What is ABA Therapy
Definition Of ABA
ABA stands for Applied Behavior Analysis. In very simple terms, ABA is a teaching method that has proven to be very effective in teaching children with ASD. This method was developed through years of research. Behavioral principles are used to motivate the student to learn.........etc.
Please read below to learn the details.
Why is Applied Behavior Analysis therapy effective?
There is a lot of scientific data to support the effectiveness of ABA therapy. You can scroll down the page to read what some well respected organizations have said about ABA. What I will explain here is in plain terms why I, as an ABA therapist for over 15 years, think ABA is effective especially for children with ASD.
1. ABA uses a systematic approach
Children with ASD are known for not wanting to look at other people, having very short attention span, and have self-stimulatory behaviors, which may include frequently rocking back and forth, frequent hand movement, or staring at lights to name a few. ABA teaches in a very structured format that we call the discrete trial or the ABC’s. The “A” stands for the antecedent or the question we ask. The “B” stands for the behavior or the response the child provides to the question. The “C” stands for the consequence that we give such as praise for answering correctly or a correction if the response was incorrect.
This is an example of the ABC format when teaching a child the one-step direction “come here”:
(A) Antecedent – “Come here”
(B) Behavior – The child comes to me within 4 seconds after my instructions
(C) Consequence – The child receives praise and a small snack
Teaching in this format provides the child with a predictable structure that allows them to learn despite having a very attention span and inconsistent behavior issues.
2. ABA therapists know how to motivate
We specialize in knowing how to motivate people to either increase or decrease their behaviors. ABA’s method of teaching is based on behavioral principles. Before we begin the therapy, we do a reinforcer assessment in which we ask the child’s parents to identify things the child likes such as snack, toys, videos, etc.. We then strategically use these items to motivate the child to respond to our instructions. As an example, we can present a child with cookies (reinforcer) to movitate them to stay in their chair. We can also remove his Ipad privileges to motivate him to stay in the chair. We are experts at using consequences.
3. ABA therapists are trained to manage behavior issues
Some children/adults with ASD have intense behavior issues such as constant self-stims (e.g. talking to self, rocking body), or aggressive behaviors towards themselves or others. These behaviors can be major obstacles to providing any kind of therapy to the child, but ABA therapists receive training in this area. We target these behaviors and include decreasing them as a part of the student’s curriculum.
4. Can provide a lot of teaching opportunities.
As mentioned above, ABA therapists know how to both motivate students and manage their behavior issues. This allows us to teach at a fast pace and thus teach more. As research shows, giving the student more opportunities to respond to questions, increases the likelihood that they will learn what is being taught.
Why do our students respond faster with us? We teach them that if they respond correctly to our instructions, they will receive something they like (a reinforcer). If they do not respond correctly, they know we will help them and teach them the correct response. Once they learn we will do this on a consistent basis, they will increase the amount of compliance they will give us. We then are able to teach at a high rate. For example, it depends on what is being taught, but I can present 150 to 200 questions to a child per hour.
5. Customize learning
Children with ASD can vary greatly from one child to the next. When designing a lesson plan for them, we do not just look at their IQ level, but we also have to take into consideration their self-stimulatory behaviors as well as other behavior issues (e.g. yelling frequently, aggressive behaviors, etc.). Children in ABA therapy are mostly taught in very small groups or in a one-to-one setting. This allows us to customize a curriculum for each child to meet their needs. In addition, if a child cannot perform a task, an ABA therapist has the knowledge to break that task into smaller more teachable units for the child to learn them. For example, if a child does not know how to perform the whole brush teeth procedure, we can break that multi step task down into a few small tasks (e.g. first, wet the toothbrush then put tooth paste on toothbrush, etc.) so that he will eventually learn how to perform the whole procedure.
ABA Has Over 40 Years Of Research To Support it
Applied Behavior Analysis (ABA) is the only form of therapy that has over 40 years of research to prove its effectiveness. Below are what some of the most well-known organizations in the United States have to say about it.
1) The Centers for Disease Control (CDC) said, “ABA has become widely accepted among healthcare professionals and used in many schools and treatment clinics” (Hagopian, 2015).
2) The Surgeon General of America United States stated, "Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior" (District Court for the Northern District of Illinois: T.H. v Board of Education of Palatine Community Consolidated school District 15, 1999).
3) American Academy of Child and Adolescent Psychiatry concluded: “ABA techniques have been repeatedly shown to have efficacy for specific problem behaviors, and ABA has been found to be effective as applied to academic tasks, adaptive living skills, communication, social skills, and vocational skills” (Volkmar et al., 2014).
4) The National Institute of Mental Health (NIMH) noted that ABA has become widely recognized as an effective treatment for individuals with autism (Hagopian, 2015).
To demonstrate how well-known and accepted ABA therapy is, all 50 states in America require insurance companies to assist families in paying for it.
The Lovaas 1987 Study
“Behavioral Treatment and Normal Intellectual Functioning in Young Children with Autism”
The Lovaas 1987 study was the research that changed people's lives. It proved there was an effective treatment available and results after therapy could be life changing. Some of the children in the study became indistinguishable from other children. This meant people could not tell the children had ASD and they did not stand out from their peers. Below is a summary of his study.
Summary of the Lovaas study
The Lovaas 1987 study - “Behavioral Treatment and Normal Intellectual Functioning in Young Children with Autism”
60 children were divided into three groups:
- Each child received 40 hours of ABA therapy per week
- Treatment lasted two to six years.
