Applied behavior analysis (ABA) is a therapeutic intervention based on the science of learning and behavior. The applied piece in ABA refers to understanding how behavior works in real-life situations. ABA was first defined and applied in the 1960s. By the 1970s, the Association for Science in Autism Treatment (ASAT) was founded to advocate for the use of ABA therapy.
The American Psychological Association (APA) considers ABA an evidence-based practice, meaning that it has been thoroughly researched and tested and is deemed an effective science-based therapy. However, modern approaches to ABA differ significantly from what ABA looked like in its early days.
According to RTOR.org, ABA has a success rate of over 89 percent in the pediatric treatment of autism. However, because of its earliest practices, controversy remains over whether ABA truly is an effective therapy for those with autism or if it is not. Some adults with autism, many of whom are part of the #actuallyautistic movement, claim that ABA is abuse, and they are firmly against it.
Read on to learn more about how ABA began, what it looks like today, and why there is controversy over this effective treatment.
What Is ABA Therapy in General?
Applied behavior analysis is an intervention often used for those with autism. It can also be effective for other conditions, such as oppositional defiant disorder (ODD) and attention-deficit hyperactivity disorder (ADHD). ABA clinicians strive to understand why behavior and learning occur, how the environment can affect behavior, and how behavior, as a whole, “works” for each individual.
ABA programs are structured in such a way that they not only decrease problem behaviors, such as aggression, but also increase social and language skills, improve academics, and help hone life skills and skills of independent living. This type of therapy has many styles and interventions tailored to the needs of each individual, but the core of ABA therapy relies on positive reinforcement and the ABCs of socially significant behavior. Through ongoing data collection and analysis, behaviors that are important to the client are targeted for increase or decrease.
When ABA clinicians look at the ABCs (antecedent-behavior-consequence) of behavior, they can determine what happened immediately before a behavior, what the behavior was, and the consequence (outcome) of the behavior; keeping in mind that the word “consequence” is not used in a negative light here—it refers to whatever happens after the behavior. Clinicians can use data to set goals and identify and decrease problem behaviors over time.
One of the criticisms of ABA therapy, discussed later, is that skills taught in ABA sessions don’t transfer well to real-life situations. However, that is one of the main goals of modern-day ABA, and therapy can be performed in various places and situations: in school, in a clinic, at home, or out in the community. ABA clinicians and other therapists in the child’s life, such as occupational and speech therapists, can work together so that everyone is on the same page regarding skill building.
Parents also actively participate in ABA services and are encouraged to attend clinical sessions. Many clinicians also provide parent training to parents, so caregivers better understand the nuances of behavior, and parents can implement ABA techniques in their clinician’s absence to help with consistency.
While ABA is efficacious today and has radically changed over time, it did not previously take into account the social significance of the behavior to the client or the ability to generalize skills to the client’s daily life as intentionally as is done today.
How Did ABA Begin?
Compared with what we know about autism today, the beginnings of applied behavior analysis can be viewed as controversial (For an in depth discussion about the past and current pathways of ABA, we recommend reading Leaf et al., 2021). In the 1960s, Dr. O. Ivaar Lovaas began working with patients in a residential facility for individuals diagnosed with autism as part of the Youth Autism Project. By 1967, he reported success with his patients, using primarily discrete trial training (DTT).
In the early days of ABA, Dr. Lovaas used positive reinforcement and punishment to change unwanted behaviors. Unfortunately, in early ABA, sometimes the punishment included applying aversives such as electric shocks. Neuropsychologist Susan Epstein elaborated on this early version of ABA, “Dr. Lovaas used principles of both positive reinforcement and punishment to reduce self-injurious behaviors in residential settings, treating severely impaired persons.” Previously, these students were bound to residential placements without any successful therapies identified. Though overall outcomes were positive, the field of science is continually evolving and building off of previous knowledge. It is vital to take into account the opinions of those who have received the therapy in the past and ensure differences and individual characteristics are embraced rather than viewed as a behavior to change.
In the psychology community, Lovaas’ work is viewed as pioneering and paved the way for modern interventions that can greatly improve the quality of life for those with autism. Over time, the majority of the field has moved away from punishment-based interventions; instead focusing on values-based and person-first approaches. The science continues to evolve as well; with more research, comes a more expanded application of applied behavior analytic principles.
What Does Modern-day ABA Look Like?
Today, ABA focuses on naturalistic principles and teaching, which meets the child where they are. Discrete trial training, which includes repetition with structured tasks, has not been as widely used as in previous decades. With the practice of ABA being focused on teaching and generalizing skills to all areas of a client’s life, naturalistic teaching within and across settings, people, and behaviors can be the most effective and efficient teaching method.
When naturalistic teaching is used within ABA, it allows for more opportunities for robust communication and social skills. A naturalistic ABA model follows a developmental-systems perspective, which means an emerging ability can be transferred from one domain to another. It also focuses more on individuality and the child’s needs in treatment incorporating both assent (the client agreeing to the intervention/treatment) and consent. Some naturalistic teaching methods include:
- Pivotal response training (PRT). This intervention allows the child to take the “lead” in the therapy and is a play-based type of intervention where the child chooses their preferred activity, often from a list that may include a choice of games, toys, and activities, etc. PRT is designed to inspire and motivate children, as they can choose what they prefer to work on. The tasks will vary during PRT, but natural reinforcers will always be used throughout therapy, depending on the location, activity, and scenario.
- Incidental teaching. This simple, yet effective teaching strategy tailors teaching to a child’s interests. For example, in a situation where a child may face boredom, the teacher or clinician can explore the situation. The clinician may introduce a favorite character from a TV show or movie based on the child’s interests. By tapping into the child’s interests, they can become more excited about learning.
- Natural language teaching paradigm (NLP). NLP is based on the idea that language skills thrive with more opportunities to use language. Skills based on NLP can first be practiced in a clinic, but using the developmental-systems perspective, the skills transfer to a child’s natural surroundings. For example, if a child wants a preferred toy on a high shelf out of their reach, they will need to ask for help. This type of teaching outlines the importance of a child’s personal initiative. NLP includes all forms of language and is tailored to individual needs. It can consist of American Sign Language (ASL), PECS, Augmentative and Alternative Communication (AAC) devices, and other forms of nonverbal communication.
- Mand-model technique. You may hear your ABA clinician use the word “mand”—during ABA therapy, that means “request.” When the child has engaged in a mand, they are rewarded (positively reinforced) with the item/action. The mand doesn’t necessarily have to be verbal—in the mand-model approach, the mand can use sign language, PECS, gestures, AAC devices, or words. This technique aids communication and language, and studies have shown it is an effective language intervention for those with ASD.
- Time-delay technique. This technique is another effective naturalistic language intervention. Similar to mand-model, It is often used when a child wants to request an item. If the child mands appropriately, then they are rewarded with the item. If they do not, the clinician imposes a delay before they receive the item until the child has manded correctly. If an incorrect mand occurs too often, the clinician will likely move to a mand-model approach to avoid frustration.
The myth that ABA techniques don’t transfer over to real life is debunked with naturalistic interventions. Naturalistic interventions, as their name suggests, occur naturally in the child’s life and can be applied at mealtimes, playtime, riding in a car, going to an event, transitioning between activities, evening and morning routines, the school day, and more. Applying naturalistic principles in ABA techniques during day-to-day life promotes better life skills and skills of independent living but can also relieve fear and anxiety in children with autism.
Autistic Adults “Against” ABA: The #actuallyautistic Movement
There are adults with autism, many of whom received ABA treatment in childhood, who have spoken out against using ABA therapy. It can create quite a divide between parents and caregivers who want to offer their child the best therapy in the form of ABA and other persons with autism claiming that the therapy is ineffective and, at worst, abusive.
An early quote by Dr. Lovaas is unsettling and is used by the #actuallyautistic movement as an argument against ABA. He once said, “One way to look at the job of helping autistic kids is you have to construct a person. You have the raw materials but must build the person.” Adults with autism argue against this quote, and with good reason: a child (or person) with autism is already complete and “constructed.”
Many people believe that Dr. Lovaas wanted to change traits of autism in those with an autism diagnosis, attempting to transform them into more neurotypical people. However, that is not the goal of modern ABA; behavior reduction is a piece of today’s ABA, but it is often used for harmful behaviors that may be self-injurious or can harm others and not without additional function-based interventions.
There are also claims that ABA is too intensive, particularly with time. Frequently, insurance does allow for up to 40 ABA hours per week. However, it is rare for children and parents (and clinicians!) to be able to “do” that much ABA per week. The norm for ABA hours falls between 10 and 20, depending on everyone’s scheduling and the medical necessity of the client. As with all components of an effective ABA program, the hours are individualized to the client. While this may seem intensive compared to other therapies, such as occupational therapy (OT) or speech therapy, it rarely reaches an intensity level of 40 hours per week.
It is also often said that ABA attempts to push children with autism into societal norms. Modern-day ABA doesn’t attempt to tell a child not to stim (self-soothe), and naturalistic interventions occur organically and are based on the child’s needs and wants.
