What is ABA?

Applied behavior analysis is the extension of operant (focus on observable behavior in individuals) methodology to the modification of human behavior.

History of ABA (very brief):

Behavioral treatment applied to autism focuses on increasing behavioral deficits and decreasing behavioral excesses.

'ABA' is a general term. There are several different behavioral treatments for many disorders including autism.

Behavioral Treatments/Programs for Autism

Like behavioral treatments for other disorders, behavioral treatments for autism focus on observable, measurable actions of the individual. It is assumed that behaviors are under control of the environment Change is accomplished by manipulation of that environment.

There are many behavioral treatment programs for people with autism. Each program has many variations and improvements are consistently being attempted, often successfully. Major differences between programs are based on philosophical differences and include variations in intensity and specific behaviors targeted for intervention.

 

Review of Principles of ABA

The "ABC's" (Antecedents, Behaviors and Consequences)

A Antecedents are the events that happen before the behavior occurs.

B Behavior is the specific way the child acts.

C Consequences are the events that happen to the child immediately following the behavior

example:

A Patrick is in speech therapy. His speech therapist tells him to "sit down"

B Patrick hits the therapist.

C The therapist takes him back to his classroom.

Behavior

  1. What is Behavior?
  2. Defining Behaviors

    In order to change behaviors they MUST be well defined!

  3. Measuring Behaviors

    Measuring behaviors allows us to determine whether or not a behavior is increasing, decreasing or staying the same.

    Measurement is important to let us know if a program is effective.

  4. Measurement over the course of intervention occurs during baseline, treatment, post treatment and follow-up.

Graph here

Antecedents

  1. What is an antecedent?

    An antecedent is the event that happens just prior to occurrence of the target behavior. It includes: General circumstance- the circumstances that set the stage for the behavior (e.g. at breakfast, at speech therapy) Specific trigger event (e.g. "no", a command)

  2. Why is the antecedent important?

    Identification is important for 2 reasons:

    1. It allows you to predict when the behavior may occur
    2. By changing the antecedents, you can change the behavior
  3. Is there always an antecedent to a behavior?

    There is always an antecedent however, it is not always readily identifiable (e.g. with self-stim)

 

Consequences

  1. What are Consequences?

    Consequences are events that follow a behavior. They include Reinforcers, Punishers and neutral events.

    In general: Behaviors followed by pleasant consequences are more likely to occur again. Behaviors that are not followed by pleasant consequences are less likely to occur again.

    This principle is important to remember when you are working with your child. If you are teaching a skiII and the behavior is not increasing, you may not have a powerful reinforcer. If you are trying to decrease a problem behavior and it continues to increase, you may not have an effective consequence.

  2. Behaviors are generally maintained by 3 general types of consequences (see A-B-C Pattern examples 1-3):
    1. Attention (scenario 3)
    2. Escape or avoidance of an aversive event (Scenario 2)
    3. Tangible rewards (play, candy, beverage, etc.) (Scenario 1)

    By examining and understanding antecedents and consequences maintaining behaviors, we can change them to alleviate problem behaviors and increase desired behaviors.

EXCERCISE

The next two pages contain vignettes. Identify:

How would you treat (behaviorally) the problem?

  

A-B-C PATTERN

Scenario I

Paul's dad takes him to the grocery store. In the store Paul sees a toy he wants but his dad tells him no. Paul throws himself on the floor, kicking and screaming. His father, quite embarrassed by the tantrum, buys the toy for Paul.

Scenario 2

Sarah screams and bites her hand whenever her parents try to teach her a new activity, pointing to pictures. As soon as she begins to scream, they terminate the teaching session.

Scenario 3

Matthew jumps up from the table at mealtimes and runs around the house. One of the family members always chases after him and brings him back to the table.

 

 

A-B-C Pattern Examples

Instructions: For each example, identify the antecedent(s),..specific behavior and consequence maintaining the inappropriate behavior.

