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Why Does ABA Help Children With Autism?

Why is Applied Behavior Analysis treatment helpful when teaching children with autism?  What is it about these principles and techniques that seem to be a good fit in helping improve the lives of those affected with autism? These are very important questions to ask and their answers are imperative to understanding why individuals with autism often need specialized teaching environments to learn.

We all know that typically developing children learn throughout all waking hours, even when they are not being formally taught. Typically developing children watch other children, watch adults, watch TV, learn from school, and incorporate what they have learned into their repertoire.  Often times they only need to see something once or twice before it comes easily to them. Parents are often amazed at what their children are learning and frequently ask, “where did you learn to do that?” Furthermore, when children acquire language, they often begin to ask questions of others in their environment. From the basic “why” question that parents so often get asked to more elaborate questions about “How this thing works, or how that thing works”. They become their own information seeking beings.

Unfortunately, this is not the case for the majority of children with autism. Children with autism learn much less from their environment. They have a weakness in what’s called observational learning or learning via imitation, that is, watching someone else do something, and learning to do it themselves without any specific teaching.  Children with Autism typically have decreased language skills and thus attend less to others, or they understand less of what is said to them, or they ask fewer questions of others. For most children with autism, you cannot expect to put them in a classroom setting and have them learn and absorb what the teacher is saying, mainly as a direct result of the characteristics of autism.

However, ABA programs create a very structured environment where conditions are optimized for learning, and over time, this very structured environment is systematically changed so that it mimics what a child could expect if and when they are placed in the classroom. In other words, initially, an ABA program will create a somewhat unnatural or atypical learning environment for a child, such as teaching them in a distraction free, one-to-one environment in their home, but over time, this environment will slowly change so that it looks like every other classroom that a child may encounter in their school years.  It is important to note that the main premise of an ABA program is teaching a child, “how to learn,” so that they will no longer need such structured and specialized services.

Also, ABA programs take into consideration generalization and maintenance and plan accordingly for these issues. That is, another common challenge with children with autism is that they don’t easily apply something that was learned in one environment into another environment (e.g., if something was taught at home, the child may not do it at school). Last, it is sometime difficult for children with autism to remember something that was taught at some time in the future. That is tough for all of us sometimes. However, it is essential for children with autism as their programs often are composed of skills that build on one another.

Individualization in the Treatment of Children with Autism

In ABA programs, the individual’s behavior is the primary focus when it comes to intervention development, execution, and monitoring. As such, the design and implementation of all ABA programs must be individualized. This is not only an ethical requirement, but also clinically relevant because each child has their own strengths, skill deficits, environments they spend time in, learning histories, and a unique biology. These factors must be considered during the design of an ABA program. Autism is a spectrum disorder and that means there are a lot of differences in the characteristics that each individual may have.

To illustrate, the goal of teaching pretend play skills to a child who has limited pretend play skills might be a high priority goal. However, the same goal might not be a high priority goal for a different child who already demonstrates age level pretend play skills since he or she already has this skill in their repertoire. In the case of the latter scenario, it may be more clinically appropriate to teach ways in which the pretend play skills can be expanded upon, generalized, or to target different curricular areas in which there are deficits. This is an example of how one particular goal may not be clinically appropriate for two different children.

As mentioned earlier, individualization should take a learner’s strengths and skill deficits into consideration. With this, a learner’s strengths can be built upon while the areas of deficit are strengthened. Remember, ABA is never ‘one size fits all’ and a good program should rely on assessment tools such as observations, interviews, clinical assessments, and collaboration with the learner’s family to establish individualized goals that are in the best interest of the client.

Below are a few ways in which individualization can be achieved in an ABA program:

  • Consider the interests and preferences of the child. Create ways to incorporate these in to the ABA program.
  • Consider the sociocultural values of a child’s family, along with their top concerns as they relate to behavior challenges and skill deficits.
  • Through use of validated clinical methods, explore the child’s strengths and deficits as they relate to major domains – socialization, communication, self-care, motor skills, etc.
  • Promote collaboration between a child’s family members, other professionals (teachers, speech therapists, occupational therapists) in the child’s life, and the ABA provider.

Though the list above is not exhaustive, we hope this post has provided you with some information about individualization in ABA programs!

Some Considerations and Strategies for Students with Autism in Classroom Settings

When creating an educational program for students with ASD, each student’s unique characteristics present unique challenges for administrators and school support staff. An effective classroom must include a physical structure that enhances learning opportunities and instructional approaches that facilitate learning, language acquisition, behavior management, social skills, and academic goals. We can apply many of the basic principles of effective instruction that are used in within the general education classroom as we work with students with autism and Asperger Syndrome, however, there are certain strategies that have been proven to be particularly effective. These strategies provide structure and predictability to the learning process, allow students to anticipate task requirements and setting expectations, and teach a variety of skills across content areas in the natural environment, enhancing the likelihood of generalization.

