*3.10.2. Overview of the technique*

Based on principles developed by B.F. Skinner in the 1950s, Clinical Psychologist O. Ivar Lovaas created ABA as a behavior modification program for use in children with ASD [63]. The program is intended for use across a variety of instructional formats, including both group and individual sessions, which allows for independent and observational learning [80].

In ABA programming, once a functional behavior assessment has determined the ABC (antecedent, behavior, consequence), the therapist will determine the target behavior and how the environment will be modified to achieve that behavior. Additionally, the therapist will determine what reinforcement to use and the reinforcement schedule. Reinforcement is a critical component of ABA, and determining appropriate reinforcers is crucial for program success. Often people are tempted to use edible reinforcers (candy, chips). This practice is highly discouraged, as it can lead to unhealthy eating habits and an inability to develop other motivating reinforcers [80].

Embodied cognition is created only when an individual can actively engage in his or her environment [83], which requires social interaction with objects and others. To encourage these interactions and relationships, the Developmental, Individual Difference, Relationship-Based Model (DIR®/Floortime™) was created. This treatment approach is used by both occupational and physical therapists to encourage participation in therapy for children with ASD.

Occupational Therapy's Role in the Treatment of Children with Autism Spectrum Disorders

http://dx.doi.org/10.5772/intechopen.78696

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**3.12. Developmental, individual difference, relationship-based model (DIR®/FloortimeTM)**

DIR®/Floortime™ is a framework for assessment and intervention that focuses on building social, emotional, and intellectual abilities [84]. This framework seeks to assist children in creating an emotional foundation on which other skills can be encouraged to grow and develop. An important concept of this framework is that is does not seek to teach individual skills in isolation, but rather focuses on the child with ASD as a unique being that is capable of growth by establishing relationships and circles of communication within the environment [84].

According to Greenspan and Wieder [84], the DIR® Model was created by Dr. Stanley Greenspan in the 1980s. The model highlights the developmental, individual differences, and relationship-based components of emotional development in children. The developmental part of the model focuses specifically on the six identified developmental levels that are required for emotional health. These hierarchical levels include: (1) self-regulation and interest in the world, (2) engaging and relating, (3) purposeful two-way communication, (4) complex communication and problem-solving, (5) using symbols and creating emotional ideas,

Individual differences in the DIR® Model refer to the child-specific ways that information can be taken in and processed [84]. It is commonly understood that children with ASD are unique; with each child demonstrating individualized ways of responding to sensory input. These individual differences need to be considered when attempting to factiliate in social–emotional

The relationship-based component of the DIR® model refers to the use of emotional connection to foster development. Clinicians utilizing a DIR® approach need to purposefully tailor their actions and communication to engage the child in an emotional relationship [84].

Clinical application of the DIR® model occurs in what is called Floortime™. Therapists engaging in Floortime™ techniques demonstrate skills in getting to the child's level and allowing the child's actions and communications to lead the emotional relationship [84]. By engaging in the child's world, this technique postulates that you can then bring the child into a "shared world" [85]. These techniques, when employed correctly, can help the child with ASD prog-

Research regarding DIR®/Floortime™ appears to be somewhat limited in both scope and vigor, although the research base is expanding. A pilot randomized controlled trial was

*3.12.1. Purpose of the technique*

*3.12.2. Overview of the technique*

development.

*3.12.3. Review of literature*

and (6) logical thinking and building bridges between ideas.

ress through the levels of emotional development.

Therapists using ABA must be cognizant of their surroundings and the influence of all types of reinforcement, applying a variety of positive reinforcement to keep the child focused and on track. Knowledge of what may reinforce poor behavior is as important as knowing what impacts pro-social behavior. For example, if a child seeks attention and receives it every time he or she acts out, then the attention serves to positively reinforce the acting out behavior. Therapists need to be aware of this and modify reinforcement accordingly.

Once the reinforcement is determined, ABA can begin. A commonly used form of ABA is called Discrete Trial Training (DTT). DTT identifies a specific task, then teaches the task by breaking it into its component parts and repeatedly presenting it to the child until mastery is achieved [63]. This is a repetitive process that often involves multiple presentations over days or weeks. Reinforcement occurs each time the child correctly responds, or in the case of a developing skill, when the response approximates the skill.
