Applied Behaviour Analysis Therapy (ABA)
Hello! I am Dr Amit Sinha and I would like to present in this article an overview of ABA Therapy with special emphasis on its usage to treat children with Autistic Spectrum Disorders (ASD).
1. Applied Behaviour Analysis (ABA) is based on the fact that by influencing a response associated with a behaviour, may result in that behaviour to be shaped and controlled. It is a combination of psychological and educational techniques that are employed based upon the needs of each individual child. Applied Behavior Analysis is the use of behavioural methods to measure behavior, teach functional skills, and evaluate progress.
2. Baer, Wolf, and Risley in 1968 defined Applied Behaviour Analysis ‘as the science in which the principles of the analysis of behavior are applied systematically to improve socially significant behavior, and in which experimentation is used to identify the variables responsible for change in behavior’.
3. It is believed that an individuals behaviour is determined by past and current environmental events in conjunction with organic variables such as genetics. Thus, it emphasises on explaining behaviour in terms of external events that can be manipulated rather than internal constructs that are beyond our control.
4. It is one of the most researched behavioural interventional techniques. Three decades of research has established to a reasonably large extent that it can be used effectively in a wide range of settings.
5. ABA-based interventions are recognised for treating people with developmental disabilities, most notably autism spectrum disorders (ASD). However, applied behavior analysis can be aplied to a wide range of areas and people like parenting, education, managers, AIDS prevention, conservation of natural resources, gerontology, health and exercise, industrial safety, littering, seatbelt use and traffic rules, sports, and zoo management and care of animals.
6. Dr Ivar Lovaas, a psychologist first applied ABA to autism in 1987. His research demonstrated that even profoundly autistic children could be taught social and behavioural skills by ABA methods. Many children who receive ABA training learn to behave appropriately at least some of the time, and some after intensive therapy for years may not be differentiated from the normal children.
7. The ABA approach teaches autistic child, social, motor, and verbal behaviors as well as reasoning skills, as autistic children may not develop these naturally, unlike normal children. Specific targets of the interventions based on the child’s problem are identified. The ABA approach can be used by a parent, counselor, or certified counselor. It is based on careful observation of the child’s behaviour and positive re-inforcement to teach each step of a behaviour. “A child’s behaviour is reinforced with a reward when he or she performs each of the steps correctly. Undesirable behaviours, or those that interfere with learning and social skills, are watched closely. The aim is to determine what happens to trigger a behavior, and what happens after that behavior that seems to reinforce the behaviour. The strategy is to remove these triggers and reinforcers from the child’s environment. New reinforcers are then used to teach the child a different behaviour in response to the same trigger.’
8. ABA therapies consist of several established teaching tools: Discrete Trial Training (DTT), Incidental Teaching, Pivotal Response Training, Fluency Building and Verbal Behaviour, Video Modeling, Self Management are amongst the one’s that have been applied commonly.
9. In discrete trial training the practitioner gives a clear instruction about a desired behaviour; if the child responds correctly, the behaviour is reinforced. If the child doesn’t respond appropriately, the practitioner gives a gentle prompt. The hope is that the child will eventually learn to generalise the correct response.
10. Pivotal response training uses ABA approaches to address crucial skills that are important for many other skills. As a result, if the child improves on one of these pivotal skills, improvements are witnessed in a wide range of behaviours that were not specifically trained. This method helps the child to generalize appropriate and correct behaviours from the therapy setting to his/her everyday routine settings.
11. Incidental teaching employs the same strategy as discrete trial training, except the aim is to teach behaviors and concepts throughout a child’s day-to-day experience, rather than focusing on a specific behavior.
12. In fluency building, by using the ABA approach i.e. behavioural observation, reinforcement, and prompting, the practitioner helps the child learn and build up a complex behaviour. This then forms the basis or starting point for developing further complex behaviour patterns.
13. Verbal behaviour is another ABA related approach wherein the child’s language skills are analysed and reinforcements instituted, with objective of teaching him/her more useful and complex language skills.
14. ABA has the reputation of being the most researched and successfully used interventional therapy for autistic children. In a study Dr Lovaas found that almost half (48%) of the children who were subjected to intensive ABA therapy showed rapid learning, achieved average post treatment scores, and at 7 yrs of age, were succeeding in regular education classrooms. However research clearly brings outthat ABA therapy should start early and about 40 hrs a week by a trained practioner is required to achieve desirable results.
15. A number of interventions have shown that adolescents or adults with autism can be taught community living skills. Daily living skills targeted have ranged from appropriate mealtime behaviors; to eating in public places, clothing selection skills, pedestrian safety, nondisruptive bus riding, vending machine use, and coin summation etc.
16. ABA has some drawbacks too. Parents and families feel 40 hrs a week of training is rather too much in terms of time, cost and availability of trained practioners/therapists. Availability of centers where such structured training can be carried out is another issue that affects institutionalized ABA training. Another drawback of ABA is the fact that many "practitioners" are, themselves, untrained. This means that, while many are competent providers of ABA training, they have no clear idea of how to take the skills learned in a home or school environment and help learners to implement those skills in the real world. As a result, some autistic learners develop "robotic" speech and behavior patterns.
17. In conclusion it will be prudent to say that ABA therapy is a time tested and scientifically researched modality to apply in a wide range of settings to bring about improvement in social behaviour. Its application in treating autistic spectrum disorder has been accepted globally. However, its cost and lack of trainers and training institutes are some issues that need to be addressed to make it even more popular in treatment of autistic spectrum disorder.
Author Brief: Dr Amit Sinha MD is a specialist in Aerospace Medicine. Areas of interest are aerospace physiology and human factors in military and civil aviation. Keen golfer and a wild life enthusiast.