Applied Behavior Analysis (ABA) is both one of the most common, and controversial, therapies used in the autism community. According to Psychology Today, ABA takes a research approach to therapy based on proven theories of learning and behavior. Therapists who use ABA understand how human behaviors are learned and how they can be changed over time.
What is ABA?
One of the pioneers of Applied Behavior Analysis was psychologist Ole Ivar Lovaas in the 1960s. Lovass’ early work using positive and negative reinforcement to change the behaviors of people that would self-injure lead to the development of ABA. This has evolved into today’s modern ABA therapy in which reinforcement is used to teach social skills, develop language abilities, and personal habits to individuals on the autism spectrum.
Applied Behavior Analysis involves many techniques for understanding and changing behavior. In a perfect environment, ABA should be a flexible treatment:
- That can be adapted to meet the needs of each unique individual.
- Provided in many different settings – home, school, facility or in the community.
- Teaches skills that are useful and beneficial to improving the quality of the individual’s daily life.
- Can involve one-to-one teaching or group instruction.
A certified behavior analyst (BCBA) designs and directly oversees the program. They start by determining which behaviors require change and creating a detailed assessment to customize the ABA program to each individual’s skills, needs, interests, preferences and family situation. This allows them to write specific treatment goals and expected outcomes. Family goals and preferences may be included, too.
Treatment goals should be written based on the age and ability level of the individual. Goals can cover many areas including:
- Communication and language
- Learning and academic skills
- Social skills
- Motor skills
- Self-care (toileting, showering, getting dressed, etc.)
- Play and leisure activities
The plan should break down complex skills into small, specific steps. The therapist then teaches the skill one step at a time, building onto the next until the final skill is accomplished.
The BCBA and therapists measure progress by collecting data in each therapy session. Data helps them to monitor the person’s progress and track improvement toward the goals on an ongoing basis. The length of time spent in ABA therapy depends on the severity of the problem and the individual’s rate of improvement and completion of goals.
No two ABA programs are alike however; this is where most of today’s controversy stems from. How ABA is taught varies between service companies and even therapists within the same company.
Some programs and therapists are very child focused and are flexible/child driven to work with what works best for the individual and some are more behavioral and data focused and completely miss the point by being to rigid and strict and do not modify to support the individual’s learning style.
Types of Children That Benefit From ABA
There are several different types of children that benefit from ABA:
- Children who highly struggle to follow directions.
- Children who are completely in their own world and do not interact with anyone.
- Children who need to learn a new skill (academic, social, play, attention, communication, motor, etc.).
- Children learning cause and effect of behaviors.
- Children who need help with aggressive behaviors.
Questions to Ask Before Selecting an ABA Center/Company
Just like each individual person is different from one another, so are ABA centers/companies. It’s important to find one that is a good fit for your child. Remember to trust your instincts!
There are several questions to ask prior to enrolling:
- Do you offer home-based or clinic-based therapy or both?
- How many BCBAs do you have on staff and are they licensed with the BACB and through the state?
- How many behavioral therapists do you have and how many will specifically working with my child?
- How do you determine goals for my child? Do you consider input from parents or therapists that work directly with my child?
- What is the turn over rate with the therapists?
- What does a typical ABA session look like? Does the schedule involve lots of table time or child lead play?
- How is progress evaluated and how much of the session does this take up?
- How often do you re-evaluate goals?
- How do you manage safety concerns?
- If your child has a specific behavior (give example) what would they do? (We want to see compassion along with consequence.)
- How do they respond to negative behavior in general?
- How open is the team to collaborating with other professionals?
- Can you be in the room at the same time? (this can help you observe what they do so you can replicate and also make sure you agree with how they are treating your child)
- What are their expectations for your child and are they realistic? (Many ABA programs expect more out of autistic children than typical kids including more sitting at table, total complying, total following, not having control.)
