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.