(1) Rachel's father asks her to pick up her toys and Rachel refuses by saying "no." Her father asks two more times without success and then he picks up the toys himself.

(2) Jackie is able to dress herself and does so independently without making a fuss on the weekends and when changing into her pajamas at bedtime. However, every weekday morning she fusses and whines as her mother stands over her urging Jackie to dress quickly before the school bus comes. Her mother, annoyed, helps Jackie finish dressing as the bus pulls up in front of the house.

(3) Nicholas' father fixes him a well-balanced dinner of foods his teacher reports he will eat for lunch at school. However, at home, Nicholas refuses to eat pushing his plate away. His father, not wanting him to go hungry, gives Nicholas his favorite food, jello.

(4) Tammy often rocks and bangs her head against the wall as her mother attends to her new baby sister. Tammy's mother reacts to this by immediately hugging and attending to Tammy, often offering her food and toys.

(5) Archie has a language delay but has been observed to use some appropriate language at school. Archie's parents have not been able to elicit the same language at home. Before giving Archie something he clearly wants, his parents prompt him to use his words to ask for it. Archie responds by tantrumming until his parents finally give him what he wants.

(6) Kathy's parents have decided that it is time she learn to eat with a fork and spoon. To start out, they have decided to teach her during dessert time. After Kathy finishes eating her dinner with her hands, she is presented with a bowl of ice cream and a spoon. Her parents put the spoon in her hand, and guide it toward her mouth. Kathy reluctantly takes the first bite then shoves the bowl off the table as her parents prompt her to take another. Kathy's parents remove the bowl, clean her up then continue their typical evening.

 

 

 Behavioral Assessment

  1. Find the function of the behavior
    1. Define the behavior
      • What, where, who, when, How intense, what does it look?
      • Your description should allow someone not familiar with the behavior to readily identify it
    2. Obtain history of the behavior
      • When was the onset?
      • Has it happened before, under what circumstances?
      • Does it or has it corresponded to certain times of year, events, etc?
    3. Analyze antecedents and consequences
      • Circumstances that precede the behavior: Where, w/whom, what activity (scatterplot)
      • Circurnstances that follow the behavior
    4. Environmental analysis
      • Is the learning situation appropriate (developmentally, cognitively, functionally)?
      • Is the child healthy
    5. Meaning of the behavior
      • From the data you collect, what can you conclude about the meaning of the behavior for that person? Communicative, stress release, attempt at socializing?? 
  2. Find an acceptable functional equivalent of the problem behavior

    A Functional Equivalent of a problem behavior is an alternative, acceptable behavior that serves the same purpose for the child.

    Example: Tommy hits his teacher sometimes when she sits next to him at his desk during a color sorting drill. Ms teacher reacts by explaining to Tommy why he shouldn't hit and putting him into time-out. When he comes back she gives him another activity to do.

    1. Problem behavior:
    2. Antecedent:
    3. Consequence:
    4. Functional Equivalent to problem behavior:
  3. Changing the Behavior
    1. Teach the functional equivalent (appropriate skill) to replace the problem behavior
      • Once the functional equivalent is found, it needs to be taught using basic behavioral principles.
      • Skills to be taught may include: Communication (verbal, non-verbal), self-help skills, play skills, academic skills underlying more complex skills
    2. Change the antecedents of the problem behavior
      • If the child's problem behavior functions to avoid a situation change the antecedents. Ask yourself the following?
        • Is the task too difficult?
        • Is the environment overstimulating?
        • Is the environment understimulating (boring)?
        • Does the child require more structure in his/her activities?
    3. Change the consequences of the problem behavior

      If a problem behavior has developed, it has been rewarded in the past. To decrease a problem behavior, the consequences must be changed.

