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Applied Behavior Analysis
(ABA): What Is It?
an introductory talk by John
McEachin, Ph.D.
[This article By Stacy Hultgren
appeared in a recent edition of the PDD Network, 21
Sharon Court, Shelton, CT 06484. Ph: (203)924-0457. E-mail: BHULT40@aol.com.
It is a summary of the presentation by Dr. John McEachin at the Spring 1998
conference of the Autism Society of Connecticut in Hartford.]
John McEachin, Ph.D., is
a clinical psychologist with 20 years of experience servicing families with
autism. He worked under Dr. Ivar Lovaas (the "father" of ABA) during
his graduate training and now has a private practice devoted to children with
autism. He lectures extensively, develops treatment programs, and trains parents
and professionals.
If you see a video on Applied Behavior Analysis (ABA)
principles, you may feel that it’s not a new concept, and in a way,
you’d be right. What Dr. Ivar Lovaas did in establishing the ABA program, was
to take basic principals in behavior science, and emphasize the intensity that
is needed for our particular kids. Dr. McEachin says that if 30 minutes
two times a week of speech therapy is a good thing, imagine how much more can be
done in 30 hours.
There are many "challenges to learning" encountered
by children with autism. Below are some of the individual challenges and how ABA
specifically addresses those issues. Again, remember that this is an extremely
basic description, and if you would like further information about ABA there is
a list of sources at the end of this article.
Low motivation – Reinforcers for our children tend to
be on the idiosyncratic side, so the types of things used for other children in
various behavior modification interventions probably will not work with these
kids, at least at the beginning. You need to find what will work for this
particular child to motivate his interest in completing a task. Every effort
should be made to maximize the contrast between positive and negative
consequences so that the concept of cause-and-effect can be learned.
Limited reinforcement repertoire – ABA principles
recognize that social reinforcers (approval or disapproval) are usually not
effective. Praise, in and of itself, is not enough at first, but can be paired
with a more tangible reinforcer (such as grapes, a favorite toy, etc.).
Eventually the tangible reward can be taken away and the
continuing smiles and words of praise "come to be effective in their own
right."
Short attention span – ABA breaks each task into very
small, measurable steps.
Easily distracted – Teaching in a quiet environment by
reducing auditory and visual distractions is important. Noise level, movement of
others, windows, even air conditioners can be excessively distracting to
autistic children. The goal is to begin in a very structured environment, but to
move the child into more and more ordinary environments as they become more
successful "so that the child becomes able to work in the presence of
distracters."
Learn more slowly –
Repetition is an important method
for autistic children, but it should not be boring or tedious. "In
fact," Dr. McEachin says, "that’s our responsibility - to make sure
it’s NOT tedious". Some kids require literally hundreds of trials
on order to learn a specific concept, but they also will learn it more
effectively if it is practiced within a short time span. In other words, a skill
that is practiced once a day is not as effective, and could take months longer
to master, than one practiced twenty times a day. In order to know when a child
has really mastered a skill, it is rehearsed, and then the child is distracted
with other tasks. Then, they go back to the first task and see "can
they still do it?" It is not repetition for the sake of repetition; it is
done in a manner to maximize learning.
Difficulty understanding abstract concepts – ABA
therapists use concrete examples of concepts and begin with the simplest
language that the child is able to understand. Then more complex language is
added as the skills and concepts are learned. "We definitely want to get
the children to the point where they can understand everyday language –
natural language".
Poor learning by observation – These children have
difficulty picking things up incidentally, so the need is to explicitly and
systematically teach each skill or behavior. ABA stresses the skill of imitating
people "because if they can imitate, they are able to learn a lot of skills
that they would otherwise not," says Dr. McEachin.
Poor differentiation between relevant and irrelevant stimuli
- These children often do not know the difference between the essential
aspect of a situation and those aspects that are trivial. Focusing attention and
presenting only stimulus that is considered essential is a way of
circumventing this problem. It is important to watch out for erroneous
associations. They may learn to tell boy dolls from girl dolls based on the
shoes that they wear rather than the more obvious differences. These
associations may not be reliable and "we have to teach them to zero in on
the relevant aspects of the situation". Be careful with tools like flash
cards, he says, because you could find out that the child is discriminating one
from another based on a bent corner or smudge on the cards. He stressed the need
for using different materials and in different ways to avoid their "making
responses based on things that really are not an essential part of the
concept."
Behaviors such as self-stimulation interfere with learning
– "When they are stimming," Dr. McEachin tells us,
"that’s often where their attention is." If 90% of their attention
is invested in their self-stim activity, there’s only 10% left to focus on the
task at hand, "so we have to work on suppressing those behaviors that
interfere with learning."
Difficulty learning in large groups – Once the child is
learning well in a one-to-one setting, they can begin moving to a 1:2 setting;
1:4; 1:8; etc. by gradually increasing the size of the environment as they are
able to maintain attention and remain on task.