- 47% of the children (i.e., 9/19) improved to the point they became indistinguishable from their peers (known as the “best outcome” in this research)
- Many had their “autism” label removed
- 42% (i.e. 8 out of the 19) moved from a classroom for children with ASD to a language-delayed room where the students had less severe conditions and were higher functioning
- 10% (i.e. 1 out of the 19) two of the children or 10% saw little improvement
As a whole, 89% of the children in the experimental group saw substantial improvement (e.g., significant gains in IQ and socialization)
Control Group One:
- Each child received 10 hours per week of the same therapy as the experimental group with special education
- Treatment lasted two to six years
- No children achieved “best outcome” meaning all were still distinguishable from their typical peers
- 42% of the children had improvement
Control Group Two:
- Received only special education
- Data was collected over four years
- 5% (1 child) achieved “best outcome” and became indistinguishable from his peers
The follow up study was done in 1993 – “Long-Term Outcome for Children With Autism Who Received Early Intensive Behavioral Treatment.”
- In the experimental group, 8 of the 9 best outcomes children had maintained had their gains
- These children, now adults, have been interviewed by the British Broadcasting Company, the LA Times, and other reputable news sources. They are productive members of society and can attribute their success to the ABA treatment.
Frequently Asked Questions Parents Have Before Doing ABA Therapy
1. Can I wait and do therapy later?
Numerous research studies have shown that the prime time for learning language is the first few years of life. This is why research has shown that receiving the appropriate therapy early in the children’s life can have a more significant impact than if the children receive therapy later in life.
2. My child might be a late talker and develop more as he gets older. Why do I need therapy now?
As your children grow, if they cannot communicate effectively with others, they will be frustrated and will learn to communicate in other inappropriate methods; such as crying frequently, tantruming, hitting themselves or others, doing disruptive behaviors to gain attention, etc.
In addition, children with ASD are known to have self-stimulatory behaviors. These behaviors are like habits. The longer you do them, the harder they are to decrease. If children are not taught to communicate more effectively and a behavior plan is not created to decrease the stimming behavior(s), this kind of behavior will increase in frequency and intensity as the child grows older.
If you wait, keep in mind they will grow physically bigger as well. In my 15 plus years of teaching, I can say there is a difference between teaching a 2-year-old to stay in the chair as compared to asking a stronger 5-year-old. In general, older children with ASD are more difficult to teach as compared to younger children. They have practiced their inappropriate behaviors and stims for a longer period, which makes them more difficult to decrease. By postponing therapy, it may be harder to find a therapist because some people can’t physically deal with the more severe behavior issues.
3. Can I just send my child to a regular daycare center or after school program (e.g. exercise class, music class, sports class, etc.)?
Children with ASD do not learn the same way as typical children. Many may have difficulty understanding what you are saying. For example, you may say a sentence using six words like, “What do you want to do,” but they can only consistently hear and understand up to three words at a time.”
Due to this comprehension issue, children with ASD may require many teaching opportunities before they learn what you are teaching. Being in a daycare or after school program where there are many children will not allow the teacher to focus a lot of attention on just your child. Speech and ABA therapy is mostly a one-to-one ratio in which there is one therapist and just your child. This allows the therapist to focus their full attention on your child and customize a curriculum just for your child.
Children with ASD also have challenging behaviors that typical teachers are not trained to deal with. Disruptive behaviors such as not wanting to sit down, refusing to follow routines, and loud tantruming can happen. If people do not know how to respond to these behaviors, they can actually increase the behaviors.
To be clear, daycare or after school programs can offer some benefits to children with ASD. Exercise classes or outdoor activities can be a great break in between therapy sessions. The staff at daycare or after school programs will offer some social interaction and engage the children. This is important because when children with ASD have downtime, they often like to perform their stims. If the children are engaged, they will have less time to perform their stims. These programs, however, are not meant to teach children how to overcome the challenges of ASD like speech and ABA therapy. These programs will not provide your child with anything close to the progress that can be achieved with ABA and speech therapy. The quality of your child’s life and your family’s life would be much better if they receive the proper therapy.
Be aware of activities or classes in which the child is given an opportunity to do self stimulatory behaviors. For example, if a child has self-stimulatory behavior of rocking back and forth in a chair, don’t send him to an after school program in which he can sit for a long period of time and perform this stim without anyone telling him to stop. People at typical daycare or after school programs are trained to deal with this kind of behavior and will very likely just allow the child to keep stimming. The more a child is allowed to stim, like other kinds of habits, the harder it is to decrease the stim.
4. Does the therapy work?
Speech therapy can significantly help your child. From my experience, if you can find a speech therapist who knows how to deal with the various behavior issues that a child with ASD can present, then they can be very helpful. When you first meet the speech therapists, ask them how will they respond if your child will not sit in the chair or start having tantrums during therapy. Their response should give you an idea of whether they know how to handle behavior issues. If a therapist cannot teach a child to stay in a chair, it can be very difficult to gain significant progress.
As for ABA therapy, please click on the link if you have not read the information above. (Why is ABA therapy effective?)
5. How much therapy should you give to your child?
My professor Ivar Lovaas did a research study in 1987 to figure out the answer to this question. If you like to read the details of the research, (click the link here to “The Lovaas 1987 study...” page). To state very briefly, in his study, he provided 40 hours of ABA therapy per week to 19 children with ASD. Of those 19 children, 9 of them improved to the point where they were indistinguishable from their peers. (To learn more about ABA therapy, click on this link: (Why is ABA therapy effective?).
It would be very difficult to receive 40 hours of ABA therapy in Taiwan because of
the extreme shortage of qualified ABA therapists. What I recommend is to find as many hours of ABA therapy as you can and then find as much speech therapy as you can.