Program

Treatment Overview

Applied Behaviour Analysis (ABA) is “the science in which tactics derived from the principles of behaviour are applied to improve socially significant behavior and experimentation is used to identify the variables responsible for the improvement in behavior” (Cooper, Heron & Heward, 2007, p.690). ABA is therefore a science of behaviour, focusing on socially important behaviours such as communication, language, socialization and more. In addition, ABA is the process of systematically applying interventions based on the principles of learning (Baer, Wolf & Risley, 1987). All those interventions are tailored to meet every child’s needs and uses evidence-based techniques.

Although ABA is not only used with individuals diagnosed with an Autism Spectrum Disorder (ASD), it has been found to be one of the most, if not the most, effective treatment for this population (Love, Carr, Almason & Petursdottir, 2009). This treatment is especially useful in teaching behaviours to children with ASD that would not otherwise learn it independently in their own environment, as some other children would. Every observable behavior can be altered or changed through the positive approach of ABA. A parent, counsellor, instructor therapist, or a certified behavior analyst, such as a Board Certified Behavior Analyst (BCBA), can use this approach.

ABA uses careful behavioral observation and positive reinforcement or prompting to teach each step of a behavior. A child's behavior is reinforced with a reward when he or she performs each of the steps correctly. Undesirable behaviors, or those that interfere with learning and social skills, are watched closely. The goal is to determine what happens to trigger a behavior, and what happens after that behavior to reinforce it. The idea is to remove these triggers and reinforcers from the child's environment. New reinforcers are then used to teach the child a different behavior in response to the same trigger. The aim of therapy is to have a child generalize previously taught items during therapy, and uses those new responses in a new setting, with new people, and with new objects.

ABA treatment can include any of several established teaching tools: discrete trial training, incidental teaching, pivotal response training, fluency building, and verbal behavior (VB). In discrete trial training, an ABA practitioner gives a clear instruction about a desired behavior (e.g., "Pick up the paper."); if the child responds correctly, the behavior is reinforced (e.g., "Great job! Have an M&M."). If the child doesn't respond correctly, the practitioner gives a gentle prompt (e.g., places child's hand over the paper). The hope is that the child will eventually learn to generalize the correct response.

Incidental teaching uses the same ideas as discrete trial training, except the goal is to teach behaviors and concepts throughout a child's day-to-day experience.

Pivotal response training uses ABA techniques to target crucial skills that are important (or pivotal) for many other skills. Thus, if the child improves on one of these pivotal skills, improvements are seen in a wide variety of behaviors that were not specifically trained. The idea is that this approach can help the child generalize behaviors from a therapy setting to everyday settings.

In fluency building, the practitioner uses the ABA approach to help the child build up to a complex behavior by teaching each element of that behavior until it is automatic or "fluent". Then, the more complex behavior can be built from each of these fluent elements.

Finally, an ABA-related approach for teaching language and communication is called Verbal Behaviour (VB) (Skinner, 1957). “Verbal behavior plays a central role in most of the major aspects of a person’s life, and in the laws, conventions, archives, and activities of a society” (Cooper, Heron & Heward, 2007, p. 527). In VB, the practitioner analyzes the child's language skills, then teaches and reinforces more useful and complex language skills. Rather than focusing on the formal classical description of a word such as nouns, verbs and prepositions, VB views words as independent objects; there is a difference between saying words under different conditions. For example, there is a difference between saying “milk” because you want milk, compared to saying “milk” because you see a carton of milk. Indeed, it is proposed that just like any other behavior, language is a learned behavior that is acquired and maintained by environmental consequences, such as reinforcers.

Children with ASD have different learning styles, and therefore they are often less likely than other children to learn from their everyday environment. The ABA approach attempts to fill this gap by providing teaching tools that focus on simplified instructional steps and consistent reinforcement. In addition, the ABA approach can help children with ASD lead more independent and socially active lives. Research suggests that this positive outcome is more common for children who have received early intervention (Wong et al., 2014).

