What Is ABA Therapy?

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What Is ABA Therapy?

ABA (applied behavioral analysis) therapy is an approach to treatment that focuses on using positive reinforcement to improve behavioral, social, communication, and learning skills. ABA therapy utilizes behavioral principles to set goals, reinforce behaviors, and measure outcomes.

This approach is often described as the "gold standard" in the treatment of autism. It is also controversial because it has been seen as disrespectful and even dehumanizing at times. It is widely used and has been shown to be effective for improving specific skills and decreasing problem behaviors.

When It's Used

ABA therapy can be used to teach desirable behaviors and to reduce or extinguish undesirable ones. It can be used to treat a variety of conditions including:

Types

There are a number of different types of interventions that can be used as part of ABA therapy. These include:

  • Discrete trial training (DTT): This involves breaking a skill down and teaching it step-by-step. The three components of this process include the antecedent (a cue that triggers the behavior), the behavior (the response to the cue), and the conclusion (what happens after the response.) When the behavior has been successfully produced, the individual will receive positive reinforcement, but will not be rewarded if they do not successfully produce the desired response.
  • Early intensive behavioral intervention (EIBI): This approach may be used in young children to teach social, adaptive, communication, and functional skills. It is usually highly individualized, intensive, and comprehensive.
  • Early start Denver model (ESDM): This technique is based on applied behavior analysis and is often used for children with autism between the ages of 12 and 48 months. It utilizes play activities to help foster cognitive, social, and language skills.
  • Natural environment training: After people have acquired skills through discrete trial training, they then begin learning and practicing those skills in more natural environments. For example, a child may learn a specific skill and then begin practicing it at home or in school.

ABA therapy is also often delivered in two different ways. It can either be used as a comprehensive program that provides intensive intervention in many environments and situations. It can also be part of a more focused program that may involve only specific behaviors or situations.

  • Comprehensive ABA therapy: This approach delivers treatments that usually last for several hours each day. A therapist or behavior technician works with the individual for at least several hours each week and often in different contexts, such as both in the home and in school settings. Therapists work directly with the individual but may also work with parents and caregivers to teach skills that can be used outside of ABA therapy sessions.
  • Focused ABA therapy: This type of treatment may focus on helping an individual in a specific situation where they are facing difficulty. It may also focus on specific skills that an individual needs to work on. The individual often works one-on-one with a therapist, but may also practice these skills in small groups or in community settings.

How It Works

ABA therapy usually involves a few different steps. Treatment plans are tailored to the needs of the individual.

  • Assessment is the first step of ABA therapy. During this stage, the child or individual will meet with a therapist who asks questions about strengths, weaknesses, needs, and goals. From this information, the professional will develop a treatment plan.
  • Treatment will involve using different techniques to work toward the individual's goals. Treatment sessions can sometimes be as short as an hour, but they often last for several hours at a time. 
  • Caregiver training involves offering support and training to parents and other caregivers and family members. Therapists teach parents and family members skills and strategies that will help maintain desirable behaviors in the home, school, and community settings.

Impact

Some ways that ABA therapy can impact an individual's life include:

  • Acquiring and practicing social skills
  • Decrease problem behaviors
  • Develop memory and cognitive abilities
  • Improving emotional connections with other people
  • Improve language and communication skills
  • Improve attention and focus
  • Learning daily living skills
  • Managing feelings of aggression and anxiety

Research suggests that ABA therapy can have a number of benefits in the treatment of autism. Some evidence supporting its effectiveness and impact:

  • One study found that long-term comprehensive ABA treatment could help autistic children improve their daily living skills, language development, and social abilities, and intellectual functioning. 
  • A 2011 review of 27 studies found that ABA interventions were effective for improving social skills, adaptive behaviors, language abilities, and cognitive skills. These interventions were also helpful for reducing aggression and anxiety in children and adolescents.
  • A 2012 study suggested that children with autism spectrum disorder should have access to a minimum of 25 hours per week of comprehensive ABA therapy. This has been linked to improvements in play skills, behaviors, language, and social communication.

How those results translate to long-term benefits throughout life are still being examined. 

Tips/Tricks

If you are ready to try ABA therapy for yourself or your child, there are some steps that you can take to help find the best treatment for your needs.

  • Get a referral. Talk to your doctor or child's pediatrician for a referral to an ABA provider. They may be able to recommend someone, but you can also search online for local service providers.
  • Check with your insurance. ABA therapy is often covered by insurance, so check with your policy provider about coverage and contact your therapy provider to be sure that they take your insurance.
  • Find the right therapist. Start by checking that your therapist is a board-certified behavioral analyst (BCBA). Early ABA sessions often focus on building a rapport with the therapist, so pay attention to whether it seems like a good match.

As with other types of therapy, it can be helpful to give it a try and keep an eye on how things go. If you notice good outcomes over time, it may be a good idea to stick with it over the longer term. If you or your child struggles with treatment or does not achieve good progress over time, it may be a good idea to switch to a different treatment approach.

Controversy

While ABA is widely used today, it is not without controversy. In the past, this type of treatment involved hours of treatment each day, often done in rigid environments. Failures to produce desired behaviors were often addressed with harsh punishments. This approach is both disrespectful to those in therapy but often dehumanizing.

More recent approaches focus on either applying or withholding reinforcement and do not involve punishments. Rather than sitting at a desk doing discrete trials for hours each day, treatment is now often delivered in natural settings including the home, schools, and community settings. 

ABA therapy also often focused on getting people to engage in "typical" behaviors. Today, there is a greater appreciation and value for neurodiversity.

Rather than trying to force people to fix a specific mold, newer approaches are instead focused on helping people develop and strengthen the skills that will allow them to reach their potential and live a fulfilling life. 

History of ABA Therapy

ABA therapy is rooted in the principles of behaviorism, particularly operant conditioning and the use of rewards and consequences to mold behavior. During the 1950s and 1960s, mental health professionals began utilizing principles such as token economies in the treatment of conditions such as schizophrenia and developmental disabilities. 

Later, Dr. Ivar Lovaas adapted ABA in the treatment of autism. His approach was that behavioral and social skills could be taught while other behaviors could be extinguished by applying rewards and consequences. 

Since then, a wide variety of techniques have emerged to treat autism and other conditions. Many newer approaches are still rooted in the basics of ABA therapy, but also incorporate aspects of emotional and social engagement as well.

A Word From Verywell

ABA therapy has become a widely used treatment approach in the treatment of autism and other conditions. It has been linked to improvements in key areas including language, social skills, and adaptive skills, but that doesn't mean that it is right for everyone. ABA is not the only approach to treatment, so it is important to listen and look at how a person is responding in order to determine which treatment is right for their individual needs.

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  3. Maglione MA, Gans D, Das L, Timbie J, Kasari C; Technical Expert Panel; HRSA Autism Intervention Research – Behavioral (AIR-B) Network. Nonmedical interventions for children with ASD: recommended guidelines and further research needs. Pediatrics. 2012;130 Suppl 2:S169-78. doi: 10.1542/peds.2012-0900O

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