ABA, Floortime, RDI: Do you combine teaching methods?
August 26, 2007 by Kristina Chew, PhD
Filed under Health
A few days ago, a parent, Lisa, posted this comment on a post from over a year ago, The First Principle of Floortime, regarding combining different types of educational therapies:
We are going to be starting a program with our son, that combines RDI and ABA. The private therapist feels ABA alone doesn’t address the social deficits of autism. I know ABA by itself would be too rigid for our son. I’m hoping to see more providers blend various methods together, to determine which approach best suits the child. He is responding well to floortime, but we seem to have hit a plateau, hence our interest in bringing in a stronger behavioral component, without discarding the joy and affection of floortime. I believe RDI follows much the same philosophy as DIR. But as parents, we’re so uncertain if we’re doing the right thing. Does anyone have an opinion on combining methods?
ABA has been the most effective teaching method for my son Charlie and his particular educational needs. He has been doing home ABA therapy since he was just over two years old; since he was about 4 1/2, he has been in a number of self-contained 1:1 special education classrooms that use ABA. The speech therapists whom Charlie has worked best with have all had some training in ABA. Charlie is currently in a self-contained ABA classroom housed in an elementary school in our town and also has three home ABA sessions a week; his home program is supervised by the Lovaas agency.
From reading about Floortime and RDI and observing these in practice, and from my own observation of Charlie’s preference for a certain amount of structure and predictability when he is in an educational setting, ABA seems to be the educational methodology best suited for his learning needs. But, ABA can really differ depending upon the provider. ABA programs that recall 1960s-style “behavior modification,” require that a child do ten trials of a program at a table, and that generally take a mechanistic view of learning and of teaching have not been successful with Charlie. Under some of these programs, some of Charlie’s difficult behaviors (such as SIBs) have gotten worse.
The history of behavioral science contains more than a few troubling details, such as the use of aversives and I think that, as a parent, it is essential to be aware of this history and of as many different teaching methodologies as possible. While Charlie’s ABA therapists keep careful data and teach him in a highly structured manner, they are trained to be flexible and fluid in their teaching (there is no requirement that Charlie has to do X number of trials at the table before he can go), in how they speak to him, in where they teach him—while playing games, outside on his scooter, around the house—and in as many ways as possible. Our ABA consultant emphasizes that sessions have to be motivating and fun for Charlie; if he is struggling with a program, we talk about how the therapists need to adapt their teaching. The therapists follow Charlie’s lead. Indeed, I think he has learned so well with ABA because his best therapists always develop a real relationship with him and, too, compassion and fondness. (A former therapist left a comment a few days ago—-I had lost contact with her and was thrilled to get back in touch.)
For Charlie, a really good ABA therapist is able, almost intuitively, to combine methods. Charlie needs ABA as the core of his education just as much as the college students I teach appreciate having outlines to lectures, syllabi to show them what will happen in a semester, and clear guidelines about the course goals and requirements. And as a teacher, I have to know when to bend the rules, and mix and blend.
What therapy do you choose? What do you think about combining educational methodologies?
I appreciate your description of ABA with regards to Charlie’s program. I have not sought ABA out for Pete, mostly because I’ve been successful with other methods and haven’t felt the need. I worked with autistic kids before I had my own children and have a very negative impression of ABA because of what I saw…and yes, the history of Lovaas isn’t always pretty.
Again, I’m glad to have my eyes opened to another view. It seems like Charlie’s ABA program is very flexible and progressive, very much taking Charlie as an individual into account. I think this is how all therapies should be!
karen in ca
“Sessions have to be motivating and fun”. True for all children. Fondness and love, also true. Advice for researching aversives…true, true so true.
ABA is the only option in my area, but the Speech Therapists available use different methods such as Floortime and SCERTS, so the kids are exposed to different types of therapy. In any case, my son’s learning is not restricted to the therapy hours, and I develop my own methods for teaching him new concepts during play and daily interactions. Things I’m focusing on right now: storytelling/reading; using his favorite scripts from videos/preschool computer games to help him generalize that language to real situations.
