How Is Applied Behavioral Analysis (ABA) Therapy for Autism Different From "Consequences" and "Rewards?"
In my opinion, Applied Behavior Analysis (ABA) is the “gold standard” for education — not only for people with autism, but for everyone. Whether you realize it or not, every teacher uses the principles of ABA to positively or negatively condition the behaviors of their students. Why do schools use a grading system? Not only do educators use grades as a metric to guage academic progress, but also as a form of reinforcement or punishment to condition their students to learn. And why do children go to school, listen in class, do their homework, and allow “uncool” adults to educate them? It sure isn’t because they don’t want to stay at home and play video games, watch TV, or talk to friends on the telephone. No, they go to school and learn because either the reinforcement of what an education can bring them (e.g., a good job, freedom, money, power, pleasure) is more desirable or the fear of positive or negative punishment (e.g., getting grounded, rotting in juvenile hall, losing the respect of their parents) is more aversive.ABA does use a reward system (and did use a consequence system) to encourage selected behaviors. And, of course, parents and teachers do this all the time: "do a great job and you get ice cream;" "misbehave and you're grounded." So do managers: great review leads to a raise; rotten review leads to dismissal.
The basic theory is the same: people (and animals) respond to carrots and sticks. And... people (and animals) function best in a world that is structured, predictable, and just.
But ABA is, ideally, a structured 40-hour per week one-on-one program which relies almost entirely upon immediate, tangible rewards for specific behaviors. Therapists who provide ABA are (or certainly should be) trained and certified to do so. ABA therapy includes benchmarks for success, and evaluates outcomes based on individualized goals. The primary provider of ABA, the Lovaas Institute, has created an very specific curriculum for their providers, and conducts outcomes-based research. This is certainly not the case when moms tell their children "clean your plate or you get no dessert!" In addition, for many children with autism, ABA is the ONLY educational tool used. For typical children (and adults), while rewards and consequences are a part of the landscape, there are many other avenues open for learning and growth.
Are these differences enough to make ABA significantly different from ordinary parenting and management techniques? Or is it just a more intense, more focused version of what every parent, teacher and boss does to encourage positive behaviors?
What's your take?
Comments
Lisa — you’ve mischaracterized ABA — ABA is a scientific enterprise. What you describe is the practice of ABA — you seem to be describing Intense Behavioral Interventin; commonly mis-labeled as ABA. It is not. IBI may be similar, but should not be confused with ABA.
One thing that I keep reading from so many parents is that ABA didn’t work for them — but I wonder if they were truly making data based treatment decisions, and had a qualified practititioner…it sounds like a cop-out…but, it is something that should be evaluated.
Also - there are some that are interested in looking at the other treatments (RDI, Floortime, Sonshine, etc…) through a behavioral lens…it is our bet that what is effective in those treatments can be explained with a behavioral principle…to a parent, I can imagine that they don’t care what underlying principles are at work, as long as their child is doing better!
As scientists, we want to know how things work — and this will translate into better treatment if we can eliminate things that are not effective — so we can streamline parts of these other treatments that aren’t necessary — and even more positive effects would occur.
I’m not sure I fully understand the distinction between IBI and ABA. Having talked with some length with the folks at Lovaas, I believe I am accurate in my depiction of ABA as, ideally, a 40-hour-a-week intensive program which begins, at least, with 1-on-1 behavioral interactions to build specific skills, behaviors, etc.
It’s unfortunate that developmental approaches are less amenable to the scientific method than ABA - because they are idiosyncratic (the program is individualized to the child, so it’s tough to compare apples to apples). But I do know that both RDI and Floortime have been developing rubrics that will make it easier to study outcomes. I’d love to see a head-to-head comparison of different therapeutic techniques for similar children!
Meanwhile, though, I’d like to know whether your definition of behavioral principles is as simple as… “people will work for what they want, and will avoid what they don’t want.” If that’s the case, then certainly the idea of engaging a child based on his or her interests (a “floortime” principle) could be considered behavioral - but that, to me, isn’t especially helpful. All it really says is that people prefer pleasure to pain, whether they’re autistic or not.
More helpful would be looking at the relative longterm effectiveness of developmental TECHNIQUES versus behavioral TECHNIQUES for various different groups of people with autism.
