The Big 3 Therapeutic Approaches to Autism


The Big 3 Therapeutic Approaches to Autism

By Alexandra Solomon

July/August 2009


The main therapeutic approaches with autism today are Applied Behavior Analysis (ABA); Developmental, Individual Difference, Relationship-Based Therapy (DIR, also known as "Floortime"); and Relationship Developmental Intervention (RDI), the one we use for Brian.

Ivar Lovaas developed the ABA treatment, the most researched of the ASD therapies, based on the principles of psychologist B. F. Skinner's operant conditioning. Children are helped to learn by breaking goals down into small steps and chaining them together—a process called Discrete Trial Teaching (DTT). For example, the process of putting on socks and shoes is broken down into its component steps and practiced until mastered. It's an extremely labor-intensive form of one-on-one individually oriented training, done by therapists or paraprofessionals, who take extensive notes to direct future activities. The original model required up to 40 hours a week of therapy with professionals and paraprofessionals, but today, families generally do fewer hours, perhaps because the costs are prohibitive.

Like everything else having to do with autism, ABA raises controversies, despite its relatively stronger research base. I remember being told to avoid ABA because it made kids "robotic and less juicy." Some say that ABA is the treatment of choice for low-functioning children, because it helps them learn basic skills, like sitting in a chair and following simple directions, but that it doesn't work as well with…

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