In our Guide to ABA Therapy, we will get you up to speed on what Applied Behavior Analysis Therapy is, why it works, and how our integrated approach can be beneficial for your child’s development in therapy for autism.
Published on August 8th, 2020
Updated on January 27th, 2022
What is ABA Therapy?
ABA stands for Applied Behavior Analysis. ABA therapy is a science focused on improving behaviors that are important to your child and family and teaching new skills to help your child reach their maximum potential. ABA therapy is used to target challenging behaviors that may be getting in the way of your child’s development and improving those areas. Ultimately, we want to increase desired behaviors and decrease challenging or undesired behaviors.
Whether you realize it or not, you and everyone around you are using the basic science of ABA. Because we are all connected to and influenced by our environment, we all experience our behaviors changing based on the reinforcement and/or consequences that are happening around us. In other words, the context of our environment shapes our behavior by the positive and negative reactions in which we come into contact with.
The science of ABA therapy is an efficient and effective way to improve upon the behaviors of your child. This is all done in a safe, ethical way and it’s all supported by decades of thorough research.
What Are Benefits of Applied Behavior Analysis Therapy?
The benefits of ABA therapy are well documented. The ways we have improved upon and adapted different strategies within the realm of ABA has only served to increase the success of its methods. Specifically for parents, being familiar with the strategies and techniques of ABA allows you to be more confident in teaching your children new skills, meaning you are able to become more involved in their development.
Also, you will increasingly become more effective in handling any problem behaviors your child may exhibit, opening up more avenues to integrate your child into different environments. For example, if your child has a tendency to display problem behaviors in crowds of people or out in the community, being able to recognize the precursor behaviors, and how to deescalate those behaviors, will help you to ease your child into these situations more effectively. Having the knowledge of ABA as a parent will increase your confidence, decrease stress, and lessen some of the obstacles to the healthy development of your child.
Further along in this guide we will discuss more specifics on different ABA therapeutic teaching strategies. By being familiar with these ABA practices that your child’s technicians or Registered Behavior Technicians (RBT’s) are using within sessions, you will be able to take those same principles and bring them into your home environment. This will keep the learning journey consistent across settings and help you to optimize your child’s motivation to learn. This can increase compliance, create more natural opportunities for learning, and greatly improve the likelihood that your child will appropriately interact with family and peers.
The biggest takeaway you can have as an ABA parent is that your child’s learning will become more interactive, fun, and engaging. Having even a basic understanding of ABA therapy and its principles will allow you to have a more involved role in this learning and you will be right in the thick of things with the therapists in terms of seeing the improvements your child makes.
Eventually, as your child progresses through therapy, you will be able to see the benefits of the strategies being used. When your child starts developing the various skills they will be working on, you will see the increased confidence they have to behave independently in situations they otherwise would have held back on. The use of reinforcement gives you a way to naturally teach your child that certain behaviors will be less “valuable” to them, meaning they don’t gain access to the things that they want in that moment if they exhibit that specific behavior. Or, behaviors will become more “valuable”, meaning they will gain access to those reinforcing items based on appropriate behaviors.
Is ABA Therapy only for Autism?
In your research of ABA therapy, you’ve probably noticed that it is primarily used to teach and help the development of children with Autism. ABA is not just for autism and is actually used to help with many mental or behavioral disorders. The behavioral interventions used within ABA therapy can be utilized to treat any type of mental or behavioral disorder. The strength of ABA comes in its ability to shape human behavior. It is also easily adaptable to individuals and can be tailored to fit the needs of that individual, meaning there isn’t just one specific situation or diagnoses that can benefit from ABA.
At its core, ABA therapy uses techniques in order to assess, analyze, and treat any behavioral excess or behavioral deficit. This pertains to all ages and levels of development as well. It’s the science of teaching and learning and its principles can be used to help children, as well as adults, with any skills they may be lacking in order to help them be better integrated into their environments. The variety ABA therapy provides makes it a great option for any behavioral needs.
