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In the early 1970s, researchers in California found that by rewarding certain positive behaviors, they could make it easier for children––particularly those with developmental challenges like autism spectrum disorder––to learn new skills and curb problematic behaviors.
The concept is not a new one and we all likely use these techniques subconsciously every single day. Maybe you’ve promised yourself a new pair of sneakers if you go to the gym three days in a row. Or you told your child they’ll get a popsicle for good behavior and their mood improves rapidly. That’s the idea behind applied behavior analysis therapy or ABA for short.
While this may seem like a simple concept, ABA therapy requires careful training, and sessions must be individually tailored for each person receiving treatment. Overall, research has shown types of ABA therapy can be effective at increasing communication skills, improving social and learning skills, and reducing behaviors that might be problematic.
This therapy is typically used to help people with autism spectrum disorder (ASD) and other conditions like ADHD. While ABA therapy is more commonly used to help children, it can also be used for adults.
What is ABA therapy used for?
ABA therapy has become synonymous with treatment for ASD. The various disorders that fall on the autism spectrum share some common features, such as developmental problems, social challenges, and learning disabilities. Each case is unique and requires a different approach for treatment.
ASD can have a strong impact on a person’s behavior. For example, a person with ASD may:
- Withdraw from activities that are too stimulating or overwhelming
- Make repetitive movements
- React strongly to changes in routine
- Have difficulty communicating (verbally or nonverbally)
- Repeat words or memorized phrases
- Have a short attention span or narrow focus of interest
- Have difficulty making eye contact
How ABA therapy works
Most ABA therapists start by observing current behaviors and defining treatment goals around those behaviors.
Therapy sessions typically take place face-to-face, though the COVID-19 pandemic has made telehealth a favorable option as well. Because ABA therapists rely heavily on observing behavior, it’s critical for them to be able to see and note how a person acts in order to create a plan of action for treatment.
Sessions may take place once to several times per week and can require varying levels of involvement from parents or caregivers at home between sessions. Some techniques used in ABA therapy include (Granpeesheh, 2009; Wong, 2013):
- Positive reinforcement: Giving something the child wants (a reinforcer) after they perform the targeted skill or desired behavior. The reinforcer can be food, a prize, an activity, or some other tangible reward. For example, if a child usually screams when being strapped into their car seat, positive reinforcement would be giving them something they like (say, stickers or a favorite toy) when they don’t scream.
- Extinction: Taking away anything that reinforces or encourages unwanted behavior with the goal of reducing or extinguishing the behavior. With the car seat example, if a parent normally pleads with a child to stop screaming in their car seat, extinction would be to ignore the behavior entirely.
- Prompting: Assistance given by a therapist, caregiver, or peer before or while a child is engaged in a specific activity. Prompting can be done with words, body language, or hands-on help. For example, if you ask a child to pick up their toys and they don’t, prompting would be to wait a few seconds, and then gently ask them again while moving the toys closer or demonstrating how to put one away.
Sensory processing disorder (SPD): what is it, symptoms, testing
Principles of ABA therapy
Other types of therapies are modeled on the core principles of ABA, though they each have different focuses, techniques, and target patient populations. Let’s take a look at a few.
Discrete trial training (DTT)
DTT was one of the first forms of ABA therapy specifically developed to help children with autism.
An example is teaching a child their colors. In DTT, the therapist will break a big task down into smaller, simpler tasks. For example, they may start by teaching the child just the color blue instead of all colors at once. They would show the child the color, asking them to select a blue item from a pile of other items, and reward them with a small game or toy when they succeed.
Each color they learn is a distinct task and learning the names of each is also a distinct task. By breaking it down into smaller, simpler steps, the process can be more digestible for a person who faces the challenges that can come with autism.
Early Start Denver Model (ESDM)
Researchers and therapists have learned that early intervention for children diagnosed with ASD is the best way to get optimal results from treatment.
ESDM builds structured activities into regular, organic playtime for children on the autism spectrum, helping them learn behaviors and skills that will serve them in the long term. One of the most important components of the method is that family members and caregivers are involved in the therapeutic process from the very beginning.
Pivotal Response Training (PRT)
While DTT focuses on small tasks, PRT focuses on larger objectives. It’s been proven to be an effective treatment for ASD, especially when practiced upwards of 25 hours per week. The technique is frequently used to improve language and communication skills, and much like ESDM, caregivers are encouraged to learn techniques and participate in therapy.
ABA therapy might only be one part of a behavioral treatment plan for ASD or similar developmental disorders. It can also be part of a comprehensive treatment model, which is a long-term, time-intensive approach used to help people with ASD.
Who leads ABA therapy?
Since autism spectrum disorders affect every aspect of a person’s life, therapy is often integrated into regular school programming, rather than doled out in small, hour-long sessions like many other types of therapy.
This often requires caregivers, parents, teachers, and social workers to get involved. This community-style approach provides children with consistent reinforcement of the therapy’s objectives.
Depending on the exact behaviors being modifying, other specialists could be involved including speech therapists, physical therapists, psychologists, and occupational therapists.
Therapist vs. psychologist: what’s the difference?
Does ABA therapy work?
No single therapeutic approach is right for everyone, and every treatment must be carefully tailored to each person. But ABA is widely accepted as an effective form of therapy for ASD (Scott, 2021).
There is no cure for autism spectrum disorder, but many people find that therapy goes a long way in terms of improving language, social, and behavioral skills.
Several studies have found ABA is most effective when practiced consistently––that is, many hours of therapy each week, even over 36 hours in some cases. An intensive weekly schedule may be helped for children under age 7 (Lindstead, 2017).
To be effective, any therapeutic approach for ASD (including ABA) takes time, commitment, realistic expectations, consistency, and patience.
ABA therapy costs
The cost of ABA therapy varies, but in-home services tend to be more expensive than community-based options.
ABA therapy costs anywhere from $100–$150 per session, which quickly adds up if the treatment plan includes several sessions per week. Note that the cost of ABA therapy for ASD in public schools may be covered under a federal law called the Individuals with Disabilities Education Act.
Most states have laws requiring insurance providers to cover ASD treatment. A statement from your child’s healthcare provider noting the need for ABA therapy can help increase the likelihood that insurance will cover at least a portion of the cost.
Controversies around ABA therapy
There is some controversy surrounding ABA therapy, partially fueled by the fact that some behavior analysts claim it can “cure” autism (Herbet, 2002).
Alternatively, autism advocates claim that ABA therapy is sometimes pushed aggressively onto parents by healthcare providers, when in fact there are many other therapeutic approaches available. Some also believe the way ABA therapy encourages behavior modification actually threatens a patient’s autonomy and infringes on a child’s right to say no (Wilkenfeld, 2020).
ABA therapy is generally considered to be one of the most effective therapeutic approaches to ASD and similar developmental disorders. Speak to a healthcare professional about your options and which treatment is right for you or a loved one.
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Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.