I need help chosing between ABA or RDI...

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Hi, I have a son who has an ASD diagnosis. He's 3 years, 3 months old and non-verbal. Our doctor did genetic/metabolic tests and he determined it's from an unknown cause. Overall, my son is really happy and seems pretty smart, he just doesn't communicate at his age level, we were told he's at about a 9 month old level for most things in that area (decent receptive speech, non existent expressive speech, lots of pulling us by the hand to show us what he wants), little to no eye contact and some stimming (jumping up/hand flapping/blowing air thru his lips - only when he's really excited). In all other areas he's at or pretty close to his developmental age. He's doing good with PECs on a ring (he can show us what he wants) and generally gets concepts pretty quickly. And over all he's in his own world, but seems to chose when to listen to us (I don't know if it's a "choice" all the time).

I love my son and only want to help him. He's a person with an ASD disorder and always will be, but I need help choosing between two very different types of therapies: ABA and RDI. I've read so much on these two therapies and I have to chose one of them, as my local government will only allow one - I have to jump of one of two cliffs with my son so to speak. Here's what I'm being offered:

ABA: starting in September, 3 years of 40 hours/week and once my son is in school and additional 3 years of 20 hours/week. This type of therapy is a behavioral type training, meaning it teaches skills in a positive manner (no adverse or negative consequences). It's all paid for by the government.

RDI: 2 years, up to 24 two hour classes for parents to be trained in RDI therapy - parents then work with the kids at home. No support at all at home or in school. It's paid for by the government too.

I'm torn to what to choose. From my limited understanding, ABA teaches static skills in a wrote way using Discrete Trial Training and apparently RDI teaches kids how to think flexibly which helps to treat some of the core issues with ASD - how I have no idea as the RDI therapist is vague in describing their techniques.

Basically, I'm getting two sets of people saying their therapy is the best one and the other therapy may not help or even hurt my sons development.

The RDI therapist explained how ASD effects children's development - in short, in her opinion something causes a-typical change(s) in the development of kids brains and leads to trouble with dynamic or flexible thinking, which causes their brains to develop more static-type thinking which leads to a cascade of changes in the way their minds develop. Over time, their minds develop routines to compensate the lack of flexible thinking. The RDI therapist was quite vocal on how ABA or behavioral type therapies only treat the surface symptoms of ASD and often cause greater strengthen of static thinking which alters kids neurological development in the long run. What she didn't do is say what RDI does that treats ASD so much better than ABA or how it's applied and what I as a parent will be doing with my son which is so vastly different.

So after all of the above, I'm asking opinions (good or bad) from people who's kids have done either therapies - how much did it help or hurt your kids development? Or anyone else who's knowledgeable on this topic. I need some guidance on what might be the most important decision I'll ever make for my son.

Thanks,
-BB400guy

My son wasn't nonverbal, and I don't have experience with either therapy, but in my reading I came across a program called DIR/Floortime that I was very impressed with. Their program focuses on using play to engage the child and gently draw him or her into more and more reciprocal interaction with the parent.

I attended a presentation on RDI that I found less impressive. The program I saw involved a lot of planing of activities and videotaping that was than reviewed by the therapist. I'm wondering if you are getting the full program if it's only 2 hours of support a week.

ABA is not well-regarded by most adult Autistics. This blog post, written by Amy Sequenzia, a well-regarded non-speaking advocate, details why ABA is problematic and can be traumatizing. http://autismwomensnetwork.org/my-thoughts-on-aba/

I just want to say that it's a good idea to protect your child's stims if he is not hurting himself or others. I stim by rubbing my fingers on the satin of my security blankets, sometimes for hours a day. I am so glad that no one has ever tried to take them from me. It is profoundly relaxing to me, like drinking a glass of wine. I consider silking my blankets a healthy way to relax when I am feeling stressed, and I am glad I have that option.

I also used to flap my hands, but stopped around high school because people acted like I was weird and childish for doing it. I miss hand flapping, and it doesn't feel the same to do it again. It feels like there is now an entire positive emotion I am not able to express, and the lack of ability to express that emotion has a feedback loop and I can feel less of it.

