Applied Behaviour Therapy (ABA )
ABA is the science which has revolutionized the treatment of children with Autism worldwide. Each person with autism has challenges that prevent them from being integrated in society. Children with autism have poor social skills, repetitive behaviours and restricted interests and are not able to communicate. Learning to communicate and interact, happens naturally in typically developing children, however, children with autism do not learn from the natural environment. They seem to be lost in their own world and learn only what they are interested in. These severe issues pose a challenge to parents and teachers. Lack of communication results in behaviour problems which results in confusion and frustration in the parents.
Applied behaviour analysis ( ABA) becoming popular and accepted after 1987 when a researcher Dr Lovaas, published an article on the dramatic improvement in children after receiving 40 hours of intensive ABA therapy per week.
ABA began in California State and soon spread to all parts of USA. Today all top universities are offering bachelor’s and master’s program and doctoral programs in applied behaviour analysis in USA.
Prior to the advent of ABA, children with Autism were taught using visual methods and their spoken language was limited . Families were told to accept the child’s stereotype behaviors and adjust their daily routine for the child. Intensive ABA therapy has shown good improvement in all aspects of development especially speaking and listening abilities. ABA researchers have devised systematic methods to reduce behaviour problems and stereotyped behaviors. ABA is considered the Gold standard in the treatment of children in the autism spectrum disorder in the USA.
WHAT IS ABA ?
ABA is the application of behaviour principles to improve socially appropriate behaviours. BF Skinner, the father of ABA, defined behaviour as anything a person does. Learning to do anything, is in technical terms acquiring new behaviours. In his experiments he uncovered the principles that are responsible for a person to do any action and what prevents a person to stop doing an action. He discovered that any behaviour can increase if it is followed by reward and any behaviour will stop if it is followed by punishment. You will agree that this is common knowledge and is used in all walks of life.
In simple terms , ABA is the science of learning. The therapist is trained to understand how to motivate a child to learn and what are the variables required for learning to happen. The approach uses positive reinforcement which gives long lasting results. The therapist works to increase desirable behavior (paying attention, following commands, asking for his needs and answering questions, etc. ) and decrease undesirable behavior (throwing objects, not sitting in one place, tearing books, injuring self and others, etc. ) in a one to one setting. All target behaviours are broken down into simple steps and each step is worked on to reach the target skill. Parent training is an important component in a successful ABA program, as behavior needs to be practiced and generalized in all situations
Why does a ABA therapist use sweets and toys during therapy?
Typically developing children learn to communicate effortlessly and by 3 years are talking about their experiences. Children with autism are not watching adults or other children and do not learn from imitation nor do they have a natural interest to learn like other children do. They also do not respond to social rewards like verbal praise. According to behavior principles, a child (adult) will learn only with positive reinforcement. So an ABA therapist will use a positive reinforcer that is specific for each child. For each child the reinforcer is different. Some like toys, some like spicy snacks , some like sweets , some like parent’s attention and clapping etc. The amount of reinforcer reduces with time as therapy progresses and moves to more age appropriate reinforcers. This profound understanding has helped break the learning barrier of children with autism and has resulted in children learning at a rate that was never imagined possible earlier and increased the integration rate like never before .
How is ABA different from speech therapy?
Speech therapy is the science of human communication and is very effective in improving communication. For speech therapy to be effective , the child must be attentive and motivated to learn. Children with hearing impairment or cerebral palsy respond very well to speech therapy. However, the core challenge for children with autism are attention, motivation and compliance. Speech therapy does not have a systematic approach to working on lack of motivation and selective listening and compliance issues.
The most important aspect for any therapy/teaching to be successful is for the child to be motivated. Children with autism do not have the motivation to learn age appropriate things. Parents often report difficulty in teaching the child the simple concepts (like pointing to body parts) and they are surprised that their child can operate electronic gadgets, sing rhymes and recite the alphabets without any training. This is an example of a selective interest a child with autism would exhibit. Hence to teach the child what he should know but is not interested to learn requires a completely different approach. Children who are motivated to learn and have no attention or compliance issues will benefit from speech therapy.
Why does an ABA program use sign language for children who do not talk ?
The common myth is that sign language will prevent speech development. However, research has consistently proved that sign language reduces behavior problems and facilitates vocalizations. The objective of an ABA therapist is to teach the child an appropriate and easy way to ask for his needs instead of crying or pulling parents. No one can or should force a child to talk. It will not give results and will make the child develop an aversion to the therapist.
