ABA and Autism – a very brief primer
©Teresa Phillips, MS CCC-SLP
Speech Language Pathologist
November 2007
The parents of young children who are given a diagnosis of an autism spectrum disorder are suddenly faced with a whole new vocabulary. The amount of information about autism available online and in the bookstores has risen dramatically in the past few years, and sorting that information into manageable and meaningful chunks can be challenging. I will attempt here to summarize a core component of the first recommendation that most parents receive at the time of diagnosis. Behavioral intervention for autism – also often called ABA – is often the first term parents hear.
What is ABA? Where do we get it? How do we identify an appropriate program? What is the role of the parent in an ABA program?
ABA
Applied Behavioral Analysis (ABA) is an umbrella term that refers to any educational or therapeutic discipline that attempts to change behavior through a systematic process of analysis/observation and application of certain types of interventions. It is not a specific training program or methodology. The origins of ABA are in the field of behavioral psychology, and ABA is used in many settings for many purposes, including military training, targeted training intended to increase productivity in the workplace, management training, and special education. For our purposes, we’ll focus on the educational aspect of ABA and how this applies to children with autism.
Applied Behavioral Analysis
A = Applied -something an educator, therapist, or parent does that is intended to change (increase/refine, reduce/eliminate) a specific behavior in the student/child
B = Behavior is something the student/child does.
A = Analysis is the process by which an educator or therapist identifies a target behavior (talking, putting on shoes, eating with a spoon, going to bed) and measures change in the behavior as a result of what the educator/therapist/parent applied (applied = your first A)
Here are some commonly heard terms in the fields of autism intervention and special education that all fall under the overall umbrella of ABA:
Pivotal Response Training
Contingency Training
PECs
TEACCH
SCERTs
Lovaas Training
Natural Language Paradigm
and more
All of these and many other comprehensive programs operate on behavioral principles and are used with children with autism. All of them are ABA based. However, they are not the exclusive providers of behavioral intervention.
Discrete Trial Training
What does it mean when someone says to do “ABA” therapy with your child? In common usage, the term “ABA” is often used specifically to mean discrete trial training. What is discrete trial training? Good question. In this context:
Discrete = a very explicitly defined behavior that we want to increase/refine, reduce/eliminate.
Trial = something the educator/therapist does to see if the child’s behavior changes in the way that is hoped.
Training = Apply the intervention (this is the trial), assess to see if the response is what you want. If yes, repeat the trial a lot — This is also called mass trials.
Discrete Trial Training is a specific technique used in many behavioral disciplines, including psychology, speech therapy, special education, occupational therapy and more.
Intensive Programming
In some parts of the country, there are behavioral programs available for young children with autism that are self-contained, intensive and comprehensive. The teams that implement these programs are typically multidisciplinary and include psychologists, speech therapists, special educators, occupational therapists and others. There may be graduate students or special autism educators that work under the guidance and supervision of the senior members of the team to create and implement the treatment plan. Parent training and inclusion is a key feature of these educational programs, which may take place in home, clinical, educational and community-based settings.
There is no single program that will provide intensive in-home, school or community based behavioral autism intervention in New Mexico at this time.
Programming for children with autism is currently provided through a combination of the public school system, after school therapies, periodic short term training programs for parents with limited availability, and commercially available curriculum that may be acquired through on-line trainings.
Treatment Planning
Here are some examples of questions parents, educators and therapists need to ask in order to design an appropriate behavioral intervention plan to help their child with autism learn:
What do you want the child to do?
What is the child doing right now?
What are you (parent/therapist/educator) doing that you hope will change the child’s behavior?
How are you measuring that change?
Now let’s apply those questions to a specific child with autism.
What do we want the child to do?
The big picture is we want him to communicate, have positive social behaviors, and we want him to be able to learn and function effectively in the world. That’s the big picture.
Components of an effective team
We create an effective team by bringing together professionals to provide education, therapies, and consistency across settings. Although we don’t have the specific programs that can be found in some states, the good news is that education and the therapies (speech, occupational, physical) are all BEHAVIORAL DISCIPLINES — they all draw from the principles of ABA!!!!! Let me go into that a little more.