My son at the age of 5 1/2 was also non-verbal or at around 1yr old in speech. After reading about ABA and other therapies, I decided on none of the above lol I focused ONLY on speech therapy. Everything else, I did on my own. I learned about autism and what made him tick through this website.

In addition to this website, I did my own thing. It would take too long to write, but not long ago I found about Raun Kaufman and I have read his last book. Without a doubt, just about everything he says are the things that I did with my son. Not all. I wish I did more, however, at 14 he is doing great. I have ZERO issues with him. He is doing as well if not better than all of his other friends the same age, with the same diagnosis or even higher functioning diagnosis, who took ABA and many other therapies.

I highly recommend you look up Raun Kaufman and his latest book.

PS sorry I didn't answer about ABA, etc. I believe most of these therapies are incredibly ridiculous and treat our children and autistics as "pets to be trained".

PS I never purposely tried to take away his STIMS or echolalia

I'm afraid I don't know anything about RDI therapy, at least not from that abbreviation, but I have heard a lot about ABA over the years. ABA is very behavioral, but whether that turns out to be good or bad seems to depend on the therapist and the priorities they have chosen to work on. As others have noted, we on this forum do NOT think it is a good idea to squash your child's stims or to force eye-contact; the stims are self-calming and once the child is older and you've come to understand his patterns you may be able to redirect them into effective but more socially appropriate versions. Right now, making your child "look" normal should not be where time gets invested, IMHO.

My son not non-verbal and was never a candidate for early intervention, so I have to confess to a lack of personal experience with some of the issues, although I have been on this forum for an extremely long time and have seen and read quite a variety.

My son is 18 now, by the way, heading off to college in the fall and by all accounts an ASD "success" story. It was a very rough journey at times, but I feel like we did OK and actually ended up making some pretty smart decisions, even though many were against the grain.

My personal feeling is that your first decision is as to what you feel the priorities with your child should be over the next two years. Are you trying to get him to acknowledge and follow instructions? Are you trying to get him potty trained? Are you trying to increase his ability to engage in the world? I don't feel you can choose a therapy without knowing what it is that you, personally, most hope to accomplish. Every child is different and what they need is different; every family is different, too. There are no universal goals at this age and, so, there is no universal best way to approach therapy.

I realize that choosing priorities can be difficult, since you must be overwhelmed and overloaded right now. But try to give yourself that space to find out what your instincts are telling you, pushing out all outside influences and considering only what you know about your child and what your time with him tells you.

I also want to remind you that the most important time he will spend is going to be the time he spends with you. Finding an arrangement that allows you to be your best self, best able to respond to his needs and clues, in the time you do spend with him is an important factor. You will want to spend as much time with him as possible, but not at the expense of your sanity and ability to roll with the difficulties. What that means is going to be very personal, and not something someone else can tell you. You have to know yourself as well as your child. Again, try to find a way to get enough space to think clearly and see what your instincts tell you.

Good luck.

Can you get an ABA therapist who does VB (verbal behavior therapy)?

I was heartily warned against ABA (by adults on the spectrum) when my daughter was young and I started this journey. The short version of the story is of all of the therapies that we did (OT, PT, ST, and ABA/VB), VB had the most impact on my daughter because it gave her the ability to communicate. She also had more "traditional" ABA, but at least around here "traditional" ABA is nothing like what I think most people are "against" when they think of ABA therapy. There were no aversives at all, stims were never targeted (in fact, her favorite stims were incorporated as rewards for doing her "work"), and eye contact was never forced (her therapists were allowed to request it, but if she did not do it, they proceeded. One would ask her to "touch her nose if she was listening", and as long as she did that, she just proceeded). The therapists eventually dropped DTT because it became ineffective (my daughter was annoyed and refused to participate), but they still structured the learning by breaking things down into chunks and chaining the chunks. The thing with my daughter is, she can learn almost anything, including social skills. Her problem is that she cannot learn incidentally or through observation alone. She needs everything taught in a very concrete manner. Her ABA therapists were able to do that with her. FWIW, she was never traumatized by any of it (the most she ever had, though, was 20 hours a week and I think more would have been too much). In fact, she would be upset if her therapists couldn't come for some reason and she still remembers 2 of them at the age of 9.5 even though she stopped receiving services at 5.

