Parents facing the diagnosis of Autism Spectrum Disorder (ASD) in one or more of their children are presented many options for treatment. While parents generally employ speech therapy, occupational therapy, and Applied Behavioral Analysis (ABA) across the board, there are many other therapies gaining momentum. Floortime and RDI are two of them. However, RDI and Floortime use core principals which run in contradiction to each other, therefore those parents considering using one will ultimately need to decide against the other. To make an informed choice, consider the philosophies and methodologies of each.
A Summary of Floortime
Dr. Greenspan and his colleague Serena Weider developed Floortime. The approach was formally introduced in their co-authored book, Engaging Autism, [Da Capo Press, 2006]. They formally named the approach "Developmental, Individual Differences, Relationship-based" or "DIR" but it has become primarily known by its nick-name of Floortime. Floortime is so called because the central methodology of the approach is to get down on the floor and play with the child.
Autistic children generally show little interest in interactive play. When one begins attempting to engage such a child in play, the child will usually react with very mild interest or ignore the intruder entirely. It becomes the job of the one attempting to engage the child to interject themselves into the child's play. To do so, they follow the child's cues, play along with the child, and impede the child's play in an effort to entice the child to engage with them.
For instance, if the child is playing with a toy truck, the adult may crash their own toy truck into the child's. The adult will use large gestures and facial expressions, cover their mouth and say "Oh, no!" If the child looks at the adult, the adult has succeeded in engaging the child, or in other words, the adult has gotten the child to interact with them. The interaction will likely be fleeting, but with continued play, the length and frequency of the child's engagement with the adult will grow.
Getting the autistic child to engage with his or her therapists and teachers is the primary step toward teaching him or her language, occupational skills, social skills, educational skills, etc., since a child cannot learn from someone whose mere existence they refuse to recognize.
A Summary of RDI
Dr. Gutstein introduced RDI in his book Autism Aspergers: Solving the Relationship Puzzle - A New Developmental Program that Opens the Door to Lifelong Social and Emotional Growth [Future Horizons, Inc., 2000]. Though RDI has been around longer than Floortime, it has not yet come to enjoy the same popularity. RDI focuses mainly on giving the autistic child the ability to build meaningful relationships with a goal of providing the child with a higher quality of life.
Like Floortime, the child's engagement leads to success under the RDI approach. However, unlike Floortime, the means of engaging the child is parent-driven, not child-driven. The methodology of RDI teaches the child to look to his or her parents for direction thereby establishing the natural parent/child relationship that children with autism often lack. Achieving success with this therapy requires the parents' devotion to learning the unique techniques of RDI and consistently applying them in their day-to-day life. Here is one example of how parents might put RDI to work in a daily setting:
The parents and child are having dinner; the parents begin discussing a television show that they know their child likes, not attempting to involve the child in the conversation. The child, hearing the conversation, is naturally interested. Eventually the child joins the conversation by making a comment or gesture of interest, which the parents acknowledge briefly, continuing on with the conversation. This exchange goes on with the child adding to the conversation at will.
Over time, these exchanges result in the child looking to the parents for instruction and guidance and the typical parent/child relationship slowly develops. Once achieved, the child has gained the skill to build relationships. This, in turn, provides the child with the ability to build relationships with others, engage with teachers, succeed in school and develop life skills. Having friends and life-skills will allow the child to have a higher-quality, more-independent adult life.
Summary
Both approaches have merit, and some parents have asked whether they can utilize both simultaneously. Both Floortime and RDI experts will likely answer no. Because Floortime is child-driven and RDI is parent-driven, and both require consistency and follow-through, parents will need to choose one or the other. Floortime requires substantial time from parents as they must play and interact with their child; however, RDI requires an extensive amount of time and effort from parents and this may be a factor to consider when choosing which path to take.
Another consideration is cost. While Floortime is relatively easy to learn from an Occupational Therapist, RDI requires hiring a specialist in that field, and their services are not covered by medical insurance. Perhaps these factors help to explain why RDI has not seen the popularity that Floortime has achieved.
However, the issue of "quality-of-life" deserves serious consideration. If a family's circumstances allow for the undertaking of RDI, and they feel they can fully-devote themselves to the approach, the benefits of RDI could prove far greater than Floortime.
Ultimately, parents need to choose therapies that they feel are best for their child and family and that they believe they can use successfully. Whether parents decide to utilize Floortime or RDI in their child's therapy regimen, they are providing their child with a well-respected approach.
copyright (c) 2011, FatherMag.com
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My daughter Jasmijn (10) has a mild form of autism called ppd-nos (Pervasive Developmental Disorder - Not Otherwise Specified). It is this kind of ASD that many people seem to get away with - meaning their symptoms are neglected, ignored or underrated. Precisely because this type of ASD is very often overlooked (whereas it seems to be the most common type of ASD), it is more interesting in my opinion, than the "traditional" and more serious forms of autism.
PDD-NOS manifests itself in a number of ways:
Jasmijn shows all of these and has developed in a remarkably positive way. Because of her limited ability to place herself in someone else's position, she had a hard time understanding what was going on socially, especially at school. We have stimulated her to speak up for her self and to give off understandable signals if she feels she cannot handle certain complex situations, where she needs to withdraw. The children at school understand this now and she has become very sociable kid. She has a couple of very good friends who are familiar with her sometimes aberrant behaviour and accept it.
Egocentric behaviour is something she -and the rest of her world- seems to have to deal with for the rest of her life. Hopefully it diminishes with time, but currently she can be jealous for virtually no reason - even though she is fully aware that she is. She will always see to it that she gets the most, the best, or be first. Our 'remedy' is to point out to her what she is doing and making it clear to her what the results are of her behaviour.
Empathy is of course directly correlated to social interaction. Jasmijn is now of an age where she is conscious of the usefulness of empathy. And although it is not part of her, so to speak, she works very hard to make it a part of her, even though it doesn't come naturally. But then, as all new forms of behaviour, over time she'll get used to it and it will become more natural. Currently, we admire her attempts, even though they sometimes make us smile - for example when she says things like "you're the sweetest mommy/daddy in the world" in a tone that would disqualify her at any theatre audition ;-) Interesting though it is. She does actually feel it that way, but it's communicating it to the outside world that seems to be the problem.
Unexpected events
This is something books could be written about! Whereas every kid would shout with joy if I would come into the room and say "OK kids, let's go - we're going to the zoo, pack your things and we'll be off", Jasmijn will just explode. She cannot handle that sort of fast transitions from one situation to the other. The same thing with sending the kids to bed: the same thing will happen. The remedy is very simple here: a 5-minute warning. If I say to her "It's bedtime in 10 minutes", followed by "It's bedtime in 5 minutes", she won't have any problem if the actual moment finally arrives.
copyright (c) 2011 FatherMag.com
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