Autism Therapies From Alpha to Omega
Autism therapies vary, the latest article in the Ped Med series on autism, describes a number of different therapies for autistic children—Floortime, RDI (Relationship Development Intervention, TEACCH (Treatment and Education of Autistic and related Communication-handicapped CHildren), Pivotal Response Training—by setting them in opposition to ABA (Applied Behavior Analysis).
ABA is described as “highly structured” and involving “repetitive, rote-memory exercises” and is generally described as a lot less fun and encouraging of interactions between a child and others, particularly her or his parents. Pivotal Reponse Training is described as “child-directed” and as blending “rewards for requested behaviors with play techniques.” Floortime is said to get “tykes and therapists down on the floor in interactive imitation play” (”Therapists place toys to which the baby is attracted in their mouths or on their heads”). RDI is “intended for the wide spectrum of autism disorders”; in it, “rake leaves, prune trees, buy groceries, fix car engines and otherwise share the simple joys of everyday experiences with their parents, particularly with their fathers.”
The Ped Med evaluation of ABA as rigid and not simply structured but overly so is typical of comparisons made between ABA and other therapies that refer more to teaching children through play and to developing relationships (as in last year’s Time magazine article in which an ABA school was compared to a school using Floortime, and cast the former in unflattering light). The therapies do have their differences and it is these that get made most of, and amplified, in comparisons among them.
It is the case that ABA has been the most effective teaching methodology, both in a classroom setting and at home, for my son Charlie. I think it also worthwhile to note similarities and even overlaps among the therapies, all of which recognize that specialized and focused teaching drawing on methods perhaps unfamiliar to a regular classroom setting is needed for autistic children (for some and even many, not necessarily for all).
I have written critically on Stanley Greenspan’s ideas as presented in his book Engaging Autism: Helping Children Relate, Communicate and Think with the DIR Floortime Approach in some previous posts. In particular, I have some questions about how Greenspan writes about addressing some behavioral concerns (such as aggressive or self-injurious ones). But perhaps this is simply a sign of my own son needed a different teaching approach. And I tend to think that the mere existence of so many approaches is a good thing in and of itself: When my son started doing ABA at the age of 2 years old in September 1999, our program was, indeed, highly structured and exacting (for the record, we never did an eye contact program). We did a verbal behavior program instead of what gets called more traditional “Lovaas-style” ABA when Charlie was around 4 years and even took something of a hiatus from ABA when Charlie was 6-7 1/2. When we started doing ABA again in September of 2005 the program and the teaching style of our new Lovaas consultant still emphasized structure, and plenty of flexibility, natural environment teaching, and fun. The only time that Charlie did what can be called “behavior modification” was in his previous public school placement; this resulted in his self-injurious behaviors increasing.
I also tend to think that, just as our autistic children are all different in their different ways, so are us parents of autistic children. If you are going to have therapists in your house spending so much time with your child and you, it is crucial that you agree about fundamental issues and ideas and that you can work together (I have drawn figurative swords with one behavior consultant who told me that our program was a “benign dictatorship” and he did not mean that Jim and I, the parents, were in charge). My own teaching style in the classroom tends to be more structured and analytical, with plenty of smiles and good cheer mixed in: When teaching the Latin ablative absolute, the perfect middle and passive tenses of classical Greek verbs, and rules for acquiring ownership in Roman law, being able to dance around the room and lead the class in singing hoki poki in classical Greek can make the lesson go down with laughs and syntax learned.
As a teacher, I also know that, when faced with a hungry, unfocused, and sleepy group of students, you use any methods at your disposal to get the lesson across—by whatever initials might choose to call them—-ABA, RDI, DIR, TEACCH, alpha beta gamma, omega. The goal is not methodological purity (I think) but good teaching, and good learning.
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POSTED IN: Education, Psychiatry, Psychology, Treatment
8 opinions for Autism Therapies From Alpha to Omega
Caroline
Mar 19, 2007 at 6:17 pm
What were the biggest differences between the ‘behavior modification’ of the old program which was so stressful for C. and the new Lovaas ABA style that C. is thriving under?
Was it the langauge used by the teachers or the work? Behavior consultants really seem to believe in food as a reinforcer which can be a complicated thing.
I think lots of kids find learning interesting and reinforcing enough if its presented properly.
Do you find OT in a sensory gym to be helpful? I mean does Charlie find it helpful?
Leila
Mar 19, 2007 at 8:10 pm
ABA is the most widely available therapy. In my area there are no Floortime, TEACCH, Pivotal Response or RDI providers. So many times there’s not much choice for the parents besides ABA, except educate themselves about the other methods and try to incorporate them to their daily interactions with the kids. So far the books I’ve read on Floortime and Hanen Program (Canada) have been very helpful. However the ABA has been fantastic for my kid, I can’t complain. They are able to make him pay attention to, and follow instructions - and therefore learn new concepts/skills/games/rules - that he would not do otherwise if you mostly “follow his lead”. Things that I’d been trying to teach/show my son for months (same for his preschool teachers) with no success, he learns with the ABA tutors in one day, because he loves all the reinforcements he gets, he likes the structure, he loves the teaching materials, he loves the praise for every little achievement. I’m also using a lot of the ABA techniques on his free time, which has helped a lot with both language and compliance.
