C.

Communicative Domain
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 FCT
 PECS
 VS
 NI
 PMII
 PII
 DIR

 PCIT
 C1: Functional Communication
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Training (FCT)
 Replacement of interfering behavior that has a
communication function with more appropriate
communication that accomplishes the same function.
 FCT usually includes FBA, DRA, and/or EX.
 C2: Picture Exchange
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Communication System (PECS)
 Learners are initially taught to give a picture of a
desired item to a communicative partner in
exchange for the desired item.
 PECS consists of six phases which are:
• (1) “how” to communicate,
• (2) distance and persistence,
• (3) picture discrimination,
• (4) sentence structure,
• (5) responsive requesting, and
• (6) commenting.
 C3: Visual Support (VS)
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 Any visual display that supports the learner

engaging in a desired behavior or skills
independent of prompts.
• Examples of visual supports include pictures,
written words, objects within the environment,
arrangement of the environment or visual
boundaries, schedules, maps, labels, organization
systems, and timelines.
 C4: Naturalistic Intervention
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(NI)
• Intervention strategies that occur within the typical
setting/activities/routines in which the learner
participates.
• Teachers/service providers establish the learner’s
interest in a learning event through:
• arrangement of the setting/activity/routine,
• provide necessary support for the learner to engage in the
targeted behavior,
• elaborate on the behavior when it occurs, and/or
• arrange natural consequences for the targeted behavior or
skills.
 C5: Peer-Mediated Instruction
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and Intervention (PMII)
 Typically developing peers interact with and/or help
children and youth with ASD to acquire new behavior,
communication, and social skills by increasing social
and learning opportunities within natural
environments.
 Teachers/service providers systematically teach peers
strategies for engaging children and youth with ASD
in positive and extended social interactions in both
teacher-directed and learner-initiated activities.
 C6: Parent-Implemented
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Intervention (PII)
 Parents provide individualized intervention to their
child to improve/increase a wide variety of skills
and/or to reduce interfering behaviors.
 Parents learn to deliver interventions in their home
and/or community through a structured parent
training program.
 E.g. DIR, PCIT
 DIR/FLOORTIME
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2003 USA Stanley • Published “Engaging Autism”: The

Greenspan Floor Time Approach to Helping

(1941 - 2010) Children Relate, Communicate and
Psychiatrist, Think”.
Psychoanalyst • The book was influential in
treating children with ASD and
related developmental disabilities.
 Stanley I. Greenspan (1941 - 2010)
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 DIR/Floortime Approach
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 Developmental, Individual Difference, Relationship-

based/Floortime:
 Becomes increasingly popular approach to working
with children with autism.
 The DIR/Floortime model was developed by Dr. Stanley
Greenspan and Dr. Serena Weider (Greenspan &
Wieder, 1999).
 It is based on a hypothesis that ASD is acquired as a
result of a child’s early environment not providing
specific kinds of emotional nurturing.
 DIR/Floortime Approach…
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 This leads to them missing one or more of the six hypothesized

emotional developmental milestones.
 DIR is described by proponents as a child directed “process or
concept, through which therapists, parents, and other
caregivers make a special effort to tailor interactions to meet
the child at his unique functional developmental level and
within the context of his processing differences”.
 It considers the “Development of functional emotional
capacities, Individual processing differences, and the parent or
caregiver-child Relationship” to create new learning
opportunities and centers around circles of communication.
 DIR/Floortime Approach…
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 A circle of communication involves two participants who

respond to each other verbally or nonverbally.
 DIR proposes six developmental milestones that create the
foundation for a child’s learning and development.
 Specifically, the milestones are:
 1) self-regulation or interest in the world,
 2) engagement and relating,
 3) two-way intentional communication,
 4) purposeful complex problem solving communication,
 5) creating and elaborating ideas, and
 6) building bridges between ideas (Wieder & Greenspan 2003).
 DIR/Floortime Approach…
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 Each milestone increases the length and complexity of

the circle of communication.
 Floortime is the intervention technique used to facilitate
mastery of the DIR developmental milestones.
 Specifically, Floor time involves guiding the child
through the developmental milestones by following the
child’s lead through play.
 That is, the therapist or caregiver will build on the
child’s current skills to create more complex circles of
communication.
 DIR/Floortime Approach…
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 Proponents of Floortime suggest it facilitates

