kitchen table math, the sequel: 5/9/10 - 5/16/10

Tuesday, May 11, 2010

The end of an era for unstructured, child-centered autism therapy?

Reading about the death of Dr. Stanley Greenspan in last week's New York Times, I wondered about the future of Floor Time. This was the approach that Greenspan, a well-known child psychologist, championed as the most effective therapeutic intervention for autism--an approach I've critiqued first here and later in Raising a Left-Brain Child.

Some of Floor Time seems reasonable but obvious: a wheel re-invented time and again by those who work with autistic children--parents and professionals alike--whether or not they've ever heard of Greenspan. What do you do with a child who pays you no attention; who remains immersed in a world of his or her own? Jump into this world and follow the child's lead. Much easier said than done, of course, and therein lies the devil. Wouldn't it be wonderful if someone would do what Floor Time devotees have yet to do:  start publishing lists of specific strategies that those who work directly with autistic children have come up with and found helpful?

Far more problematic are Floor Time's not-so-obvious recommendations: avoiding teacher- or therapist-centered instruction; avoiding formal structure; using a social- and emotion-based mode for interaction, language acquisition, and concept-development that flies in the face of the specific strengths and weaknesses of children with autism--depending, for example, on an ability to read facial expressions and tone of voice.

The curious thing about Floor Time is that, in both its child-centered approach, and in its emphasis on social and emotion-based learning, it strongly resembles the "whole child" Constructivist classrooms in which all too many children (neurotypical as well as autistic) are languishing.

Floor Time's biggest competitor is a behaviorist approach called ABA. It has its own problems (which I've also critiqued first here and later in Raising a Left-Brain Child), but it at least has been subjected to fairly rigorous empirical studies, has something of a proven track record, and provides the structure and direct instruction that children with autism depend on.

Who is winning this competition? In light of current trends in education, you'd think it would be Floor Time. But autism is a pretty powerful condition, and the reality of autism tends to favor ABA.

Two days ago I finally watched Temple Grandin, the movie, which concludes with a scene at the 1984(?) Autism Society of America Conference. Here an aged, bearded, unnamed psychotherapist stands at a podium, holding forth on an outdated emotional attachment theory of autism (one that could easily be the philosophical father of Floor Time). The Temple Grandin character, sitting in the audience with her mother, rises and starts talking about her own experience: all about structure, drills, being pushed by her mother and others out of her world and into the worlds of science and engineering. All heads turn towards her, and she ends up literally upstaging the bearded sage on the stage.

I thought of Stanley Greenspan then, and then I read his obituary.

(cross-posted, in a slightly different version, at Out In Left Field)