The science of Behavior Analysis comprises three branches: Behaviorism, Experimental Analysis of Behavior, and of course, Applied Behavior Analysis (ABA) with the last more focused on applying researched concepts to promote socially-significant behavior. From ABA comes the multitude of research-based therapies or interventions which include Discrete Trial Training, Pivotal Response Training, Natural Environment Training, and Incidental Teaching to name a few.
Examples of techniques that ABA therapies will apply during therapy sessions
There are several techniques that an ABA therapist will use depending on the behavior, the child’s development level, and the end result desired. The focus may be on improving specific behaviors; such as social skills, communication, reading, and academics as well as adaptive learning skills, such as fine motor dexterity, hygiene, grooming, domestic capabilities, and punctuality. The ABA therapist may use a combination of the techniques listed below. These are by no means the only techniques used by ABA therapists/practitioners. As we learn more about autism and children’s learning styles the methods have evolved.
To name a few:
- Discrete Trial Training
- Pivotal Response Training
- Natural Environment Teaching
- Incidental Teaching
1. Discrete Trial Training
Discrete Trial Training has its place in ABA therapy when the therapist is attempting to develop social and behavioral skills within the child. DTT, as the name suggests, simplifies a teaching step into three parts:
- the instruction,
- the response specified by the instruction, and
- the consequence that depends on whether the learner performed the specified response or not.
Not only does DTT break down learning into short, clear three-part instruction. It also builds in the repetition and intensity at which these trials are given to teach one concept, for example, responding to the instruction, “What is your name?”
Practical use of Discrete Trial Training is for teaching factual information like:
- learning the alphabet
- learning someone’s address
- learning names
- learning the lyrics to a song
DDT is less effective when teaching abstract concepts such as:
- mathematical operations
- comprehension (e.g., understanding a paragraph the learner just read)
Developed by Ivar Lovass at the University of California in Los Angeles, Discrete Trial Training (DTT) is perhaps the most widely-known ABA-based therapy for individuals living with ASD.
2. Pivotal Response Training
Pivotal Response Treatment is a naturalistic intervention model derived from Applied Behavior Analysis (ABA). Pivotal Response Training focuses on tapping into a learner’s motivation, teaching the learner to respond to multiple cues, encouraging learner- initiated behaviors, self-management, and empathy development.
Goals of the PRT approach include:
- Development of communication and language skills
- Increasing positive social behaviors
- Relief from disruptive self-stimulatory behaviors
In contrast with DTT which may appear very contrived and unnatural, PRT takes place in a learner’s natural environment which includes the participation of the learner’s family or caregivers with treatment coordinated across all of the learner’s environment (e.g., home, school, community). As mentioned, the key element in a PRT program is the learner’s naturally occurring motivation which significantly increases social validity of the teaching instructions and skills learned as the consequences correspond with the behavior learned via PRT by incorporating the positive or negative reinforcement systems based on the behavior.
Developed by Robert and Lynn Koegel at the University of California in Santa Barbara, Pivotal Response Training (PRT) is another ABA-based therapy for individuals living with ASD.
3. Natural Environment Teaching
Natural Environment Teaching (NET) is an ABA-based therapy which leads to a child being able to learn skills in one scenario and apply them to other scenarios. This method incorporates activities that use familiar toys, games, and materials through play to maximize the child’s motivation to continue the activity and actually learn while playing. In a way, it can be similar to PRT as both do implement the teaching opportunities in the natural environment; however, that’s where the similarities end as PRT is more comprehensive. Not to say NET is the weaker of the two—choosing between the two depends on what goal is to be achieved by the learner. NET can be used to teach new skills such as basic functional communication skills to advanced language skills and a wide variety of important social skills.
Example of Natural Environment Teaching:
The child may be playing with a toy dog and cat. The ABA therapist might ask the child to put the dog next to the cat to see if the child understands the meaning of ‘next to’. When the child demonstrates the correct meaning then the therapist will provide praise. This increases the likelihood that the child will be able to demonstrate the ‘next to’ in a different scenario.
