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Asian American Parents’ Subjective Asian American Parents’ Subjective Experiences with the Utilization of Experiences with the Utilization of

Floortime Method for Children with Floortime Method for Children with Autism: A Preliminary InvestigationAutism: A Preliminary Investigation

Thao P. Trinh, M.A.Thao P. Trinh, M.A.Pepperdine UniversityPepperdine University

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Prevalence of AutismPrevalence of Autism

Autism Spectrum Disorder (ASD)Autism Spectrum Disorder (ASD) One of the fastest growing developmental disorders in the One of the fastest growing developmental disorders in the

United States (1 in every 166 births; Gibbons, 2005) United States (1 in every 166 births; Gibbons, 2005)

With the increase of prevalence, there is increased need for With the increase of prevalence, there is increased need for treatmenttreatment

Individuals with Disabilities Education Act of 1990Individuals with Disabilities Education Act of 1990 Made it possible for family members to participate in making Made it possible for family members to participate in making

educational decisions for their special needs children (Parette, educational decisions for their special needs children (Parette, VanBiervliet, & Hourcade, 2000)VanBiervliet, & Hourcade, 2000)

33

Treatments for AutismTreatments for Autism

A variety of treatments exist despite lack of A variety of treatments exist despite lack of empirical evidence of effectivenessempirical evidence of effectiveness Sensory-motor therapies (Smith, 1996)Sensory-motor therapies (Smith, 1996) Facilitated communication (Green, 1994)Facilitated communication (Green, 1994) Auditory Integration Training (Stehli, 1991)Auditory Integration Training (Stehli, 1991) Sensory Integration Therapy (Ayres, 1979) Sensory Integration Therapy (Ayres, 1979) Psychotherapies Psychotherapies

Psychoanalysis (Beratis, 1994; Bromfield, 2000)Psychoanalysis (Beratis, 1994; Bromfield, 2000) Holding therapy (Welch, 1988)Holding therapy (Welch, 1988) Options therapy (Kaufman, 1976) Options therapy (Kaufman, 1976)

44

Treatments for AutismTreatments for Autism

Medical treatmentsMedical treatments Secretin (Horvath et al., 1998) Secretin (Horvath et al., 1998) Gluten- and casein-free diets (Kvinsberg, Reichelt, Gluten- and casein-free diets (Kvinsberg, Reichelt,

Nodland, & Hoien, 1996; Whiteley, Rodgers, Nodland, & Hoien, 1996; Whiteley, Rodgers, Savery, & Shattock, 1999) Savery, & Shattock, 1999)

Most widely used behavioral interventions Most widely used behavioral interventions Discrete Trial Training (DTT)Discrete Trial Training (DTT) Floortime TrainingFloortime Training

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Discrete Trial TrainingDiscrete Trial Training

Established by Ivar Lovaas, Ph.D., at UCLA in Established by Ivar Lovaas, Ph.D., at UCLA in the 70s (Lovaas, 1987) the 70s (Lovaas, 1987) 47% recovery rate with in-home implementation 47% recovery rate with in-home implementation

for 40 hrs/wkfor 40 hrs/wk Use of operant conditioningUse of operant conditioning

small unit of instruction usedsmall unit of instruction used stimulus-response-consequence sequence stimulus-response-consequence sequence teaches imitation, discrimination, and to increase teaches imitation, discrimination, and to increase

receptive and expressive language (Smith, 2001)receptive and expressive language (Smith, 2001)

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Floortime TrainingFloortime Training

Developed by Stanley Greenspan Developed by Stanley Greenspan Child-centered developmental modelChild-centered developmental model Acknowledges each child is different Acknowledges each child is different

(Greenspan & Weider, 1998) (Greenspan & Weider, 1998) Relationship-based method of teachingRelationship-based method of teaching Major emphasis on using natural interactionsMajor emphasis on using natural interactions

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Floortime Training ComponentsFloortime Training Components(Greenspan, 1998)(Greenspan, 1998)

Parents do floortime with child to facilitate Parents do floortime with child to facilitate development along milestonesdevelopment along milestones

Professionals (speech, occupation, physical, Professionals (speech, occupation, physical, educators, psychotherapists) address specific educators, psychotherapists) address specific challenges challenges

Parents work on their own responses/styles of Parents work on their own responses/styles of relating to facilitate the child’s developmentrelating to facilitate the child’s development

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Floortime Training GoalsFloortime Training Goals

Encourage attention and intimacyEncourage attention and intimacy

Two-way communicationTwo-way communication

Encourage expression and use of feelings and Encourage expression and use of feelings and ideasideas

Logical thoughtLogical thought

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Floortime Training Parental RoleFloortime Training Parental Role

Find 20-30 min time to give child undivided Find 20-30 min time to give child undivided attention (optimally 6-10x/day)attention (optimally 6-10x/day)

Stay patient and relaxedStay patient and relaxed Empathize child’s emotional toneEmpathize child’s emotional tone Beware of own feelingsBeware of own feelings Monitor own tone of voice and gesturesMonitor own tone of voice and gestures Follow child’s lead and interactFollow child’s lead and interact

