ABA for Autism: Its Not What You May Think

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ABA for Autism Its Not What You May Think!

• Gina Green, PhD, BCBA

San Diego, CA December 2005
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Objectives

• Overview of applied behavior analysis (ABA) in
  the treatment of autism
• What ABA is
• State-of-the-art ABA treatment for autism
• History and research foundation
• What ABA is not
• Summary
• Video Finding the Words

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Applied Behavior Analysis What it Is

• Behavior analysis a natural science approach to
  understanding behavior
• Originated by B.F. Skinner (1938)
• Conceptual, experimental, and applied components
• Applied behavior analysis (ABA) Application of
  scientific principles or laws of behavior (e.g.,
  reinforcement) to improve socially significant
  behavior to a meaningful degree
• Many applications in addition to autism
• Based on the work of many researchers and
  practitioners

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What ABA Is (contd)

• Effective for building skills and reducing
  problematic behaviors in people with and without
  disabilities
• Stresses positive reinforcement and scientific
  demonstrations of effectiveness
• Highly individualized, contextual, flexible
• Complex and intricate, comprising many techniques
• Continuously evolving

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State-of-the-Art ABA Treatment for Autism

• Comprehensive all skill domains addressed
• Skills broken into small components, defined in
  observable, measurable terms
• Individual strengths and weaknesses assessed by
  direct observation and measurement
• Each component skill taught via many trials or
  learning opportunities, each comprising a
  specific antecedent stimulus, response, and
  consquence
• Multiple, repeated learning opportunities
  arranged, in both structured and naturalistic
  situations

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State-of-the-Art ABA (contd)

• Little unstructured time for practicing autistic
  behavior
• Various techniques used to arrange learning
  opportunities and enhance motivation discrete
  trials, incidental teaching, activity-embedded
  instruction, task analysis and chaining, prompts
  and prompt-fading, child choice, etc.
• All aspects of intervention tailored to
  individual needs and preferences
• Simple skills built systematically into more
  complex repertoires
• Emphasizes teaching the child how to learn,
  developing relationships, and making learning fun.

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State-of-the Art ABA (contd)

• Problematic behaviors are not reinforced
  alternative adaptive behaviors are.
• Data used to evaluate progress and "fine tune"
  teaching procedures continuously.
• Programming directed by individuals with graduate
  degrees in behavior analysis specific training
  and experience in autism
• Board Certified Behavior Analysts (BCBAs) or the
  equivalent (see www.BACB.com for information
  about international certification program for
  practitioners of behavior analysis)

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ABA for Autism History

• Sidney Bijou, Director of Institute of Child
  Development, U of Washington starting in 1948
• Brought together many pioneers of behavior
  analysis Wolf, Risley, Baer, Birnbrauer, Hart,
  Sloane Lovaas a postdoctoral fellow
• Blended experimental analysis of behavior with
  developmental psychology
• 1st applications of behavior analysis to autism
  Ferster DeMeyer (1961) Wolf, Risley, Mees
  (1964)
• 1st to use discrete-trial procedures with
  children with autism Risley (early 60s)
• 1st to develop naturalistic, child-initiated
  procedures to promote language (incidental
  teaching) Hart Risley (1968)
• 1st to define applied behavior analysis Baer,
  Wolf, Risley (1968)

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ABA for Autism Research

• At least 550 studies published 1960-1995 (Matson
  et al., 1996) and hundreds more since 1995
  document effectiveness of specific ABA methods
  for teaching many important skills
• Learning to learn looking, listening, imitating,
  following instructions, discriminating and
  matching stimuli, etc.
• Communication verbal and nonverbal
  comprehension and production from simple
  vocalizations to complex conversations
• Social simple reciprocal exchanges, playing
  with peers, sharing, expressing emotions,
  empathizing, dramatic play, etc.
• Self-care hygiene, personal safety, community
  living, etc.
• Academics
• Motor and leisure
• Vocational

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Research on early intensive ABA

• Early children entered treatment before age 5
• Intensive 20-40 hrs/wk of 1-to-1 treatment
  (initially), year around, for at least 2 years
  (all waking moments)
• Programs directed by individuals with advanced
  training in ABA (mostly PhDs) and experience with
  young children with autism conducted initially
  in quiet settings (often homes) involved parents
  as active co-therapists

