Posts Tagged ‘aba’

Integrate Floortime, developmental approaches with ABA to enhance learning for children with autism

August 28, 2010

Stuffed animals, musical instruments, balls, and beanbags with text can be used during Floortime activities. Photo by Mike Frandsen.

Integrating developmental teaching models into behavioral approaches can help children with autism generalize skills so they can apply them in real world, natural environments.

Dr. Stanley Greenspan’s Developmental, Individual Differences, Relationship-based (DIR) model of autism therapy aims to improve social, emotional, and intellectual abilities in a way that is meaningful for the child rather than focusing on isolated skills and surface behaviors.

Applied Behavior Analysis (ABA), considered the gold standard for autism therapy, is a proven method of teaching children with autism functional and cognitive skills. One of the criticisms of ABA, though, is that it can result in answers that are scripted.

Children with autism need both structure and meaning when they learn. Therefore, combining elements of ABA and DIR may result in the best opportunities for success.

To read the rest of my article on Examiner.com, please click here.

Greenspan’s DIR Model for Autism: Part 1

September 20, 2009

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.

Greenspan’s DIR Model for Autism: Part 2

September 20, 2009

I decided to take some of the most important passages from “Engaging Autism” by Stanley Greenspan and Serena Wieder, with other quotes paraphrased.  These are the lines from the book that I underlined when I read the book three years ago.  I did the same for the John Gottman relationship books on a blog a while back.  Of course, like Rodney Dangerfield said in “Back to School,” the guy underlining the pages “could have been an idiot.”  So with that said, here goes:

Quotes from Stanley Greenspan’s “Engaging Autism” (I bold parts that I think are most important, and I divided the quotes into categories where I thought they fit best).

Developmental vs. Behavioral Approaches

  • Many programs that focus…on symptoms or behaviors rely on the troubling assumption that many children with ASD cannot ever acquire skills for truly intimate relating, empathy, and creative problem solving.  The DIR model focuses on the underlying deficits that lead to symptoms.

  • Schools tend to be very structured and to put a high priority on compliance and limit setting, rather than on engaging, interacting, problem-solving, and thinking creatively and logically.
  • The behavioral model led to modest educational gains and little or no social or emotional benefits.
  • The old way:  children could learn social behaviors in a scripted, memorized way, but not engage in spontaneous and creative social interactions and thinking.
  • With the new developmental approaches, we see it as a continuum on which all children can become warm and related and purposeful.
  • We now understand that the lines of early development are interrelated.  Rather than assessing language skills, motor skills, and social-emotional skills separately, we should look at how well these abilities are integrated, how they work together as a whole.
  • An example of a non-DIR approach:  isolated skills, such as matching shapes, rather than essential developmental building blocks.
  • The DIR model shows how to use a range of interventions in a truly integrated manner.

  • Parents and clinicians need not make a Solomon’s choice between relationships on one hand and cognitive and language skills on the other.  Cognition, language, and social-emotional development all stem from the same foundation.

  • DIR is organized by asking:  What are the problem behaviors?  How is the child doing on the fundamentals of relating, thinking, and communicating?  How is the child doing on her processing capacities, and what are the contributing factors (including biomedical challenges) affecting these capacities?  What experiences work and don’t work to help the child, and how capable is the family of doing the things that work?

Don’t have a Ceiling

  • Progress comes from getting the child to take the initiative.  The biggest mistake is telling the child what to do to provoke a set response, rather than challenging her to take the initiative or to solve a problem with you.

  • It’s just as important to work with children when they’re at peak performance as when they’re struggling, because then we help them advance developmentally and master higher levels all the time.
  • Never assume a ceiling on a child’s abilities.  Always assume you can get to one more level, and after that, one more level.
  • The child may have a disorder or a set of problems, but he is not the disorder.  He is a human being with real feelings, real desires, and real wishes.
  • The brain develops into the fifties and sixties, so it’s never too late.

Learning and Language through Emotions, Engagement, and Relationships

  • Mastery of the early stages of emotional interaction is associated with language and thinking skills.
  • Language, cognition, and mathematical and quantity concepts are all learned through emotionally significant interactive experiences and relationships.  Emotions enable us to learn.
  • Emotion is critical for many elements of language.
  • When engaged, children have a desire to communicate.
  • At the second level are the ongoing and consistent relationships that every child requires for emotional and cognitive competency.  Children with ASD need even more warm, consistent caregiving than do typically developing children.  Almost all human learning occurs in relationships, which must foster warmth, intimacy, and pleasure.
  • Use words meaningfully through emotions and pretend play rather than by rote.
  • The goal is to have all of the emotional experiences of life expressed through circles of emotional interaction.
  • Turn the activity into shared interaction.
  • The ability to love deeply is present in children with ASD, whether or not it can be easily expressed.
  • Children should be encouraged to express negative feelings.  Don’t take the child’s expressions of negative feelings personally, but respond sympathetically so he doesn’t get the idea that expressing his feelings is dangerous.
  • Emotion always come before behavior.  The child needs to enjoy relationships with parents, peers, and teachers in order to learn.

  • Many adults who had ASD and other special needs as children achieve a high level of empathy or enter the helping professions, because often they had to struggle more with challenges or feelings of disappointment than their peers did.  (My comment – this proves that kids with autism can learn empathy.)
  • We believe the primary problem in individuals with ASD is a biological difficulty in connecting emotion to motor actions and later to symbols.  Emotions link different types of mental functioning.

