What is ABA?
Applied Behavior Analysis, or ABA, is often mentioned as an intervention for children with developmental disorders, but there are many misconceptions about it. Many providers and schools talk about packaged ABA programs, but it is important to remember that there is no single program or plan that “is” ABA.
ABA is simply the application of behavioral principles to everyday situations that will, over time, increase or decrease targeted behaviors. ABA has been used to help individuals acquire many skills, such as language, self-help, and play skills; in addition, these principles can help to decrease maladaptive behaviors such as aggression, self-stimulatory behaviors, and self-injury.
ABA employs objective data to drive decision-making for an individual’s program. That is, data is collected on responses made by the individual to determine if progress is being made or not; if there is no progress under a particular approach, we need to reevaluate the program and change it so that the person begins to make progress.
What can ABA be used for?
The short answer is almost anything. If it is an observable behavior, ABA principles exist that can be used to either increase or decrease that behavior. ABA providers are charged with the improvement of socially significant behaviors, which include communication, social skills, academics, reading, and adaptive living skills such as gross and fine motor skills, toileting, dressing, eating, personal self-care, domestic skills, and work skills.
How much ABA is enough?
Research supports a minimum of 25 hours per week of intensive behavioral intervention year-round for young children diagnosed with autism(2). The original Lovaas studies showed that approximately half the children were able to achieve typical development with an average of 40 hours per week over at least 2 years(3). There is no single study that can inform a parent of the optimal number for their child. ABA should be incorporated into a family’s everyday lifestyle, like breathing and eating. This does not mean doing flashcards all day long, or sitting at a desk for every waking hour. It does mean that the family should learn ABA principles and apply them in the natural context of daily activities.
What is the role of the parent in an ABA program?
Parents are indispensable in the child’s program. Studies show that children whose parents are actively engaged in the process make measurable gains(4). First, no one knows the child better than the parent; they provide critical and insightful information that will help guide the ABA program. Second, parents are able to continue to prompt and reinforce the child through his or her various daily activities - an essential component to generalizing skills. Finally, parents are in a position to be able to record and track data in the home and community setting. This information is vital in hypothesizing the function (the “why”) of specific behaviors as well as for determining which conditions encourage behaviors to occur.
Components of an Effective Program
Children need, and education law supports, effective interventions. Based on the National Autism Center’s National Standards Report, (note 3) the following components meet the criteria of research-based, effective interventions for children with autism:
Antecedent manipulation - modification of situational events that precede the target behavior. These alterations are designed to increase the likelihood of success of the targeted behavior. Examples include: prompt/fading procedures, behavioral momentum, contrived motivational operations, inter-trial intervals, incorporation of special interests, etc. Behavioral treatment -programs designed to decrease problem behaviors and to increase functional alternative behaviors. Examples include: functional communication training, chaining, discrete trial training, mand training, generalization training, reinforcement, shaping, etc. Comprehensive intervention - low student-to-teacher ratio (1:1, or low as appropriate) in a variety of settings, including home, school, and community. Effective programs are based on a treatment manual, provide intensive treatment (25hrs/wk+), and include data-driven decision-making.
Joint attention intervention - programs designed to teach a child to respond to the social bids of another, or to initiate joint attention interactions. Examples include: pointing to objects, showing items, activities to another, and following eye gaze. Modeling - adults or peers provide a demonstration of the target behavior; the student is expected to imitate. Thus, imitation skills are a necessary prerequisite to this type of intervention. Modeling is often combined with prompting and reinforcement strategies that can assist the student to acquire imitation skills.
Naturalistic teaching strategies - use of child-initiated interactions to teach functional skills in the natural environment. This intervention requires providing a stimulating environment, modeling play, providing choices, encouraging conversation, and rewarding reasonable attempts
Peer training - involves teaching peers without disabilities strategies for interacting (play and social) with children with autism. Some commonly known peer-training programs include: circle of friends, buddy skills, peer networks, etc.
Pivotal response training – a program designed to target specific, “pivotal,” behaviors that lead to improvement across a broad range of behaviors. These pivotal behaviors include: motivation to engage in social communication, self-initiation, self-management, responsiveness to multiple cues, etc. Schedules - teaching a student to follow a task list (picture- or word-based) through a series of activities or steps in order to complete a specific activity. Schedules are accompanied by other behavioral interventions, including reinforcement.
Self-management - this treatment intervention teaches a student to regulate his or her behavior by recording the occurrence or non-occurrence of the target behavior, and secure reinforcement for doing so. Story-based interventions - involves a written description of the situations under which specific behaviors are expected to occur. The stories seek to teach the who, what, when, where and why of social interactions to improve perspective taking. The most well known of these interventions is Carol Gray’s “Social Stories.”
Note (3) National Standards Report. (2009). National Autism Center. Retrieved from http://www.nationalautismcenter.org/pdf/NAC%20Standards%20Report.pdf
First Steps in Getting an ABA Program Started:
The first step for parents wanting to start an ABA program is to get an assessment of their child’s current skill level. There are a number of assessments available, and parents should try to get an assessment that is as comprehensive as possible. This could include:
Diagnostic Assessment. This provides information related to your child’s diagnosis, and is completed by a licensed psychologist (hyperlink to our diagnostic page). Diagnostic assessments should be conducted initially and then again each year. Common diagnostic assessments include the Autism Diagnostic Observation Schedule (ADOS), Autism Diagnostic Interview Revised (ADI-R), PDD Behavior Inventory (PDD-BI), Childhood Autism Rating Scale (CARS), and Gilliam Autism Rating Scale (GARS).
