Intensive Applied Behavioral Analysis – sometimes also referred to as Early Intervention (EI) or Intensive ABA, refers most often to therapies that focus on verbal skills & behavior.
While there are many things about autism that are highly debated, one area that all experts agree on is that starting ABA as soon as possible is crucial. While it’s unusual to have wait-times to start professional ABA in Wisconsin, it may take may take time for a new therapist to be hired and trained in some of the rural areas – which may lead to a gap in service. If that happens, parents might consider learning ABA therapy styles and techniques on their own (books, internet, you tube, etc) in order to get the process started while they are waiting for professional services. It’s also important to add that ‘Do it yourself’ ABA should be thought of as a gap-filler, and not necessarily a long term solution.
WHAT IS IT?
ABA is a therapeutic technique by which a child is taught appropriate methods to communicate, instead of doing so with negative behavior. ABA is technically defined as ‘the science in which the analysis of behavior is used to improve socially significant behavior’.
In short, an analyst helps to determine the areas of focus, and trained therapists then work with the child on those behaviors. Analysts make observations of specific behaviors – including the factors that might be triggering those behaviors. Positive reinforcement is used to shape appropriate responses and new behavior.
ABA was first developed in the 1970’s by O. Ivar Lovaas
Intensive ABA therapies are usually done in the family home, for more than 25 hours per week. This type of ABA therapy often is recommended for children who are moderately to severely impacted by autism.
ABA is an evidence-based treatment program for autism spectrum disorders. Evidence-based, meaning that it’s been documented in multiple studies to significantly improve many of the negative aspects of autism, for those at varying levels of functioning.
Generally, a play-based or non-intensive ABA type of therapy is recommended for higher functioning children, whereas intensive is often used for children more severely impacted.
BEHAVIOR ISN’T JUST BEHAVIOUR
ABA is based on principles of ‘behaviorism’ – a psychological theory that explains how people learn and behave. It asserts that behavior isn’t random – that all behavior has a purpose. According to this theory, behaviors that are reinforced with a positive consequence (treat, reward) or those that accomplish a desired outcome (receiving what they are trying to express a need for) are more likely to be repeated and used in the future.
Behavior has a purpose. Often there is something that’s sensory (noise is too loud, lights are too bright), or they want to escape (I really don’t want to do this work right now), or feels good (I want to climb on things because it helps me to feel centered) or their need is for something tangible (I want more French fries).
Here is a video that explains the purpose of behavior, and gives a great example of how one of the goals of ABA is to replace negative behavior with appropriate responses and requests.
ABA often refers to the ‘ABC’s’. Antecedent (what happens), Behavior (what occurs), the Consequence (what took place as a result).
An example might be:
Antecedent: Mom is on the telephone
Behavior: Child screams
Consequence: Mom gets off the phone
ABA looks at the entire process of what’s happening. In the example above, the analyst might determine that the child has learned that when they do X behavior, that Z is the outcome – or that when they scream, Mom gets off the phone.
ABA’s goal is to give the child a more appropriate method to express what they need.
GET IT COVERED.
Talk with your private health insurance company to inquire about the coverage, co-pays, deductibles and coverage limitations on your current policy, and any specific ABA providers they work with. Not all insurance companies have to work with all providers.
ABA does fall under the 2009 mandated insurance coverage laws in Wisconsin, but ABA services are still subject to per-visit copays. Here is more about insurance coverage in Wisconsin when it comes to ABA services.
It’s important to note that Medicaid (Or Wisconsin’s FORWARD card) does not cover ABA. Since Medicaid is paid for using federal funds, and since coverage of ABA is not a federal insurance requirement, Wisconsin’s Medicaid program does not cover ABA therapy services.
In the absence of private health insurance, contact the Wisconsin Department of Health Services to inquire about coverage options for ABA services. Due to the very high demand for these services the wait can be years – so don’t delay.
Some families pay out of pocket, receive grants, or utilize other resources until coverage for ABA can be arranged. If ABA is done on your own, it should be considered only as a gap-filler until professional services can be received.