Other Language Skills

  • It’s better for children to use single words interactively with meaning than to recite whole sentences or paragraphs they have memorized.
  • Children with auditory processing challenges especially need to hear the rhythm of a voice.  Repeat what you say, and emphasize it.
  • Since John’s main form of communication related to getting fed, mother played a little dumb to extend those moments with John was negotiating for some of his favorite foods.
  • Help the child connect ideas by pretending you don’t understand.

  • Say something like, “I went to the zoo and I saw a _______.”  Have the child fill in the blank.  Or, “He has four legs and barks.  He is a ______.”
  • Ask a child what he enjoyed most at school, and why?  (Keep in mind many of these suggestions will have to be adapted for the level of the child.  This one wouldn’t work for a child unable to communicate that level yet.)
  • Listen to audiotapes of stories in the car.

Family Involvement

  • Not enough time is spent watching the child interact with a parent or other trusted caregiver.  In many evaluations, children are separated from parents and challenged to perform various types of developmental tests in a way that fails to take into account the child’s individual differences.  The child becomes stressed and confused.  To make a proper diagnosis, a practitioner also has to see children at their very best.
  • The clinician may see the child for a couple of hours, but parents see the child for hours and hours every single day for years.
  • However gifted a particular therapist is, what really counts is what is done every single day, for hours a day, with a child.
  • The key is to have fun together.
  • A child’s progress with a DIR/Floortime program requires parents who are emotionally very available.
  • If you don’t pull the sibling into the family challenge, the sibling feels excluded.
  • Siblings and peers can help a great deal.
  • In general, it’s most effective for the child’s therapeutic team – including parents, educators, coordinator, and specific therapists – to meet regularly to design goals for the program.

Floortime:  Following the Child’s Lead

  • Observe what kinds of interactions bring the child pleasure.
  • Follow the child’s lead, regardless of where his interests lie.  That give us a clue about what he finds important.
  • Often we look for a way to reach a child – the magic key that will unlock the hidden door – when all the while the child is showing what he needs by his actions and the way he’s processing what comes his way.  We need to observe what children are doing to help themselves in the moment and then figure out how to meet them there.
  • We build on the child’s interest to help him move up the ladder of shared attention, engagement, two-way communication, shared problem solving, and creative and logical use of ideas.  That requires not just following the child’s lead but also challenging him.  So we don’t mean simply copying or imitating the child.  We mean taking the child’s cue in order to build new interactions and experiences.
  • The idea is to go with the flow but without giving into the child’s agenda.
  • In Floortime, why do you follow the child’s lead?  A child’s interests are the window to her emotional and intellectual life.
  • Always challenge the child to initiate.

Oral-Motor Skills

  • Some children have oral-motor problems that make it hard for them to move their tongue and the muscles in their mouth in order to speak.  Some children with both oral-motor problems may appear to have cognitive disabilities and to lack social skills when in fact they are limited in expressing their abilities by their motor impairments.

  • The teacher can play little imitative games, starting with sounds the child can make, with the child and teacher looking in a mirror together so the child can imitate the way the teacher’s mouth moves.

Sensory-Motor Skills

  • Orienting kids in space can help them with postural control, which helps them organize their nervous system, which makes it easier to get interaction.  One example is walking on a balance beam.

  • To help children be comfortable, caregivers must learn which sensations help children become calm and regulated, which ones overwhelm them, and which don’t pull them in enough.
  • The level of a child’s motor planning skills must also be gauged.  The best way to do this is by watching the child play.

Social Skills and Play Dates

  • We always recommend that kids have at least four playdates a week, so that their main source of companionship begins shifting from parents to peers…Mommy is still important for security, warmth, and problem solving, but not for going out and riding bikes together.

  • If we try to teach logical thinking to a child who is not yet able to engage in reciprocal social interactions, we are trying to build the upper story of a house on a very weak foundation.

  • A child who learns how to be social in fun and emotionally engaging learning environments at home will want to be social and will be able to do it at school or at home, because he has generalized what he has learned.
  • Teach with images, action, and drama.
  • Children with ASD often take everything literally.  One of the most effective activities is pretend or imaginative play.  Encourage role play and play with puppets.
  • They need opportunities for playing and communicating with peers.  It’s important for children to learn to use words and gestures and develop relationships with peers at the same time they are learning to do these with adults.  If they wait, this learning will be more difficult later on.
  • We have never worked with a child or adult who didn’t have a desire to relate to others.

Coachmike.net and Autism

May 22, 2009

This table shows what types of therapies I do for children with autism compared with some other providers.  I currently have spots available for toddlers and kindergarteners for playdates and other activities during the day.  See www.coachmike.net for more information.

  Area of Instruction or Therapeutic Intervention
  Cognitive Skills and Academics using ABA, VBA, or other techniques Playdate Facilitation Understanding and Handling Emotions Sports, Exercise, Motor Skills, Coordination Trips in the Community
Coach Mike Yes – Great Results Yes Yes Yes Yes
Most Autism Therapy Programs Yes – Good results No No No No

ABA = Applied Behavior Analysis.  VBA = Verbal Behavior Analysis

Mike Frandsen