectrum disorder.” Journal of Pediatrics 147, (2005): 335-340.

Ospina, M., Krebs Seida, J., Clark, B., Karkhaneh, M., Hartling, L., Tjosvold, L., Vandermeer, B., Smith, V. (2008) Behavioural and Developmental Interventions for Autism Spectrum Disorder: A Clinical Systematic Review, PLoS ONE 3(11): e3755. doi:10.1371/journal.pone.0003755.

Pajareya, K., Nopmaneejumruslers, K. (2011) A pilot RCT of DIR/Floortime parent training intervention for pre-school children with ASD. Autism, 15(2),1-15.

Prizant BM and Wetherby AM (1998) Understanding the continuum of discrete-trial traditional behavioral to social-pragmatic developmental approaches to communication enhancement for young children with autism/PDD. Seminars in Speech and Language 19:329–353.      

Reichow B., Volkmar, Cicchetti, 2008 Development of the Evaluative Method for Evaluating and Determining Evidence-Based Practices in Autism J Autism Dev Disord 38:1311.

Seida, Ospina, Karkhaneh, Hartling, Smith, and Clark. Developmental Medicine and Child Neurology, (2009), 51.95-104 Systematic reviews of psychosocial interventions for autism: an umbrella review.

Siller, M., & Sigman M. (2002). The behaviors of parents of children with autism predict the subsequent development of their children’s communication. Journal of Autism and Developmental Disorders32(2), 77-89.

Solomon, R., J.  Necheles, C. Ferch, and D. Bruckman. “Pilot study of a parent training program for young children with autism: The P.L.A.Y. Project Home Consultation program.”  Autism 11, no. 3 (2007) 205-224.

Recent Relevant Evidence Based Practice Reviews

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. 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)


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.

Effect of Transdisciplinary Approach in Group Therapy to Develop Social Skills for Children with Autism Spectrum Disorder

RDI® Specific

Autism Aspergers: Solving the Relationship Puzzle by Dr. Steven Gutstein. This was the first book to describe the model and theory of Relationship Development Intervention (RDI™ Program). The reader will begin to learn the basics of a new developmental program that will open the door to lifelong social and emotional growth for individuals on the autistic spectrum.

Dynamic Thinking and Development

Cradle of Thought by Peter Hobson. This is Dr. Peter Hobson’s brilliant book which explains the basis of his theory that Autism can be thought of as a failure to develop active mental engagement. Dr. Hobson is a Psychiatrist and Experimental Psychologist who is a professor at the world-renowned Tavistock Institute of the University of London. His theoretical approach is at the cornerstone of RDI®. (HL1)

Emotional Development: The Organization of Emotional Life in Early Years by Alan Fogel. I think it is the single most important book re: the development of RDI… Dr. Alan Sroufe is generally recognized to be the world’s leading expert on children’s emotional development. In this technical but brilliant work, Dr. Sroufe details the developmental sequences that lead to children’s learning to successfully function in dynamic systems and to crave incongruity and cognitive challenge. (HL1)

The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are by Daniel Siegel. Dr. Daniel Siegel has produced the first non-technical, readable book about the amazing development of the human mind. He provides excellent sections on the way the brain communicates, the development of episodic memory and a host of other areas that are essential reading for anyone seeking a background to RDI. (HL1)

The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children by Ross W. Greene, Ph.D. In The Explosive Child, Dr. Ross Greene proposes that challenging behavior should be understood and handled in the same manner as other recognized learning disabilities. In other words, difficult children and adolescents lack some crucial cognitive skills essential to handling frustration and mastering situations requiring flexibility and adaptability. The Second Edition of The Explosive Child is the internationally acclaimed book that provides a more contemporary conceptualization of inflexible, easily frustrated, explosive children, and describes a new, practical, comprehensive approach for helping these children at home and school. This approach – called the Collaborative Problem Solving Approach — is aimed at decreasing adversarial parent-child interactions, reducing family hostility, and improving children’s capacities for flexibility, frustration tolerance, communication, and self-regulation. A perfect companion to the book, the DVD, Parenting the Explosive Child is also available through

