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Many experts agree that people with autism, while they're very different from one another, share "core deficits." These include difficulties with social and communication skills and emotional engagement. Of course, many autistic people also have other difficulties ranging from sensory disorders to motor issues, but because these difficulties are not shared across the spectrum they are not considered "core" deficits.

Traditional therapies, such as speech, physical and occupational therapy, address specific areas of need which are generally NOT considered "core" concerns. Behavioral therapy, such as ABA, is intended to address outward behaviors and to teach concrete skills.

Pharmaceutical and/or biomedical intervention treats physical differences which may underlie core deficits.

Developmental therapies are intended to directly addresses autism's core deficits. To achieve this goal, they recommend that therapists and parents work with the child's own interests or actions to slowly build engagement, interaction, communication, affection, and then specific skills such as logical reasoning, symbolic thinking and more. [Note: developmental therapy is generally first recommended for very young children, but the techniques are applicable through adulthood.]

Most practitioners of developmental therapy recommend that treatment for autism should also include additional therapies as necessary, including speech, PT and OT. Some are also advocates of biomedical interventions -- while others, generally those from more traditional medical backgrounds, recommend against biomedical therapies.

It's important to note that developmental therapies are extremely child-oriented, which means that there is no one-size-fits-all approach. In addition, they demand a great deal from parents. Developers of these therapies see the family as the key to an autistic child's development, and they want to see parents take on the lion's share of actual, day to day intervention. But because there is no specific curriculum or single "approved" approach (after all, each child is unique), parents are called upon to be very creative, engaged and energetic -- and must be willing and able to become a therapist to their own child.

When a parent is personally and financially available, developmental therapy can be terrific. Speaking from my own experience with Floortime, I can say that therapeutic play can be fun, exciting and fulfilling. But there is a danger that parents who take on developmental therapy in their own home can become exhausted, overwhelmed, and even guilt-ridden. This is especially the case when, as so often happens, mothers leave their careers to care for their autistic child -- and find that they may not be cut out to be fultime therapists to their own offspring!

Of course, help is available -- but very little of that help is supported financially through insurance. And while it's possible to convince a school district to provide developmental therapy for a preschooler, it is a gargantuan task to push a district into individualized developmental programming as a child moves into elementary school.

Unlike behavioral therapies, developmental therapies are relatively new -- and relatively poorly researched. While there is evidence that developmental approaches can be effective, no one has actually compared developmental therapies head to head. And there is very little research comparing the relative outcomes of developmental versus behavioral therapies. It may be the case that the outcomes depend largely upon (a) the child's constellation of issues, deficits and strengths and (b) the parent's ability to provide a great deal of high quality engagement.

All this said, however, developmental therapies have several great advantages.

First, their impact is almost instantly obvious. After just one or two sessions, parents see that their child really CAN engage with them, even if on a very simple level -- and that engagement is inspirational.

Second, if you have the inclination, it is possible to do a creditable job of developmental therapy in your own home for very little money (just invest in a book and set of videos).

Third, if you enjoy pretend play, developmental therapy can be a lot of fun.

Fourth, again, if you enjoy the process, developmental therapy can be a terrific way to build a relationship with your child with autism.

It's really impossible to injure a child through developmental therapy; the worst that happens is that nothing really comes of it!

While there are quite a few variations on "play therapy" available, there are really only three well-known developmental therapies available. The differences among them are more related to style and approach than to content.

Floortime/DIR was developed by Dr. Stanley Greenspan and associates. Its basic premise is that autistic individuals learn to communicate when they are engaged at their own level, and by things that interest them. Whether a child is lining up cars, flapping their hands or reading Harry Potter, there is a way to connect.

As the therapist begins to establish a relationship with the child, the child begins to respond -- whether verbally or non-verbally. Over time, the child starts to open and close "circles of communication" -- at first by knocking the parent's hand away, or by leading the parent to a favored toy that's out of reach; later through words and multiple exchanges.

Pros: By reading the book "The Child with Special Needs" or "Engaging Autism," most parents can begin to use use floortime on their own. Other free and low-cost resources include floortime videos and listservs.

Cons: It is tough to be a floortime parent. It requires a lot of patience, imagination, and stamina. In addition, since there is very little in the way of specific direction (each child is different) it can be hard to know if you're doing it right. There are floortime trained therapists, but they're tough to find -- and expensive when you find them. And Greenspan and associates recommend hours of therapy a day -- difficult to achieve if you're working, coping with several children, or otherwise engaged in life!

RDI(Relationship Development Intervention)

RDI is similar to floortime in that addresses "core deficits" through individualized therapy -- and the parent is the primary therapist. Some of the most important differences appear to be the level of support and clarity of direction provided by the RDI organization. Dr. Steven Gutstein, creator of RDI, has established a formal organization which trains consultants. Consultants work with parents to evaluate children and create personalized therapeutic programs. They also put together concrete benchmarks, so that parents know they have reached their goals.

Pros: The RDI organization offers books, consultants, and even products to support parents in their therapeutic efforts. Clear guidelines provide a sense of direction and a feeling of accomplishment for hard-working parent therapists. RDI is flexible enough to meet the needs of autistic children across the spectrum.

Cons: Like floortime, RDI is very demanding. Unlike floortime, RDI is likely to be extremely expensive. Parents are encouraged to attend multi-day training programs, hire pricey consultants, and purchase expensive products sold on the RDI website

Son-Rise

The therapeutic concept behind Son-Rise is very similar to that of Floortime: parents become therapists, and engage with their child at their child's own level of interest. Over time, relationships and skills emerge. Some of the key differences include a tremendous focus on the idea of the family as the key to success, and love and respect as the tools for success. There is also a focus on the home as the source of security and the foundation for growth. In practice, this translates into a series of on-site workshops for parents and children, followed by a very unusual lifestyle in which parents (or one parent) is homebound for a very protracted period of time.

Son-Rise does recommend that families recruit volunteers to work with their children in the home.

Pros: For families seeking a sense of community and empowerment, Son-Rise offers all of that and more. It also makes use of many of the same developmental approaches as Floortime and RDI to help children with autism to engage and communicate.

Cons: Son-Rise is expensive, and of all of the developmental therapies it is the most demanding. Even more than RDI, it places the family at the center of the therapeutic approach. For families with limited time or money, Son-Rise can become quite overwhelming. It also seems to be the case that Son-Rise families are extremely dedicated to the therapy and the organization -- which, depending upon your own inclinations, can be a plus or a minus.

Updated: July 29, 2006

Lisa Jo Rudy is a veteran science writer and author of dozens of articles and educational materials for organizations including the National Geographic Society and the National Science Foundation. As the mother of a boy with autism, she is also an active member of the autism community.

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