The FirstSteps Treatment Program is based in the scientifically validated principles of Applied Behavior Analysis (ABA). Because there are many misconceptions about the field of ABA, this section will help elucidate what ABA is by including a review of ABA terminology, a brief history of the approach, and the relevant teaching procedures used.
Applied Behavior Analysis: Easy As A-B-C
Behavior refers to the whole range of measurable activities of a living animal. In simple terms, behavior refers to everything people do and say, be it saying, “Hello,” upon seeing a friend, asking for some “water,” or jumping on the bed. Behavior analysis is a science concerned with the behavior of people, attempting to identify, explain, and predict behavior. Behavior analysis includes observations of the environment in which a behavior occurs, and describes factors associated with a behavior, including what factors are present prior to (antecedents) and following (consequences) a behavior.
Applied Behavior Analysis (ABA) is the use of behavior analytic (learning) methods, as validated by scientific research, to change socially important behavior in meaningful ways. These “socially important behaviors” may include communication and language, social skills, and adaptive behavior such as eating and toileting. The field of ABA is broad, addressing socially important behaviors across a wide range of people and settings. While most recognizable in the treatment of children with developmental disabilities, the science of ABA is regularly used to improve performance in a variety of fields, such as education, organization and business management, and sports.
The critical factor in any ABA program is the application of behavior analytic principles, including identification and modification of the Antecedents (A) preceding a behavior, and the Consequences (C) following a behavior, to affect change in the Behavior (B).
In sum, preferred consequences (or “reinforcers”) are used to increase new, appropriate skills, such as communication and language, social skills, and self-care, while no reinforcement is given for the occurrence of inappropriate behaviors, thereby reducing their frequency in the future.
History Of The Approach
For the last 35 years, ABA has been at the forefront of treatment options for people with developmental disabilities, with researchers publishing hundreds of peer-reviewed studies demonstrating the efficacy of the approach.
While the science of ABA was first applied as a treatment for Autism as early as the 1960s, it was not until the publication of Ivar Lovaas’ 1987 study that the approach gained recognition from the general public.
In this seminal study, Lovaas compared three groups of young children with Autism, all under the age of 46 months at intake. A high-intensity treatment group consisted of 19 children who received 40 hours per week of 1:1 (one child : one instructor) ABA intervention from the Lovaas staff for approximately three years. The first control group also consisted of 19 children who received ABA intervention. However, these children only received an average of 10 hours per week of 1:1 ABA intervention for an average of three years. A second control group received a similar level of intervention as Control Group 1 (approximately 10 hours per week of intervention); however, treatment was conducted by an outside provider.
Results from the Lovaas study indicated that the children receiving intensive 40 hour per week of 1:1 behavioral intervention did substantially better than those children only receiving 10 hours per week or less of intervention regardless of the treatment type. Specifically, 47% of those in the high-intensity treatment group achieved “normal” functioning, as defined as scoring within the normal ranges of intellectual functioning on standardized IQ tests, typical school placement in a general education first grade classroom without assistance, and being described as indistinguishable from their peers. In contrast, just 2% of the low intensity groups (10 hours or less per week) achieved normal cognitive functioning and attended mainstream placements, while 45% required language impaired classes for mentally disabled children, and 53% were placed in Autistic / severely mentally handicapped classrooms following treatment. This study demonstrated that both method and intensity of treatment are crucial to outcome.
Following the publication of Lovaas’ study, treatment programs based on the principles of ABA increased exponentially, as did the research. Numerous studies continue to support the efficacy of ABA as a treatment for individuals with developmental disabilities.
Evolution of the Approach
When ABA first gained prominence in the treatment of developmental disabilities, most providers utilized discrete trials to teach new skills. Commonly referred to as Discrete Trial Training (DTT), this teaching method consists of rapidly and repeatedly presenting teaching trials with a discrete beginning and end to maximize learning.
DTT is a powerful teaching tool, often resulting in rapid acquisition of new skills, and is widely used in ABA programs. However, DTT is generally adult-directed, and does not always consider the child's individual strengths and preferences. Further, because of a sometimes artificial set-up and high rate of repetition, new skills may not generalize to non-teaching environments and have been reported to appear "rote." Because of these issues, researchers continue assessing effective teaching methods.
State of the art ABA programs are now comprised of a variety of empirically validated teaching tools, with DTT being just one of the many tools at our disposal.
Natural Environment Training (NET) and Incidental Teaching represent other effective means of utilizing behavior analytic principles to teach new skills. In NET, rather than selecting a target skill and presenting repeated learning opportunities in discrete trials, the instructor may seize the child's current motivation, or create motivation, to teach a new skill. For example, when teaching a child to name animals, rather than setting up a series of formal trials with flashcards, the instructor might observe the child approaching a pile of stuffed animals and use these for a teaching session. NET is still behavioral, because preferred consequences are used to reinforce new skills. NET can also be a powerful teaching tool, because reinforcement is built-in to the activity. However, it is not always easy to identify current motivation or to create motivation for a necessary skill. For this reason, ABA programs often utilize a mixture of DTT and NET approaches.
Approaches To Behavior Management
Safe and effective interventions for reducing problem behavior have been the focus of hundreds of studies over the last few decades, and researchers have identified a number of best practices. Procedures for reducing challenging behaviors, such as aggressive and disruptive behaviors, generally include systems for not reinforcing the problem behaviors while teaching alternative behaviors. Functional Assessment refers to procedures used to gather information about a behavior, its antecedents, and its consequences, in order to develop a hypothesis of what is reinforcing or maintaining the behavior. State of the art behavioral programs include functional assessments as a means of defining behavior problems and developing appropriate behavior intervention plans.