Thao P. Trinh, M.A. Pepperdine University

1. Asian American Parents’ Subjective Experiences with the Utilization of Floortime Method for Children with Autism: A Preliminary Investigation Thao P. Trinh, M.A. Pepperdine University

2. Prevalence of Autism • Autism Spectrum Disorder (ASD) • One of the fastest growing developmental disorders in the United States (1 in every 166 births; Gibbons, 2005) • With the increase of prevalence, there is increased need for treatment • Individuals with Disabilities Education Act of 1990 • Made it possible for family members to participate in making educational decisions for their special needs children (Parette, VanBiervliet, & Hourcade, 2000)

3. Treatments for Autism • A variety of treatments exist despite lack of empirical evidence of effectiveness • Sensory-motor therapies (Smith, 1996) • Facilitated communication (Green, 1994) • Auditory Integration Training (Stehli, 1991) • Sensory Integration Therapy (Ayres, 1979) • Psychotherapies • Psychoanalysis (Beratis, 1994; Bromfield, 2000) • Holding therapy (Welch, 1988) • Options therapy (Kaufman, 1976)

4. Treatments for Autism • Medical treatments • Secretin (Horvath et al., 1998) • Gluten- and casein-free diets (Kvinsberg, Reichelt, Nodland, & Hoien, 1996; Whiteley, Rodgers, Savery, & Shattock, 1999) • Most widely used behavioral interventions • Discrete Trial Training (DTT) • Floortime Training

5. Discrete Trial Training • Established by Ivar Lovaas, Ph.D., at UCLA in the 70s (Lovaas, 1987) • 47% recovery rate with in-home implementation for 40 hrs/wk • Use of operant conditioning • small unit of instruction used • stimulus-response-consequence sequence • teaches imitation, discrimination, and to increase receptive and expressive language (Smith, 2001)

6. Floortime Training • Developed by Stanley Greenspan • Child-centered developmental model • Acknowledges each child is different (Greenspan & Weider, 1998) • Relationship-based method of teaching • Major emphasis on using natural interactions

7. Floortime Training Components(Greenspan, 1998) • Parents do floortime with child to facilitate development along milestones • Professionals (speech, occupation, physical, educators, psychotherapists) address specific challenges • Parents work on their own responses/styles of relating to facilitate the child’s development

8. Floortime Training Goals • Encourage attention and intimacy • Two-way communication • Encourage expression and use of feelings and ideas • Logical thought

9. Floortime Training Parental Role • Find 20-30 min time to give child undivided attention (optimally 6-10x/day) • Stay patient and relaxed • Empathize child’s emotional tone • Beware of own feelings • Monitor own tone of voice and gestures • Follow child’s lead and interact

10. Caveats to Treatment • Families encounter challenges with implementing the interventions their children require • Characteristics that relate to a family’s adherence to treatment (Bruns and Corso, 2001) • Cultural background • Economic and social status • Educational background

11. Caveats to Treatment(continued) • Family’s cultural background has substantial influence on the success of their child’sintervention (Van-Biervliet & Parette, 1999)

12. Asian/Asian American Families’ Views of Mental Disability • Traditional Asian American families attributed their child’s disability to supernatural influences or sins committed by the child’s ancestors. (Chan, 1997) • Strong stigma and shame • Embarrassment and disgrace to the family (Uba, 1994)

13. Asian/Asian American Families’ Views of Psychological Treatment • More likely underutilize mainstream mental health services (Matsuoka, 1990b) • Psychological barriers and the incompatibility of mental health services (Zhang, Snowden, & Sue, 1998) • Emphasis on restraining the expression of strong emotions

14. Views of Psychological Treatment (continued) • Manifested as somatic complaints  seek treatment from physician instead • Collectivism vs. Individualism • Effects on treatment seeking (Tata & Leong, 1994) • Decision-making process • Asian American families and opinions of professionals • Defer important treatment decisions to professionals (Chan, 1997)

