When my now five-year-old son was first diagnosed with Autism Spectrum Disorder, we immediately enrolled him in a thirty hour per week Applied Behavior Analysis (ABA) program. Our family was in chaos and all the research I had done and experts in the field I had spoken to pointed us to ABA. In the years since, I’ve seen confusion over what ABA is as well as heard negative comments surrounding it. While I can’t speak for everyone’s experience, I can speak for my own and ABA has been life changing for not only my son, but our entire family.
What is Applied Behavior Analysis?
Applied Behavior Analysis, or ABA, is the term used to describe specific behavior change techniques used primarily with children on the autism spectrum. The techniques include the use of positive reinforcement, repetition, and behavior replacement to help children on the spectrum increase communication, increase independence, increase positive social interaction as well as to decrease maladaptive behaviors such as aggression, self-injury, eloping and tantrums. ABA therapy can be done in a center, in the client’s home, in school or in the community.
What Types of Specific Skills are Targeted in Applied Behavior Analysis?
Most children organically learn appropriate communication, social and behavioral skills. Skills such as introducing themselves to a new person, taking turns when playing a game with a peer and waiting for a snack if mom is busy washing dishes. But children with autism, which is a developmental disability, may need direct instruction in skills such as these:
- Tolerating items being removed
- Tolerating waiting for preferred items
- Tolerating being told no
- Transitioning from a preferred activity to a non-preferred activity
- Transitioning between locations
- Getting attention appropriately
- Participating in group activities
- Sharing with peers
- Responding to peers
- Eating independently
- Toileting independently
- Appropriate verbal and/or nonverbal communication
- Developing gross and fine motor skills
How Does the Therapist Determine Which Skills a Child Needs?
Prior to a child beginning ABA therapy, a Board Certified Behavior Analyst (BCBA) will collect input from the family and conduct several thorough assessments. This can last several sessions. These assessments may cover areas such as independent functioning and life skills, executive functioning skills, adaptive skills, verbal and nonverbal communication, fine and gross motor, cognition and social-emotional development. During these initial assessments therapists also work to uncover what the child is highly motivated by so they know what to use as reinforcement during therapy, such as favorite snacks, toys or games.
What Happens in an Applied Behavior Analysis Session?
ABA is individualized for each child, but most ABA sessions have several similar components. Very detailed data is collected during each session and that data is used over time to adjust the child’s program.
At the start of each session, the therapist will begin by creating positive rapport with the client usually by doing something with the child they enjoy such as a playing a favorite game or playing with a favorite toy before requesting any work from them.
Discrete Trial Training
Discrete Trial Training (DTT) is used for skills the child has not mastered. These skills are taught in a direct-instruction setting by being broken down into small steps, taught in repetition (called mass trials) with positive reinforcement. For example, if a child is learning to write their name the therapist may first work to have have them recognize their name. Then to recognize the letters in their name. Then to trace the letters. Until eventually the child is writing it on their own. This could take weeks or even months. During each session, the activity is done multiple times and each time the client responds correctly reinforcement is given. Reinforcement can be things such as praise, a highly preferred snack or a token board towards a reward.
Social Skills, typically taught in a natural environment, are skills such as responding to, taking turns and sharing with peers and participating in group activities. For example, if the skill being taught is taking turns, the therapist may read a social story about taking turns with the child. Then play a board game with them that involves taking turns. Finally, pairing the child with a peer to practice taking turns playing the board game.
Self-Care/Daily Living Skills
Self-Care/Daily Living skills are what children need to be able to do to independently function in places such as school or a peer’s home as well as in their own home. These are skills such as getting dressed, independent toileting, hand washing and teeth brushing. As children get older they may be taught skills such as how to make simple meals or do laundry.
To help communication in children with autism, many therapists used what is called “mand training.” A mand is simply a request. Mand Training is based on teaching the client the principal of “want it, request it, get it.” The mand can be in the form of words, gestures, sign language, picture cards or communication devices. Over time the therapist increases the expectation. For example, if the child is only speaking in one word phrases, and requests juice saying, “juice,” the therapist may tell the client “Say, juice, please.” The mand will be honored when the child attempts to use the second word. Mand training gives children with ASD the tools to effectively communicate their wants well as improving social interaction.
Listener training means the therapist asks the child a question or gives a statement with a fill-in-the blank and they as the “listener” must respond. The types of questions are “tacting”, which is asking a child “what is this?” or “what do you see?” showing a picture of a common object or the object. Also intraverbals such as answering “wh” questions, “what do you use a towel for?” or “where do you take a shower?”
