What Is ABA (Applied Behavioral Analysis) Therapy for Autism?

ABA can teach skills and change behaviors.

ABA Therapy Session
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ABA is short for Applied Behavioral Analysis, and it is often described as the "gold standard" for autism treatment. Applied Behavioral Analysis (ABA)is a system of autism treatment based on behaviorist theories which, simply put, state that "correct" behaviors can be taught through a system of rewards and consequences (or, more recently, rewards and withholding of rewards). One definition of the technique describes it as follows:

  • Applied - principles applied to socially significant behavior
  • Behavioral - based on scientific principles of behavior
  • Analysis - progress is measured and interventions modified

History of ABA

Dr. Ivar Lovaas, a behavioral psychologist, first applied ABA to autism at the Psychology Department at UCLA in 1987. He believed that social and behavioral skills could be taught, even to profoundly autistic children, through the ABA method. The idea was (and is) that autism is a set of behavioral symptoms which can be modified or "extinguished." When autistic behaviors are no longer evident to the observer, the assumption is that the autism itself has been effectively treated.

When he first began using ABA, Lovaas had no hesitation about employing punishments for non-compliance, some of which could be very harsh. This approach has been modified in most situations, but it is still in use in some settings.

In general, however, "punishment" has been replaced by "withholding of rewards."  For example, a child who does not properly respond to a "mand" (command) will not receive a reward (reinforcer) such as a favorite food.

Whatever one's opinion about Lovaas's approach (and many people feel that ABA is both dehumanizing and inhumane), his idea turned out to be quite correct: many if not most children who receive intensive ABA training learn to behave appropriately at least some of the time -- and some even lose their autism diagnosis after years of intensive therapy.

Whether learning appropriate behavior is the same thing as "being cured" is, of course, a debatable question.

Over time, Lovaas's techniques have been studied and modified by therapists with slightly different visions of behaviorism. Techniques such as "pivotal response" and "language-based ABA" have become well-established autism treatments in their own right.

What Can Children Learn Through ABA?

Most of the time, ABA is intended to "extinguish" undesirable behaviors and teach desired behaviors and skills. For example, ABA may be used to reduce outbursts and tantrums or to teach a child to sit quietly, use words to make requests, or wait their turn in the playground. ABA can also be used to teach simple and complex skills. For example, ABA can be used to reward a child for brushing his teeth correctly, or for sharing a toy with a friend. 

While ABA can be used in a "natural" setting (a playground, for example), it is not intended to build emotional or social skills. So, for example, while ABA might teach a child to shake hands or greet another person with a handshake, it won't help that child to feel an emotional connection with another person. It takes an extraordinary therapist to use ABA for teaching academic content, imaginative or symbolic thinking, or empathy; as a result, those skills are usually taught in other ways.

How ABA Works

The most basic Lovaas method starts with"discrete trials" therapy. A discrete trial consists of a therapist asking a child for a particular behavior (for example, "Johnny, please pick up the spoon"). If the child complies, he is given a "reinforcer"or reward in the form of a tiny food treat, a high five, or any other reward that means something to the child. If the child does not comply, he does not receive the reward, and the trial is repeated.

It's important to note that the specific content of the discrete trials therapy is based on an evaluation of the individual child, his needs, and his abilities.

So a child who is already capable of sorting shapes would not be asked to sort shapes indefinitely for rewards -- but would focus on different, more challenging social and/or behavioral tasks.

The very youngest children (under age three) receive a modified form of ABA which is much closer to play therapy than to discrete trials. As they master behaviors, well-trained therapists will start to take children into real-world settings where they can generalize the behaviors they have learned and incorporate them into ordinary social experiences. ABA can also be used, in one of its many forms, with older children, teens, or even adults.

Is ABA Right for Your Child?

ABA is everywhere, it's often free, and it helps children with autism to use "expected" behaviors and control some of their more challenging impulses. These behavioral skills can make a big difference in how well your child manages school and social experiences.

But not every ABA therapist is well suited for the job, and not every child responds well to behavioral therapy. 

As with many approaches to autism, ABA is certainly worth a trial. Before getting started, however, be sure your child's therapist is trained, know how and where she will be working with your child, and work with your therapist to set up measurable goals. Keep a close eye on the process and outcomes. 

Most importantly, be aware of your child's responses to the therapist and the therapy. Is she excited when she "gets to" work with her therapist? Is she responding to the therapist with smiles and engagement? Is she learning skills that are helping her in her daily life? If the answers are "yes," you're moving in the right direction. If not, it's time to reassess.

Sources:

Smith, T. et al. Efficacy of applied behavior analysis in autism. J Pediatr. 2009 Jul;155(1):151-2.

Granpeesheh, D. et al. Applied behavior analytic interventions for children with autism: a description and review of treatment research. Ann Clin Psychiatry. 2009 Jul-Sep;21(3):162-73.

 

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