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Who Can Provide ABA Therapy?

Applied Behavior Analysis (ABA) therapy is typically provided by Board Certified Behavior Analysts (BCBAs), Board Certified Assistant Behavior Analysts (BCaBAs), Registered Behavior Technicians (RBTs), and paraprofessionals.

A BCBA is a person who has met the educational and professional training requirements established by the Behavior Analysis Certification Board. A BCBA will typically hold a Master’s degree in Psychology, Child Development, or a related field. Some BCBAs may also hold a doctoral degree in one of these fields and are referred to as BCBA-Ds (doctorate level BCBAs). The primary duties of BCBAs include: conducting clinical assessments, establishing skill based and behavior goals, updating and modifying treatment goals, conducting parent and caregiver trainings, supervising Registered Behavior Technicians and BCaBAs, ensuring the ABA program is implemented correctly and effectively, and writing progress reports required by funding sources.

A BCaBA (assistant Behavior Analyst) works under the supervision and direction of a BCBA and has similar duties as a BCBA. A BCaBA is also certified by the Behavior Analysis Certification Board and has met the necessary training and education requirements. A BCaBA will typically hold Bachelor’s degree in the field of Psychology, Child Development, or related field.

As stated by the Behavior Analysis Certification Board, an RBT is a person who practices under the close, ongoing supervision of a BCBA, BCaBA, or BCBA-D. The Registered Behavior Technician is primarily responsible for the direct implementation of ABA services. This is the person who is typically working 1:1 with an individual in designated treatment settings (home, school, clinic, etc.) RBTs must be over 18 years old, possess at least a high school diploma, go through a designated training program, and pass other eligibility requirements. RBTs do not conduct assessments or create treatment programs, however they implement the treatment program designed by a Behavior Analyst and collect data on progress.

Other professionals such as Marriage and Family Therapists and Licensed Clinical Social Workers may also provide ABA therapy in some instances. However, the majority of ABA services are provided by Behavior Analysts and Registered Behavior Technicians. Other paraprofessionals, including individuals pursuing undergraduate or graduate degrees in Psychology and related fields and/or pursuing certification by the Behavior Analysis Certification Board, may also provide ABA therapy under the Supervision of Behavior Analysts.

Can Autism be Treated?

Therapy

This is a common and very good question that we hear “new” families ask during intake or in the very early phases of services; however, before we proceed, something needs to be clarified: treatment is not cure.  Cure implies that we know a definitive cause and we have stopped the cause. Right now, we don’t know a definitive cause of autism. Although some, professionals will claim that autism can be cured based on their studies or personal experience, it is fairly safe to say that for now, there is no cure for autism.

That last statement can be something difficult for some families to take in. From our experience in the applied setting working with families over the years, we have heard that question a handful of times and as professionals, we do feel some responsibility to, in a way, inform new parents early on duirng services so they can focus on what is doable: autism can be treated.

You have probably heard the statement “no two individuals living with autism are the same.” This statement is fairly accurate as what differentiate one person from another are the “symptoms” or difficulties that each live with.

Symptoms. Difficulties. Focusing on these then make addressing the diagnosis of autism doable.  As behavior analysts, it is our responsibility to only administer ABA-based treatment programs that have been proven to be effective given a specific difficulty.  This is called evidence based practices. The specifics of a treatment program will vary of course from one person to another, but the foundations of treatment programs are the same. A foundation derived from sound, empirically proven methods repeatedly implemented in the applied setting over time.

As parents, we will do pretty much anything for our child; however, before doing so, it is highly advised that we inform ourselves about a specific treatment before committing to such treatment especially if it will require additional resources from you (for example, money, time, and effort).

With qualified ABA professionals, proper assessments in the beginning and throughout services, goal-setting, teaching supports to maintain and generalize learned behaviors or skills, and hard work over time, measurable and quality gains can be observed.

The topic of treatment is beyond the scope of this blog; therefore, we do encourage you to communicate with a qualified behavior analyst in your area or you can check out our website at www.leafwingcenter.org for more information on this and other related topics.

Does Research Show that ABA is Successful in Treating Children with Autism?

Yes—research does show that ABA is successful in treating children living with autism. As a matter of fact, since the early 1960s, the effectiveness of ABA based interventions has been very well documented particularly when helping children with developmental disabilities. Over 400 research articles were published between 1964 and 1970 alone and all have concluded that behavior analytic interventions demonstrated the most consistent results with individuals living with developmental disabilities. From the mid ‘80’s to 2010, there were over 500 peer-reviewed, published articles on autism and Applied Behavior Analysis.

Many families of children with autism are or are becoming familiar with the 1987 study published by Lovaas. That 1987 study was the first “group study” looking at children with autism receiving intensive ABA treatment (i.e., 40 hours per week) and children with autism that received 10 hours of ABA treatment or none at all.  In this famous study, Lovaas and his research team implemented many of the basic principles and techniques of behavior analysis into an early intensive intervention program for children with autism. After approximately two years of ABA based interventions, 47% of the children in his study made tremendous gains and were able to enter a typical first grade classroom without any additional assistance and scored in the average range in IQ tests when prior to the intervention these same children scored in the low range in IQ tests. Of the control groups, the children in the study that did not receive ABA interventions but only community supports, only one child was placed in a first-grade placement and scored average IQ.

While this study is over 30 years old, there are recent replications and research studies that indicate similar findings. While it’s beyond the scope of this post to go into all the research studies indicating the effectiveness of ABA programs for children with autism, ABA currently is widely recognized as a safe and effective treatment for autism.  It has been endorsed by a number of state and federal agencies, including the US Surgeon General and the New York State Department of Health. And for that reason, the use of ABA principles and techniques has rapidly expanded in recent years as more studies demonstrate that these principles help individuals with autism live more independent and more productive lives.

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.