B. Behavioural and Other Intensive Programmes

Contents:

  1. ABA and Lovaas
  2. Floor Time
  3. Son-Rise Program (Option Institute)

See also:

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1. Applied Behaviour Analysis (ABA) and Lovaas

ABA literally means any of a family of techniques utilizing Behavioral Psychology to change behaviors. It is believed that behaviors are learned, and that they can be extinguished and/or new behaviors can be learned based on ignoring unwanted behaviors and rewarding preferred behaviors.

As used in the context of Autism, ABA usually means Discrete Trial Training, a highly-structured intervention in which desired tasks are broken down into the smallest possible steps and taught to autistic children using mass trials (many repetitions) and reinforcers (most commonly small food treats and/or praise, depending on the child) for correct responses to each step. Once one step is mastered, the next is tackled, and later they are combined into the desired behavior.

Developed most famously by Dr. Ivor Lovaas at UCLA, it is the one intervention with data commonly accepted by the scientific community to show effectiveness (defined mainly as improved IQ scores), although some question even these findings. Many parents and professonials swear that ABA is very effective in helping children with autism learn to attend and communicate, but there are three major areas of controversy in ABA.

First, many proponents of ABA believe autistic children need 30-40 hours/week of ABA training, and advise against using other therapies and "watering it down." Others feel that this is too many hours for children, or that a mixture of therapies can be equally or more effective.

Second, Lovaas originally used aversive techniques (shocks or hitting) to discourage incorrect responses, and some people using ABA still use aversives, even though Lovaas has disavowed them. Even when they don't use aversives, ABA tutors who are not very well trained can cause more harm than good when mis-applying discrete trial techniques.

Third, some parents, teachers and others believe it creates robotic behaviors in autistic children without addressing the children on any meaningful level. They point to difficulties in generalizing skills learned in discrete trial to more natural settings.

One behavioral offshoot of DTT, PRT (Pivotal Response Training), attempts to address these concerns by emphasizing incidental learning (where the child is given choices and teaching centers around the child's preferred activity) and natural reinforcers (the child is allowed to play with the toy he selects, rather than given an "M&M", for instance).

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2. Floor Time

Floor Time is a play based approach built on cognitive principles, developed originally by Stanley I. Greenspan, M.D. and Serena Wieder, Ph.D., as outlined in their book "The Child with Special Needs".

From that book:

"What is Floor time?

"Floor time is a special play time that you set aside for the child. During this period, play is a spontaneous, unstructured activity when you get down on the floor with the child and try to follow his/her lead. Your initial goal is to tune in to whatever motivates or is of interest to the child?. This time allows you to reaffirm a rhythm and sense of connectedness and enables you to elaborate growing empathy and shared meanings" (Essential Partnership, p.19).

"Floor time [is] a systematic way of working with a child to help him climb the developmental ladder?By working intensively with parents and therapists, the child can climb the ladder of milestones, one rung at a time, to begin to acquire the skills he is missing...[During floor time, children at first learn] the pleasure of engaging with others and the satisfaction of taking initiative, making wishes and needs known, and getting responses. [Floor time then creates opportunities for children] to have long dialogues, first without words and later with them, and eventually to imagine and think" (p.121).

"Floor time is like ordinary interaction and play in that it is spontaneous and fun. It is unlike ordinary play in that you have a developmental role. That role is to be your child's very active play partner. Your job is to follow your child's lead and play at whatever captures her interest, but to do it in a way that encourages your child to interact with you?Your role is to be a constructive helper and, when necessary, provocateur by doing whatever it takes to turn her activity into a two-person interaction" (p.123-124).

"Floor time can be implemented, both as a procedure and as a philosophy, at home, in school, and as a part of a child's different therapies" (p.121)."

The six "Emotional Milestones" that make up this "developmental ladder" are:

  • Self-regulation and interest in the world
  • Intimacy
  • Two-way Communication
  • Complex Communication
  • Emotional Ideas
  • Emotional Thinking

(The therapy also includes elements to tackle other common aspects of ASDs such as sensory difficulties, motor problems, intellectual needs etc.)

"The Child with Special Needs" outlines four main goals of the Floortime program (with further goals added later, as the child progresses):

FOUR GOALS

(p. 125-126)
  • Goal 1: Encouraging attention and intimacy.
  • Goal 2: Two-way communication.
  • Goal 3: Encouraging the expression and use of feelings and ideas.
  • Goal 4: Logical thought.

There is obviously more to the Greenspan/Floortime approach than this very brief introduction allows. Suitable links will be added in future.

Parents have found both approaches (DTT and Floor Time) useful to their children. Floortime can be used at home as well as in the classroom, in mainstream schools as well as special schools.

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3. "Son Rise" Program

The program is run by an organisation called The Autism Treatment Center of America (TM) and claims to be very effective in helping children with Autistic Spectrum and related disorders.

Although not everyone is convinced by their somewhat extragent claims of dramatic results, and the program is extremely expensive, it does appear respectful towards the child and beneficial to parents in helping them understand the autistic child's point of view. Their philosophy is about "connecting" with the child by going into the child's world, rather than trying to force the child into the non-autistic world, and they uphold parents as the child's best "therapist" and greatest advocate.

Unlike ABA/Lovaas, this program has not been dogged by ethical controversy and seems accepting and non-judgemental of both the parents and the autistic child.

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