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Caveats to TreatmentCaveats to Treatment

Families encounter challenges with Families encounter challenges with implementing the interventions their children implementing the interventions their children require require

Characteristics that relate to a family’s Characteristics that relate to a family’s adherence to treatment (Bruns and Corso, adherence to treatment (Bruns and Corso, 2001)2001) Cultural backgroundCultural background Economic and social status Economic and social status Educational backgroundEducational background

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Caveats to TreatmentCaveats to Treatment(continued)(continued)

Family’s cultural background has substantial Family’s cultural background has substantial influence on the success of their child’sinfluence on the success of their child’s intervention (Van-Biervliet & Parette, 1999)intervention (Van-Biervliet & Parette, 1999)

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Asian/Asian American Families’ Views of Asian/Asian American Families’ Views of Mental DisabilityMental Disability

Traditional Asian American families attributed Traditional Asian American families attributed their child’s disability to supernatural their child’s disability to supernatural influences or sins committed by the child’s influences or sins committed by the child’s ancestors. (Chan, 1997)ancestors. (Chan, 1997)

Strong stigma and shameStrong stigma and shame Embarrassment and disgrace to the family Embarrassment and disgrace to the family

(Uba, 1994)(Uba, 1994)

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Asian/Asian American Families’ Views of Asian/Asian American Families’ Views of Psychological TreatmentPsychological Treatment

More likely underutilize mainstream mental More likely underutilize mainstream mental health services (Matsuoka, 1990b) health services (Matsuoka, 1990b)

Psychological barriers and the incompatibility Psychological barriers and the incompatibility of mental health services (Zhang, Snowden, & of mental health services (Zhang, Snowden, & Sue, 1998) Sue, 1998)

Emphasis on restraining the expression of Emphasis on restraining the expression of strong emotions strong emotions

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Views of Psychological Treatment Views of Psychological Treatment (continued)(continued)

Manifested as somatic complaints Manifested as somatic complaints seek seek treatment from physician insteadtreatment from physician instead

Collectivism vs. Individualism Collectivism vs. Individualism Effects on treatment seeking (Tata & Leong, 1994)Effects on treatment seeking (Tata & Leong, 1994)

Decision-making processDecision-making process Asian American families and opinions of Asian American families and opinions of

professionalsprofessionals Defer important treatment decisions to Defer important treatment decisions to

professionals (Chan, 1997)professionals (Chan, 1997)

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Parenting StyleParenting Style

Focus on interdependence among individuals Focus on interdependence among individuals Hierarchical system (E. Lee, 1997)Hierarchical system (E. Lee, 1997) Authoritarian approachAuthoritarian approach

Controlling, restrictive, and hostile (Lin & Fu, 1990)Controlling, restrictive, and hostile (Lin & Fu, 1990) A way to show concern, care, and involvement A way to show concern, care, and involvement

(Chao, 1994) (Chao, 1994) Immigrant Chinese mothers were more controlling, Immigrant Chinese mothers were more controlling,

placed a greater emphasis on achievement, and placed a greater emphasis on achievement, and promoted interdependence ( Lin & Fu, 1990) promoted interdependence ( Lin & Fu, 1990)

Importance of self-control and academic success Importance of self-control and academic success (McKenry & McKelvey, 1994)(McKenry & McKelvey, 1994)

1616

Coping StylesCoping Styles

Problem-focusedProblem-focusedo Planning or taking action to change the stressful Planning or taking action to change the stressful

situation, e.g., seeking information to become situation, e.g., seeking information to become better informed about their child’s condition and better informed about their child’s condition and more familiar with treatment options more familiar with treatment options

Emotion-focused Emotion-focused o Efforts to contain or regulate his/her feelings Efforts to contain or regulate his/her feelings

about the stressor about the stressor

Lazarus and Folkman (1984)Lazarus and Folkman (1984)

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Coping Styles (Cont’d)Coping Styles (Cont’d)

Major themes in parental adjustment Major themes in parental adjustment (Fisher, 2001) : (Fisher, 2001) :

o The need for normality and certaintyThe need for normality and certaintyo The need for informationThe need for informationo The need for partnership.The need for partnership.

Social stigma (S. Sue, 1993; Sue & Social stigma (S. Sue, 1993; Sue & Morishima, 1982)Morishima, 1982)

o Lack of willingness to seek helpLack of willingness to seek help

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Factors Which May Affect CopingFactors Which May Affect Coping

Acculturation Acculturation Asian American families and opinions of Asian American families and opinions of

professionalsprofessionals Defer important treatment decisions to Defer important treatment decisions to

professionals (Chan, 1997)professionals (Chan, 1997) Education (Parette, Chuang, & Huer, 2004)Education (Parette, Chuang, & Huer, 2004)

Positive outlook toward child’s disabilityPositive outlook toward child’s disability

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Treatment Style PreferenceTreatment Style Preference Views about counseling (Arkoff, Thaver, & Views about counseling (Arkoff, Thaver, &

Elkin 1966) :Elkin 1966) : Directive, paternalistic, and authoritarian Directive, paternalistic, and authoritarian More instructional and structuredMore instructional and structured Favor immediate resolution (Kim, Li, & Liang, Favor immediate resolution (Kim, Li, & Liang,

