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Top 10 Myths About Applied Behavior Analysis (ABA)


Applied Behavior Analysis (ABA) therapy is currently the most universally heralded treatment for children diagnosed with autism spectrum disorder (ASD). ABA is a science based on the principles of behavior and backed by decades of empirical research demonstrating its effectiveness at changing outcomes for children on the spectrum. Intensive ABA therapy, which consists of a minimum of 25 hours a week of therapy, is designed to fit the specific needs, strengths, and weaknesses of the individual receiving treatment. The therapy is typically overseen by a Board Certified Behavior Analyst and its principles can be adopted into the home so that your child is undergoing intervention in their natural setting. Despite the acceptance of the scientific community, Applied Behavior Analysis is still mired in myth and misconceptions. This article will discuss some of these myths and provide the truths that debunk these misconceptions.

Myth #1: ABA is a not a scientifically proven form of therapy for autism.
Fact: Actually, the scientific evidence backing the use of ABA therapy for individuals with autism is overwhelming. Applied Behavior Analysis is an evidence-based practice and an analysis of past research articles yielded more than 550 published articles in scientific journals demonstrating the effectiveness of ABA. Furthermore, the National Standards Project and The National Professional Development Center on Autism Spectrum Disorderseach recently established the techniques that make up ABA, such as reinforcement, prompting, and discrete trail teaching (DTT) as evidence-based.1-2 The intervention was also endorsed by the U.S. Surgeon General in 1999 as effective “in reducing inappropriate behavior an in increasing communication, learning, and appropriate social behavior.”3 ABA is also the only autism-specific treatment commonly covered autism treatment by insurance providers, further solidifying its efficacy as a scientifically established intervention in the eyes of the medical community.

Myth #2: ABA therapy is a new treatment for autism.
Fact: Some fear that ABA is a new form of treatment for children with autism and that the practice is still in its infancy. In fact, the foundations of the principles of ABA can be traced as far back as the late 1950’s and early 1960’s with experiments on animal behavior. B.F. Skinner, who spurred the development of what is now known as behavior analysis, never intended it to be a science of animal behavior, but instead proposed “that the techniques of behavior analysis should be extended to explain and change the behavior of people in everyday arenas such as education, work, clinical problems, and social behavior.”4 In 1970, Ivar Lovaas, expanded upon Skinner’s work and applied it to children with autism. In 1981, Lovaas published The Me Book, which is essentially a training manual detailing the principles of behavior therapy and was supplemented with five videos to demonstrate his methods.5 Today, leaders in the field of autism may utilize teaching procedures evident in a Lovaas Model of ABA or lean more towards a Verbal Behavior approach. Both utilize principles derived in Applied Behavior Analysis, but look quite different in their implementation. A brief description between the differences of the two approaches can be found here.

Myth #3: All ABA programs are the same.
Fact: Not only are there possible differences in implementation, but NO TWO ABA programs are the same. Before an ABA treatment program is implemented, Board Certified Behavior Analysts (BCBAs) collect baseline data of children’s needs, interests, preferences, strengths, and family situation. Applied Behavior Analysis is a data-driven treatment and because no two datasets of individuals on the autism spectrum reveal the same symptoms at the same levels of severity each ABA treatment program is unique to the individual receiving intervention.

Myth #4: ABA is composed of solely table work/ sitting.
Fact: Individuals unfamiliar with ABA commonly mistake the intervention for Discrete Trail Training (DTT), which is indeed a teaching methodology used in an ABA program and does involve one-on-one instruction, commonly at a desk or table. However, it is only one of the many teaching methods and strategies used throughout a competent ABA treatment program. Others may include natural environment training (NET), activity schedules, modeling, reinforcement systems, PRT, self-management, and incidental teaching.6 One of the goals of an ABA program is to take advantage of naturally occurring learning opportunities. For this, ABA providers will give instruction in the setting when the skill will naturally occur during child-directed treatment sessions. The seemingly limitless, evidence-based options help make the intervention so effective at treating a disorder with a myriad of symptoms and varying degrees of severity.

