Floortime Model in Autism Spectrum Disorder Treatment

For children with Autism Spectrum Disorders (ASD), early treatment is as important as early diagnosis. Behavioral approaches are commonly used to treat children with ASD. These approaches include various programs such as the Developmental-Individual Difference-Relationship Based Model (DIR) and Applied Behavior Analysis (ABA).

Floortime Approach for Treating Autism Spectrum Disorder

The DIR model is a treatment approach that focuses on teaching communication skills essential for social interaction with others. It also emphasizes "opening and closing circles," which the child uses in context to direct play. Collaboration between the family and the educational team is crucial for expanding these circles. The development of appropriate play and interaction is facilitated by adults. The DIR model is beneficial for building shared interests that lead to engagement and for improving communication and problem-solving skills. A component of the DIR model is the Floortime model, which encourages the ASD child to interact with parents and others through play activities on the floor in natural settings such as home, play sessions, and playgrounds. It targets multiple goals: following the child's lead, challenging the child to be more creative and spontaneous, and involving their senses, motor skills, and emotions. Intensive DIR/Floortime programs can involve more than 25 hours per week (Greenspan & Wieder, 2006).

Applied Behavior Analysis (ABA) Approach

The ABA approach is used to help the child develop a variety of skills, including social skills, communication, self-monitoring, and control, as well as to assist them in generalizing these skills to other situations. It is based on the theory of behavior, which posits that behaviors can be learned and taught through a system of rewards and consequences. Analyzing behavior using the ABC model (A for Antecedent, B for Behavior, and C for Consequence) is the first step in ABA. ABA strategies help reduce problematic behaviors and build socially useful ones. These strategies include task analysis, chaining, prompting, fading, shaping, differential reinforcement, generalization, video modeling, discrete trial training (DTT), and natural environment training (NET). ABA techniques can be applied in both structured (classroom) and everyday (family dinnertime) settings, and in one-on-one or group instruction. ABA techniques are used in intensive, early intervention programs, especially for children below the age of 4 years. Intensive ABA programs typically involve 25 to 40 hours per week for 1-3 years (Lovaas, 1987).

Similarities Between DIR and ABA

The DIR and ABA share three main similarities: the involvement of parents, intensive planning, and progressive steps toward a goal.

Firstly, the involvement of parents in therapy is significant. In Floortime, parents are a large part of the therapy process. They work with therapists to set goals and engage their child in both therapy sessions and everyday environments. In ABA, parents are involved in planning programs, setting goals, and attending regular meetings to monitor their child's progress (Koegel et al., 1999).

Secondly, both programs require intensive planning. Floortime involves dedicated time with parents throughout the day plus sessions with a therapist, totaling more than 25 hours per week. ABA often involves more than 25 hours per week of direct therapy with a therapist.

Finally, both ABA and Floortime aim for progressive steps toward a goal. Floortime focuses on capturing the child's attention and focus so that the child becomes willing to learn, while ABA teaches "how to learn" behaviors.

Differences Between DIR and ABA

Despite their similarities, DIR and ABA have several differences in how they address the child's mood and attention levels, the role of relationships in therapy, how the child processes and learns, how the child views the world and shares ideas, and how emotions are regulated.

Firstly, the child's mood and the role of relationships in therapy differ between the two approaches. In Floortime, parents play a major role, with a supportive and loving relationship that brings emotions to the forefront of therapy, enhancing communication, attention, and engagement. Every behavior is important and is interpreted to understand what the child with ASD is trying to communicate. Although parents are involved in ABA, they do not need to play a role in implementing therapy but rather reinforce the ABA mechanism across settings (Greenspan & Wieder, 2006).

Secondly, the approaches differ in how the child processes and learns. DIR focuses on the unique "sensory motor profile" of each child, which explains the child's behaviors and guides future treatments. ABA, however, considers these behaviors and individual differences as antecedents or consequences of other behaviors (Lovaas, 1987).

Thirdly, the child’s perception of the world and sharing of ideas are approached differently. In Floortime, the child uses self-directed play to express internal impressions of the world and thoughts. However, ABA teaches the child with ASD how to play, which is expected to support future development and growth in their processes and expressions of internal thoughts (Koegel et al., 1999).

Emotion Regulation

Finally, emotion regulation is handled differently in each approach. In Floortime, parents demonstrate emotions and share them with their child, providing support and love. When the child with ASD reacts emotionally (anger, fear, joy, etc.), therapists and parents try to understand the cause of that response. In contrast, ABA treats moods and emotions as behaviors that can be measured and modified through reinforcements. Desired behaviors are rewarded with positive reinforcement, but the origin of behaviors is not typically explored (Greenspan & Wieder, 2006; Lovaas, 1987).

References

Greenspan, S. I., & Wieder, S. (2006). Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate, and Think. Da Capo Press.

Koegel, R. L., Koegel, L. K., Harrower, J. K., & Carter, C. M. (1999). Pivotal response intervention I: Overview of approach. Journal of the Association for Persons with Severe Handicaps, 24(3), 174-185.

Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55(1), 3-9.