Thursday, 6 December 2012

Autism Evidence 3. What is ABA for children with autism?

 Many people seem to misunderstand what Applied Behavioural Analysis (ABA) actually is when applied to the education of children with autism. I have found some limitations in understanding also among ABA folks themselves. This blog is the result of many discussions with colleagues about how to answer the question “What is ABA?” when applied to working with children with autism. However, the description presented here is my own perspective. Not all of my points will be agreed upon by all experts in ABA. See whether you find this blog helpful.

What is ABA?

ABA has evolved from a science of learning (called behaviour analysis). Basic scientific research has identified how humans learn, and the application of this scientific knowledge for social benefit is essentially what ABA is all about. ABA practitioners focus on changing behaviour. “Behaviour” is not shorthand for problematic behaviours. Although ABA practitioners do work with people to help reduce problematic behaviours, much of the focus of ABA when working with children with autism is on building new behaviours, new skills, and so helping children to learn new things.

One of my colleagues is fond of saying that whenever we achieve some change in behaviour, the principles of learning will have been brought into play. The laws of learning are universal so whether we intend to use them or not when people learn, when behaviour changes, this happens via underlying learning processes.

Behavioural interventions, drawing on those principles of learning and behaviour change, also feature in many contexts to help improve quality of life. For example, in the UK, the National Institute for Health and Clinical Excellence (NICE) has recommended a number of behavioural interventions in different areas of health and well-being. These recommendations include:

  • Dialectical Behaviour Therapy for Borderline personality disorder (Jan 2009)
  • Behavioural Activation for Depression in adults (Oct 2009)
  • Multi-component intervention including behaviour change, and goal setting for Obesity (Dec 2006)
  • Behavioural parent training in Parent training/education for child conduct disorder (July 2006)
  • “Behavioural and functional analysis” for challenging behaviours in Dementia (Nov 2006)
  • Behavioural intervention to improve daily living skills and for challenging behaviours in adults with autism (April 2012)

So, ABA is all around us, and is used in a variety of contexts. In addition to ABA interventions in health, social care, and education, ABA practitioners have used their skills to (amongst other things): improve safety behaviours, train elite athletes, and to increase productivity in work settings.

It has often been said that neither of the As in ABA are for Autism. Hopefully, it is clear by now that ABA is not an intervention for autism, but can be applied to help children with autism.

Defining ABA for autism

The following single sentence might be a good way to capture the essence of ABA when applied to working with children with autism:

ABA is a values-driven, child-centred, developmentally-informed, evidence-based, effective use of principles of learning to help children with autism achieve their full potential.”

The core values and commitments of ABA in the field of autism are:

  • ambition for the child, and optimism about what is possible for them
  • an assumption of every child’s ability to learn (not dis-ability)
  • empowering the child by establishing skills and supporting management of their own behaviour
  • collaborative working with other professionals, family members, and carers to best support the child

A further characteristic that is important to emphasise is that ABA does not “decide” on what behaviours to change or what skills should be developed for a child with autism. ABA practitioners are skilled at teaching skills and decreasing problematic behaviours, but the behaviours to be changed need to be externally defined by others. When working with children with autism, there are perhaps three sources used to identify the foci for intervention:

  1. Children themselves, their families, and others around the child identify what outcomes are important to them
  2. An understanding of typical development (what key developmental skills has the child developed, or what they need to learn next), and also the requirements of statutory educational curricula
  3. A focus on pivotal behaviours that will facilitate further development: teaching communication, social skills, daily living or academic skills that can support independence and choice-making

Comprehensive ABA intervention for children with autism

There are many ABA-based short-term focused interventions carried out when working with children with autism. A particular skill might be taught over a few days or weeks, or a particular behaviour problem might be the target for reduction again over a few weeks. Behavioural interventions are used probably in the majority of educational settings for children with autism in this focused way.

The main debate in the field of autism about ABA is actually focused on comprehensive ABA educational models. These comprehensive models bring together multiple elements of ABA intervention in a co-ordinated way and share probably all of the following features:

  • Teaching multiple, rather than only one, skill areas
  • Breaking down complex skills into small, teachable steps to facilitate learning
  • Teaching over a long period of time – years, rather than weeks or months
  • Can be used for all ages of children and adolescents
  • The intervention model includes structured learning opportunities and also incorporates “natural” opportunities across much of the day/week
  • Involves a team of people (often including parents)
  • Can take place at home or in school and other settings

What may be a surprise to some is that I have not included a prescription of intensity of intervention in this list of shared features – no mention of the number of hours per week that must be delivered. My perspective on this is that a focus on the number of hours of intervention is linked to when comprehensive interventions are used as an early intervention model. When used as an early intervention model, comprehensive ABA intervention is often called Early Intensive Behavioural Intervention (or EIBI). When intervening early, accepted wisdom is that one should deliver as much intervention as possible. In fact, this is slightly more than accepted wisdom. International expert consensus in the field of autism is that intervention should ideally be early and the more that can be delivered probably the better in terms of longer term outcomes. So, autism experts (not ABA experts alone) recommend early and reasonably intensive intervention.

