For therapists and families to be effective in working with kids with autism, they should be able to do any methodology.
There is an alphabet soup of different methods to teach kids with autism – Applied Behavior Analysis (ABA); the Developmental, Individual Differences, Relationship-Based (DIR) Model; Relationship Development Intervention (RDI); Treatment and Education of Autistic and Communication – Handicapped Children (TEACCH), and others.
Regardless of which methodologies are used, programs need to have goals and targets and teach in such a way so that kids can generalize skills to apply what they have learned to a natural environment. Teaching methods should also integrate academics and cognitive skills; emotional awareness and social skills; exercise, sports, and motor skills; along with spontaneous, imaginative, and creative play. Skills should be taught in a meaningful way rather than a robotic, rote way.
Children need to develop a relationship with caregivers in order to learn. The revolving door philosophy of bringing people in and out so that a child has had 100 caregivers by the time he is 10 does not work. Stanley Greenspan says, “Emotion always come before behavior. The child needs to enjoy relationships with parents, peers, and teachers in order to learn.” Emotion is critical to brain development. It’s more than “cute” when a child is engaged with a caregiver. The child learns better.
I have been an advocate of Greenspan’s DIR method for the past few years. The Interdisciplinary Council on Learning Disorders (www.icdl.com) says this about DIR.
DIR is a comprehensive, interdisciplinary approach that focuses on the emotional development of the child. It takes into account the child’s feelings, relationships with caregivers, developmental level and individual differences in a child’s ability to process and respond to sensory information. It focuses on the child’s skills in all developmental areas, including social-emotional functioning, communication, thinking and learning, motor skills, body awareness, and attention.
The goal of treatment is to help the child master the healthy emotional milestones that were missed in his early development and that are critical to learning. Building these foundations helps children overcome their symptoms more effectively than simply trying to change the symptoms alone.
Then it says this about Floortime:
Floortime, a vital element of the DIR/Floortime model, is a treatment method as well as a philosophy for interacting with children (and adults as well). Floortime involves meeting a child at his current developmental level, and building upon his particular set of strengths. Floortime harnesses the power of a child’s motivation; following his lead, wooing him with warm but persistent attempts to engage his attention and tuning in to his interests and desires in interactions. Through Floortime, parents, child care providers, teachers and therapists help children climb the developmental ladder. By entering into a child’s world, we can help him or her learn to relate in meaningful, spontaneous, flexible and warm ways.
Floortime is a component of DIR but not the same. In Floortime, you follow the lead of the child. In DIR, once kids move past the initial stages of the developmental ladder, you create programs that revolve around the child’s interests, in which he is emotionally engaged, with meaningful two-way interaction, customized toward his individual differences. The kids don’t tell you what to do; you just do things that are meaningful to them. Again, Floortime is only a subset of DIR. In the lower developmental levels of DIR (Floortime), you follow the child’s lead (but even then that means you follow and join what the child is interested in – the child doesn’t tell you what to do), and in the higher levels there are more structured, therapist or parent-led programs.
Two and a half years ago, I wrote on my website at http://www.coachmike.net/autism-faq.php (see #4) a little about DIR and Floortime, as well as a summary of Applied Behavior Analysis (ABA).
I combine elements of Applied Behavior Analysis (ABA) as well as the Developmental, Individual-Difference, Relationship (DIR) based method. I believe a combination of ABA and DIR methods is optimal because ABA provides step-by-step instruction while DIR focuses on relationships, emotions and interests. Children need both structure and meaning when they learn.
ABA is used to teach academic, communication, problem solving, behavioral, social, play, and other skills by breaking tasks down into small steps and practicing drills. ABA also uses positive reinforcement and just as much prompting as is necessary. Inappropriate behaviors may be phased out by redirecting to target activities rather than drawing more attention to those behaviors. Antecedents, behaviors, and consequences are tracked to try to determine the reasons behind behaviors and implement appropriate interventions. However, some behaviors may be accommodations children need to manage their body or sensory difficulties. Therefore, I focus on building skills more so than reducing behaviors.
The DIR method focuses on the emotional development of the child. It takes into account the child’s feelings, relationships and individual differences. DIR involves following the child’s lead and enables the child to learn by doing what he or she likes to do in a fun and meaningful way. According to ICDL.org, “DIR focuses on the child’s skills in all developmental areas, including social-emotional functioning, communication, thinking and learning, motor skills, body awareness and attention.” The DIR method can also help a child generalize skills initially learned through drills.
Part of the DIR model includes Floortime, which is based on working with a child at his or her current developmental level, and building upon strengths and interests in a way that is meaningful to the child, rather than just focusing on surface behaviors and drills that don’t always generalize into life skills. Floortime can be especially effective during periods when a child needs more play and less work.
5. Which is better – ABA or the DIR model?
In my opinion, this question is kind of like asking, “Which is better in football – running the ball or passing the ball?” or “Which is better in basketball – a zone defense or man to man?” They’re both necessary in different situations, and a balance of both may be most effective. For example, you can do repetitive drills broken down into small steps based on the child’s individual differences, interests and relationships, making sure to incorporate social skills and emotions.
In doing so, children can learn valuable skills such as sequencing the steps needed to complete a task. Children with autism benefit from structure, but they will be more engaged if the drill involves something in which they are emotionally invested. The DIR model is harder to quantify than ABA, but DIR is built on relationships, spontaneity and interaction. Children are not robots, and drills can’t be done in a vacuum.
For example, you can teach a child who is obsessed with a particular toy communication and problem solving skills in the following way: Hide the toy in one of your hands and get the child to reach for it and choose which hand it is in. Then you can do the same thing by holding the toy behind your back, or placing it near your face to establish eye contact. Subsequent steps may include getting the child to make sounds or use speech if possible to request the toy. The toy is used as a reward. This example is based on one in Engaging Autism by Dr. Stanley Greenspan.
For the rest of the FAQs on my website, see www.coachmike.net.
Lately, it seems that RDI has taken off as the method of choice. I can’t really see how RDI is much different than DIR, except maybe that the order of the letters sounds a little bit more catchy. If anything, RDI seems like an implementation of DIR. However, this summary from Chicago Floortime Families points out some differences as well as many similarities.
According to about.com (I went there because the RDI website at http://www.rdiconnect.com/ doesn’t do a good job of describing RDI), children can develop the following through RDI:
- Dramatic improvement in meaningful communication,
- Desire and skills to share their experiences with others,
- Genuine curiosity and enthusiasm for other people,
- Ability to adapt easily and “go with the flow,”
- Amazing increase in the initiation of joint attention,
- Powerful improvement in perspective taking and theory of mind,
- Dramatically increased desire to seek out and interact with peers.
This looks a lot like DIR to me. In any case, whether it’s DIR, RDI, or you want to create a new acronym such as IRD or IDR, the goals of each system are the same.