All of these disciplines target large broad goals (communication, behavior, learning) and small objectives (x will speak in 3-word sentences, x will use a tissue instead of picking his nose, x will hold his pencil with a developmentally appropriate grasp).
Here are some examples of ways in which your therapists and educators provide behavioral training:
Speech therapy is always behavioral (although not all behavioral therapy is speech). The behaviors your speech therapist identifies and targets include motor speech, cognition, attention, memory, problem solving, social communication, comprehension and expressive language. Your occupational therapist targets fine motor behaviors (use of fingers for eating, writing, drawing), regulation of sensory systems, social skills and functional behaviors. Physical therapists identify gross motor behaviors, coordination, motor planning, balance. Psychologists often concentrate on identifying maladaptive behaviors and designing positive replacement behaviors. Educators target the larger developmental domains and attendant behaviors — the ability to sit and pay attention, to read and write, to meet appropriate academic expectations, to follow basic rules in a structured setting, the overall ability to learn.
There is a lot of overlap and interplay among these important people when helping the child to learn and the parent to gain a better understanding of supporting the child’s behavior and learning style.
To go back briefly to the idea of discrete trial training, the most explicit and familiar example of discrete trial training that you may or may not have thought of in these terms may be seen every day in ordinary articulation therapy:
The targeted behavior: make the /r/ sound
The trial: say r to the child (model). Offer the child a sticker or skittles or whatever for attempting to make the /r/ sound
Training: child makes the attempt, you give the skittle. You do it a lot (mass trials), the /r/ begins to improve, you reduce the skittles as the skill becomes more automatic and eventually you have a child who can say his /r/s without reward or recognition. Behavior has been successfully modified.
Behavior specific
When people like us — teachers, therapists, psychologists — say ABA, we are often talking about using a behavioral approach to teach positive new behaviors, which in many cases helps reduce unacceptable old behaviors. So we see things like:
X will greet his classmates by saying hi when he comes in the classroom.
Let’s analyze that:
His current behavior is to come into the classroom and knock people over.
We target the behavior: a teacher, therapist (or even a peer) stays with the child as he enters the room, teaches the child to say hi, rewards the effort (using skittles, praise, stickers, favorite toys, whatever the reinforcer is), and does it again and again until the behavior is automatic. Then that behavior no longer needs to be targeted and the goal can be discontinued.
Choosing the right team:
Autism is a challenging and complex neurodevelopmental disability. Not all educators and therapists are familiar with methods of intervention that are most effective for children with autism. When you are working with a school system or early intevention program putting together a program for your child, make sure the members of the team are trained and have experience specifically in autism. Can they perform basic functional behavioral assessments? Are they familiar with the core features of autism? How familiar are they with the most successful strategies in teaching children with autism? Are they providing crossover information or training for families? There is ideally a high degree of collaboration and cooperation in a successful autism team, and this is one of the things to look for.
Summary
ABA for children with autism means more than one thing. It means an entire TEAM of behavioral experts, from a number of different, equally significant perspectives are needed to provide a functional behavioral learning program.
Short list for quick info:
National Resource Center: Educating Children with Autism
Polyxo – no frills, straightforward information that tries to dymystify some of the jargon of ABA.
American Academy of Pediatrics. Autism: Caring for Children with Autism Spectrum Disorders: A Resource Toolkit for Clinicians. Elk Grove Village, Il: American Academy of Pediatrics; 2007.
Autism Speaks. Parent based organization. Lots of good video.
This is a very short list, but keep in mind that there is no shortage of information out there, and start with some clearly recognized source material.
Short list of programs that provide intense ABA intervention for children with autism (to give you an idea of what these programs look like once they’re in place).
UCLA – http://www.autism.ucla.edu/index2.php
University of Washington – http://depts.washington.edu/uwautism/
Yale – http://www.med.yale.edu/chldstdy/autism/
TEACCH – http://www.teacch.com/
