How effective is Applied Behavior Analysis (ABA) Therapy?

Just how effective is Applied Behavior Analysis (ABA) Therapy? Several studies have been conducted on the effectiveness of this therapy since it gained popularity via the Lovaas method. The great thing about this therapy is it is so comprehensively tested most insurances cover it for children with Autism. ABA is proven to be extremely beneficial.

Here are several sources that state just how crucial ABA is for children with autism:

Current Opinion in Pediatrics, 2011; Vol 23: pp 616–620: Found that behavioral interventions are effective for cognitive abilities, language, adaptive behaviors, social skills and reduced anxiety/aggression.

American Journal on Mental Retardation, 1993; Vol. 97, No. 4: pp 359-372: Children who received ABA were tested again at an older age and were found to have benefited from long-term progress.

Journal of Consulting and Clinical Psychology, 1987; Vol. 55, No. 1: pp3-9: 9 out of 19 children attained average functioning after 40 hours a week of ABA.

Pediatrics 2012; Vol. 130; S186: Forty-eight autistic patients received ABA at the age of 2, their IQ and communication improved significantly.

Committee on Educational Interventions for Children with Autism, National Research Council: States; 40 years of testing ABA has shown that it decreases problem behaviors and teaches new skills to those with autism.

American Psychological Association website: “Since medications on their own rarely improve behavior, behavioral interventions are crucial.”

ABA is not an experimental therapy that pokes and prods at your child in hopes of finding a ‘cure’ or something that might help. ABA is a proven method that will help your child with autism reach a level of skills and functioning you may never have thought possible.

Techniques for Sensory Issues

The other week I discussed reasons for why a child would act out. We then went through techniques an Applied Behavioral Analysis (ABA) therapist uses when a child elopes.

But what about techniques for sensory issues?

Sensory integration is the process of normalizing sensation and making it easier for your autistic child to cope with them.

Occupational Therapy

Alongside ABA your child may benefit from Occupational Therapy if you find they have a lot of physical issues. OT in simple terms helps people do what they want to do in everyday life, be it taking off a t-shirt or using a pen. Sometimes these issues are accompanying sensory problems, like the feel of fabric, or not knowing you are squeezing too hard. An OT’s job is to identify the sensory issues and guide your child through them until they can physically handle the task. They’re a perfect addition to ABA.

Applied Behavioral Analysis Therapy

An ABA therapist identifies why your child is having an issue and either teaches them something new, or reduces it. When a child can’t handle, or process sensory information because of autism they may have extreme reactions to it, such as self harm, violence, or meltdowns. It’s important to identify when your child is behaving this way because they simply don’t want to do something or don’t know how to communicate, and when they truly cannot process what is going on around them.

This is no easy task.

We cannot personally dive inside their minds, so we can only observe, watch and wait until we know the answer. Which is what your ABA therapist or analyst will do before they introduce an intervention.

Communication Skills

Sometimes, our children have a meltdown when there are bright lights or loud noises because they don’t know how to ask to leave the situation. In this case, the therapist would prompt the question of leaving and the stimulation would stop. For e.g.

Therapist, “Say, turn the light off.”

Child says, “Turn the light off.”

Therapist turns the light off.

This way your child learns that communication is a wonderful way to remove uncomfortable stimulation.

Reducing Stimuli

In other cases we can tell when a certain situation will be triggering in advanced, and know that our child has to go through it and get out the other side; like grocery shopping or school. In these cases tools are used, such as noise blocking headphones and weighted vests. These keep the child grounded and block out sounds, thus reducing the sensory stimuli to begin with.

Sensory Integration

Other times our child has to get through a stimulatory process, but there is no way to reduce it. Like brushing hair, or clipping nails. Either way they have to brush their hair and clip their nails, for health and cleanliness reasons. In this circumstance the child can’t ask to leave the situation and we can’t reduce it, so what does the therapist do?

