Applied behavior analysis – Giving kids the skills they need for life

Imagine living in a world that operates in a pretty standardized way with a brain that perceives and processes everything differently.

That push and pull is what children with autism spectrum disorder (ASD)—a neurodevelopmental disorder that affects communication, social interaction and behavior—experience every day.

It is estimated that one in 31 children in the United States has ASD, and it is more commonly diagnosed in boys than in girls. For these children, the struggle between what their brains are telling them and how they are expected to respond can be exhausting, overwhelming and isolating.

For parents of children with an autism diagnosis, seeking ways to make sure their children can flourish, grow and experience life in a safe way, can also be paralyzing.

Children with ASD have a wide range of abilities and strengths, and with the right support, they can thrive.

Applied behavior analysis (ABA) is one resource available to find the balance for children, to meet them where they are and to bring out the best of their unique personalities.

Autism is highly misunderstood by those not living it. In a black and white world, behavior can be labeled as good or bad by standards set by society. In the world of autism, behaviors are respected as the way the child communicates. A child’s actions or inactions can be the way they are telling parents, teachers and others, this makes me anxious or sad or happy.

Child is sitting on the floor and playing with block. BCBA sits next to child to observe and take notes on a clipboard

ABA myths and realities

MYTH: ABA is a new approach to autism

ABA was introduced as a scientific intervention for autistic individuals in the 1960s and 1970s, but behavior analysis has been around as a science since 1938. What is important to know is that ABA has evolved since its inception and methods have adapted as the understanding of autism has grown.

Considered an evidence-based approach, ABA uses principles of learning and behavior and positive reinforcement to teach new skills and behaviors, addressing challenges like communication, social interaction and self-care.

Board-certified behavior analysts (BCBA) provide ABA therapy services and are often assisted by behavior technicians in implementing care plans.

MYTH: Children with autism score low to high functioning

One major shift is thinking of autism in a linear fashion — a flat line with functioning levels moving from low to high. This is a much too simplified approach that can miss capturing the full picture of the child.

Modern ABA uses a more comprehensive approach and looks instead at a wheel of abilities taking into consideration the whole child and their views of the world. Everyone’s autism wheel looks different – and that’s the way it’s supposed to be. No two people are the same and everyone’s individual autistic experience should be recognized, celebrated and supported.

The autism wheel is a visual representation of different aspects of autism and how they are interconnected. Each spoke represents different characteristics or challenges associated with autism. The scores on the wheel indicate to BCBAs the strengths and areas for growth unique to each child.

These include:

Communication and social interaction – Challenges such as difficulties with requesting needed or desired items, following directions, nonverbal cues, maintaining eye contact or understanding social nuances.
Repetitive behaviors and restricted interests – Looks at the need for routines or rituals and explores areas of intense focus (called special interests).
Sensory processing differences – Increased or diminished response to sensory input like sound, touch, taste, smell and visual stimuli.
Cognitive and learning abilities – Understanding the unique learning profiles of a child, including areas where they have challenges or demonstrate exceptional skills.

Graphic of the Autism Aheel

MYTH: ABA sets to change who a child is or punishes behaviors

Today’s ABA centers around assent, or a child's willingness and agreement to participate in therapy or activities, even if they cannot legally consent, ensuring their voice and freedom are respected. Programs rely on cooperation and participation to work with a child to achieve goals. This allows them to be part of the process, not to comply just because they are presented with a task, but instead to be working together to engage in the best way possible to meet a goal.

In the past, ABA may have been seen as trying to eliminate behaviors or changing who the child is. Today’s ABA addresses behaviors that could interfere with learning, independence or create a safety issue such as hurting self or others and works instead to bring out what makes the child unique.

Instead of focusing on eliminating the behavior, ABA teaches how to replace that behavior with something more productive or providing an alternative that fosters safety and adjustment.

Instead of a focus on “no” or “bad,” positive reinforcement is used to shift to “let’s do this instead” and “this is better.”

MYTH: ABA is only for children with autism

Because it reflects how all human brains learn through positive and negative reinforcement, ABA therapy helps differently-abled children and adults who are neurodivergent adopt beneficial behaviors.

The principles and techniques of ABA can foster basic skills, including looking, listening and imitating. It can also help cultivate complex skills, such as daily living activities, conversing and understanding another individual’s perspective.

When should ABA be considered?