How ABA Works
ABA focuses on the ABC model of positive behavior support (PBS) when working to modify an individual’s behaviors. This helps a therapist/technician to understand why behaviors happen and are repeated and why a person behaves the way they do.
The ABC model is:
- Antecedents – what happens before a behavior. It is what “sets off” the target behavior.
- Behaviors – what is targeted for change. You will need to change either the antecedent or the consequence to change a behavior.
- Consequence – what happens after the behavior.
Positive reinforcement is one of the main strategies used in ABA. Positive reinforcement operates under the assumption that when a behavior is followed by a reward, a person is more likely to repeat that behavior and that over time, this encourages positive behavior change.
In many cases parents choose ABA therapy to “get rid” of unwanted/undesired behaviors. In many cases you can accomplish this goal without using positive reinforcement. There’s nothing wrong with positive reinforcement, but don’t say “do this to get your toy”, as they come to expect rewards. Eventually you will want to phase this out and it is easier to do if you don’t create a “do this to get this” action on a regular basis. Once the skill is learned start fading out the reinforcement so they will do it on their own without reinforcements.
Instead of starting with positive reinforcement, find out what may be causing the unwanted/undesired behaviors. Look at the events leading up to the behavior. See if you can find out what triggered the event. Many unwanted/undesired behaviors can be avoided by learning the trigger and avoiding it or removing the individual from the environment/circumstance that leads to the behavior.
Best Ways to Ensure Your Child’s Success With ABA
Before placing your child in ABA check out the ABA centers closest to you. Look at reviews about them. Find out as much as you can about that center. Note any information about teaching styles, personalities, outcomes of past clients and see if they match the learning styles and environment of your child.
Not every center offers home based care, but if they do therapists recommend starting in the home first, if possible. It is definitely beneficial to have parents observe. When the parent sees something that works, they can carry this over into their routine and if the parent sees something that does not work, they can educate the team and find something that does work.
Find an ABA professional that models the desired behavior. Lauren Eskin Conley, SLP and former ABA therapist, advises that ABA therapists “need to MODEL MODEL MODEL. Going right to ‘do this’ and ‘touch this’ just isn’t natural.” Use the supports they already have in place. Use natural language, words and actions.
Find therapists (ABA, Occupational Therapists, and Speech Therapists) that work as a team with you to help your child and are willing to make adjustments as necessary and directed by the child. Conley says, “My best experiences with ABA (as an SLP) were when the BCBA was open minded and made adjustments based on my and the OT’s input. Parents who I work with who truly understand neurodiversity are able to make important adjustments in the home. Often, parents are wonderful for inserting what works for their child and not traditional methodology. The team is then a support for the family with parents guiding the goals and the processes, as it should be.”
Home Based Vs Center Based
In home ABA means more opportunities for parents to learn, observe and give input. It can help you see what works in your home and how you can use what you are learning. However, there are challenges at home such as environmental distractions. Also it could create stress in the child’s home, which is their “safe place.”
Center based ABA can be good with social groups (if offered). It is more of a school like feeling and is a more structured environment. The challenge with this is that it is easier do the same thing over and over with each person rather than focus on what works for a particular individual and parents can’t easily give input or even in some cases be in the same room.
In many cases starting with in home ABA and then transitioning to center based may be the best option, after making sure it is a good fit for your child.
Warning Signs or Things to Avoid
Sometimes you will find technicians who are “By the book” or “My way or the highway” in their style. These technicians can actually make a behavior worse. You need a therapist who will work with the family and the individual who isn’t just focused on what they can easily measure, but what can achieve the desired goal. Conley recommends watching out for responses like “we can’t take data using that more child-centered approach so we aren’t going to do it” or “I’m following the behavior plan.”
Kids are people, and we would never respond to people in a single static way. It depends so much on what is happening in the specific circumstance. Don’t be afraid to switch out the people working with your child. There are awesome people and there are those that aren’t looking at the big picture.” Find someone who is a good fit for your child.
