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Applied Behavior Analysis is the primary therapy that is used for children who have autism. There are other types of therapies available to people with autism, such as Cognitive Behavioral Therapy, Verbal Behavior Therapy, Social Skills Groups, Floortime and Classroom-based programs. However, the most widely accepted therapy, which is covered by medical insurance due to the volume of research supporting it, is Applied Behavior Analysis.
How Does ABA Therapy Work?
Using positive reinforcement and repetition, an ABA Therapist will focus on teaching skills that have been identified as beneficial to the child’s future growth and success, both academically and socially. These skills include social skills, communication skills, motor skills and functional skills that lead to higher achievement and more meaningful relationships
While it may not be within the behavior tech’s scope of practice to address certain skills such as motor or academic skills, it is within the boundaries of the behavior tech to address a behavior that might prevent a child with autism from being able to complete academic tasks. For example, if a child is having difficulty staying seated to complete worksheets in class, a therapist might work on increasing the amount of time by 30 seconds each time the student sits in his/her chair to complete a worksheet. Or, if a student is having trouble keeping their hands still, the therapist may give continual reinforcement for calm hands and encourage longer periods of time that their hands stay calm in order to complete a task.
In this way, the Behavior Tech is not breaching any boundaries into the occupational therapist’s role or the teacher’s role; they are helping to regulate the behavior that leads to greater success in academics and occupational/motor skills.
Is ABA Really Effective?
Applied Behavior Analysis has been researched for over fifty years, beginning in 1962 with a psychologist named O. Ivar Lovaas, PhD. Through the studies of Lovaas in 1987, it was found that 50% of children with autism were considered “indistinguishable from their peers” after receiving intensive applied behavior analysis therapy for forty hours each week. In addition, 90% were said to have improved significantly.
It is also hard to deny the validity of a therapy that is endorsed by organizations such as:
● American Academy of Neurology
● American Academy of Family Pediatrics
● American Academy of Pediatrics
● American Academy of Occupational Therapy Association
● American Psychological Association
● American Speech-Language Hearing Association
● Society for Developmental and Behavioral Pediatrics
● Autism Society of America
● National Institute of Child Health & Human Development
● National Institute of Mental Health
Applied Behavior Analysis is an objective, data-driven science. As therapists are working with clients, they are documenting real-time data. Depending on the type of program they are working on with a client, they might take frequency data (the number of times that something occurs), duration data (the length of time that something continues), or interval data (the absence or presence of an event within an certain time frame), latency data (how much time goes by before a response occurs after a prompt), or ABC data (antecedent, behavior, consequence data which translates to before the behavior, the behavior itself and what occurred directly after the behavior).
When you take accurate and objective data at every session, there is more than enough evidence to begin noticing trends. These trends can show an increase or decrease in a behavior, scattered responses in a behavior, no response, or no change at all. Given enough data, the Behavior Analyst can evaluate how the client is responding and adjust programming accordingly. The most important thing that the data provides is the evidence that the client is improving, which is also necessary in order for applied behavior analysis to be considered a necessary medical intervention for children with autism. If there is no scientific evidence to show progress to insurance carriers, they will not support it as a genuine therapy. Considering that the cost of applied behavior analysis can easily exceed $50,000 per year, it is important to provide solid evidence based progress to continue these services for families who require behavioral intervention for their child.
What makes ABA So Effective?
There are several reasons why applied behavior analysis can be so effective as a behavioral intervention for children who have autism. The most important factor that almost guarantees a successful outcome is early intervention.
Early Intervention provides the best outcome because if the gap between the first noticeable deficits and behavior therapy can be kept to a minimum, the likelihood that the child will learn and integrate these new skills into their daily lives is much greater. Teaching a four year-old that was diagnosed at the age two or three to sit calmly or to communicate with a PECS board would be less challenging than teaching an adolescent who was misdiagnosed or undiagnosed and left untreated for several years.
