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ABA (Applied Behavioral Analysis) and Autism

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What is ABA and would it be useful for my autistic son or daughter?

ABA is an acronym for Applied Behavioral Analysis.  It is one of the few behavioral interventions that has been extensively researched and tested and found to be effective for helping people with autism develop new and better skills.

Autistic Boy Sits Near Flowers

With Autism, It Is Not Always Easy To Find Pleasure, But Sometimes A Visit To An Outdoor Garden Can Provide A Moment Of Peace For The Autistic As Well As His Family

Also, several people from ORL have/do work with or have consulted for FEAT’s Rising Stars Academy in Bellevue which provides a precision learning/ABA preschool in Bellevue, WA.   They also have Saturday Autism and Siblings Drop-Off and Play Time, as well as summer programs.

It is much like dog training, in which a structure is created that demands a behavior (e.g. sitting still in a chair, saying a word) and a reward is offered when the behavior is demonstrated.  There is no punishment.

My sister actually worked in an ABA lab on the campus of Claremont McKenna University when she was there getting her undergraduate degree in psychology.  She talked about working with many children of differing ability levels.  On the lower-functioning end of the spectrum, children might be asked to sit still in a chair for a certain amount of time, or to make a “P” sound, puffing air onto their hand with their lips, as a precursor to saying something, like the word, “Please”, for example.

In her lab, they used food rewards frequently, such as Cheetos, but they also used other rewards like getting to spin the wheels on a truck (a stimming behavior that the autistic student enjoyed or found soothing).

When our son was diagnosed with autism, Children’s Hospital recommended we seek out ABA services.  We have used ABA for about 9 months now and it has been very effective in teaching him skills and new behaviors, even though he is on the high-functioning end of the spectrum.  They identified areas he needs to work on that I wouldn’t have realized myself, and have found effective ways to teach him things.

 

Examples of How We Are Using ABA To Teach Skills For High Functioning Autism

1) Verbal Processing practice – where he has to follow a series of instructions like “Put your hand on your knee, stick out your tongue and touch your nose with your other hand.”

2) See/Say – These are fun programs where he looks at pictures on a PowerPoint, and has to identify whether there is a problem, like is the person sitting on the floor relaxing, or did he fall and get hurt.  He also has done ones where he learns “community helpers” like police, firemen, lifeguards, etc.

One of the most important things to remember when training new skills, especially to autistic people is whether they can generalize what they have learned to other contexts.  For example, you can’t just show a flashcard of a policeman, or an apple, and consider that they know what that is.  You have to show a female police officer, a male police officer, an officer in a car, a drawing of a policeman, a photo of policeman, different colored uniforms, doing different jobs, and in different settings.  It’s not as easy at it looks.

3) Voice volume and positioning.  Helping Blake identify when it is appropriate to use quiet, regular or loud voices (e.g. at the library, when a baby is sleeping, in a conversation, getting someone’s attention across the playground, and in an emergency).  This is especially helpful, since he tends to look away and speak too quietly for people to hear, at least he used to.

4) Personal Data: He has memorized parents names and phone numbers, as well as his own name, and city of residence, in case of emergency/getting lost.

These are just a few examples of things that we have been learning.

We are using a model of ABA called “precision learning,” in which students are expected to be able to say a certain number of answers in a short period of time (e.g. name 20 hot foods in 30 seconds).  By learning the skill and drilling it until a certain research-studied-and-approved level of proficiency is reached, students are more likely to be able to remember and retain the information.  It is “burned in” a little better.

I think of it as creating new neural pathways in their brain that are then grooved deeper and deeper, just like a path in the forest, until it is a comfortable walking trail that they can go on more easily when they want to travel in that direction.