Lisa Rudy
Hi Lisa,
I agree that looking at the relative and comparative longterm effectiveness of techniques would be useful. I think that effectiveness will require some definition of what that means–removal or remediation of diagnosis, independent function in mainstream setting, degree of functional independence, etc.?
I think that I see Josh’s point in that IBI or EIBI is the use of the methods derived from the science of ABA in a specific application, but not necessarily the sum of the science, and not necessarily the only specific application. For example, I use Precision Teaching, another model of ABA based on the antecedent-response-consequence model using specific techniques of timing, prompting and charting with my typical high schooler to develop fluency in essay skills, but not for 40 hours/week and not with tangible reinforcers. Even with my child with autism, we do work intensively on some skills and not on others, but the specific techniques used depends individually on the assessed needs and strengths and sometimes includes discrete-trial, but not always, sometimes looks like parenting-plus capitalizing on her interest as motivation (Natural Environment Teaching), and I believe that the goal is always to move to normalized learning and normalized consequences, such as for typical children, rather than the stereotyped “good job + m&m”, so our reinforcers are individualized, both by type and schedule.
What has been helpful to me in using behavioral methods is focussing on the observable and using the analysis to track that what is hypothesized to be affecting behavior and learning is the contributor, and in the case of IBI, that sufficient intensity is being used to accelerate learning opportunities above incidental levels, in a step-wise, skill based order. Even within developmental models, I could probably use the same definition and analysis to determine what the goal of intervention is, and measure progress.
As far as comparison reports–I think that the MADSEC and NYDOH reports have some background of relative evidence and reported efficacy of different methods. RDI is probably not included, since those were issued pre-RDI.
Thanks so much for your note, Regina!
From what I know, at this point the vast majority of research on developmental therapy is being done by the therapy’s developer (eg, Gutstein researches Gutstein’s ideas and RDI; Greenspan researches Greenspan’s ideas and floortime). While this isn’t necessarily a bad thing in and of itself, of course others need to replicate similar findings to make the research really significant.
What’s more (just my guess - I’m not a researcher) - it seems to me that Gutstein and Greenspan are probably extraordinarily talented therapists. As a result, I think it’s likely that ANY 1:1 therapy they personally do with ANY child is likely to be effective!
The question in the long run will have to be - what happens when ordinary “Joe therapist” uses the same technique? From what I know of ABA, a great deal of its usefulness depends not on whether kids respond to rewards and consequences, but on whether the therapist can accurately determine appropriate rewards and then move to more natural settings to help the child generalize what he’s learned through discrete trials or other formal techniques…
By the way: is “Natural Environment Teaching” the same thing as “taking ABA into a more natural environment in order to help the child generalize what he’s learned?”
Lisa
Hi Lisa,
Thank you.
I agree with you that descriptions of therapies are one thing, but real-time implementation is the make or break. Systematically coordinating a group of folks to teach in tandem is tough, and gifted and well-trained therapists and teachers are worth their weight in gold.
Natural Environment Teaching, as I have used it, can be used as generalization (either after or concurrently) of discrete-trial instruction, but can also be the initial approach. We have goals within regular setting, regular routines and functional, leisure or play activities to spotlight and teach language (often manding/requesting), functional and social goals. It is similar to the Incidental Teaching and Milieu-Mand models of teaching (also ABA-based, but with some differences in focus and some specifics of method). NET has more emphasis on capitalizing on motivation within an activity and the natural reinforcers related to a response. If my daughter has difficulty learning a skill or concept within NET, sometimes we either restage how we are teaching there, or take it back to a more discrete-trial approach to build the skill and keep the success rate high. I hope that explanation is understandable.
Lisa,
Any good behavior analytic therapy will also be individualized to a student. It isn’t(shouldn’t be) “here is the package, stick it on your kid.”
Many parents I hear decry behavior analysis and say they want ‘floortime’ or some other ‘intrinsically motivating’ technique are not understanding behavior analysis.
From the behavioral point of view, there is no ‘intrinsic motivation’ in the sense that people will begin to do things because it is the ‘right’ or ‘good’ thing — kids don’t start to say communicate because an emotion wells up inside and must escape. All of these things are learned. However – this is very different than being programmed, or brainwashed, or whatever else the prior post’s commentors implied…what I find interesting is that this viewpoint scares people – it seems to make them feel as if they’ve lost something…but we are still who we are. We still experience the entire myriad of feelings which makes us ‘human’. The biggest problem I have with some of the other techniques I see is that they are based on principles that will lead parents/therapists to ‘wait’ for certain behaviors to emerge – touting that ‘Bobby isn’t ready to communicate, or I don’t want to reward him, I want him to want to do it’ – these types of beliefs will unfortunately hamper progress.