Teaching a sign is a first step child responds positively to the therapist as there is no pressure to speak and he gets access to all his favorite things. In this environment there are no behavior problems. Gradually, the child start to vocalize and produce sounds and slowly words appear. Putting pressure to speak is not advisable and will not give results. Massaging the mouth also is not a solution. Speaking is a complex skill and the brain controls speech production. Children who do not talk are often thought to be lazy to talk or is not trying enough. However, parents need to understand that there are some foundation skills required before a child begins to talk . An ABA therapist will build the foundation for speech to be used as a form of communication .
The steps that we use are as follow
- Rapport building between therapist and child
- Select the reinforce of the child , decide on the signs to be taught
- Teach the Sign
- Sign +eye contact
- Sign +eye contact + vocalizations
- Sign +eye contact + first sound of the word
- Sign +eye contact + full word ( sign dropped )
- Eye contact +full word
Target achieved !
How soon can results be seen in ABA?
Most parents report subtle changes in their child within one month of regular therapy. The subtle changes are, child wanting parent’s attention compared to be playing by himself. Success of an ABA program depends on a good team work between therapist and parents. Parents who are able to follow the ABA program at home and give the child the required practice will see results within 3 months. Changes are that child begins to use either signs or words for communication and begins to follow instructions. ABA teaching methods are very different from regular parenting methods, hence parents need to adapt to the new method.
Apart from behavior does ABA improve speech and language?
Yes, ABA uses a different approach to language training, which is based on the Skinner’s classification of language. This approach is very effective for children with autism and may not be useful for children with hearing impairment or developmental delays. It emphasizes the use of words based on its function e.g the word ‘chocolate’ can be used to ask for chocolate as well as to label it while seeing a picture of it. The first words that are taught to the child are the ones he can use to get his favorite things, after the child understands how words can be used to get what he wants. Only then the other aspects of language (labeling pictures in a book) are taught. This approach reduces behavior problems and gives the child an understanding on how communication can be useful for him.
What is the qualification to be a behaviour analyst ?
There are graduate and post graduate courses offered in the USA in behaviour analysis. At present there are no universities offering course in India. Professionals from different fields, like psychology, special education, speech language pathology can do their bachelors or masters in behaviour analysis from universities in USA.
After doing the course work from different universities, students have to do 1000 to 1500 hours of practical work. (75 hours of mentoring is required by a senior behavior analyst). All the documents are then submitted doc to US board for behaviour analysts. The documents are verified, then students have to sit for the exam conducted by the US behaviour analyst certification board – BACB and after clearing that exam the student is given the certificate and is permitted to work in the US and other countries.
The different levels are
1. BCABA( Board certified assistant behaviour analyst) Graduates
2. BCBA ( Board certified behaviour analyst ) Post graduate
Since treatment of children with developmental disabilities requires intensive training and requires hands on work with the child , j most BCBA s are not able to provide the required number of hours ( 20 to 40 hours per week )hence , the general practice is to train junior staff to implement the program .These professionals can only implement a program and cannot make a program or plan the intervention. These professionals can do the course called RBT – registered behaviour technician which requires 40 hours of course work and 40 hours of practicals.
How is Samvaad’s ABA program different?
Samvaad combines the efficacy of ABA and strategies of speech and language therapy together in a session and hence parents do not have to take separate sessions for behavior therapy and speech therapy. We provide an integrated approach to children with autism. We are the only center in India that has an integrated approach.
What are the other skills an ABA program can address?
Most children with autism have limited ability to play and keep themselves occupied in an appropriate manner. The Samvaad ABA program also teaches children to play in meaningful manner, and train him to do his activities of daily living independently e.g dressing, brushing, bathing etc.
SAMVAAD ABA Team
RADHIKA POOVAYYA, MSc, BCBA,
Speech language pathologist and behaviour analyst, head the ABA program at all the centers.
- Suchitra, MSc, is the supervisor and head of the team in Domlur and Marathahalli.
- Sabitha Raj, MSc, is the supervisor at the hebbal centre
- Nandini Reddy , BASLP, is the junior supervisor at the hebbal centre
- Rashmi R, BASLP, is the junior supervisor at the hebbal centre