Applied Behavior Analysis (ABA) therapy is an evidence-based scientific technique used in treating individuals with Autism Spectrum Disorder (ASD) and other developmental disabilities. In general, Applied Behavior Analysis therapy relies on respondent and operant conditioning to change or alter behaviors of social significance. ABA therapy differs from behavior modification in that ABA therapy changes behavior by first assessing the functional relationship between a particular or targeted behavior and the environment. The ultimate goal of Applied Behavior Analysis therapy is for the learner to gain independence by learning and developing new skills resulting in an increase in positive behavior while reducing the frequency of negative behaviors.
An introduction to Applied Behavioral Analysis
Applied Behavior Analysis is the applied science of behavior formalized by B.F. Skinner. It is sometimes referred to as Behavior Modification, ABA, or Behavior Analysis. The theories, laws, and techniques have their foundations in years of basic research and describe some of the most fundamental things we know about behavior. Some early influences on the field of ABA include Watson, Thorndyke, Pavlov, and groups of psychologists, philosophers, and scientists in the late 1800’s and early 1900’s that pursued empirical science.
Hallmarks of Applied Behavioral Analysis
Contemporary hallmarks of ABA include the Law of Reinforcement, functions of behavior, contextualism, and determinism. Let’s briefly look at these areas to get a better understanding of the field of Applied Behavior Analysis.
Law of Reinforcement
Simply put, the Law of Reinforcement states that behavior that is reinforced will continue to occur or will occur more often in the future. Conversely, a behavior that is not reinforced will not occur or will decrease in occurrence over time (though, sometimes we see a short increase after reinforcement is discontinued for a behavior that has been previously reinforced).Through a great deal of clinical experience, it has become apparent that one challenge with really applying this law and understanding its fundamental truth relates to a not having a good understanding of what reinforcement is or can be. Some general misunderstandings include the assumption that consequences most people would describe as positive or pleasant will function as reinforcers. For example, most people would assume that receiving a thank you note would be a reinforcer for a job well done. In practice, this is not the case. There are individuals that would have no interest in a thank you note, but would rather prefer a pay increase. There are, of course, some that would.
Oftentimes, people attribute what they would find reinforcing to another person. Life shows us, this is not the case. Conversely, when we talk about reinforcement, something that we think may be reinforcing may in fact be punishing (a consequence that causes a behavior not to occur or to decrease in the future). Similarly, reinforcers can vary in their magnitude or effectiveness depending on the environment and on what has happened in the time before the reinforcer is being used.
One final thought is that behavior is often under multiple schedules. Some of the schedules are reinforcing and some of them are punishing. The effects of the reinforcers and punishers that are a part of each schedule vary. This makes it challenging for all but only the most skilled Behavior Analysts to have a good understanding of reinforcement, reinforcers, and schedules of reinforcement. The field of Behavioral Economics is making strides in empirically describing these concerns. However, the law of reinforcement remains one of the important concepts in Applied Behavior Analysis.
One of the more recent (relatively speaking as it dates back to the very early ’80’s) concepts in Applied Behavior Analysis is behavioral function. Previous to this notion, the field was more commonly known as behavior modification and behavior was mainly changed by modifying consequences (e.g., reinforcers and punishers).
Research in the early 80’s demonstrated functional relationships between problem behavior and the conditions that reinforced it. This research led to the concept of behavioral function. Simply, a behavior must be analyzed in terms of what function (i.e., purpose) the behavior served for the individual performing it.
Nowadays, we commonly look at the inappropriate behavior that children with autism perform in these terms. We ask, “are they performing this behavior for attention? Are they performing it to escape or avoid something that they do not like? Are they performing the behavior to get access to something that they want? Are they doing it because it gives them some sort of pleasure?”
Additionally, there are two questionnaire-based assessments, the Questions About Behavior Function (QABF) and Motivation Assessment Scale (MAS), that assist users with determining the function of the behavior in question. The QABF was developed with adults who have developmental disabilities and the MAS was developed with children diagnosed with developmental disabilities.