Myth #5: ABA therapy is only for children with autism.
Fact: Although the treatment has been found to be highly effective as a tool for early intervention for autism, ABA treatment programs have been utilized to correct all sorts of behaviors for individuals around the world. According to Applied Behavior Strategies, “ABA providers are charged with the improvement of socially significant behaviors. Socially significant behaviors include communication, social skills, academics, reading and adaptive living skills such as gross and fine motor skills, toileting, dressing, eating, personal self-care, domestic skills, and work skills.” Furthermore, ABA therapy has successfully been applied to environment/sustainability issues, organizational behavior management, addictions, gambling, criminal forensics, and exercise.8 ABA strategies have also worked in adults who suffered from a stroke or brain injury.9

Myth #6: ABA therapy promotes robotic language/ behavior.
Fact: This myth stems from the misconception that ABA therapy is nothing but a series of drills and rewards, which causes children to display “appropriate” but robotic behaviors.10 People who mistakenly connect ABA treatment to robotic behavior often fail to realize the following:10
Rigidity and receptiveness are one of the diagnostic criteria for autism. Fortunately, research has demonstrated that “repetitive behaviors can be replaced with more appropriate behaviors that serve the same function for a child or adult with autism.”10
ABA employs a number of teaching strategies, which often consist of more than teaching children to answer questions or make statements in a preprogrammed way. Teaching language skills in a manner consistent with typical development, as well as teaching skills in a natural (generalized) setting (s) decrease the probability of responses being 'memorized' in both content and intonation.
Children undergoing ABA therapy have failed to comprehend what adults have attempted to communicate in the natural environment. These children have dealt with continuous failure in learning situations. Therefore, every effort is made to construct a teaching situation that maximizes a child’s success. To that end, when necessary, ABA providers will simplify requests. Opponents of ABA believe these procedures, such always asking a question the same way, using short instruction, rewarding with food, lead to robotic responses. However, they fail to realize that “these initial responses are just one part of an intervention focused on teaching new skills and transferring those skills into a variety of new situations, until a child learns how to learn in the natural environment.”10
Information purporting that ABA therapy and robotic behavior are connected is old, outdated, or just plain inaccurate.8

Myth #7: Anybody can direct an ABA treatment program.
Fact: Regardless of the state in which you live, if they extend coverage for ABA treatment, then it must be provided/overseen by a Board Certified Behavior Analyst (BCBA). These professionals undergo years of schooling, 1500 hours of fieldwork, and must successfully pass a lengthy exam before becoming eligible for certification.11 There is typically a team of people who support the therapeutic interventions (i.e. parents, teachers, direct care workers, siblings), but they are best overseen by an individual who is highly skilled, draws from the research, and has the ability to create data-driven individualized programs.

Myth #8: Children must undergo 40-hours of ABA therapy a week to achieve a positive effect.
Fact: The number of hours of ABA therapy an individual receives is based upon their baseline data and how quickly they exhibit progress. Applied Behavior Analysis for children with autism is most effective when ABA techniques are combined into a comprehensive, individualized and intensive early intervention program.12 The term “intensive early intervention” refers to treatment programs that are designed for children to begin under the age of four and are designed to be implemented 25-40 hours a week.”12 The aforementioned National Standards Report recommends that services for children with ASD should include a treatment program that engages the child for a 25 hours a week, 12 months a year “in systemically planned, and developmentally appropriate educational activity toward identified objectives.”1 Furthermore, these hours will “vary according to a child’s chronological age, developmental level, specific strengths and weaknesses, and family needs.”1

Myth #9: ABA programs institute punishment in their teaching procedures.
Fact: It is true that in its infancy, the pioneers of ABA implemented punishment within their treatment procedure in the last 1950’s, but, as you might imagine, this practice has been abandoned for decades.9 Dr. Lovaas originally used aversives, which is the use of something unpleasant, or punishment, to get an individual to cease engaging in a negative behavior, during his initial ABA experiments.13-14 Fortunately, according to the Lovaas Institute, aversives are void from ABA treatment programs, which currently rely on reinforcement as its fundamental principle. In a competent ABA treatment program, the only form of “punishment” should be the use no, or if necessary, withdrawing from the preferred object.9 In fact, within the Board Analyst Certification Board Code of Ethics manual there is an emphasis to use reinforcement over punishment whenever possible.

Myth #10: ABA uses bribes consisting of food and toys to manipulate children’s behavior.
Fact: Reinforcement is one of the cornerstones of ABA therapy. In the beginning of an ABA therapy program reinforcement is used frequently “in order to shape appropriate behavior and motivate the child to learn.”16 In the beginning, food, is paired with social praise to teach the child verbal praise, a type of secondary reinforcement, and is delivered at a high frequency.16 Food is often the initial reinforcer of choice because treatment participants are young, have a limited range of preferred items, and it is a natural reinforcer because it is something we need to survive.8 When teaching a child with autism, it is important to understand the difference between a promise and a bribe. For both, you are providing an item that has reinforcing value after a desired behavior, however the difference is when the possibility of that reward is offered. If the child's behavior is good or neutral and the offer for reinforcement is presented contingent upon behavior, then it is considered a promise. If the child is exhibiting non-compliant behavior and the offer of reinforcement is given as a means to gain compliance, then that would be considered a bribe. It is important for ABA treatment providers to not only find items that are reinforcing, but to also know when to offer those reinforcers/ possibility of reinforcement. Secondary reinforcers will be key to the intervention and “quality behavior analytic professionals will take strides to fade out food and introduce other types of reinforcers. This is often done by pairing the new item (e.g., preferred toy, song, etc.) or activity (e.g., high-five, hug, smile, etc.) with the original reinforcer.”8

