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.

Echolalia in Autistic children

A lot of children who have autism will start their speech journey with something called echolalia. Echolalia is when a child repeats what you have just said back to you. It is done for many purposes, but the main reason a child does this is because they have a hard time with fluent or creative spoken language.

Some good news about echolalia is it can be a sign your child is trying to speak and they may grow out of it. In some cases however, the child never fully overcomes echolalia.  There are some classic examples of this, as some children began with echolalic speech which slowly filters out as they speak more fluently, but rears its head again when they are under stress.

Some parents are told their child would always use echolalia and never speak but through ABA they can form fluent sentences and communicate effectively.

Applied behavioral analysis (ABA) therapy often works with a child's speech. After-all, speech is used for everyday functioning. The way they go about this is by modeling the correct response. As a child can already repeat what has been said this is quite easy to implement. For example;

Therapist: Do you want a cookie?

Child: Want a cookie? (Whilst holding out their hand indicating yes)

Therapist: Yes, please.

Child: Yes, please.

Therapists: (gives the child the cookie)

Basically, this teaches the child that when they say yes to this question, they receive a cookie.

You may notice once this is put in place your child uses an echoic response first and THEN the correct response. For e.g. “Want a cookie? Yes, please.” This is wonderful news as the child is now using the echolalia to process the question before they answer it. Much the same way we do.

Have you ever been in a situation where you weren’t quite sure what somebody said and you repeated it in your head to understand it? This is the function for an echolalic response in this circumstance. It’s quite normal really, and remarkably intelligent problem solving for a child who's having trouble processing the outside world.

ABA can help in so many ways! Echolalia is just one of the many struggles a child with autism faces. ABA looks at the behavior your child uses and normalizes it, trying to both understand it and change it so they still receive the benefits they are looking for.

Reinforces: How to make them effective

We talked about token boards and how they help reinforce good behavior during Applied Behavioral Analysis (ABA) therapy sessions. But there is a way you can improve on the token boards and other reinforces to make them as effective as possible. Your therapist should use some of the following methods to help your child move forward through their skills quickly.

When offering a token or sticker for each completed task, your therapist will ensure it is given as soon as the child completes the task. It is here reinforcement will be the most powerful, mostly due to instant gratification. If you promise a treat later for doing something they were asked to do, the behavior change will not be as rapid. This is why stickers and tokens on hand are such an amazing tool, there’s no wait period.

The stickers, token or reward must also mean something to the child/teenager. If the reward isn’t very exciting, then it’s not motivating. Sure they might do it for the benefit of getting a sticker, but they’d do it with more gusto and energy if that sticker was of their favorite cartoon character and not a gold star.

The therapist should give the treat frequently. It would be a little ineffective to tell your child, ‘if you behave all day you can get a sticker.’ Not only is that unrealistic (who doesn’t make mistakes? What child doesn’t misbehave once or twice?) but the goal is out of reach, and the reward isn’t tangible. It’s not something they can easily imagine themselves receiving. Giving your reward frequently reminds your child how awesome it feels to get it.

The therapist should also make the reward exciting with the use of social engagement. Compliments, hyping up the gift, and being as positive about the reward as possible are some examples.

Another mistake newer ABA therapists make is turning the reward into a negative. Instead of saying, ‘if you don’t do X you won’t get this’, the therapist should say, ‘if you do X you will get this cool sticker!’ In an upbeat happy tone. Now the sticker is exciting, the praise is rewarding, and the outcome is something they want to work towards.

Just think about how it feels when someone tells you that you can’t have something unless you do as they say. Instantly we evaluate if we want that thing anyway, which makes us less likely to be happy about getting it. This is just human nature. One simple change in language can do a lot for any child.

ABA therapy is such a simple therapy really when broken down. From the outside it can be confusing and even a little scary at first, but when we look at it from a common sense angle, it’s little wonder why this therapy is so vastly used in all sorts of fields. Tokens, and stickers are nothing new, and if you ever have any issues with how they are used you can always ask the advice of your BCBA certified analyst or therapist.