Predictability and sameness are significant factors throughout student’s daily lives. One way to address these elements in the classroom is with “Environmental Supports”. Environmental supports help students organize the physical space in ways that help our students predict any changes in their daily routines or deviations from typical expectations that may take place during the school day; different activities or events, a substitute teacher, or fire drills. We can help students understand expectations, and in general, make sense of their entire environment. Researchers have defined environmental support as “aspects of the environment, other than interactions with people, which affect the learning that takes place”. Examples of environmental supports are: Labels, Boundary settings, Visual schedules, Behavioral-based education tools, Activity completion signals, Choice boards, and Waiting supports.

All of these environmental support strategies are a simple yet effective way to help a student respond appropriately in their day-to-day activities throughout their school day. Environmental supports can be effectively utilized across all environments and all settings to help support individual with ASD. Additionally, environment supports have been shown to increase student independence, and help stimulate language.

The physical organization of the classroom can be a crucial element for them enhancing success. Structure and predictability facilitate the students understanding of the environment, which can help decrease worry or agitation the student might have. This is really important for students with autism who tend to react negatively or really that difficult time with changes and unsent uncertainty in their environment. Something as simple as labeling furniture and objects in a classroom can have numerous benefits for students with autism; label boxes or containers with visual representations such as icons or hand-written labels. Students can then be taught to match the label on the container to the label on the shelf, allowing independents in retrieving or returning an activity to its appropriate place in the classroom.

Again, we want to emphasize that each student is unique and the strategies used need to reflect their unique needs.

What is ABA (Applied Behavior Analysis)?

Applied Behavior Analysis is a scientific approach to understanding behavior. Behavior Analysis is a theory with principles and laws that are derived from research. All of the practices in Applied Behavior Analysis are derived from basic research. ABA is considered an evidence-based practice, which means that ABA has passed scientific tests of its usefulness, quality, and effectiveness. When such principles and laws are put into practice, it is said that behavior analysis is being appliedbehavior analysis helps us to understand how behavior works, how behavior is affected by the environment and how learning takes place, thus the term APPLIED BEHAVIOR ANALYSIS or ABA for short.

Simply put, applied behavior analysis is a science concerned with the behavior of people, what people do and say, and the behavior of animals. Behavior analysis attempts to understand, describe, and predict behavior – why is it we do what we do and how did we learn to do what we do? The goal is to increase behaviors that are helpful and decrease behaviors that are harmful or affect learning.

The years of basic research in Applied Behavior Analysis have given us many Laws of Human Behavior that we can apply to the treatment of children with autism.  ABA has its roots in behavior therapy since the 20th century. The earliest behavior analysis on children with autism spectrum appeared in the early 1960’s and 1970’s in the USA.  ABA requires implementation of established principals of learning, behavioral strategies and environmental modifications to improve and teach new behaviors. Applied Behavior Analysis is founded on 7 core dimensions.  This means that all interventions that are provided through ABA services should fall within these 7 categories.  The 7 dimensions are, Generalization, Effective, Technological, Applied, Conceptually Systematic, Analytic and Behavioral. Generalization is when skills and or behaviors occur in environments other than where they were taught. Effective interventions are monitored to evaluate the impact on the target behavior.  Technological procedures are described clearly and concisely so that others may implement accurately. Applied is when socially significant behaviors are selected. Conceptually Systematic interventions are consistent with principals demonstrated by literature.  Analytic decisions are data based. Behaviors targeted are observable ad measurable.

It is important to understand that Applied Behavior Analysis is not only limited to autism. There is a variety of populations and fields that ABA can be applied to. The interventions that have been developed based on ABA principals are used in every walk of life and every profession.  Different types of people use ABA in their jobs and in their lives. Parents, teachers, psychologists and these ABA principals can be used in education, weight loss, animal training, sports and within many other fields and activities.  The ultimate goal of Applied Behavior Analysis is to establish and enhance socially important behaviors!

