Autism and Applied Behavior Analysis
by Dr. Alan Kadish NMD
First, let me encourage you to read the whole article published by Autism Speaks. They are an awesome resource and their article describing ABA therapy is very much on the mark.
I encourage this form of therapy as in the 30+ years I continue to see changes in our ASD/PPD patients that totally amaze and often times delights. Hence, my endorsement.
The therapy is not a sole means of addressing autism but rather one of the necessary therapies that when combined with the biomedical approach, time and again rank as some of the highest responding means of treatment for our autistic and PDD patients.
There is also a free toolkit that I encourage you to use.
Applied Behavior Analysis (ABA)
Behavior analysis is a scientifically validated approach to understanding behavior and how it is affected by the environment. In this context, “behavior” refers to actions and skills. “Environment” includes any influence – physical or social – that might change or be changed by one’s behavior.
On a practical level, the principles and methods of behavior analysis have helped many different kinds of learners acquire many different skills – from healthier lifestyles to the mastery of a new language. Since the 1960s, therapists have been applying behavior analysis to help children with autism and related developmental disorders.
Autism Speaks Autism Treatment Network (ATN) now has a toolkit to help parents work with their children’s applied behavior analysts. (Learn more and download it here.) Although the toolkit was developed with children and teens in mind, it also contains helpful information for those wanting to better understand and support ABA therapy, for an adult with autism.
What is Applied Behavior Analysis?
Behavior analysis focuses on the principles that explain how learning takes place. Positive reinforcement is one such principle. When a behavior is followed by some sort of reward, the behavior is more likely to be repeated. Through decades of research, the field of behavior analysis has developed many techniques for increasing useful behaviors and reducing those that may cause harm or interfere with learning.
Applied behavior analysis (ABA) is the use of these techniques and principles to bring about meaningful and positive change in behavior.
As mentioned, behavior analysts began working with young children with autism and related disorders in the 1960s. Early techniques often involved adults directing most of the instruction. Some allowed the child to take the lead. Since that time, a wide variety of ABA techniques have been developed for building useful skills in learners with autism – from toddlers through adulthood.
These techniques can be used in structured situations such as a classroom lesson as well as in “everyday” situations such as family dinnertime or the neighborhood playground. Some ABA therapy sessions involve one-on-one interaction between the behavior analyst and the participant. Group instruction can likewise prove useful.
Today, ABA is widely recognized as a safe and effective treatment for autism. It has been endorsed by a number of state and federal agencies, including the U.S. Surgeon General and the New York State Department of Health. Over the last decade, the nation has seen a particularly dramatic increase in the use of ABA to help persons with autism live happy and productive lives. In particular, ABA principles and techniques can foster basic skills such as looking, listening and imitating, as well as complex skills such as reading, conversing, and understanding another person’s perspective.
More information about behavior analysis and ABA is available at the websites of the Association of Professional Behavior Analysts, the Association for Behavior Analysis International and the Behavior Analyst Certification Board.
What Does Research Tell Us About ABA and Autism?
Autism Speaks has funded and continues to fund research on developing and validating ABA techniques. You can explore these research grants here.
A number of completed studies have demonstrated that ABA techniques can produce improvements in communication, social relationships, play, self care, school and employment. These studies involved age groups ranging from preschoolers to adults. Results for all age groups showed that ABA increased participation in family and community activities.
A number of peer-reviewed studies have examined the potential benefits of combining multiple ABA techniques into comprehensive, individualized and intensive early intervention programs for children with autism. “Comprehensive” refers to interventions that address a full range of life skills, from communication and sociability to self-care and readiness for school. “Early intervention” refers to programs designed to begin before age 4. “Intensive” refers to programs that total 25 to 40 hours per week for 1 to 3 years.
These programs allow children to learn and practice skills in both structured and unstructured situations. The “intensity” of these programs may be particularly important to replicate the thousands of interactions that typical toddlers experience each day while interacting with their parents and peers.
Such studies have demonstrated that many children with autism experience significant improvements in learning, reasoning, communication and adaptability when they participate in high-quality ABA programs. Some preschoolers who participate in early intensive ABA for two or more years acquire sufficient skills to participate in regular classrooms with little or no additional support. Other children learn many important skills, but still need additional educational support to succeed in a classroom.
Across studies, a small percentage of children show relatively little improvement. More research is needed to determine why some children with autism respond more favorably to early intensive ABA than others do. Currently, it remains difficult to predict the extent to which a particular child will benefit.