Sensory integration is teaching the child how to handle sensory input, with breathing techniques, and practice. Just like when we as adults have irrational fears and have learnt how to face them—like public speaking, or roller coaster rides—our children have to learn how to face their fears and remain calm too.

It will be heart wrenching to watch at first as they scream and cry, but guiding them through it slowly, and teaching them how to step over their fears is something all parents should teach their children no matter whether they have autism or not.

The only difference here is that autistic children will often scream and tantrum rather than whine or talk about it, because they either have no other way to communicate or little understanding of the consequences of the tantrum in a social setting. All they know is, if I scream I won’t have to do this.

An Example of Sensory Integration

A child was petrified of nail clippers; he wouldn’t even let you cut your own nails. He would scream, cry, and have meltdowns every time someone used a pair. We would have to hide them and his nails never got clipped. This had the added down-side of learning to use his nails as weapons to cut open people’s skin, when he got mad. We couldn’t reduce the stimuli, and we had to clip his nails, so the therapist slowly introduced the stimulus to him.

At first she showed him videos and clippers.

Next she cut her own nails and the nails of others.

Then she placed the clippers on his skin.

And finally she cut one finger nail.

This took more than a month, and on every step he screamed at the top of his lungs like he felt petrified. He cried and fought and sobbed his eyes out, until he didn’t. Until he barely even noticed what you were doing. As a parent at first though, it was traumatic to watch every new stage brought with it a wrenching feeling in the parent’s gut.

But by the end? Even though he still screamed and cried, he would ask the therapist to do it! He had grown courage, and the ability to see his fear as irrational, despite still feeling it. He had learned something that takes even adults a long time to learn; fear will not kill me. A life lesson that will serve him. So although listening to his fear was uncomfortable for many parents, seeing how this process empowered him makes it all worth it.

Why your child is acting a certain way

Every child, anywhere, regardless of autism, acts a certain way for a reason. We don’t do things out of nowhere. Honing down those reasons are the key to helping a child overcome a behavior that won’t serve them in their adult years.

Let’s look at some common reasons people engage in certain behaviors so you notice what makes your child act the way they do!

Sensory

Sometimes we do things because it feels good to do them. Even though soda is bad for us, when we drink it the taste feels worth it, or the energy it gives us feels good. Sometimes we know we shouldn’t do something but we do it anyway because it makes us feel something we crave.

For an autistic child they may involve themselves in sensory stimulation, like flapping, rubbing their hands on things and spitting. This behavior is self soothing; they do it because it feels good! You may see it occur more when the child is frustrated, bored or even excited.

Escape

If you could escape from a painful situation without consequence, instead of facing it head on, would you? Most of us would!

Autistic children are known to bolt (they call it eloping now, officially) they run from situations, they hide under tables and do anything they can to escape doing something. Sometimes that something could be as simple as putting their plate in the sink. It’s not always because of doom and gloom circumstances.

A client of ours loves to use this behavior, he has several places in the house he knows is hard for adults to get to and as soon as you ask him to do something unpleasant (like chores) off he runs to hide under the bed.

There are other ways to escape situations like violence and yelling.

Children do this when they don’t want to engage in something. Maybe that something is boring, scary, annoying or too hard for them.

Attention

Yup, people do things for attention. This is a difficult one for some people to understand because it has such negative connotations wrapped around it. It shouldn’t, ‘attention seeking’ is just communicating that you want someone’s attention in the wrong way.

This is probably my middle child’s favorite reason to act out. He is a show star, he is loving, cute and by golly if he can be center of attention he will find a way! His autism (low empathy) means he often pushes children, hits them or bullies them so he can take their attention from them. It’s not about the child being a ‘bad kid’, this is just a child that doesn’t know how to say, “Hey I want a connection with you right now but I don’t know how to do it.”

Children do this when they want social interaction, or they want you to connect with them.

