[Reprinted from the book Act Early Against Autism by Jayne Lytel. (Copyright © 2008 Jayne Lytel; published by Perigee. Reprinted with permission. This article may not be reproduced for any other use without permission.) In this excerpt from Chapter 6, "Promising Treatments," Lytel compares the way she would work with her son Leo using Applied Verbal Behavior (AVB), a type of Applied Behavior Analysis, and Floortime, a more child-directed approach outlined in the book The Child With Special Needs. Besides providing a good comparison of the two approaches, this excerpt also illustrates the way parents think on their feet while applying treatments and interacting with their kids.]
If I were reading a board book to Leo during an AVB session, we might cuddle on the couch while I prompted him to turn the page: "Leo, turn page." If he didn't turn the page, I'd show, then help him. Then I'd point to the first animal and say its name. I'd ask Leo to point to the animal and say, "Can you say 'cat'?" If Leo complied, I acknowledged his success with praise and might say something like, "Good talking. You said that word so nicely. Leo, do you see the bird in the tree? Point to the bird. Good boy! Is the bird on a high branch or a low branch? You're right! The bird is on a low branch."
If I were doing Floortime, I could also be reading the same book, but I wouldn't assume the role of task master while Leo played the role of learner. I'd find out what Leo might be interested in and work to develop a more equal partnership in conversation, much as in daily life encounters.
I'd let Leo explore the book, and if he took interest in an animal by making a suggestive sound or placing his hand on it (since he couldn't point very well), I'd say excitedly, "Oh, a cat!" and look in his eyes so he could see the worried expression on my face. If Leo didn't notice the bird, I might say, "Oh, no, a bird! Fly away, bird. The cat's going to chase you," and then I'd let out a big meow. I'd then say, "Fly, bird, fly." If Leo waved his arms, I'd wave mine, too. If Leo said, "Tweet, tweet," I'd develop a "tweet, tweet" dialogue with him. Or if he wanted to crawl off my lap and run around the house with me pretending to be a big chicken, I'd assume that role.
Our interaction would be characterized more by laughter, distinctive and exaggerated facial expressions and gestures, pleasurable tickles, stroking, and tender moments. I'd join Leo in the interaction and trade the lead back and forth, rather than dominate it, so that the emphasis was on Leo enjoying the fun of the social contact rather than showing me what he knew.
As I became secure in understanding both approaches, I could more clearly see their benefits. But I relied more on AVB since it was hard to have a back-and-forth interaction with Leo; he didn't stick with one activity for very long, and his ability to reason and express himself verbally was poor. Nonetheless, I tried to incorporate elements from Floortime when I played with him.
According to AVB instruction, I'd get Leo to say words; describe actions, tastes, and smells; or tell me the answers to questions I'd taught him. I gave Leo praise, big hugs, or M&M's when he did a good job. I borrowed elements of Floortime I found useful in challenging, arguing, and debating with Leo when he began to talk more fluently. For example, we once built a zoo out of blocks and plastic animals. Leo placed a lion in the same cage as a monkey. "Oh, no, Leo," I said in a shaky, quivering voice. "What's going to happen to the monkey if you leave him in with the lion?" I'd pick up the lion and let out a roar, moving it closer to the monkey. The point was to get Leo to think logically and to understand that actions have consequences. In reality, the monkey would be in a separate cage from the lion because, if not, the monkey would end up as the lion's dinner. If Leo couldn't make that logical connection, I'd help him problem solve or brainstorm a new idea to save the monkey's life.
As I think back, I might have structured his therapy program differently and focused on Floortime and his social and emotional development, rather than on getting Leo to talk, if I'd taken the time to reflect on the purpose of all his therapy, which was to develop a deeper relationship with my son so that he could one day form relationships with other people. But I couldn't find time for the reflection required to make sense of this. Where could I find the moments to reflect when therapy dominated our days? It would take another three years for me to understand that he needed more than language in order to develop the ability to feel and interact with others.[Reprinted from the book Act Early Against Autism by Jayne Lytel; copyright © 2008 Jayne Lytel; published by Perigee. Reprinted with permission. This article may not be reproduced for any other use without permission.]