Behavioural interventions are designed to encourage appropriate behaviour (such as getting dressed or talking to other people) and to discourage inappropriate behaviours (such as self harm or aggression towards others). Therapists, teachers and/or parents break down the desired behaviours into small, achievable tasks which are then taught in a very structured manner.
In practice, behavioural techniques are often used alongside other techniques within many other types of intervention such as many Educational Interventions.
Some people think that behavioural interventions can significantly improve the core features of autism such as difficulties in social communication, social interaction and restrictive and stereotyped patterns of behaviour. Furthermore, some people have claimed that behavioural interventions can lead to recovery in some autistic children.
In this section we cover applied behaviour analysis, early intensive behavioural interventions, techniques which usually form part of a larger programme of intervention (such as discrete-trial training, incidental teaching and the verbal behaviour approach), pivotal response training, and positive behaviour support.
Some high quality evidence shows that the core features of autism are difficulties with social communication and social interaction as well as restrictive and stereotyped patterns of behaviour. Resulting behaviours include aggression and selfharm, as well as difficulties in learning appropriate behaviours such as communicating with others, making requests and getting dressed.
Some forms of early intensive behavioural interventions may provide some benefits to some young autistic children according to a very limited amount of research evidence of sufficiently high quality. Pivotal response training may provide some benefits to some children on the autism spectrum according to an extremely limited amount of research evidence of sufficiently high quality. Determining the benefits of other forms of behavioural intervention, such as positive behavioural support or the individual techniques used within some forms of early intensive behavioural interventions, is more difficult. We must wait for further research of sufficiently high quality to be completed.
There are no known risks for most forms of behavioural interventions.
Applied behaviour analysis (also known as ABA) is a systematic way of observing someone's behaviour, identifying desirable changes in that behaviour and then using the most appropriate methods to make those changes.
It is based on the idea that someone's behaviour can be changed by altering what happens before the behaviour occurs (known as the antecedent) and /or by altering what happens after the behaviour occurs (known as the consequence).
So, for example, an ABA therapist may try to improve a child's communication and social skills (the behaviour) by demonstrating more effective ways to interact with other children (the antecedent) and then rewarding him (the consequence) when he demonstrates the improved behaviours. The therapist will then analyse how well that approach has worked and, if necessary, make changes to the intervention to improve the child's behaviour next time around.
Applied behaviour analysis has been used to treat a wide range of people, including children and adults on the autism spectrum, as well as individuals with other conditions.
The principles of applied behaviour analysis are incorporated within many specific interventions (such as discrete trial training, incidental teaching and pivotal response training). They are also incorporated within many forms of early intensive behavioural intervention (such as the University of California at Los Angeles Young Autism Project model).
Discrete trial training (DTT) is a highly-structured training technique that involves a trainer instructing an individual with autism using a series of learning opportunities or 'trials'. Each 'trial' has a definite beginning and end, which is why the technique is described as 'discrete'.
The trainer begins each trial with a short, clear instruction or a question. The trainer may also prompt the learner, showing him how to respond correctly to the instruction or question.
If the learner does what the trainer wants, she will immediately reward him. For example, she may praise him or allow him to have something he wants. If the learner does not do what the trainer wants, she will repeat the instruction or try a slightly different approach.
DTT is the main (but not the only strategy) used to teach children with autism in early intensive behavioural interventions, such as the UCLA Young Autism Project Model.
Early intensive behavioural interventions (EIBIs) are multi-component packages which use a wide range of behavioural techniques and which are aimed at preschool children on the autism spectrum.
EIBIs are sometimes referred to as 'ABA' because they are based on the principles of applied behaviour analysis.
Specific EIBIs include
Incidental teaching is a form of teaching in which a teacher takes advantage of naturally occurring 'incidents' or situations to provide learning opportunities for the student.
Incidental teaching is based on the idea that students, including children on the autism spectrum, are more willing to learn if the teaching is based around their own interests and preferences.
In incidental teaching the teacher organises the learning environment around a set of pre-planned learning objectives but taking into account the student's individual preferences. When the student demonstrates an interest in an item or activity, the teacher encourages that interest by questioning or prompting the student. For example, the teacher may place something that the student wants just out of reach, so that the student has to communicate with the teacher in order to get it.
