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Applied Behaviour Analysis and Autism Ranking: Unable to rate

Carer teaching a child with autism

Applied behaviour analysis (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 practitioner 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 practitioner 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 like the University of California at Los Angeles Young Autism Project model.

Our Opinion

Because there are many different interventions, programmes and techniques which incorporate the principles of applied behaviour analysis it is not possible to provide a ranking for applied behaviour analysis as a whole.

However there is strong positive evidence for some individual interventions based on the principles of applied behaviour analysis, such as some early intensive behavioural intervention programmes like the University of California at Los Angeles Young Autism Project model.

There is less strong but still positive evidence for other approaches based on the principles of applied behaviour analysis, such as incidental teaching.

Thus there is still a need for more research in some areas. For example,

  • Research is needed to evaluate the longer term effects of those interventions and techniques which incorporate the principles of ABA - most studies involve only relatively short follow-up periods.
  • There is a need for more comparative studies of interventions and techniques vs. other high quality, autism specific pre-school programmes.
  • Although some randomised control trials have been conducted these are small in number and the quality of the alternative intervention has not necessarily been of a high standard.
  • Any new research will need more focus on fidelity (of both the ABA-based interventions and the comparison interventions).There is also a need to explore in much greater detail moderators and mediators of treatment effectiveness.
  • In particular, the characteristics of the individuals who do, and do not, respond to intervention require systematic investigation.
  • Any future research should also involve people on the autism spectrum (including individuals who may be non-verbal) to review the efficacy and ethical basis of interventions based on applied behaviour analysis.

In addition, if any type of ABA  is undertaken, it is important to consider any benefits against the possible impact on the child (in terms of the intensity and possible stress of the intervention) and on the families (in terms of time, finances, organisation, and effects on siblings).

Disclaimer

Please read our Disclaimer on Autism Interventions


Audience

Applied behaviour analysis is designed to help a wide range of individuals of all ages and abilities.  For example, according to Green, G (200?),

“ABA methods have been used successfully with many kinds of learners of all ages, with and without disabilities, in many different settings.”

According to the Maine Administrators of Services for Children with Disabilities (2000),

“Over the past 30 years, several thousand published research studies have documented the effectiveness of ABA across a wide range of populations (children and adults with mental illness, developmental disabilities and learning disorders).”

Aims and Claims

Aims

The aim of applied behaviour analysis is to encourage meaningful and important behaviours in individuals. For example, it may be used to develop basic skills such as looking, listening, and imitating, as well as complex skills such as reading, conversing, or taking the perspective of others.

The Maine Administrators of Services for Children with Disabilities (2000) provides a comprehensive list of possible behavioural changes.

  • “To increase behaviors (e.g. to increase on-task behavior, or social interactions) and to teach new skills (e.g., life skills, communication skills, or social skills);
  • To maintain behaviors (e.g., self control and self monitoring procedures to maintain and generalize job-related social skills);
  • To generalize or to transfer behavior from one situation or response to another (e.g., from completing assignments in the resource room to performing as well in the mainstream classroom);
  • To restrict or narrow conditions under which interfering behaviors occur (e.g., modifying the learning environment); and
  • To reduce interfering behaviors (e.g., self injury or stereotypy).”

Claims

There have been numerous claims for the use of applied behaviour analysis for individuals on the autism spectrum. For example, according to the Maine Administrators of Services for Children with Disabilities (2000),

“There is a wealth of validated and peer-reviewed studies supporting the efficacy of ABA methods to improve and sustain socially significant behaviors in every domain, in individuals with autism. Importantly, results reported include "meaningful" outcomes such as increased social skills, communication skills academic performance, and overall cognitive functioning. These reflect clinically-significant quality of life improvements. While studies varied as to the magnitude of gains, all have demonstrated long term retention of gains made.”

According to Hagopian and Boelter (2005),

 “ABA-based procedures have been implemented across a variety of settings including hospitals, schools, and homes; across a variety of forms of problem behavior including self-injurious behavior, aggression, stereotypic behavior, and pica. Additionally, ABA-based procedures have been employed to establish and increase adaptive behaviors as alternatives to problem behavior including communication, daily living skills, and academic skills.”