Does not occupy self appropriately during free time –
ABA provides structure and teaches leisure skills. Dr. McEachin says to
"build in play skills and other types of activities that they can do
independently so that they’re not going off into their autistic world.
Sensory/motor impairments – Sometimes their reactions
can be over-responsive or under-responsive. Often the visual channel works
better than the auditory for obtaining information. Dr. McEachin stresses that
the children who are the most successful in ABA are children who are able to use
the auditory channel successfully. Therapists attempt to balance playing to
their strength by using the visual channel in teaching, with pushing the child
to develop better use of their auditory system. For children who don’t like
touch, Dr. McEachin says, "we touch them." He believes they end up not
only becoming able to tolerate it, but actually enjoying it.
Components of a discrete
trial
Each skill is taught in very small
and very brief units called "trials". Each trial consists of an
instruction, a prompt, an opportunity/response, and feedback. The instruction is
given in very clear language that the child can understand, and, as the child
becomes able to handle more complex language, it moves toward a more natural
language base. They may begin with a direct stimulus "look at me" then
move to a more natural stimulus such as just saying the child’s name to get
his attention.
Prompts are not always needed, but
they will use "anything that will facilitate the desired response".
These can be visual prompts such as a gesture or taking the child’s hand and
moving it through the desired motions (a physical prompt), but the aim is to
reach a point where the child can do the desired task with no prompt at all. The
response should be evident within about 5 seconds. If there is no response, or
an incorrect response, the trial is considered to be over and a new one begins
(although it may be the same task – in fact, many people would not be able to
tell where one "trial" ends and the next begins. It is broken up this
way so that data can be obtained on the progress of the child).
Feedback on each trial is given
immediately. The more information that is provided to a child here, the faster
the learning can take place. It is important, he says, not to praise every
response; some will be terrific, some barely adequate, some not quite
accurate and some simply unacceptable (such as throwing things). Use the
feedback, Dr. McEachin says, to indicate where the response falls. ABA has a
reputation for using strong aversives because that was the way the program was
originally designed years ago, however, that has changed and they no longer use
very strong negative feedback. He points out though, that "some people
think that merely saying ‘no’ to a child constitutes an aversive.
What I would say about that is, hearing the word ‘no’
is a very common, everyday event. It is part of the world, part of life, and if
you’re a person who cannot handle simply hearing the word ‘no’,
you’re going to have a really, really rough go of it. I think it’s important
for us to teach children to be able to handle the word ‘no’ simply at
an informational level." That doesn’t, he stresses, imply that screaming
at children is OK, but firmness can be conveyed without disrupting the
situation. There are times, he says, to be very supportive even though they have
given the wrong answer. They worked hard, they are sitting appropriately, they
are careful about their response, but it is incorrect. Clear information is
conveyed in the words and the vocal inflection "Oh, no. Good
try." If they are not attending, it’s OK to say "No. You need to
look."
The only way to tell if learning is actually taking place is
if the child gives some kind of response "that he can only make if he, in
fact, understands." Evaluation of the effectiveness of trials is a critical
part of the therapy, he says. Data tells whether a student is making progress or
not, and if not, "I conclude there’s something wrong with what I’m
doing, rather than ‘this student doesn’t learn very well’." He
stated that behavior experts need data to demonstrate the cause-and-effect
relationship between the intervention and the outcome, "we want to see
measurable, observable changes."
The hallmark of the Applied Behavior Analysis program is the
intensity with which it is delivered. It takes many, many hours a day, and is
very directive and instructionally based. Dr. McEachin says that if a family is
not comfortable with a directive-type program, they should find another program
that would better suit their needs. He says, "our goal, our responsibility
to children is to direct them because they are not able to direct themselves.
And, in fact, I’ll bet that there are many times a day when you are quite
directive of your children." Brushing their teeth is a good example.
"They would rather not do that. But I make a decision as a parent that I
know, from a health standpoint, this is important and I’m going to insist that
it be done."
A lot of people fault the ABA program because they believe
that generalization does not occur, and if a child can’t take information from
one situation and use it in another then it’s not really learning; it’s just
mimicking. But Dr. McEachin says that generalization is part of the ABA package
"and if you (the therapist) understand that, and if you include that in
part of the work that you do, you will get generalization."
Strong parental involvement in the ABA program is stressed as a very large
component of its success.
School
programming
One of the difficulties about an ABA program is that
"when you’re going to school districts and proposing something a little
different than what the school system is used to doing", there is a great
deal of resistance. Sometimes working with young children in a home setting is
viewed as "restrictive". But, says Dr. McEachin, "you have to
understand that the approach here is based on, first of all, accelerating
development that may be (delayed). We want to, as quickly as possible, give to
children language, ability to follow instruction, paying attention, and behavior
to learn." He states that "this can best be
accomplished, or more rapidly be accomplished, working with children
one-to-one." While the program can be center-based, rather than at home,
home sometimes has it’s advantages when working with very young children (3-4)
since naptime and breaks can be incorporated into the program in this setting.