Early Relationships and Relationship Development

Developing Through Relationships by Alan Fogel. Dr. Fogel is the developmental psychologist who has had the most influence in bringing the study of co-regulation in dynamic systems to the forefront of developmental psychology. His work, especially his explanation of the co-regulation process, was a revelation to me and is still a foundation for progress in RDI. (HL1)

The First Relationship: Infant and Mother by Daniel Stern. For over 30 years, Dr. Daniel Stern has been known as the most poignant narrator of the parent-infant experience. While this book is somewhat dated, Dr. Stern’s vivid narrative accounts and illustration provide a timeless glimpse into the miraculous dance that begins at birth between the young infant and caretakers. (HL1)

The Infant’s World by Philippe Rochat. Dr. Rochat has been recognized on the leading edge of the new generation of developmental psychologists. Dr. Rochat’s volume, while quite readable, also is a detailed account of the most recent findings about infant’s development of mental processes that only a few years ago were thought to occur at a much later developmental stage. Rochat nicely summarizes the research literature in an understandable manner. (HL1)

I Love You Rituals by Becky A Bailey. I Love You Rituals offers more than seventy delightful rhymes and games that send the message of unconditional love and enhance children’s social, emotional, and school success. Winner of a 1999 Parent’s Guide Children’s Media Award, these positive nursery rhymes, interactive finger plays, soothing games, and physical activity can be played with children from infancy through age eight. In only minutes a day, these powerful rituals:
Prime a child’s brain for learning
Help children cope with change
Enhance attention, cooperation, and self-esteem
Help busy families stay close
Affirm the parent-child bond that insulates children from violence, peer pressure, and drugs, and much more.
Easy to learn and especially effective in stressful situations, I Love You Rituals gives parents, grandparents, caregivers and teachers inspiring tools to help children thrive.

Joint Attention

Joint Attention: Communication and Other Minds edited by Naomi Eilan, Chirstoph Hoerl, Teresa McCormack, and Johannes Roessler. Joint Attention has been a pivotal concept in Autism for over twenty years. Unfortunately the concept has been misrepresented and grossly misunderstood in many clinical approaches. This volume presents the thoughts of world experts in Joint Attention including Michael Tomasello, Dare Baldwin and Peter Hobson. Each chapter places a unique spotlight on a different aspect of joint attention. The book provides an important foundation for anyone wishing to understand the nature of joint attention impairments in autism spectrum disorders. (HL2)

Master-Apprentice Relationship

Apprenticeship in Thinking: Cognitive Development in Social Context by Barbara Rogoff. Barbara Rogoff has spent her long career studying cultures in all parts of the world to determine the ways that parents and communities facilitate the development of productive thinking and problem solving in their children. This book details some of her findings and is a cornerstone in developing our concept of the ‘Master-Apprentice’ relationship. (HL1)


Wisdom, Intelligence and Creativity Synthesized by Robert J. Sternberg. This is the latest work from noted Yale University professor Dr. Sternberg who, more than any other scientist has worked to understand intelligence in a real-world manner. In this book, Sternberg provides an alternative model for understanding intelligence and many cogent ideas for assessing it and developing the types of cognitive abilities that are most related to real-life success. (HL2)

Language Development

How Children Learn the Meanings of Words by Paul Bloom. No account of modern understanding of children’s language development can be considered complete unless it includes the work of Dr. Paul Bloom. His elegantly written, powerfully convincing work provides a unique door into our modern understanding of language development. In this account Dr. Bloom focuses on a single, critical aspect of language; how children come to understand the meaning of words. (HL2)

Constructing a Language: A Usage-Based Theory of Language Acquisition by Michael Tomasello. Dr. Tomasello has been acknowledged as one of the world leaders of modern developmental psychology. This volume is especially important to those in the autism community, as it provides an up-to-date understanding of the amazing progress that has been made, in the past twenty years, in understanding language development. This book should be considered essential reading in a field that is still largely mired in a 1950’s Skinnerian view of language as “verbal behavior”. (HL2)

Sensory Processing

The following two books are recommended by The Autism Group, Inc. with descriptions by

The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder by Carol Stock Kranowitz. The Out-of-Sync Child broke new ground by identifying Sensory Processing Disorder, a common but frequently misdiagnosed problem in which the central nervous system misinterprets messages from the senses. This newly revised edition features additional information from recent research on vision and hearing deficits, motor skill problems, nutrition and picky eaters, ADHA, autism, and other related disorders.

