The Family Room

Bumping into ‘NO”: Managing Tantrums in Kids on the Spectrum

By Lisa deFaria, LCSW, BCD, Faculty, ICDL (Interdisciplinary Council on Developmental and Learning Disorders)

Susan’s note: Lisa originally posted an earlier version of this on the Yahoo Floortime board. I thought it was so timely and helpful that I asked if she would be willing to let me share it with you all, and, lucky for us, she did.

As our children move forward developmentally, "typical" phases that were previously delayed may emerge. One example is the (so-called) "terrible twos." Many kids on the autism spectrum never had the "terrible twos," a time when children become more engaged in their world, with new-found communication, mobility and intentions ("I want”/”Me do it...")

So when parents start reporting to me that their child is tantruming and oppositional and won't do what they say, I say "great!” The child has moved beyond the earlier, more disconnected, passive or self-absorbed phase and demonstrated that he is "cooking." It's when a child doesn't move to this phase that I am concerned.

Of course, with these changes, the child is, perhaps for the first time, bumping into "NO."

Now we have a new set of challenges--not bad, just different. As your child moves forward into this phase, he is also much more aware of the complexities of his environment, the expectations of others, the world moving too fast, too loud, too bright around him. Though he now understands far more language, he may be slow to process it, and many adults forget that the child can't take in a wall of words.

Motor planning, still often immature, becomes frustrating for your child, for how exactly is little Johnny going to get from here to there? A profound desire to be "in control" kicks in, as though saying, "Wait a minute! Slow down!!!" So many kids in this situation need to put their brakes on and try to hold onto control, particularly during transitions (into the car, into bed, out the door, TV off...).

Sensory issues may also be involved. "No" for our children is a bit of a different experience than it is for a typically developing child. With awareness and engagement with their environment, often more sensory issues emerge during this phase. This can create a very challenging pattern of behaviors--look at how many transitions occur in any given day!

A child at this phase needs a lot of transactional support to help ease his movement through the day. You have to experiment with what will work.

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.

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.