Applied behavior analysis (ABA) is a type of therapy that focuses on teaching certain behaviors through a series of rewards and consequences.
ABA therapy is one of the most popular therapies for autistic children. Autism spectrum disorder (ASD) is a neurodevelopmental condition.
ABA therapy may help enhance communication, social, and learning skills.
This article will explore how ABA works for autistic children, its purpose, the costs for treatment, benefits, and risks.
ABA therapy attempts to modify and encourage certain behaviors, particularly in autistic children. It is not a cure for ASD, but it can help individuals improve and develop an array of skills.
This form of therapy is rooted in behaviorist theories. This assumes that reinforcement can increase or decrease the chance of a behavior happening when a similar set of circumstances occurs again in the future.
ABA tends to use positive reinforcement. This is a reward system wherein a child will receive an item or privilege that they enjoy when they demonstrate the desired behavior.
In previous decades, if the child did not produce the desired behavior, they would face physical punishment. However, this is rarer now. Instead, the child may receive punishment by not getting the reward if they do not display the desired behavior or skill.
This theory assumes that the child will choose to demonstrate the desired behavior so that they can receive the reward.
A child and family can expect the following things to happen during their time participating in ABA therapy:
The first step in ABA therapy is to attend an assessment. A child and their parent or caregiver will meet with a board certified behavior analyst (BCBA).
The BCBA will assess the needs and goals of the child through a series of questions and interactions. From this meeting, the BCBA will tailor a treatment plan.
The first few sessions of ABA therapy will focus on the BCBA and the child building a rapport. This may be through the BCBA spending direct time with the child or supervising the person who is working with the child. During this time, the therapist will get to know the child in terms of their likes and dislikes.
Working toward goals
Depending on the needs and goals of the child, ABA sessions can last between 1 hour and several hours.
The contents of each session will also vary depending on the child’s treatment plan, but the BCBA will likely combine the following two techniques:
Discrete trial training
Discrete trial training (DTT) breaks down a skill and focuses on teaching it in a step-by-step process.
This involves three steps: antecedent, behavior, and conclusion.
- The antecedent is the cue that leads to a behavior.
- The behavior, in this instance, is the child’s response to the cue.
- The conclusion is what happens following the child’s response.
If the child produces the desired response, the BCBA will reward them. However, if the child does not provide the appropriate response, the BCBA will correct them and not give them a reward.
Natural environment training
Once a child learns a skill through DTT, the next stage is teaching them the same skill within a natural environment.
For example, if during DTT the child has learned to identify foods through pictures, natural environment training will involve them going into a kitchen and the BCBA, parent, or caregiver asking the child to retrieve a food item.
This process also uses the approach of antecedent, behavior, and conclusion.
The BCBA also provides training and support to the parents or caregivers of the child. This is so that they have the skillset to maintain the child’s new positive behaviors and manage any challenging behavioral issues.
The design and research relating to ABA originally focused on autistic children. However, it has since become a useful form of therapy for other conditions, such as:
- eating disorders
- attention deficit hyperactivity disorder
- post-traumatic stress disorder
- panic disorder
- anger issues
- obsessive-compulsive disorder
Research suggests that autistic children who engage in high intensity ABA therapy over a long period of time are more likely to meet their personal treatment objectives.
Even though the research is promising, it is important to note that, like with other kinds of therapy, ABA therapy may work for some people but not for others.
Anecdotal evidence suggests that ABA can cost approximately $54,000 per year. However, this will depend on factors such as the type of treatment plan a family chooses and the experience of the BCBA.
More health insurance policies are now covering ABA therapy. If a person is considering ABA therapy for their child, it may be worth contacting their policy provider to see if they can cover part or all of the cost.
People can find organizations and providers of ABA therapy online. Alternatively, they may consider asking their healthcare provider for recommendations.
If a person is searching for someone to deliver ABA therapy and wants to verify that the BCBA is legitimate, they can ask to review their letter of verification.
The location of ABA therapy can vary, as it involves teaching the child skills in a natural setting. Therefore, the BCBA may conduct the therapy at a practice, in the child’s home, or in an environment where the child may demonstrate a new skill, such as the park.
Some research has been positive regarding the benefits of ABA therapy. For example, an older meta-analysis examining ABA therapy suggests that it improves the following in autistic children:
- intellectual functioning
- language development
- the acquisition of daily living skills
However, there is a lack of research exploring whether or not the benefits of undergoing ABA therapy in childhood will continue throughout a person’s lifetime. That said, the short-term results are promising.
There are several levels of ASD. One scientific article from 2019 suggests that autistic children who are nonverbal or who require substantial support may not benefit from ABA therapy, and it may cause them more harm than good.
Another study examining why parents discontinued their children’s ABA therapy states that many quit due to noticing symptoms of psychological trauma after commencing the intervention.
ABA is a widely used therapy to help autistic children develop skills and improve certain behaviors.
Although some research suggests that it can work, other research argues that it may cause more harm than good.
Ultimately, it is down to the child’s parent or caregiver to decide whether or not they want their child to try this type of therapy.
However, this form of therapy may not benefit every autistic child, so it is important to listen to the needs and emotions of the child.