Starting therapy as early as possible during a child’s development can significantly improve outcomes. A reliable diagnosis cannot be made until two years old with most children officially professionally diagnosed by age five.

Between the ages of two and six, children’s brains are like sponges when soaking up new information, offering up the opportunity to start building strong behavior practices.

Age 3: Start with the basics of building trust with the therapists and then working on communicating and playing, setting the stage for future skills.
Ages 4-6: Take basic skills to the next level through building social skills, understanding emotions and learning independence moves.
Ages 7-12: Mix in strengthening school smarts and practicing social mingling.

For ages 13 and up, therapists help children and their parents find programs that are appropriate for the age group, where they won’t become bored or be surrounded by much younger children. This could be connecting them to recreational activities, social groups or talk therapy that can continue their progress.

The goal for older children is to guide them in life changes, daily skills and getting ready for education and work beyond school as they move toward adulthood.

Once diagnosed by a medical specialist as having autism, a BCBA performs a clinical assessment over the period of an hour or an hour and a half, one-on-one with the child, most of which is done through play and observation. The BCBA follows the child’s lead and looks at things like:

Ability to listen and follow directions, including imitation
Ability to identify and label items
Ability to engage in conversation
Ability to sit and stand in space
Ability to pay attention
Learner readiness skills

Based on this snapshot, they score the formal assessment and write up a report. There is a full realization that an hour is not enough time to capture a full picture of the child, but is a start.

Treatment plans are ever-evolving as the team gets to know the child better and adjust and flex with the child and family needs as the relationship grows.

Child at school wearing headphones and coloring at a desk

What is the time commitment?

Based on observation and the score during assessment, the intensity of services and level of support needed is determined. The first step is building a positive relationship with the child, creating an atmosphere of trust and safety, making sure they want to be there, tapping into how they respond best.

For a younger child who may be preparing for school, it could be recommended to do between 25-30 hours a week (comprehensive program). During that time, the team works on skills across all domains, including:

Communication
Socialization
Flexibility
Learner readiness
Toilet training

All of these skills focus on decreasing any behaviors that could be a barrier to learning and independence.

For some children, a more focused program could involve 5-15 hours a week, where only a few domains need to be featured.

A successful ABA program wants the child to be successful and enjoy coming to the center so there is built-in flexibility. That could require building up to the hours needed based as determined by the child, their ability to engage and what works best for the family unit.

The goal is always to support the child and the family as much as they need, in the easiest way possible, with the hope that as progress is made hours can decrease and the child will need the program less.

Benefits of a comprehensive ABA program

Not all ABA programs are the same. Though built on a foundation of principles, a strong program works with the child, parents and even teachers to create a personal treatment plan centered on what the child shows they need.

When ABA meets occupational, physical and speech therapy, families have a whole team working with and for them. When parents find a program that combines the specialized skill sets of many professionals, the whole child is considered. The collaboration of therapies allows kids to progress by addressing many areas of need, with therapists who fill each other’s gaps in expertise and specialties.

Occupational therapists focus on developing fine motor skills, sensory integration and work on activities of daily living like dressing, eating and hygiene.
Physical therapists address motor skill challenges like balance, coordination, posture and movement patterns through exercise and activities.
Speech-language pathologists help children with autism improve their verbal and nonverbal communication skills, including articulation, language comprehension and social communication.

Child and speech-language pathologist sit together at a table to complete speech exercises

Partnering with parents and other support persons

Key to all of this is the parents and others who are present for the child every day. ABA is meant to be a team of experts supporting families to bring out the best in their child. That includes partnering with parents through education, modeling and working together for a purpose.

Consistency in support and positivity takes away negative feelings the child may have from processing things differently. ABA allows the experts to work side-by-side with families to carry what is learned during the sessions over to the home and at school where children can test their newly-found skills and problem-solve challenges that carry over to the real world.

Creating a new world of respect and safety

Giving children the tools they need to weave their unique abilities into life in an atmosphere of respect is the collective goal of any pediatric therapy. ABA aims to bring more awareness and acceptance to those who walk among us and experience the world differently.

Resources are available to give parents the support they need to ensure the best possible future for their children. ABA and complementary therapies are extensions of the support children have at home and school, filling gaps, enhancing routines and reinforcing behavior that strives for independence.

Clinical contribution to this blog provided by Board-Certified Behavior Analyst Anna McFadden.

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