BUILDING ON SKILLS


LIFE GOAL INDEPENDENCE      
LONG TERM GOALS ELIMINATE DISRUPTIVE BEHAVIORS INCREASE SOCIAL SKILLS INCREASE SELF-HELP SKILLS INCREASE ACADEMIC PROFICIENCY
INERMED. GOALS
  • Communication
  • Self-help skills
  • Self-management
  • Environmental Adjustment
  • Play
  • Language
  • Play
  • Perspective Taking
  • Language
  • Specific skill chains
  • Self management
  • Language
  • Fine Motor
  • Pre-Academic skills
SHORT TERM GOALS
  • Short term goals are the many small steps that are combined to make up intermediate goals.
  • For example: short term goals for development of language may include functional use of specific sounds, words or guestures.
  • Short term goals can be effectively taught using Behavioral methods such as Discrete Trial, PRT, or Structured Teaching.

 

Concepts for Individualized Programming. Behavioral "Tool Chest"

The population of persons with Autism is heterogeneous, each having some similar characteristics but so divergent that individual programming is essential. There are a myriad of different treatments for autism. Some are comprehensive programs and some address only specific areas of the disorder. Treatments not considered to be behavioral include Biological treatments (e.g. naltrexone, Fenfleuramine, nutritional supplements, etc.), Sensory integration therapy, Facilitated communication, Psychoanalytically influenced treatments (e.g. holding therapy, play therapy, etc.) and Auditory integration training. Behavioral treatments (those incorporating ABA principles) have to this date shown the most promise experimentally. Numerous studies are now showing neurological correlates to Autism suggesting future success in treating autism biologically. The other treatments mentioned have had mixed results and few if any conclusive, valid studies have been performed on them. Ideas to Keep in Mind

  1. There is no cure for Autism-yet
  2. There is no single correct approach for all children-yet
  3. It appears that high functioning children can sometimes attain near "normal" functioning in some areas.
  4. There are many variables that determine the success of a program
  5. Unlike children with Down's or other developmental disabilities, these children look "normal". This may be one factor that encourages parents to unlock "the normal child within" and to be vulnerable to those who advertise "cures".

A Review of Popular Programs

The above programs have been implemented with large numbers of children and have been empirically validated as effective, although different studies report different success rates. These programs each place emphasis on different areas of intervention. Discrete trial methods are effective to teach novel responses, discriminations, chains of responses to form new skills and some academic skills. Naturalistic strategies such as PRT are most effective for teaching emerging skills, spontaneous responses, for fostering generalization and for developing functional/social use of skills. Programs that emphasize environmental structure such as TEACCH are most effective for teaching functional routines, fostering generalization and providing structure and predictability in the child's daily routine.

None of these programs alone provide a complete intervention. Using the 3 approaches together in some form may be the most optimal programming for children with Autism. A possible combination is to rely primarily on naturalistic strategies within a structured environment using discrete trial methods to hasten acquisition of certain skills.

Discrete Trial

Pivotal Response Training (PRT)

Pivotal Response Training (PRT) ( is another behavioral program that like Discrete Trial utilizes empirically validated methods based on the Principles of Learning. It incorporates the Stimulus ----->Response ~> Consequence paradigm that unlike Discrete Trial emphasizes Child directed activities, Reinforcement of goal directed attempts as well as correct responses, Turn taking, and Direct reinforcement. Because it is easily adapted to any environment at any time PRT is an ideal strategy to be implemented by parents, siblings and peers. PRT shares some ideas of Incidental Teaching (A teaching strategy that relies on naturally occurring opportunities in the environment to promote learning) although it is more structured. Older references to the language component of PRT are labeled Natural Language Paradigm.

 

Structured Teaching (e.g. TEACCH: Schopler, Mesibov & Baker, 1982)

Teacch is a program whose principles have been implemented for over 20 years. It is wen adapted to classroom use as it promotes independence in students. TEACCH is designed to improve environmental adaptation. This is accomplished through structured teaching by a) modifying the environment to accommodate the child with autism's individual needs and b) by teaching specific skills

The 4 components of structured teaching are:

  1. Attention to Physical Structure
  2. Schedules
  3. Work Systems
  4. Task Organization