 

We are also using ABA in school in the following ways

Blake has an aid that goes with him to school 2-3 days a week.  She helps guide and coach him, sort of shadowing and prompting him.  TAG teaching is another unobtrusive way to reinforce desired behavior without being as intrusive/conspicuous, which I have encouraged my ABA aid to do with Blake.  (TAG teaching is clicker training for people.  You can learn more about it here.)  For example, when he goes up to apologize to a friend, like she asked him to, he might here a click from her when he says I’m sorry.  He might later receive a raisin from her (reinforcer), for his good behavior.

1) Collecting Data and coaching Blake to help him engage in imaginary play, respond to peers when they talk to him, and initiate conversations or requests (self-advocacy).

2) Tracking whether Blake is leading and following in imaginary play.

3) Helping Blake learn other students names via a photo book.

 

Arguments Against ABA

When we first told our Speech Therapist we were beginning ABA, she was surprised and disappointed.  She felt that ABA could be “robotic” and trained in methods that were not interactive or developmentally appropriate.  I subsequently found out our speech therapist and occupational therapist (Floor Time Model) followed methodologies that were more “developmentally based and student-led” where as ABA tends to be more teacher-led, where the teacher is going to tell you what they want you to learn, and going to help you learn it.

I was surprised that there was animosity between the two camps, but I guess if one therapist sees his/her work/progress with the student “Set Back” by training implemented by another instructor, that could be frustrating.

However, in reality, this has not been the case.

What I have found is that Blake is sometimes more willing to do ABA than others.  If he’s going through a lot of anxiety, he might fight it, and some programs are more “fun” for him than others, just like you would have harder or easier subjects to learn in school.

I think the key for him is to have an instructor who is engaged with him and his progress and gets very excited if he does well, who offers good rewards for accomplishments, including stickers, play time, and occassional field trips to places he wants to go.  Having a good reward schedule of short- and long-term rewards set up has been sufficient to motivate him in most cases.  The ABA therapists we work with actually monitor “assent withdrawal” where Blake asks not to have do a program, and when that is happening too much, they make adjustments to keep him happier with what is going on.

ABA has been an important part of our program and I feel it has been very helpful for Blake.  It’s the only therapy we have that actually keeps data tracking his performance.  It’s nice to be able to look at dots on a chart going up.  I’ve definitely had days where we’ve spent an hour in OT, playing with balloons and wondering “what is this teaching him?”  The therapist explains about gross motor skills and tracking where your body is in space, and dealing with the unexpected.  These are balloon lessons, and I know she has more in her head than what she explains to me each week, but it’s also nice to have part of his learning be “black and white.”

Apparently research shows that ABA therapy 40 hours a week is more effective at teaching measurable skills than 40 hours of mixed therapy, including ABA, and OT, and ST, etc.

The biggest objection to ABA, in my mind, is the very real problem of its cost.  It’s EXPENSIVE.  You can go through individuals, volunteers, students in training and pay $15+/hour for therapy delivery, plus the oversight of someone with a Master’s Degree, but increasingly the ABA model is moving toward the Agency approach which, with increased overhead, is more expensive.

Many people have turned to fund-raising, grandparents, and retirement funds to pay for ABA services.  Fortunately, there are many who have gone before us and advocacy has generated increasing instances of medical insurance coverage for this service, which can cost $50,000/year or more if paid out of pocket.  40 hours a week of programming might be more than you can afford, and I believe good results can be seen with fewer hours a week.  Right now we have 9 hours a week at school, and 9 hours a week at home for our program.  And our insurance just started covering it this year.  Thanks Premera!

This is one worth fighting for, if you can.  If you don’t have insurance, consider implementing a similar positive reinforcement training program, if you can, teaching the skills and ideas you think may be most useful.  Son-Rise and RDI are two alternative parent-led programs that can give you a structure for reaching out to, connecting with and teaching your autistic student.

Where to Find ABA Services In Seattle or Bellevue, WA

Since I like to leave a trail for those who follow, I wanted to list the ABA service in Seattle that we are using.  They are called the Organization for Research And Learning, and I have found them to be very helpful and flexible.  They do accept payment via self-pay, or they take insurance, if you have insurance coverage.

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