Incidental teaching can be used as a focussed (standalone) technique but it is also a key element in many comprehensive, multi-component programmes, such as the Early Start Denver Model, LEAP and the UCLA YAP model. It is also the main technique used in programmes run by the Walden Early Childhood Center at Emory University in Georgia, Atlanta.
Milieu teaching is a behavioural intervention in which individuals are taught language skills and behaviours within the natural environment (the milieu). The teaching is delivered in places (such as the kitchen) and in situations (such as when a child wants a snack) in which individuals are most likely to want to communicate with other people.
Teaching begins when an individual shows an interest in activities or materials (for example, by standing next to a table with snacks on) or begins to communicate (for example by pointing to a snack). The teacher responds by using one or more specific techniques including Modelling: demonstrating the desired behaviour ; Manding: asking questions or providing verbal instructions; Time delay: waiting for a short period of time in order to prompt the desired response.
There are several variations of milieu teaching such as prelinguistic milieu teaching (where the focus is on teaching pre-verbal skills to very young children) and enhanced milieu teaching (where the focus is on responding to and interacting with the child).
The individual elements which make up milieu teaching (modelling, manding and time delay) can be delivered as standalone techniques, can be used together in specific milieu teaching programmes (such as the Responsive Education and Prelinguistic Milieu Teaching programme) or can be used together as part of multi-component social communication programmes (such as the Comprehensive Communication Intervention for Minimally Verbal Children With Autism).
Pivotal response treatment (previously known as pivotal response training or the natural language paradigm) is a form of teaching in which the teacher concentrates on changing certain 'pivotal' behaviours, such as motivation and self-management.
Pivotal response treatment is based on the idea that certain aspects of a child's development are considered to be 'pivotal', that is crucial for the behaviours which depend on them. The pivotal areas are motivation, self-management, self-initiation, and the ability to respond to multiple cues.
In pivotal response treatment the trainer concentrates on changing these pivotal areas in order to change the behaviours which depend on them, such as speech and language, social behaviour, and challenging behaviour.
There are several multi-component programmes (such as the Early Start Denver Model and the Nova Scotia early intensive behaviour intervention) which include pivotal response treatment as a key element.
Positive behavioural support is a process in which individuals are assisted in acquiring adaptive, socially meaningful behaviours and encouraged to overcome maladaptive behaviours.
The aim of positive behavioural supports is to teach functional skills as a replacement for problem behaviour.
Positive behavioural support plans typically involve changing existing environments in a manner that makes problem behaviours irrelevant, ineffective and inefficient.
The University of California at Los Angeles Young Autism Project model (sometimes known as ABA, Applied Behaviour Analysis, early intensive behavioural intervention, EIBI, the Lovaas method or the UCLA YAP model) is a comprehensive, highly structured and intense programme designed to help very young autistic children.
The UCLA YAP model is based on the idea that autistic children struggle to understand and to communicate with other people, and react to such frustrations with tantrums and other challenging behaviours.The therapy team therefore constructs a teaching environment that is designed to maximise the child's success and minimise failure. Desired behaviour, such as use of language or social or self help skills, is positively reinforced and accompanied by lots of praise. Negative behaviour (such as self harm or aggression towards others) is not reinforced.
The UCLA YAP model uses a variety of specific teaching methods including discrete trial training, discrimination training and incidental teaching (although the therapists may also use a wide range of other interventions, such as sign language and the Picture Exchange Communication System, to suit the needs of the individual child).
The UCLA YAP model is very intensive (up to 40 hours training a week) and is usually delivered by parents helped by a consultant. The consultant develops and oversees a programme personalised to the needs of the individual child and designed to cover all relevant developmental areas.
The verbal behaviour approach (also called VBA) is derived from applied behaviour analysis and used within various interventions, such as early intensive behavioural interventions.
VBA is designed to teach someone how to use language to make requests and communicate ideas. It does this by teaching specific components of expressive language first.
The components of expressive language (called verbal operants) include: