Effectiveness of Floor-time therapy in comparison to Floor Time Therapy Adjunct to Music Therapy in the Children with Autism

Effectiveness of Floor-time therapy in comparison to Floor Time
Therapy Adjunct to Music Therapy in the Children with Autism
Spectrum Disorder

Manasi Rani Panda1 , S. Haque Nizamie2, Narendra Kumar Singh3

1Psychiatric Social Worker, Department of Psychiatric Social Work, S.C.B. Medical College, Cuttack, Odisha, 2Ex -Professor of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, 3Psychiatric Social Worker, Department of Psychiatric Social Work, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand.

Correspondence: Manasi Rani Panda, e-mail id:


Background: Autism Spectrum Disorders (ASD) is a group of neurological disorders characterized by impaired social communication and interaction as well as the presence of stereotyped behaviours and interest. The Floortime Therapy (FT) has been evolved around the principles of DIR (Developmental, Individual-differences, Relationship-based model) i.e. an intervention that is used to promote an individual’s development through a respectful, playful, joyful, and engaging process and music has also been studied to be an adjunctive therapy in numerous psychological problems and combined use of music and FT would fetch better results for children with ASD. There is paucity of studies on the impact of combined therapy in children and adolescents with ASD. Aim: The present study intended to see the effective comparison between FT and FT adjunct to Music Therapy in ASD. Method: Ten children diagnosed with ASD, as per ICD-10 DCR criteria were selected in the study through purposive sampling method and allocation of treatment was done. Those two groups of children were appropriately matched as per their age and clinical condition. Measures like ‘Socio-demographic and Clinical Data Sheet’, ‘Childhood Autism Rating Scale (CARS)’ & ‘Indian Scale for Assessment of Autism (ISAA) were used for data collection. Results:  There was significant change in the scores of CARS and ISAA, over treatment from baseline to middle, baseline to post and middle to post in both groups i.e. FT and FT adjunct to Music Therapy. Conclusion:  Adjunctive use of Music Therapy with DIR Model (e.g. FT) can hasten the improvement process in ASD as compared to single use of Floor-time therapy.

Keywords: Autism spectrum disorder, floortime therapy (FT), music therapy.



Autism Spectrum Disorders (ASD) is a group of neurological disorders characterized by social communication impairments as well as the presence of stereotyped behaviours and interest (APA, 2000). Although precise neurobiological mechanisms have not yet been established, it is clear that Autism Spectrum Disorders (ASD: henceforth it will be spelt as ASD) reflect the operation of factors in the developing brain. The Autism Spectrum Disorders occur along with IDD and language disorder in many cases. Even though there are strong and consistent commonalities, especially in social deficits, there is no single behaviour that is always typical of autism or any of the autistic spectrum disorders and no behaviour that would automatically exclude an individual child from diagnosis of ASD (Lord & Gee, 2001). Autism is the current global health crisis, which is not bounded by any margins and also does not distinguish between any nationality, ethnicity or social status.  It’s high time that the world begins to recognize the scope of this problem and acts internationally and locally to improve the lives of the growing number of individuals and families affected by this devastating disorder (Kopetz & Endowed, 2012).

Theory of mind signifies the deficit in empathy towards other people’s feelings and ideas. They could seldom connect with the surrounding and their inability to consider other people perspective leads to significant social and communicative challenges (Richard, 2000; Baron-Cohen, 2000). The Connectivity Theory has demonstrated decreased connectivity in the central nervous system in autism. It is clinically reasonable to assume that individuals with autism have poorly developed connections between separate brain circuitries. The Default Network Theory of the brain have long been shown to be dysfunctional or even damaged in autism (Klin et al., 1995).

Developmental Individual-difference Relationship-based model (DIR) was derived from over years of study and research about child development from the various fields. Floortime is the heart of the DIR model and it plays an important component on comprehensive programme for infants, adolescents and their families with a variety of developmental challenges including autism spectrum disorders. DIR model on FT was created by child psychiatrists Stanley Greenspan and Serena Wieder. The theory of DIR was initially described by Greenspan and was further developed over the next 20 years. FT focussed on the interest of child needs and how to respond to the child interest. It creates parent-child connections and brings out a child’s creativity and curiosity (Greenspan &Wieder, 1999).

FT takes place in a calm environment based at home or in a professional setting. Parents were encouraged to use this approach in their daily lives to expand their child’s circles of communication and strengths. The parents were asked to play with the child on the floor for at least 20 minutes or more which leads to associate them in their child’s world. Their shared world later helps the child to master each of his functional, emotional and developmental capacities. Following a child’s lead, interests and natural desires actually encourages the child to allow the parents into their emotional life. FT is also applicable to children with moderate to severe forms of developmental delays and it helps the child master the first stage of shared attention. Developmental capacities seek to measure changes in an individual’s ability to form warm intimate and trusting relationships. The capacity to initiate intentional actions and social engagement leads to spontaneous communication. Because of the wide range of individual differences in children with autism and the many unique relationships within families, it is necessary for parents to have the information and options to make informed choices about the type of services their child will receive. FT has a solid base of empirical evidence, and is widely used for children of all ages and abilities (Anderson, 2008).

Music therapy has been defined as a systematic process where the therapist helps the client to promote health, using musical experience and the relationship that develop through them. It is also perceived a type of therapeutic intervention where musical interaction in addition to verbal interaction used as a mean of interaction and expression of feelings (Gold et al., 2005). Though music therapy consists of music, the therapy covers a much larger definition and techniques or activities. In the physical therapy setting, dancing and moving to the music are activities that boost strength, balance as well as moods. Soft music playing in the background of a therapeutic session is one of the more positive and practical music therapy activities (Wigram, 2004).

