APPLIED BEHAVIOR ANALYSIS

'Applied behavior analysis (ABA)' is a systematic process of studying and modifying observable behavior through a manipulation of the environment. Its principles are derived from extensive basic research, often with non-humans, but has seen recent popularity in applied therapy with autism and other developmental disorders. It is comprised of an experimental approach to manipulating the environment and tracking alterations in behavior.^[1] This allows the discovery and manipulation of functional relationships between behavior and environmental variables.

Definition

Definitions of ABA vary considerably; one example states:
:[ABA is] the design, implementation, and evaluation of environmental modifications to produce socially significant improvement in human behavior. ABA includes the use of direct observation, measurement, and functional analysis of the relations between environment and behavior. ABA uses antecedent stimuli and consequences, based on the findings of descriptive and functional analysis, to produce practical change.^[2]
This definition places emphasis on socially significant changes, but ABA can be used to alter virtually any behavior irrespective of its social relevance.
The components of any behavior are as follows:

★ 'Antecedent': a verbal or physical stimulus such as a command or request. This may come from the environment or from another person, or be internal to the subject

★ 'Behavior': the subject's response

★ 'Consequence': outcome, conditional to the behavior. In controlled situations the consequence depends on the subject's behavior and goal of the program and can include reinforcement of desired behavior, no response or punishment.
The key aspects of ABA are:^[3]

★ observing current behavior for topography (what the movement looks like), frequency, antecedents and consequences

★ breaking down desired skills into steps

★ teaching the steps through repeated presentation of discrete trials

★ tracking performance data to show changes over time.
A signature of both the basic and applied field of behavior analysis is the almost exclusive use of single-subject research designs.

Autism treatment

Among the available approaches to treating autism, ABA has demonstrated efficacy in promoting social and language development and in reducing behaviors that interfere with learning and cognitive functioning. Mental Health: A Report of the Surgeon General, U.S. Dept. of Health and Human Services, , , U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, , Retrieved on 2007-07-11.^[4]^[5]^[6]^[7] The ABA approach teaches social, motor, and verbal behaviors as well as reasoning skills.^[8] ABA therapy is used to teach behaviors to individuals with autism who may not otherwise "pick up" these behaviors spontaneously through imitation. ABA teaches these skills through use of behavioral observation and positive reinforcement or prompting to teach each step of a behavior.^[9] Generally ABA involves intensive training of the therapists, extensive time spent in ABA therapy (20–40 hours per week) and weekly supervision by experienced clinical supervisors known as a certified behavior analyst.^[10]
An increasing amount of research in the field of ABA is concerned with autism; and it is a common misconception that Behavior Analysts work almost exclusively with individuals with autism and that ABA is synonymous with discrete trials teaching. ABA principles can also be used with a range of typical or atypical individuals whose issues vary from developmental delays, significant behavioral problems or undesirable habits.
ABA is often confused as a ''table-only'' therapy. Properly performed, ABA should be done in both table and natural environments depending on the student's progress and needs. Once a student has mastered a skill at the table, the ABA team should move the student into a natural environment for further training and generalization of the skill.
Frequently, the Assessment of Basic Language and Learning Skills (ABLLS) is used to create a baseline of the autistic (or otherwise diagnosed) learner's functional skill set. The ABLLS breaks down the learner's strengths and weaknesses to best tailor the ABA curriculum to them. By focusing on the exact skills that need help, the teacher does not teach a skill the student knows. This can also prevent student frustration at attempting a skill for which he or she is not ready.

Discrete trials

Discrete trials were originally used by B. F. Skinner in his experimental studies with rats and pigeons intended to demonstrate how learning was influenced by rates of reinforcement. The discrete trials method was adapted as a therapy for developmentally delayed children and individuals with autism. For example, Ole Ivar Lovaas used discrete trials to teach autistic children skills including making eye contact and following simple instructions and advanced language and social skills. These discrete trials involved breaking a behavior into its most basic functional unit and presenting the units in a series.
A discrete trial usually consists of the following: The antecedent, possibly combined with a prompt (a non-essential element used to assist learning or correct responding), the behavior of the student, and a consequence. If the student's behavior is what is desired, the consequence is something positive: food, candy, a game, praise, etc. If the behavior was not correct, the teacher offers the correct answer, then repeats the trial, possibly with more prompting if needed.
There is usually an inter-trial interval that allows for a few seconds to separate each trial, to allow the student to process the information, teaches the student to wait, and makes the onset of the next trial more discrete. Discrete trials can be used to develop most skills, which includes cognitive, verbal communication, play, social and self-help skills.