What does an ABA therapist do?
Ultimately, an ABA therapist is there to help your child with development and learning. But in order to do this effectively, the therapist needs to make the environment positive, fun, and reinforcing. One of the first things an ABA therapist does with any child is “pair.” Pairing is a technique used to really get to know your child, finding out what they enjoy and what they don’t enjoy. This allows the therapist to not only make the experience fun for your child, but also figure out what motivates your child and how strong that motivating factor can be during the learning process.
Learn more: What does an ABA Therapist do?
The goal is to “pair” a learning objective, an action, or even just the therapists themselves, with a reinforcing item or action. The process of pairing is critical to creating that connection and trust between the therapist and your child. It’s not uncommon for a therapist to spend a good portion of the first few sessions just playing with your child. Knowing that therapy involves more than just completing tasks and objectives allows your child to be more comfortable and willing during a session.
Experienced therapists will use reinforcers, like your child’s favorite toy or their favorite game, to show that they are more than just an instructor. The goal of the therapist will be to establish the fact that they are an avenue for fun and that your child’s reinforcing items or actions are more enjoyable with the therapist involved, rather than without them. If a therapist is successful in creating this relationship, it makes the teaching of your child that much easier.
Another way therapists will work off of reinforcers is to expand those interests into more of a variety of items and activities. This is important because it creates more opportunity for your child to interact with peers. The more activities and toys your child enjoys means more connections that can be made with those around them.
Within a session, the therapist is working off of a comprehensive and individualized treatment plan that is designed to address the specific needs of your child. The plan is developed by a team made up of one or more Board Certified Behavior Analysts (BCBAs). Goals will be developed directly based on assessment results. The BCBA will pull the goals that directly meet the deficits that are displayed in the assessment. It will also include a behavior intervention plan for any challenging behaviors that may need to be targeted.
Read More: Why is ABA Important for Early Intervention?
Throughout the session with your child, the ABA therapist will be collecting data. The data includes correct and incorrect responses during programs, frequency and duration of behaviors, instances of communication, prompts needed to complete the skill, among other things. This data is then graphed, allowing the BCBA(s) to analyze the progress or lack of progress made by your child. Having this data readily available allows for any modifications to be made if/when necessary to increase progress with your child.
Communication is key within ABA therapy. A therapist will be in regular contact with the BCBA overseeing the treatment plan. This includes any significant changes or needs during the session or new behaviors that arise. Communication also comes into play when discussing sessions with you as the parent. An ABA therapist knows the importance of keeping you in the loop, and will give you updates at the end of each session.
What is a typical Session Structure of ABA Therapy?
Before each session, the therapist will have an idea of what programs they will work on that day.
Each therapy session will typically start with the therapist going through a pairing phase with the child. This includes pairing themselves with reinforcers so that the child sees them as a “giver of fun things.” Also, it’s important for the therapist to find out what the child will be motivated by during that particular session. It’s not always the same reinforcers that are motivating from session to session, so it’s important to figure this out each and every time.
Another big part of this pairing process is to demonstrate for the child that their session isn’t all about work with no play. Therapy should be fun for the child and the therapist, that’s when the most meaningful learning takes place. This phase of the session is when the all-important rapport building takes place. Trust is developed during this time and a connection is made between the child and the therapist.
During the session, the therapist will intertwine play with teaching. It’s important to keep learning engaging for the child, so introducing moments of play and interaction is key to a successful session. A good therapist will always be looking for reasons to praise and reinforce the child. Even if the child is having an off day, displaying more problem behaviors than usual, or just not quite grasping programs as well as they normally would, there are still small victories to celebrate. These small victories can help get the learning momentum back on track and also keep your child comfortable, happy and motivated. This is where that rapport building in the beginning of the session comes into play. Good rapport between the therapist and the child can help the session through some of the tougher times.