Research studies and clinical reports have shown that music created spontaneously and creatively through structured and flexible improvisation attracts the attention and provokes engagement in children with ASD, and promotes the development of reciprocal, interactive communication and play. Data seems to suggest that active music therapy sessions could be of aid in improving autistic symptoms such as gestural and communication skills (Wigram & Gold, 2006).

In recent years, there has been a great effort to meet rising need and demand for innovative and therapeutic services that can give children with ASD the best chance to develop intellectually on a social basis, to discover their talents and to cope with their challenges. Among the effective and existing treatment options for individual with special needs are both FT and Music Therapy. There are many researcher applied music as a basic part in FT and it creates a great interest in between children (Wolfberg, 2009). The music Therapies combined with the DIR model creates a unique and comprehensive approach that accomplishes these tasks. The blend of a child-centered focus along with creative and expressive modalities brings together a dynamic and integrative model that children thrive on. Music Therapy can help children with sensory issues. Dr. John Carpente, a music therapist has incorporated the DIR model into his work as well. He states that the therapist’s task is to improvise music built around the child’s responses, reactions, responses, and/or movements to engage him or her in a musical experience that will facilitate (musical) relatedness, communication, socialization, and awareness (Carpente, 2009). FT based music therapy that involves the implementation of interactive music within the FT (Carpente & Gasse, 2015). Music therapy pioneers Nordoff and Robbins (1977), described their work with Edward, a young boy with autism: Personal and musical conditions, combined to make it possible for him to participate in sustained two-way communication. Researchers highlight varied music therapy treatment approaches, such as applied behaviour analysis, social stories and FT combined with improvisational music therapy and strategies such as collaborative consultation and family-centered practice (Kern &Humpal, 2012).


The present research intends to see the impact of Music Therapy (Classical Instrumental Hindustani Ragas) in children with ASD, as an adjunct to FT.

The present study has the following objectives:

  • To find out the impact of FT on children with ASD.
  • To know the impact of Music Therapy on children with ASD.


In this study, two different forms of therapy (FT and Music Therapy) – this implies that one group gets only FT and another group gets FT adjunct to Music Therapy) were applied and compared on two groups of children with same type of condition (ASD). Those two groups of children were appropriately matched as per their age and clinical condition. The study was conducted at the Department of Erna Hoch Center for Child and Adolescent Psychiatry (CCAP), Central Institute of Psychiatry, Kanke, Ranchi. The study sample consisted of 10 children (age range in between five to fifteen) with diagnosis of ASD, as per ICD-10 DCR criteria. Patients were selected through purposive sampling method and allocation of treatment (FT vs. FT adjunct to Music Therapy) was done on the selected samples by using the ‘odd-even formula’. Selected 10 children were assigned with digits and children with odd numbered digits were selected for FT adjunct to Music Therapy and children with even numbered digit were selected for only FT.

Tools Used

  • Socio-Demographic and Clinical Data Sheet
  • Childhood Autism Rating Scale (Schopler et. al,1980)
  • Indian Scale for Assessment of Autism (Patra & Arun, 2011)
  • Indian instrumental classical music viz. Raga Pilu and Raga Khamaj


Statistical package for social science version 22.0 was applied for analysis of the data. Descriptive statistics were used to describe the various sample characteristics. Distribution of socio-demographic variables across two groups of participants was done by using Chi square/fisher-exact test for categorical variables and Mann-Whitney test for continuation variable. For further understanding of difference within the group and locate the changes at different phase of measurement and intervention Friedman and Wilcoxon sign rank test was applied for the CARS and ISAA. To see the percentage change on CARS and ISAA, Mann-Whitney test was applied.To compare the impact of FT and FT adjunct to Music Therapy on children with ASD.


Table 1 shows the comparison of the socio-demographic characteristics of children with ASD participants.
The sample selected for study consisted of 80% of males and 20% female. About 60% samples belongs
to joint family and 30% of participants have family history of various mental illness. Among those who
participated, 50% were from urban habitat, 20% were from semi-urban and 30% were from rural area.
The result also show that 20% of sample belongs to lower socio-economic status, 30% belongs to middle
socio-economic status and 50% belongs to higher socio-economic status. Out of all the participants 80%
were Hindu, 10% Muslim and 10% belongs to other category of religion. Almost 60% of them had
associated with IDD. Majority of the participants’ mothers were unemployed (80%) whereas fathers were
employed (90%) in the selected sample, out of them 80% were government employees.

Table 2: explains socio-demographic and clinical profile of continuum variable by using Mann- Whitney test. The mean rank age of the respondents were found higher (6.30) in FT group as
compared to mean rank (4.70) of FT adjunct to music therapy group. The mean rank of family
monthly income was found (5.00 & 6.00) similar in both the groups i.e. FT adjunct to music therapy
group and FT group. However mean rank of the fathers education was found (5.00) in FT adjunct to
music therapy group and (6.00) FT group. The mean rank of the mother’s education was found
(5.60) in FT adjunct to music therapy group and FT group (5.40). The mean rank score of VSMS was
found higher (6.70) in FT group as compared to FT adjunct to Music Therapy group (4.30). Results
also indicated that the mean rank score of DST was found higher (7.10) FT group than FT adjunct to
music therapy group (3.90). However no significant difference was found with regard to age of
respondents, monthly family income, and education of father, education of mother, number of
family member, number of sibling, position of respondent among sibling in the both groups.