By Daniel B. Kessler, M.D.
Behavioral therapies are among the most commonly applied intervention methods for autism and the most studied. Many of the intensive behavioral therapies (or Early Intensive Behavioral Interventions — EIBIs) that have been studied are based on the concepts of Applied Behavioral Analysis (ABA).
Applied behavior analysis is a science that involves using modern behavioral learning theory to modify behaviors. Behavior analysts focus on the observable relationship of behavior to the environment. By functionally assessing the relationship between a targeted behavior and the environment, the methods of ABA can be used to change that behavior. Though highly effective for large numbers of children at early ages and later, ABA therapies are not for everyone. Some individuals are put off by the perception of a highly robotic intervention in a disorder characterized by difficult social interactions.
Forms of ABA are not the only tested interventions for children with autism. Other methods, such as Floortime™, are perceived to be more interactive and flexible. Floortime™ (or DIRFloortime™) is designed to both follow the child’s lead and at the same time challenge the child toward greater mastery of social, emotional, and intellectual capacities. DIRFloortime™ emphasizes the importance of the role of parents’ and other family members’ emotional relationships with the child.
Programs and providers increasingly are looking to implement blended models to obtain the benefit of multiple interventions. The Denver Model (which interweaves multiple perspectives) and the child-directed Pivotal Response Training (which blends rewards with play techniques) are examples. The Relationship Development Intervention (RDI) model developed by Dr. Steven Gutstein tends to focus on the social challenges of autistic individuals. Relationship-based models give importance to the relationships that help children reach and master early developmental milestones often missed or not mastered in children with autism spectrum disorder. Examples of these early milestones are engagement and interest in the world, intimacy with a caregiver and intentionality of action.
Often it comes down to what is available and what you can afford in a given community. There is a growing body of evidence that developmental/relationship-based approaches with very young children are showing promise and represent an important and valid treatment approach. Such is the model for the Side-by-Side Program (SxS) at Southwest Human Development, which involves parents and their toddlers. Increasingly parents are looking to train themselves and provide therapy at home.
Next: Will insurance pay for therapies?
Daniel B. Kessler, M.D., is a developmental and behavioral pediatrician and medical director of the Children’s Developmental Center at Easter Seals Southwest Human Development. His private practice, where he provides evaluation and treatment for children and adolescents, is located at Southwest Human Development.
The views he expresses in this series are based on his training, his reading of the literature and his more than 30 years of experience taking care of hundreds of kids on the autism spectrum. The series begins here.