According to Green, G. et al. (200?),

“Competently delivered ABA intervention can help learners with autism make meaningful changes in many areas. But most learners require a great deal of carefully planned instruction and practice on most skills, so changes do not occur quickly. As mentioned earlier, quality ABA programs address a wide range of skill areas, but the focus is always on the individual learner, so goals vary from learner to learner, depending on age, level of functioning, family needs and interests, and other factors. The rate of progress also varies from one learner to the next. Some acquire skills quickly, others more slowly. In fact, an individual learner may make rapid progress in one skill area - such as reading - and need much more instruction and practice to master another, such as interacting with peers.”

Key Features

Applied behaviour analysis (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 practitioner 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 practitioner 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.

Systematic procedures

The process of applied behaviour analysis is intended to be very scientific, objective and systematic.

According to Schoen (2003),

“Children are first individually analyzed to assess the behavior that needs to be altered. Once the behavior is identified, intervention strategies are determined to suit the situation and, then, used to modify the behavior. During this time, the instructor provides reinforcement to elicit and maintain the desired behavior. Evaluations are made throughout the modification process to assess the effectiveness of the intervention. When an intervention is found to be ineffective, another strategy is substituted.

“Each case of applied behavior analysis (ABA) must be conducted around the context of the environment and particular characteristics of the individual. The behavior that is targeted for change must also be observable and measurable. Five more specific steps are followed in the ABA process. First, the positive behavior is measured directly. Second, the behavior is measured daily based on the target responses. Then, systematic procedures are followed so that, if successful in modifying the behavior, those procedures can be replicated. Fourth, data is recorded on the individual level, usually by graphing progress. Finally, the interventionist demonstrates that the results were completed in a controlled manner in an attempt to prove that the intervention accounted for the change in behavior.”

Specific approaches and interventions

A practitioner using the principles of ABA may use one or more specific approaches and interventions, including

  • discrete trial training - a highly-structured form of training that involves a trainer instructing an individual using a series of learning opportunities or trials.
  • early intensive behavioural intervention - highly structured and intense intervention in which a child is taught a range of skills by a team of practitioners beginning in the pre-school years.
  • functional assessment - the process for gathering information that can be used to maximise the effectiveness and efficiency of behavioural support interventions.
  • functional communication training  - teaching people to use other forms of communication as substitutes for the messages underlying challenging behaviours.
  • incidental teaching - form of teaching in which a teacher takes advantage of naturally occurring incidents or situations to provide learning opportunities for the student.
  • milieu training - form of teaching in which the teacher takes advantage of the child's interest in the things around him, the milieu, to provide learning opportunities for the child.
  • pivotal response training - form of training in which the trainer concentrates on changing pivotal areas in order to change the behaviours which depend on them.
  • positive behavioural support - intervention in which individuals are assisted in acquiring adaptive, socially meaningful behaviours and encouraged to overcome maladaptive behaviours.
  • verbal behaviour approach - intervention which focuses on teaching specific components of expressive language first (such as the ability to make a demand).

Specific techniques

In addition, the practitioner may use one or more of many specific techniques within one or more of the interventions listed above.

  • chaining - the linking of component behaviours into a more complex, composite behavior.
  • fading - gradually reducing the strength of a prompt.
  • fluency building - building up complex behaviours by teaching each element of those behaviours until they require less effort.
  • modelling - method of teaching in which an individual learns a behaviour or a skill by watching someone demonstrating that behaviour or skill.
  • prompting - verbal or physical cue or hint that is used to encourage an individual to perform a desired behaviour.
  • reinforcement - a response (such as praising or attending to the child's behaviour) that affects the likelihood of that behaviour recurring.
  • shaping - technique, in which successively closer approximations of a desired behaviour are reinforced.
  • time out and extinction - a procedure to ensure that unwanted behaviours are no longer rewarded.

Specific programmes

There are many comprehensive, multi-component programmes for people on the autism spectrum which incorporate the principles of applied behaviour analysis.

Some specific programmes that have been evaluated in peer-reviewed journals include the Autism Preschool Program, the Douglas Developmental Disabilities Center Program, the Early Achievements program, the Early Start Denver Model, the JASPER: Joint Attention, Symbolic Play and Engagement Regulation program, the Lovaas method/UCLA Young Autism Project, the May Institute Program, the Murdoch Early Intervention Program, the Princeton Child Development Institute Program, Project ImPACT, the SCERTS model and many others.