Applied behavior analysis therapy does focus on decreasing problem behaviors, but these are often harmful, maladaptive behaviors, such as aggression, elopement, and self-injury.
The history of ABA is a spectrum. At one end is its inception, which included harmful interventions as stated by autistics who experienced the therapy. Over time, it grew to what it is today, using play-based, naturalistic interventions, but it took some time to develop. Those who received ABA therapy ten or more years ago likely had more discrete trial training and table time as part of their program, which can be repetitive. It is easy to understand that negative opinion of ABA as it is based on personal experience, but the scope of ABA has grown exponentially over the past few years.
What Are Some Modern-day ABA Advances?
Behavior is everywhere, and as ABA grew, it appeared in many more places as well, such as school curriculums. Board-certified behavior analysts (BCBAs®) and registered behavior technicians (RBTs®), who comprise the core of your child’s ABA team, have access to much more technology, partnerships, and resources than ever. This includes advances, such as:
- Advances in early detection. Advances in the early detection of autism allow a larger window of opportunity for intervention. Studies have shown ABA early intervention, often known as early intensive behavioral intervention (EIBI), to be highly effective.
- Advances in data collection. Technology can benefit ABA greatly; clinicians can carry iPads and other technology to use during sessions. However, when it comes to data, many more software systems allow for a clearer interpretation of data, such as BIP Track, AccuPoint, ABA Teamwork Express, and ACE® ABA Software System.
- Advances in ABA inclusion. The inclusion of ABA in teaching curriculums allows teachers and educators to be familiar with the tenets of ABA, allowing them to implement ABA techniques in an academic setting. More educators are becoming familiar with behavioral assessments and behavior plans. Remember that ABA is not just limited to those with autism, so this is a great help for teachers. Having an educator familiar with ABA can also aid in your child’s overall treatment plan and allows for ease of collaboration.
Changes in ABA philosophy and technological advances have changed the face of ABA for the better, even during the past five years.
What Are the Benefits of ABA?
Despite the controversy, ABA is considered the most efficacious of all ASD interventions and is the gold standard for decreasing problem behaviors (Office of communications, 2021; Satcher, 1999). Every child with autism will eventually become a teenager and an adult with autism. One of the end goals of ABA therapy is to help a person with autism maintain independent life skills. The earlier the treatment begins, the more successful it may be. Some of the benefits of ABA therapy include:
- Social skills improvement. Children with autism often have trouble interacting with peers because of differences in social skills. Over time, ABA can help improve these skills in a group setting with several children.
- Independent living skills. ABA is not solely focused on behavior modification and can help individuals with autism learn basic life skills, such as using the bathroom independently, brushing their teeth, sleeping through the night, and living independently as they transition into adulthood.
- Creating and maintaining friendships. Applied behavior analysis can help children with autism create and maintain friendships, which allows individuals to improve social and communication skills. Social skills groups provide a structured curriculum to help develop social skills with individuals of similar age and ability.
- Improved parenting interactions. Parents are strongly encouraged to be involved in ABA sessions. ABA therapy helps parents better recognize their child’s abilities and strengths rather than focus on negative behaviors. Because an ABA therapist cannot be present 24 hours a day, this helps reinforce skills learned during ABA sessions. Also, BCBAs can help guide parents so that every situation becomes a learning experience instead of a difficult situation.
- Generalizing and retaining skills. Individualized ABA treatment plans generalize newly learned skills across settings with retention in mind. Regular sessions over time help children with autism retain skills, allowing individuals to use coping and other skills when presented with difficult or new situations.
Those who have heard negative things about ABA may have natural apprehension, considering the way ABA was first implemented, but modern-day ABA and naturalistic interventions allow children with autism to thrive and to improve skill sets of all types in real-world situations. Early intervention is encouraged if your child has been newly diagnosed.
Leaf, J. B., Cihon, J. H., Leaf, R., McEachin, J., Liu, N., Russell, N., Unumb, L., Shapiro, S., & Khosrowshahi, D. (2021). Concerns about ABA-based interventions: an evaluation and recommendations. Journal of Autism and Developmental Disorders, 52, 2838-2853. https://link.springer.com/article/10.1007/s10803-021-05137-y
Office of Communications (2021). Behavioral Management Therapy for Autism. Eunice Kennedy Shriver National Institute of Child Health and Human Development. https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/behavioral-management
Satcher, D. (1999). Mental health: A report of the surgeon general. U. S. Public Health Service. Bethesda, MD. Available at: http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec6.html#autism