Observational Learning and Children with Autism

One of the main obstacles to learning that many children with autism face is a lack of observational learning skills. What is observational learning? It is learning that occurs without explicit teaching and by observing another person do something and simply doing what they do. Children with autism have difficulty learning by watching someone else and absorbing that information incidentally. For example, a typically developing child may look across the classroom and watch another child building a house using blocks. The next day at school this child may then build his or her own house using blocks without specifically being taught this task. This child simply watched another child, observed what the child was doing, was able to retain this information in his or her memory, and then accessed this information the next day in order to build a house. On the other hand, parents of typically developing children sometimes complain that their children are learning bad habits at school. This can also be observational learning at work. A child with autism may lack these imitation skills and so when they are in an environment filled with peers from which to learn, often times very little learning takes place. Opportunities for observational learning occur throughout the day and may contribute to a considerable amount of what we learn. Just think, was everything that you know explicitly taught to you? Chances are you answered “no”.

In an ABA program, one of the first skills taught to a child with autism is the skill of attending and imitating. Initially, this imitation might be as simple as imitating a handclap, or a wave. Over time, these imitation skills will expand so that the child can imitate complex behaviors such as how to watch a child from afar and build what they are building, how to play T-ball, how to draw pictures, or how to engage in self-care tasks such as brushing their teeth simply by watching, absorbing, and imitating. Imitation is one of the basic foundational skills needed for any child to be a successful learner. Therefore, there is much emphasis placed on imitation in ABA programs, particularly in the beginning stages of programs.

Why Do Some ABA programs Use Basic Language When Working with Children with Autism?

We know many children with autism typically have difficulty understanding language. These difficulties can be subtle. For example, a child may have difficulty understanding humor. In other cases, they may be more pronounced. That is, a child may respond to little or no language that is spoken to him or her. Taking this fact into account, most ABA programs will teach a child using simple and concise language at the beginning stages of the program. For example, if the goal is to teach a child to imitate a ‘clap’ the teacher would simply say, “Do this” or “Copy me” while demonstrating the action. The instruction would be limited to as few words as possible (in this example, two words and then a demonstration of the action). The teacher would refrain from using a longer instruction that contains more words such as, “okay, now I’m going to do something and I want you to watch me and then copy me after I’m done. Are you ready?” For a child who has difficulty understanding language, this instruction is laden with words that are unnecessary to complete the instruction and probably will include many words that the child does not presently know. Another example of this can be seen with one-word instructions given to children when attempting to teach them to perform actions. With this type of program, an instruction to the child may include something like “clap” or “stand up” and the child would perform the action. The general idea is here is to use fewer, and simpler words to evoke the desired response from the child.

Therefore, in the initial stages of an ABA program, the more concise and simpler the instruction, the more successful the child will be. It is important to note that the simplicity or complexity of language used should be based on the child’s language repertoire at the time of assessment. Over time, and with success, simple and concise instructions will be elaborated and more language will be incorporated into the instruction.

Using Boundary Markers to Support Students with Autism in Classroom Settings

Boundary settings are a type of environmental support for students with ASD. Basic boundary markers which establish physical space for specific activities such as break time areas, and reading areas help students differentiate expectations across settings, especially when one area is used for different activities (this is very common in classrooms around the world). For example, if two or more tasks must be completed at the same work space or work area, using a colored tablecloth can help distinguish one activity from another. Reading could take place at the table and then it could be covered with an orange tablecloth when it is time for math. Additionally, sectioning off an area on the floor with colored tape, rugs, or anything else that would indicate where a student is expected to be during any given activity is an effective environmental support. This type of marking or labeling is simple and seems to be a minor modification, but in fact, it is highly effective for working with students with ASD. These modifications can reduce students’ confusion and increase clarity by identifying expectations.

It is important to note that simply applying these types of environmental supports without explicitly demonstrating them to the student and explaining what they are intended for will likely not result in the desired outcome. It is almost always necessary to show the student how they are intended to be followed for the markers and boundaries to be effective. Often times, showing or demonstrating to the students how the boundaries and markers are to be followed needs to be done repeatedly and over time.

Finally, when boundaries and markers begin to show effectiveness with students with ASD, rewards for appropriately following the supports should be utilized. That is, when a student correctly follows them they should be provided with social praise or other types of rewards.

What Constitutes Effective Intervention for Individuals with Autism? The National Research Council’s report on Effective Treatments for Autism Still Stands True

In 2001, the National Research Council published findings effective treatments on Educational Interventions for Children with Autism from birth to age 8. The committee set out with the question “What are the characteristics of effective interventions in educational programs for young children with autism spectrum disorders?” The findings were published in a comprehensive book titled, “Educating children with autism.”

In answering the above question, the committee recognized that there were numerous articles written on autism treatment and that there were numerous treatment programs across the country claiming to be effective in helping children with autism. Treatments ranging from ABA-based programs to developmentally-based programs to diet-based programs or more idiosyncratic programs such as sensory integration. In order to base their recommendations on clear evidence of effectiveness, the committee ruled out treatment that did not base their statements on some form of data regarding the outcome of the children.

