Applied Behavior Analysis Therapy In Autism Spectrum Disorder

Applied Behavior Analysis (ABA) is a controversial therapeutic intervention that aims to augment social, communication, and learning skills through reinforcement. It is founded on the science of learning and behavior. Besides augmenting general adaptive behaviors, such as social skills and learning skills, its focus is on specific skill learning including fine motor skills, hygiene, grooming, etc.

Focuses, practices, and quality of ABA therapies can be very different.

The use of ABA for autism is controversial due to concerns about potential psychological harm, ethics, and quality of evidence. Many autistic people who went through ABA say they found it more harmful than helpful.

How it works

This therapy involves some simple and complex steps. The therapist breaks these skills into small, solid steps.

Techniques used in ABA Therapy

Positive Reinforcement

Positive reinforcement uses tools like praise, smiles, prizes, and other things the child likes. The goal is to encourage a child to engage in more of that behavior.

Autism applied behavior analysis

Antecedent, Behavior, Consequences

1. An antecedent: It occurs just before a behavior. It can be verbal, like a request or a command. It can be physical as well, like an object, or a toy or light, sound.
2. A resulting behavior: Behavior is the person’s response to the antecedent; or there’s no response to the antecedent. It varies from an action to verbal response, etc.
3. A consequence: The consequence comes immediately after the behavior. This might be positive reinforcement, ignoring, or punishment.

Using Prompts and Cues

Prompts may come as visual or verbal cues that would be used to instigate the behavior. Verbal cues are reminders, but visual cues are not so direct. They can either be a gesture or a look. The child after seeing this cue will remember to behave in an appropriate manner.

Negative Reinforcement

Negative reinforcement means punishment. It is done when the therapist dislikes the autistic child's behavior. Punishment can be taking away something the child likes or (more controversially) using aversives, e.g. forcing the child to eat wasabi or spraying them with a spray bottle.

The field of ABA recommends being consistent with punishment.

Task Analysis

Task analysis is an autism applied behavior analysis model of present behavioral trends and actions, that helps to learn about the child instead of correcting or reinforcing the behavior. The psychologist gives a task to the child and sees how they complete it. This analysis is divided into various categories:

• Physical actions
• Repetition
• Cognitive actions
• Environment
• Allocation

Generalization

With Generalization, the therapist picks what the child has learned in a certain situation and applies it to another situation. For instance, if a child can sing the alphabet, the psychologist can take their knowledge of the alphabet and then try to apply it to teaching the child to spell out their name.

Efficacy

ABA has long been considered the "gold standard" for treating autistic people. However, research quality has been limited, lacking in random assignment and sample size. A 2018 Cochrane review found only weak evidence that ABA may help some autistic children, noting a high risk of bias.

One literature review found that 84% of studies published in top journals one year had conflicts of interest, with only 2% disclosing this. Conflicts of interest often go unreported.

Few studies look at long-term outcomes. While some studies mention adverse effects, these are typically not investigated.

Controversies

Some researchers have criticized the ethics of ABA. The ethical code has been described as lenient, with no restrictions on use of aversives.

Potential harm and abuse

Autistic people, researchers, former ABA practitioners, and family members of autistic people have raised concerns about ABA harming autistic people. They discuss potential abuse in ABA. Early research shows some evidence of increased PTSD symptoms in people who have gone through ABA.

A few criticisms include:

• Training autistic people to mask their autistic traits can be harmful. Masking in autism has been linked to anxiety, depression, suicidality, and other harms.
• Spending dozens of hours per week in therapy may be exhausting for young children and may prevent them from experiencing other therapies or a "regular childhood." One meta-analysis found no benefit from an intensive schedule relative to one with fewer hours.
• Children are taught to suppress their instincts and discomfort.
• Training children to unquestioningly obey adults may harm the development of assertiveness skills and leave them especially vulnerable to sexual abuse. Previous research has shown autistic people to be at high risk for sexual abuse victimization.

Quality of ABA therapy can vary. BCBA certification requires no training on autism.

Some parents have alleged that ABA therapists coerced them and refused to let them help when their children cried.

Research on potential long-term harms is minimal. Two surveys of autistic adults who went through ABA as children found that most of them viewed it as harmful. Evidence is limited at this point in time.

See also

• Autism

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