HOW TO GET STARTED
The first step in starting ABA Therapy is for a licensed therapist to conduct a Functional Analysis. In this process, behaviors that interfere with meaningful functioning in the classroom or in the family are identified. The therapist then uses that information to identify the purpose of the behavior, in order to correct the problematic behavior.
Here is an exaggerated example of how this might work: Remember – behavior is a form of communication.
If a child knows that by hitting their sibling they will get a glass of water, they’ll continue that behavior as long as they find that process gets them what they need – a glass of water. A therapist helps the child understand that the hitting is unacceptable – and that they receive water when the child says ‘water’ or when they point to a picture of the water. They receive praise for asking – the theory is that the behavior then changes to the provided & more desirable process.
In ABA circles there are two dominant methods that are used.
DISCRETE TRIAL TEACHING
Also known as the Lovaas method, this is what most people are referring to when they use the term ‘ABA’.
These are one on one sessions with a therapist, with each session focusing on one particular skill. ‘Discrete’ implies that each goal is separate from the next. Each task is brief and is broken down into parts: The instruction, the child’s response, the immediate reward (or consequence), and then a short break before repeating it again.
PIVOTAL RESPONSE TRAINING
Pivotal Response is loosely structured and focuses more on social functioning.
It’s play-based, and centers more on appropriate social communication & behaviors and alternatives to undesirable stimulatory behaviors.
Motivation strategies are an important part of the PRT approach. These emphasize a more natural reinforcement. For example, if a child makes a meaningful attempt to ask for a stuffed bear, the reward is the bear – not a candy or other unrelated reward.
Though used primarily with preschool and elementary school learners, studies show that PRT can also help adolescents and young adults.
PRT was also developed in the 1970s by Robert Koegel, Ph.D., and Lynn Kern Koegel, Ph.D.
Each program is tailored to meet the goals and needs of the individual learner and his or her school and home routines. As the child gets better at certain tasks, the focus of each session changes to accommodate more advanced goals and needs.
WHATS THE DIFFERENCE?
Discrete Trial Training (DTT) breaks a skill into smaller parts teaching each subpart one at a time. Pivotal Response Training (PRT) focuses on strategies that motivate the child to attempt the larger task, and by reinforcing these attempts, the rate of responsivity is improved.
DTT is structured and often uses flash cards and drill-type activities, where PRT uses activities found in everyday environments.
DTT uses a reinforcer not necessarily related to the task (a small treat). PRT uses reinforcement directly related to the task in most cases. (Say ‘Bear’, to receive the Bear)
DTT advantages may include fast acquisition of skills, high level of structure to learn, and clear data collection procedures to monitor progress. Some drawbacks might include a lack of the ability to generalize new skills to different scenarios, or the potential of increased disruptive behavior. DTT is not always developmentally appropriate for very young children or even for older children who continue to need intensive therapy.
PRT advantages include easier maintenance of and generalization of skills in different settings, the addition of parent / caregiver involvement in the therapy, and a greater ability to keep the child in their natural environment. It’s also often times easier for these kids to adapt to different settings. Some of the drawbacks to this type are that some children don’t do as well with less structure, and the collection of data (in order to monitor progress) can be more difficult.
Different ABA providers tend to specialize in one method or the other. It’s a good idea for parents to investigate and have some familiarity with both types so they have a sense of what method they think might be the best fit for their child.
And remember – if you try one, and it’s not the right match, try the other method. Also remember that improvement may take weeks to months to be seen, and may be subtle at first.
In January of 2014, an in-home ABA therapy session in the Milwaukee area was video recorded by a parent who had become concerned about her nonverbal son. She was noticing unusual behaviors, but was unable to personally observe the sessions due to a policy in place by the service provider. The video recorded session reportedly shows aggressive handling of the child on the part of the therapist. Law enforcement officials are investigating.
Our volunteers have talked with families and therapy service providers, and have offered hints, tips and points to think about to help keep our children safe when working with any therapy provider.
Please note: This information was compiled by a parent volunteer from public sources, and is not intended to be medical or legal advice.
For specific questions about your circumstances regarding this topic, contact your Regional Center for Children & Youth with Special Health Care Needs. The Centers are staffed by specialists who can help get answers, find services and connect you to community resources. Their services are free, unbiased and private.