Introduction

You may have heard the term ABA as it relates to Autism, but have may have no idea what it means.  In this article, we cover what ABA, or Applied Behavior Analysis, is, as well as what ABA therapy looks like for Autism.  Because ABA can be applied to any behavior, it is used in a variety of contexts.  One of the most common is in working with individuals with Autism Spectrum Disorder.  While ABA therapy for Autism involves the application of the same basic ABA principles, ABA therapy for Autism is unique.  If you are considering ABA therapy for your child with Autism and want to know what to expect, we will cover that below.      

What is ABA, anyway? (or jump to “What is ABA therapy for Autism?“)

ABA, or Applied Behavior Analysis, is the science studying behavior change.  Behavior Analysts apply behavior principles to create socially significant changes in behavior and analyze measured data to monitor that behavior and make decisions regarding interventions.  I know- a lot of lingo.  So, what does that mean?  Let’s break it down with some basics first:

The Basics of ABA:

The 3-Term Contingency:

Surrounding all behavior are an antecedent and a consequence.  The antecedent is what comes immediately before the behavior, and the consequence is what immediately follows the behavior.  Thus, forming the 3-term contingency: Antecedent-> Behavior-> Consequence.  Changing the antecedents and consequences changes the behavior.

The Consequence:

The consequence plays a major role here, because the consequence that follows the behavior determines whether that behavior will increase or decrease in the future.  Example: If I get a cookie following my behavior of washing the dishes, I am more likely to wash the dishes in the future.  However, this also holds true if I were to get a cookie following my screaming for a cookie.  I’d be more likely to scream the next time I wanted a cookie.

Reinforcement:

The consequence that increases the likelihood of the behavior occurring in the future.  Think of structural reinforcement of a building.  The purpose is to strengthen the building.  Reinforcement of behavior is basically strengthening behavior, increasing the probability of it occurring again in similar situations.  We use reinforcement following behaviors we want to see more of, for instance, when teaching new skills.  Reinforcement is also operating in challenging behaviors.  Something is keeping this behavior going, and we need to know what that things is.  We call this the behavior’s “function”.

The Functions:

We all engage in behavior for a reason.  In ABA, we refer to this as the “function” of a behavior.  This basically means the purpose this behavior is serving.  We ask for things in order to get them.  We take a drink to quench a thirst.  Challenging or maladaptive behaviors, such as those exhibited by children with Autism, also have functions, fundamental to establishing behavior change. There are 4 main functions of behavior:

  • Access: The behavior results in gaining access to something. Example: I see a cookie- I scream- I get the cookie
  • Attention: The behavior results in gaining attention. Example: I don’t have mom’s attention- I hit my sister- I get mom’s attention (in the form of a reprimand)
  • Escape/Avoidance:The behavior results in an escape or avoidance of something. Example: I’m playing soccer- I fake an ankle injury- I get out of playing soccer.
  • Automatic: The behavior is not mediated by social consequences.  (I don’t need anyone else to get what I want). In children with Autism, these are often behaviors with a sensory component or referred to as self-stimulatory behaviors.Example: I don’t have enough visual stimulation- I wave my hand in front of my face- I have visual stimulation.

Behavior Change:

In order to change behavior, we must know the function of the behavior.  We use this knowledge to make decisions regarding modifications we’ll make in the environment to change the behavior.  For instance, let’s say my child with Autism often throws things during homework, and I send him to his room.  While getting sent to his room may feel like a punishment, if the purpose of his throwing behavior is to get out of doing homework, I am reinforcing this behavior by sending him to his room.  Once I determine that escape is the function of this throwing behavior, I may change the consequence by no longer letting him escape, i.e., continue doing homework.  I would also want to change the antecedent to make it less likely that he will throw.  For instance, I might break the homework down into only 3 problems at a time or offer to help.  One more piece of this puzzle is teaching replacement behaviors.  What can I teach him to do instead of throwing that achieves the same results?  In this instance, asking for a break or to be “all done” might be good alternatives.

Teaching new skills:

These same principles of behavior change pertain to teaching new skills.  A new skill involves a behavior we want to increase.  For instance, if working on a child with Autism answering social information questions, such as, “What’s your name?”, the behavior we want to increase is stating one’s name in response to the question.  We may use slightly different language in talking about it, but the foundation is the same.

What behavior?

Only those behaviors which will have a significant impact on an individual’s life.  For instance, if an individual with Autism engages in frequent screaming, it becomes difficult to interact with others socially.  Behaviors around language and communication are also vital for accessing one’s environment.  We do not change any old behavior because we feel like it.

Data:

Behavior Analysts, or the technicians working with them, collect data to monitor behavior. This may look something like tracking the number of times kicking occurs in an hour or calculating the percentage of correct responses to a question.  It is necessary to see objectively what’s happening and if the interventions are working.  We use these data to design and revise our interventions.

So, what does ABA mean again?

Behavior Analysts use the function of a behavior to determine how to alter the antecedents and consequences in order to change a behavior that will impact an individual’s daily life in a meaningful way.  We collect data on these behaviors over time and make decisions about our interventions based on these data.

What is ABA therapy for Autism?