They took a look at over 900 articles written on the treatment of autism and also enlisted the assistance of ‘model’ programs currently in place for the treatment of autism.  These model or state-of-the-art programs were typically university or research ran programs who that enlisted the services of highly qualified professionals. Of the ten model programs selected, seven were from an applied behavior analysis framework, one was from a developmental framework, one was purely parent training, and the last was a combination of behavioral and developmental frameworks.

The committee listed key features seen as variables of effective programs in an effort to use this information from these state-of-the-art programs and translate it to publicly funded early education programs across the country and to begin some quality control.

The first characteristic identified as a key feature of an effective treatment program is that of early entry into a program.  When reviewing the information from these model programs and based on findings from the literature, the committee saw that the earlier a child is placed in treatment the better their chances of making gains.  Therefore, their first recommendation was that educational services begin as soon as a child is suspected of having an autism spectrum disorder highlighting the importance of early intervention. Early detection and treatment are key phrases often heard in the medical field and this is the exact same case when it comes to the treatment of autism.  So, early entry is recommendation number one.

Next, the committee looked at the intensity of these programs and what has been shown in the literature  to be an effective level of intensity. Their conclusion upon review of the information was that educational services include a minimum of 25 hours a week, 5 days a week, 12 months a year during which time a child is actively engaged. The word minimum in this recommendation is key as some children may need more than this minimum of hours given the severity of their symptoms or their resistance to treatment.

Additionally, the notion of active engagement is very important as the recommended number of treatment hours is not merely the number of hours recommended for a child to be placed in a treatment program, but the number of hours to child is actively learning while in the program.  This means that the child should not be just physically present in a treatment program, but that each and every hour of that program is designed in a way in which the child will learn for a minimum of 25 hours per week.

Another way of looking at this is if it was recommended that a child attend a special education program 30 hours a week, one would initially think that the recommendation for a minimum number of hours has been met. However, if, within these 30 hours, the child spends at least two hours a day playing alone in the playground, one hour a day eating lunch, a few hours a day in unstructured and unsupervised solitary play activities, and only two hours of actual teaching occurs within the school day, a child is left with only a 10-hour a week treatment program. And while play time is extremely important for any child, if a child does not yet have the skills to know how to play, how can the child be expected to interact with other children during these free play times without specific structured teaching?  So, it is important to look beyond the number of hours and actually look at what each hour of the treatment program will entail whether that be an ABA program, school-based program, or any type of recommended treatment program.  It’s imperative that a child be placed in a program where they can access the curriculum and where the teachers or therapists are actively engaging the child so as to capture each and every teaching opportunity and make it a worthwhile experience. There needs to be intensive teaching and learning occurring during a child’s time in an intervention program.

The committee actually described intensity as a “large numbers of functionally, developmentally relevant, and high-interest opportunities to respond actively.”  In other words, a child’s time spent in a treatment program should result in high levels of learning when it comes to the matter of reaching their educational goals. So, the higher the level of active engagement, the higher the intensity, the higher the change rate for steady gains.

Next on the list of key characteristics was the child to teacher ratio. The committee recommended that programs consist of sufficient amounts of adult attention in order for a child to meet their educational goals, either learning with one-to-one or very small group instruction. The decision of student-to-teacher ratio should be made, depending on the learning ability of the child rather than depending on the staffing needs of the program.  Therefore, if a child can learn in a small group of maybe two children and one teacher, then that should suffice; however, as is the case for many young children with autism, if the child cannot occupy their own free time in a constructive manner, redirect their attention when asked, or learn via observation of a peer, then the teaching instruction should be in a one-to-one manner, that is one teacher with one child.

The committee recognized the need for well-trained personnel.  The committee noted that all the model programs they reviewed were developed by persons with Ph.D.’s in autism-related fields and the programs were directed and implemented by teams of professionals who had extensive training and experience in autism spectrum disorders. It is so important that the person designing a treatment program for a child with autism has extensive knowledge not only in the field of autism, but hands on experience in designing effective programs.

Next, the committee recognized the notion of individualization. A key characteristic of these model programs was that of comprehensive, individualized treatment goals based on the needs of each individual child rather than a one-size-fits-all curriculum for all the children in the program. The curriculum or individualized plan developed for each child should be based on their own personal strengths and weaknesses.  The goals for each child should also focus on the development of a child’s social and cognitive abilities, their verbal and non-verbal communication skills, adaptive or self-help skills, and the reduction of behavioral difficulties using more positive behavioral approaches rather than punitive approaches.