Techniques

Chaining

Main articles: Chaining

The skill to be learned is broken down into small units for easy learning. For example, a person learning to brush teeth independently may start with learning to unscrew the toothpaste cap. Once the he or she has learned this, the next step may be squeezing the tube, and so on.

Prompting

The parent or therapist provides assistance to encourage the desired response from the student. Prompts are faded systematically and as quickly as possible from a more intrusive prompt to the least intrusive prompt, with completely independent responding as the goal. Prompts include:

★ Verbal prompts—for example, "Take the toothpaste cap off" (Should be avoided when possible as verbal prompts are the hardest to fade);

★ gestural prompts—for example, pointing at the toothpaste;

★ Physical prompts—(often called spatial fading) involves fading from full physical (such as hand over hand) to hand on wrist, hand on elbow, hand on shoulder, shadowing, to fading your proximity; and

★ Modeling—for example, taking the cap off to show the student how it is done

Fading

The overall goal is for an individual to eventually not need prompts. This is why the least intrusive prompts are used, so the student does not become overly dependent on them when learning a new behavior or skill. Prompts are gradually faded out as then new behavior is learned. Learning to unscrew the toothpaste lid may start with physically guiding the child's hands, to pointing at the toothpaste, then just a verbal request.

Generalization

Once a skill is learned in a controlled environment (usually table-time), the skill is taught in more general settings. Perhaps the skill will be taught in the natural environment. If the student has successfully mastered learning colors at the table, the teacher may take the student around the house or his school and then re-teach the skill in these more natural environments.

Shaping

Main articles: Shaping (psychology)

Shaping involves gradually modifying the existing behavior into the desired behavior. If the student engages with a dog by hitting it, the he or she could have their behavior shaped by reinforcing interactions in which he or she touches the dog more gently. Over many interactions, successful shaping would replace the hitting behavior with patting or other gentler behavior.

Differential reinforcement

Reinforcement provides a response to the student’s behavior that will most likely increase that behavior. It is “differential” because the level of reinforcement varies depending on the student's response. Difficult tasks may be reinforced heavily whereas easy tasks may be reinforced less heavily. Therapists must systematically change the student's reinforcement so that he or she will eventually respond appropriately under natural schedules of reinforcement (occasional) with natural types of reinforcers (social).

Video modeling

One teaching technique found to be effective with some students, particularly children, is the use of video modeling (the use of taped sequences as exemplars of behavior). It can be used by therapists to assist in the acquisition of both verbal and motor resoponses, in some cases for long chains of behavior.^[11]

Maintaining parental and professional relationships

An adequate communication and a supportive relationship between educational systems and families allow the student to receive a beneficial education. This pertains to typical learners as well as to individuals who need additional services. It was not until the 1960s that researchers began exploring Applied Behavior Analysis as a method to educate those children who fall somewhere on the autism spectrum. Behavioral analysts agree that consistency in and out of the school classroom is key in order for autistic children to maintain proper standing in school and continue to develop to their greatest potential.
Applied behavior analysis involves an entire team working together to address a person's educational or behavioral needs. This team includes professionals such as speech therapists as well as the primary caregivers, who are treated as key to the implementation of successful therapy in the ABA model. The ABA method relies on behavior principles and a recommended curriculum that reflects an individual's needs and abilities. As such, regular meetings with professionals to discuss programming are one way to establish a successful working relationship between a family and their school. When a caregiver can be the outlet source for the generalization of skills outside of school, it helps the therapy process by catering to the student's individual needs. In the ABA framework, developing and maintaining a structured working relationship between parents or guardians and professionals is essential to ensure consistency of thought and practice of behavioral methods.

Criticisms

Applied behavioral analysis has been criticized for several perceived failings:

★ 'Effectiveness'—Not all studies have agreed that ABA therapy is more effective than other treatment programs. A 2007 British study found that home-based early intensive behavioral interventions, a form of ABA, was no more effective than nursery-based eclectic programs.^[12]

★ 'Outcomes'—The long term outcomes of ABA therapy on quality of life, relationships and employment have not been established and are still being debated scientifically and in courts^[13] (for example, the case of Auton v. B.C. Attourney General^[13] which is attempting to force the Canadian health care system to pay for ABA treatment)

★ 'Language'—ABA and discrete trials are seen as less effective for improving the ability to use language to communicate effectively; best practices for learning language now involve naturalized teaching that mimics the functions of language - requesting, labeling and obeying commands^[15]

Autism rights movement

Main articles: Ethical challenges to autism treatment

The Autism rights movement oppose ABA for several reasons:

★ The use of aversives in the 1960s when ABA started to be used to treat autism (currently aversives are only used for potentially injurious behaviors)

★ The effort by some practitioners to render individuals indistinguishable from peers by eliminating harmless behaviors

★ ABA has also been challenged on ethical grounds by autistic individuals^[16] and their advocates

History

Applied behavior analysis is the applied side of the experimental analysis of behavior. Its origin can be traced back to Teodoro Ayllon & Jack Michael's 1959 article ''The psychiatric nurse as a behavioral engineer.''^[17] as well as initial efforts to implement teaching machines.^[18]The research basis of ABA can be found in the theoretical work of behaviorism and radical behaviorism originating with the work of B. F. Skinner. Much like Skinner himself attracted controversy for the perceived cruelty and inhumanity of his theories, ABA has itself been criticized with some justification for the methods used by early interventions with autistic individuals. Initially ABA used far more aversives such as cattle prods, shouting and slaps to reduce unwanted behaviors,^[19] though currently these practices are used only in unusual situations.
Applied behavior analysis now encompasses treatments in applied settings in things as varied as leisure skills development, improving sports performance, cigarette smoking cessation, increasing exercise, and other areas.

Gendered behavior

In 1973 the American Psychiatric Association removed homosexuality from its Diagnostic and Statistical Manual. In 1974, Ole Ivar Lovaas (who pioneered the use of ABA to treat autism) was second author on an journal article describing the use of ABA to reduce 'feminine' behaviors and increase 'masculine' behaviors of a male child in an effort to prevent adult transsexualism.^[20] The promotion of traditional sex-role behaviors was not unopposed within the field of behavior analysis, with at least one author arguing that it was not justified.^[21]

Notes

1. Radical behaviorism: The philosophy & the science, , Mecca, Chiesa, Authors Cooperative, 2004,
2.
3. Autism and ABA: Frequently Asked Questions about Autism and Behavior Analysis
4. Randomized trial of intensive early intervention for children with pervasive developmental disorder, Smith T, Groen AD, Wynn JW, , , American journal of mental retardation : AJMR, 2000
5. Parent implemented early intervention for young children with autism spectrum disorder: a systematic review, McConachie H, Diggle T, , , Journal of evaluation in clinical practice, 2007
6. Intensive behavioral treatment for children with autism: four-year outcome and predictors, Sallows GO, Graupner TD, , , American journal of mental retardation : AJMR, 2005
7. Intensive behavioral treatment at school for 4- to 7-year-old children with autism. A 1-year comparison controlled study, Eikeseth S, Smith T, Jahr E, Eldevik S, , , Behavior modification, 2002
8. Applied behavior analysis: Its application in the treatment of autism and related disorders in young children, , SLP, Harris, Infants and Young Children, 2002
9. ABA and students with autism spectrum disorders: Issues and considerations for effective practice, Simpson RL, , , Focus on Autism and Other Developmental Disabilities, 2001
10. Ensuring appropriate qualifications for Applied Behavior Analyst professionals: The behavior analyst certification board, Shook GL, Neisworth JT, , , Exceptionality, 2005
11. Using video modeling to teach complex play sequences to a preschooler with autism, , P, D'Ateno, Journal of Positive Behavior Interventions, 2003
12. A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders, Magiati I, Charman T, Howlin P, , , J Child Psychol Psychiatry, 2007
13.
14.
15. Comparisons of discrete-trial and normalized behavioral language intervention for young children with autism, Delprato DJ, , , Journal of autism and developmental disorders, 2001
16. An Autistic at the Supreme Court - The Auton Case: The Intervener's Factum Michelle Dawson
17. The psychiatric nurse as a behavioral engineer, Ayllon T, Michael J, , , Journal of the experimental analysis of behavior, 1959
18. The Techology of Teaching, , B. F., Skinner, B. F. Skinner Foundation, 1968/2003,
19. Screams, Slaps & Love: A surprising, shocking treatment helps far-gone mental cripples, , Dan, Moser, Life Magazine, 1965
20. Behavioral treatment of deviant sex-role behaviors in a male child, Rekers GA, Lovaas OI, , , Journal of applied behavior analysis, 1974
21. Isolated presynaptic inotropic beta-adrenergic supersensitivity of the transplanted denervated human heart in vivo, von Scheidt W, Böhm M, Schneider B, Reichart B, Erdmann E, Autenrieth G, , , Circulation, 1992

External links

★ - Provides lay summaries of current research in the field of Applied Behavioral Analysis and other autism therapies

★ - Discrete Trials? Prompting? find out more about ABA and how it has been applied to children with Autism

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