Benefits of Natural Environment Teaching:
- The child learns the skill and doesn’t realize they are being taught a skill.
- It takes place in a natural environment for the child.
This technique can be used by the ABA practitioner, parent, and even a special education teacher.
Natural Environment Intervention (NEI) or Natural Environment Training (NET) is a language intervention approach for children with autism that was developed by Sundberg and Partington (1999) based upon Skinner’s Analysis of Verbal Behavior (1957).
4. Incidental Teaching
The theory behind Incidental teaching or informal learning is a strategy that uses the principles of applied behavior analysis (ABA) to provide structured learning opportunities in the natural environment by using the child’s interests and natural motivation. Incidental Teaching (IT) is an ABA-based therapy similar to Natural Environment Teaching (NET); however, the biggest difference is teaching for opportunities that are not contrived or intentionally triggered by the instructor. These naturally occurring situations that include the learner’s motivation to get or accomplish something makes it a compelling teaching technique as, like PRT, the consequence or the “reward” for performing a behavior is directly tied-in with the reward for doing the behavior. For example, after walking a couple of blocks, the learner naturally feels thirsty. The learner grabs for the water bottle held by the instructor at which time, the instructor provides the learner with prompts to communicate “water please.” Upon performing the action, the learner gets the water bottle.
Examples of Incidental Teaching:
It is when a child learns something new from
- watching television
- reading a book
- hanging out with peers
- playing a video game
The initial concept of incidental teaching was originally developed by Risley and Hart in the 1970s (Risley & Risley, 1978) and then expanded as part of the Walden Project under the supervision of Dr. Gail McGee and her colleagues at Emory University in the 1990s (McGee, Morrier, & Daly, 1999).
Which children benefit the most from ABA therapy
Applied behavior analysis is widely used for children who are on the spectrum. Furthermore, ABA therapy gives parents the necessary know-how to help in supporting the development of their child with autism. ABA therapy is most effective when trying to develop social skills. Children with various emotional, cognitive, and behavioral disorders will benefit the most from ABA techniques as well.
Examples of where ABA therapy can provide help to children who may be facing:
- Attention-deficit hyperactivity disorder
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
- Clinical depression
- Bipolar disorder
- Oppositional defiant disorder
- Conduct disorder
- Eating disorders
As you may have noticed, there is a difference between DTT and PRT/NET/IT as DTT appears to be very limited in scope albeit the teaching technique being intense in delivery. Whereas, PRT/NET/IT appear to be more in-tune with teaching socially significant behaviors taught in a more natural setting. True. However, it is very rare for an ABA-based service or program to be solely based on a single ABA-based intervention. Depending on the goals of the ABA-program for your child, the ABA professional may use two or all four examples that have been discussed or perhaps even more not covered by this blog (e.g., FCT, TA, shaping, et cetera).
For more information regarding this topic, we do encourage you to speak with an ABA practitioner or email us at [email protected].
Frequently asked questions about ABA therapy
What is ABA Therapy used for?
ABA-based therapy can be used in a multitude of areas. Currently, these interventions are used primarily with individuals living with ASD; however, their applications can be used with individuals living with pervasive developmental disorders as well as other disorders. For ASD, it can be used in effectively teaching specific skills that may not be in a child’s repertoire of skills to help him/her function better in their environment whether that be at home, school, or out in the community. In conjunction with skill acquisition programs, ABA-based interventions can also be used in addressing behavioral excesses (e.g., tantrum behaviors, aggressive behaviors, self-injurious behaviors). Lastly, it can also be utilized in parent/caregiver training.