In some studies, researchers compared intensive ABA with less intensive ABA and/or other early intervention or special education programs for children with autism. Generally, they found that children who receive intensive ABA treatment make larger improvements in more skill areas than do children who participate in other interventions. In addition, the parents of the children who receive intensive ABA report greater reductions in daily stress than do parents whose children receive other treatments.
ABA and Adults with Autism
A number of recent studies confirm that ABA techniques are effective for building important life skills in teens and adults with autism. Many comprehensive autism support programs for adults employ and combine ABA techniques to help individuals transition successfully into independent living and employment. However, the benefits of intensive ABA programs remain far less studied in teens and adults than they have been with young children. This is a research area of particular interest to Autism Speaks and its supporters.
What Does ABA Intervention Involve?
Effective ABA intervention for autism is not a “one size fits all” approach and should never be viewed as a “canned” set of programs or drills. On the contrary, a skilled therapist customizes the intervention to each learner’s skills, needs, interests, preferences, and family situation. For these reasons, an ABA program for one learner will look different than a program for another learner. That said, quality ABA programs for learners with autism have the following in common:
Planning and Ongoing Assessment
* A qualified and trained behavior analyst designs and directly oversees the intervention.
* The analyst’s development of treatment goals stems from a detailed assessment of each learner’s skills and preferences and may also include family goals.
* Treatment goals and instruction are developmentally appropriate and target a broad range of skill areas such as communication, sociability, self-care, play and leisure, motor development and academic skills.
* Goals emphasize skills that will enable learners to become independent and successful in both the short and long terms.
* The instruction plan breaks down desired skills into manageable steps to be taught from the simplest (e.g. imitating single sounds) to the more complex (e.g. carrying on a conversation).
* The intervention involves ongoing objective measurement of the learner’s progress.
* The behavior analyst frequently reviews information on the learner’s progress and uses this to adjust procedures and goals as needed.
* The analyst meets regularly with family members and program staff to plan ahead, review progress and make adjustments as needed.
ABA Techniques and Philosophy
* The instructor uses a variety of behavior analytic procedures, some of which are directed by the instructor and others initiated by the learner.
* Parents and/or other family members and caregivers receive training so they can support learning and skill practice throughout the day.
* The learner’s day is structured to provide many opportunities – both planned and naturally occurring – to acquire and practice skills in both structured and unstructured situations.
* The learner receives an abundance of positive reinforcement for demonstrating useful skills and socially appropriate behaviors. The emphasis is on positive social interactions and enjoyable learning.
* The learner receives no reinforcement for behaviors that pose harm or prevent learning.
What Kind of Progress Can Be Expected with ABA?
Competently delivered ABA intervention can help learners with autism make meaningful changes in many areas. However, changes do not typically occur quickly. Rather, most learners require intensive and ongoing instruction that builds on their step-by-step progress. Moreover, the rate of progress – like the goals of intervention – varies considerably from person to person depending on age, level of functioning, family goals and other factors.
Some learners do acquire skills quickly. But typically, this rapid progress happens in just one or two particular skill areas such as reading, while much more instruction and practice is needed to master another skill area such as interacting with peers.
Who Is Qualified to Provide ABA Intervention?
Just as a medical treatment program should be directed by a qualified medical professional, ABA programs for learners with autism should be designed and supervised by qualified professionals, which include either licensed clinical psychologists with training in applied behavior analysis or behavior analysts, who are board certified with supervised experience providing ABA treatment for autism or who can clearly document that they have equivalent training and experience.
Because of the huge demand for ABA intervention for autism, many individuals and programs now claim to provide ABA. Some are private practitioners or agencies that offer services in a family’s home. Others operate private schools. And still others provide consultation services to public schools.
Unfortunately, some who claim to offer ABA lack the field’s established minimum requirements in education and practical experience. Family members, teachers and others involved in developing an individual’s therapy and support program should keep the following in mind when choosing an ABA program or practitioner:
Always check credentials of those who claim to be qualified in behavior analysis. For example, for licensed clinical psychologists, you should inquire about the level of training in behavioral interventions for autism, including training in applied behavior analysis. For behavior analysts, you should determine whether the person has been credentialed with the Behavior Analyst Certification Board or the Association of Professional Behavior Analysts. These professionals often supervise other people, including paraprofessionals, who will be working directly with your child. Thus, it is important that you feel confident that the licensed clinical psychologist or behavior analyst is providing regular supervision to anyone working directly with your child.
Parents, guardians and other caregivers should monitor the program by observing sessions and participating in training sessions and consultations.