Traditional versus contemporary forms of applied behaviour analysis

The early forms of applied behaviour analysis were very directive, with the practitioner controlling all aspects of the intervention. For example, in discrete trial training, the practitioner would often structure the learning environment and specify what would be learnt and when - although this might not bear any relationship to the individual's activities or interests.

Later forms of applied behaviour analysis are more naturalistic in their approach, with the practitioner taking account of the child's own interests and activities. For example, in milieu teaching, the practitioner takes advantage of the child's interest in the things around him, the “milieu”, to provide learning opportunities for the child.

In practice, few practitioners are totally directive or totally naturalistic. Instead, most use a range of techniques, incorporating some directive and some naturalistic elements.

ABA techniques can be used in highly structured situations - such as formal instruction in classrooms - as well as in less structured situations such as during play or mealtime at home.

They can also be used in one to one instruction or in whole group instruction.

Needs of the individual

According to Green et al. (200?),

“Done correctly, ABA intervention for autism is not a one size fits all approach consisting of a set of programs or drills. On the contrary, every aspect of intervention is customized to each learner's skills, needs, interests, preferences, and family situation. For those reasons, an ABA program for one learner might look somewhat different than a program for another learner. But genuine, comprehensive ABA programs for learners with autism have certain things in common:

  • Intervention designed and overseen directly by qualified, well-trained professional behavior analysts
  • Detailed assessment of each learner's skills as well as learner and family preferences to determine initial treatment goals
  • Selection of goals that are meaningful for the learner and the family
  • Ongoing objective measurement of learner progress
  • Frequent review of progress data by the behavior analyst so that goals and procedures can be fine tuned - as needed
  • Instruction on developmentally appropriate goals in all skill areas (e.g., communication, social, self-care, play and leisure, motor, and academic skills)
  • Skills broken down into small parts or steps that are manageable for the learner, and taught from simple (such as imitating single sounds) to complex (e.g., carrying on conversations)
  • An emphasis on skills that will enable learners to be independent and successful in both the short and the long run
  • Use of multiple behavior analytic procedures - both adult-directed and learner-initiated - to promote learning in a variety of ways
  • Many opportunities - specifically planned and naturally occurring - for each learner to acquire and practice skills every day, in structured and unstructured situations
  • Intervention provided consistently for many hours each week
  • Abundant positive reinforcement for useful skills and socially appropriate behaviors
  • An emphasis on positive social interactions, and on making learning fun
  • No reinforcement for behaviors that are harmful or prevent learning
  • Use of techniques to help trained skills carry over to various places, people, and times and to enable learners to acquire new skills in a variety of settings
  • Parent training so family members can teach and support skills during typical family activities
  • Regular meetings between family members and program”

Cost and Time

Cost

The costs of applied behaviour analysis vary enormously, depending on the form of ABA/specific techniques being used as well as the number of hours, location of instruction and the qualifications and number of practitioners used.

Some comprehensive, multi-component programmes can be very expensive. For example,

  • according to Eikeseth, Hayward and Gale (2011), the UK Young Autism project charges £43-45,000 per year for a full programme – not including any additional transport costs.
  • according to the ABA Educational Resources Ltd website, accessed March 2012 and the last occasion on which we were able to find this information, the annual cost of a home-based ABA programme in the USA is approximately $54,000.

Time

The amount of time required to undertake applied behaviour analysis will depend to a large extent on the form of ABA/specific techniques being used.

For example, some home-based programmes of EIBI consist of 40 hours a week of intensive therapy. The therapy is on a 'one-to-one' basis for 6-8 hours per day, 5-7 days a week for 2 or more years. Teaching sessions usually last 2-3 hours with breaks.

However other forms of ABA may only take a few hours each week or be used only when the problem behaviours occur or if a specific teaching opportunity arises.

Risks and Safety

Hazards

There are no specific hazards associated with most of the interventions based on the principles of applied behaviour analysis for individuals on the autism spectrum as typically used today. However, in the past some ABA programmes involved the use of punishment (even electric shock) to reduce problem behaviours.