For instance – when I was in school, I made good grades – and I got no ‘external rewards’[much to my chagrine, as one of my fellow students was offered $100 for each A she received!!] – most teachers said I was a very motivated student. This was not because I had some internal motivation, but rather that when growing up, I’d been taught the value of learning – I also was provided with external rewards when I accomplished things when I was younger, and then those rewards were faded out – that’s how the ‘external’ became ‘internal’ – it wasn’t that all of a sudden, I was ready to start working, communicating, or doing anything else. I was fortunate enough to have parents that naturally did this (they didn’t require training) – and because I don’t have any disability, I was probably more sensitive to their social cues. The funny thing is – this doesn’t make me feel any less ‘proud’ of my accomplishments. I still accomplished them, regardless if it was because of how I had been ‘brought up’ or whether I was just a really good guy inside.
I am a scientist, and a big proponent of behavior analysis – however, I don’t believe that all of these other treatment tools are necessarily ‘bad’ or ‘ineffective’ – evidently there are masses that have provided anecdotal evidence of them being effective. However – as you point out, if the therapist is amazing, he/she will most likely make progress, regardless what ‘treatment’ he’s using. It is by utilizing scientific methods and evidence based treatment that we can then get ‘joe-blow therapist’ to also become effective.
Another big part of what is needed is a means to separate the wheat from the chaff in regards to who is adequately trained. I imagine that could be an entirely new post. I appreciate these blogs and hearing the viewpoint of parents – I think that each parent should be determining what ‘fits’ their line of thought, how they want to approach the problem. I would posit, however, that Behavior Analytically based interventions would be the gold standard, in that they are evidence based, and treatment decisions are not made on subjective whim, but on data. Thus – if you aren’t making the progress that you want, and your therapist isn’t changing the intervention; you’re not getting what you call ‘ABA’ therapy.
I’m not a scientist, nor do I play one on TV, but ABA is so much more than the Lovaas DTT approach…
According to the Kennedy Krieger Institute’s web site
http://www.kennedykrieger.org/kki_misc.jsp?pid=4761
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…Despite more than 40 years of applied behavior analytic research there continues to be misperceptions about what constitutes ABA-based procedures. Of most concern is the misperception that ABA is a standardized treatment protocol that is used for a specific type of problem and with specific types of individuals. Another misconception is that ABA is a specific method of teaching children with autism, and that it is synonymous with “Lovaas Therapy” or “discrete trial training” - this is not the case. Although ABA-based teaching methodologies have been shown to be highly effective in teaching children with autism, ABA is not a procedure restricted to the treatment of autism but rather a discipline that is based in operant psychology and rooted in the use of scientific principles to study behavior. ABA-based interventions are essentially a highly specialized type of Behavior Therapy that place greater emphasis on more precisely defining and recording behavior, and the use of highly rigorous methods for clinical treatment evaluation. Emphasizing the focus on experimental methodology, Baer, Wolf, and Risley (1968) defined the criteria for what constitutes ABA-based procedures, specifically ABA-based procedures must: 1) involve an analysis of socially important behavior in a manner in which the behavior is operationally defined and explicitly and reliably measured so that a believable demonstration of the events responsible for the occurrence of the behavior is produced; 2) alter the targeted behavior enough to produce a meaningful change (i.e., a clinically significant improvement) and provide for the generalization of the behavior change; and 3) employ procedures that are tied to well established principles of behavioral science (i.e., operant learning). Any clinical procedure or research investigation adhering to the basic criteria developed by Baer, Wolf, and Risley is considered to be based on ABA-principles, regardless of the specific procedures used. This includes interventions based on a “functional behavioral assessment,” “functional analysis of behavior,” and includes approaches such as “Positive Behavioral Support,” and all forms of “Behavior Therapy” that rely on direct observation of behavior and analysis of behavior-environment relations..
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So the science of ABA has many subsets: DTT, Pivotal Response, PECS, etc…
And yes, my little guy has benefited from all of the above!