generalization because each interactive circle of
communication is created in a natural environment.
 Additionally, family involvement is a large
component of Floortime, again to facilitate
generalization.
 Proponents recommend that DIR/Floortime be
implemented in 20-minute blocks of time for six to ten
sessions per day.
 DIR & Research
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 Currently, DIR/Floortime simply does not meet the

basic standards of care for use as a treatment
intervention. Specifically, there is little to no objective
evidence of effectiveness.
 No one has demonstrated that results can be
replicated across a range of children with ASD.
 No one has demonstrated reliable implementation of
treatment procedures because treatment procedures
are individualized based on the child’s behavior
during treatment.
 DIR & Research…
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 Finally, measurement of treatment effects has been

limited to evaluations of DIR/Floortime procedures
and effects on the DIR/Floortime created measures
(Functional Emotional levels) rather than standardized
assessments of development and language.
 Concerns with the DIR/Floortime
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 Floortime may seem like an attractive treatment on the

surface. For example, following a child’s lead rather
than directing or controlling them as some perceive to
be the case in applied-behavior-analytic based
treatment may appear more progressive.
 However, inherent in the model are several concerns.
First, Greenspan explicitly warns against rigidity and
repetitive routines, instead encouraging variability of
teacher behavior.
 For learners whose strengths are in creating and
learning from routine, DIR/Floortime may be frustrating
or confusing.
 Concerns with the DIR/Floortime …
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 Because DIR/Floortime is a time consuming treatment

(i.e., it is recommended that Floortime be
implemented at least 20 hours a week), it may be
detrimental to implement DIR/Floortime as a
treatment for ASD as it greatly decreases the amount
of time the child can be exposed to Early Intensive
Behavioral Intervention (EIBI), a treatment that is
empirically supported for ASD.
 Is Floortime scientifically validated?
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 The National Clearinghouse on Autism Evidence &

Practice lists Parent-Implemented Interventions such
as Floortime as Evidence-Based Practices in their
most recent edition of the Evidence-Based Practices
for Children, Youth, and Young Adults with Autism.
 PCIT
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 Parent Child Interaction Therapy

 SUGGESTIONS FOR INCREASING SPEECH AND LANGUAGE
DEVELOPMENT IN CHILDREN
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 From birth, talk to your child a lot.

 Bath time, mealtime, and bedtime are
perfect opportunities to model language and
build vocabulary.
 Talk about what you are doing, seeing, or
thinking, or talk about what is going to
happen.
 Cont…
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 Provide a good language model.

Speak clearly, maintain eye contact, and use
natural intonation when talking to your child.
 Avoid using indirect forms of
communication such as indirect requests (e.g.,
“That cake sure looks good”);
 Direct forms of communication generally are
more effective (e.g., “Give me some cake, please”).
 Cont…
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 Acknowledge and expand on what your child

says.
 If he or she says,”Juice,” reply with “You want Juice? I
will get Juice for you. Here is your Juice.”
 Give your child opportunities to communicate.
 Ask questions that require a choice, such as, “Do you
want water or juice?” If your child points to something
he or she wants, encourage speech by saying, “Tell me
what you want?”
 Pause after asking questions or making comments to
give your child an opportunity to talk.
 Cont…
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 Imitate and reinforce sounds and words your

child says.
 If a word is said incorrectly, never criticize.
 Repeat it back, modeling the correct pronunciation.

 Sing children’s songs, especially repetitive

songs. such as The Wheels on the Bus and If
You’re Happy and You Know It.
 Use hand and body motions to reinforce the words.
 Cont…
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 Play with your child frequently.

 Name objects and colors, count, describe things,
make animal sounds, and take turns.
 Play “let’s pretend” and “I’m thinking of . . .”
games.
 Read to your child frequently.
 Name pictures in a book and talk about the story.
 Rhyming books are especially good for early
literacy development.
 Cont…
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 Avoid screen time as a passive activity.

 Instead,watch or play together.
 Talk about what you are watching.

 Make predictions and talk about the characters.

 Play cognitive and language-building games

together on devices such as iPads or tablets.
 Solo play does not build language and can hinder
growth.
 Cont…
27

 With older children, make up stories together

with a setting, characters, a plot with a
conflict, and a resolution.
 Follow your child’s lead.

 For example, if he or she likes animals, read books

about animals; talk about what animals say, where
they live, what they eat, what they look like, etc.;
visit a zoo together.