Tangibles

A few of our clients are obsessed with electronics. When it comes to trying to take them away the term ‘out of my cold dead hands,’ comes to mind. Sometimes children act out because they want something, plain and simple. They just don’t know how to communicate that want or they are terrified if you take it away they will never see it again.

This is the way that an ABA therapist looks at your child’s behavior, and a great thing to do for yourself as a parent. Sometimes putting meaning to situations helps us cope, and also gives us insight into how we can help our child in that moment.

How your child can perform tasks successfully

Sometimes your child doesn’t have a skill that his peers have. Recently we’ve had problems getting an (almost 4-year-old child) to remove his shirt. This is obviously a skill he should be able to do by now if he was developmentally normal but alas Autism has him behind others his age in many ways.

There could be plenty of skills that your child has yet to achieve too! Such as; washing their hands, putting on clothes or brushing their teeth, etc. But that doesn’t mean there is no hope. Applied Behavioral Analyses (ABA) therapists have a specific technique for teaching skills like this and it’s called chaining.

What is Chaining?

Well, we can break it down like this. Almost every skill has a series of steps attached. For example, when you’re learning how to make a salad, you don’t go from someone who’s never seen a salad bowl to a bowl full of salad. First you have to look up a recipe, and then set out your ingredients, cut them up, put them in a bowl and add dressing. This example had five different steps involved that we don’t even think about, but for a child learning a new skill those are all the steps they have to learn to get the result of a salad for dinner.

A therapist can’t show an Autistic child how to do something and expect that they’ve understood their complex language, have the motor skill available, remember every single step, then execute it perfectly. Because of this they use chaining.

Chaining starts by teaching a child how to do something either backwards or forwards (depending on what is easiest). Take the example washing hands, this can be placed into steps like so;

1.     Pull the stool up to the sink

2.     Find the soap

3.     Turn on the tap

4.     Get your hands wet

5.     Apply the soap

6.     Rub your hands together under the water

7.     Rinse the soap

8.     Put away the soap

9.     Turn off the tap

10.  Get down from the sink

When chaining forwards a therapist will prompt step 1, then re-enforce it until the child can perform this task perfectly three times. They then move on to the next step, and so on and so on, until the child can perform all ten steps without prompts.

When chaining backwards the therapist completes all nine steps for the child, then prompts the final step. When the child completes it on their own, they get positive re-enforcement. They then complete steps 1-8 and prompt 9, and so forth.

 This technique is not only fun for the child, with lots of praise and very few errors, but it can teach a child how to perform almost any task successfully. This way they can lead a more independent life. Using this technique my son went from not even caring if he could take off his own shirt, to removing his own shit just by asking him to, within a week in an excited happy manner.

10 Facts You Must Know About Applied Behavioral Analyses

Applied Behavioral Analyses therapy (ABA) is a fantastic therapy for Autistic children, to help them keep up with peers, learn life skills and develop into happier adults.

Here are ten remarkable facts you might not know about ABA.

1.     ABA continues to be researched and practiced, for more than 35 years. The original name of the therapy was Behavioral Modification, which goes back even further to the early 1900’s.

2.     ABA therapy is supported by the Association for Science in Autism Research, the Surgeon General and the National Institute of Health.

3.     This therapy can be performed at any age, but works best on younger children.

4.     It works anywhere, from school to home and work life. Fostering generalization across all areas of life ensures your Autistic child can live life to the fullest anywhere.

5.     90% of Autistic individuals who underwent ABA, at 40 hours a week, substantially improved. (Lovaas, 1987, study of intensive behavioral treatment)

6.     45% of therapies develop long-lasting and observable results – according to the Surgeon General Autism treatment report. ABA is one of these.

7.     ABA is not all table work; a child learns in the real world too!

8.     Corporate punishment is not a part of this therapy.

9.     ABA is used to quit smoking, help personality disorders, air those with OCD and counsel relationships. It is also used in the workplace, and with athletes.

10.  No two ABA programs are the same. By its, nature ABA is tailored towards the child so that every ABA therapy will look different.

