Impaired emotional and social functioning affect all autistic individuals regardless of where they fall on the autism spectrum. These deficits influence the quality of life and joy that comes from interacting with others. While many people with autism can learn to function in society by taking turns, using better eye contact, accepting the word “no,” or running other life skills programs, memorized scripts rather than an emotional connection control these activities.
Dr. Steven E. Gutstein, founder of the Relationship Development Intervention (RDI) program, and Dr. Stanley Greenspan, creator of the Developmental Individual-Difference, Relationship-Based Model (DIR/Floortime), believe that connecting with others at the emotional level enables children with autism to develop in ways that memorized interaction can’t; but their methods and approach differ. While RDI focuses on helping autistic children develop brain functions that didn’t mature properly as an infant, Floortime seeks to pull the child out of his current, inner personal world and into a shared connection with others.
These developmental programs are both effective, but which therapy is best? Like all treatments for autism, the answer depends upon a child’s individual deficits, sensory issues, developmental level, and degree to which he has shut himself off from the outside world.
DIR/Floortime Model is the More Popular Option
All autism treatments and therapies are expensive, but many school districts will provide therapy for deficits that interfere with learning and schoolwork:
- speech and language therapy
- occupational therapy for sensory issues
- physical therapy for fine-motor control problems
- behavior therapy
- social skills therapy
Reaching autistic children at the emotional level generally doesn’t qualify; mostly, because there’s little scientific research to back up the results. Schools zero in on scientifically proven methods, which leave most developmental therapies up to parents.
The DIR/Floortime model comes highly recommended, but like most popular therapies, relies heavily on anecdotal evidence to demonstrate the improved communication and closer relationship that develops between parent and child. Parents who have implemented the RDI program also show improved communication and parent-child relationships, yet parents recommend it less often. Why?
Relationship Development Intervention Imitates Typical Child Development
Early intervention for children with autism helps improve many of their social, behavioral, and developmental issues; however, after working with autistic children for over 20 years, Gutstein saw little in the way of real improvement. Utilizing typical behavior therapies like Applied Behavior Analysis (ABA) did improve appropriate responses, but worked only if following memorized scripts. When placed in a situation where others didn’t follow along, these autistic children had no skills to help them improvise. In addition, they were not happy.
After studying the development pattern of typical children and comparing those patterns to the autistic kids he worked with, Gutstein noticed missing developmental steps – many that typical infants experience at birth. As a result, he designed infant-like activities that helped children with autism learn to pay attention to what was going on around them; and then, taught their parents to use those same activities themselves.
Placing the child in a strict, sensory-clean environment and setting a parent up to take control of the session, RDI returns autistic children to the last developmental level they’ve mastered. After which, they move forward by imitating the development path of a typical child. To achieve permanent benefit, however, similar circumstances must also be set up at home. That’s why most parents don’t recommend RDI. They find the program time consuming, costly, and too much work.
DIR/Floortime Improves Communication
Greenspan also believes autistic children need to address six basic developmental capacities, but that these functions can be engaged and mobilized spontaneously. Rather than parents leading infant activities to develop a portion of the child’s brain that never matured appropriately, he teaches parents to imitate what their autistic child is currently doing. Whether that be sitting at the dining room table and drawing, lying on the floor spinning the wheels of his favorite truck, or flipping the lights on and off in the hallway, DIR/Floortime seeks to enter the child’s world by first joining him, and then doing something that deliberately initiates communication.
While Gutstein believes the universal need of feeling joy comes from the intimacy of sharing experiences with others, Greenspan believes autistic children find joy in what they do or possess. Floortime protocol instructs parents to gently provoke the child through doing things or saying something that makes it necessary for the child to gesture or speak. The hope is that better communication at home will lead to a desire to communicate outside the family circle.
Floortime sessions can be structured, or unstructured, staged, or unstaged. They can easily be adapted to a family’s current lifestyle and schedule. Out of all of the therapies available, parents consider it the least intrusive, since it merges well with other therapies and current living conditions.
Which is Best? Development Relationship Intervention or DIR/Floortime?
Sorting through autism therapies is time consuming, but not impossible, as no single therapy is the best choice for every child. While some programs appear more popular than others, the spectrum leaves plenty of room to make individualized choices. What’s best for one particular child, won’t be a good fit for another.
The more popular development therapy is DIR/Floortime; probably because many parents feel it is less expensive than RDI. In addition, most parents of autistic children desire better communication, improved behavior patterns, and a happier child – which the Floortime plan gives them. Others find Floortime difficult to implement. While it easily slips into their current lifestyle, many autistic children have turned so far inward that parents find it difficult to connect with them. Some children refuse to accept outsiders joining them in their inner world, and that includes their parents. For these particular children, returning to the beginning of child development and working with them at that level brings better results.
With books and other reading materials readily available today, parents can easily implement either program (or a combination of the two) without the help of a trained specialist. In fact, RDI has books that go into detail about appropriate activities and games for each development step, as well as ideas for older children. Both DIR/Floortime and RDI offer training classes and individualized help for parents, in addition to books and other materials, but RDI does recommend professional counseling once the child reaches the point where parents need to select a well-matched playmate.
One way to choose the best program is by giving both therapies a trial run to see which plan the child responds to best: a clutter-free, sensory-free environment that starts over, or a more lenient plan that allows the child to be in charge.
Sources
Autism. Gutstein, SE, Burgess, AF, and Montfort, K. “Evaluation of the relationship development intervention program (2007). 11(5):397-411.
Greenspan, Stanley I. and Serena Wieder. Infant and Early Childhood Mental Health: A Comprehensive Developmental Approach to Assessment and Intervention. American Psychiatric Association, October 2005.
Gutstein, Steven E. Autism Aspergers: Solving the Relationship Puzzle: A New Developmental Program that Opens the Door to Lifelong Social and Emotional Growth. Future Horizons Inc., 2000.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her child’s health should contact a licensed medical professional for advice.
Vickie Ewell - Vickie has worked with autistic individuals for 9 years. She has celiac disease and specializes in gfcf living.
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