Alternatives to ABA

kcisthebombdotcom

We have our follow up at the neurodevelopmental pedi on dec 11th to get DDs diagnosis. Pedi suspects she is on spectrum and/or has ADHD. She said either way she'd support aba therapy for dd (although its unlikely to get covered by insurance without an asd dx). I'm really hesitant to start it at the same time as preschool which is going to push her way out of her comfort zone--it seems like it would be overly difficult for her to be that engaged in preschool then spend her afternoon being pushed in aba. I'd rather something a little less rigid to start. She has done floortime therapy and has made Great gains in playing appropriately with a wide range of toys and being interactive with adults during play but its done little for her ability to follow directions unless there's something in it for her or I sing a song (like the clean up song for cleaning, goodbye song for leaving the playground, etc). Any suggestions? (FYI--I'm well aware that aba is the gold standard and am willing to add it if in three months she hasn't made any gains.)

kcisthebombdotcom

I didn't mean to sound defensive. I assumed the responses would be trying to convince me that aba is the way to go. I'm not completely closed off to the idea--I'm just not ready to commit to the time and the rigidity of it now. I wasn't surprised that ABA was suggested and am aware it can be beneficial regardless of where the child falls on the spectrum. I feel the difficulties that dd has in following directions are more behavior driven vs comprehension issues (though I'm sure that may play a role I don't believe it to be the driving force) and feel that she would benefit from some sort of behavioral therapy. I just wasnt sure aba was the only behavioral plan out there or not. I'm not willing to give up preschool for aba. She's ready for preschool. She wants to go, she's done a preschool readiness group which involved separation and following classroom routine which she did well with. It's an integrated, therapeutic classroom. They do pull outs for speech and ot but try to do more smaller groups within the classroom when possible.

lite-bright

As far as non-ABA therapies, we started our therapies off with a year+ of RDI, Relationship Development Intervention. It is parent-led with the help of an RDI consultant (who is usually a therapist also certified in something else -- speech therapy, psychology, etc.; we've worked with two different ones). 

It basically involved choosing specific, fairly natural activities around the home (loading or unloading the dishwasher, putting toys away, carrying a basket or bucket together) and turns them into moments of engagement and attention in specific, planned ways that are outlined by the consultant and parent with particular goals in mind, depending on what the child needs. It basically grows from the philosophy that the parent-child relationship provides the core learning that a child needs to relate to others and the world around them, and that by having parents work in therapeutic ways with their children, eventually the children are able to expand their relationships with others. 

I read Making Sense of Autism Spectrum Disorders (Coplan) when DD1 was first dx'd at three, and we looked at ABA, RDI and Floortime as our primary choices for a core therapy with guidance from that book. We frankly could not afford more than a couple hours a week of ABA paying OOP (no insurance coverage at all) and at that level, I was not convinced of its effectiveness. Plus, given DD1's level of development (only verbal stimming/echolalia, very little undesirable behavior that needed to be extinguished, no sensory issues, no diet issues, few tantrums, self-care skills on par with peers), we felt RDI was an appropriate choice for the things she most needed to work on, which largely came down to engagement and attention in various forms.  

I liked it very much and I definitely think DD1 benefited; but it is a LOT of work. A lifestyle, in a lot of ways. They do a wonderful job of providing resources to parents via their website (which you can only access via working with an RDI consultant). Unfortunately, we had some major, continuous billing issues with our therapist's office that eventually led us to sever the relationship. At that point, we bumped up Floortime and other therapy activities to tide us over until we got into full-day kindergarten, and DD1 has done very well with the regimen we've settled on.  

One thing that really helped us was to go and do interviews with providers. We did several interviews with providers of ABA and RDI to get a sense of process, what to expect, what therapy sessions would be like, their thoughts & suggestions, etc. before we made any decisions about which was the most appropriate choice. 

Susan_KW

RDI was recommended for us too. We're just starting this process and I'm not precisely sure what is involved. We need to get various in network evaluations done and then start an out of network referral process. I don't expect to see an actual therapy session until sometime in January.

typeset

ESDM was recommended for us after ABA. 

kcisthebombdotcom

Thanks for the suggestions! Dd is very engaged and compliant with both myself and her therapists. She struggles more with peer relationships vs adult ones which is why keeping her out of preschool to do aba doesn't make a whole lot of sense to me. I really like what I read about esdm--it seems like a good next step between floortime and aba. Will definitely discuss that with her doctor. Another question--is an aba therapist something we can integrate into the classroom experience like her slp/ot?

typeset

KC_13 said:

Another question--is an aba therapist something we can integrate into the classroom experience like her slp/ot?

Yes. Our preschool has ABA trainers overseen by a BCBA shadowing the spectrum kids 1:1 or 1:2 in the integrated classrooms to follow up on the intensive work done in the autism classroom. They take data on progress toward IEP goals and prompt as necessary. My kid has also had a 1:1 ABA specialist shadowing him at daycare for the past eight months. She helped him troubleshoot social stuff as it arose. She started off giving him edible reinforcement (bits of fruit leather) but switched to a delayed schedule by the end (he had to talk to three people, "give them space," and answer three questions posed by peers to earn time with trucks). Her presence was faded over time. He eventually took subtle redirection from across the playground if he got stuck on an activity rather than having her right behind him at all times.