Applied behavior analysis (ABA) is a scientific discipline concerned with developing techniques based on the principles of learning and applying these to change behavior of social significance. ABA tries to change behavior by first assessing the functional relationship between a targeted behavior and the environment. This approach often seeks to develop constructive, socially acceptable behaviors to replace the aberrant behaviors.
ABA-based techniques are often used to change behaviors associated with autism, so much so that ABA itself is often mistakenly considered to be synonymous with therapy for autism. ABA for autism may be limited by diagnostic severity and IQ.
Applied Behavior Analysis (ABA) focuses on improving specific behaviors, such as social skills, communication, reading, and academics as well as adaptive learning skills, such as fine motor dexterity, hygiene, grooming, domestic capabilities, punctuality, and job competence. ABA is effective for children and adults with psychological disorders in a variety of settings, including schools, workplaces, homes, and clinics. It has also been shown that consistent ABA can significantly improve behaviors and skills and decrease the need for special services.
A 2007 clinical report of the American Academy of Pediatrics concluded that the benefit of ABA-based interventions in autism spectrum disorders (ASDs) “has been well documented” and that “children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior”
ABA methods are used to support persons with autism in at least six ways:
- to increase behaviors (eg reinforcement procedures increase on-task behavior, or social interactions);
- to teach new skills (eg, systematic instruction and reinforcement procedures teach functional life skills, communication skills, or social skills);
- to maintain behaviors (eg, teaching self control and self-monitoring procedures to maintain and generalize job-related social skills);
- to generalize or to transfer behavior from one situation or response to another (eg, from completing assignments in the resource room to performing as well in the mainstream classroom);
- to restrict or narrow conditions under which interfering behaviors occur (eg, modifying the learning environment); and
- to reduce interfering behaviors (eg, self injury or stereotypy).
When working with an ABA therapist, you will:
1) Determine which behaviors require change
2) Set goals and expected outcomes
3) Establish ways to measure changes and improvements
4) Evaluate where you are now
5) Learn new skills and/or learn how to avoid negative behaviors
6) Regularly review your progress
7) Decide whether or not further behavior modification is necessary
The length of time spent in ABA depends on the severity of the problem and individual rate of improvement.
Discrete Trial Learning (Training) is based on the understanding that practice helps a child master a skill. It is a structured therapy that uses a one-to-one teaching method and involves intensive learning of specific behaviors. This intensive learning of a specific behavior is called a “drill.” Drills help learning because they involve repetition. The child completes a task many times in the same manner (usually 5 or more). This repetition is especially important for children who may need a great deal of practice to master a skill. Repetition also helps to strengthen long-term memory. Specific behaviors (eye contact, focused attention and facial expression learning) are broken down into its simplest forms, and then systematically prompted or guided. Children receive positive reinforcement (for example: high-fives, verbal praise, and tokens that can be exchanged for toys) for producing these behaviors. For example, a therapist and a child are seated at a table and the therapist prompts the child to pay attention to her by saying “look at me.” The child looks up at the therapist and the therapist rewards the child with a high-five.
Incidental Teaching (or Natural Environment Training) is based on the understanding that it is important to give real-life meaning to skills a child is learning. It includes a focus on teaching skills in settings where your child will naturally use them. In Incidental Teaching, the teacher or therapist utilizes naturally occurring opportunities in order to help the child learn language. The activity or situation is chosen by the child, and the caregiver or teacher follows the child’s lead or interest. For example, a child is playing on the swings and needs the therapist to push him so that he can swing higher. The therapist waits on the child to ask for a push. Only after the child asks does the therapist push the swing. The therapist waits for the child to ask each time before he/she pushes the child again.
Verbal Behavior is similar to discrete trial training in that it is a structured, intensive one-to-one therapy. It differs from discrete trial training in that it is designed to motivate a child to learn language by developing a connection between a word and its meaning. (E.g. What is this? A cup. What do you use a cup for? Drinking. What do you drink out of? A cup.)
Pivotal Response Training is an intervention that relies on naturally occurring teaching opportunities and consequences. The focus of PRT is to increase motivation by adding components such as turn-taking, reinforcing attempts, child-choice, and interspersing maintenance (pre-learned) tasks. Four pivotal areas have been identified: (a) motivation, (b) child self-initiations, (c) self management, and (d) responsiveness to multiple cues.
Natural Language Paradigm (NLP) is based on the understanding that learning can be helped by deliberate arrangement of the environment in order to increase opportunities to use language. It uses natural reinforcers that are consequences related directly to the behavior, and it encourages skill generalization. For example, a child who is allowed to leave after being prompted to say “goodbye” has a greater likelihood of using and generalizing this word when compared with a child who receives a tangible item for repeating this word. NLP transfers instruction from the therapy room to the child’s everyday environment with the interest of the child serving as the starting point for intervention
Positive Research Favoring ABA Therapy for Autism
Researchers from the MIND Institute published an evidence-based review of comprehensive treatment approaches in 2008. On the basis of “the strength of the findings from the four best-designed, controlled studies”, they were of the opinion that one ABA-based approach (the Lovaas technique created by Ole Ivar Løvaas) is “well-established” for improving intellectual performance of young children with ASD.
A 2009 review of psycho-educational interventions for children with autism whose mean age was six years or less at intake found that five high-quality (“Level 1” or “Level 2”) studies assessed ABA-based treatments. On the basis of these and other studies, the author concluded that ABA is “well-established” and is “demonstrated effective in enhancing global functioning in pre-school children with autism when treatment is intensive and carried out by trained therapists”. However, the review committee also concluded that “there is a great need for more knowledge about which interventions are most effective”.
A 2009 paper included a descriptive analysis, an effect size analysis, and a meta-analysis of 13 reports published from 1987 to 2007 of early intensive behavioral intervention (EIBI, a form of ABA-based treatment with origins in the Lovaas technique) for autism. It determined that EIBI’s effect sizes were “generally positive” for IQ, adaptive behavior, expressive language, and receptive language. The paper did note limitations of its findings including the lack of published comparisons between EIBI and other “empirically validated treatment programs”.
In a 2009 systematic review of 11 studies published from 1987 to 2007, the researchers wrote “there is strong evidence that EIBI is effective for some, but not all, children with autism spectrum disorders, and there is wide variability in response to treatment”. Furthermore, any improvements are likely to be greatest in the first year of intervention.
A 2009 meta-analysis of nine studies published from 1987 to 2007 concluded that EIBI has a “large” effect on full-scale intelligence and a “moderate” effect on adaptive behavior in autistic children.
In 2011, investigators from Vanderbilt University under contract with the Agency for Healthcare Research and Quality performed a comprehensive review of the scientific literature on ABA-based and other therapies for autism spectrum disorders; the ABA-based therapies included the UCLA/Lovaas method and the Early Start Denver Model. They concluded that “both approaches were associated with … improvements in cognitive performance, language skills, and adaptive behavior skills”. However, they also concluded that “the strength of evidence … is low”, “many children continue to display prominent areas of impairment”, “subgroups may account for a majority of the change”, there is “little evidence of practical effectiveness or feasibility beyond research studies”, and the published studies “used small samples, different treatment approaches and duration, and different outcome measurements”.
Conversely, various major figures within the autistic community have written biographies detailing the harm caused by the provision of ABA, including restraint, often used with mild self stimulatory behaviors such as hand flapping, and verbal abuse. Several of these have since been diagnosed with PTSD and depression. The Autistic Self Advocacy Network campaigns against the use of ABA in autism.