Kristina Chew, PhD
Mar 19, 2007 at 10:57 pm
ABA made the difference for Charlie. Figuring out ways to motivate him has always been a huge, huge part of the program—when he was not learning something, we figured it was something wrong in our teaching and sought to figure out what we were not doing. We debated for some time before starting it; I was particularly hesitant about having “strangers” so often in our house. In the end, their human presence—always loving and encouraging to Charlie, and gently confident—was the greatest motivator.
We created Charlie’s first ABA program—-we did hire an ABA consultant but found all the therapists, college students and one graduate student in speech pathology on our own. They were from very different backgrounds but something happened with them all coming together around Charlie. They had differing opinions about the ABA principles (and about the head consultant who appeared from time to time, who had a rather rigid way of thinking). Jim and I being both professors, we were used to talking to college students and encouraging debate and discussion and we all came to enjoy—and Charlie to relish—-weekly team meetings.
Lots of the reinforcement, esp. when Charlie was younger, was sensory. Tosses in blankets, rides in the laundry hamper and in his plastic chair “Jetson” style (the chair became a rocket, with the therapist the motor). He was especially fond of one therapist who was Philippina; he hovered at the window to watch for their cars. They were his friends and ours, not just therapists who came into the house to “work” with Charlie. In the winter (it was St. Paul and some of the students did not have cars) we drove them; Jim spent an afternoon driving around one therapist whose wallet was stolen and helped another get her car fixed (he was on sabbatical and was working at home that year).
There was something special about those young women that first year of Charlie’s therapy and I still feel sad the day we had a going away party, as we were moving back to St. Louis, where Jim had a tenured full professor job. We were never able to recreate such a cohesive group—though we certainly have had many, many wonderful therapists ever since—and I think there was something that Charlie missed about it, I can’t quite put my finger on it. He still talks about them by name. And I think that human element—-not what one associates with “behavior mod”—-was key.
Those young women became the motivating force for Charlie, and taught him to like learning.
Whereas, the “behavior modification” consultant for Charlie’s former public school placement (this consultant was an “outside contractor”) designed what I’ll call a cut and dry program to stop Charlie’s head-banging, in which Charlie was rewarded for keeping his head up (that was the language used) by a piece of food every five or so minutes. Compared to the careful planning and focused teaching of his early days, I have to think that Charlie wondered what in the world had happened that he was being offered this, and that was all—we had not used any food as reinforcers in his original program. At first, the “program” seemed to work (Charlie hit his head less), then he started to hit it just as much and more.
This consultant wrote that the reason for Charlie hitting his head could not be determined and speculated, on the basis of no evidence, that a one week’s trial of Ritalin for Charlie had caused the head-banging to begin (the behavior had occurred in the past, but had never become such a constant issue, nor so fierce). The consultant called “keeping your head up” a replacement behavior—-he was just trying to “fix” the “problem behavior.” It did not seem to occur to him that Charlie might have some quite complicated and sophisticated reasons for doing something like injurying himself.
Needless to say, the consultant did not respond well when Jim and I objected to all this. I wish we had taken Charlie out of that school then but there were no alternatives.
In June of 2005, fully aware of the objections to ABA that had arisen in me—the mechanistic view of human behavior from Skinner’s ideas, the clinical terminology, the tightly structured programming—I called the Lovaas agency in New Jersey. I did this at the behest—more and more urgent—of one of our original ABA therapists, now a speech therapist in the Twin Cities (the therapist who had insisted that Charlie must not remain in the classroom he was in). I am very glad I made the call.
Right after I published this post, Charlie and I went for a meeting with his therapists. He kept mock-running out the door for someone to chase him. He read “ball.” He used the mouse on the computer to do a puzzle—a skill he has been working at for years and recently learned at school. His teacher had written an apology for him having an “accident” at school—spilled water on his pants during art—talk about “not a problem!”.
I guess it can be said, I put so much store in ABA because I came to doubt it thoroughly for awhile. It is not perfect, not a panacea, not for everyone. But Charlie is happy and learning–doing yoga now in gym at school, talking about his teachers, smiling about his teachers and clasmates—and I am sitting here able to write this, and know he’s sleeping soundly and looking forward to when the bus comes tomorrow morning.
Leila
Mar 20, 2007 at 1:22 am
Motivation to learn is really the key on ABA.
mumkeepingsane
Mar 20, 2007 at 9:51 am
I think often people who compare therapies forget that each child is unique. ABA did not work at all with Patrick…it’s just not how he learns. But I can honestly say that I am so glad it has helped Charlie. Different children. Different ways to teach them. All from a place of love.
Club 166
Mar 20, 2007 at 10:04 am
…The goal is not methodological purity (I think) but good teaching, and good learning.
This, IMO, is key. It’s not necessarily which particular approach you use. It’s a therapist that can “read” where a child is at and what works for him/her, and modifies their approach accordingly.
And on another note…
…being able to dance around the room and lead the class in singing hoki poki in classical Greek …
For better or worse, this is an image that will stay with me all day.
Kristina Chew, PhD
Mar 20, 2007 at 11:04 am
That’s what it’s all about….. kai touto estin auto.
Caroline
Mar 20, 2007 at 5:23 pm
Thank you for the responses. It seems that perhaps what should be emphasized in M.S. Ed programs is how the therapist approaches each child individually and not the method used.
For some reason the parents are often NOT part of the team - whether in private pay or public school programs. Even if they are physically present in meetings what their input is often discounted.
If I were to work with a child or develop a program the first person I would go to is the parent(s) and ask the question:
‘what have you seen as successful and what teaching strategies have helped your child?’
This would save a lot of money in behavior consultants! (though they can be a great resource of course especially in small school districts)
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