I do not know enough about RDI to comment on it, but I can tell you that her whole life has basically been "therapy" so it is not like we stopped at ABA/ST (least effective for her)/OT/PT. I view everything as a potentially teachable moment and I look for ways to reach my kids and help them learn to cope in the world. At the age of 9, my daughter is able to compensate to the point that I don't think most people would "peg" her as autistic. We still see it, of course, and sometimes she does things at home that she does not do at school or "in public," not because she was "drilled" or "forced" to be "indistinguishable from her peers," but because this is just the way she is.

We tried a lot of things. We stuck with the things that seemed to be helping, and dropped the things that didn't. No matter what you choose, I think it is important to continue to see your kid as a kid, to recognize that they will always be autistic and your goal should never be to make them "like their peers," but rather to help them be the best "me" that they can be.

Can you start with one and change if it doesn't seem to be helping? How much control do you get over which practitioners you work with?

I suggest neither ABA or RDI.
RDI is bizarre, expensive, and unproven.
40 hours a week of ABA is too stressful for autistic child, probably any child.
Instead, I suggest teaching your son reading and writing (or typing) words and sentences.
Speaking is not critical at 3 years old and may develop spontaneously later.
If not developed by age 5, I suggest teaching speaking explicitly from english as second language materials.
If you teach him reading now, he will have language foundation on which to learn speaking for communication later.
See if he has interest in drawing or building and help him develop those skills if he does.
Encourage him in special interests that don't involve too much video games.
Try to get him to be creative and active about special interests beyond memorizing facts.
Give him lots of chances to use his smarts.
Teach him social skills yourself as he grows up, as you are good at those as NT.
About trains, I don't know why so many autistic people are interested in trains, I love trains too, also planes and maps.
Avoid following the other parents with autistic children chasing after the latest, weirdest therapies to cure their children or make them indistinguishable from their peers.
Your child can have happy full life as autistic person.
Another suggestion is to try to not make your son's growing up about autism, with autism this and autism that dominating your approach towards parenting him or talking all the time about his autism.
I would try to avoid phrases like "your autism" when talking to your son about his traits.
Raising autistic children as themselves without big autism focus is beneficial in my opinion.
Advice that I pass on from wise parents I know is use humor and make light of things, like social mistakes, meltdowns, rigid behaviors, etc.
It helps a child not to feel ashamed about their traits and also to want to develop skills to be more a part of society than an outcast from it.

What sort of support would be offered at school? More ABA?

I think people have already described how personal it is but if you don't think ABA would benefit your child and taking the early intervention won't limit any future access to support (I don't see why it would but have zero familiarity with services in your area) then maybe take the RDI.

I agree that I prefer programmes such as Floortime/DIR but going along to the training sessions may give you ideas about activities to do with your son that you can adapt to the needs of your family.

I would also consider how much time you have - do you both need to work? Would ABA (provided it is done ethically - I imagine you wouldn't get much rest if you're worried about your son) give you a much needed break/a second pair of eyes to watch him.

40 hours a week does seem like an enormous amount, though. Where I live, adults, with their fully developed attention spans, have to sign waivers if they plan to work more than 48 hours and teachers are very familiar with children flagging towards the end of the day/week with 30 hours in school including breaks.

Thank you to everyone who's given advice so far (and to those who will make more posts).

There's some good advice in this thread.

First, my son will always be my son first and a person with ASD second. My love, respect and understanding for him will never be an issue - the understanding part is hard right now because as a parent who has never met a person with ASD it's a difficult conceptualize what's affecting him and even harder to plan therapy to help him (and yes, he does need help) - but with this forum and a lot of reading I have a better grasp now than I did one year ago.

