ABA:What is it and how does it help?

Maggie Schweig, MD

UCI/CHOC Pediatrics – PGY1

Outline

GOAL:

To have a clear understanding of the principles and practices behind ABA as a General Pediatrician or subspecialist and be able to communicate this to our patients’ families.

u A bit of history

u What is ABA?

u What is done during sessions?

u Does ABA help?

u What are some other interventions available?

A bit of history…

u Time Magazine 05/07/1965 – “Screams, Slaps, and Love”

u Ivas Lovaas at UCLA; Later joined by Bernard Rimland

u Study with 4 children with “childhood schizophrenia”

u Behaviorism – reward & punishment to change behavior

u Positive reinforcers – food, hugs

u Negative reinforcers – scolding, shaking, electric shock

A bit of history…

What is ABA?

u Applied Behavioral Analysis

u Evidence-based framework from which basic principles of behavior change are applied to socially significant behaviors, to increase desired behaviors and decrease undesired behaviors

u Intensive behavioral intervention

u Based on theories of learning and operant conditioning

What is ABA?

u Goals of therapy:

u Maximize functioning

u Move toward independence

u Improve QOL for child & family

u Improve social functioning and play skills

u Improve communication skills – functional & spontaneous

u Improve adaptive skills

u Decrease non-functional or negative behaviors

u Promote academic functioning and cognition

What is ABA?

u Areas of development:

u Social skills

u Language

u Academics

u Daily living

u Self-care

u Vocational skills

u Specific intervention targets coupled with positive reinforcement and repetition

What is done during a session?

u Adapted to each patient’s needs & goals

u Low student-to-therapist ratio

u Skills are taught through repeated reward-based trials

u Variety of settings – home, self-contained classroom, inclusive classroom, community

u Data collection for monitoring changes to each behavior – frequency, duration, rate & trials to criterion

What is done during a session?

u Tools used:

u A-B-C –Antecedent - Behavior – Consequence)

u Token economy

u Differential reinforcement

u Self-monitoring

u Self-graphing

Does ABA help?

u Difficult to assess due to heterogeneity in ASD

u Diagnosis instruments may not show incremental improvements in core deficits

u Early intervention is critical

u May improve core symptoms of ASD and maladaptive behaviors but should not be expected to lead to neurotypical functioning

u Most gains with high level of intervention (30-40hrs/wkof 1:1 services for 2+ years starting before age 5yrs)

u BUT there is insufficient evidence that ALL patients NEED that much

u Controversy about use for older children & few studies to guide for this age group

Does ABA help?

u Limitations

u Length of time required to see improvements

u Questionable generalizability of learned skills

u Cost & availability

What are some other therapies available?

u TEACCH/Structured Teaching method

u Goal – modify environment & improve skills

u Focuses on – individualized person & family-centered plan, organizing physical environment, predictable activity sequence, visual schedules, flexible routines, structured work & activity systems, visually structured activities

u Developmental & relationship models

u Focus on teaching skills essential to development

u Integrative models

u JASPER (Joint Attention Symbolic Play Engagement & Regulation)

u Interventions for specific behaviors

What are some other therapies available?

u Communication interventions – speech therapy

u Traditional ST

u Behaviorally-based strategies to encourage language

u Augmentative communication strategies

u Visual supports

u Social skills instruction

u Joint-attention interventions

u Modeling

u Peer training

u Story-based intervention

u Occupational therapy

u Sensory integration therapy

Bibliography

u Applied Behavior Analysis, Autism Speaks. https://www.autismspeaks.org/applied-behavior-analysis-aba-0

u Applied Behavior Analysis: A parent’s guide, Autism Speaks. http://www.autismspeaks.org/sites/default/files/2018-08/Applied%20Behavior%20Analysis%20Guide.pdf

u DeFilippis M, Wagner KD. Treatment of Autism Spectrum Disorder in Children and Adolescents. Psychopharmacology Bulletin, 46;2:18-41.

u Helton MR, Alber-Morgan SR. Helping Parents Understand Applied Behavior Analysis: Creating a Parent Guide in 10 Steps. Behavior Analysis in Practice (2018) 11:496-503

u Sanchack KE, Thomas CA. Autism Spectrum Disorder: Primary Care Principles.AAFP.org. (2016) 94;12:972-980

u Weissman L. Autism spectrum disorder in children and adolescents: Behavioral and educational interventions. UpToDate.