Can Applied Behavior Analysis (ABA) Cure Autism?

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picture card. Erik Dreyer

ABA, or Applied Behavior Analysis, is a technique used for treating autism. Originally developed by Dr. Ivor Lovaas, it was -- and in some situations still is -- essentially a form of reward-and-punishment for specific behaviors. Some uses of ABA have involved real cruelty.  In the last few decades, however, ABA has been transformed. In the vast majority of situations, rewards are given or withheld, but no punishment is administered for "bad" behavior.

During the early days of ABA, behavioral therapy was almost always provided in a 1:1 situation, outside of a natural setting. Today, ABA therapists are more likely to use ABA techniques in a typical situation such as a classroom or home. In addition, many new forms of behavioral therapy have emerged that have elements in common with play therapy and developmental therapies.

If you read the web, you'll almost certainly find ABA described as the "gold standard" for autism treatment. You may also read that children with ABA "recovered from" or were "cured" of autism.

Are these claims of recovery and/or cure really accurate?

Dr. Lovaas himself, in the year 2000, wrote a paper entitled “Clarifying Comments on the UCLA Young Autism Project.” In it, he discussed the difference between the use of the word “cure” and “recovered.”

He states, "The term 'cure' implies removal of the original cause of the problem and because the cause of autism is unknown, claiming a cure would certainly be unjustified and unethical. In contrast, it is possible to enable a child with autism to achieve normal functioning without finding a cure for autism, just as it is possible for a physician to recover patients to normal functioning without having found a cure for their illness. Hodgkin’s disease is a case in point."

ABA teaches behaviors considered to be appropriate to the culture into which an autistic child is born. Using ABA, a therapist (or parent) can teach skills ranging from tooth brushing to language use. By using ABA techniques in naturalistic settings, social skills therapists can help youngsters with autism to behave appropriately in a playground, ask and answer questions, and so forth.

But while intensive ABA may be able to teach young autistic children to behave in ways that are "indistinguishable" from their same age peers, ABA does not change the reality that those children are autistic. Behaviors that are natural to children without autism must be taught, step by step, to autistic children -- and reinforced over and over again.

Even when very young children with autism have been taught, through ABA, to behave in certain ways with same-age peers, they may need to re-learn behaviors as they grow older. Appropriate behavior for a five year old is completely inappropriate for an eight year old -- and social and academic demands grow increasingly complex.

It is unlikely that a child with autism who was correctly diagnosed and who appears to be "recovered" at age five will have no further need for autism-related therapy as he or she grows older and confronts the increasingly complex expectations that will be placed upon them.

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.

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.

Lovaas, O. I. (2000). Clarifying Comments on the UCLA Young Autsim Project. University of California, Los Angeles. Department of Psychology.

McEachin, J. J., Smith, T., & Lovaas, O. I. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal on Mental Retardation, 97 (4), 359-372.

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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