Autism Interventions: ABA vs. Floortime
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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.
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Thank you for the clear and basic explanation (and examples!) of the two approaches! I have heard of them both but never really knew the difference… I love your blog posts!
Comment by Lewis — October 29, 2008 @ 3:14 pm
Have you asked the DOE to write these critical areas into your child’s IEP? We’re typically stonewalled no matter what we ask for.
Comment by Lani — October 29, 2008 @ 7:57 pm
Here are some comments as a result of recent conversations with some of my son’s ABA therapists in reference to this blog post:
One therapist said: “Unfortunately most people really do think that aba = discrete trial teaching which is what you are describing, and as you mentioned not great examples of it. So ABA has become synonymous with working with kids on the spectrum when in actuality it is a science based on the principles of learning to change behavior to a socially significant degree. It really doesn’t have anything specifically to do with special education, rather is has been scientifically and empirically supported to be effective with that and many other populations. That is the issue with floortime, it doesn’t have that scientific rigor behind it. However good DTT teachers will use what looks like floortime for naturalistic teaching. So there can actually be little difference in the two sessions, outside of data.”
Another therapist said: “Early intensive behavioral intervention using ABA has received the greatest scientific scrutiny of all the intervention choices for autism and has become a treatment of choice for many parents and professionals. This is true for both traditional and naturalistic ABA. However, because there is no standard for the level of experience and training for ABA providers, problematic situations sometimes arise where an ABA therapist is not well-trained in ABA and furthermore, does not have adequate knowledge about child development and how to work with the early childhood population.”
Comment by Marni Goltsman — November 2, 2008 @ 8:53 pm
Great posts! Your description of Floortime makes me realize that’s what I’ve always instinctively done with my son.
We, as a point of fact, weren’t given the choice. ABA was the only option presented to us out here in podunk Queens. But we ended up being very lucky — we had an ABA instructor who was not really ABA at all, so his interactions with our son were actually more of a combination of the 2.
Comment by janny226 — November 6, 2008 @ 10:38 am
Great explanation. I used floortime with my son, he has developed into a five year old with many interests. I believe discrete trial has its place, but not with the really little ones, like mine was when he started, 2. We have used ABA too, but not until he was older. It was a rough change, but at he thouroughly enjoyed human interaction at this point, so it didn’t have a detrimental effect. I strongly believe that at the early developmental stages, all therapy should be child led. If you aren’t innately interested in people, then you really have to have as many enjoyable experiences with them as possible. What’s more enjoyable than doing what you want to do.
Comment by Kim Reno — January 8, 2009 @ 1:27 am