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What Is ABA
What Is ABA
What Is ABA
There are probably a hundred people who have written answers, but please bear with me.
"Applied" means practice, rather than research or philosophy. "Behavior analysis" may be read as "learning
theory," that is, understanding what leads to (or doesn't lead to) new skills. (This is a simplification: ABA is just as
much about maintaining and using skills as about learning.) It may seem odd to use the word "behavior" when
talking about learning to talk, play, and live as a complex social animal, but to a behaviorist all these can be taught,
so long as there are intact brain functions to learn and practice the skills. (That is the essence of the recovery
hypothesis--that for many children, the excesses and deficits of autism result largely from a learning 'blockage,'
which can be overcome by intensive teaching.)
Typically developing children learn without our intervention--that is, the 'typical' environment they are born into
provides the right conditions to learn language, play, and social skills. (After a few years, however, this breaks
down, and we no longer learn everything 'naturally'--it takes a very structured environment, for example, for most
of us to learn to read, write, and do arithmetic.)
Children with autism learn much, much less from the environment. They are often capable of learning, but it takes
a very structured environment, one where conditions are optimized for acquiring the same skills that typical
children learn 'naturally.' ABA is all about the rules for setting up the environment to enable our kids to learn.
Behavior analysis dates back at least to Skinner, who performed animal experiments showing that food rewards
(immediate positive consequences to a target behavior) lead to behavior changes. This is accepted by everyone who
wants to train their dog to 'go' outside, but we are not so inclined to want to believe the same of ourselves. Part of
the problem is that people do respond to a broad range of reinforcements (rewards), but it is really true that an
edible treat is among the most reliable, especially at first. (The skills that we more often think lead to learning-motivation, self-discipline, curiosity--are marvelous, and really do set us apart from other animals--but those are
truly sophisticated 'behaviors' that fully develop only after more basic language and social skills are in place.)
Conversely, any new behavior that an animal (or you or I) may try, but is never rewarded, is likely to die out after a
while (how often will you dial that busy number?). And, as common sense would have it, a behavior that results in
something unpleasant (an aversive) is even less likely to be repeated. These are the basics of behavioral learning
theory. ABA uses these principles to set up an environment in which our kids learn as much as they can as quickly
as possible. It is a science, not a 'philosophy.' (Even the "as quickly as possible" part is based on science, since
there is some--not conclusive--evidence that the developmentally disordered brain "learns how to learn" best if the
basic skills are taught in early childhood.)
Behavioral learning is not the only type of learning. Most learning in schools is from an explanation or from a
model, what people call 'natural' learning. Typically developing children learn from their environment (other
people) at an astounding rate, completely unassisted. The whole point of ABA is to teach the prerequisites to make
it possible for a child to learn 'naturally.' If our kids could learn without assistance in the first place they wouldn't
have autism!
The most common and distinguishing type of intervention based on applied behavior analysis is discrete trial
teaching. It is what people most often think of when you say "ABA" or "Lovaas method." This is partly because
there are so many hundreds of hours of DT teaching, and partly because it looks so odd. But it is what it is because
that's what works--every aspect has been refined (and is still being refined) to result in maximum learning
efficiency.
(Briefly: the student is given a stimulus--a question, a set of blocks and a pattern, a request to go ask Mom for a glass of water--along with
the correct response, or a strong 'hint' at what the response should be. He is rewarded (an M&M, a piggy-back ride, a happy "good job!")
for repeating the right answer; anything else is ignored or corrected very neutrally. As his response becomes more reliable, the 'clues' are
withdrawn until he can respond independently. This is usually done one-on-one at a table (thus the term table-top work), with detailed
planning of the requests, timing, wording, and the therapist's reaction to the student's responses.)
It is a mistake, however, to think of an ABA program as just DT teaching. Lovaas (among others) notes very
clearly that a behavioral program is a comprehensive intervention, carried out in every setting, every available
moment. The skills that are taught so efficiently in discrete trial drills must be practiced and generalized in 'natural'
settings. A child who does not know the difference between 'ask' and 'tell' may slowly get a higher and higher
percentage of right answers during table-top drills until he is considered to have 'mastered' that skill; but he will not
go on to use 'ask' and 'tell' appropriately without additional support in natural situations; it takes time to go from
'mastery' to 'ownership.' It takes trained and supportive people--parents, teachers, relatives, even peers--to help
reinforce a wide range of appropriate behaviors in a variety of settings, until the level of reinforcement fades to a
typical level (such as the smile you get when you greet someone).
Here is a child's interaction with a teacher or other adult who is being as helpful as possible without appropriate
training:
Teacher: Hi, Alex, are you excited about Christmas?
A: [no response]
Teacher: What are you going to do on Christmas?
A: I don't know.
Teacher: Are you going to get presents?
A: Yes.
Teacher: What else are you going to do?
A: [no response]
Teacher: Do you have a tree?
A: Yes.
Teacher: Who's going to bring presents on Christmas?
