As a parent seeking treatment for your child with Autism, you’ve no doubt heard about ABA (applied behavior analysis). While most recently popularized by and commonly thought of as an “Autism treatment,” you might be interested to learn that ABA therapy has a long history (dating back as early as the late 19th century) and a wide application to a variety of areas – everything from education, to sports, to business. So, let’s take a look…what really is ABA?
Perhaps the easiest way to understand ABA is to break down the terms…
- Applied – When we say “applied,” we are referring to the fact that all treatment is applied to real-life, important, socially significant behaviors. For example, when working with young children with ASD, what makes treatment applied is focusing on the skills that are important for daily life – things like communication, social skills, self-care, play and leisure skills, and so on. ABA in business might be applied to skills such as leadership and team management, while ABA in in public health might be applied to increasing healthy food choices. Whenever you see ABA, you can be sure it’s focusing on addressing real-life behavior that is of social significance.
- Behavior – ABA is one of a variety of treatments rooted in behavioral / learning theory (based on the early work of behaviorists such as Pavlov, Thorndike, Watson, and Skinner). What sets ABA apart from other treatments though is the sole focus on behavior, or that the focus of treatment is on one’s actual behavior (rather than one’s thoughts or feelings, as may be seen with Cognitive-Behavior Therapy [CBT] or other “talk therapies”). With behavior, we are solely looking at what is observable and measurable. For example, let’s say we are helping a child increase his attention during group learning in class. We can’t really know whether someone is paying attention or not, but we can observe certain related behaviors, such as raising one’s hand, answering questions, following specific group instructions, and so on. In this case, with the objective of increasing attention, ABA may focus on increasing these specific types of behaviors. So, with ABA…the behavior is the thing!
- Analysis – Perhaps the most unique element of ABA is the analysis portion, which is a crucial component that makes it so effective. An essential part of any ABA intervention is the collection and analysis of data on the socially significant behavior(s) in question before treatment starts (what is called “baseline”), and then on-going once treatment begins. It is the analysis of this data that allows behavior analysts to see in real-time whether an intervention is working, and if not, to make immediate changes to the treatment plan. Hence the effectiveness of ABA!
How Does ABA Therapy Work?
As mentioned above, ABA can really be applied to almost any area – or behavior – in life (as long as it’s socially significant!). Regardless of whether a behavior analyst is partnering with a physician to treat pediatric feeding disorders, is developing a personalized plan to increase physical fitness, or is developing a comprehensive treatment plan for a child with ASD, all ABA treatment will be grounded in basic behavioral principles.
It’s all about the ABCs…
In its simplest form, behavior analysts look to see how behavior interacts with the environment, and then looks to make changes to the environment that will lead to meaningful change in the behavior. We can break this environmental analysis down to the “A-B-Cs.”
- A – Antecedent. Essentially anything in the environment prior to the behavior. For example, a question, a verbal cue, a sign, a pamphlet, some event, etc. that could cue someone to engage in a particular response.
- B – Behavior. You got this! (See above)
- C – Consequence. Anything that follows the behavior. Some consequences can cause behaviors to become more likely / frequent in the future…if things work out for us we tend to do them again! We call these kind of consequences “reinforcers.” Some consequences don’t lead to increases in behavior or may even lead to decreases. This is called “extinction.”
While there is considerably more detail and nuance beyond the scope of this introduction, at its heart, all ABA treatment will include observation and assessment of behavior occurring in its natural environment, a determination of what the current maintaining antecedent and consequences are, and plan for making changes to these environmental factors that lead to meaningful behavior change.
ABA Treatment for ASD
As summarized by the Association for Science in Autism Treatment (ASAT), based on hundreds of studies published over the past several decades, the preponderance of research supports interventions-based ABA as effective in treating ASD. However, how this treatment looks in practice has changed dramatically over the years and continues to evolve to this day. Furthermore, its approach may vary from provider to provider, as different providers might have different areas of specialization and focus.
Many erroneously think the terms “Lovaas” and “ABA” to be synonymous. While Lovaas, a former professor at UCLA and psychologist, no doubt increased public awareness of ABA through his seminal 1987 study, he did not “invent” ABA. Rather, Lovaas was the first to demonstrate that ABA therapy applied at an intensive dosage (40-hours per week) could lead to tremendous learning gains in children with ASD.
Since that time, ABA treatment for ASD has been in a constant state of evolution. What once may have been thought to look like “rote” learning in the more structured “discrete trial training” (DTT) model in the original Lovaas study, has given way to more functional and naturalistic models. For example, “natural environment training” (NET) and the “verbal behavior” model based on Skinner’s analysis of verbal behavior, where treatment is embedded within the context of play and other daily life activities.
Regardless of the specific behavioral procedures being used, all effective ABA providers will collaborate with you and your child to identify their specific core symptoms and goals for intervention (or more specifically – What behaviors would your child benefit by increasing? What behaviors would your child benefit by decreasing [those that are a barrier to learning and enjoying life]?). Common learning goals may include communication skills, play and leisure skills, social skills and friendship development, self-help and daily living skills, preparation for school, community skills, etc. Common behaviors to decrease may include aggression, self-injury, and the like.
As a valuable resource on ABA intervention for ASD, check out the Council of Autism Service Provider’s ABA ASD Practice Guidelines
ABA Dosage
Depending on your child’s age and needs, ABA treatment delivery may vary between what is considered “early intensive behavioral intervention” (EIBI) to more “focused” ABA.
A considerable body of research supports the efficacy of the EIBI model, where children, generally between the ages of two and four, receive intensive and comprehensive ABA treatment for 25-40 hours per week, generally for 2-4 years. In practice, this model can be delivered in the natural environment of the family home, in the fun environment of an ABA center, or some combination of both, allowing the child to practice skills where they are needed most. For example, in home-based services, the child gains practical experience learning to communicate effectively with their family, play with their siblings, and take care of their own grooming, while in the center they can practice participating in group-based learning, interacting with peers, and following instructions.
For older children, focused ABA programs select one or two specific goals to address in a smaller weekly intensity (generally around 10 hours per week). Such programs are called “focused” because they are just that – focusing specifically on barrier-to-learning behaviors, and/or a specific skill-building goal or two. A 10-hour program would not afford sufficient time to address a comprehensive treatment plan with goals across all areas of development.
Finding an ABA Provider
First and foremost, you will want to ensure that your ABA provider is a Board Certified Behavior Analyst (BCBA). Unfortunately, there currently is no license for ABA in California, so many people without the appropriate training, experience, or expertise can hang their shingle and say they “do ABA.” At a bare minimum, you will want to ensure your provider is certified by the Behavior Analyst Certification Board.
With that as a starting place, then you will then want to consider that all ABA providers may have a slightly different approach. Parents will want to find a provider whose values and approach best match their family and goals. One great place to start is the Council of Autism Service Providers (CASP).
And finally, going back to considering the broad spectrum that is ASD, you will also want to ensure a provider has programming for all ends of the spectrum – from programs to help establish functional communication and speech, to those that teach imaginary play, perspective taking, and executive functioning skills. The good news is if you’re here, you’ve found one such provider! To find information on your local FirstSteps services, click here
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