In skill acquisition programs, a child’s repertoire of skills is assessed in the beginning phase of the services in key adaptive areas such as communication/language, self-help, social skills, and motor skills as well. Once skills to be taught are identified, a goal for each skill is developed and then addressed/taught by using ABA-based techniques to teach those important skills. Ultimately, an ABA-based therapy will facilitate a degree of maintenance (i.e., the child can still perform the learned behaviors in the absence of training/intervention over time) and generalization (i.e., the learned behaviors are observed to occur in situations different from the instructional setting). These two concepts are very important in any ABA-based intervention.
In behavior management, the challenging behaviors are assessed for their function in the beginning phase of the services. In this phase, the “why does this behavior happen in the first place?” is determined. Once known, an ABA-based therapy will be developed to not just decrease the occurrence of the behavior being addressed, but also teach the child a functionally-equivalent behavior that is socially-appropriate. For example, if a child resorts to tantrum behaviors when she is told she cannot have a specific item, she may be taught to accept an alternative or find an alternative for herself. Of course, we can only do this up to a certain point—the offering of alternatives. There comes a point when a ‘no’ means ‘no’ so the tantrum behavior will be left to run its course (i.e., to continue until it ceases). This is never easy and will take some time for parents/caregivers to get used to, but research has shown that over time and consistent application of an ABA-based behavior management program, the challenging behavior will get better.
In parent training, individuals that provide care for a child may receive customized “curriculum” that best fit their situation. A typical area covered in parent training is teaching responsible adults pertinent ABA-based concepts to help adults understand the rationale behind interventions that are being used in their child’s ABA-based services. Another area covered in parent training is teaching adults specific skill acquisition programs and/or behavior management programs that they will implement during family time. Other areas covered in parent training may be data collection, how to facilitate maintenance, how to facilitate generalization of learned skills to name a few.
There is no “one format” that will fit all children and their families’ needs. The ABA professionals you’re currently working with, with your participation, will develop an ABA-based treatment package that will best fit your child’s and your family’s needs. For more information regarding this topic, we encourage you to speak with your BCBA or reach out to us at [email protected].
Who Can Benefit From ABA Therapy?
There is a common misconception that the principles of ABA are specific to Autism. This is not the case. The principles and methods of ABA are scientifically backed and can be applied to any individual. With that said, the U.S. Surgeon General and the American Psychological Association consider ABA to be an evidence based practice. Forty years of extensive literature have documented ABA therapy as an effective and successful practice to reduce problem behavior and increase skills for individuals with intellectual disabilities and Autism Spectrum Disorders (ASD). Children, teenagers, and adults with ASD can benefit from ABA therapy. Especially when started early, ABA therapy can benefit individuals by targeting challenging behaviors, attention skills, play skills, communication, motor, social, and other skills. Individuals with other developmental challenges such as ADHD or intellectual disability can benefit from ABA therapy as well. While early intervention has been demonstrated to lead to more significant treatment outcomes, there is no specific age at which ABA therapy ceases to be helpful.
Additionally, parents and caregivers of individuals living with ASD can also benefit from the principles of ABA. Depending on the needs of your loved one, the use of specified ABA techniques in addition to 1:1 services, may help produce more desirable treatment outcomes. The term “caregiver training” is common in ABA services and refers to the individualized instruction that a BCBA or ABA Supervisor provides to parents and caregivers. This typically involves a combination of individualized ABA techniques and methods parents and caregivers can use outside of 1:1 sessions to facilitate ongoing progress in specified areas.
ABA therapy can help people living with ASD, intellectual disability, and other developmental challenges achieve their goals and live higher quality lives.
What does ABA Therapy look like?
Agencies that provide ABA-based services in the home-setting are more likely to implement ABA services similarly than doing the same exact protocols or procedures. Regardless, an ABA agency under the guidance of a Board-Certified Behavior Analyst follows the same research-based theories to guide treatment that all other acceptable ABA agencies use.
