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Asian American Parents' Experiences with Floortime for Autism

Explore how Asian American parents utilize Floortime method in managing Autism in children, challenges faced, and cultural impacts. Discusses treatments, parental role, and coping strategies.

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Asian American Parents' Experiences with Floortime for Autism

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  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

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