Although some controversies existed in the early practice of ABA in the 1980s, current ABA practices are regulated by strict guidelines that promote reinforcement techniques over punishment and aversive techniques.

The best prognosis for children diagnosed with an ASD is to follow an early intensive behavioural intervention (EIBI). There are three characteristics that compose an early intervention program. Firstly, it must be intensive (at least 20 hours a week with a 1:1 ratio). Secondly, the programs must be based on the principles of operant conditioning, and thirdly must utilize a developmental curriculum (Love et al., 2009).

EIBI has tremendous positive results:

• improved IQ (Dawson et al., 2009, p.17; Velazquez & Nye, 2011, p.2; Virues-Ortega, 2010, p.387);
• improved non-verbal IQ (Peters-Scheffer et al., 2010, p.1; Velazquez & Nye, 2011, p.2; Virues-Ortega, 2010, p.387);
• improved expressive and receptive communication (Peters-Scheffer et al., 2010, p.1; Velazquez & Nye, 2011, p.2; Virues-Ortega, 2010, p.387);
• improved adaptative behaviour (Dawson et al., 2009, p.17; Peters-Scheffer et al., 2010, p.1; Velazquez & Nye, 2011, p.2);
• improved socialization (Velazquez & Nye, 2011, p.2; Virues-Ortega, 2010, p.387); and
• overall improved everyday competencies (Peters-Scheffer et al., 2010, p.1; Velazquez & Nye, 2011, p.2; Virues-Ortega, 2010, p.387).

Another 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 behaviour can help reveal more effective reinforcement tools. In addition, those reinforcers constantly change as the individual changes. It is therefore a constant evolution and adaptation to provide individualized motivating reinforcers to each child.

There are no known negative effective of ABA. In addition, as opposed to many other offered therapies on the market, such as sensory integration therapy, restrictive diets, aqua-therapy, supplementary pills and many more, ABA is an evidence-based technique. In other words, research has found evidence that ABA programs lead to positive results for individuals with an ASD.

 

 

Resources

Baer, D. M., Wolf, M. M., & Risley, T. R. (1987). Some still-current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 20(4), 313–327.
http://doi.org/10.1901/jaba.1987.20-313

Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, NJ: Pearson. ISBN-10: 0131421131 or ISBN-13: 9780131421134

Love, J. R., Carr, J. E., Almason, S. M., & Petursdottir, A. I. (2009). Early and intensive behavioral intervention for autism: A survey of clinical practices. Research in Autism Spectrum Disorders, 3(2), 421-428.
http://dx.doi.org/10.1016/j.rasd.2008.08.008

Peters-Scheffer, N., Didden, R., Korzilius, H., & Sturmey, P. (2011). A meta-analytic study on the effectiveness of comprehensive ABA-based early intervention programs for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 60-69

Skinner, B. F. (1957). Verbal Behavior. B.F. Skinner Foundation

Velazquez, R., & Nye, C. (2011). Systematic review offers cautious support for positive effects from ABA-based early intervention programs for children with autism spectrum disorder. Evidence-Based Communication Assessment and Intervention, 5(2), 70-73

Virués-Ortega, J. (2010). Applied behavior analytic intervention for autism in early childhood: Meta-analysis, meta-regression and dose–response meta-analysis of multiple outcomes. Clinical Psychology Review, 30(4), 387-399
http://dx.doi.org/10.1016/j.cpr.2010.01.008

Yeargin-Allsopp, M., Rice, C., Karapurkar, T., Doernberg, N., & al, e. (2003). Prevalence of autism in a US metropolitan area. JAMA, 289(1), 49-55

Wong, C., Odom, S. L., Hume, K. A., Cox, A. W., Fettig, A., Kucharczyk, S., Schultz, T. R. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45(7), 1951-1966
http://dx.doi.org/10.1007/s10803-014-2351-z