ABA-based services start with a functional behavior assessment (FBA). In a nutshell, a FBA assesses why the behaviors may be happening in the first place. From there, the FBA will also determine the best way to address the difficulties using tactics that have been proven effective over time with a focus on behavioral replacement versus simple elimination of a problem behavior. The FBA will also have recommendations for other relevant skills/behaviors to be taught and parent skills that can be taught in a parent training format to name a few. From there, the intensity of the ABA-based services is determined, again, based on the clinical needs of your child. The completed FBA is then submitted to the funding source for approval.
One-on-one sessions between a behavior technician and your child will start once services are approved. The duration per session and the frequency of these sessions per week/month will all depend on how many hours your child’s ABA services have been approved for—usually, this will be the number recommended in the FBA. The sessions are used to teach identified skills/behaviors via effective teaching procedures. Another aspect of ABA-based services in the home-setting is parent training. Parent training can take many forms depending on what goals have been established during the FBA process. The number of hours dedicated for parent training is also variable and solely depends on the clinical need for it. If a 1:1 session is between a behavior technician and your child, a parent training session or appointment is between you and the case supervisor and with and without your child present, depending on the parent goal(s) identified. Parent training service’s goal is for you to be able to have ample skills/knowledge in order for you to become more effective in addressing behavioral difficulties as they occur outside of scheduled ABA sessions. Depending on the goals established, you may be required to participate in your child’s 1:1 sessions. These participations are a good way for you to practice what you have learned from the case supervisor while at the same time, having the behavior technician available to you to give you feedback as you practice on those new skills.
As mentioned in the beginning, no two ABA agencies will do the same exact thing when it comes to providing ABA services; however, good agencies will always base their practice on the same empirically-proven procedures.
How do I start ABA Therapy?
In most cases, the first item required to start ABA therapy is the individual’s autism spectrum disorder (ASD) diagnosis report. This is typically conducted by a doctor such as a psychiatrist, psychologist, or a developmental pediatrician. Most ABA therapy agencies and insurance companies will ask for a copy of this diagnosis report during the intake process as it is required to request an ABA assessment authorization from the individual’s medical insurance provider.
The second item required to start ABA therapy is a funding source. In the United States, and in cases where Medi-Cal or Medicare insurances are involved, there is a legal requirement for ABA services to be covered when there is a medical necessity (ASD diagnosis). Medi-Cal and Medicare cover all medically necessary behavioral health treatment services for beneficiaries. This typically includes children diagnosed with ASD. Since Applied Behavior Analysis is an evidence based and effective treatment for individuals with ASD, it is considered a covered treatment when medically necessary. In many cases, private insurance will also cover ABA services when medically necessary, however in these cases, it is best to speak directly with your medical insurance provider to determine the specifics of the coverage and to ensure that ABA is in fact, a covered benefit. Additionally, some families opt to pay for ABA services out-of-pocket.
The next step to starting ABA therapy is to contact an ABA provider whom you are interested in working with. Depending on your geographic location, ABA agencies exist in many cities across the United States. Your insurance carrier, local support groups, and even a thorough online search can help you find reputable and properly credentialed ABA agencies near you. Our organization, LeafWing Center, is based in southern California and is recognized for aiding people with ASD achieve their goals with the research based on applied behavior analysis.
Once you have identified the ABA provider with whom you wish to work, they should help you facilitate the next steps. These will include facilitating paperwork and authorizations with your funding source. Once the assessment process begins, a BCBA (Board Certified Behavior Analyst) or qualified Program Supervisor should get in contact with you to arrange times in which interviews with parents/caregivers and observations of your loved one can be conducted. This will help in the process of gathering important clinical information so that with your collaboration, the most effective treatment plans and goals can be established for your loved one. This process is referred to as the Functional Behavior Assessment (FBA) and is elaborated on in different blog posts on our website. With regard as to what can be expected once ABA therapy begins, please read our blog post titled: When You Start an ABA program, What Should You Reasonably Expect from Your Service Provider?