If your child is diagnosed with autism on Monday, you have to choose a therapeutic model that will determine the rest of that child’s life by Tuesday. Okay, I’m exaggerating, but only slightly.
Unfortunately, families do not generally have the luxury of time to choose between the two major types of intervention approaches: ABA (Applied Behavior Analysis) and Floortime. Here’s a quick overview:
Traditional ABA is behavior-based, adult-directed, and reward-centered. Tasks are broken down into tiny baby steps and then taught in a rote and repetitive manner. For instance, if little Ethan will only roll a train back and forth repetitively, the therapist will redirect him to a table with a 4-piece puzzle board and then hand him a single piece. If Ethan fails to place the piece into the puzzle, the therapist will physically take his hand and perform the task “hand-over-hand,” all the while recording data about how many attempts were made and how many successes were achieved. Every time Ethan succeeds, he is rewarded: praise, cookies, whatever. The goal is for Ethan to learn how to do the puzzle. (Please note that what I’m describing here is “traditional” ABA. These days, it is generally performed in a much more naturalistic form, but this more disciplined model boasts many peer-reviewed scientific studies.)
Floortime incorporates the entire social, emotional, and cognitive landscape of the child, and treats the collection of behaviors as only one aspect. It is a gentle, child-centered approach that emphasizes the child’s own interests, no matter how simple or repetitive, and builds on them toward more complex and appropriate actions and interactions. In this model, if little Ethan persists in rolling his train back and forth, the therapist gets on the floor and rolls a second train back and forth until Ethan notices. And if he doesn’t, the therapist can bang the second train into Ethan’s train—whatever’s needed to connect and elicit a response, even if that response is as basic as Ethan retrieving his train and continuing to play by himself. The goal here is for Ethan to engage in an interaction that is meaningful to him.
When my husband and I were first presented with this choice, we were fortunate in a few ways: we both had the same gut reaction in terms of which path to choose, we had support from experienced, caring and compassionate advisors, and finally, our son’s pediatric neurologist recommended ABA occupy less than 15% of our son’s weekly schedule. Although this made our choice easier, the vast majority of families we’ve met in parent support groups chose full-on ABA programs, and our decision not to go that route always requires explanation.
Ours goes like this: Yes, we wanted our son to be able to do a 4-piece puzzle, but we wanted him to do it because he enjoyed it, not for the cookie. Those in the ABA camp say the technique is simply a door into the parts of the brain that need to be switched “on.” Once the door opens, advocates say, the kids do start to enjoy the ‘games’ of therapy, as much as any typically developing child. I have to say, I’ve seen ABA work in exactly that way, but I’m still uncomfortable with the overall approach. At its core, it still seems to me a mechanical and lifeless teaching method, and one that would not address one of our top priorities: to instill in our son a love of learning; to show him that it can be interesting and fun and exciting.
As it turns out, my son’s ABA therapists have been some of his best, and he’s made multi-faceted gains as a result of their efforts. But I’m still a huge Floortime fan. It’s complicated, like everything else about autism. To elaborate (or create further confusion), I’ll describe one of my son’s ABA sessions and one of his Floortime sessions in my next post.