Again, I see no prescription of intensity for a comprehensive ABA intervention. However, following international consensus, one would want to deliver as much high quality intervention as possible when delivering EIBI. If the resources available allow the delivery of 30-40 hours of intervention per week, one would want to do this. If the resources allow for only 5 hours of intervention per week, this should (in my view) be done too at a quality level as high as possible to ensure the biggest impact for that input.

ABA and autism after the early years

EIBI models have been developed to be used early in the lives of children with autism. The focus is on behaviours and learning that are developmentally appropriate for younger children. The teaching methods used are suitable for young children. The outcomes of interest are skills that might enable the child to benefit as much as possible from the rest of their educational experience in school, ideally within an inclusive educational setting. In fact, these are probably the general goals of all early intervention models for children with autism not just ABA.

Early intervention should, in my view, be early. However, comprehensive ABA educational models are also relevant for older children and adolescents. Although these models for older children will still share the features of comprehensive ABA interventions listed earlier, the content should look different. For example, the skills being taught to adolescents should be relevant to the adolescent stage of life and the preparation for leaving school. This is likely to involve foci such as money skills, independent use of public transport, accessing leisure facilities, and preparation for work.

7 comments:

  1. Very clear, concise explanation. It should help parents like me convince the educational establishment that ABA really is effective for autism.

    ReplyDelete
  2. Nice words. ABA is not supported by any quality evidence and recent research shows that it's assumptions about autistic learning are outdated and wrong. Add this to the fact that ABA has not been ethically approved, is not a helpful way for anyone to learn. Evidence is showing at best it is useless, at worst harmful to well-being. It is distasteful and risky to well-being that all autistic people suffering from anxiety, sensory, communication and motor issues that all they need to learn is the right motivation, reinforcement or deterrent. The autistic community does not like ABA and should be listened to about what is actually helpful for them. abacontroversyautism.wordpress.com/2017/06/27/aba-autism-discussion/

    ReplyDelete
  3. As a sign of gratitude for how my son was saved from autism, i decided to reach out to those still suffering from this.
    My son suffered autism in the year 2013 and it was really tough and heartbreaking for me because he was my all and the symptoms were terrible, he always have difficulty with communication, , and he always complain of poor eye contact . we tried various therapies prescribed by our neurologist but none could cure him. I searched for a cure and i saw a testimony by someone who was cured and so many other with similar body problem, and he left the contact of the doctor who had the cure to autism . I never imagined autism has a natural cure not until i contacted him and he assured me my son will be fine. I got the herbal medication he recommended and my son used it and in one months time he was fully okay even up till this moment he is so full of life.autism has a cure and it is a herbal cure contact the doctor for more info on drwilliams098675@gmail.com on how to get the medication. Thanks for reading my testimony .

    ReplyDelete
  4. Hello friends i am Elisabeth Bailey from Midland tx,My 15-year old son with autism. My son is verbal,followed normal education with help from me,his issues : shyness, constipation, concentration problems, problems with maturity, practically no friends because interaction with people is difficult, parasite, yeast on him, acne, kind of dandruff on top of his head. Since the age of 6, we have been trying a lot of natural supplements, hospitals med and i have wasted a lot of money trying to make him live freely without being intimidated by friends in the neighborhood also to get him better and more focused on school matters and his general health. Nothing ever seems to pull through not even his wellness until one day, i decided to check internet for help then i came across a herbal woman (Mama Kofi herbal) who cured a lady 12 years old son called (Mama Kofi herbal) and has also helped a lot of women to cure their children's Autism. quickly i contacted her email: ( mamakofiherbal@yahoocom ),just to give him a test,i spoke to him he asked me to purchase his Autism roots herbs and seed oil which i did, he promised to send it as soon as purchased and thereafter i received it and start to use the Autism herbal med immediately on him for only two weeks instructed by (Mama Kofi herbal). it was unbelievable after 21 days i was surprised,my son totally cured and free from Autism disgrace and embarrassment. There was so much improvement. He seems to get more awareness, gives more interaction at home, mingo with friends that never wanted him close. Today i am here to spread the good news of my son health on how (Mama Kofi herbal) saved him from the nightmare and outbreaks of Autism. You can contact (Mama Kofi herbal) via email: ( mamakofiherbal@yahoocom or whats-app +1-518-351-9658 ) if you are still in my past situation...I guarantee you, your Autism child is going to be healed and feel alive again just as mine right now.

    ReplyDelete
    Replies
    1. Malla, Autism is not to be healed, it is to be celebrated.

      Delete
  5. Just wanted to say a huge thank you to Dr Williams for everything he have done in my life. I have been in tears for so many years now, having found that my only son is suffering from autism, lesion after some years of being under extreme stress., . I spent 24 hours freaking out and finally calmed down after reading some testimony on here about Dr Williams herbal medicine to autism. The moment came and I mumbled out to my husband about Dr Williams product (with a few tears) and he was AMAZE – . He was just worried about our son been free from this disorder that was how will order for Dr Williams product on line , after my son finish taking Dr Williams medicine for just within a period of one month. Will went to the doc together who confirmed that he was autism free.
    Thank you again for being upfront, truthful and taking this pain away from my family for more information about his product you can email him on drwilliams098675@gmail.com i hope you can also help other terrified people in a similar situation.

    ReplyDelete