The Basics of ABA therapy for Autism:

Children with Autism Spectrum Disorder (ASD) generally have skill deficits, as well as challenging behaviors.  As such,  ABA therapy for Autism is focused on:

  1. Teaching new skills
  2. Decreasing challenging behaviors

Skills taught are typically derived from areas of:

  • Communication and Language
    • Signing for water, asking to use the bathroom, having a conversation, following instructions
  • Daily Living Skills
    • potty training, dressing, grooming, eating
  • Play Skills
    • Independent play, organized social games, pretend play
  • Motor Skills
    • Gross motor: jumping, running, climbing
    • Fine motor: writing, buttoning, tying

Challenging Behaviors May Include:

  • Hitting
  • Biting
  • Kicking
  • Spitting
  • Crying
  • Screaming
  • Eloping (running away)
  • Pica (Eating inedible objects)
  • Self-Injury

Less stressful behaviors may also be targeted in ABA therapy for Autism, such as routine oriented actions of lining up objects or repetitive actions like hand-flapping.  While these behaviors may not seem like a big deal, we may work on decreasing them if they impact the ability of a child with Autism to interact with his or her environment.

What to Expect:

ABA therapy for children with Autism Spectrum Disorder can be conducted in a variety of settings.  Most programs focus on services in the home, clinic, school, or community.  Often, a combination of settings is appropriate.  While there are many great school programs offering ABA services, it may also be necessary to receive in-home services, both for more individual attention and for the education of parents and caregivers.

The People Involved in ABA Therapy for Autism:

Most in-home and in-clinic ABA therapy programs for  Autism follow the model below.

Therapist or Registered Behavior Technician (RBT): (Depending on the service provider, this person may have a variety of titles.)

  • Education level and degree depends on place of employment and funding source.
  • A therapist comes to the home to work directly with the child, parent, or other family members.

The Supervisor:

  • Education level and degree depends on place of employment and funding source.
  • The Supervisor creates programs and curriculum for the child and supervises the therapist.
  • The Supervisor typically comes to the home 2-4 times per month (depending on number of therapy hours) and should be meeting with the parents and caregivers to provide training and discuss goals and any concerns.

The BCBA (Board Certified Behavior Analyst):

  • Has a Master’s degree in ABA or related field, has met experience requirements, and has passed the certification exam through the Behavior Analyst Certification Board (BACB)
  • The BCBA may act as the supervisor or may oversee the supervisor, depending on the model.
  • The BCBA also analyzes data to make intervention changes.

A school setting would look a bit different, in that there is a teacher and usually classroom aides or paraprofessionals who work more directly with the student.

Format of ABA Therapy for Autism:

Treatment and training procedures for ABA therapy can take a variety of forms.

DTT (Discrete Trial Training):

  • More structured format
  • The therapist and child may sit at a table
  • Discrete learning trials are repeated for mastery
  • For instance, if working on teaching a child to label an item based on seeing a picture of that item, the therapist may hold up a picture of a dog and ask: “What is it?” or “What’s this?” and the child would answer “dog”. This process would be repeated until the child was independently labeling dog.

NTAs (Naturalistic Teaching Approaches):

  • Incidental Teaching, Pivotal Response Training, and Natural Environment Training are examples of Naturalistic Teaching Approaches
  • Learning occurs in a less structured, more natural way
  • An example of Natural Environment Training may be the child and therapist making cookies. If the child were working on labeling actions, asking for missing items, and retrieving objects, the activity may include:
    • The therapist asking, “What am I doing?” while stirring the dough (labeling actions)
    • Therapist asking, “Can you get me a spoon?” (retrieving objects)
    • The child requesting a towel to wipe hands after getting them sticky from the dough.  (asking for missing items)
    • The end of the activity would have a natural reinforcer in eating the cookies.

Both DTT and NTA’s can occur in the same child’s ABA therapy program.  Some skills need to be taught in a more structured format first and can later be generalized to a more natural setting.

What happens in an ABA Therapy session:

Teaching Skills:

The therapist runs a variety of programs designed by the supervisor or BCBA. They should try to incorporate parents or family members as much as possible.  After all, parents and family members are the ones around the child the most.  It is important that the child with Autism learns to respond the same way to family members, but this is also time for caregivers to learn how to best help their child.

Regardless of format, therapists should be engaging for the child.  All providers operate a little differently with regard to activities and reinforcement.  Some therapists are expected to bring the materials to session, and others may ask to use what is available in the home.

Managing Behavior:

In addition to running programs, the therapist implements a Behavior Plan created by the Supervisor or BCBA.  The plan should be communicated to the parents and implemented with their consent.  Behavior management is an area where families may need the most help, so it’s also important for the supervisor to conduct parent education sessions.

Recording Data:

When teaching skills and implementing behavior plans, therapists record data throughout the session.  Sometimes this is done on paper and others use tablets or iPads to record electronically.  This should be done quickly and discretely throughout session, so as not to interrupt the child’s learning.

ABA Program Overview:

When starting with a new ABA agency, the supervisor or BCBA will conduct an assessment of the child’s current skills and any challenging behaviors he or she may have.  A report is usually submitted to the funding source (insurance or other) and upon approval, a treatment plan is created.  The treatment plan includes goals for skill deficits and challenging behaviors, as well as programs designed to target those goals.  This should be shared and discussed with the parent before beginning treatment.

Data is collected during each ABA therapy session.  The supervisor or BCBA analyzes that data to make ongoing programming decisions.  The data is also reported to the funding source at the end of the reporting period.  This time frame can vary from 3-6 months.  As goals are met, new goals are introduced.  In addition to being a necessary tool for the supervisor to make intervention changes, data collection is a quantifiable way for parents to track the child’s progress.

The goal/ the end game:

To instill as much independence as possible.  Each goal that is met with a therapist should also be generalized to other people, stimuli, and settings to ensure that the child with Autism is able to demonstrate the skill in his or her natural environment.  As children progress, evidenced by data and assessment results, services will be faded over time.

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