An Introduction to Applied
By David Kalmeyer (Parent of a Child With an Autism Spectrum
Although there are many therapies, teaching programs, dietary regimens, and
other interventions available to families of children with Autism and other
Pervasive Developmental Disorders (PDD), only one has been documented to have
produced significant and comprehensive improvements, up to and including
recovery. That method is a program of intervention based on the principles of
Applied Behavior Analysis (ABA).
ABA has been known by many names, including "behavioral
intervention" and "behavioral treatment." Although other
therapies may prove to be beneficial for some children, either alone or as a
supplement to an ABA program, none has yet been documented to be effective.
ABA is also referred to as Discrete Trial Therapy or DTT, since the discrete
trial method of teaching forms an integral part of any program. But this name is
a misnomer since an ABA program involves other components in addition to
ABA is also sometimes referred to as "Lovaas treatment," after the
Professor at UCLA who first packaged these methods and documented their success
for teaching children with autism. But Lovaas is just one "brand" of
ABA. There are many other successful programs in the United States using these
methods including many well known programs here in the Northeast . For example,
in Massachusetts there are the New England Center for Children and the May
Center. In New Jersey, there is the Princeton Child Development Institute
(founded in 1970) and the Douglass Developmental Disabilities Center. Just this
year, Connecticut opened its first ABA school, the Connecticut Center for Child
Development in Fairfield.
So what is ABA? It is a program of intensive one on one teaching based on
research first published by B.F. Skinner in 1938 and later expanded upon by many
others. Successful use of ABA methods for children with Autism was first
documented in 1967. But use of ABA didn't become widespread until 1993, when
Catherine Maurice published "Let Me Hear Your Voice," her moving
account of the recovery of her two children from autism. That same year, a
highly regarded, peer-reviewed journal published research documenting the
extraordinary gains made by children receiving intensive behavioral intervention
(McEachin, Smith, & Lovaas, 1993, "Long Term Outcome for Children With
Autism Who Received Early Intensive Behavioral Treatment," American Journal
of Mental Retardation, Vol.97, pp. 359-372).
This article will introduce the basics of what an Applied Behavior Analysis
program is and answer some of the questions parents ask most often.
WHAT IS ABA? ABA is an intensive, structured teaching program. Lessons to be
taught are broken down into their simplest elements. These elements are taught
using repeated trials where the child is presented with a stimulus (like
"do this" or "touch object" or "look at me").
Correct responses and behaviors are rewarded with LOTS of positive
reinforcement. When incorrect responses occur, they are ignored and appropriate
responses are prompted and rewarded. Undesirable behaviors are approached in the
same manner. At first, the child may be rewarded for doing something close to
the desired response. Over time, as the child masters the lesson, expectations
are raised and primary reinforcers (like bits of food) are replaced with social
reinforcers (hugs, praise, etc.). As the child masters the skill and generalizes
it, it becomes self-reinforcing. Once simple skills like table readiness,
imitation, attention and others are learned in this matter, they can be combined
into more complex skills, like language, imitation, play skills, social
interaction and more. The basic approach is outlined in "Behavioral
Intervention for Young Children with Autism" (edited by Catherine Maurice,
Gina Green, and Stephen Luce, Pro-Ed, 1996) and in many other sources. Since
children within the autism spectrum vary enormously in their strengths and
weaknesses, individualized lessons are developed to meet the particular needs of
a given child. The result is a truly Individual Education Plan.
WHAT IS AN ABA PROGRAM LIKE? A typical program consists of up to 40 hours per
week of intensive one on one teaching on a year round basis for two or more
years. Teaching may be done by families, by professionals, or by volunteers
guided by an expert consultant. The consultant develops the program and
instructs the teachers in the highly sophisticated teaching techniques which are
so essential to a program's success. Teaching usually begins in the child's
home, but may also begin in a school. As the child improves, lessons move out of
the home and into the school and the community . This helps the child to
generalize what he has learned.