Making him "indistinguishable from his peers" is not my objective of any therapy - lessening the disabling effects of his ASD is what I'm going to do thru therapy(s). And fortunately, to some degree which varies from person to person, it shows ASD can be treated - but as I said my local government will only allow one kind of therapy so I have to pick (by the end of August). I think I’m going to go with ABA (if they will concentrate on communication skills only, no DTT) and after that some form of relationship-type development therapy (on-line or on my own I guess), as literally it’s like we're physically in the same room by miles apart – with one exception, when he’s been sick he’s more than happy to be held/cuddled and seems to seek it out.

I’m very much agree with making my son’s childhood as fun and as positive as possible – autistic or neurotypical – a happy childhood is the foundation for the rest of any persons life. But I’m unsure how to raise him in regards to “his autism” – from the very beginning of him becoming more aware do I talk about it a lot in a very gentle manner so that him finding out later in life isn’t a gigantic blow him? I would think simply growing up knowing would be better than telling him when he’s a teenager.

Also, I will never take away his stims, unless he develops self-harming type stims. The one stim he does (jumping up/hand flapping/blowing air thru his lips - only when he's really excited) is difficult for only one reason - it seems to interfere with his ability to engage/regulate himself on what he's excited about. For example:

Last night we were trying to show him how to run thru the sprinklers. He loves water, he loved being up on my shoulders getting sprayed (lots of laughs and giggles), but when I put him down for us to both run thru the sprinkler he ran up on the deck and stared at the sprinkler jumping/flapping/blowing air thru his lips - he just couldn't engage even though it seemed like he wanted to. When I turned off the sprinkler, my son would go over and turn it back on.

I have done neither ABA or RDI, but I have a suggestion about the sprinklers. When my son was little, he liked the pool, and he liked when we would put his feet in the sink and let him kick. Rain made him freak-out. Now he loves the rain---but that took a long time.

Anyway, it is possible that the sprinklers are scarier to him because he has no control over where the water lands on him and the texture or feeling of it may be painful---like how many autistic people prefer baths to showers.

If it is not a control or feeling issue, he may just need practice with the physical act of running through. if this is the case, you could try holding his hand and running (or maybe slowing it down at first) to see if he becomes interested in it. He may just enjoy watching the sprinkler, though, or at least at first.

Edited to amend what I said about ABA: What I meant to say was I haven't done the early-intervention kind. The school attempted to do a behavioral analysis for issues they had with my son's behavior, in elementary school. I think that has impact when done properly --- but like most things with potential to help, it is only as good as the people doing it.

Okay, I just reread my second post - I hope I didn't come off as sounding rude to btbnnyr/Adamantium/Girl_Kitten or anyone else by saying my son needs help (therapy) now. I should have originally explained, once my son turns five, all government services are cut off (except ABA), as then the school system takes over (I don't want to get into how messed up that is here) - it's all government run where I live, very few private therapist of any kind (SLP, OT etc) exist. So getting him into speech therapy later than five is just not possible.

As for teaching him reading now - he's too much in his own world. He'll look at the pictures, flip the pages, but that's about it. My son can't learn things from me like typical kids do. For example: at two and a half years, I tried to teach him the alphabet by using wooden alphabet blocks that fit into a board. I tried to finger point where the letters go, but my son couldn't follow my point or understand the cues I was giving him. Yet, he knew what to do, he knew the letters all go somewhere on the board and it took him only 1 day to figure it out. I brought out a different alphabet block set the next day, he again finished that set by the end of that day too.

ASD MommyASDKid:

I don't think my son has any real sensory issues, at least none that I can tell so far. My son love the bath, kicks and splashes to the point where there's more water on the floor than in the tub. He takes the hose with a nozzle and sprays his feet and anything else in the back yard. I've tried taking his hand and running thru the sprinkler, he pulls and runs away. That's why I ask him to go "up" and he then puts his arms up, letting me know he wants to go for a shoulder ride. And then I run thru the sprinklers with him. Once his feet touch the ground he runs away again.

You could give him reading materials and see if he learns on his own.
Some autistic children learn reading by themselves at age 2 or 3.