The Out-of-Sync Child Has Fun, Revised Edition: Activities for Kids with Sensory Processing Disorder by Carol Stock Kranowitz. This book is the revised and updated edition of a groundbreaking special-needs activity guide. This revised edition of the companion volume to The Out-of-Sync Child includes new activities that parents of kids with Sensory Processing Disorder can do at home with their child, along with updated information on which activities are most appropriate for children with coexisting conditions such as Asperger’s, autism and more.

Learning and Educational Resources

Awakening Children’s Minds: How Parents and Teachers Can Make a Difference by Laura E. Berk. In this very well written book, Dr. Berk provides a well-written, easily understood account of the practical application of Vygotsky and the development of children’s mental life. Dr. Berk takes difficult concepts such as the Zone of Proximal Development and makes them both understandable and useable. This is an essential volume for any professional or parent. (HL2 and HLP)

Guided Reading: Making It Work by Mary Browning Schulman and Carleen DaCruz Payne. Guided reading is a proven method for teaching reading as a thoughtful, reflective process. The guided reading method is based on understanding reading as an integrated process involving perception, thought, reflection and emotion. It provides an excellent method for parents to actively participate in ensuring that reading is learned in a “connected” manner. (HLP)

Creative Homeschooling: A Resource Guide for Smart Families by Lisa Rivero. An excellent text for parents considering or already engaged in home schooling. 


This info is provided for your information. Although we validate each source, sometimes links and sites can change. So please be sure to check the details of each source. And contact us if you have any questions.

First Signs is devoted to educating parents and pediatric professionals on the early warning signs of autism and other developmental disorders.

Autism Society of America is a national non-profit organization dedicated to providing education, advocacy, research, services, and support for families and professionals.

San Diego Autism Society of America is the local ASA chapter. The SDASA strives to provide extensive information and resources for families and professionals. A few of the programs include monthly informational meetings, an informative newsletter, conferences, a monthly pool party, and funding for CAMP I CAN, a summer Surf Camp, and swim lessons.

Division TEACCH hope to enable children with autism to function as meaningfully and independently as possible in the community.

Sensory Smarts provides extensive information regarding Sensory Integration. It includes functional techniques, sample sensory diets, information about different types of sensory input as well as recommended sensory toys.

Teaching Materials

Future Horizons is a leading publishing company dedicated to providing resources for parents and professionals in the field of autism. This site includes books, journals, videos, medical resources, and conference information.

The Lake Shore Learning Store provides extensive educational materials, classroom furniture, organizational tools, and toys for teachers and parents.

Diff Learn is a web site dedicated to supplying autism specific materials for parents and professionals. These include a variety of visuals, programs, games, puzzles, timers, books, flashcards, software, handwriting tools, etc.


The Autism Research Institute (ARI) is devoted to conducting research, and to disseminating the results of research, on the causes of autism and on methods of preventing, diagnosing and treating autism and other severe behavioral disorders of childhood.

The National Alliance for Autism Research (NAAR) is devoted to funding biomedical research for autism and related disorders.

Cure Autism Now (CAN) is an organization of parents, physicians, and researchers, dedicated to promoting and funding research with direct clinical implications for treatment and a cure for autism. is a web site dedicated to providing information for people on gluten free diets due to celiac disease, gluten intolerance, dermatitis herpetiformis, wheat allergy, or other health reasons.

The Gluten Free Casein Free web site is a free resource for parents who are implementing the GFCF diet. It includes books, educational videos, vitamins, and liquid calcium.

The Gluten Free Pantry provides gluten free recipes, products, and resources for parents and professionals.

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