Why choose Applied Behavior Analysis (ABA)?

By: Shweta Ghayal 

Parents of kids with special needs fight for advocating their child’s rights to necessary health-care services. Life can be extremely tough for the parents. They are vulnerable as they always try to make their child normal again. Unfortunately, many non-evidence based therapies take advantage of their hopes.Every now and then, a new therapy or a treatment comes in claiming cure of autism.  It is hard to decide which way to go, what to choose, what will make the most difference. Even though the medical field has not yet offered a cure, many treatments try to offer false claims.They claim to cure autism. It is advised to be skeptical about such claims. Always question the sources of information, look for the objective data, and don’t rely on anecdotes, reviews from the third parties. Rather ask the parents of the child to show you data, ask them what behaviors were changed the most, ask them if they did anything simultaneously for the behavior change, due to which the behaviors might have changed. Ensure that only this therapy or treatment that’s been offered caused the changes inskills and there was no other factor. Also ensure that it’s been effective with many other children, and expected outcomes can be achieved. ABA is growing in fame because there is sufficient evidence that it is effective in bringing significant changes in many children’s lives and it has been replicating the same outcomes over decades.

ABA is an effective therapyparticularly for kids with autism and developmental disabilities. ABA therapy is based on science that uses strategies that are tested to be effective. ABA is used to teach socially important behaviors such as life skills, communication, attending skills, social skills, play skills and to reduce interfering behaviors that might interrupt learning or/ and the normal daily routines for families.

ABA therapy uses strategies for understanding how behaviors are learned. ABA understands behaviors in context with the situations that happen immediately before and after it. The situations that trigger behaviors and exist just before behaviors are known as antecedents. Whereas, the events that occur right after the behaviors and shape the behavior in the future are known as consequences. Consequences act like motivators for the people to engage in a behavior. That is, if one is motivated to eat Garlic Fried Rice, you will make it for dinner even when you are tired to eat it.One of the principles that ABA uses to teach skills is reinforcement. Reinforcement iswhen access to one’s favorite toy/ activity or removing something non-desirable from one’s surroundings post the completion of a target skill or an instruction, results in an increased probability of future engagement in same skill or following the same instruction.

As various aspects of the therapy such as required skills, motivators are different for each child, there is a need to design the strategies basedon each individual’s needs. When onestartsthe therapy, initially a few sessions are designed to build the rapport with the child- that is, to gain the child’s trust. Even though it might look like that the therapist didn’t teach the child anything during these sessions, it is the most important phase for the therapist and the child. Rapport building helps to create positive environment and your child perceives the therapist as fun and not only the one who makes him work. During this phase, the therapist learns about child’s likes and dislikes. By getting to know one’s motivators, the therapist can use the child’s preferences to teach him the necessary skills. There is no set durationfor building a rapport. One can consider the rapport is builtwhenthe child attends more to the therapist, follows easy instructions given by them, and/ or follows them around.

Once rapport is built, an assessment is done to check the current skills one may possess. Data are gathered on the appearance of problem behaviors and on the reasons or when they occur.These assessments help develop a plan for the child [just like an Individualized Education Plan (IEP), but not academic]. Based on this plan, skills are selected for teaching.

During teaching, ABA uses preferences of the child to ensure motivation-based learning. If responding in a specific way results in getting something one is motivated for, there is a high chance that one will engage in the same behaviors to get the same outcome. For example, if a child is given popcorns (assuming he likes popcorns), after he independently washes his hands, when next time asked to wash hands, there is a higher probability that he will follow the instruction. ABA changes the events so that one remains motivatedto earn the same outcomes. The value of that outcome increases if we haven’t accessed it over a long period, however the value reduces if we have constant access to it. Let’s say you are motivated to eat a pizza. Due to current quarantine stage, you haven’t had any since past two months. How likely it is if I offer you a pizza right away after you finish taking a shower? If you are a pizza lover and showering is an easy activity, you will be right on board with me! Let’s flip the situation. You had pizza for breakfast, lunch, and dinner for past two months, and today if I gave you a pizza for showering, would you shower to get the pizza as a reward? Having eaten pizza for over two months, there is a very low chance that you will take any efforts to get the same pizza. When we are deprived of something, the value of that item/ event increases, whereas when we have abundance of that item/ event, the value of it might just decrease. That is why, your therapists might ask you not to use some of the same fun activities that they use during therapy sessions. The value of outcomes will depend on the exposure. Also, if one gets free access to her most favorite activity in one place, why would she want to pay for the same in another place? That is, if you have learned that without completing math sums, you get to still color at home and you get access to coloring activity all the day long, would you still be motivated enough to complete the math sums to get access to coloring activity at the centre? ABA uses motivation (something that’s internal) through external observations (child’s daily choices) and uses it as consequences to increase engagement in the targeted skills.

In ABA, data collection is a core part of the system. Collating data gives a basis for determining pre-existing knowledge of the child. It also helps to identify if the strategies that we use are effective on the targeted behavior. The changes in programs are made accordingly. That is, if a strategy is effective it can be continued; if not, it can be modified. When the child progresses, new goals can be set. In ABA, one strategy is changed at a time, and any changes in the targeted skills are carefully analyzed. This ensures that only effective strategies are used and only these strategies result in changes in the targeted skills and nothing else. This is what makes ABA an effective therapy. One has to remember that it takes a lot of practice and consistency with the implementation of the therapy to see the desired outcomes. ABA is not a medicine, it doesn’t offer a cure, but it aims to teach skills and reduce interfering behaviors, so it may not give us fast outcomes, but it will give long-lasting ones provided the ABA protocols are followed. The more intensive ABA will yield better results and faster acquisition of skills. Research has shown that weekly 30-40 hours of therapy is beneficial to the children. The intensity of therapy might depend on the targeted goals and other considerations specific to the each child. Higher the intensity, larger the progress will be for children.Thus, more intensivetherapy is necessary to make further progress in learning skills that are required in essential areas of life.

Another very important aspect of the therapy is well-planned on-going supervision by experts. Behavior analysts are thosewho have completed a Masters or PhD degree in ABA. The ones who have just finished their graduate courses are recommended to seek guidance from or have discussions with behavior analysts in the field. Having mentorship or colleagues who provide guidance ensures the high quality in services.We have already discussed the process of planning the goals above. The behavior analyst is accountable for changing the plan when the goals are met, or when the progress is stagnant. They make assessment reports and intervention plans on a regular basis. They also train staff to deliver effective ABA therapy.

Behavior analysts also coach parents to implement the therapy at home and in community. ABA should be practiced in a wide variety of places where the child generally goes. Only when one learns to practice the same learned skills in all the places, the therapy has achieved the goals. Imagine, your child can count one to ten on paper, but if he can’t measure two cups of water to make a juice, would counting be useful in life? Training the parent becomes crucial for this reason. Once parents learn to implement therapy, therapy can be practiced for a better part of the day rather than restricting to only the hours in the session. It is also advised to start as early as possible. Yes, it is proved the earlier, the better! However, don’t stop yourself if you missed the early years. It’s never too late to start with intensive hours for the first few years to learn the essential skills. The aim of the therapy is to achieve set goals, to make one independent, and not to rely on it for too long but until it helps you make progress consistently to achieve the goals.

Shweta Ghayal
Purple Clouds Center for Behavior Analysis

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