The ABA consultants that Charlie has now have a very different view about dealing with self-stimulatory behaviors and with how the programs are done. One therapist was emphasizing to me how the Lovaas agency trains them to be flexible—-we’ve been training a new therapist whose background is in special ed, autism, and ABA but done as “10 trials and then the reinforcer.” It’s been a bit hard for the new therapist to unlearn doing things.
Not knowing the age of the child, it’s hard to suggest an accessible program. My son seemed to do best with Integrated Play Groups in preschool/Kindergarten. He has taken what he learned about social interaction and has been able to apply that on his own since. (he’s 7 now)
It’s simply a directed play time with peer friends under the guidance of trained teachers or aides. They most often had board games or cooking. Peer friends seemed to be the best teaching tools for modelling.
The problem with RDI and Floortime (and SonRise for that matter) is that there’s not much of a reason to think they do anything. It’s not too different to trying biomed, except that maybe they have less potential for harm.
Even ABA, although mainstream, is not very convincing. It’s an interesting case of “the emperor has no clothes” IMHO. There is a large quantity of studies on ABA to be sure, but not much quality of methodology. Also, AFAIK, there are no studies on ABA that look at any potential adverse effects.
Do check out some approaches backed up by randomized trials which Dr. Gernsbacher reviews here:
http://psych.wisc.edu/lang/pdf/Gernsbacher_reciprocity.pdf
All education is something of a combination. When people stake out claims to a new educational theory, they always end up staking out territory that overlaps with someone else’s claim.
Another way to look at educational models is as tool kits. And if a tool from a different kit seems suited for a particular task, it makes sense to use it.
We used Floortime with quite a bit of success, now we are starting to use elements of MLE.
I prefer a combination of methods myself, but I’m working with higher-functioning students. Social scripts and social stories are a large part of what I do.
I’ve come to see ABA as at the core of Charlie’s education; some ABA-type methodology can be found in some other educational protocols. But more than anything else, I’m interested in good teaching for Charlie, in whatever “method” or “technique” works best. In truth, it is the relationships he has formed with his many therapists, aides, and teachers that have very much helped him.
We use ABA, which for us may encompass procedures of errorless learning, precision teaching, incidental teaching, time delay, sometimes discrete trial, the analysis of verbal behavior… but a given procedure depends on what we are teaching and whether the “initial conditions” chosen, work as indicated by rate of acquisition AND my daughter’s affect, interest and other behaviors. (For example–if the goal is hypothetically “colors”, but the procedure is not improving things in learning colors and/or making her miserable, then that was a bad choice of how to teach that skill or we need to examine and analyze what prerequisite is missing or is there a more meaningful or clear way to teach that…and on occasion, suspension until we do). Otherwise time for a change. The most important part for me is the last A=”analysis”…am I collecting the right information and do I analyze it to see how I am doing in teaching, since the data is intended to be a critique of the success of the instruction, not a test for the student. Even if I was doing something else by another name, I would still take real-time data, for the same reason.
I am about as ABA as it gets, but I have been known to be rough on people who are simply teaching badly, coldly, mindlessly, choosing arbitrary instructional targets or bludgeoning the student under the impression that that is “ABA”. I believe that well done ABA is an inductive science, with the premise that “the child is always right”, i.e., the behavior that is being dished up is a function of the contingencies s/he is encountering.
BTW–My daughter is quite happy.
FWIW, i’ve never done the ten trials thing before I started with a new student recently, so I guess i’m having the opposite problem of Charlie’s new therapist. I’ve only ever been in programs where we took data on first time probes, and continued teaching the things that were missed the first time. I don’t think i’ll ever be a huge fan of it for most students and most situations, for this student, and particularly for the situation we have there, I can understand why it’s the best choice for the time being.
I think for us the one word you used that descibes our parenting method is “intuitive.” Bubba craves peer direction. For good or for bad, if a peer does it he is more likely to do it. For Mooser, he thrives on any type of 1:1 adult interaction, but could care less if same aged peers are around and doing anything. We have methodologies for speech, reading, etc., but no one method for life, just our intuition (and the following mistakes and successes). I’m sure if someone analyzed what we do day in and day out, they would probably see specific traits from many “teaching methods.”