Conley suggests, “Try not to use food or tablets as reinforcements or requiring a behavior that does not match the result (“say ‘cheese’ and I will give you a sticker”) or overusing reinforcements to motivate communication (we communicate because it is intrinsically motivating not because we need a prize).”
Signs of a Good ABA Therapist
Selecting the right ABA therapist is critical to success. You need to find someone who can work with your child, who understands their learning style and communication style. Some signs of a good ABA therapist are:
- Giving the individual lots of time to respond.
- Wanting the individual to succeed.
- Planning goals and being clear with the plan.
- Creating visual resources to support the family.
- Seeking family input to get information about the individual (likes, dislikes, triggers, learning style, communication style, etc.)
- Hand on assistance in difficult moments (potty training, outings).
- Understanding that routine and consistency is important.
- Willing to try something different.
- Knowing when an individual just needs a nudge and how to best apply them.
How Long Should ABA Last?
The time and the duration varies based upon the child and what the family hopes to accomplish from ABA. However, ABA may not need to last as long as it is typically recommended. Many success stories about children who have used ABA are from parents whose children started talking or are finally following instructions.
This is because these kids needed complex concepts broken into smaller pieces. However, to create independent children and adults, ABA needs to shift its focus from “you do what I say” to “let me guide you to be successful”. Once the child has mastered the goal, I would suggest pausing services and restarting only if necessary. The key is to transition kids into a more natural environment with assists if needed.
ABA Controversy
As with anything, there can be good and bad experiences with ABA. Many times I’ve heard people people say “all public schools are horrible,” however walk just down the street, and ask another person what they thought of public schools and they would rave about their child’s school. Every person’s experience is unique.
With ABA it seems you could ask 10 people the same question and get 10 different answers. Many people have wonderful experiences with ABA therapy and it has helped their child be successful. However, many other people have had some terrible results with some even experiencing PTSD symptoms.
As you might expect given some of the previous comments, not everyone has had a good experience with ABA. We want to share some of those as well, including what to look out for to see if your clinic and technician will be a good fit.
Can ABA cause PTSD?
In some cases, it could. It all depends on the therapist working with the child. If you have a therapist who demands compliance at all costs, this could trigger PTSD.
One article I read described how a child was in ABA due to elopement from a classroom. The child felt like the ABA therapist is always hovering over them, making them feel like the therapist is always watching and waiting for them to run away. The child felt overwhelmed in an already noisy classroom. So the child starts pacing, trying to calm themself. However, the therapist demands the child return to their seat, because that’s what the goal is.
Now the child may have been able to self-soothe and return to their seat on their own in a few minutes, however the therapist saw this as undesired behavior and intervened. Instead, it escalated into fight or flight reflex and the child tried to run away. The therapist stood in the way and block them causing further escalation and may even drag the child back to their seat. This resulted in a full blown meltdown.
Now imagine this over and over every day. Had the therapist realized that the child was being overwhelmed by the noise, they could have solved the problem – taking the child out of the room for a few minutes to calm down or given her headphones. But the therapist was too focused on the plan and not the child. Situations like this is where someone could start to experience PTSD because the therapist fails to do what is best for the child.
The best thing you can do is to research any facility and person who will be working with your child on ABA. Look up reviews, ask questions, try to make sure you are in the room, make sure you tell them your child’s triggers and best coping methods. Minimize the risk. If you are not comfortable with what you learn, follow your gut and look for a different facility or treatment. Look at works best for your child. Make sure personalities and learning/teaching styles are a good fit for your child. Don’t be afraid to ask for someone different, stop the therapy or decide not to start ABA.
The End Goal of ABA
Good ABA programs for autism are not “one size fits all.” ABA should not be viewed as a specific set of skills to be measured, accomplished and recorded. Rather, that each program should be designed to meet the needs of the individual.
The goal of any ABA program should be to help each person work on skills that will help them become more independent and successful in the short term as well as in the future.