Judith
http://parents.com/autismville
It is easy to see how parents can get confused about ABA. There are too many acronmys out there! The first port of call for a parent should be to decide whether they want to use Science or something else. If you want something that is not science, then there are many to choose from. If you want to use science, then you should check that anyone who works with your kid is properly trained in the science of behaviour. Internatioanl standards can be found at www.bacb.com. Other information about the science of behaviour analysis can be obtained from www.behavior.org. Once you make your choice then you can learn about the minute details of the applications of the science. But don’t start there! Science or not, that’s the starting point.
Mickey - you have a wonderful point, but you may not be aware of how incredibly difficult it is for parents to tell districts or agencies who they should hire! In fact, it can be extremely difficult just to GET the credentials of the person who will provide therapy to your child. Very often, districts and agencies hire someone right out of school and give them a few days of training - then pop them into the field. Sometimes they have a natural talent; just as often they don’t. Of course, you can go out and hire your own highly trained ABA therapist for 40 hours a week - if you happen to have tens of thousands of “extra” dollars. Otherwise, it generally winds up being potluck - unless you’re willing to actually spend most of your time and money dragging the schools and/or agencies through time and money consuming mediation and/or litigation!
Lisa
Hi Lisa, First off, thanks for addressing this issue. As a parent of a child with autism, I was overwhelmend with information and decisions as to what we should do to help our child. ABA was of course one of the most highly recommended forms of therapy we were suggested to implement and we did, or we thought we did. Although my son has improved greatly over the last 4 years, we were seriously misled by his autism school leading us to beleive they were an ABA based program, but no data was collected and the credentials of the staff were never revealed. We have come to find out that there were no certified Behaviorists on staff including the director and no analysis was being done to update programs. Hindsight is 20/20, but I wish I had known more about ABA to ensure that my $’s were being spent in the best place for my child. As you noted, this was not an inexpensive endeavor and unfortunately there are people who will take advantage of desperate parents. On the bright side, we were fortunate to have some amazing, highly trained, certified therapists move to our area, that have made such a difference for the children with autism in our community. They however utilize ABA specializing in Verbal Behavior, which I wish we had had from the beginning. I find it a much more appropriate form of ABA to help children generalize and utilize in “natural environments”. I thank you again for touching on this topic. Knowledge truly is power.
I just wanted to add a correction to one of the links that Mickey posted, since I think there was an extra period included–
Cambridge Center for Behavioral Studies
http://www.behavior.org/
Which has sections under “Behavioral Solutions” for Autism, Clinical Behavioral Solutions, Education, Everday Life, Parenting, Verbal Behavior, and much more. I think a browse shows all the areas that are encompassed within applied behavior analysis.
Also,
What is behavior analysis?
www.behavior.org/behavior/what_is_behavior_analysis.cfm
Even if we hypothetically or actually agree that ABA, of whatever ilk, is the gold standard and the value of training and qualifications, both Lisa and Cathy have points about accessibility and representations of practice of ABA. My experience is that there’s alot of geographic variability for both, and even with the certification, disparities in availability. Not a criticism of the science or the clinical field, just an observation.
Many people attach these preconceived stereotypes to Applied Behavior Analysis (ABA) as it applies to people with autism:
* You must do at least forty hours per week or it’s not ABA
* You must sit down at a table and “drill” a person with cards or it’s not ABA
* You must work one-on-one with an ABA therapist in some dungeon far away from civilization or it’s not ABA
* You must give M&M’s, suckers, cookies, or stim toys to reinforce a behavior or it’s not ABA
* You must avoid the use of “aversives” or it’s not ABA
And what about, you must “write down” the antecedent and consequence of every behavior or it’s not ABA. When working with people with autism, I wonder how many Board Certified Behavior Analysts “write down” every variable in the design, implementation, and evaluation of instructional and environmental modifications that produces understanding and socially significant improvements in behavior? Let’s say, for example, a child with autism grabs at the hand of a BCBA for her cell phone. The BCBA blocks the hand, counts to five, and then asks the child, “What do you want?” The child points towards the cell phone and says, “train.” So, the BCBA runs an error correction procedure. She counts to five and says, “What do you want? Phone.” The child echoes, “phone.” The BCBA repeats the Sd, “What do you want?” The child says, “phone,” and the BCBA hands him the cell phone. No data is recorded (except to the memory of the BCBA and the child). Through the design, implementation, and evaluation of instructional and environmental modifications, socially signficiant improvements in the child’s behavior did occur. So, is this not ABA?