How can one get written into an IEP:
-teachers need to develop a relationship with child showing empathy and respect for child
- teachers need to be flexible and speak positively to child always in a natural age appropriate manner
- foster a caring, relaxed and loving atmosphere for learning to happen
Everyone tells me certain things should be written into my child’s IEP but I do not know how to ask for the above without offending the teachers who think they know best.
Caroline, Unfortunately the difficult part doesn’t stop with getting those things in the IEP (we have those things in my son’s behavior intervention plan)…the difficult part is getting everyone to follow through. And the easiest way to get it into an IEP (IMO) is to state it as a parental concern and shape it from there.
Caroline–
I’m a sped teacher, and if you feel comfortable contacting me privately, I’d be willing to make some private suggestions. I have to rush to work this morning or I would say more.
For myself (again, remember, I am not working with students in a self-contained classroom but in the mainstream), I appreciate candid, polite and calm conversations about your concerns. Depending upon your state’s particular IEP form, there are appropriate places for your concerns to be recorded in the IEP.
It is entirely appropriate for you to be your child’s advocate, and as both a parent and professional, I’ve walked that thin line between being effective and not being effective, and have observed the differences between the two.
For more general information, I’m part of a community on Daily Kos that is posting weekly diaries on special ed, and I’ll be doing two general diaries at the end of September on both eligibility issues and IEP writing issues. The series is called “A Little Bit Special” and my username is the same as here. Some of that discussion may be helpful to anyone reading here.
Thank you Ange and Joyce for your suggestions. I will look for the series at the end of Sept.
Right now I have to get thru a busy week as a Stepford Wife haha and then I will revisit your kind offer!
(I also had a quick look at VAB’s blog which really resonated with me so it was comforting)
But all this is way off track from Kristina’s post I just wanted to respond with thanks.
In terms of the question, whatever method is used, the therapists must always assume that the individual is competent.
You can not combine RDI and ABA. They completely contradict eachother. ABA used prompts and doesn’t allow the child to think for themselves. RDI is the opposite using dynamic communication to encourage children to attend without being told and think on their own.
We define our quality of life by our feelings of competence, relationships, and independence. People with autism desire that same quality of life. In order to achieve this we need to remediate the core deficits of autism instead of compensating for them. Give your child the ability not only to survive in a dynamic world but thrive in it!
RDI™ (Relationship Development Intervention) is geared to remediate these deficits. It is a home-based program that works with both parents. The
main goal is to re-establish the relationship between parents and child. This relationship is knows as guided participation. In this interaction the parent acts as a guide and the child is the apprentice. It’s not about compliance, but about having a guide who will set limits, allow collaboration, and break down a task into small steps so that the child can feel competent. It is
when the child feels competent that small challenges can be introduced in a safe environment and relationship.
Behavioral approaches have been successful at teaching skills and rules and increasing good behaviors, but have not been successful at increasing a child’s quality of life. Quality of life meaning they will have friends, get married, have jobs and live independently. RDI has not only shown to improve quality of life, but has been successful at changing childrens ADOS catagories. Behavioral treatments are great for learning skills, but don’t provide meaning in a dynamic world.
For example, some behavioral approaches might teach a child to “look at you” using discrete trials in order to teach the child eye contact. The RDI™ approach would be to show the child the importance of eye contact. A foundational skill would be that my gaze has meaning. In order to teach the child this we would break the objective down into smaller pieces. One could take three cups and hide a toy or chip under one of them. The guide would them look directly at a cup (first with her face right next to the cup) then later with just glancing with her eyes. Another way of showing the importance of eye contact would be to cut out all verbal communication. In place of this you would communicate using gestures, facial expressions, head nods, and exaggerated movements. You are then requiring your child to look and decode your language by observing instead of verbal direction. By doing this you are giving your child the tools to become an active learner and participant in life.