A: I don't know.
Teacher: Is it Santa Claus?
A: Yes.
Teacher: [smile] Thanks, Alex!
This is the child's half of the conversation:
"I don't know, Yes, Yes, I don't know, Yes."
Any learning going on? (By the way, I've watched people have conversations like this, then comment "He's talking
so much more!")
Here's how a trained person might make this an opportunity for practicing conversation skills:
Teacher: Hi, Alex, are you excited about Christmas?
A: [no response]
Teacher: Are you excited about Christmas? Say, Yeah, I want to open my...
A: Yeah, I want to open my presents!
Teacher: [Smile] Me too! What presents did you ask for?
A: I asked for presents.
Teacher: What presents did you ask for? Say, For Christmas, I asked for...
A: I asked for a bike. For Christmas.
Teacher: Cool! [Small tickle] Are you excited about Christmas?
A: Yeah, I want a bike.
Teacher: [Bigger tickle] A bike! That's great! I've got my tree all decorated with ornaments. I put lots of ornaments
on MY tree. [Point to A's tree.]
What's it like?
Through ABA training, parents and other caretakers can learn to see the natural triggers and reinforcers in the
child's environment. For example, by keeping a chart of the times and events both before and after Sammy's
tantrums, a parent might discover that Sammy always throws a tantrum right after the lights go on at night without
warning. Looking deeper at the behavior, Sammy's mother might also notice that her most natural response is to
cuddle Sammy in order to get him to calm down. In effect, even though she is doing something completely natural,
the cuddling is reinforcing Sammy's tantrum. According to the ABA approach, both the trigger (lights going on at
night without a warning) and the reinforcer (cuddling) must be stopped. Then a more appropriate set of behaviors
(like leaving the room or dimming the lights) can be taught to Sammy, each one being reinforced or prompted as
needed. Eventually, the hope is that this kind of approach will lead to a time when the lights can go on without
warning and Sammy still does not throw a tantrum.
Does it work?
ABA is considered by many researchers and clinicians to be the most effective evidence-based therapeutic
approach demonstrated thus far for children with autism (10). The U.S. Surgeon General states that thirty years of
research on the ABA approach have shown very positive outcomes when ABA is used as an early-intervention tool
for autism (11). This research includes several landmark studies showing that about 50% of children with autism
who were treated with the ABA approach before the age of four had significant increases in IQ, verbal ability,
and/or social functioning. Even those who did not show these dramatic improvements had significantly better
improvement than matched children in the control groups. In addition, some children who received ABA therapy
were eventually able to attend classes with their peers (8, 12, 13). A similar study in older children showed
improvements in behavior but not IQ (14).
Parents are often trained in ABA therapy, and several single-subject studies have shown that parental training helps
children with autism who receive ABA therapy. Larger controlled studies looking at this issue are underway (15).
Studies of parental satisfaction with ABA indicate that parents believe the approach is effective (16). Parents also
report that they experience less stress as a result of applying ABA (17).
There are, however, some controversies surrounding the ABA approach (10). Early ABA practice (in the 1980's and
early 1990's) included the use of aversive techniques such as yelling at or restraining a child. Most ABA
practitioners no longer consider aversive techniques to be acceptable, and the current ABA approach is equally
effective without these techniques (18).
Experts also disagree as to whether the ABA approach should be used alone or along with other treatment methods.
While there are varied opinions (10), most practitioners agree upon the importance of early intervention, intensive
treatment for as much time as possible each day (in the range of 25 to 40 hours per week), well-trained
practitioners, and consistent application of the ABA approach within and outside of school (3).
A crucial element of the ABA approach that is especially important for children with autism is finding appropriate
reinforcement for each child. Because praise may not be rewarding for these children, careful analysis of each
child's behavior can help reveal more effective reinforcement tools (19). Examples of successful reinforcers may
include access to a favorite toy or chair.
Is it harmful?
There are no known negative effects of the ABA approach. This is especially the case if gentle prompting is used
rather than aversive techniques.
Cost
In order to effectively implement ABA, both parents and any other major caretakers must be trained in ABA (15).
Workshops covering the basics of ABA treatment can last from 2-7 days, and cost between $175-1,000 per person.
Online ABA courses are especially useful for parents who do not live in a large city.
Children can also be enrolled in schools and clinics that specialize in ABA treatment. These can be found in most
major cities and university towns. The cost of such schools can be quite high; tuition ranges from $16,000-25,000
per year. However, some schools offer scholarships to parents in need.
It is possible to set up ABA treatment at home using therapists in training or college students who have taken a
workshop in the ABA approach. This can also be expensive ($5,000-20,000/year), and requires a great deal of time
organizing and structuring the program.
A qualified, full-time (30 hours/week or more) ABA therapist devoted to your child costs approximately $30,000$50,000 per year. Because of the success of ABA and the evidence indicating that training should be intensive (2540 hours/week), there is very high demand for ABA-trained therapists, and it may be difficult to find one who is
available (see Resources).
