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Everything You Need to Know About ABA for Autism

by Shea Brogren, MOT, OTR/L October 28, 2019 2 Comments

Everything You Need to Know About ABA for Autism

Applied behavior analysis (ABA) is a field of study that stems from the theory of behaviorism. Behaviorism is based on the idea that human behavior can be changed or altered through conditioning (ex: rewards and consequences). ABA therapy is an extension of this, as it focuses on using techniques to alter behavior patterns. It is one of the most common interventions used for children with autism.

In this article, we will provide an overview of ABA therapy and discuss how this field of study applies to children with autism and their families. 

What is ABA therapy? 

The phrase ABA stands for applied behavior analysis, meaning that this discipline focuses on understanding how humans learn, how behavior is impacted by the environment, and how the learning process and the environment affect behavior.

ABA therapists use this knowledge to increase helpful behaviors and decrease unhelpful or harmful behaviors. 

Who are ABA therapists?  

There are three levels of training that one could pursue to be involved in ABA therapy. They are highlighted below. 

A BCBA (Board Certified Behavior Analyst) has the highest level of training in the ABA field. A person with a BCBA credential has completed a master's degree in another discipline, typically psychology, counseling, or social work. They also must complete additional, supervised training specifically related to providing ABA services. They are the only professionals in the field of ABA allowed to complete the functional behavior analysis assessment, which helps determine the focus of the behavior modification plan. 

ABA TherapyAnother credential you may encounter in the ABA world is a BCaBA (Board Certified Assistant Behavior Analyst). These individuals work under the supervision of a BCBA and have an undergraduate degree in a related field. BCaBAs can assist with tasks delegated to them by their supervising BCBA. 

In some states, you might also come across the designation RBT (Registered Behavior Technician). These individuals have earned a certificate (high school diploma is required first) and can assist with carrying out parts of a developed behavior modification plan and have earned a certificate as an RBT. They must work under the supervision of a BCBA or a BCaBA. 

What does ABA therapy look like? 

In ABA therapy, a BCBA will complete a thorough analysis of a child’s behaviors in order to develop a behavior modification plan. This assessment is called a Functional Behavior Analysis. Each plan is unique according to the child’s needs and involves one-to-one teaching.

ABA is effective at analyzing a child’s problem behaviors and what might be reinforcing the behaviors in the environment, causing them to be maintained. For example, an ABA therapist might examine a child’s emotional meltdowns and how the environment responds to those to either make them worse or better. 

Once a plan is developed, it can be implemented. An important piece of a behavior modification plan is ensuring that important people in the child’s life such as parents, caregivers, relatives, teachers, etc. receive training and can assist with supporting skill practice and reinforcement.

A behavior modification plan is most effective when the target skills can be practiced and reinforced multiple times per day, in a variety of settings. A recent study outlined 27 evidence-based strategies used in ABA therapy. Next, let’s look at some of the most common strategies an ABA therapist will use to develop and implement behavior modification plans. 

Antecedent, Behavior, Consequence (ABC) 

One of the fundamental methods an ABA therapist uses is analyzing the antecedent, behavior, and consequences of a given behavior. This means determining what occurs right before the behavior, then analyzing the behavior that occurs, and evaluating the outcome of that behavior. Here is an example below: 

ABA for autismA student is working on an assignment in class. The student is concentrating very hard, hoping to complete the work in the allotted time. The teacher then announces to the class that time is up and the students must put their work away in order to transition to the next activity. The student hears this and throws his paper across the room and begins to clench his fists. When the teacher notices this, she tells the student that he needs to calm down and asks him to move to the back of the classroom. 

Let’s take a look at the ABCs in this situation: 

  • Antecedent- The antecedent in this situation would be the teacher announcing that time is up and it is time to transition to a new activity. 
  • Behavior- The behavior is that the student throws his paper and starts to clench his fists. 
  • Consequence- The consequence is that the teacher asks him to calm down and move to the back of the room. 

If this behavior occurred on a regular basis and was becoming a problem behavior, this is where ABA therapy might come into play. The ABA therapist would use this method to determine the best way to modify the behavior. 

Reinforcement

In general, reinforcement involves either taking something away or providing a reward or positive experience after a behavior in order to increase the likelihood the behavior will occur in the future. In ABA, both positive and negative reinforcement is used as an intervention method.

First, let’s discuss positive reinforcement.

positive reinforcement

Positive reinforcement means that after the desired behavior is performed, a motivating or positive reward is provided to the person in order to promote that behavior occurring in the future. In the ABA process, the ABA therapist would identify a target or goal behavior and each time the child carries out the behavior successfully, a reward is given. The reward must be something that is motivating to the child and could include a special toy or video, providing praise, taking the child to a desired area or room, etc.

 

Below are some additional examples of positive reinforcement: 

  • A teacher gives a student praise after receiving a favorable score on a test. 
  • A child is given his $5 allowance after completing his chores. 
  • After cleaning up his toys, a child and his mother engage in one of the child’s favorite/preferred activities. 

In each of these scenarios, the desired behavior is being rewarded, which will increase the chance the child will continue to engage in the behavior. 