Recently, Dr Marianne Barton PhD. spoke at the Connecticut Autism Society about changes that will be made to DSM V based on a study looking at long term diagnostic markers of Autism. Two of the current categories required for an ASD diagnosis, delayed speech and the presence of repetitive and stereotypical behaviors, would no longer be required. The only criterion that will be used is social “experience sharing” deficits, which detect ASD earlier and more accurately.
These DSM changes corroborate with the core deficit theory of RDI founders, Dr. Steven Gutstein and Dr Rachelle Sheely.
“…Quality of life meaning they will have friends, get married, have jobs and live independently. RDI has not only shown to improve quality of life, but has been successful at changing childrens ADOS catagories…”
—————-
Indeed, I have read one manuscript stating the change in ADOS, but there is a caveat:
From Discussion
Gutstein, S.E. Preliminary Evaluation of the Relationship Development Intervention. Manuscript accepted for publication by the Journal of Autism and Developmental Disorders.
http://www.wesd.org/journals/Files/Research/Preliminary%20Evaluation%20of%20the%20Relationship%20Development%20Network.pdf
“…Several limitations of the present study forestall definitive conclusions. Results
are based on examination of a small sample of relatively “high functioning” children.
Few children in either group had significant cognitive deficits. The variety of measures
used to evaluate cognitive functioning make a valid comparison impossible. Future
studies should make sure that RDI and non-RDI groups are comparable and that standard cognitive measures are employed. Similarly, the assortment of measures of language functioning made it difficult to evaluate its potential influence.
Additionally, older children and Teenagers were not studied. Thus, the effects of age, cognitive and language functioning on treatment effectiveness are as yet untested. The current results were obtained using consultants from a single setting – the clinic where RDI was initially developed. The efficacy of training other clinicians to provide effective RDI consultation has not been determined. Finally, the retrospective nature of the study, precluding random assignment or matching procedures, opens up the possibility of a self-selection bias where important variables led to parents choosing RDI vs. another intervention method.
The findings presented in this paper call for replication with larger sample sizes, more
rigorous evaluation of language and cognitive functioning, other measures of social and emotional functioning and randomization and matching designs. Future research should investigate the impact of parent variables in treatment selection, language and cognitive functioning as well as other important variables on subsequent outcome…”
There is another paper (maybe it’s actually this one) published in Autism last summer, but I haven’t looked at it recently. Sorry, otherwise I’d post the citation.
I don’t have a particular concern, because if it is positive for the child, it is and certainly the results of this study look good. What does concern me is extrapolating to adult outcomes without data, followup study on the participants in this case study or without that larger sample study that the author himself states.
@AA,
I first learned about RDI from a friend who is a long-time ABA-er and seemed to find it worked to combine them.
We never did “look at me” in our original Lovaas program; lots of emphasis on fun and keeping everyone motivated.
While RDI and ABA have many differences, they can certainly be combined in a session with a child if not in a single moment. I use RDI strategies in my play with high functioning children to improve referencing and eye contact, to build our bond, and to demonstrate the purpose of and joy of connections and communication.
But it is easy to be inadvertantly prompting certain reactions with your behavior and ABA has helped me to carefully analyze what I’m doing to illicit a response so that I’m not creating prompt dependence before gaining that eye contact. ABA pushes me to fade my prompts, to be mindful that I am varying my interactions, and to be diagnostic about what is actually working.
I might use RDI guidance to gasp loudly with excitement to gain a child’s attention, share natural eye contact with the child as we gaze at the butterfly I’ve pointed to and then extend the moment with a “Why” question like “Why is the butterfly sitting there?” to help target a goal from his ABA program. As the moment fades and his interest moves on I’ll use pacing ideas from floortime to follow his lead and keep the interaction going until another opportunity arises, or until I see the need or chance to create one.
I think each program has it’s weaknesses to be sure. But I think families are but under undue stress to CHOOSE, and I think many opportunities for collaboration are lost through the disdain and fighting amongst the various therapies. We’ll need to work together, learn about the valid criticisms from outside our field and chosen programs, and share validated ideas if we are going to make a deep impact on the lives of the children for whom we all care.