Applied Behavior Analysis for children with autism:

What ABA is and how to select the best ABA service provider
Applied Behavior Analysis (ABA) is the most well-researched and scientifically validated method of intervention for
children with autism. The process involves examining how a particular behavior looks, how long it lasts, and how often
it occurs, then applying ABA principles to reinforce appropriate behaviors and/or discourage inappropriate behaviors.
Various ABA approaches such as Discrete Trial Training (DTT), Pivotal Response Training (PRT), Picture
Exchange Communication System (PECS), self-management, and a range of social skills training techniques are all
critical in teaching individuals with autism. Ultimately, the goal should be to find a way to motivate the child using a
number of strategies and positive reinforcement techniques.

Discrete Trial Training (DTT)

Discrete Trial Training (DTT) is a component of most ABA programs for children with autism. DTT consists of a
series of repeated lessons or “trials” taught one-on-one. For younger children, DTT often begins with a series of brief,
simple trials that build “learning to learn” skills and help to increase attention span. DTT encourages motivation by
rewarding certain behaviors with praise, toys, extra time to play, and so forth.

Pivotal Response Training (PRT)

Like the hub of a wheel, Pivotal Response Training (PRT) is used to teach behaviors that are central to broad areas of
functioning. Rather than target specific behaviors one at a time, PRT focuses on “pivotal” behaviors that can lead to improve-
ments in other areas of behavior. Children with autism typically lack the motivation to learn new tasks and participate in their
social environment, which may be observed as temper tantrums, crying, fidgeting, staring, noncompliance, inattention, or
lethargy. PRT targets motivation by encouraging the child to respond to increasing expectations related to communication
and socialization, using methods such as turn-taking, child choice, modeling, shaping, and direct reinforcement. The child
plays a central role in determining what activities and objects will be used during a PRT session. Compared with the more
highly structured nature of DTT, PRT uses a more play-based format to develop skills and utilize discrete trials as needed.

Picture Exchange Communication System (PECS)

Many young children with autism lack the language skills that other children have, which makes it difficult and
frustrating for them to communicate their needs. The Picture Exchange Communication System (PECS) is designed to
teach children with limited language skills how to initiate communication with other people. Typically, training begins
by teaching the child to give a picture of a desired item to a partner (such as a parent or a therapist) in exchange for that
item. Later, as the child progresses, the program focuses on sentence structure and the child is taught to use sentence
strips to make longer requests and comments. Children are encouraged to seek out “communication partners” in natural-
ly occurring settings, and an emphasis is made on communication that is child-initiated, meaningful, and empowering.

Self-management training
Self-management training helps a child with autism achieve personal autonomy and rely less on others, such as
teachers and parents. The process uses different techniques, including self-monitoring, self-evaluation, and self-rein-
forcement. These techniques help a child to be more aware of his/her own behavior, to determine whether or not he/
she has engaged in appropriate behavior, and to reward him- or herself for reaching set behavior goals.

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Play-based ABA approaches
As the child builds a larger repertoire of communication skills, play-based ABA approaches gradually expand
sessions into more unstructured formats, which help prevent rote responses and allow a child to apply new skills to
a range of activities, individuals, and situations.

Combining interventions
The right proportion of intervention techniques should be selected through close supervision and collaboration
between interventionists and parents.

Selecting an ABA service provider for your child

Look for service providers that use a blend of ABA-based strategies to ensure programs are collaborative and fun
and make measurable progress. These programs are often family-focused and incorporate everyday home routines.
Qualified staff members should make parents and the child feel comfortable; take an individualized and collabora-
tive approach to treatment planning; and provide honest and realistic feedback.
Parents should be encouraged to ask questions of a potential service provider, such as the following:
• Do you offer ABA-based therapy?
• Can you provide a basic developmental screening for autism?
• Does the assessment outline the child’s unique strengths/challenges?
• What specific activities can be done at home to support the child’s progress?
• Will your agency work with the child’s teachers at school?
• Can you refer parents to other families you have worked with in the past?
• What happens during a typical treatment session?
• How involved will parents be in the day-to-day delivery of the child’s program?
• How many hours of therapy per week will the child need?
• Do you provide weekly/monthly reports on the child’s progress?
• Do you provide training or support for families?
• What are the qualifications of your therapists regarding ABA?

This handout was adapted from “parent tip sheet” materials on the website of Autism Spectrum Therapies (AST), a
private agency serving several regions of Southern California: http://www.autismtherapies.com/default.aspx.

Editor: Gregory K. Fritz, M.D.

Editor’s Note: Subscribers are permitted to photocopy multiple copies for patients and colleagues who would benefit
from the material. Not for resale or mass distribution. Executive Editor: Karienne Stovell, kstovell@wiley.com.
Associate Editor: Sarah Merrill. For reprint information, contact the reprint coordinator at (201) 748-6011.
The Brown University Child and Adolescent Behavior Letter, © 2011 Wiley Periodicals, Inc., A Wiley Company. 01/11