15. Parenting Style • Focus on interdependence among individuals • Hierarchical system (E. Lee, 1997) • Authoritarian approach • Controlling, restrictive, and hostile (Lin & Fu, 1990) • A way to show concern, care, and involvement (Chao, 1994) • Immigrant Chinese mothers were more controlling, placed a greater emphasis on achievement, and promoted interdependence ( Lin & Fu, 1990) • Importance of self-control and academic success (McKenry & McKelvey, 1994)

16. Coping Styles • Problem-focused • Planning or taking action to change the stressful situation, e.g., seeking information to become better informed about their child’s condition and more familiar with treatment options • Emotion-focused • Efforts to contain or regulate his/her feelings about the stressor Lazarus and Folkman (1984)

17. Coping Styles (Cont’d) • Major themes in parental adjustment (Fisher, 2001) : • The need for normality and certainty • The need for information • The need for partnership. • Social stigma (S. Sue, 1993; Sue & Morishima, 1982) • Lack of willingness to seek help

18. Factors Which May Affect Coping • Acculturation • Asian American families and opinions of professionals • Defer important treatment decisions to professionals (Chan, 1997) • Education (Parette, Chuang, & Huer, 2004) • Positive outlook toward child’s disability

19. Treatment Style Preference • Views about counseling (Arkoff, Thaver, & Elkin 1966) : • Directive, paternalistic, and authoritarian • More instructional and structured • Favor immediate resolution (Kim, Li, & Liang, 2002) • Treatment adherence • Social validity • Clinician’s competency (Albin et al., 1996; Detrich, 1999) • Having clear direction of treatment (Arkoff et al., 1966; Exum, & Lau, 1988; Ford, 1981; Ho, 1984; Wang, 1994)

20. RESEARCH OBJECTIVES • Explore how Asian/Asian American parents view, understand, and cope with their child’s diagnosis of an ASD. • Explore the treatments, if any, Asian/Asian American parents tried prior to engaging in Floortime and their experience with these treatments. • Explore how Asian/Asian American parents made the decision to engage in Floortime and their experience with using the technique. • Identify how Asian/Asian American parents feel they have benefited from Floortime. • Identify how Asian/Asian American parents feel their Floortime experience could be improved.

21. Overview of Methodology • Research Approach • Phenomenological inquiry approach • Multiple case study methodology • Participants • Five families with at least one parent who identified as Asian/Asian American met study criteria • 5 of 55 families identified as Asian/Asian American • 3 of 5 families participated

22. Methodology (Cont’d) • Instrumentation • Semi-structured interview • 28 questions: • Demographics • Parents’ views, understanding, and coping strategies • Prior treatments • Utilization of Floortime and experience with it • Floortime benefits • Floortime improvements

23. Methodology (Cont’d) • Procedures • Recruitment • Recruitment brochure • Obtaining consent • Conducting the interview

24. RESULTS • Major Themes derived from cross analysis of data • Themes corroborated by all 3 parents: • Denial/minimization commonly used as coping strategy • Reliance on various methods to face reality of child’s dx • Seeking additional information via various sources • Used various support systems to help with coping • Experienced changes in lifestyle in order to meet child’s needs

25. RESULTS (Cont’d) • Themes that were endorsed by 2 of 3 parents: • Experienced changes in outlook on life & priorities • Considered Floortime to be most effective treatment • Expressed concerns about the adequacy of training provided for Floortime therapists • Suggestion made to establish more specific goals

26. Clinical Implications • Coping styles of parents • Acculturation and education and its role on coping • Shame and social stigma’s role on the process of accepting and coping with child’s difficulties • Values and beliefs that affected parents’ intervention choices • Treatment adherence and factors which influence it • Social validity • Views of psychological treatment and style preference

27. Clinical Implications (Cont’d) • Themes which emerged for parents who favored Floortime • Therapist’s training and competence in Floortime • Integration of more structured interventions

28. Direction for Future Research • Large scale descriptive study • Direct assessment of acculturation • Assessing influence of ethnic-matching of therapist to family