Likewise, what about a mother who tells her child: “Clean your plate.” The child says, “No,” and the mother responds with “Clean your plate or you get no dessert!” Again, the child says, “No!” So, the mother removes the child’s dessert from the table and ignores any crying, screaming, or begging. The next night, the mother again tells her child: “Clean your plate.” However, this time, the child responds by eating everything on the plate. Afterwards, the mother gives the child a dessert and the appropriate behavior occurs each following night. No data is recorded (except to the memory of the mother and child). Through the design, implementation, and evaluation of instructional and environmental modifications, socially signficiant improvements in the child’s behavior did occur. So, is this not ABA? Not to mention, is this not outcome-based?
While the BCBA and the mother didn’t record data on a sheet of paper or in a computer database, they still followed a scientific process with the principles of ABA to produce socially significant improvements in behavior.
On a different note, there has been much debate lately over external versus internal rewards or reinforcement. But the external is simply an association of the internal. Thanks to MRI and CT scans, scientists now know that human behavior is a biochemical event. In other words, an external stimulus triggers a release of associated brain chemicals (e.g., neurotransmitters like endorphins) that reinforces behavior. So, an “external” stimulus is never what’s really desirable; instead, the effect of released brain chemicals (triggered by an external stimulus) is the “true” reinforcer of behavior.
And as I said in a previous comment, just because a person receives forty hours of one-on-one therapy per week doesn’t mean they will improve — regardless of the therapy (e.g., ABA, RDI, Floortime/DIR). Quality of therapy matters more than quantity. As a result of forty hours of “defective” therapy, a person could experience massive setbacks and regression due to the development of abherrent behaviors.
Okay.. I am an ABA tutor. I have a degree in Special Education, and I am currently working on my master’s degree in Guidance and Counseling. There are my credentials.
With the right tutor that understands the child’s INDIVIDUALIZED program, ABA can be very effective. The therapist, the tutor, and the parent need to be on the same page working on the same goal. This may require what seems to be baby steps, but every step forward is a huge obstacle that has been overcome. The main goal needs to be stated at the beginning of therapy (i.e. being mainstreamed to gen ed, being able to live independently, and so forth). That is the most important. From this point the ABA therapist can set up a program using the appropriate assessment procedures. The next step is to make sure that you find good tutors to work with the child/children. If the proper procedures are followed, ABA can be successful, but like all therapies, strategies, or incentives not everything will work for the same child.
Now on to the conditioning and intrinsic/extrensic reward system. People need to be educated on how children with autism interact (or not) with the typical world. Even with the reward system that is set up, it moves from the extrinsic motivators to internal. Some children do not need extrinsic motivators for long. This all needs to be highly monitored. The children will need to be assessed even on motivators to make sure that one thing is not becoming a compulsion.
There is much evidence to suggest that ASDs are related to, maybe in large part a function of, neurological deficits and/or problems — “black box” problems that ABA in its various forms tends to show a reluctance or refusal to acknowledge and an inability to effectively address. Without successfully addressing these “black box” problems in whole or in part, it seems to me any form of ABA treatment must remain incomplete. Sure, behaviors can and will be changed through arrangements of environmental variables, but there is always the worry that the continued influence of neurological deficits or problems will exert a powerful and omni-present counter-force resulting in the possibility of regression during behaviorally “weak moments”. Imagine, if you will, an advanced Alzheimer’s patient being “cured” through strictly behavioral efforts. It may be hard to imagine due to the fact that the “wiring” is damaged in such unfortunate people and behavioral “work-arounds” are never likely to fully compensate for the damage — certain memory-based routines may be established, but global memory function will likely remain impaired.
Further, it is not clear how effective ABA therapy, in and of itself, is. Despite its often inflated claims of effectiveness, even claims of more effectiveness than other forms of ASD therapies, solid, comprehensive, and replicated comparative studies have not yet borne out these claims. Also, let’s face it, many parents of children with ASDs don’t rely on one intervention; they throw whatever they think might work at the wall to see what sticks. ABA therapies don’t occur in a vacuum and probably are used in many cases in conjunction with, for example, special diets, other teaching methods, etc.