Applied Behavior Analysis (ABA)
What Is Applied Behavior Analysis?
Applied Behavior Analysis, or ABA, is a discipline that focuses on the application of behavioral principles to socially significant behaviors. There are more than 40 years of empirical research that demonstrate the use of behavior-analytic procedures in reducing problem behaviors and increasing appropriate behaviors in adults and children diagnosed with developmental and intellectual disabilities. Based on this empirical research, the use of ABA-procedures is considered best practice by the scientific community and many governmental agencies including the Surgeon General of the United States, the National Institute of Mental Health (NIMH), and the Center for Disease Control (CDC).
What Types of Behaviors Are Typically Addressed During ABA Sessions?
Increasing Functional Skills:
- Communication and Language – Echoing sounds (echoics), requesting items and activities (manding), labeling items and activities (tacting), conversational skills (intraverbals)
- Daily Living Skills – Toilet training, dressing, feeding, hygiene routines, chore completion, meal preparation and clean-up, functional listener skills (following directions)
- Social Skills
- Appropriate and Functional Play
Decreasing Problem Behaviors:
- Self-Injurious Behaviors (SIB) – Self-hitting, self-pinching, self-biting, head-banging.
- Aggression – Hitting, kicking, head-butting, punching, pinching, scratching, biting, hair pulling.
- Property Destruction – Throwing items, ripping items, pushing items over, turning over furniture.
- Elopement – Running away from caregivers
- Stereotypy – Repetitive movements (e.g., hand flapping, spinning items, body rocking)
- Tantruming – Crying, screaming, whining
How Do We Get Started and What Can We Expect?
Your first appointment will be an intake appointment, called an initial evaluation, where you and your child will meet with a Board Certified Behavior Analyst (BCBA) to discuss your presenting concerns and, if appropriate, how ABA service may benefit your child. The BCBA will conduct an in-depth parent interview with you, where you will be asked to provide background information including your child’s developmental and medical history. You will also be asked to outline your main concerns and areas that you would like to see addressed in therapy. During this appointment, the BCBA will also observe your child playing and engaging with you. Information from the parent interview and this direct observation will help the BCBA outline treatment goals and to begin developing a preliminary treatment plan. The BCBA will discuss these preliminary treatment goals with you and make a recommendation regarding where therapy should take place (i.e., clinic, home, or school) and the number of hours of therapy that would be appropriate to work on these treatment goals. The number of hours recommended will be based on your child’s needs. Additional factors that may impact the number or hours recommended include therapist availability, your child’s availability (i.e., children who attend school full-time or require other therapies may have more limited availability), and payment or insurance coverage.
The initial phase of therapy will be the assessment phase. This phase will vary in duration depending on your child’s needs and availability. If the primary treatment goals for your child include the assessment and treatment of problem behavior, this phase will consist of assessing the environmental conditions that evoke the problem behavior. Oftentimes, problem behavior can be a barrier to progress in other skill areas (e.g., problem behaviors that occur during academics often preclude a child from acquiring new academic skills until the problem behaviors are reduced and the child is able to attend to the new tasks being taught). For this reason, the assessment and treatment of problem behavior is typically addressed prior to adding skill acquisition programming. If the primary treatment goals for your child are to increase functional skills, a skills assessment will be conducted. Depending on your child’s needs, a variety of skills assessments may be used including the Verbal Behavior Milestones Assessment Placement Program (VB-MAPP), the Assessment of Basic Learning and Language Skills Revised (ABLLS-R), and the Sunshine State Standards. The purpose of the skills assessment is to gather baseline information about your child’s language, daily living, social, academic, and play skills. This allows the therapist to see what skills are currently in your child’s repertoire and to begin planning treatment goals at a level that is appropriate for your child.
Following the assessment phase, the treatment phase will begin. Again, the treatment phase will vary in duration based on the needs of your child. It should be noted that the treatment phase often lasts from several months to several years. Based on information gained during the assessment phase, your child’s therapist will develop treatment goals and an individualized behavior plan. The therapist will collect data on your child’s progress with the goals outlined in his or her behavior plan. These data will be analyzed to monitor your child’s progress and make modifications to the behavior plan as needed. As your child masters new skills, additional goals will be added to his or her plan.
The format of each child’s ABA sessions may look very different depending on your child’s needs. For children whose primary treatment goals are to increase functional skills, some common teaching formats include rotating between intensive trial teaching (ITT) or discrete trial teaching (DTT) and natural environment teaching (NET). ITT or DTT can be used to develop a wide variety of skills including motor skills (fine and gross motor imitation), language and communication skills (labeling items, receptively identifying items, answering questions), and visual perceptual skills (matching and sorting). ITT involves breaking a skill down into smaller, sub-skills and teaching each sub-skill to mastery before moving on to the next sub-skill. ITT involves errorless teaching, prompt fading, and techniques for correcting learner errors. ITT typically takes place at a table or desk and incorporates repeated practice of each skill and reinforcement for variety of appropriate behaviors during the ITT session, including correct responding, more independent responding, and attending. In contrast to ITT, NET takes place away from the desk, in the natural environment. During NET, the therapist typically will use the child’s motivation to contrive learning opportunities to work on teaching new skills. Additionally, the therapist may also rely on incidental teaching, whereby the therapist observes and interacts with the child as they are playing. The therapist follows the child’s motivation and will use the play situation as an opportunity for teaching new skills. Many of same skills that are taught during DTT can also be taught during NET. Play skill and functional daily living skills may be taught more easily and naturally using NET methods.
Finally and most importantly, you are an integral part of your child’s treatment planning. During the treatment phase, your child’s therapist will ask you to continue working on some of his or her treatment goals at home. Think of this as homework. The more practice that your child has with a skill, the greater the likelihood of success. You will be given specific instructions and training on how to work with your child on these goals. It is important that your child learns to utilize the skills that he or she is learning during session with multiple people (i.e., the therapist and you, the caregiver) and in multiple environments (e.g., clinic, home, and school). You may also be asked to collect data on your child’s problem behaviors or success with certain skills at home. Again, your child’s therapist will offer you training on how to work on his or her goals and how to collect data at home. Your involvement throughout the treatment process is immensely important for your child’s success.