When Evan was first diagnosed on the autism spectrum, we looked into treatment options, and ABA was immediately recommended. We hired an ABA therapist to train several “junior therapists” (teenagers and friends in the neighborhood) to work with Evan daily, and administer the program. ABA is adult-led and applies behavioral science to change conduct or to teach skills. Further, DTT is an ABA technique in which competencies are broken down into smaller, “discrete” steps, and the therapist engages the child, one step or skill at a time. The therapist rewards the child as he learns the new skills, for example with a preferred food or toy.
Michelle, our ABA therapist, taught us the ins and outs of ABA and DTT, and we diligently engaged. However, the repeated drills and focus on robotic responses didn’t make sense to me, especially since Evan clearly disliked the ABA sessions and avoided them. At times, he was visibly upset, refused to cooperate with the therapist, and tried to escape the room.
My gut told me that ABA DTT wasn’t the best approach for Evan, and we began looking for other treatment options. I feel beyond blessed that we eventually discovered DIR/Floortime therapy and the most fabulous therapist, Dave Nelson. Dave Nelson is a Licensed Professional Counselor (LPC), a DIR Expert Training Leader, and the Executive Administrative Director of The Community School in Atlanta, Georgia. Back in late 2003 and early 2004, we were fortunate to work one-on-one with Dave and learn to embrace the Floortime approach.
The father of Floortime, Dr. Stanley Greenspan focused on emotional connections rather than strictly behavior. To me, this approach makes intuitive sense. I recall it was described as “stretching a rubber band without breaking it”. We would aim for increasing the circles of communication, following Evan’s lead by engaging in play based on his interests.
I love in this video how Dave engages Evan by jumping into a game that Evan clearly enjoys – “Calculator”. Dave doesn’t try to dissuade Evan from his game, he simply hops in and joins him. However, as you can see in the video, Dave “stretches the rubber band” by making Evan wait a few seconds to get what he wants, and he ever-so-gently pushes Evan to engage in “minus problems” instead of “plus problems”, thus playfully stretching him further, keeping him engaged without overly stressing him. It’s clear that Evan enjoys the session. Even better, it’s obvious that he’s engaged, interested and invested sufficiently to communicate his wants, needs, desires and objections with Dave as they open and close circles of communication.
Over the years, other Floortime therapists played/ worked with Evan, and it was awesome – we gained leaps and bounds of progress. I would say that most of Evan’s therapies over the years, including OT, PT, SLT, were sensory-based and play-based, and this approach suited Evan perfectly.
I get it that ABA DTT has lots of research supporting its efficacy, but it just wasn’t for us. Floortime on the other hand, became the new normal.
Evan (now 20), has for years occasionally bitten his fingers when he gets upset or stressed out. He doesn’t break the skin, but has callouses on both hands due to gnawing. As “unfunny” as this behavior is, we had zero success in eliminating it…until I began emulating Evan. When he bites his finger, I put my finger in my mouth and pseudo-bite while stimming, moving my head back and forth, as he does, but in a super-exaggerated manner. The first time I did so, he was so shocked, he stopped biting and stared at me. Subsequent attempts often resulted in him laughing at me, because I looked so ridiculous engaged in such behavior. Does he still bite himself from time to time? Yes. But now we talk about why he was upset to begin with and work through the issue. And sometimes we laugh about the “ridiculousness” of chewing on a finger. And as we laugh, we bond. Evan is an AMAZING young man, and has come so far, in large part, I believe to all the wonderful therapists, teachers, camp counselors, and others who embraced the Floortime approach. Thank you guys…you’re our heroes!