Children with autism may engage in maladaptive behaviors that don’t respond with redirection or positive reinforcement. Some of these behaviors can be dangerous such as self-injurous or eloping (leaving a safe and supervised area for an unsafe and unsupervised area). Therapists may use what is called the ABC’s of Behavior (antecedent, behavior, consequence). Based on the belief that all behaviors serve a function, therapists look to determine what that function is and adjust what happens before (the antecedent) and after (the consequence) the undesired behavior. This is a highly effective way to help children overcome challenging behaviors.
Gross and Fine Motor Skills
Gross motor skills and fine motor skills can be impaired in children on the spectrum for a variety of reasons such as sensory sensitivities, neurological problems, hand-eye coordination difficulties as well as issues with proprioceptive and vestibular functioning. If a client has deficits in any of these areas, the therapist will add activities in the treatment plan to target those skills. For example, if a child has gross motor deficits the therapist might do things such as practice throwing a ball back and forth, teach the client to ride a tricycle or bike, and sing songs such as Head, Shoulders, Knees and Toes and Freeze Dance. For fine motor difficulties, the therapist might have the child work on things such as stringing beads, coloring, writing and using scissors.
What Applied Behavior Analysis is Not
Applied Behavior Analysis is not severe abusive techniques meant to mask a child’s autism. The goal of ABA isn’t to morph an autistic child into a neurotypical child, because for one, that just isn’t possible. People with autism will always have autism. As it should be, neurodiversity is celebrated within the field of ABA. In the past, autism was a misunderstood condition, but modern research and science have uncovered much about how to help children on the autism spectrum thrive and Applied Behavior Analysis is one of the many tools that emerged.
How to Form Your Own Opinion
The best way to form your own opinion of ABA therapy isn’t Google. You will find articles to support any narrative you a looking to build a case for. Instead, go directly to the source:
- Speak to parents who have autistic children that are CURRENTLY in an ABA program
- Speak to CURRENT Board Certified Behavior Analysts
- Speak to CURRENT Registered Behavior Technicians
- Request a tour of an ABA Center in your area
The most important take away for you today is this, unless you have done ALL of the above you can not form an accurate opinion of Applied Behavior Analysis.
My Family’s Experience
Prior to ABA, my family was in shambles. My autistic son couldn’t communicate his needs which led to daily meltdowns and aggressive behavior. He couldn’t tolerate simple things like changing his clothes, brushing his teeth, haircuts or dental visits. Because he has no sense of danger and would run away from us, we couldn’t take him to restaurants or even to the grocery store. He wasn’t potty trained. He not only had no interest in food, he also lacked the fine motor skills to be able to feed himself. He had been kicked out of preschool because they “couldn’t meet his needs.” All confidence I had in my parenting skills was shattered and not that this is about me, but I began to spiral downward into a depression.
The first moment I stepped foot in the ABA center for my initial tour, I felt hope. I felt the genuine empathy of the therapists to not only want to help my son, but to help our entire family. And two years in, these professionals have been our lifeline. My son’s therapists have worked diligently in the center to help him overcome his challenges as well as come into our home to help our daily routines be more effective. They have worked with my son at school. They have gone with us to multiple doctor’s visits, dental visits and haircuts and given us and our son’s providers assistance in making these previously stressful visits easier. They have gone above and beyond to not only help my son overcome challenges, but to help us understand his unique needs and to respect and appreciate that uniqueness.
Today, our family is not only happy, we are thriving. We have learned so much from our ABA team and part of that is knowing that, yes, autism will always be a part of my son’s truth, but I know now I can learn the tools I need to help him feel that the world also belongs to him. That I know how to help him navigate his unique way of being in a world that isn’t designed for him. And as he gets older I, along with his therapists, can help him learn to advocate for himself. I will forever be grateful to my son’s team of ABA therapists.
My son is so excited and happy each day when I drop him off at his ABA center, and he is equally enthusiastic when I pick him up to tell me what fun things he has done. Most recently his therapist is working with him on drawing pictures of familiar objects and telling jokes. It is so adorable when I pick him up and he’s excited to show me a picture he has drawn or to recite a Knock-Knock Joke! Seeing his smiles, both at the beginning and the end of each day, tells me this, as his therapists help him overcome his struggles, his strengths are finally able to shine!
If they can’t learn the way we teach, we teach the way they learn. – Dr. O. Ivar Lovaas