There are also concerns that time-out procedures, if used incorrectly and unsystematically, can result in children being isolated or excluded for unnecessarily lengthy periods of time.

Some critics claim that applied behaviour analysis does not enable children to generalise the skills they have learnt i.e. they can only do exactly what they have been taught to do, nothing else.

Others claim that the methods can lead children to become very prompt- or cue-dependent whereby they can perform tasks when prompted but do not spontaneously use these skills in everyday interactions.

Some critics also claim that extensive use and over reliance on early intensive behavioural interventions may be problematic because these are very time consuming and costly, leaving little time or money for other interventions.

There is also the moral debate about subjecting a child to very intensive therapy - some people argue that as adults we are only supposed to work 35 hours per week and yet we could be asking autistic children to work 40+ hours with little free or unstructured time.

ABA has been heavily criticised by some people on the autism spectrum. For example, Milton objects to the “goal of the practice and its ideology; to its moribund [dying] theory; to the lack of good evidence in its support and a history of its advocates not answering criticisms; and to a disregard for reports of harm arising from its use”. (Source: personal correspondence with Research Autism, June 2013)

The website Autism.Wikia Com accessed on 29 February 2016, contains a detailed list of criticisms by other people on the autism spectrum.

Contraindications

There are no known contraindications (condition which makes a particular treatment or procedure potentially inadvisable for a particular group of people) for applied behaviour analysis as an intervention for individuals on the autism spectrum.

Suppliers and Availability

Suppliers

There are a number of organisations which can provide details of applied behaviour analysis practitioners in various countries who specialise in treating individuals on the autism spectrum. For example, according to Green, G. et al. (200?),

“Because of the huge demand for ABA intervention for autism, many individuals and programs now claim to ‘do ABA.’ Some are private practitioners or agencies that offer to provide services by periodically coming into a family’s home; others operate private schools, and still others provide consultation services to public schools. Not all of them have the education and practical experience that the field of behavior analysis considers minimum requirements for practicing ABA. Family members and concerned professionals are urged to be cautious when enlisting anyone to ‘do ABA’ with a child, youth, or adult with autism”.

Credentials

In the UK some universities offer degrees in behaviour analysis. A stronger indication, but not a guarantee of professional expertise, is the letters BCBA (Board Certified Behaviour Analyst) or BCABA (Board Certified Associate Behaviour Analyst), which is similar but requires less experience. These qualifications indicate that the person has completed coursework in behaviour analysis, had clinical training and passed an exam administered by the Behaviour Analyst Certification Board.

In the USA, ABA programs for learners with autism should be designed and supervised by qualified behavior analysts, preferably individuals who are Board Certified Behavior Analysts - with supervised experience providing ABA treatment for autism, or who can clearly document that they have equivalent training and experience.

History

Applied behaviour analysis has its roots in behaviour therapy developed in the 20th century.

The earliest examples of the use of behaviour therapy for children on the autism spectrum appeared in the early 1960's and 1970's in the USA. These early programmes involved both reinforcement and punishment techniques. ABA used both of these techniques to improve social and communication skills and to reduce disruptive behaviours.

Dr. O. Ivar Lovaas was one of the earliest pioneers of ABA, initially working with non-verbal, institutionalised children with autism. He concentrated on improving verbal skills using applied behaviour analysis. However many of the children lost their verbal skills when the programme ceased and they returned home. Those whose parents were directly involved in therapy made much better progress.

Lovaas went on to work with younger children, aged 2 to 4, in their home setting to see if the skills learned by the children were maintained. He developed Early Intensive Behavioural Intervention (The Lovaas Method) from this work.

Over the last 50 years researchers and practitioners have developed a range of other ABA-based interventions and techniques for individuals on the autism spectrum.

Current Research

Current Research Studies

There are thousands of scientific studies of the use of interventions which use the principles of applied behaviour analysis to help individuals on the autism spectrum published in peer-reviewed journals.