Because therapy sessions should never be all work with no play, we make sure to incorporate reinforcer leisure/break time between programs. However, even during these times there are learning opportunities to be had. Keeping the child engaged and interacting with those around them throughout the session is important, even during these leisure times. An example of this is when two children are playing together during a break. Maybe they both want access to the same toy. The therapist can take this opportunity to teach sharing or even collaborative play. This is also a great opportunity to work on social skills with peers as well.
How long does ABA therapy last?
How long your child’s ABA therapy lasts is completely dependent on several different factors. Each child is different and it’s impossible to give a concrete timetable on how long treatment will take. Some factors to take into consideration are the complexity and severity of your child’s problem behaviors, the scope of skill deficits, the age of your child, your child’s learning history, and parental involvement.
In some cases, ABA therapy is a temporary intervention for your child’s development process. In other cases, the child may need to have long-term therapy to ensure the continuation of progress in certain areas, as well as reducing the chance of regression. Again, this will totally depend on the specific child and situation.
However, it’s important to remember that your child will be progressing, even if the changes are more subtle. Because ABA has so much evidence pointing to its effectiveness, it’s important to be patient and trust the process involved. Also, don’t be afraid to ask as many questions as you can think of so that you fully understand how your child is developing.
Does Insurance Cover ABA Therapy?
Over the last decade or so, huge strides have been made in the awareness and development of ABA therapy. Because of this, over 200 million people have insurance coverage for ABA therapy and all 50 states now have mandated coverage for ABA. The details of your insurance plan will dictate what coverage you have.
We understand that this can be a stressful process to set in motion, and because of this, we will be there every step of the way. Our team at Ally Pediatric Therapy will answer any questions you have and will take some of that burden off of your plate. We want to help you get set up with your coverage as quickly and seamlessly as possible so we can start helping your child. Different plans cover ABA in a variety of capacities and we are happy to check to see what that looks like.
Because ABA therapy is not a one-size fits all treatment plan, it means there needs to be different ways of teaching based on the patient. There is an abundance of different techniques and strategies we use within ABA therapy that can be tailored to the individual child.
While doing your research about ABA therapy, it’s likely that you’ve come across many different terms that you probably aren’t too familiar with. This can be frustrating as a parent, not knowing exactly how your child may be taught going forward. It’s natural to have questions as a parent being introduced to ABA therapy, which is why we want to provide you with this guide to help make the transition easier.
What are these ABA strategies I’ve read about? How do they work? What does this mean for my child’s therapy? What will my child’s day look like during therapy? Which one is right for my child?
The following will provide you with some answers to these questions and hopefully allow you to be more familiar with the teaching methods that will be used during your child’s development.
Natural Environment Teaching (NET)
Natural Environment Teaching, or NET, is one of the most commonly implemented principles of Applied Behavior Analysis (ABA). ABA is the gold standard for treatment of children with autism, and this is because NET and other naturalistic teaching strategies contribute to a framework that is designed for long-term behavioral development.
Incorporating natural environment teaching lesson plans can help your child’s therapist or clinician target specific impediments and allow your child to generalize across other environments. Because ABA therapy is so data-driven, the efficacy of these teaching techniques is traceable, while these metrics give credence to NET being extremely effective for treating certain behaviors. Read more to see how NET might be appropriate for your child’s ABA framework.
What Are Naturalistic Teaching Strategies?
NET is a tenet of ABA strategy, and it is all about naturalistic learning through play or education. This means that your child isn’t only learning in a clinic, with a therapist, or in a predetermined school curriculum; the goal is to apply ABA parameters across multiple environments and locations.
Because there are so many highly structured ABA principles, NET can act as a balance both for the way your child learns but also the way they feel about their exercises. After all, we don’t want therapy to seem like a chore, and getting into a more natural environment can make these exercises seem less like work for a child. Some tactics to achieve this include:
Sometimes the behavioral chain in a real-life setting can be the best teacher. For example, if a child is hungry or thirsty and learns to ask correctly (using the correct term for a food, or including ‘please’), the reward can be that food or beverage.
Education in Natural Settings
Almost any environment can provide opportunities for teaching moments within a NET framework. Grocery stores, playgrounds, and restaurants all have unique challenges that can be related to specific skills. If these behaviors begin to appear across multiple environments, there is a better chance your child will grasp the generalization of them.
Teach While Your Child is Interested
It is human nature to devote more effort to a subject or situation that excites you. Thus, when your child is showing interest in something that you can use as a teaching moment, this is one of the best times to apply a NET behavioral strategy you are working with.
There are many other naturalistic teaching strategies encompassed in both ABA therapy and NET. The most important thing for you and your therapist to focus on is maintaining the ‘natural’ portion of any environment. To your child, playing or interacting with their peers is the main focus, and they will be able to generalize each lesson better if it occurs within an environmental flow.
Pivotal Response Treatment
Pivotal Response Treatment (PRT) is one of the core components of Applied Behavior Analysis (ABA) therapy. It is a play-based therapy technique initiated by your child, and the goal of PRT is to help improve behaviors in language, communication, and life skills. More importantly, PRT is able to target areas of behavioral development or ‘pivotal’ points, rather than focusing solely on individual behaviors.
In order to get your child the best autism treatment at the right clinic, having an understanding of the services offered is ideal. We will detail how PRT can and likely will be an integral strategy used by you, your therapist, and your child’s support group moving forward.
The short and long-term results of PRT have been extremely positive; this is why the data-driven therapy approach to ABA has become the gold standard for modern autism treatment. It is much easier to make decisions about specific treatment pathways for your child based on a framework designed by therapists who will track each behavior and adjust as need be. PRT plays right into this, as it works to help your child with their specific needs, rather than trying a one-size-fits-all approach.
The behaviors, exercises, and treatments that are implemented in PRT will typically include:
Natural environment-based treatments
These environments include home, school, and socializing with peers.
The more allies that your child has across each environment, the more teaching moments can be created.
Communication and Coordination
Your therapist or clinician should be providing the goals, exercises, and framework of a PRT treatment to anyone who is interested in helping your child change their behavior.
Specific Pivotal Areas
Your child and your family have unique environments and circumstances to deal with. As such, the pivotal areas and behaviors being worked on need to be specific to what everyday life looks like for you and your child.
Pivotal Response Treatment breaks down behaviors into micro-components that can be worked on in friendly environments, which increases your child’s chance of success. ABA therapy and PRT do a great job of showing you and your child’s therapist the logical next steps and the best ways to achieve behavioral change.
Discrete Trial Training
Discrete Trial Training (DTT) is adult directed instruction that uses mass trials and a chosen reinforcer to teach new skills. The formal steps in the DTT process are as follows:
- The behavior tech will deliver the instruction.
- The behavior tech will provide the appropriate prompt if/when necessary to assist your child in evoking the correct response.
- Your child will emit the response
- The behavior tech will deliver the chosen reinforcement for the correct response or corrective feedback for the incorrect response to your child.
- Intertrial interval ends one trial and signals that the next trail will be starting.
DTT uses arbitrary reinforcement and is often done at a table. This method is best for targeting discrete skills: skills that have a clear beginning and a clear end. Examples of discrete skills are: colors, letters, numbers, vehicles, etc.
In the field of ABA, we define maintenance as teaching skills so they will remain in your child’s repertoire, even after the teaching of that skill or behavior has ended. To achieve independence, we need to ensure your child is able to perform these skills or behaviors without prompting and have them occur naturally.
Generalization is one of the more important aspects in providing this meaningful learning. We want to make sure the results we get with your child are long-term results that will bleed into other skills, behaviors, environments, and with other people. This means making sure each behavior and skill is learned so that it’s carried over into environments other than where it was originally taught, as well as with other people outside of the therapist(s) who did the teaching. Achieving generalization is an indicator that the skill or behavior has been fully learned.
Prompting isn’t necessarily a teaching method, however, it is used in all of the teaching methods listed above in one way or another. When first learning a skill, your child will obviously need some assistance. Prompts are ways to help your child learn and are a necessary avenue for independence.
It’s certainly possible that when first learning a new skill, your child will reach a correct response by continually making mistakes along the way. It would be more beneficial for your child to learn the most efficient way to a correct response, however. When learning, allowing the child to continually make mistakes on the way to a correct response may increase the likelihood those mistakes remain. Afterall, they did eventually reach the desired behavior. But by prompting, we are teaching your child to get to that response with the least amount of resistance possible.
Like most things within ABA therapy, prompting comes in a variety of forms. It all depends on the skill being taught, how far along the child is with this skill, and how the individual child learns best. Some prompts are more intrusive while others allow for more independence. Some examples of prompting are:
- Physical prompts: Physically helping the child complete a task
- Gesture prompts: Using an observable gesture (pointing, nodding, etc.) towards a correct response
- Model or Visual prompts: A picture or cue given by the therapist that provides information about correct response
- Verbal prompts: Giving some sort of verbal cue towards the correct response
There are different variations of each of these prompts, some more intrusive than others. The prompts used will be chosen based on the program being taught and how the child learns best.
Eventually, the goal is to continually fade prompts until your child is independent with the skill or behavior. Some practices use a prompting hierarchy to fade prompts. In these cases, programs will start with the most intrusive prompt and, as criteria is met, the teaching will include less intrusive prompts until it’s mastered at full independence. This method is known as Most to Least prompting.
There are also programs that call for Least to Most prompting. This is where the therapist would start with either no prompting or the least intrusive prompt possible. More intrusive prompts would only be introduced with incorrect responses. This provides the child an opportunity to succeed with independence before corrections are given by the therapist.
Data-Based Decision Making
Regardless of the teaching method, ABA is a data driven form of treatment. It relies on research, as well as data recorded in real time, to produce the programs and methods that are effective for each individual patient. The continuous influx of relevant information is what sets ABA apart from other teaching methods and makes it the most effective way of teaching our children.
Paying close attention to the details on a case by case basis ensures that the decisions we make on programming are best for that child. Each decision will be backed up by data and results, guesswork will never be in the equation. All members of the team working with a child will have access to data and each session will have data taken throughout its duration. The most up to date information will always be there for the team to make the most effective decisions. By doing so, we can adapt our methods as each child progresses throughout therapy.
Three – Term Contingency for ABA Therapy
Three – Term Contingency is a foundational aspect of ABA Therapy. Many times referred to as the “ABCs of behavior”, it generally highlights how behavior is influenced by our environments, as well as how the consequences of these behaviors can shape its propensity for future occurrences.
The three step process, or the “ABCs”, we are referring to are:
- Antecedent: events or actions that come BEFORE a behavior or response
- Behavior: resulting action from the antecedent
- Consequence: event or action that comes AFTER a behavior or response
Within our teaching environments, the RBT will be looking for a specific response or behavior from the child after delivering a specific opportunity. When the desired response or behavior occurs, a desirable reinforcer is presented for the child. This increases the likelihood that the response or behavior will occur again. The child will recognize that certain behaviors or responses will give them access to what they want.
Understanding the three-term contingency will also allow the supervising clinician to know why a challenging behavior is happening or determine its function. The BCBA will look at the consequence, or what is maintaining, the challenging behavior. How or why your child is getting what they “want” by engaging in the challenging or undesired behavior.
ABA says there are four main functions of problem behavior. Your child will engage in the challenging behavior to either gain attention, escape or avoid a non-preferred task or situation, to gain access to tangibles or something they desire, or automatic reinforcement. Automatic reinforcement can be thought of as something that appeals or offends the senses.