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Research (contd)

• 1st to document effectiveness of early intensive
  ABA Fenske, Zalenski, Krantz, McClannahan
  (1985) -- quasi-experimental (uncontrolled)
  study
• 6/9 children who entered before age 5 enrolled
  full-time in regular classrooms after 2 yrs 1/9
  who entered after age 5 did so
• 1st to document similar outcomes in a controlled
  study with multiple measures and long-term
  followup Lovaas (1987) McEachin, Smith,
  Lovaas (1993)
• 9/19 intensively treated children had IQ scores
  in normal range (mean gain 30 pts), completed
  1st grade independently maintained gains at
  adolescence only 1/41 children in two comparison
  groups had comparable outcomes.

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Research (contd)

• Partial and systematic replications of Lovaas
  model with comparison groups
• Birnbrauer Leach (1995)
• Smith, Eikeseth, Klevstrand, Lovaas (1997)
• Smith, Groen, Wynn (2000)
• Eikeseth, Smith, Jahr, Eldevik (2002)
• Full replication of Lovaas (1987) intensive
  treatment
• Sallows Graupner (2005)
• Quasi-experimental study (no comparison group) of
  Lovaas model with independent diagnoses,
  objective measures of pre- and post-treatment
  functioning
• Weiss (1999)

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Research (contd)

• Studies of broad-based intensive ABA
• Controlled study (two comparison groups) Howard,
  Sparkman, Cohen, Green, Stanislaw (2005)
• Case studies with objective measures Perry,
  Cohen, DeCarlo (1995) Green, Brennan, Fein
  (2002)
• Other ABA models, quasi-experimental studies
• Douglas Developmental Disabilities Center
  Handleman et al. (1991) Harris et al. (1991)
  Harris Handleman (2000)
• May Institute Anderson et al. (1987) Luiselli
  et al. (2000)

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Collectively, studies show

• Of children who entered treatment before age 5
  and received at least 30 hrs/wk of competently
  delivered intensive ABA for at least 2 years,
• about 90 made moderate to large gains.
• 40-48 had IQ, language, and/or adaptive skills
  test performances in normal range, performed at
  grade level with no specialized help, and/or no
  longer met diagnostic criteria for autism or any
  similar disorder.
• 40-50 made substantial gains but continued to
  receive some special services.
• about 10-12 continued to require intensive
  treatment.
• Most comparable children receiving other
  therapies and services (e.g., eclectic
  treatment) made small gains or had losses.
• Most children who received less-intensive ABA (lt
  30 hrs/wk, lt 2 years) made small-to-modest gains,
  but more than similar children in comparison
  groups.

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ABA for Autism What it is Not

• New
• Experimental
• Just another fad treatment
• A quick, easy fix
• A therapy
• A curriculum
• A cookbook approach
• A technique that can be learned simply by reading
  some books, watching some tapes, taking some
  courses, or attending some workshops

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What ABA is Not (contd)

• Lovaas treatment
• Discrete-trial training
• Different from Applied Verbal Behavior
• The exclusive discovery or property of any
  individuals or programs
• Just for bad behavior, or people with severe
  disabilities
• An intervention that turns children into robots
• Just for teaching simple, rote skills
• A miracle cure (though some children have
  achieved normal functioning)

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Summary

• Contemporary ABA treatment for autism rests on
  more than 40 years of research
• No other treatment approach has a comparable
  empirical foundation.
• Lovaas and colleagues have made very important
  contributions, but so have many others.
• The Lovaas model of early intervention has been
  better researched than other models, but
• Has not been compared directly to other forms of
  intensive ABA, or to other treatments except
  less-intensive ABA and eclectic programming

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Conclusions (contd)

• Best available evidence supports competently
  directed and delivered early intensive ABA as
  effective treatment for autism, producing
  measurably large improvements in multiple areas
  of functioning for many children
• Factors responsible for variable responsiveness
  to early intensive ABA are not yet known.
• Which of the many ingredients of early
  intensive ABA are necessary for maximal
  effectiveness are not yet known.
• ABA techniques are also effective for producing
  improvements in many skill areas for older
  children and adults with autism.