The Family Room

More About Combining ABA and Floortime

I've been seeing a lot of searches and getting a lot of questions lately about combining ABA and Floortime, or at least approaching ABA from more of a play-based perspective. In addition to pointing you to this post by Melissa Willa, I thought I'd share a little video of one of Isaac's ABA sessions so you can see what play-based ABA looks like in practice. This one involves a consult, so there are two therapists involved, but you get the idea. This is part of our IEP, for those of you involved in that lovely process.

Here's my guy, having a great time playing "airplane." Please leave any questions in the comment box and Melissa or I will answer to the best of our ability.

Sleep Strategies for Kids with Special Needs

Here's a presentation that Melissa Willa of Gateway Learning Group recently gave entitled "Strategies to Improve Your Child's Sleep." There's some really helpful information on assessing sleep disturbances, and practical advice on how to deal.

If you would like to download the presentation, click here: Download supportforfamiliessleeppres.pdf

And, if you would like to contact Melissa for more information, visit her website or email her at melissa [at] gatewaylg [dot] com.

Happy sleeping!

Notes From "Support For Families" Conference

Yesterday I went to the Support for Families of Children with Disabilities 2007 Information & Resource Conference. It amazes me what this group, which seems to be run on about five dollars and sheer will, can pull off. They ran 14 workshops in two tracks, ranging from "Adaptive Sports" to "Planning for Inclusive Transitions Across School Levels" to "Legal Rights of Public School Students with Disabilities." I chose two subjects that are near and dear to my heart these days: "Food & Eating Issues for Children with Autism" and "Toilet Training Children with Special Needs," the latter of which was run by Melissa Willa of Gateway Learning Group. Both sessions took a behavioral approach, and I could again see how these new ways of conducting ABA can open up whole worlds for children: a new degree of independence, the tolerance for--even interest in--new types of foods. The initial approach in these specific instances may be more adult led, but the consequences ultimately empower the kids to make a broader range of choices for themselves over time. So again that difficult balance between ABA and Floortime, between the child's agenda and the therapist's.

Both sessions reminded me that too often we rush into our kids' programs without really getting enough of the context behind what our providers plan to do. As a result, things that you think of as kind of optional (switching reinforcers, or forgetting to tell your school what you're doing at home) can have an impact and stretch out the learning process. And things that you slowly begin to disagree with (for example, the degree to which your child is pushed in a particular session), can become a real source of tension. So it was helpful to have an opportunity to sit down and start from the very beginning.

I can't possibly do justice to each session, but I do have one suggestion, and it's pretty simple. Even if you do team meetings already, try to find some non-therapy, non-IEP time to talk to your providers individually, even for a few minutes, so you can discuss what's on your mind and start to work it into your child's program. I realized yesterday that I had been worrying about Isaac's somewhat limited food repertoire, but in the chaos of everything else I wasn't even aware of it until I saw this class on the agenda. So now I'll approach his case manager to talk about it, and probably even add it to the IEP. (Tip: you CAN add eating and potty objectives to your child's IEP...I didn't realize that before).

Last thing, since I'm apparently on an advice kick today: take a breath. Not every minute of our lives should be a learning opportunity, or a heroically therapeutic moment. Autism may be a communication disorder, but there's plenty of communication in stillness, and silence, too. (Not to mention the guilty pleasure of sharing a pizza while you watch "Dancing with The Stars" together.)

For a copy of Melissa's presentation on toilet training, click here: Download toilet_training_presentation.pdf

Potty Training, Part Deux

Several months ago, we began the bizarre and weirdly emotional process of potty training our son. We bought pull-ups, we collected whimsical potty books, we got detailed instructions and excel spreadsheets from our ABA team (for data collection) and a plastic bucket (for...). We loaded up on fun DVDs he can watch during potty sessions. He learned the steps quickly: he loved sitting on the potty, loved flushing, loved the ritual of washing and drying his hands, even loved his potty seat, proudly carrying it around the house, but...no luck.

Fast-forward a few months (okay, several months) and we are being politely but firmly encouraged to try this again. Again we have the spreadsheets, the paraphernalia, and on Saturday I went to buy my boy his very first set of big kid underpants. And I have to tell you, I felt a little emotional standing there at the display. Do I get colors? White? Dinosaurs? Superman? (In the interest of protecting whatever shred of privacy is left at this point, I leave that to your imagination, dear reader.)