Most of these studies have been positive. For example, according to Hagopian and Boelter (2005)

“Over the past 40 years a large body of literature has shown the successful use of ABA-based procedures to reduce problem behavior and increase appropriate skills for individuals with intellectual disabilities (ID), autism, and related disorders. Several review articles and meta-analyses have been published summarizing this large body of literature. Six of these articles collectively reviewed thousands of published studies spanning the years 1946 to 2001. Each of these reviews supported efficacy of ABA-based procedures in the assessment and treatment of problem behavior associated with autism, mental retardation, and related disorders. Similarly, three meta-analyses that collectively analyzed hundreds of studies published between 1968 and 1994 concluded that treatments based on operant principles of learning were more effective for reducing problem behavior displayed by individuals with ID as well as typically-developing individuals than were alternative treatments. The large body of literature reviewed in these studies provides empirical evidence indicating that procedures developed using ABA-based principles are effective at assessing and treating a variety of socially important behaviors engaged in by individuals with a variety of diagnoses. Furthermore, ABA-based approaches for educating children with autism and related disorders have been extensively researched and empirically supported.

However some reviews have been less positive. For example, according to Spreckley and Boyd (2009),

“Currently there is inadequate evidence that [ABA] has better outcomes than standard care for children with autism.”

Moreover, several reviews note that although certain types of ABA, notably early intensive home based behavioural interventions, clearly work for some children many children show little change sometimes after years of therapy. Others may even regress during the course of treatment.

Ongoing Research

This website is aimed at anyone with an interest in autism. This includes people on the autism spectrum, parents and carers, service providers and policy makers.

This website provides up-to-date, scientifically reliable information about autism. It provides information about some of the issues, problems and challenges facing individuals on the autism spectrum. It also provides information about a wide range of treatments, therapies and services used to help them.

Read More


Having autism myself and having children with autism this site is most refreshing, it's up to date info, on all aspects of ASD highly recommended by myself and recommended on my autism forum, a first stop for newly diagnosed individuals/parents and us veterans.

-- Shell Spectrum.

Have Your Say/Read More Feedback

Future Research

Recommendations for Future Research

There is still a need for more research in some areas. For example,

  • Research is needed to evaluate the longer term effects of those interventions and techniques which incorporate the principles of ABA - most studies involve only relatively short follow-up periods
  • There is a need for more comparative studies of interventions and techniques vs. other high quality, autism specific pre-school programmes.
  • Although some randomized control trials have been conducted these are small in number and the quality of the alternative intervention has not necessarily been of a high standard.
  • Any new research will need more focus on fidelity (of both the ABA-based interventions and the comparison interventions). There is also a need to explore in much greater detail moderators and mediators of treatment effectiveness.
  • In particular, the characteristics of the individuals who do, and do not, respond to intervention require systematic investigation.
  • Any future research should also involve people on the autism spectrum (including individuals who may be non-verbal)  to review the efficacy and ethical basis of interventions based on applied behaviour analysis.

Studies and Trials

Please see the entries for the specific interventions and techniques which use the principles of applied behaviour analysis.

Other Reading

This section provides details of other publications on autism and applied behaviour analysis. You may be able to find more publications on applied behaviour analysis in our publications database.

If you know of any other publications we should include in this section or in our publications database please email info@researchautism.net with the details.

Please note that Research Autism is unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.

Personal Accounts

This section provides details of personal accounts of the use of applied behaviour analysis for people on the autism spectrum.

Personal accounts can be useful sources of information about the intervention but are not as scientifically valid or reliable as research trials. This may be especially true where the accounts are published by an organisation which might gain a financial advantage from the take-up of the intervention.

Please note that the views expressed in these personal accounts do not necessarily represent the views of Research Autism.


We have identified numerous accounts of the use of interventions based on the principles of applied behaviour analysis on the following websites

Additional Information

This website is aimed at anyone with an interest in autism. This includes people on the autism spectrum, parents and carers, service providers and policy makers.

This website provides up-to-date, scientifically reliable information about autism. It provides information about some of the issues, problems and challenges facing individuals on the autism spectrum. It also provides information about a wide range of treatments, therapies and services used to help them.

Read More


Having autism myself and having children with autism this site is most refreshing, it's up to date info, on all aspects of ASD highly recommended by myself and recommended on my autism forum, a first stop for newly diagnosed individuals/parents and us veterans.

-- Shell Spectrum.

Have Your Say/Read More Feedback

Updated
31 Oct 2017
Last Review
01 Sep 2016
Next Review
01 Sep 2019