Applied Behavioral Analysis (ABA) Therapy has techniques to help teach an Autistic child empathy

People with autism often struggle with empathy; as a parent of a child who shows little empathy, it may be pretty terrifying to wonder what might happen to your child in relationships or how their morals might develop. A child with little empathy may laugh when another is upset, or take a toy from another child and not understand why they should share, or even be violent with little remorse.  

The good news is Applied Behavioral Analysis (ABA) Therapy has techniques to help teach a child empathy and how to respond to situations appropriately. Which is a huge relief when you’re the parent or even child. The other great news is lack of empathy does NOT make someone with autism an awful person who’s choosing not to care. The issue doesn’t lie in choice (typically seen with people who have autism, it’s caused by abnormal neural connectivity), and when given the option to learn and choose to care, a child with autism absolutely can!

First, the ABA therapist will likely teach your child to recognize emotions. Once they can recognize what an emotion actually is in a simple way, it will be way easier to teach them it in everyday interactions, and how to respond to those emotions. This is done through pictures of faces, the therapist demonstrating or even silent clips of facial expressions.

Apart from recognizing emotion, there are two other steps to mastering empathy. Taking someone else's point of view into account and controlling how we respond. This can be done through role-playing situations, using life skill books demonstrating situations where empathy is needed, having the child role play another's emotions through facial expressions, or even asking questions in everyday conversation when an empathetic response is needed.

The other cool thing about empathy is there are actually three types.

Emotional Sharing: Where you feel what another feels

Empathetic concern: Where you want to help others in distress

Perspective taking: Which is when you can see someone else's point of view

Knowing this as parents of autistic children can help us to understand why your child might run to help their sibling up when they’ve fallen down one second, but call them names and laugh the next.

ABA is a fantastic therapy which can help so many children with autism thrive and live a far more high-functioning life than they would have. The vast amount of things the therapists can teach and help your child with is so worth the time investment and bond you will build with both the therapist and your child.

Emotions for an ASD child

Almost all children struggle with recognizing emotions in others, but for a child with autism, this skill is even more complex. Their inability to read body language or facial expression well lends to even more complications throughout their life, which is why it’s important to teach this skill early. Learning how to recognize emotions impacts all areas of a person's life, from school, to work, to making friends and strengthening family bonds.

One great thing about teaching a child emotions is that they have to look at faces to achieve it. Something that people with autism struggle to do. An applied behavioral analysis (ABA) therapist can teach this in a variety of ways, one way is to show pictures faces that are sad, happy, worried, angry, etc. They ask the child which face is which and have the child point or tell the therapist.

Therapists can also teach this through expressing the emotions to the child and having them identify it. They express the emotion in an overt way, by grinning and clapping and asking what the child thinks the therapist feels.

The more the child practices identifying emotions in an artificial setting, the more likely they can recognize emotions in an everyday setting. Once a child can label and identify emotions, they can move on to learning how to deal with the emotions in themselves and others.

ABA is a great tool that helps children to learn a range of complex abilities that will help them with life skills across a range of areas, from school, to home to friends. Learning emotions is just one tool of many.

Researching the Therapy

As a parent new to the diagnoses of Autism or with little knowledge of Applied Behavioral Analyses (ABA) therapy, the whole process of researching the therapy and life your child could face is overwhelming. But reading about the nuts and bolts of the therapy and what kids with autism go through, in clinical dry ways, only gives us so much information.

Researching the step by steps, understanding the language, and talking to a therapist about your concerns are all legitimate ways to discover what you’re getting into—but it can’t prepare you for how it feels or even looks like living it.

There is however a book When Everybody Cares: Case Studies of ABA with People with Autism  by Bobby Newman which is a first-person account of ABA. It can show you in a very real way how this therapy affects a child’s life and what issues arise with someone on the spectrum.

The book When Everybody Cares: Case Studies of ABA with People with Autism gives a unique insight into the life of a behavioral analysis and the solutions they develop for common problems. The great thing about this book is you aren’t just reading step by step, you're reading the struggles and insights and even the raw emotions that come along with working through difficult behavioral issues: such as a child refusing to eat or learning how to follow instructions.

Like a diary, this book doesn’t tell you what ABA will be like, it shows you like a story, a biography of sorts. ABA is a beautiful journey for everyone involved, so it’s little wonder such a beautiful book has been written because of it.  If you want to really see what ABA looks like, or even feels like, then give this book a try.

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.

7 dimensions of ABA

Applied Behavioral Analyses (ABA) is based on 7 core dimensions. Any interventions your therapist uses with your child will fall within or be defined by these 7 categories. Therapists use the anagram GET A CAB to remember each part of the therapy.

G is for Generalization: This is moving skills from one situation to another. Sometimes your child with autism may perform certain skills like using the potty in one location but not in another. Generalization is the process of moving this skill from one place to another.

E is for Effective interventions: All interventions are monitored to ensure effectiveness and to see how they impact the behavior you are trying to change. They must be strong changes that affect something for the better.

T is for Technological: Where interventions and procedures are described thoroughly enough that anyone trained can implement them.

A is for Applied: Socially significant behaviors are worked on, more so than others.  

C is for Conceptually Systematic: The concept of the interventions is chosen from a specific theoretical base, rather than just a trick.

A is for Analytic: All decisions for an intervention or anything within the therapy must be data related.

B is for Behavioral: Only behavior that can be observed and measured should be targeted.

In ABA when measurable behaviors are targeted based on how well it will help your child cope in society, data is collected and explainable interventions are tried and tested, then your child will go far. ABA is a therapy where you record the changes in your child for the better, or worse leaving nothing to chance. This is why this therapy is so effective and gets results more often than any other intervention.

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.

How prompting can help during ABA

Prompting is a wonderful tool in applied behavioral analyses therapy (ABA) and probably the reason some children learn to communicate at all. This simple way of moving a child through the motions of an action/response so he/she can see the consequence is so powerful yet so simple. It really answers the question, how do you teach a child that can’t understand language intuitively, what you are asking of them?

My son was completely non-verbal until his speech therapist used hand-over-hand prompting to show signs and slowly weaned him through the process of prompting until he could mand (request things) for himself.

Here is a list showing some most invasive to the least invasive prompting.

Most invasive: Full Physical Prompting

This is when your therapist will essentially use your child’s hands to carry out a request. For instance, she/he may say, ‘pick up your toys,’ then take the child’s hands and close them around the toy, guiding it to the toy box.

Next Invasive: Partial Physical Prompting

In this case the therapist will put the child’s hand onto the toy to show them what she means and wait to see if the child carries out the rest of the direction. Normally this is the first step taken once the child has mastered full physical prompting.

Next Invasive: Modeling

The therapist will act out what she wants the child to do. For instance, she will pick up the toy and put it in the box after asking them to do it and wait to see the child’s response.

Next Invasive: Gestural

Where the therapist will point at the toy and the toy box to gesture to the child what is needed of them.

Next Invasive: Positional Prompt

The therapist places the object close to your child and tells them to clean it up.

Least Invasive: Simple Direction

The therapist will simply ask your child to clean up their toys and expect that they will do it without further help.

When we move down this chart the child slowly learns what is expected of them, or basically, what you’re asking them to do! Much of the time, just telling them what to do and showing them won’t work for an autistic child. Going from most invasive to least invasive (depending on the specific skill set of your child and what they are asked to do) teaches them in a way that they will actually understand. It’s so simple and effective but works beautifully.