Developmental Assessment. Norm-referenced developmental assessments provide information about how your child is developing in all areas compared to same-age peers. Developmental Assessments measure cognition, communication, motor, adaptive, and social skills. Some developmental assessments, such as the Bayley Scales of Infant Development, may only be completed by a licensed psychologist. Other developmental scales may be implemented by anyone with advanced training in assessment. These assessments include (but are not limited to) The Battelle Developmental Inventory (BDI), Developmental Activities Screening Inventory-Second Edition (DASI-II), Developmental Assessment of Young Children (DAYC), and the Merrill-Palmer Revised Scales of Development (M-P-R).
Domain-Specific Assessment. Specialized assessments are available for each area of development. For example, a number of them exist for the sole purpose of assessing language development. These measures are utilized to determine specific information about a child’s delay. For example, if a developmental assessment reveals that a child has delays in language and social skills, re-assessments must then be completed in those areas in order to determine the nature and extent of the delay. You might find it beneficial to consult with specialists to assist you within each domain. Typically, speech and language pathologists assist with language and speech issues, while physical therapists assist with gross motor and occupational therapists assist with fine motor.
Neuropsychological Assessment. These tests measure cognitive function and can only be administered by licensed psychologists. While we do not offer this, we recommend having this assessment completed at least once in the early phases of your child’s intervention program. These measures are more accurate if your child speaks, but appropriate measures for non-verbal children are available.
Criterion-Referenced Assessments. Criterion-referenced assessments provide information about skills in your child’s repertoire. Criterion-referenced assessments are not designed to diagnose or to measure delay, but rather to determine which skills your child is able to perform, as well as which skills your child should learn next. Criterion-referenced assessments may be completed by anyone with advanced training in assessment. Additionally, these assessments are excellent to use for program development. Popular criterion-referenced assessments include The Brigance, the Assessment of Basic Language and Learning Skills (ABLLS), the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP), and the Hawaii Early Learning Profile (HELP).
Other Assessments. These assessments include preference assessments, functional behavioral assessments, and skill probes. These measures should be regular components of your child’s educational program.
Solid assessments provide a baseline upon which to begin building an ABA program. In addition, the assessment outcomes can provide year-to-year objective markers of progress (or lack thereof) of the interventions chosen. The American Academy of Neurology and the Child Neurology Society(6) have provided guidance on appropriate assessments for professionals working with children with autism. (See: http://www.aan.com/professionals/practice/pdfs/gl0063.pdf)(5) .
Parents will need to find a qualified provider of ABA services. There is formal credentialing within the profession of behavior analysts, coordinated by the Behavior Analyst Certification Board (http://bacb.com). Certification provides parents with some safeguards, ensuring that the professional has undergone specific training and supervision by qualified Behavior Analysts, and has completed specific coursework related to behavioral analysis and interventions. However, parents need to understand that a BCBA certification does not guarantee that the professional has any training or experience specific to autism or that that individual has the skills necessary to produce optimal treatment outcomes. Thus, a parent should ask about the professional’s specific experience and training in the implementation and training of ABA programs for individuals with autism. Finally, since the BCBA certification process is relatively new, there are a number of professionals who have actively been working in the field for many years and who are in the later stages of their career who are not BCBAs. If you are interested in working with a non-certified professional, you are urged to request information relating to their qualifications and experience.
Next, parents will need to find therapists to implement the ABA program designed by the consultant or supervisor. Some ABA providers can provide parents with trained therapists; others rely on parents to find and hire therapists who the consultant subsequently trains. Costs for programs vary tremendously. Comprehensive intensive programs (in which therapists are provided to the families) can run between $30,000 to $70,000 per year. Programs in which parents hire and manage their own therapists can run substantially less than comprehensive programs, and yet remain financially burdensome (between $18,000-$35,000 per year).
Securing ABA services through early intervention services or through the school system can alleviate the cost. Federal law requires that individuals with disabilities be provided individualized and appropriate education that is research-based and effective (see http://idea.ed.gov/ ). ABA is the only intervention that passes such standards; thus schools and early intervention providers are required to utilize such interventions with students with autism.
Another avenue that parents can pursue for financial assistance is through their insurance plan. Insurance coverage will vary depending on your state of residence, and whether your plan is self-funded or fully funded.
For residents of Texas, H.B.451 requires that fully funded plans governed by the Texas Department of Insurance must provide coverage for children with autism, up to the age of 10. FEAT-Houston has put together an informative page on autism insurance coverage.
If you live elsewhere, we urge you to find out your state’s laws on insurance coverage for ABA therapy.
(1) Baer, Wolf & Risley, 1968; Sulzer-Azaroff & Mayer, 1991
(2) National Research Council (2001) Educating Children with Autism. Committee on Educational Interventions for Children with Autism. Catherine Lord and James P. McGee, eds. Division of Behavioral and Social Sciences and Education. Washington, D.C.: National Academy Press.
(3) Lovaas, O.I. (1987) “Behavioral treatment and normal educational and intellectual functioning in young autistic children,” Journal of Consulting and Clinical Psychology, 55, 3-9
(4) Johnson, C.R., et al. 2007. “Development of a Parent Training Program for Children with Pervasive Developmental Disorders.” Behavioral Interventions 22(3):201-221
(5) http://www.thelovaascenter.org/autism-aba-study.php (No longer available)
(6) Filipek, P.A., MD et al (2000), “Practice Parameter: Screening and Diagnosis of Autism.” Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society.
Thanks to Applied Behavioral Strategies for providing some of the information listed here.