It makes sense that the longer a child with autism is left without behavior intervention, the more difficult it is to transition them from behaviors that they are attached to and perhaps have been comforted by for many years. It is extremely important to intervene as early as possible. Currently, physicians are trained to test for autism spectrum disorders as early as six months in some cases.
Another reason that ABA is so effective for the treatment of autism is that it is not merely a one-size-fits-all type of remedy. Applied Behavior Analysis requires just what the name states: analysis.
- The child with autism is observed
- Parents are interviewed
- Data is taken
- Hypotheses are formulated, tested, and revised
And only then are the results revealed.
Applied Behavior Analysis is an evidence based science and as a treatment for autism it is individualized to meet the needs of the individual client. Each element of a treatment plan addresses the social, physical (motor), behavioral and functional (daily living skills) of the client as it pertains to their lives.
The target behaviors that are chosen by the behavior analyst are behaviors that are necessary to improve the quality of life for this specific child with autism and this specific family of the child with autism. In addition to that, outside communities (school, church, public settings) are taken into the equation. The goal is to help the child and their family achieve a sense of peace and well being for the child first, then everyone surrounding the child so that integration into varied social settings is possible.
One-on-One Intensive Instruction
ABA is one-on-one, direct teaching for several hours every week. For some clients this can be ten hours and for others this can be up to forty hours per week. This can be grueling for the child and the family. That is why it is so important to have two things in place for a successful intervention.
1) A good professional relationship with the family
2) A bond with the child that is nurturing, but has boundaries so that the child looks forward to the time with the therapist, respects the boundaries, and listens to instruction.
These intensive hours are intentional because one or two hours a week, as though it were a piano lesson or a doctor’s appointment, would be quickly forgotten.
Having hours and hours of instruction, correction and modeling,
- Enables the parents to learn from and follow begin to flow the lead of the therapist
- Establishes a way of life and conduct for the child with autism and the entire family.
None of these interventions would work without reinforcement. The way that appropriate behaviors are reinforced in applied behavior analysis is by the use of positive reinforcement. Positive reinforcement is the immediate addition of a reinforcing stimulus (verbal praise, access to favorite toy, free play, favorite snack etc) after a behavior that makes it more likely that the behavior will be repeated again. So when a child with autism completes a task correctly, such as pointing and saying the name of an object, the therapist would immediately deliver positive reinforcement to the child. The reinforcer will vary from child to child because each child has different preferences. Some children may be highly motivated by the praise and smiles from the therapist, while others will only be motivated by something that they want access to. These are some of the details that are evaluated at intake.
Eventually all of these methods that are used to teach new social, communication and behavioral skills will be introduced into other settings. This is what we call generalization of skills in applied behavior analysis.
Generalization of skills is the most important part of therapy because it is evidence of the child’s understanding. A child might practice saying “you’re welcome” over and over after the therapist says “thank you” in a session. But true generalization is when the child remembers to say “you’re welcome” to a different person in a different setting. Generalization of necessary skills for the sake of quality of life is the end goal of applied behavior analysis.
The Evidence Speaks for Itself
Applied Behavior Analysis is the most highly accepted for of therapy for autism for good reasons. It is a data driven, evidence based science that has consistently delivered successful outcomes for at least half of the individuals who receive treatment.
People with autism enjoy a higher quality of life as their communication and social skills improve with applied behavior analysis. With extensive ABA therapy, they acclimate well with peers in academic settings, work settings and social settings and utilize their interests and expertise in areas of specialization that most of us would only have a limited understanding of.
In many cases, even though we know that there is no “cure” for autism, many children appear to outgrow their symptoms after extensive ABA therapy. The reason is simple. ABA therapy treats the function of the behaviors and teaches socially appropriate responses and behaviors in place of those behaviors that separate these children from their peers and from learning.
In addition to the established science behind ABA, the high rate of successful outcomes coupled with the fact that the field of Behavior Analysis is one of the fastest growing degree programs and career paths are strong testaments of the effectiveness of ABA therapy for autism.