What is the best program for my child…how do I know whether a behavioral approach (like ABA) or DIR/Floortime is right for my child?

When parents confront the issue of how to help their child with serious problems of relating and communicating, it can be confusing knowing where to begin.  Some approaches emphasize changing behaviors; others emphasize building relationships; others emphasize working on academic skills; and others emphasize specific therapies like speech or occupational therapy. Sometimes areas of the country tend to follow one approach or another.  But each child’s needs are unique, no matter what diagnosis he may have received, and one size, or one approach, does not fit all.

Determining which intervention program is right for your child requires that you first identify his or her profile, which can be done by answering the following questions:

• What are your child’s problem behaviors?  These are generally readily apparent, and may include perseverative (repetitive) behavior, self-absorption, avoidance, difficulty speaking or self-stimulation.

• Where is your child in terms of his mastery of the fundamental building blocks of relating, communicating and thinking?   Is he able to calm himself so that he’s able to share attention with others?  Does he enjoy warmth and intimacy?  Can he engage in two-way communication with gestures?  Can he use ideas creatively and logically?  Difficulties in these areas often underlie the more obvious symptoms or problem behaviors. 

• What about your child’s sensory and motor strengths and weaknesses?  How does she take in sounds; how are her visual-spatial skills; is she able to plan actions and carry them out?  Can she regulate basic sensations such as touch, sound and movement, so that she isn’t overwhelmed all the time or under-whelmed to such a degree that she doesn’t take an interest in the world?  Difficulties in these processing areas often interfere with a child’s ability to relate, communicate and think.

• How is your child doing within the family?  What types of interactions with parents and siblings tend to help him share attention, relate and communicate with gestures? What kinds of experiences don’t work?

Once you’ve identified your child’s profile, you will be in a position to make an educated decision about whether to work on only some of the elements identified above (e.g., problem behaviors) or all of them, including the fundamental building blocks of emotional and intellectual health.

Behavioral approaches, such as ABA-Discrete Trial, work on addressing specific behaviors, such as repeating certain sounds or words or eliminating undesirable behaviors (e.g., staring at the fan). With relationship-based approaches, the goal is to build warm relationships with the child and help him learn to enjoy interacting and relating.  Other approaches focus on improving various processing areas, such as auditory processing, motor planning, and sensory modulation.

The DIR/Floortime approach is a framework for understanding each child and creating a comprehensive program tailored to his needs.  It is not a specific technique; rather, it often includes many different elements or approaches.   The goal of the DIR/Floortime model is to help your child master the fundamentals of relating, communicating and thinking, based on your child’s profile (i.e., answers to the questions outlined above).  By creating learning relationships that are tailored to the child’s unique profile, you help him master the fundamentals that build emotional and intellectual health.  Following are some DIR/Floortime principles to guide you as you set out to build an optimal program for your child:

Don’t fit the child to the intervention; fit the intervention to the child.  A comprehensive program should include different interventions that are integrated into a program for that child.  Be wary of a one-size-fits-all approach, or of only doing one thing when your child may have challenges in numerous areas. 

Seek a comprehensive approach that addresses the fundamentals as well as the surface symptoms.   Understandably, our instinct is often to emphasize treating the surface symptoms or behaviors.  These get our attention because they make the child look different out on the playground or in the restaurant, and we want to change that right away.  But that’s like treating the fever with aspirin, but not treating the underlying pneumonia with proper antibiotics:  you may get some relief from the symptoms temporarily, but the overall condition may not improve.  You’ve got to do both.  And when you work on the primary problems of relating, thinking and communicating, the secondary symptoms often get better on their own.   A child who learns to relate and love will usually not want to be self-absorbed anymore.  A child who learns to communicate purposefully tends not to communicate in a chaotic way.  A child who learns to take actions to solve problems tends to not line up his toys repetitively because now he can use his toys to build houses and castles.

Know your child first.  Know how he is unique.  Know how he attends, relates, communicates, and thinks.  Know how he processes information – auditory and visual.  Know how he plans actions.  Know your family’s strengths and weaknesses.  Then develop your program accordingly.  It is a tall order, but a complex problem requires a complex approach.

What goes in tends to be what comes out. Children who learn something in a very structured, rote way tend to give it back in a very structured, rote way.  Children who learn to relate with warmth, excitement and a sense of humor tend to enjoy relating warmly with excitement and a sense of humor.

If at all possible find a professional who can help you put together a comprehensive program.   There are professionals who can be “co-quarterbacks” with your family, helping you put together a comprehensive plan for your child.