The ABC’s of ABA

We got the referral for Killian to start ABA Therapy. The only problem? I had no clue what that even was. I have a friend who is an ABA Therapist and she briefly explained it but I still didn’t fully understand what it was. All I really got was the it is a positive behavior therapy to help alter the negative behaviors that my child has like his aggression, temper, and inability to follow simple instructions without having hand-over-hand guidance.

So, I decided to do my favorite thing and research. Then share with you what I have learned and tell you the most important piece of information that a therapist feels parents need to know.

Ready? Let’s go!

What is ABA Therapy?

Applied Behavior Analysis (ABA) is a type of therapy that focuses on improving specific behaviors, such as social skills, communication, reading, and academics as well as adaptive learning skills, such as fine motor dexterity, hygiene, grooming, domestic capabilities, punctuality, and job competence. ABA is effective for children and adults with psychological disorders in a variety of settings, including schools, workplaces, homes, and clinics. It has also been shown that consistent ABA can significantly improve behaviors and skills and decrease the need for special services. ABA therapy applies our understanding of how behavior works to real situations. The goal is to increase behaviors that are helpful and decrease behaviors that are harmful or negatively affect learning. The methods of behavior analysis have been used and studied for decades. They have helped many kinds of learners gain different skills, from healthier lifestyles to learning a new language. Therapists have used ABA to help children with Autism and related developmental disorders since the 1960s.

How does ABA Therapy work?

Applied Behavior Analysis involves many techniques for understanding and changing behavior. ABA is a flexible treatment. It can be adapted to meet the needs of each unique person and can be provided in many different locations such as in the home, at school, and in the community. ABA teaches skills that are useful in everyday life and involves either one-on-one teaching or group instructions.

ABA therapy involves multiple treatment steps that help children overcome challenging behaviors and develop socially significant skills.

Overcoming challenging behavior

  • Functional Behavior Assessment (FBA): An FBA is one of the first assessments conducted in ABA Therapy when a child engages in challenging behavior. It is a comprehensive set of assessment procedures to help understand why problem behavior occurs so that the therapist can best provide intervention services. FBA involves an indirect assessment, direct observational data collection and sometimes a systematic, structured assessment called a functional analysis. The results can reveal a cause and effect relationship between a problem behavior and what is maintaining it.
  • Defining a plan: After assessing challenging behavior, specialists develop a collaborative function-based treatment plan with parents to reach a set goal. The team discusses the best therapeutic methods and measurements of success to try under the ABA plan.

Developing new skills

  • Systematic instructional procedures: Specialists are trained in the most-effective ways to teach children with Autism. Some of these methods include discrete trial training (or breaking down a task into small, achievable pieces), positive reinforcement, repetition, and altering antecedent stimuli. These strategies help children with Autism learn.
  • Ongoing assessment: ABA Therapy does not end when a goal is met. An effective behavior specialist will continue to support their client, revisiting instruction when needed. The goal is to help the child continually experience success with their learned skill, in different settings and as they grow.

With the right interventions through ABA therapy, children can improve their behaviors and reach their full potential.

When is ABA recommended?

ABA is commonly practiced as a therapeutic intervention for individuals with Autism. According to the Center for Autism, ABA helps the autistic client improve social interactions, learn new skills, and maintain positive behaviors. ABA also helps transfer skills and behavior from one situation to another, controlling situations where negative behaviors arise and minimizing negative behaviors. With Autism, ABA is most successful when intensely applied for more than 20 hours a week and prior to the age of 4. ABA can also help aging adults cope with the losses that come with age, like memory, strength, and relationships. For young and old, ABA can help individuals manage some of the lifestyle challenges that accompany many mental and physical health conditions.

Positive reinforcement is the key!

Positive reinforcement is one of the main strategies used in ABA. When a behavior is followed by something that is valued (a reward), a person is more likely to repeat that behavior. Over time, this encourages positive behavior change. First, the therapist identifies a goal behavior. Each time the person uses the behavior or skill successfully, they get a reward. The reward is meaningful to the individual – examples include praise, a toy or book, watching a video, access to playground or other location, and more. Positive rewards encourage the person to continue using the skill. Over time this leads to meaningful behavior change.

So where do the ABC’s come in to play? Well here they are!

Antecedent, Behavior, and Consequence

Understanding antecedents (what happens before a behavior occurs) and consequences (what happens after the behavior) is another important part of any ABA program.

