What is Applied Behavior Analysis (ABA) Therapy?
ABA Therapy is a method of treating people with autism and other behavioral challenges by modifying behavior using positive reinforcement. This approach employs the principles of applied behavior analysis, which states that desired behaviors can be developed using a rewards-and-consequences system. In this method, a therapist identifies and sets a goal for the child to develop a target skill or behavior and measures his/her progress throughout the treatment period.
ABA Therapy is the most common therapy for people and children with autism and is considered the most established and well-documented approach due to its scientific and systematic nature. To date, ABA therapy is reported to be one of the most effective treatments for autism as parents and specialists see significant improvement in the child’s behavior.
Some concerns about ABA therapy
Despite its popularity, ABA therapy has received some criticism from parents and advocates with the way some practitioners apply certain strategies that can be considered inhumane and disrespectful.
This conduct started in the 1960s when clinical psychologist Dr. Ole Ivar Lovaas created Discrete Trial Training, which is a method of treating people with autism based on the principles of ABA. Dr. Lovaas used positive reinforcement to reward good behavior, but also used “averse reinforcement methods which included electric shocks” even to severely impaired patients.
Thankfully, harmful and painful negative reinforcement is no longer being practiced in ABA therapy today. Instead of punishment, some ABA therapists might take away privileges or withhold a desirable object from the child when he/she does not act out a target behavior.
Another criticism of ABA is its tendency to be repetitive, which might be considered tiresome and disrespectful to the child being treated. This might be true with earlier instances of ABA therapy, but these days, ABA therapists are trained to be energetic, creative, and spontaneous when interacting with children.
Lastly, some ABA therapists focused too much on eliminating undesirable behavior rather than redirecting children into the tasks that they should be doing. It goes back to Dr. Lovaas’ ideals that children with autism act the same way as their neurotypical peers rather than accepting neurodiversity.
Today, the majority of ABA practitioners have acknowledged the early faults of the method and made adjustments to make it more flexible and respectful of each child’s learning and developmental capacity.
If you are concerned that ABA therapy might not suit your child, be ready to ask questions and bring up these concerns directly to an ABA specialist to help you come up with your assessment.
If you do decide to start ABA therapy, make sure to monitor each session and be up to date with your child’s progress.
How does ABA therapy work?
Following the idea that behavior can be taught or modified by using rewards and consequences, ABA therapy usually starts with the therapist observing your child and identifying behaviors and skills that need to be improved.
Once a challenging behavior is identified, the therapist will then create a strategy using the principles of ABA to shift this behavior into the “target behavior.”
ABA therapists might use the ABC approach when understanding your child’s behavior and applying strategies to modify it. ABC stands for Antecedent, Behavior, and Consequence.
Broken down, this means:
Antecedent: The event that happens before the behavior
Behavior: The child’s behavior
Consequence: The event following the behavior
The ABC method is used before therapy to understand how a child behaves prior to treatment. It is then used to change or adjust the antecedent to achieve the target behavior.
For example, ABA therapy can be applied to a child who throws a tantrum when he/she is interrupted from playing. The antecedent here is the child engrossed in his/her playtime. A therapist might use the ABC approach in this way:
Antecedent: The therapist tells the child that he/she can play for two more minutes, but he/she needs to put the toys away when time is up.
Behavior: The child stops playing after two minutes and packs the toys away.
Consequence: The therapist rewards the child verbally (“Great job!”) or with a physical gesture (high five, thumbs up).
The consequence can change if the child does not behave the way he/she was expected to behave. While punishment is no longer a common practice in ABA therapy, a consequence for not behaving accordingly can be simply taking away privileges like screen time or playing video games.
To give you a bigger picture, an ABA therapist might do the following:
- Identify challenging or undesirable behaviors
- Plan a strategy and establish specific goals
- Create a system to measure changes and improvements
- Assess and record the current status or progress
- Teach new skills and/or lessen challenging behaviors
- Determine if further behavior modification is necessary
The goal of ABA therapy is to lessen or completely remove a specific challenging behavior or teach a new skill. In some cases, ABA therapy is used to reduce violent and self-harming behavior in children.