He says that, "although the child may not be in a group setting of
children, the fact is that the program definitely does promote development of
social behavior." Having first established the underlying skills, they can
then transition to a mainstream setting and "they’ll be able to
participate at a much higher level and participate much more meaningfully."
Having already learned the basics, they can be much more acceptable right from
the beginning of the school experience. He gives the example that, in order to
teach soccer, you would typically put any child on the field with some other
kids and have them play. They learn by watching and doing. OR he says, you can
spend some time before going to the playing field teaching the basic skills of
how to kick a ball, what the rules are, how to dribble, and then put
him/her with other kids. "Which way will we end up with a better soccer
player who has more fun?"
The time that a family invests into
an Applied Behavior Analysis intervention for the child will depend on the
family dynamics, but according to the research, the optimum amount of time is
about 40 hours a week. People think that that is unrealistic when talking about
a three-year-old, but that time includes naptime, mealtime, and a lot of
playtime that can be used for breaks or rewards and be facilitated by someone
who can use that time to the child’s advantage. It is not, as people
picture in their minds, a child sitting at a table responding to questions all
day long. The children tend to be more connected to those around them, more
tuned in to the world.
Families may believe that a program
this intense would be very demanding and add a lot of stress to their lives. One
must consider that a lot of families feel that the child’s behavior alone adds
a lot of stress to the family situation, and improving the behavior can actually
reduce the stress. That is a decision that each family must make based upon
it’s own dynamics, abilities, and patience, and if you decide that you cannot
manage 40 hours, but 25 would be possible, that’s OK, too. There is no ‘all
or nothing’ about the program (Ed. note: in fact, if you make use of the
basic principal of rewarding positive behavior and extinguishing negative
behavior, it will have a positive effect for TYPICAL children as well).
It has been rumored that ABA produces "robots" who
are unable to think for themselves. But that conclusion, says Dr. McEachin, is
sometimes based upon the ‘flat affect’ that children with autism inherently
have, and shouldn’t be attributed to the intervention, but to the disorder
itself. In fact, he says, ABA can improve the lack of emotion in the voice by
teaching a greater range of emotional behavior. That you can "train
spontaneous behavior sounds like an oxymoron," but Dr. McEachin says that
spontaneity is something that occurs in the absence of obvious outward stimulus.
Conversation skills can be taught by cueing, then transferring the cue to a
stimulus that would occur naturally, and then they will be better able to do it
on their own. As an example, during a conversation children are taught not just
to say, "I don’t like pizza." They are taught to follow it up with
what they DO like "I like chicken." And then to follow that
with a question " Do YOU like chicken?" This is what a
conversation is all about, the give-and-take, and they have now learned a
strategy to achieve that. They teach four components that can happen in a
conversation – initiate a statement, initiate a question; respond to a
statement, respond to a question. Learning must take place across different
settings and by using different language if it is to be truly useful learning.
Therapists don’t just teach "touch your nose"; that language needs
to be variable to include "where’s your nose?", "can you find
your nose" and "show me your nose", so that they learn to
recognize that there are different ways to ask for the same thing.
If your child is no longer a preschooler, don’t think that
ABA can’t work for you, says Dr. McEachin. There is a misconception that the
theories only apply to young malleable minds. The studies that have been done in
the past only involved young children, but that does not conclude
that it doesn’t work for older individuals, in fact, they have experienced
substantial improvement for them as well. Different reinforcers are needed for
older children and creativity is the key to success. For kids who are not
capable academically, there needs to be a focus on self-help and independence
skills – doing laundry, going to the grocery store. Reading is one academic
skill that needs to take precedence since it is important for so many every day
happenings. There needs to be a focus, he says, on parent concerns and long-term
prognosis when planning programs for older children.
What is the possibility for getting ABA programming in a
child’s public school system? There are advantages to center or school-based
programs, but there are some drawbacks, too, that might make home-based programs
more desirable. Since the school is a large system, they have a great deal of
resources that are not available to an individual. The availability of space and
materials can sometimes be an advantage, of course, with today’s overcrowded
schools and small budgets these things are not necessarily always easy to come
by. Peers for practicing socialization skills and access to adjunct therapies
such as occupational therapy and speech/language therapy are a consideration, as
well as the ability to serve a larger group of students than would be possible
in the home. It not only is easier and most cost-effective
for a therapist to go to one location rather than several in a day, it makes the
transitioning to mainstream classes easier for the children if they can remain
in the same space.
Of course, there are obstacles that are inherent in the fact
that the school is a system. There is a culture within the system,
and that means learning to work within the structure that exists. Money is
certainly a major issue, and so are the hiring policies. There are unions and
seniority issues to consider – sometimes the person best suited for the job is
not available, or someone else is required to fill the position due to hiring
hierarchies. In a home-based program where all of the control is in the
parent’s hands, you can choose whomever you feel
would be the best individual and be in control of building the program from the
ground up. When a school is responsible for the program, you depend greatly on
the decisions made by others. It is a choice that needs to be made very
carefully.
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