Next, let’s look at negative reinforcement.

Often, the term negative reinforcement is perceived as giving a punishment, however, this is not the case.

Negative reinforcement means removing or taking away a stimulus that is uncomfortable or unwanted.

Over time, the goal is that the targeted behavior will increase because the negative, unwanted, or uncomfortable stimuli are taken away. For example, during work time at school, a child might be bothered by a perceived high pitch noise in the classroom. In order to help with this, the teacher provides a pair of noise-canceling headphones. When the child puts the headphones on, they no longer hear the noise and therefore are no longer bothered and upset.

In this situation, removing the unwanted stimulus (high-pitched noise) will increase the target behavior of completing classwork at the designated time. 

Other Common Strategies

Below is a condensed summary of some other common strategies used in ABA therapy. Keep in mind this is not a comprehensive list, just a brief overview.

Modeling: demonstrating the expected behavior to the individual 
Prompting: providing a reminder or cue to help the individual learn the desired behavior
Redirection: involves noticing an undesired behavior and directing the individual to a more appropriate or desired behavior
Discrete Trial Training: breaking down behaviors or tasks into smaller units to help with learning new skills 
Scripting: providing a script or expectation to the individual, so they can anticipate what will occur

A well-developed behavior modification program will include objective, measurable target behaviors. These behaviors should be reassessed on a determined basis.

Each behavior in the plan is broken down into parts so that all members of the team understand the behaviors and progress can be easily monitored. 

ABA and autism spectrum disorder

According to the American Psychological Association, ABA is considered an evidence-based practice for individuals with autism.

This means that there is sufficient research indicating that ABA is a helpful, effective intervention for people with autism. Numerous studies have shown that intensive ABA therapy can help improve skills such as language development, daily living skills, and social skills for children diagnosed with autism.

Most ABA programs require 20-40 hours a week of intense therapy and the therapy process can last anywhere from one to three years. This intensive therapy has been shown to provide the most positive outcomes, especially when it is started before the age of five. However, the intensity and duration can be difficult for some families to maintain, therefore this needs to be considered before pursuing ABA therapy. 

ABA and collaboration with other disciplines 

There are well-established positive outcomes for the use of ABA therapy for individuals with autism, however, it is always important to remember that the most effective treatment plan is a comprehensive one, that offers a collaborative approach amongst different disciplines. This will ultimately provide the best outcomes for children receiving any type of services.

For example, a child with autism will likely have an occupational therapist, speech therapist, and psychologist or psychiatrist on their treatment team.

play based therapy

An OT will likely address any sensory issues, emotion regulation, social skills, activities of daily living,  etc. A speech therapist is likely to address language or speech delays and communication skills. A psychologist or psychiatrist should be generally overseeing the child’s treatment plan and additional treatment which may include family and individual therapy or counseling, medication management, and skill-building.

ABA is often an important part of this treatment plan and should be offered in conjunction with other needed services. 

 

Closing Thoughts

ABA therapy is one of the most commonly used interventions for children with autism. Research has shown it can be effective at altering difficult to manage behaviors. It is important to remember that a behavior modification plan should be individualized to each child’s needs, include the parents and other significant individuals, and be mindful of the child’s interdisciplinary treatment plan and goals for the best outcomes.

We hope this article highlighted how ABA can be a helpful tool to assist with analyzing behaviors and developing potential solutions. 

 


References

Dawson, G. (2011). Behavioral interventions in children and adolescents with autism spectrum disorder: A review of recent findings. Current Opinion in Pediatrics, 23. 

Linstead, E. et al. (2017). An evaluation of the effects of intensity and duration on outcomes across treatment domains for children with autism spectrum disorder. Translational Psychiatry, 7 (9). 

Shea Brogren, MOT, OTR/L
Shea Brogren, MOT, OTR/L

Shea Brogren, MOT, OTR/L, is an occupational therapist with over three years of experience in pediatrics and child/adolescent mental health and has also worked as an adjunct lecturer at the University of North Dakota. Shea has a special interest in program development and developed and implemented occupational therapy programming at a residential treatment center for children. She now practices in an outpatient setting.

Her primary area of interest involves working with children who have experienced developmental trauma. Shea has advanced training in SMART treatment (Sensorimotor Arousal Regulation Treatment), the Zones of Regulation, using sensory-based interventions to address trauma, infant mental health, attachment, and arousal regulation related to trauma disorders.


2 Responses

Nicole
Nicole

November 08, 2019

Hi Hartmut!

Thank you so much for reading our blog. I really appreciate your feedback and hearing about your view of ABA! It’s always helpful to see other’s perspectives.

All the best,
Nicole from Harkla

Hartmut
Hartmut

November 08, 2019

For me ABA is cruelty. It’s like training a dog and often results in leaving the children in miled behavior, because the natural behaviors like hand flapping in no more allowed and the child can’t use its natural behavior anymore, because it’s forbidden or changed so it’s not useful for it.
This is what I learned from a former patient and I see what desaster can be caused. It’s like the natural emotions are locked in and you don’t have a chance to regulate anymore.

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