2002)2002) Treatment adherenceTreatment adherence

Social validitySocial validity Clinician’s competency (Albin et al., 1996; Clinician’s competency (Albin et al., 1996;

Detrich, 1999)Detrich, 1999) Having clear direction of treatment (Arkoff et al., Having clear direction of treatment (Arkoff et al.,

1966; Exum, & Lau, 1988; Ford, 1981; Ho, 1984; 1966; Exum, & Lau, 1988; Ford, 1981; Ho, 1984; Wang, 1994) Wang, 1994)

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RESEARCH OBJECTIVESRESEARCH OBJECTIVES

1.1. Explore how Asian/Asian American parents view, understand, Explore how Asian/Asian American parents view, understand, and cope with their child’s diagnosis of an ASD.and cope with their child’s diagnosis of an ASD.

2.2. Explore the treatments, if any, Asian/Asian American parents Explore the treatments, if any, Asian/Asian American parents tried prior to engaging in Floortime and their experience with tried prior to engaging in Floortime and their experience with these treatments.these treatments.

3.3. Explore how Asian/Asian American parents made the decision to Explore how Asian/Asian American parents made the decision to engage in Floortime and their experience with using the engage in Floortime and their experience with using the technique.technique.

4.4. Identify how Asian/Asian American parents feel they have Identify how Asian/Asian American parents feel they have benefited from Floortime.benefited from Floortime.

5.5. Identify how Asian/Asian American parents feel their Floortime Identify how Asian/Asian American parents feel their Floortime experience could be improved. experience could be improved.

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Overview of MethodologyOverview of Methodology

Research ApproachResearch Approach Phenomenological inquiry approachPhenomenological inquiry approach

Multiple case study methodologyMultiple case study methodology

ParticipantsParticipants Five families with at least one parent who Five families with at least one parent who

identified as Asian/Asian American met study identified as Asian/Asian American met study criteriacriteria

5 of 55 families identified as Asian/Asian American5 of 55 families identified as Asian/Asian American 3 of 5 families participated3 of 5 families participated

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Methodology (Cont’d)Methodology (Cont’d)

InstrumentationInstrumentation Semi-structured interview Semi-structured interview

28 questions:28 questions: DemographicsDemographics Parents’ views, understanding, and coping strategiesParents’ views, understanding, and coping strategies Prior treatmentsPrior treatments Utilization of Floortime and experience with it Utilization of Floortime and experience with it Floortime benefitsFloortime benefits Floortime improvementsFloortime improvements

2323

Methodology (Cont’d)Methodology (Cont’d)

ProceduresProcedures RecruitmentRecruitment

Recruitment brochure Recruitment brochure Obtaining consentObtaining consent Conducting the interviewConducting the interview

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RESULTSRESULTS

Major Themes derived from cross analysis of Major Themes derived from cross analysis of datadata Themes corroborated by all 3 parents:Themes corroborated by all 3 parents:

Denial/minimization commonly used as coping strategyDenial/minimization commonly used as coping strategy Reliance on various methods to face reality of child’s dxReliance on various methods to face reality of child’s dx Seeking additional information via various sourcesSeeking additional information via various sources Used various support systems to help with copingUsed various support systems to help with coping Experienced changes in lifestyle in order to meet child’s Experienced changes in lifestyle in order to meet child’s

needsneeds

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RESULTS (Cont’d)RESULTS (Cont’d)

Themes that were endorsed by 2 of 3 parents:Themes that were endorsed by 2 of 3 parents: Experienced changes in outlook on life & prioritiesExperienced changes in outlook on life & priorities Considered Floortime to be most effective treatmentConsidered Floortime to be most effective treatment Expressed concerns about the adequacy of training Expressed concerns about the adequacy of training

provided for Floortime therapistsprovided for Floortime therapists Suggestion made to establish more specific goalsSuggestion made to establish more specific goals

2626

Clinical ImplicationsClinical Implications

Coping styles of parentsCoping styles of parents Acculturation and education and its role on copingAcculturation and education and its role on coping Shame and social stigma’s role on the process of Shame and social stigma’s role on the process of

accepting and coping with child’s difficultiesaccepting and coping with child’s difficulties Values and beliefs that affected parents’ Values and beliefs that affected parents’

intervention choicesintervention choices Treatment adherence and factors which influence itTreatment adherence and factors which influence it

Social validitySocial validity Views of psychological treatment and style Views of psychological treatment and style

preferencepreference

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Clinical Implications (Cont’d)Clinical Implications (Cont’d)

Themes which emerged for parents who Themes which emerged for parents who favored Floortimefavored Floortime Therapist’s training and competence in FloortimeTherapist’s training and competence in Floortime Integration of more structured interventionsIntegration of more structured interventions

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Direction for Future ResearchDirection for Future Research

Large scale descriptive study Large scale descriptive study Direct assessment of acculturationDirect assessment of acculturation Assessing influence of ethnic-matching of Assessing influence of ethnic-matching of

therapist to familytherapist to family