April is National Autism Awareness Month, a time when raising awareness and promoting autism research receives countrywide recognition. According to the Centers for Disease Control and Prevention (CDC), one in 68 children is identified with an autism spectrum disorder (ASD). ASDs reportedly occur in all racial, ethnic and socioeconomic groups, though they are almost five times more common among boys (one in 54) than girls (one in 252).
With numbers like these, it is no surprise that there is a growing need for effective, empirically validated autism therapies. For many individuals and families navigating the complex world of ASD treatments, applied behavior analysis (ABA) is the right option. This early-intervention, evidence-based approach is endorsed by the American Medical Association, National Academy of Science, American Academy of Pediatrics, U.S. Surgeon General and New York State Department of Health. What makes this approach the most effective option for many individuals with autism spectrum disorders? The answer lies in both the decades of research behind ABA and the encouraging outcomes it generates.
As one of the most widely accepted autism therapies, ABA is “based on the idea that people are more likely to repeat behaviors that are rewarded than behaviors that are not recognized or ignored.” Many children with autism and related disorders exhibit unwanted behaviors that inhibit their ability to complete daily tasks. ABA helps correct these behaviors by enabling children with autism to develop skill sets and reduce the likelihood of problematic behaviors. Since the 1960s, researchers have recognized that ABA is the most effective approach to early intervention, and the medical community agrees: 32 out of 50 U.S. states have laws that “require health insurers to cover it.”
In traditional ABA therapy, therapists work one-on-one with children for up to 40 hours a week. Modified ABA therapy, which allows the child time for other therapies like speech and occupational therapy, decreases this one-on-one time to about 15 hours a week. ABA therapy is most effective if it begins when children are under the age of 5, though older children with autism can also benefit.
There are two broad categories of ABA therapy: comprehensive and focused interventions. The main difference between these two types of procedures is the desired outcome. Comprehensive ABA interventions aim to produce changes in specific skills that impact global measures of functioning. This includes IQ, adaptive skills and social function in children with autism. This category of treatment is continued for an extended period and is home- or center-based. Some skills targeted by comprehensive ABA interventions include:
- Language and communication
These programs “rely on the use of clear instructions, reinforcement, teaching small units of behavior and repeated trials to maximize learning opportunities,” according to the Kennedy Krieger Institute. When used as therapy for young children, these types of interventions are often referred to as “early intensive behavioral interventions” (EIBI).
Focused ABA interventions are more short-term and time-limited than comprehensive interventions, because they are designed to “address specific behavior deceleration concerns including aggression, self-injury, disrupted behavior, pica and other challenging behaviors.”
Typically, focused ABA interventions involve changing a child’s environment to minimize problem behavior, establishing and reinforcing adaptive behaviors and “withholding reinforcement for problem behavior.” This category of ABA therapy can also address concerns such as anxiety and skill deficits, though these services are generally needed only when standard teaching and parenting practices are ineffective.
Regardless of the specific category or treatment goals, the Kennedy Krieger Institute identifies the following common features of all ABA therapy approaches:
- The objective measurement of behavior
- Use of procedures based on scientifically established principles of behavior
- Precise control of the environment to allow for the objective evaluation of outcomes
Therefore, only clinical procedure or research that meet these criteria can be classified as an ABA-based intervention.
Applied Behavior Analysis is different from all other autism therapies because it is an objective discipline that focuses on reliable measurement and objective evaluation of measurable behaviors. It takes the principles of learning and motivation from behavior analysis and applies them to the solution of
“problems of social significance” such as adaptive living and social skills. The Center for Autism and Related Disorders (CARD) reports that, over the past four decades, thousands of published research studies have documented the effectiveness of ABA across a wide range of:
- Populations (children and adults with mental illness, developmental disabilities and learning disorders)
- Interventionists (parents, teachers and staff)
- Settings (schools, homes, institutions, group homes, hospitals and businesses)
- Behaviors (language; social, academic, leisure and functional life skills; aggression, self-injury, oppositional and stereotyped behaviors)
The key to understanding what makes ABA different is reliable measurement. Problem behaviors must be defined objectively, with vague terms like anger, depression and aggression redefined in “observable and quantifiable terms,” so measurable properties can be directly recorded. The methods of analysis used by ABA professionals yield results that are convincing, reproducible and demonstrable. This ensures that specific behavior changes can likely be accomplished using previously successful ABA approaches. Another important component of ABA therapy is that it evaluates behavior within relevant settings: schools, homes and the community.
According to Autism Speaks a number of completed studies demonstrate that ABA techniques produce improvements in communication, social relationships, play, self-care, school and employment. These studies are encouraging because they involve all age groups, from preschoolers to adults. In all age groups, ABA is shown to increase participation in “family and community activities.” When intensive ABA interventions are compared to other types of early intervention, children who receive intensive ABA treatment are shown to “make larger improvements in more skill areas.” Finally, early intervention programs (those implemented before age 4) have the highest rate of effectiveness.
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