ABA is highly structured and quantified. A key element of most ABA programs
is taking objective and precise data to identify needs and to measure progress
as each drill and lesson is repeated. This data is used to judge mastery of the
lessons, to document progress over time, and to modify the teaching plans when a
particular lesson or drill is not effective for teaching the child.
ABA IS NOT: harmful to the child. While aversives and negative reinforcement
were used for a few of the children in the original study (Lovaas, 1987,
"Behavioral Treatment and Normal Educational and Intellectual Functioning
in Young Autistic Children,"Journal of Clinical and Consulting Psychology,
Vol. 55, pp.3-9) to address some truly problematic behaviors, no reputable
program uses them today. In fact, just the opposite is true: most reputable ABA
programs use positive reinforcement to increase desirable behaviors. These
desirable behaviors are then used to replace the undesirable behaviors. One sign
of a good program is that a strong bond develops between the child and the
people who teach him. Many children ask to do more ABA therapy because they
enjoy the positive reinforcement.
ABA IS NOT: just a way to "eliminate bad behaviors" or to
"knock off a few symptoms." ABA normally teaches acceptable behavior,
academic skills, self-help skills and more. In most cases, when undesirable
behaviors are not reinforced and rewarded, the child loses interest in
perpetuating them. For more difficult behaviors, the child is redirected from
the problem behavior to an alternative that is socially acceptable.
ABA DOES NOT: turn children into robots. While the initial teaching is often
repetitive and involves a large amount of structure and imitation, significant
efforts go into teaching the child how to learn and into making sure that the
lessons are fun for the child. If the program is done well, children often enjoy
the lessons enough to request them. Also, as the child advances, the highly
structured program becomes more flexible. Lessons are taught in a variety of
situations as skills become generalized to the point where the child can adapt
to new situations.
WHO BENEFITS FROM ABA? While research has documented recovery rates of 40 to
50 percent among children who started between the ages of 2 and 5, there are
many reports of significant improvements (but not recovery) in children who
started at 7, 8, and later. Recovery in these studies was defined as children
who attended school as "typical children" without support. In addition
to the recovered children, an additional 40 percent of the children were
mainstreamed with some support.
HOW MUCH ABA DOES MY CHILD NEED?: Some research into intensive intervention
has shown positive results with as little as 20 hours or more per week. But most
of the research documented success involves children who had between 30 to 40
hours of ABA on a year round basis for at least two years. Since no research has
been published to identify the optimum level more precisely, most families try
to do 40 hours per week. People who are unfamiliar with how an ABA program
actually works may question the ability of a young child to "handle"
40 hours per week of intense instruction. It helps to remember that a typical
child learning about the world naturally spend at least that much time playing
and learning on his own. When a child is not tolerating 40 hours, it's probably
a sign that the people teaching him are not doing things correctly. A good
program supervisor or consultant will be looking for this and will adjust the
WHERE CAN I LEARN MORE? There are many
information resources available, especially on the World Wide Web.
There are numerous consultants who provide workshops and ongoing consultation
for families and school systems.
This is an edited version of an article which first appeared in the
newsletter of The Autism Partnership for Applied Behavior Analysis of
Massachusetts (MASS TAP) and is used with permission. It was adapted from the
chapter "Early Behavioral Intervention for Autism: What Does the Research
Tell Us?" by Gina Green, Ph.D. in "Behavioral Intervention for Young
Children with Autism," edited by C. Maurice, Gina Green, and Stephen Luce,
(Pro-Ed, 1996). MASS TAP is a partnership of parents and professionals who
believe that ABA is the primary therapy for autism/P.D.D. The organization is
working to increase both awareness and availability of ABA is Massachusetts. For
more information about MASS TAP call 508-579-7827.
David Kalmeyer is the father of a child with autism who now attends public
school. and a former board member of MASS TAP.
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