Behavioral Interventions Beyond ABA

Article
Feb. 22, 2022Updated Dec. 12, 2022

Applied Behavior Analysis (ABA) therapy aims to teach, maintain, or reduce behavior based on a system of reinforcements, and is widely considered the gold standard for supporting children with autism. However, no single solution will be a perfect fit for every child, and you may find that ABA isn’t right for yours. So, what are the alternatives to ABA? How can you find a provider and obtain funding? To learn more, we spoke with Dr. Douglas Vanderbilt, director of Developmental-Behavioral Pediatrics at Children’s Hospital Los Angeles and professor of clinical pediatrics at Keck School of Medicine and Occupational Science/Therapy at the University of Southern California, and Dr. Susan L. Hyman, a Professor of Pediatrics and Division Chief of Developmental and Behavioral Pediatrics at the Golisano Children’s Hospital of the University of Rochester.

Considering non-ABA therapies

While ABA therapy is considered the gold standard of behavior therapy, some adults with autism describe having negative experiences during sessions when they were younger. In addition, some parents question whether ABA is appropriate for children with other diagnoses.

According to Dr. Vanderbilt, ABA is engineered to promote data collection, which has led to large amounts of research in support of this intervention. However, “the key is, ABA doesn’t work for everybody. It doesn’t work for every family.” Other techniques may suit your child’s needs and individual goals.

Dr. Hyman explains, “There is an incredible amount of variation in the needs and presentation of autism at various ages; there’s no singular treatment.” However, she points out that the practice of ABA has grown enormously and is very different than when it was first developed. (Learn more about types of ABA therapy here.)

What to think about when choosing a specific intervention or provider

Dr. Hyman suggests focusing first on the goals of your child’s therapy, how to include the child’s family and natural environment, and how your child can learn both functional and spontaneous skills. She explains that this is so they “learn how to apply these skills across [their] day.”

When your child is evaluated either in early intervention or by their school district, the results can help you narrow down your options based on the areas where your child needs the most support. As Dr. Hyman explains, it’s essential for parents, schools, and other providers to match “an individual child and their profile (what their needs are) with what’s available” when making a decision.

When choosing a provider, Dr. Hyman wants to remind parents that even research-based therapies might not be implemented by some practitioners in the same way they were intended by the researchers, so they might not show the same results.

In addition, some interventions, like Floortime, offer classes and consultations that allow parents to implement them at home. Dr. Hyman suggests working with a provider to learn the system and help ensure that the therapy is practiced the way it was intended.

Dr. Vanderbilt suggests getting recommendations from parent support groups, your local autism society or Regional Center, or non-profit groups like Family Voices or the Autism Alliance SoCal.

Developmental Relationship–Focused Interventions

Dr. Vanderbilt tells us that relational development approaches focus on the interactions between a child and their caregiver, which families may find attractive. However, these therapies are less structured than traditional ABA therapy. He recommends relationship-based therapies for younger children in cases where the relationship between the parent and child needs to be strengthened.

According to Dr. Hyman, “the research around relationship-focused interventions and Floortime is in its infancy and is more narrative than the literature regarding ABA.” Their effectiveness will become more clear with further research.

DIRFloortime/Floortime

Developed by Dr. Stanley Greenspan, The Developmental, Individual Differences, and Relationship-Based (DIRFloortime) model is a play-based therapy that seeks to help your child progress through creativity and connection. It is a child-led but still targeted approach where all or most of the child’s senses will be engaged while using their emotional and motor skills. (Find the answers to commonly asked questions in this brochure.)

In a 2011 study, researchers “found that after the parents added home-based DIRFloortime intervention at an average of 15.2 hours/week for three months, the intervention group made significantly greater gains in all three measures employed in the study.”

Professionals such as child psychologists and special education teachers can become certified to provide Floortime. The Interdisciplinary Council on Development and Learning (ICDL) created a searchable directory where you can find qualified practitioners.

Parents can also implement Floortime at home. ICDL offers free virtual consultations for parents who are new to Floortime, during which they can review videos of you and your child interacting to learn how a Floortime provider can help. You can also sign up for paid courses or take advantage of free resources from stanleygreenspan.com.

Relationship Development Intervention (RDIⓇ)

According to RDIconnect, “RDI programs teach parents how to guide their child to seek out and succeed in truly reciprocal relationships while addressing key core issues.” RDI providers will concentrate on critical skills like creative problem solving, communication, and self-awareness.

