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An Introduction to Applied Behavior Analysis

By David Kalmeyer (Parent of a Child With an Autism Spectrum Disorder)

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 discrete trials.

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 program accordingly.

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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