Focused or Comprehensive Therapy Approaches; Which is Right for You and Your Family
I'm going to go out on a whim here, but I'm willing to bet many of you have heard of Applied Behavioral Analysis, or ABA. I'll also venture to guess that many of you receive these services for your child, or have looked into them. ABA has received a "gold standard" notion and I've even heard some parents feel hopeless when/if their child doesn't respond to ABA as well as others have.
I won't discredit ABA and the similar "focused" therapies. They are data-driven, so research and reimbursement sources love the structure and replicability. I've seen the amazing improvements some students make in these approaches and the significant gains they were able to attain. Hands down, I will not argue, that was great for the parents and the team.
However, we cannot ignore the growing response from adults with ASD who are speaking out now against ABA (more information here). Ole Ivar Lovaas, the developer of ABA, structured it for the ultimate goal of making individuals with ASD "normal". To us as "neurotypicals", we may see this goal and agree with it. Who doesn't want a "normal" child? But what is "normal" and who decides this? We are living in a neuro-diverse world, is it right for us to fit our children into these boxes?
As time is going on, research for comprehensive therapy approaches is building. These approaches are more individualized and span over months, even years. They are designed to impact broad developmental goals and social-emotional skills. Greenspan Floortime Approach, Intensive Child-Centered Play Therapy, DIR Floortime, The Play Project, and The Denver Model are all examples of comprehensive approaches.
According to a recent systematic review of autism therapies (citations: here & here), only 2 out of 7 approaches led to significant improvements in at least 1 of 15 outcome areas. These two therapies were developmental behavioral intervention and a broad category of developmental interventions. Developmental interventions encourage a positive relationship between the child and caregiver, such as the foundation for Greenspan Floortime Approach.
Another pilot study (found here) found comprehensive approaches, specifically as Child Centered Play Therapy, were successful in improve social-emotional skills in children with ASD. I found the quote below to be especially important:
Whereas applied behavior analysis may be effective in eliminating or reducing specific behaviors and reinforcing preferred behaviors and is considered an “established” treatment intervention, it is very time intensive, requiring 30–40 hours per week for 2 or more years (Granpeesheh, Tarbox, & Dixon, 2009). In contrast, in our investigation, we found that just 12 hours of CCPT with six parent‐consultation sessions improved social behaviors for children with ASD. Thus, these preliminary results indicate that CCPT may be a cost‐effective intervention to help improve the social functioning of children with ASD.
Further research is necessary on all therapy approaches, and no single therapy approach should receive a "gold standard" connotation. If your child hasn't responded well to ABA, or you are not comfortable with ABA's approach, please know that you are not alone. If you do not feel it is a good fit, try something different. Listen to your child when they do not like something. Are there times when your child will have to comply with something they don't like? Sure, of course. But therapy shouldn't be torture. We shouldn't have adults telling us how cruel our methods were to them as children, and if we do have adults telling us this, we should listen.