ABA therapy can have varied specific methods, such as:
Discrete Trial Training
Discrete Trial Training employs the ABC approach in modifying behavior and/or teaching new skills. This method is done in clinical, one-on-one sessions where tasks are broken down into smaller steps to help the child understand and follow instructions.
Incidental Training
This method has the same goal and approach as DTT, but the difference is that this can be done outside a clinical setting. This method is designed to be implemented in school and at home.
Pivotal Response Training
Pivotal Response Training takes place in the child’s natural settings (school, home, playground). This strategy is less structured and more focused on using the child’s interests in teaching skills. The idea behind pivotal response training is there are four key areas that are essential to a child’s development. They are motivation, self-initiation, self-management, and responsiveness.
Can ABA Therapy help improve skills for children with autism?
In addition to minimizing challenging behavior, ABA therapy is also useful in improving social, emotional, and communication skills in children with autism.
In general, ABA therapy’s goals include:
- Increase social interaction with others
- Improve communication skills (especially asking for what the child wants)
- Enhance focus on academic tasks
- Lessen or extinguish self-injurious behaviors
- Lessen tantrums or other outbursts
How does Applied Behavior Analysis provide structure and support?
ABA Therapy follows a systematic and scientific approach and can sometimes be repetitive, which can provide the structure that most children with autism prefer.
The strategies applied in the therapy can also be accomplished outside of the treatment center. Therapists can train parents so they can continue ABA strategies at home, in school, or other outdoor venues and events.
Who provides ABA therapy services?
Ideally, ABA therapy services are done by board-certified behavior analysts (BCBA). These professionals undergo ABA training and ABA certification to be able to practice ABA therapy. However, in some treatment centers where there are not enough BCBAs, therapists, and registered behavior technicians (RBTs) can provide sessions under the training and supervision of a BCBA.
Where do I find ABA therapy services?
The best person to ask for a recommended therapist would be your child’s pediatrician or doctor. You can also discuss or ask any questions you might have about ABA.
Another way to find a behavior therapist in your area is to go to Google.com and type in “best ABA therapy near me,” or you can visit the BCBA registry website to find a therapist near your location.
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Getting ready for ABA therapy
Before starting ABA therapy, you may want to go through some ABA therapy checklists to ensure that you are getting the best treatment for your child.
To help you prepare for your child’s ABA therapy, you can do the following:
- Have a support system – Inform family members of this treatment plan and ask for their support.
- Have a “therapy” space at home – It helps to have a dedicated spot for carrying out treatment sessions at home.
- Prepare your child – Establish routines and structure with your child. When this is done, he/she will be more likely to do well during ABA therapy.
- Learn about ABA therapy – Read as much as you can about ABA and how it works, and the many ways you can implement its strategies at home.
What are the questions that I need to ask about ABA therapy?
ABA therapy is not cheap – in fact, one session can cost an average of $120. Fortunately, ABA therapy is covered by most insurance plans. It is covered by Medicaid for children under 21 years old and with a doctor’s recommendation. Note that this policy may vary according to where you live.
Before choosing an ABA therapy center, you can ask these questions first to help you make an informed decision:
- What type of insurance do you accept?
- How many behavioral therapists and BCBAs do you have?
- How many therapists will be working with my child?
- How do you manage safety concerns?
- How do you determine the goals for my child? Do you consider input from parents?
- How is progress evaluated?
- How many hours per week can you provide?
- Do you have a waiting list?
ABA therapy is not for every child on the spectrum. It is, therefore, your responsibility to do proper research and talk to professionals before choosing this treatment for your child.
References:
Autism and Insurance Coverage | State Laws. 8 August 2018. Retrieved from: http://www.ncsl.org/research/health/autism-and-insurance-coverage-state-laws.aspx
The Controversy Around ABA. Retrieved from: https://childmind.org/article/controversy-around-applied-behavior-analysis/
The controversy over autism’s most common therapy. 10 August 2016. Retrieved from: https://www.spectrumnews.org/features/deep-dive/controversy-autisms-common-therapy/