About the routines that the therapist talked about, she doesn't make much sense about how routines develop.
I was super rigid when I was 2 or 3 and became increasingly more flexible as I got older through the natural course of development, which includes in particular development of intellectual abilities, problem-solving skills, logical thinking, etc.
I think intellectual stimulation through problem-solving from a young age can help be flexible and resourceful instead of super rigid and ruled by routine in a maladaptive way.
It is ok to have some routines, as many normal people also function well with routines and have quirks about what routines they can't give up or how they want things a certain way.

My son has had an intensive VB/ABA program since the age of 4. My only knowledge of RDI comes from some books that I purchased on Amazon. I may be entirely wrong, but RDI seems to be much the same thing as Son Rise / Floor Time etc.

My conclusion, after 2+ years of ABA, is that while DTT can teach some skills (such as receptive identification of objects), other skills (such as social skills) are best taught in a naturalistic environment through play. A Floor Time approach has been immensely useful in teaching my son joint attention, learning to interact with people (adults only, he still avoids other children) etc. You cannot teach these skills or others (such as how to behave whilst out shopping at a crowded store) via an exclusively table-top based program. We just recently reduced his ABA hours, to incorporate more play based intervention, and currently teach him motor skills using ideas in the numerous books written by Barbara Sher (a very talented and creative OT and author).

And, to his credit, while my son did learn a lot of skills from VB/ABA, language continues to elude him. He has a dual diagnosis of apraxia and autism, so speech does not seem to be on the horizon for us, just yet. But we have now started to teach him to type, and are thinking about investing in the Keyboarding Without Tears program, in order that he has some means of communicating. Again, the VB/ABA people are not helping us with this. We are doing this on our own, with a once-a-month consult with a local OT. He still does not show much interest in learning to type, but I don't expect instant results with him anymore. My boy is the slow but steady turtle who takes a while to learn, but learn he does.

What I am trying to say is that you can and should utilize a variety of teaching styles while working with your child. I wouldn't see this as a mutually exclusive ABA or RDI / ABA vs RDI approach. Instead, I think that you should look to incorporating a variety of ways of working with him - teach some skills using DTT, some skills using play, and some skills using Floor Time / RDI etc.

Good luck !

My twins are 4 and got diagnosed at 18 and 20 mo, respectively. Both were speech delayed, but at 3, one was consistenly talking (still very delayed), and the other used mostly sign and gesture, but had about 30 words. At 4, one is only six months behind expressively and the other is about a year behind. I'm very happy with where they are.

I think any of the main therapies can work, if you look at it as your responsibility to teach your child and don't leave it to the therapists. We did 15 hrs of ABA even though they qualified for 40, because every brain needs to rest, and children deserve a childhood. It was always ironic to me that when social bonding/awareness is one of the difficulties autistic people can have, ABA takes very young toddlers and sits them at a desk away from their parents/loved ones for all of their waking hours (if you do the math for a toddler, count naps and lunchtime/dinner, 40 hours of ABA is pretty much all of their awake time in a 5 day period, even worse if you have separate speech, OT, physical therapy, etc).

So, we capped at 15 hours, I was actively involved in developing all goals, which mostly focused on social reciprocity and speech, and I say in the sessions and redirected if I thought my boys needed a break. I also actively dis-invited (fired) therapists to return if I thought they they were not bonded to my children and were acting more like my kids were dogs needing training. I was very lucky in that I mostly had very good therapists who really saw my children as children first, who needed to be able to laugh and play.

I really liked Floortime too, and that is what we did when the ABA therapists weren't here. The good thing about FT is that once you understand it, it's very easy to incorporate into all aspects of just regular life. It really just changes the way you communicate with your children, and it teaches you how to really listen to/see them. FT was the most instrumental in helping my develop an interaction model with my children that was positive, and it brought down a lot of my frustration/fear because finally I could see what was actually happening in their little heads.

So, I'd say go for the ABA, but get very educated on it and oversee it like a hawk (sounds like you already are). Limit the hours to allow for meaningful kid time - a couple of hours outside playing, trips to museums, tickles from Daddy, etc. - a 3 year old does not need a full time job. Id feel this way no matter how severe the autism. Every human being needs time to just...be. And finally, check out Floortime. It will help you think differently about how you play with your son (I'm thinking back to your sprinkler example). Good luck!