11.  Since ABA is personalized, it is also a data driven therapy. Lots of information and facts are written down and recorded about your child to help them progress.

12.  Bribes are not used during ABA, re-enforcements are. This means a child is not told they will get something if they do something; the positive behavior is praised after the child has performed the needed action or behavior.

The Benefits of Getting Your Autistic Child ABA Services Before the Age of Three.

If you’re a parent of a child who has recently received a diagnosis of Autism under the age of 2, you will consider what therapies can help them. After all, they may not be verbal right now, they may have little comprehension of the world around them – you may wonder how on earth anyone could teach them socialization and if therapy is even worth it. I know I had many of those thoughts myself; especially since many parents spend countless hours trying to teach my Autistic sons skills with little progress.

One of the first therapies you will likely hear about is Applied Behavioral Analyses (ABA). That sounds like a formidable name by itself, but ABA is simple teaching your Autistic child skills they can use in the world, be it social, verbal, play or correct behaviors.  You may also visualize this as your one-year-old sitting attentively at a desk and ask yourself “how will that work?”

Actually, you’d be surprised what little things a one-year-old with Autism needs to learn that will heavily impact them later on – and a lot of it doesn’t involve desks at all. Like the ability to point, the ability to engage for short amounts of time, and most importantly, the ability to play. Teaching a child these simple age appropriate skills will help them build up to more intense things later on. If a child can point to something, they can communicate better and reduce frustration as they grow. If a child can engage for a short amount of time, then your relationship will grow and you will bond. If a child is taught to play with toys appropriately, then they can learn from these toys (as children learn through play).

According to a study performed by researchers at the New England Center for Children 90% of children under the age of 2 made significant social and communication skill gains within a year, when enrolled in an early intervention program. 90% is a big deal, and this drops to 30% if a child begins after the age of 2 and a half. So ABA is almost guaranteed to help your child, and should definitely be a therapy you look into.

ABA is always aimed at a child as an individual; it isn’t a step-by-step program that can be followed out of a book. This is a complex therapy that takes therapists years of study to master, so you can rest assured your little one won’t be put under any learning regiment they are not ready for.

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Find Out How Rote Learning Allows Children to Comprehend Without Boring or Upsetting Them

Often Analytical Behavioral Therapy (ABA) uses tools every child needs to learn and intensifies them for the Autistic child. This can look strange when you watch a session, but when you understand the underlying reasons it makes total sense. There are many different ways this can be seen, but one way is with Rote learning.

Many children learn through the process of Rote learning; Rote learning is the act of memorizing. Sometimes with Analytical Behavioral Therapy (ABA) things are repeated to our child many times, over and over again in the first stage of learning to facilitate Rote learning. It may seem alien to watch a therapist repetitively teach something to your child, but we as parents do this too. We repeat numbers, songs, objects and request many times a day.

One example of this is to repeat numbers often. Once a child learns the basics of counting, they can apply that in an abstract way perhaps to objects; how many marbles are in a bag? For example, the same process is intensified in ABA therapy so your child can quickly learn concepts on a basic and then advanced level.

The reason an ABA model does this is because conceptual learning is often confusing for an Autistic child. Once they learn one rule, they will think it’s a ‘hard and fast’ rule and have a hard time applying extra rules to it; at least until that rule is solid in their mind. For example, a tree can be big or small. But what if you taught your child the trees were big, and they didn’t have time to memorize this concretely before you told them some trees are short?  Autistic minds, being very literal, may think that now all trees are short. This is why it is important for a concept to be burned into their minds before they are able to understand new concepts.

However, this doesn’t mean your therapist should be repeating concepts such as this is blue, until your child is bored or even upset. This won’t give your child a positive experience or allow them to learn anything at all. Often you will see things repeated depending on the child, this could be four times or eight times or more. ABA is always a very individualized therapy that should be just challenging enough to teach your child but not too challenging or boring to upset them.

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