Too High Functioning for Applied Behavior Analysis

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Is it possible for an autistic child to be too high-functioning for Applied Behavior Analysis (ABA)?

The answer is no -- and yes.

Why No One Is "Beyond" Behavior Modification

Behaviorism, in itself, is simply a way to teach a desired behavior by offering rewards for compliance (or consequences for non-compliance, though negative reinforcement has gone out of style in recent years). We use a behaviorist approach when we say "you'll get dessert if you finish your peas," or "you can go out with your friends if you clean your room."  Workplaces use behaviorist techniques when they offer incentives for reaching specific goals.

Behavioral treatment is effective for many children with autism. The goal of behavioral treatment is to help children catch up to the skill level of typically developing peers. The program is individualized to incorporate areas of strength and areas of weakness specific to each child. Therefore, even high-functioning children can benefit from behavioral treatment.

Why ABA May Not Be Offered In a Way That's Right for Your Child

ABA is a therapeutic approach to teaching children with autism.  As such, it is often offered in the context of an "autism classroom" which specifically serves children with relatively severe symptoms. Most children who spend their days in an "autism classroom" spend little or no time in the general education setting. If you have a high functioning child who is intellectually and behaviorally capable of learning in a general education classroom, the "autism classroom" is likely to be a poor fit.

 ABA may also be offered in a one-on-one setting. This can be very helpful for a child who is learning very basic skills or who is not yet able to engage with peers on a playground or in another typical setting. For a higher functioning child, however, ABA should be offered in a "real world" setting.

If ABA therapists are unable or unwilling to work with your child in a natural setting, ABA may be a poor fit.

According to the Lovaas Institute and many ABA providers, ABA should be offered for many hours a week (40 hours is the "ideal").  At this level of intensity, it is literally impossible for a child to also take part in anything other than therapy outside of school. No sports, no music, no down time -- unless an ABA therapist is actually working with the child during his or her after school activities. If you have a child who is capable of taking part in typical activities, and ABA would make those activities impossible, ABA may be a poor choice.

How ABA Should be Customized for a Higher Functioning Child

The Lovaas Institute, which specializes in (and pioneered) ABA for autism, offers this information:

In general, there is little data available in peer-reviewed, research articles that compare outcomes of behavioral treatment for “low-functioning” and “high-functioning” children. Regardless, the following points should be made:

  • The goal of behavioral treatment is to help children catch up to the skill level of typically developing peers. Behavioral treatment is not just a program to teach a child to speak, or request, or label objects. It is a comprehensive program that also deals with teaching complex behaviors and social skills such as recognizing facial expressions and non-verbal behavior of others, development of cooperative social behavior, verbalizations of empathy, and conversing with peers on a variety of topics rather than a restricted range of interests.
  • Behavior therapy may look very different for a “low-functioning” and “high-functioning” child with autism. In addition to discrete trials, other behaviorally sound procedures such as incidental teaching, video modeling, and generalization in the natural environment may be more strongly emphasized.
  • Behavioral therapy attempts to help a child so that he can learn in less structured settings in the future (for example, in peer groups). However, even in these less structured settings, the principles of applied behavior analysis are often key to a child’s success. Some of these principles include: 1) defining measurable behaviors for change, 2) investigating the function of inappropriate behaviors, 3) reinforcing appropriate behaviors, and 4) measuring progress routinely.

In summary, parents who dismiss behavioral treatment because they are told their child is already “high-functioning” may miss out on an effective intervention. A reputable organization that specializes in behavioral treatment for children with autism should be able to assess a child and then discuss with the parents specific objectives and teaching strategies based on their child’s particular strengths and needs. Parents can then decide on the appropriateness of behavioral treatment for their son or daughter.

Sources:

Cohen, Howard, Amerine-Dickens, Mila, Smith, Tristram. (2006). Early Intensive Behavioral Treatment: Replication of the UCLA Model in a Community Setting. Journal of Developmental & Behavioral Pediatrics, 27 (2), 145-155.

Downs, Andrew & Smith, Tristram. (2004). Emotional Understanding, Cooperation, and Social Behavior in High-Functioning Children with Autism. Journal of Autism and Developmental Disorders, 34 (6), 625-635.

Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.

Smith, T., Groen, A. D., Wynn, J. W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal of Mental Retardation, 105, 269-85.

Sallows, Glen O. & Graupner, Tamlynn D. (2005). Intensive Behavioral Treatment for Children with Autism: Four-Year Outcome and Predictors. American Journal on Mental Retardation,110 (6), 417-438.

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