RDI programs focus on the family’s role in supporting a child’s growth. Sessions are conducted in the home with all family members because “every family member is critical to success.”

One 2009 study states, “Preliminary research suggests that parents, through the RDI curriculum and consultation process, have the potential to exert a powerful impact on their children's experience-sharing communication, social interaction, and adaptive functioning.” Read a more detailed rundown of how RDI works here.

You can find a consultant near you by visiting RDIconnect’s website.

Naturalistic Developmental Behavioral Interventions

As Dr. Vanderbilt explains, naturalistic development interventions “blend both ABA principles and developmental relationship principles,” and emphasize parent training. “If you want generalization of learning, you have to put it in naturalistic settings and have parent involvement.”

Dr. Hyman says that in both modern ABA therapies (like Pivotal Response Training) and developmental behavior interventions, you will be playing, identifying communication and social goals, and responding to children where they're at. “This idea of neurodevelopmental behavioral interventions is the pinnacle of what we’re aspiring to right now,” Dr. Hyman adds.

Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER)

JASPER was developed by Dr. Connie Kasari at the University of California, Los Angeles (UCLA) and emphasizes social communication skills while teaching and modeling:

  • joint attention, which is the ability to focus on both objects and people,
  • symbolic play, where children can use one object to represent another (for example, using a banana as a phone),
  • engagement, and
  • regulation of emotions and behavior.

JASPER is typically conducted one-on-one between a child and their therapist using developmentally appropriate toys and activities. Children can receive JASPER in conjunction with other therapies in various settings, such as their home or classroom.

According to Kasari Lab, children taking part in a JASPER program showed improvements in “joint engagement, social communication, and emotion regulation with decreasing negativity over time, as well as increasing parental co-regulation strategies.” JASPER was also recognized by the National Institute of Health and Care Excellence (NICE) as being evidence-based in 2013 and was one of just two social communication interventions they recommended.

Kasari Lab, in Los Angeles, California, offers JASPER treatment and can be contacted by email or by phone at 310-206-1268. For more on using this method to help kids with autism learn how to play and interact with others, see our article here.

Early Start Denver Model (ESDM)

ESDM is a hybrid therapy that combines aspects of ABA therapy with relationship development. It is typically used for infants and toddlers with autism between the ages of twelve and forty-eight months. ESDM primarily focuses on developing social-emotional, language, and cognitive skills.

Dr. Hyman explains that there is a difference of opinion as to whether ESDM is a type of ABA or a closely related alternative. Unlike other ABA models, therapists may have multiple goals per activity (if a child is presented with blue and red triangles, for example, and asked to point to the blue ones to teach them to differentiate between colors, in ESDM they may be simultaneously learning about color, what a triangle is, and to repeat the words “triangle” or “blue”).

To find a provider near you, refer to the directory on ESDM’s website. To learn more about how to practice ESDM at home, visit helpisinyourhands.org to access a series of video modules featuring intervention practices you can add to your daily routines.

Social Skills Groups

Other types of behavioral interventions

How can I fund non-ABA therapies?

Have you tried using a different behavioral therapy with your child? What therapy did you choose, and how is it going? Let us know in the comments!

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Contents


Overview

Considering non-ABA therapies

Developmental Relationship–Focused Interventions

Naturalistic Developmental Behavioral Interventions

Social Skills Groups

Other types of behavioral interventions

How can I fund non-ABA therapies?

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Related Parent Questions

How can I fund non-ABA therapies?
Many private insurers won’t cover ABA or alternatives if the child doesn’t have an autism or pervasive developmental disorder diagnosis. Medi-Cal and Regional Center will, but they require evidence-based treatments.
What is DIRFloortimeⓇ/Floortime?
The Developmental, Individual Differences, and Relationship-Based (DIRFloortime) model is a play-based therapy that seeks to help your child progress through creativity and connection. All or most of the child’s senses will be engaged while using their emotional and motor skills.
Can ABA effectively support my child?
ABA has been used effectively for children with varying diagnoses, including Autism Spectrum disorder, Down syndrome, ADHD, and Intellectual Disability. Behavior therapists have also used ABA therapy to support children who use wheelchairs, assistive technology, or ventilators.

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