Resources
Although autism is a condition covered under the Individuals with Disabilities Education Act (IDEA), whether
IDEA covers intensive ABA treatment is still being considered by the courts. See
www.wrightslaw.com/info/autism.index.htm for a discussion of court cases and their outcomes.
The Behavior Analyst Certification Board was established to provide consistent credentialing for behavior analysts;
search in their "Certificant Registry " to find a local behavior analyst.
The Association for Behavior Analysis International was developed to enhance and support the growth and vitality
of behavior analysis. The Web site provides links and resources for ABA practitioners.
Several books that might be helpful in understanding the ABA approach are:
Psychosocial Treatment for Child and Adolescent Disorders: Empirically Based Strategies for Clinical Practice
(2nd Edition). by E. D. Hibbs & P. S. Jensen (Eds.). 2005. American Psychological Association.
Raising a Child with Autism: A Guide to Applied Behavior Analysis for Parents, by S. Richman. 2000. Jessica
Kingsley Publishers.
Teaching Language to Children with Autism or Other Developmental Disabilities, by M. Sundberg and J.
Partington. 1998. Behavior Analysts, Inc.
Understanding Applied Behavior Analysis: An Introduction to ABA for Parents, Teachers, and Other Professionals,
by A.J. Kearney. 2007. Jessica Kingsley Publishers.
References
1. Harris, S.L.P., and L.P. Delmolino. 2002. "Applied Behavior Analysis: Its Application in the Treatment of
Autism and Related Disorders in Young Children." Infants & Young Children 14(3):11-17.
2. Simpson, R.L. 2001. "ABA and Students with Autism Spectrum Disorders: Issues and Considerations for
Effective Practice." Focus on Autism and Other Developmental Disabilities 16(2):68-71.
3. Jensen, V.K., and L.V. Sinclair. 2002. "Treatment of Autism in Young Children: Behavioral Intervention and
Applied Behavior Analysis." Infants and Young Children 14(4):42-52.
4. Schreibman L. 2000. "Intensive behavioral/psychoeducational treatments for autism: research needs and
future directions." J Autism Dev Disord. 30(5):373-378.
5. Koegel, R.L. et al. 2000. "Pivotal Areas in Interventions for Autism." J. Clin Child Psychol. 30(1):19-32.
6. Binder, C. 1996. "Behavioral Fluency: Evolution of a New Paradigm." The Behavior Analyst 19:163--197.
7. Sundberg M.L., and J. Michael. 2001. "The Benefits of Skinner's Analysis of Verbal Behavior for Children
with Autism." Behav Modif. 25(5):698-724.
8. Lovaas, O. 1987. "Behavioral Treatment and Normal Educational and Intellectual Functioning in Young
Autistic Children." J Consult Clin Psychol. 55(1):3-9.
9. Rosenwasser B., and S. Axelrod. 2001. "The Contribution of Applied Behavior Analysis to the Education of
People with Autism." Behav Modif. 25(5):671-677.
10. Simpson, R.L. 1999. "Early Intervention with Children with Autism: The Search for Best Practices."
Journal of the Association for Persons with Severe Handicaps 24(3):218-221.
11. U.S.Department of Health and Human Services. 1999. "Mental Health: A Report of the Surgeon General Executive Summary." U.S. Department of Health and Human Services, Substance Abuse and Mental Health
Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute
of Mental Health. Rockville, MD.
12. Howard J.S., et al. 2005. "A Comparison of Intensive Behavior Analytic and Eclectic Treatments for Young
Children with Autism." Res Dev Disabil. 26(4):359-383.
13. Cohen H., et al. 2006. "Early Intensive Behavioral Treatment: Replication of the UCLA Model in a
Community Setting." J Dev Behav Pediatr. 27(2 (Suppl)):S145-S155.
14. Bibby P., et al. 2002. "Progress and Outcomes for Children with Autism Receiving Parent-Managed
Intensive Interventions." Res Dev Disabil. 23(1):81-104.
15. Johnson, C.R., et al. 2007. "Development of a Parent Training Program for Children with Pervasive
Developmental Disorders." Behavioral Interventions 22(3):201-221.
16. Hume, K., et al. 2005. "The Usage and Perceived Outcomes of Early Intervention and Early Childhood
Programs for Young Children With Autism Spectrum Disorder." Topics in Early Childhood Special
Education 25(4):195-207 (13).
17. Smith T., et al. 2000. "Parent-Directed, Intensive Early Intervention for Children with Pervasive
Developmental Disorder." Res Dev Disabil. 21(4):297-309.
18. Sallows G.O., and T.D. Graupner. 2005. "Intensive Behavioral Treatment for Children with Autism: FourYear Outcome and Predictors." Am J Ment Retard. 110(6):417-438.
19. Horner, R., et al. 2002. "Problem Behavior Interventions for Young Children with Autism: A Research
Synthesis." Journal of Autism and Developmental Disorders 32(5):423-446.