Contextualism is a concept somewhat close to behavior function. In short, contextualism refers to analyzing behavior in terms of the context that it occurs. What are the characteristics of the environment? Is it loud? Quiet? Hot? Who is there when the behavior happens? What happens right before the behavior occurs? What happens earlier in the lead up to the occurrence of the behavior? What happens after?
All of these questions are things that we ask when we analyze behavior. Taking these things into consideration is why we refer to Applied Behavior Analysis as contextual.
Our final hallmark of ABA is one of the more ephemeral concepts. It is complex and philosophical in nature and oftentimes needs to be reflected on to really get a grasp of it. This is the concept of determinism. This is also one of the more controversial concepts in ABA. Essentially, the concept of determinism says that our behavior is under the influence of our learning histories, the antecedents that occasion the behavior, and the consequences that reinforce or punish it. We are not operating under the umbrella of free will.
Like was said earlier, this is a controversial concept. Some say that our verbal behavior (i.e., thoughts) can control our behavior. In some cases, it may mitigate our behavior and, of course, it is behavior and therefore is under the same influences of antecedents, consequences and learning history. However, with the exception of the species-specific behavior with which we are born, we are products of our learning histories and present environmental factors.
Looking beyond the foundations of applied behavior analysis
Applied Behavior Analysis is an elaborate science of behavior and it has been applied in many arenas (businesses, animal training, individuals with developmental disabilities, individuals with Traumatic Brain Injury, etc.,). There are many laws and principles and even more techniques based on these laws and principles. Some of the main hallmarks remain those referenced above (i.e., reinforcement, functions of behavior, contextualism, and determinism).
Applied Behavior Analysis therapy is effective in identifying and treating challenging behaviors. Effective ABA programs will identify challenging and undesirable behaviors at the onset of services. Once the challenging behavior(s) have been identified, a comprehensive Behavior Intervention Plan (BIP) will be established. An effective BIP should include research-backed principles used to reduce the unwanted behavior and should also include replacement behaviors. Replacement behaviors are behaviors that achieve the same result as the challenging behavior but are considered to be socially appropriate, easy to engage in, and, generally speaking, more desirable than the challenging behavior. For example, if it is determined that a learner engages in aggressive behaviors to escape a difficult task, replacement behaviors which will be taught may include requesting a break or asking for help. Hence, one of the ways in which ABA therapy is effective is through the assessment and treatment of undesirable behaviors.
A child or adult with autism spectrum disorder may have limited, repetitive patterns of behavior, interests or activities, including any of these signs:
- Performs repetitive movements, such as rocking, spinning or hand flapping
- Performs activities that could cause self-harm, such as biting or head-banging
- Develops specific routines or rituals and becomes disturbed at the slightest change
- Has problems with coordination or has odd movement patterns, such as clumsiness or walking on toes, and has odd, stiff or exaggerated body language
- Is fascinated by details of an object, such as the spinning wheels of a toy car, but doesn’t understand the overall purpose or function of the object
- Is unusually sensitive to light, sound or touch, yet may be indifferent to pain or temperature
- Doesn’t engage in imitative or make-believe play
- Fixates on an object or activity with abnormal intensity or focus
- Has specific food preferences, such as eating only a few foods, or refusing foods with a certain texture
Applied Behavior Analysis therapy and skill development goals
Another way in which ABA therapy is effective is through the identification and targeting of skill development goals. Applied behavior analysis therapy will typically address skill deficits across several domains. These domains will vary and depend on the individual needs of the learner. For example, skill development goals may be targeted to address deficits in communication, self-help skills, motor skills, social skills, or play skills. Again, the specific skill development goals that are chosen by the family and ABA team will vary based on the current clinical needs of the learner. Ultimately, the goal of skill development programs is to improve the learner’s quality of life and promote more independence.
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?