The second part of this recommendation, that “goals “are frequently adjusted,” cannot be emphasized enough. While the initial curriculum and targets developed for a child may be individualized at the onset of a treatment program, it is critical that these goals and targets be reviewed routinely and adjustments be made when necessary.

And lastly, the committee recognized the important role parents have when it comes to the effectiveness of treatment programs. A key characteristic amongst all model programs was their emphasis on parental training and involvement in the program. The involvement of parents is a very valuable tool in the treatment of autism because children spend most of their time with their parents; therefore, parents must play an active part in the treatment team so as to continue where the formal treatment sessions end. With parents as active participants of the program, a child will always be in a consistent environment where their skills can be generalization generalized and maintained.

Increasing Language for Children with Autism

Impairment in communication is one of the main diagnostic criteria for a child with autism, specifically a delay in or total lack of spoken language.  Behavior analysts break down “language” into many reasons a child would communicate.  Based on these reasons, they identify where there are deficits and how they can increase these deficit areas.  We will outline some of them here in a very easy-to-understand manner and then give some advice on how to increase these forms of language every day.

The first form of language a child engages in is repeating.  This happens when a child repeats what another person says.  You may be thinking at this point that your child with autism does this a lot!  Many children with autism engage in this behavior although it is repetitive in nature and they do not do it to get attention from others (why typically developing children repeat language); they do it because it is fun for them. In order to learn other forms of language (which we will discuss below), a child should be able to repeat what an adult says on command. If your child does not do this regularly, give many opportunities for repetition, each day throughout the day.  Get your child’s full attention, say a simple sound or word very clearly to them (e.g., “ahhhh”) and continue to do this until they repeat or approximate what you are saying.  Provide lots of praise and even preferred items.

Another important form of language a child engages in is requesting.  Many children with autism engage in challenging behaviors as a form of requesting (e.g., crying to get a cookie and this results in them getting a cookie so they will quiet down), instead of using appropriate language (e.g., “mommy, can I have a cookie?”).  This form of language can be taught throughout the day, every day, if you know what your child wants.  Keep many of their preferred items out of reach, especially food items.  Whenever they show a desire for something, model what they should say or do to communicate (e.g., you say “cookie”, engage in the manual sign for cookie, or point to the cookie icon or picture for them to give you) and require them to engage in the same communicative behavior that you modeled before you give them the cookie.  Give them small pieces of food items, little sips of drinks, or a short amount of time to play with preferred toys so you can remove the item and practice requesting for the item again.  If you do this about three times each time they want varied things throughout the day, your child will begin to gain this requesting skill, and you may see a decrease in challenging behaviors.

Remember, to learn language your child must receive lots and lots of learning opportunities per day.  You can provide this by engaging in simple strategies such as the ones we discussed above.

What challenges have you faced? Please write us back and we will respond.

What are the Changes to the Diagnosis of Autism with the DSM-V?

The first change with the new edition of the DSM is to combine the formerly separate diagnoses of autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not-otherwise-specified into one group with the name of Autism Spectrum Disorder. The stated reason for this was that of reliability and validity. That is, the DSM IV could, to the satisfaction of the committee, distinguish individuals with autism from typically developing individuals. Further, the committee stated that because autism is described by a common set of behaviors that it is best represented as a single disorder. Finally, the committee stated that a single spectrum disorder represents the current state of knowledge regarding the disorder and how it appears clinically to clinicians.

The second change is the combining of the three domains that appeared in DSM-IV (Qualitative impairments in social interaction, Qualitative impairments in communication, and restricted repetitive stereotyped patterns of behavior) into two domains (Social Communication Deficits and Fixed Interests and Repetitive Behaviors). The following rationale were provided: 1) deficits in communication and social behaviors are inseparable and; 2) delays in language are neither unique to autism (i.e., they appear in other disorders), nor are they universal (i.e., not all individuals with autism have them); 3) The changes improved specificity of the diagnosis while not compromising the sensitivity; 4) Increased sensitivity across severity levels of autism; 5) Secondary analyses of data sets support the combination of categories.

The third change is a change in the criteria within the social/communication domain were merged and streamlined to clarify diagnostic requirements. The following rationale was provided. In the previous version of the DSM several criteria measured the same symptom thus giving greater importance to that symptom (social/communication) and the merging of these criteria requires a new approach to them. Secondary data analyses were conducted to determine the most sensitive and specific symptom clusters to facilitate diagnosis for a range of ages and language levels.

Next, there is a new requirement of two symptoms from repetitive behavior and fixated interests be identified. It was also proposed that this change will increase specificity while not decreasing sensitivity. In addition, there is a requirement for multiple sources of information (clinical observations and parent/caregiver report).

These changes represent the current iteration of the DSM-V diagnosis of autism.