ABA (Applied Behavioral Analysis) Therapy for Autism

ABA is short for Applied Behavioral Analysis, and it is often described as the “gold standard” for autism treatment. Applied Behavioral Analysis (ABA) is a system of autism treatment based on behaviorist theories which, simply put, state that desired behaviors can be taught through a system of rewards and consequences. ABA can be thought of as applying behavioral principles to behavioral goals and carefully measuring the results.

While the idea of using rewards and consequences to teach behavior is probably as old as human civilization, the idea of carefully applying rewards and consequences to achieve specific, measurable goals is relatively new. While many people are strong advocates of ABA because of its demonstrable success in achieving specific outcomes, others believe it is at best disrespectful and, at worst, actually damaging to the individual.

History of ABA

Dr. Ivar Lovaas, a behavioral psychologist, first applied ABA to autism in the Psychology Department at UCLA in 1987. He believed that social and behavioral skills could be taught, even to profoundly autistic children, through the ABA method. The idea was (and is) that autism is a set of behavioral symptoms that can be modified or “extinguished.” When autistic behaviors are no longer evident to the observer, the assumption is that the autism itself has been effectively treated.

When he first began using ABA, Lovaas had no hesitation about employing punishments for non-compliance, some of which could be very harsh. This approach has been modified in most situations, but it is still in use in some settings. In general, however, “punishment” has been replaced by “withholding of rewards.” For example, a child who does not properly respond to a “mand” (command) will not receive a reward (reinforcer) such as a favorite food.

Whatever one’s opinion about Lovaas’s approach (and many people feel that ABA is both dehumanizing and inhumane), his idea turned out to be quite correct: many if not most children who receive intensive ABA training learn to behave appropriately at least some of the time, and some even lose their autism diagnosis after years of intensive therapy. Whether exhibiting appropriate behavior is the same thing as “being cured” is, of course, a debatable question.

Over time, Lovaas’s techniques have been studied and modified by therapists with slightly or significantly different visions of behaviorism. Techniques such as “pivotal response” and “language-based ABA” have become well-established autism treatments in their own right. Several of these techniques bring together ideas from both the behavioral and the developmental realm, meaning that they focus not only on behaviors per se but also on social and emotional engagement.

What Can Children Learn Through ABA?

Most of the time, ABA is intended to “extinguish” undesirable behaviors and teach desired behaviors and skills. For example, ABA may be used to reduce outbursts and tantrums or to teach a child to sit quietly, use words to make requests, or wait for their turn in the playground. ABA can also be used to teach simple and complex skills. For example, ABA can be used to reward a child for brushing his teeth correctly, or for sharing a toy with a friend.

While classic ABA can be used in a “natural” setting (a playground, for example), it is not intended to build emotional skills. So, for example, while ABA might teach a child to shake hands or greet another person with a handshake, it won’t help that child to feel an emotional connection with another person. It takes an extraordinary therapist to use ABA to teach academic content, imaginative or symbolic thinking, or empathy; as a result, those skills are usually taught in other ways.

How ABA Works

The most basic Lovaas method starts with “discrete trials” therapy.1 A discrete trial consists of a therapist asking a child for a particular behavior (for example, “Johnny, please pick up the spoon”). If the child complies, he is given a “reinforcer” or reward in the form of a food treat, a high five, or any other reward that means something to the child. If the child does not comply, he does not receive the reward, and the trial is repeated.

The specific content of discrete trials therapy is based on an evaluation of the individual child, his needs, and his abilities. So a child who is already capable of sorting shapes would not be asked to sort shapes indefinitely for rewards—but would focus on different, more challenging social and/or behavioral tasks.

The very youngest children (under age three) receive a modified form of ABA which is much closer to play therapy than to discrete trials. As they master behaviors, well-trained therapists will start to take children into real-world settings where they can generalize the behaviors they have learned and incorporate them into ordinary social experiences. ABA can also be used, in one of its many forms, with older children, teens, or even adults.

Discrete trials ABA is still in use in some settings, and for some children. Other forms of ABA, however, are becoming increasingly popular. In addition, rather than providing 1:1 therapy in a classroom or office, many therapists are now administering ABA in natural settings such as playgrounds, cafeterias, and community locations. This approach makes it easier for children to immediately use the skills they learn in a real-world situation.