Conclusion
We hope that this article has helped to clarify some of the most popular and damaging myths surrounding what is currently viewed as the most effective treatment for autism spectrum disorders. For decades, ABA therapy has proven to help child acquire new skills and decrease behaviors impeding learning. Although highly touted, the therapy is not without its drawbacks. The treatments can be timely and costly, with some programs costing as much as $60,000-80,000 annually. For more information about ABA therapy, view our article on National Autism Network. Also, visit our Provider Directory for listings for ABA providers, specialty schools for autism, additional treatment programs, legal resources, and more autism-related services in your state.




References:
1. National Standards Project. Massachusetts: National Autism Center, 2009. Accessed September 19, 2014. http://www.nationala...ards Report.pdf.
2. Wong, C., Odom, S. L., Hume, K. Cox, A. W., Fettig, A., Kucharczyk, S., … Schultz, T. R. (2014). Evidence-based practices for children, youth, and young ddults with Autism Spectrum Disorder. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development Institute, Autism Evidence-Based Practice Review Group. Accessed September 19, 2014. http://autismpdc.fpg...-EBP-Report.pdf.
3. “Endorsement of ABA: Surgeon General Endorses Behavioral Intervention for Autism.” Applied Behavior Center for Autism. Accessed September 19, 2014.http://appliedbehavi...ndorsements.htm.
4. Dixon, Dennis R., Talya Vogel, and Jonathan Tarbox. “A Brief History of Functional Analysis and Applied Behavior Analysis.” Functional Assessment foe Challenging Behaviors Autism and Child Psychopathology Series (2012): 3-24. Accessed September 19, 2014. file:///C:/Users/NAN1/Downloads/9781461430360-c1%20(3).pdf.
5. Buckmann, S. (1995). Lovaas revisited: Should we have ever left? Indiana Resource Center for Autism Newsletter, 8(3), 1-5,7. Accessed September 19, 2014.http://www.iidc.indi...edu/?pageId=436.
6. “Summaries of Scientific Research on ABA Training Procedures.” Association for Science in Autism Treatment (ASAT). Accessed September 19, 2014.http://www.asatonlin...edures_desc.htm.
7. “Getting to Know ABA.” Applied Behavioral Strategies. Accessed September 19, 2014. http://www.appliedbe...hat-is-aba.html.
8. Kelly, Amanda N. “Common Misconceptions about Applied Behavior Analysis.” Behaviorbabe. November 2008. Accessed September 19, 2014.http://www.behaviorb...conceptions.htm.
9. Kosky-Deskin, Brenda. “Autism & Applied Behavior Analysis: 10 ABA Myths Debunked.” Brenda’s Autism Blog (blog), July 10, 2013. Accessed September 19, 2014.http://autismbeacon....ut#.VBxVDvldXz-.
10. Rudy, Lisa Jo. “Can Behavior Analysis Make Children Robotic?” About Health. July 22, 2013. Accessed September 19, 2014.http://autism.about..../ABArobotic.htm.
11. “Standards for Board Certified Behavior Analysis (BCBAs).” Behavior Analyst Certification Board (BACB). Accessed September 19, 2014.http://www.bacb.com/index.php?page=158.
12. “Applied Behavior Analysis.” Autism Speaks, Inc. Accessed September 19, 2014. http://www.autismspe...or-analysis-aba.
13. “Aversive Conditioning.” Psychology Glossary. Accessed September 19, 2014. http://www.alleydog....ve Conditioning.
14. Coplan, James. “Making Sense of Autistic Spectrum Disorders.” Psychology Today, September 26, 2010. Accessed September 19, 2014. http://www.psycholog...-lovaas-and-aba.
15. “Myths about the Lovaas Institute.” Lovass Institute (brochure). Accessed September 19, 2014. http://www.lovaas.co...ovaas_model.pdf.
16. “Reinforcement and ABA Therapy.” ABA Therapists. September 5, 2003. Accessed September 19, 2014. http://abatherapists...nd-aba-therapy/.
17. “Myths and Misconceptions about ABA.” Priorities ABA. Accessed September 19, 2014. http://www.prioritie...tions-about-aba.