During his bath that night, he played with a green plastic dolphin, filling it with water and letting the water run out into the tub. Then he looked up at me and said: "The dolphin has to go pee-pee," and emptied it into the tub again, giggling. Yesterday, Jesse came home to a whole potty convention in our house, including one ABA tutor, one case manager, our nanny and, of course, the life of the party himself, who was looking a little grumpy by this point. Then this morning, as soon as he woke up, he demanded to sit on the potty again, where he ate a banana, drank a glass of milk, and happily watched an episode and a half of Harold and the Purple Crayon (delaying my shower and causing a Very Bad Hair Day). And I suddenly realized: the bathroom has become his new office. And I can't help but wonder: how did we do this stuff before there were specialists, and Microsoft Excel, and DVDs and cheese crackers and--honestly--does it really take a village to potty train a child?

Integrating Floortime and ABA

Interview with Melissa Willa, M.A., BCBA
Gateway Learning Group

When I first contacted Melissa Willa a little more than a year ago, I was extremely nervous and skeptical about whether behavioral therapy, specifically, Applied Behavior Analysis (ABA), would be a good choice for Isaac.  I was worried that it would be too rigid and that it would conflict with the more child-led DIR/Floortime approach we were taking.  Melissa and her team proved me wrong.  They are respectful of Isaac, tuned into his personality, strengths and challenges, and are able to bring out his joy in learning.  Then about a month ago at the Jumpstart Conference, I learned that eclectic approaches to therapy are becoming more common.  So I asked Melissa to share her point of view on how to make an integrated ABA and Floortime program work.

Can DIR/Floortime and ABA be integrated?
Definitely. The field of ABA has evolved over the past ten years; there has been a "leftwards" movement toward a more developmental approach.  Ten years ago, most ABA providers were still very traditional. Sessions were largely adult-directed, and it was rare to see teaching sessions conducted using more naturalistic approaches. Natural environment techniques were always included to some degree; however, these tactics often took the back seat to more structured "discrete-trial" learning opportunities. Today we're seeing a movement toward more naturalistic, developmentally appropriate behavioral interventions.  What this means is that instead of ABA sessions being 90 percent adult-directed, sessions are conducted with a more natural back-and-forth flow of adult-led and child-led activities. Instructional activities are more play-based, centering on the unique interests of each child. If you look at the Floortime model, it's maybe 90 percent child-led. In the past, there used to be a real disparity between these approaches; now they are closer together.  So Floortime and ABA can be integrated into a child's overall program, just like speech and occupational therapies. And if Floortime and ABA therapists collaborate within a session, each can pick up some techniques from the other.

So how does this work?
You really do need to have providers who are willing to work together. It's true that there are folks who feel these methods to be mutually exclusive, and they don't need to be. So look for people who are open to collaborating, and who see the other approach as having value to the family.

What do you do when there's a conflict between DIR/Floortime and ABA approach within a session?
Talk about it. That's why it's so important to have team meetings monthly, or for therapists to touch base over the phone when they can't meet in person.

Can you give an example?
Sure. I had a situation where a child was having a challenge mastering a new skill. The Floortime therapist felt that the child needed to be provided with more "wait time" after being given the direction, while our ABA team felt that an "errorless learning" prompting approach was necessary. Historically, ABA has developed a bad rap for making kids prompt dependent. So we had a dialogue about that. I asked the Floortime therapist why she felt the child needed more time to figure it out on his own, and I explained why we felt that we should prompt him--to help him respond correctly, in order for the child to receive lots of positive feedback without practicing the skill incorrectly. When we talked about it, we came to the conclusion that it made sense to give the child extra time on skills that he had already demonstrated independently, but for new skills, we would help him sooner--to reinforce a sense of accomplishment. So both of us learned something through that experience.

Do you have any other advice for parents who are trying an integrated ABA/Floortime approach?
I think that the use of videos--videotaping portions of sessions and being able to share those--are really valuable. Video enables you to see something, pause the tape, and talk about how you might approach a situation differently. This is becoming more and more possible as video becomes more accessible. It isn't that commonplace now, but Dr. Lynn Koegel uses this technique at her clinic in Santa Barbara, and we try to use it whenever possible.  Don't be afraid--ask your therapists for permission to videotape the sessions. Both sides will discover great new ways to reach the child.

If you have a question for Melissa, please leave a comment here or email her directly at: melissa [at] gatewaylg [dot] com.