Applied behavior analysis (ABA) is the most common treatment for autism spectrum disorder (ASD). It’s also one of the oldest and most effective ASD treatments. Both the U.S. Surgeon General and the American Psychological Association consider ABA an evidence-based, best practice treatment, and nearly two dozen studies have shown that intensive, long-term behavior therapy improves outcomes for many (but not all) people with autism.
ABA is not a quick-fix. It requires considerable time and effort–in many cases, as many as 25 to 40 hours of therapy a week for 1 to 3 years.
Applied behavior analysis encourages positive behaviors and discourages negative behaviors. Board-certified behavior analysts work with patients and families to identify skills and behaviors to work on during therapy sessions. Usually, families select goals that will help the patient become more independent and successful.
ABA can help people develop
Communication skills
Social skills
Self-care skills
Learning and academic skills, including attention, focus and memory
Motor skills
Generally speaking, ABA uses positive reinforcement to encourage desired behavior and skills. Patients are rewarded—with verbal praise, a high five, or a physical reward, such as a small toy—when they perform the desired behavior (say, getting on pajamas when asked). Undesirable behavior—throwing a temper tantrum when asked to put on pajamas, for instance—is ignored.
ABA also teaches skill development by breaking skills into small chunks, and teaching (and reinforcing) each step. “Brushing your teeth,” for instance, involves getting the toothpaste, taking off the cap, putting toothpaste on the brush, physically brushing teeth, rinsing the brush, putting the cap on the toothpaste, and putting the toothpaste and brush away.
With continued practice, patients build new skills.
There are a variety of types of applied behavior analysis, including:
Discrete trial training (DTT), which breaks complex skills down into tiny, manageable steps. Therapists and parents reward positive steps toward the desired behavior.
Pivotal response training (PRT), which focuses on behaviors that are considered “pivotal” because development of those behaviors will positively affect other behaviors as well. PRT also helps develop motivation and self-monitoring skills.
Verbal behavior intervention (VBI), a structured, one-on-one approach that teaches language by emphasizing the connection between a word and its meaning, in the context of everyday life.
Positive behavioral support (PBS), which addresses problematic behavior by identifying contributing factors and structuring the environment to encourage desired behavior.
Early intensive behavioral intervention (EIBI), an approach used with very young children. EIBI usually includes lots of one-on-one floor time and deliberate, playful interaction between the therapist and child.
Look for a board-certified behavior analyst (BCBA); these individuals have a master’s degree or PhD in psychology or behavior analysis and have passed a national certification exam. Your healthcare provider may be able to refer you to a BCBA. Or, call an autism center and ask for recommendations. You may also want to ask other families about their experiences with specific therapists.
Most insurance plans cover ABA therapy for autism, particularly if your healthcare provider has designated ABA as “medically necessary.”
It takes time to see results from applied behavior analysis. Setbacks are normal, and the family and therapist should meet on a regular basis to review progress and adjust therapy as needed.
