In the field pediatric disorders, families are faced with choosing between many different types of interventions that all may sound appropriate and even have some evidence supporting them in the application of helping children with diagnoses like autism, social communication disorders, and other developmental delays. While each of the interventions parents are usually recommended do have the potential to help a child, the potential growth a child can achieve from each intervention is different based on how the intervention actually works Some of the most significant differentiating factors in learning outcomes is whether an intervention is thinking-based or skill-based, child-lead or adult-lead, and developmental or behavioral. While some of these distinctions overlap, there are fundamental differences between the various types of interventions that will make some less effective than others. While some may be effective in the short run, unfortunately it can mean they can be less effective in the long run, and vice versa. For example, behavioral interventions like ABA have been shown to encourage initially rapid learning, but then not only does the learning slow down over time, but they’ve found that the learning does not generalize. This means that in the short run we get rapid results, but in the long run children actually develop maladaptive learning techniques. It’s been shown that this can have an impact on their future learning in general. Their overall learning is inhibited by being exposed to a specific type of intervention when they are young.
With adult-led interventions, children are usually following instructions, responding to prompts, and primarily learning compliance and relying on someone else for ideas. As a result, many children might develop the ability to respond in the appropriate manner as suggested by the adult, but they generally don’t fully understand what it is they’re doing and why they’re responding the way they are. There’s less meaning behind their response. We see this frequently with children who are participating in traditional adult-led speech therapy or special education classes where they’re supposed to repeat a word they just heard or follow an instruction like pointing to a certain picture.
When you look at the child’s understanding of why they’re doing what they’re doing, there’s usually a disconnect. Oftentimes children develop the habit of repeating the last word they heard because they think that’s how to come up with an answer. Children learn to follow instructions verbatim, but don’t understand why they’re doing it and as a result can’t adapt it and generalize it. In these adult-led skill- acquisition interventions, they’re trying to teach the child a specific adult desired outcome, solution, or answer without the child developing their own internal process coming up with words, ideas, and solutions. In these situations, who came up with the answer? We did, they just repeated it.
With developmental interventions, the key is that we’re working from the ground up. Instead of teaching a child age appropriate skills, we’re actually helping them learn skills based on their developmental age, which may be significantly less than their chronological age. Building from the ground up has been shown to be a far more effective way to encourage learning for all human beings, especially children with developmental delays.
While developmental interventions have been shown to be more effective than behavioral interventions at stimulating neuroplasticity, there’s an additional component in some developmental interventions that make them even more effective. This component is the difference between a thinking-based intervention and a skill-based intervention. Most developmental interventions are still trying to teach a child a specific skill or outcome. While they may be child led in the beginning, they end up being adult led at the end, which causes it to lose some of its effectiveness. Letting a child pick an activity or encouraging a child to play and have fun within an activity of their interest is a great place to start. This will help ensure that a developmental intervention is working around a child’s natural abilities and interests. Unfortunately, when the adult takes over towards the end to teach a specific outcome or skill, it’s no longer truly a developmental intervention. It’s now a behavioral intervention that’s adult led because now we’re looking for a specific outcome or answer that’s being driven by the adults’ own ideas and perception of the expectation.
This method can actually be effective when teaching very specific simple skills. Something like tying your shoes can be done this way very effectively because we probably will only need to know one way of tying our shoes most of our lives. However, when it comes thing to things like self-regulation, social interaction, communication, creativity, adaptability, flexibility, none of these social-emotional capacities can be learned by someone telling us how to perform them. Someone can’t tell you how to be creative because ultimately the creativity has to come from inside. If someone tells you to be flexible and do something their way, they’re actually modeling rigidity because now they’re telling you their way is the flexible way, but they’re giving you one potential way of doing it, which is by definition rigid. When we learn to communicate, it’s not about just knowing and memorizing words and phrases and when to say them, is about being able to figure out what to say based on the context of the environment. What did the last person just say and do? And how do I respond in the most appropriate and adaptive manner?
Unfortunately, in the field of developmental interventions, even people teaching versions or Floortime are still misunderstanding this fundamental concept of what the difference between a skill-based intervention and a thinking based intervention is. When Dr. Greensman created The Greenspan Floortime Approach, the only version of Floortime that prioritizes it as a thinking-based intervention, he wanted people to understand that one of the most important growth inducing elements of The Greenspan Floortime Approach is that it focuses on a child developing a thinking process versus just learning and or memorizing an answer to achieve an adult determined goal.
This type of intervention is much harder for therapists to apply because they are no longer teaching the specific adult desired outcomes that they would like to check off their list. However, developing the process of thinking been shown to be significantly more beneficial at encouraging neurological growth in children who need to develop the ability to conceptualize and apply meaning to what they’re learning. The process of thinking, the process of problem solving, the process of creating and adapting is something that we can take with us and utilize in many different shapes and forms throughout our lives. However, learning a singular answer, word, movement, or phrase is something that may only be applicable in select situations and likely will not generalize outside of that situation.
A skill-based approach is equivalent to ‘teaching to the test’. Telling the child what the desired answer is and having them repeat it or write it in the case of a school is frowned upon in most classrooms because it’s been shown to be an ineffective method for long-term learning. Yet, it is exactly this method that that proliferates our special ed classrooms and our therapy centers. In these settings the adult’s mission is to check goals of a list versus encourage the child’s internal thinking processes. It is outcome-based, not process-based. Remember, child development is a process, it is a journey and we have to help a child develop fortitude, the ability to create, adapt, problem, solve, and think during that journey. If we are able to do that, we see much, much greater, much more successful adult outcomes for the individuals that we’ve worked with. However, when we teach a child a specific skill in place of a thinking process, we’re actually short-changing them and making it much harder to be truly successful.