Returning this week as our guest is Dr. Joshua Feder, a child and family psychiatrist in Solana Beach, California using the Developmental, Individual differences, Relationship-based (DIR) model, an Expert DIR Training Leader, and an advocate with the DIR Coalition of California. We discuss how a behavioural approach can fit in with a developmental approach, such as DIR, as the autism world is moving away from Applied Behaviour Analysis (ABA) as the only option and towards family choice.

The Shift Towards Developmental Approaches

by Affect Autism

The Light Bulb Moment

Dr. Feder started in the field doing behavioural (mostly doing pre-vocational) work and figuring out how to manage behavioural challenges. As he came in through medical school, behavioural methods were still the norm. In the early 1990’s, Dr. Feder’s own son was diagnosed with autism. One day when his son was playing with his trains, his younger daughter crawled up and took his son’s train. For the first time ever, his son said a full sentence. It struck Dr. Feder that his son cared about his toy so was able to put together his motor planning and ideas to construct a full sentence. It was seeing the affective diathesis hypothesis in front of his eyes.

Dr. Feder had heard about Dr. Stanley Greenspan so brought his son to work with him and Dr. Serena Wieder and the rest is history. Dr. Feder works with ABA practitioners and works with a developmental model himself. While the ABA field works to make autistic children appear more neurotypical, he has seen that the things you get with a relationship-based approach become more functional even when it doesn’t seem so obvious at the beginning.

The Move Towards Developmental Models

Dr. Feder worked with a research program in the San Diego area where they tried to meet the needs of the community–some who wanted behavioural approaches, and some who wanted developmental approaches. They reviewed and vetted many programs and went with Project Impact, a blended behavioural developmental approach based on a book that was more goal-oriented. They added more robust pieces on Individual differences, brought in more nuance to some concepts such as ‘be animated’ which they called, “adjust your animation“. It starts with securing the Relationship with the child. First you do Floortime, then you set the limits and learn like Dr. Greenspan discussed in The Learning Tree.

The result is two great manuals for parents and practitioners, which Dr. Feder blogged about. The research that’s quoted in these books is some of the research for Floortime including the PLAY Project, but also research on Naturalistic Developmental Behavioural Interventions (NDBI)–people who grew up doing ABA but recognized was too rigid for kids and families and that parent-mediated work was necessary and moved towards some developmental concepts such as Pivotal Response Training, where children are given choices.

There is a nice annotated bibliography showing the evidence base for DIR and other developmental relationship-based interventions such as for the PLAY Project, MEHRIT, and others like Green’s PACT out of the UK. The DIR research is relatively recent because the DIR folks were all clinicians and theorists. The research behaviourists, in the meantime, have been putting what the developmental models do into ‘ABA speak’. A new book about the NDBIs is a step in the right direction, according to Dr. Feder.

Where Dr. Feder also sees this trend towards developmental approaches is in the move towards ‘pairing’ in the ABA community. They call it a non-contingent interaction with the child, i.e., Play! “Yes!” Dr. Feder says that the behavioural leaders he’s met are realizing that you have to use play over compliance and discrete trials.

The Components of Floortime

Dr. Feder reviewed Dr. Greenspan’s daily components of Floortime that would involve rotating every hour with 20 minutes of Floortime play, 20 minutes of unstructured fun activities that is usually motor-based or sensory-based, and 20 minutes of semi-structured Floortime where you focus on ideas and concepts that you’re trying to work with by working on a meaningful project for the child, for example, such as building a robot that can involve a lot of learning. It’s more structured and focused with a goal in mind.

Dr. Feder’s graphic novella illustrates how we develop the Relationship with the child around what interests them and then branch out from there–whether it be a toothbrush, LEGO, elevators, etc. It doesn’t happen overnight. You work just at the edge of the comfort level of the child. You observe to figure out why the child is doing what they’re doing or why they’re interested in what they’re interested in, then join the child. We imbed the learning, for example, math, into the child’s main interest rather than worry about how the child is unable to sit still and complete math problems.

Thank you to Dr. Feder for taking the time out of his very busy schedule to discuss this blended approach with us! If you found it helpful and informative, please consider sharing this post on Facebook or Twitter, and if you have any related experiences, comments or questions, please feel free to comment in the Comments section below.

Until next time… here’s to affecting autism through playful interactions!

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