Applied Behavior Analysis
Applied Behavior Analysis (ABA) is a type of therapy frequently applied to children with autism and other developmental disorders that focuses on imparting skills in specific domains of functioning, such as social skills, communication, academic and learning skills, motor dexterity, hygiene and grooming, and more. Tailored to individual needs, ABA is delivered in a variety of settings, including school, home, clinic, and other community settings. The goal of treatment is to help children function as independently and successfully as possible.
Originally developed by psychologist Ole Ivar Lovaas in the 1960s reflecting traditional principles of behaviorism, the therapy has evolved somewhat as understanding of autism has increased. ABA utilizes positive reinforcement to teach and promote social skills, communication abilities, learning and academic skills, and self-care habits. ABA therapy is intensive; sessions typically last two or more hours and are conducted several days a week. Ideally, the therapy is attuned to each patient’s specific developmental needs, and a course of therapy typically spans two or more years.
Nevertheless, the therapy has garnered criticism over the years. In its earliest iterations ABA relied not only on positive reinforcement of behavior but also on negative reinforcement, including outright punishment, if children failed to learn skills. Many critics considered it too harsh. Today’s ABA generally relies on positive reinforcement to promote behavior change. More recent criticism of the therapy reflects a “neurodiversity” perspective: It rejects attempts to “normalize” behavior because it considers autism not a disorder but a normal variation of the brain’s operations.
ABA is commonly practiced as a therapeutic intervention for individuals with autism. According to the Center for Autism, ABA helps people with autism improve social interactions, learn new skills, and maintain positive behaviors. ABA also helps transfer skills and behavior from one situation to another, controlling situations where negative behaviors arise and minimizing negative behaviors. With autism, ABA is most successful when intensely applied for more than 20 hours a week and prior to the age of 4.
ABA can also help aging adults cope with the losses that come with age, like memory, strength, and relationships. For young and old, ABA can help individuals manage some of the lifestyle challenges that accompany many mental and physical health conditions.
When working with an ABA therapist, clients will:
- Determine which behaviors require change
- Set goals and expected outcomes
- Establish ways to measure changes and improvements
- Evaluate where you are now
- Learn new skills and or learn how to avoid negative behaviors
- Regularly review your progress
- 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.
First, a trained behavior analyst assesses a person’s needs and ability level and designs a bespoke program of therapy with specific treatment goals typically focused on several skill areas. These include:
• social skills
• play and leisure
• motor skills
• learning and academic skills
ABA therapists deploy a variety of techniques depending on the individual’s treatment needs and the target behavior. Among them:
Discrete trial training (DTT), which is usually conducted in a one-on-one session with a therapist, breaks skills into small (discrete) units, and teaches them one by one, with the appropriate reinforcement as each unit is mastered. For example, in teaching speech skills, one unit may be devoted to producing the vocal sound S. The therapist will typically ask for the desired behavior, reward the correct response, and repeat the process until the sound is produced spontaneously. DTT may be used for teaching communication skills, social skills, motor skills like writing letters of the alphabet.
Modeling is a technique in which the therapist presents an example of the desired behavior, either personally demonstrating it or providing a video or audio recording of the desired behavior. The learner is then asked to imitate the target behavior. For example, in teaching social skills, a learner might be shown a video of a person saying thank you when given a toy or other object, and then asked to repeat the behavior as the teacher hands them an object.
Picture exchange communication system (PECS) involves the use of pictures to teach communication and vocabulary skills to children. The child, working with a set of cards having pictures of foods or other objects, gives the therapist a picture of a desired object. In exchange, the therapist provides the object shown in the picture. The technique can be used with children who do not have speech skills as a way for them to communicate their needs. But it is also used to expand the communication skills of those who can speak and teach them how to express their wants and needs in socially adaptive ways as they progress through increasingly sophisticated vocabulary and sentence structure.
Reinforcement systems involves the use of methods to teach children the consequences of engaging in specific behaviors and activities, with the purpose of increasing the likelihood such behaviors will be repeated in the future. For example, one method of reinforcement might be a token system. A child earns tokens as a form of reward for accomplishing a target behavior. Those tokens may then be used in exchange for some desired activity, such as access to a specific toy or computer game, which functions as a backup reinforcer.
All desired behaviors are broken into smaller steps, and as each step is learned, the child is rewarded for carrying out the target behavior successfully. ABA therapists typically conduct training to parents and caregivers, to that behavioral progress occurs outside the clinical setting. .
For every behavior where change is desired, the therapist identifies the ABCs—the antecedent, the behavior, and consequence of the behavior. The antecedent is what prompts the person to act. The behavior is the response itself, which could be an action or verbal expression, which the therapy aims to change. The consequence is what immediately follows the behavior.
For example, if the goal is to reduce tantrums when the child has to go to sleep, the parent might reward the child with praise if the child gets ready for bed. The parent would not provide those positive reinforcements if the child threw a tantrum instead.
An ABA therapist is a licensed mental health professional who has additional training and experience in ABA. Most states now have regulations requiring specific licensure for ABA therapists.
Certification programs for practicing ABA therapy are provided by the Behavior Analyst Certification Board (BACB). Board-Certified Behavior Analysts with a master’s degree and appropriate training are identified by the initials BCBA after their name; those with a doctorate-level degree are identified by the initials BCBA-D. (In Florida only, a BCBA may use the initials FL-CBA or the term Florida Certified Behavior Analyst).
In addition, there is a certification program for those who serve as supportive ABA therapy team members. Board Certified Assistant Behavior Analysts have bachelor’s degrees and ABA training and are identified by the initials BCaBA. A BCaBA cannot practice alone but can work in therapeutic settings when supervised by someone who is certified at a higher level.
The BACB also certifies Registered Behavior Technicians with a minimum of a high school diploma and 40 hours of specialized training who work only under the direct supervision of a BCBA or BCaBA.
When seeking an ABA therapist, experience counts. It is advisable to seek a therapist who has had not just extensive training but experience using ABA to treat patients presenting with concerns such as your child’s.
Important as qualifications and experience are, so is good fit. As with all forms of therapy, it is also advisable to find an ABA therapist with whom you and your child feels comfortable. Look for someone with whom you can establish clarity of communication.
Here are some important questions to ask a prospective ABA therapist:
- How often have you dealt with problems such as my child presents?
- How do you know whether child is a good candidate for ABA therapy?
- How does ABA therapy work?
- What is a typical plan of treatment and how long is a typical course of therapy?
- How do you measure progress?
- What is the nature of your training in ABA therapy?
- What is your policy on communication with parents?
- What length of time do you initially ask a client to commit to?