ABA is a safe and proven therapy for removing socially and physically harmful behaviors, including behaviors associated with ASD.
ABA relies on evidence-backed principles based on academic study, which are applied based on direct observation by the therapist in a clinical setting. A licensed and certified behavioral therapist is specifically trained to apply ABA safely and effectively, and to design programs in a way that reduces behaviors in the long term.
ABA often appears very natural to an observer. This is because a trained ABA therapist will meet a child where they are, and then gradually guide them to experience their full potential. A lot of ABA will therefore look like play. Some very early learners cannot absorb information the way a typical child does. DTT (Discrete Trial Training) may be used with children like this until they develop the foundational skills to be successful in more natural forms of play.
Sometimes, ABA may cause a child to temporarily intensify a behavior when the therapist does not reward or validate the behavior in the first instance—this is part of the process of extinction and, while it can be uncomfortable, is a normal part of the child learning that a harmful behavior will not help the child to get what they want.
In short, ABA is a safe, highly beneficial therapy. But if a therapist is not properly trained or attuned to the child, the therapist could inadvertently make target behaviors worse or lead to the creation of new problem behaviors. As with any type of therapy, it is important to look closely at the specifics of the therapist and the therapist-child relationship to determine if your child is receiving ABA therapy that is meaningful and helpful.
Here is some information to help you evaluate ABA in a particular situation.
How to know if your ABA therapist is qualified to provide Applied Behavioral Analysis?
Your ABA therapist should be a Board Certified Behavior Analyst (“BCBA”) or have another certification from the Behavior Analyst Certification Board (BACB). Alternatively, your therapist should be a graduate student in ABA receiving direct, weekly supervision by a BCBA. Other individuals may or may not be talented providers, but they are not qualified to provide ABA services and may have never formally studied ABA.
Notably, different states have different rules when it comes to who is legally permitted to provide ABA. Some states, like New York, have strict criteria that overlap with the criteria to become a BCBA. In other states, however, a master’s degree in a therapeutic field is all that is legally required to provide ABA without supervision. Providers should be able to give proof of their credentials upon request.
How do you know if your child’s ABA therapist is providing appropriate therapy?
- Goals should be established between the parent and the professional. Any goals your ABA therapist wants to work on with your child should be explained and communicated to you up front.
A qualified, experienced behavioral analyst should explain what they are doing and why, which behaviors they are targeting and why, and whenever possible, find a way to address these behaviors in a way that conforms to their code of ethics (is evidence based), while also making parents feel comfortable. Goals should be established between the parents and the professional.
- Therapy should also be individualized to your child.
Part of what makes ABA (when done well) so effective, is that it is individualized to each child’s unique needs. If your child’s therapist has procedures written up for your child that look like they were made for another child (have the wrong name, etc.), this could be a sign that this person is not thinking of your child’s unique needs.
- If something isn’t working, it should change.
If your child is consistently melting down during therapy during the same task (for more than 6 consecutive days), your ABA therapist should be discussing why they continue to elicit this behavior, why they think this is happening and what they want to do to help a child improve. Most good therapists want children to be able to feel successful, calm and happy. This doesn’t mean they aren’t afraid to elicit a tantrum (actually, good behavioral intervention often intentionally elicits tantrums), but the goal is always for these tantrums to extinguish. The reason that ABA therapists take such scrupulous data is to see if an intervention is effective or not. If the data indicates and intervention is not effective, they change what they are doing.
What is DTT (Discrete Trial Training)?
Discrete Trial Training is an intensive, highly structured form of ABA therapy in which children are required to sit for significant periods of time and run drills. This particular style of ABA is not appropriate for every child. Unlike other applications of ABA, DTT does not look like natural play. DTT is useful for very early learners who do not yet have the skills to absorb information from their natural environment, but who are capable of learning with targeted motivation and encouragement. DTT helps these early learners build numerous skills quickly, which is crucial for children who are developmentally delayed. The goal of DTT is to develop the building blocks to engage in more creative, functional, natural play. As your child’s skills evolve, DTT should be faded from their therapy sessions, and a more advanced type of learning like PRT (Pivotal Response Training) can begin.
- How long should a particular DTT session last?
Depending on the age of your child they should be given appropriate breaks. Sitting for DTT longer than 30 minutes is probably too long for most children under 5. Furthermore, DTT should not be the only technique your therapist applies. DTT should be mixed with other activities that allow your child to move around, explore and grow.
Is the point of ABA for my child to be indistinguishable from his peers?
The goal of ABA is unique to each particular family. Therapists work with clients and families to establish goals that are appropriate based on the child’s development, the family’s priorities, and the child and family’s sensibilities. Not all children with ASD are the same, nor are their families. A good therapist will work with your family to target a goal that is right for you.
- Really, ABA wants to be socially significant
ABA therapy should target goals that are socially significant, meaning that what a therapist teaches a client makes a meaningful difference in their lives, and the lives of their families. Overall, ABA therapists want to teach children skills that will help them be successful across settings and situations. They want to use scientifically validated approaches to make this happen. They want to make sure that they are being consistent, effective and using the principles they are trained in and qualified to assess to help their clients succeed. Sometimes this goal is speech, sometimes it is toilet training, and sometimes it is matching pictures of animals. If a parent and therapist disagree on the importance of a goal, they should talk about it together and come to a conclusion that is right for the child.
Does ABA force children to do things that are physically painful?
No—an ABA therapist should not make a child do something that is physically painful. That said, a family may want to desensitize a child to certain textures or sounds, and an ABA therapist can facilitate this, likely in conjunction with an Occupational Therapist. For example, if a child cannot stand the sensation of soap, it may be appropriate for a Behavioral Analyst to work on desensitizing them, so they can bathe, avoid getting sick, and participate at school. ABA therapy teaches this should be done gradually, methodically, and compassionately. First, they may just have the child tolerate having the soap next to them, then they might touch it for one second. They should not be pushed to another step until they are very comfortable with whatever step they are currently working on. So, if your child cannot tolerate being in the same room as soap, they should not be asked to wash their hands yet. A good therapist will not try to rush this process, so the child will not experience pain.
Should my therapist ever use aversives with my child?
The use of punishment (introducing a consequence that makes a behavior less likely to happen in the future) should only be used if all other attempts at reinforcement have failed. Furthermore, punishment should only be considered for dangerous behaviors. If a child is engaging in a behavior that’s very dangerous to themselves or others, punishment may be introduced for safety purposes. Just like if a neurotypical child tries to touch a hot stove and a parent screams “NO!”
The purpose of ABA is not to force children to engage in activities that hurt them. It’s not to make them look normal. It’s not to make them touch things they don’t like, smile when they aren’t happy, or force them to confirm to social norms that are uncomfortable and don’t make a meaningful difference in their lives. The purpose of ABA is to use evidence based strategies to help children actualize their full potential, usually with a lot of laughter, fun and adventure along the way. If you have any questions about ABA, and how to know if it is right for your family, please email me at db@manhattanpsychologygroup.com
More information about the benefits of ABA:
https://www.ktnv.com/news/previously-non-verbal-las-vegas-boy-is-speaking-with-aba-therapy
https://www.youtube.com/watch?v=68XQBechJb4
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196209/
https://www.autismspeaks.org/what-autism/treatment/pivotal-response-therapy-prt
https://www.ncbi.nlm.nih.gov/pubmed/28963874
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488784/
https://www.appliedbehavioranalysisedu.org/how-is-discrete-trial-training-used-in-aba-therapy/
https://www.autismparentingmagazine.com/what-is-pivotal-response-training/
