ABA for Autism: It s Not What You May Think!

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1 ABA for Autism: It s Not What You May Think! Gina Green, PhD, BCBA San Diego, CA December 2005

2 Objectives Overview of applied behavior analysis (ABA) in the treatment of autism What ABA is State-of-the-art ABA treatment for autism History and research foundation What ABA is not Summary Video: Finding the Words 2

3 Applied Behavior Analysis: What it Is Behavior analysis: a natural science approach to understanding behavior Originated by B.F. Skinner (1938) Conceptual, experimental, and applied components Applied behavior analysis (ABA): Application of scientific principles or laws of behavior (e.g., reinforcement) to improve socially significant behavior to a meaningful degree Many applications in addition to autism Based on the work of many researchers and practitioners 3

4 What ABA Is (cont d) Effective for building skills and reducing problematic behaviors in people with and without disabilities Stresses positive reinforcement and scientific demonstrations of effectiveness Highly individualized, contextual, flexible Complex and intricate, comprising many techniques Continuously evolving 4

5 State-of-the-Art ABA Treatment for Autism Comprehensive; all skill domains addressed Skills broken into small components, defined in observable, measurable terms Individual strengths and weaknesses assessed by direct observation and measurement Each component skill taught via many trials or learning opportunities, each comprising a specific antecedent stimulus, response, and consquence Multiple, repeated learning opportunities arranged, in both structured and naturalistic situations 5

6 State-of-the-Art ABA (cont d) Little unstructured time for practicing autistic behavior Various techniques used to arrange learning opportunities and enhance motivation: discrete trials, incidental teaching, activity-embedded instruction, task analysis and chaining, prompts and prompt-fading, child choice, etc. All aspects of intervention tailored to individual needs and preferences Simple skills built systematically into more complex repertoires Emphasizes teaching the child how to learn, developing relationships, and making learning fun. 6

7 State-of-the Art ABA (cont d) Problematic behaviors are not reinforced; alternative adaptive behaviors are. Data used to evaluate progress and "fine tune" teaching procedures continuously. Programming directed by individuals with graduate degrees in behavior analysis + specific training and experience in autism Board Certified Behavior Analysts (BCBAs) or the equivalent (see for information about international certification program for practitioners of behavior analysis) 7

8 ABA for Autism: History Sidney Bijou, Director of Institute of Child Development, U of Washington starting in 1948 Brought together many pioneers of behavior analysis: Wolf, Risley, Baer, Birnbrauer, Hart, Sloane; Lovaas a postdoctoral fellow Blended experimental analysis of behavior with developmental psychology 1st applications of behavior analysis to autism: Ferster & DeMeyer (1961); Wolf, Risley, & Mees (1964) 1st to use discrete-trial procedures with children with autism: Risley (early 60s) 1st to develop naturalistic, child-initiated procedures to promote language (incidental teaching): Hart & Risley (1968) 1st to define applied behavior analysis: Baer, Wolf, & Risley (1968) 8

9 ABA for Autism: Research At least 550 studies published (Matson et al., 1996) and hundreds more since 1995 document effectiveness of specific ABA methods for teaching many important skills: Learning to learn: looking, listening, imitating, following instructions, discriminating and matching stimuli, etc. Communication: verbal and nonverbal; comprehension and production; from simple vocalizations to complex conversations Social : simple reciprocal exchanges, playing with peers, sharing, expressing emotions, empathizing, dramatic play, etc. Self-care: hygiene, personal safety, community living, etc. Academics Motor and leisure Vocational 9

10 Research on early intensive ABA Early: children entered treatment before age 5 Intensive: hrs/wk of 1-to-1 treatment (initially), year around, for at least 2 years (all waking moments) Programs directed by individuals with advanced training in ABA (mostly PhDs) and experience with young children with autism; conducted initially in quiet settings (often homes); involved parents as active co-therapists 10

11 Research (cont d) 1st to document effectiveness of early intensive ABA: Fenske, Zalenski, Krantz, & McClannahan (1985) -- quasi-experimental (uncontrolled) study 6/9 children who entered before age 5 enrolled full-time in regular classrooms after 2+ yrs; 1/9 who entered after age 5 did so 1st to document similar outcomes in a controlled study with multiple measures and long-term followup: Lovaas (1987); McEachin, Smith, & Lovaas (1993) 9/19 intensively treated children had IQ scores in normal range (mean gain: 30 pts), completed 1st grade independently; maintained gains at adolescence; only 1/41 children in two comparison groups had comparable outcomes. 11

12 Research (cont d) Partial and systematic replications of Lovaas model with comparison groups: Birnbrauer & Leach (1995) Smith, Eikeseth, Klevstrand, & Lovaas (1997) Smith, Groen, & Wynn (2000) Eikeseth, Smith, Jahr, & Eldevik (2002) Full replication of Lovaas (1987) intensive treatment: Sallows & Graupner (2005) Quasi-experimental study (no comparison group) of Lovaas model with independent diagnoses, objective measures of pre- and posttreatment functioning: Weiss (1999) 12

13 Research (cont d) Studies of broad-based intensive ABA: Controlled study (two comparison groups): Howard, Sparkman, Cohen, Green, & Stanislaw (2005) Case studies with objective measures: Perry, Cohen, & DeCarlo (1995); Green, Brennan, & Fein (2002) Other ABA models, quasi-experimental studies: Douglas Developmental Disabilities Center: Handleman et al. (1991); Harris et al. (1991); Harris & Handleman (2000) May Institute: Anderson et al. (1987); Luiselli et al. (2000) 13

14 Collectively, studies show Of children who entered treatment before age 5 and received at least 30 hrs/wk of competently delivered intensive ABA for at least 2 years, about 90% made moderate to large gains % had IQ, language, and/or adaptive skills test performances in normal range, performed at grade level with no specialized help, and/or no longer met diagnostic criteria for autism or any similar disorder % made substantial gains but continued to receive some special services. about 10-12% continued to require intensive treatment. Most comparable children receiving other therapies and services (e.g., eclectic treatment) made small gains or had losses. Most children who received less-intensive ABA (< 30 hrs/wk, < 2 years) made small-to-modest gains, but more than similar children in comparison groups. 14

15 ABA for Autism: What it is Not New Experimental Just another fad treatment A quick, easy fix A therapy A curriculum A cookbook approach A technique that can be learned simply by reading some books, watching some tapes, taking some courses, or attending some workshops 15

16 What ABA is Not (cont d) Lovaas treatment Discrete-trial training Different from Applied Verbal Behavior The exclusive discovery or property of any individuals or programs Just for bad behavior, or people with severe disabilities An intervention that turns children into robots Just for teaching simple, rote skills A miracle cure (though some children have achieved normal functioning) 16

17 Summary Contemporary ABA treatment for autism rests on more than 40 years of research No other treatment approach has a comparable empirical foundation. Lovaas and colleagues have made very important contributions, but so have many others. The Lovaas model of early intervention has been better researched than other models, but Has not been compared directly to other forms of intensive ABA, or to other treatments except lessintensive ABA and eclectic programming 17

18 Conclusions (cont d) Best available evidence supports competently directed and delivered early intensive ABA as effective treatment for autism, producing measurably large improvements in multiple areas of functioning for many children Factors responsible for variable responsiveness to early intensive ABA are not yet known. Which of the many ingredients of early intensive ABA are necessary for maximal effectiveness are not yet known. ABA techniques are also effective for producing improvements in many skill areas for older children and adults with autism. 18

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