The following three steps – the “A-B-Cs” – help us teach and understand behavior:

  1. An antecedent: this is what occurs right before the target behavior. It can be verbal, such as a command or request. It can also be physical, such a toy or object, or a light, sound, or something else in the environment. An antecedent may come from the environment, from another person, or be internal (such as a thought or feeling).
  2. A resulting behavior: this is the person’s response or lack of response to the antecedent. It can be an action, a verbal response, or something else.
  3. A consequence: this is what comes directly after the behavior. It can include positive reinforcement of the desired behavior, or no reaction for incorrect/inappropriate responses.

Looking at A-B-Cs helps us understand:

  1. Why a behavior may be happening
  2. How different consequences could affect whether the behavior is likely to happen again

EXAMPLE:

  • Antecedent: The teacher says “It’s time to clean up your toys” at the end of the day.
  • Behavior: The student yells “no!”
  • Consequence: The teacher removes the toys and says “Okay, toys are all done.”

How could ABA help the student learn a more appropriate behavior in this situation?

  • Antecedent: The teacher says “time to clean up” at the end of the day.
  • Behavior: The student is reminded to ask, “Can I have 2 more minutes?”
  • Consequence: The teacher says, “Yes, you may have 2 more minutes!”

What does an ABA program involve?

Good ABA programs for Autism are not “one size fits all.” ABA should not be viewed as a canned set of drills. Rather, each program is written to meet the needs of the individual learner.

The goal of any ABA program is to help each person work on skills that will help them become more independent and successful in the short-term as well as in the future.

Planning and ongoing assessment

A qualified and trained behavior analyst (BCBA) designs and directly oversees the program. They customize the ABA program to each learner’s skills, needs, interests, preferences and family situation.

The BCBA will start by doing a detailed assessment of each person’s skills and preferences. They will use this to write specific treatment goals. Family goals and preferences may be included, too.

Treatment goals are written based on the age and ability level of the person with ASD. Goals can include many different skill areas, such as:

  • Communication and language
  • Social skills
  • Self-care (such as showering and toileting)
  • Play and leisure
  • Motor skills
  • Learning and academic skills

The instruction plan breaks down each of these skills into small, concrete steps. The therapist teaches each step one by one, from simple (like imitating single sounds) to more complex (like carrying on a conversation).

The BCBA and therapists measure progress by collecting data in each therapy session. Data helps them to monitor the person’s progress toward goals on an ongoing basis.

The behavior analyst regularly meets with family members and program staff to review information about progress. They can then plan ahead and adjust teaching plans and goals as needed.

Who provides ABA services?

A board-certified behavior analyst (BCBA) provides ABA therapy services. To become a BCBA, the following is needed:

  • Earn a master’s degree or PhD in psychology or behavior analysis
  • Pass a national certification exam
  • Seek a state license to practice (in some states)

ABA therapy programs also involve therapists, or registered behavior technicians (RBTs). These therapists are trained and supervised by the BCBA. They work directly with children and adults with autism to practice skills and work toward the individual goals written by the BCBA. You may hear them referred to by a few different names: behavioral therapists, line therapists, behavior tech, etc.

What is the evidence that ABA works?

ABA is considered an evidence-based best practice treatment by the US Surgeon General and by the American Psychological Association.

“Evidence based” means that ABA has passed scientific tests of its usefulness, quality, and effectiveness. ABA therapy includes many different techniques. All of these techniques focus on antecedents (what happens before a behavior occurs) and on consequences (what happens after the behavior).

More than 20 studies have established that intensive and long-term therapy using ABA principles improves outcomes for many but not all children with autism. “Intensive” and “long term” refer to programs that provide 25 to 40 hours a week of therapy for 1 to 3 years. These studies show gains in intellectual functioning, language development, daily living skills and social functioning. Studies with adults, though fewer in number, show similar benefits.

Here is a List of questions that I found online to use as a tool for finding the best ABA team for you and your child.

  1. How many BCBAs do you have on staff?
  2. Are they licensed with the BACB and through the state?
  3. How many behavioral therapists do you have?
  4. How many therapists will be working with my child?
  5. What sort of training do your therapists receive? How often?
  6. How much direct supervision do therapists receive from BCBAs weekly?
  7. How do you manage safety concerns?
  8. What does a typical ABA session look like?
  9. Do you offer home-based or clinic-based therapy?
  10. How do you determine goals for my child? Do you consider input from parents?
  11. How often do you re-evaluate goals?
  12. How is progress evaluated?
  13. How many hours per week can you provide?
  14. Do you have a wait list?
  15. What type of insurance do you accept?

Killian is currently on the waitlist for an ABA program that is connected through the same behavioral therapy office that he goes to every Friday morning. They will be able to work closely with his current therapist to make sure that he receives the best care possible and that everyone is working on the same goals and in the same way in order to offer the proper support. I personally can not wait for him to start and see what kind of positive differences we can achieve.

-The Lazy Mama

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