What is ABA and how does ABA work?

Applied Behavior Analysis is a way to take some of the most challenging or inappropriate behaviors and replace them with behaviors that are viewed as more appropriate.

But it is so much more than that. It is helping the individual become a part of the environment they live in.

One analogy that I continue to use with parents is that imagine a child with autism is much like a person in foreign land learning the nuances of a different culture.

We are helping that individual get their needs and wants met at the most basic of level and teaching them about the foreign culture on a more in depth level.

We want them to keep who they are and their unique characteristics, but also want them to be able to navigate the world around them.

Typically when a child is diagnosed and referred for ABA therapy the next steps are crucial in the development of a plan for the child (also referred to as a treatment plan).

It requires a Functional Behavioral Assessment which is comprised of multiple measures of a child’s current levels including: a direct observation of the child, parent / guardian interview, reviewing medical records or their IEPs, and usually a diagnostic report from the professional that gave them the autism diagnosis.

From all this information a plan is developed to best assist the child by meeting them where they are developmentally. This is where parent input is key to helping develop goals and mapping out what the parents want for their child.

ABA is only really the most successful when done in a truly collaborative manner with parents and families being an integral part of the child’s success.

What behaviors should we change?

During intake meetings and interviews with the parents, we discuss behaviors that have impeded the child’s ability to navigate in the community or have caused negative reactions from community members.

It is imperative that the behaviors requiring change are done so in a manner that it is paired with a behavior that replaces it.

For example, if a parent comes to me and says that they are unable to take their child to a store due to extreme tantruming behavior (may include dropping to the ground, screaming, crying, etc.) and furthermore avoid taking the child out in public, this may be a behavior that is deemed socially significant that we would target during therapy.

Not only would we work to decrease the tantrum behavior, but we would do that by working on increasing behaviors that we want to see such as: reinforcing their use of words to communicate or setting a timer and working with them on waiting or holding parents hand in the store.

Note that some critics of ABA have stated that the goal of ABA is to make a child with autism fit into our world without understanding theirs. This ideation has culminated in the idea that we are creating “robots” to blend in to our society.

How do we work on behavior change in therapy?

ABA is based on science and as with any science there are the fundamentals of making predictions, experimenting, analyzing and revising things if necessary.

Let’s say for example, a parent comes to me and says that their child engages in severe self-injury, which has been observed to be banging their head against an object (wall, floor, toys, etc.). What I would first do is rule out any medical concerns by asking the parents to seek out a medical professional to examine the child.

Once that is done we would look at the “function” of the behavior, why is the child engaging in this behavior. We then make a prediction.

In this example, let’s say that it is for attention (which may be that the child is looking at you while they’re doing it or if in the past the child was given a form of attention right after engaging in the behavior).

Once we have made a prediction, we would then experiment by coming up with a plan. In our example of self-injury, if we know it’s for attention we may come up with a plan to ignore by avoiding eye contact and verbal input.

We may at the same time implement a procedure to give the child attention every few minutes when they’re not engaging in self-injury.

We would then analyze the graphs by asking: Was it effective to avoid eye contact and verbal input? (Meaning: Did the behavior of self-injury decrease or increase?) Did the behavior decrease or increase when we gave attention intermittently?

By looking at graphs and analyzing data we make informed decisions about the goals and objectives written to ensure that ABA therapy is effective.

There have been instances when a child has met all their goals and objectives, they are participating with typically developing peers, and/or they’ve made tremendous progress to the point that ABA therapy is no longer warranted.

These are times when we would discharge or say that the child no longer needs ABA therapy.

What are some pros and cons of ABA therapy?

The advantages of using ABA are building a repertoire of behaviors that help the child communicate their needs without them resorting to challenging behaviors. Parent and guardians have difficulty understanding that every behavior a child is displaying is communicating a want or need.

When children don’t have the language to express themselves, what happens is they learn their behaviors will get them their desired outcomes. They engage in those behaviors more frequently.

If we learn from them what their behaviors are communicating we can often find ways of teaching them a more appropriate way of getting their needs met before a challenging behavior occurs.

There seem to be few cons of ABA therapy that I have seen in my years of practice. I often tell parents that the principles of ABA are based on human behavior and as the child develops skills and make gains or their behavior changes, their plans should evolve with them.

I have seen that ABA is less effective when a plan is implemented and changes are not made according to the child’s progress or lack thereof.

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