What Is ABA Therapy?

Applied behavioral analysis (ABA) therapy is an approach to treatment that focuses on using positive reinforcement to improve behavioral, social, communication, and learning skills. ABA therapy utilizes behavioral principles to set goals, reinforce behaviors, and measure outcomes.

This approach has been described as the "gold standard" in the treatment of autism. It is widely used and is associated with improvements in specific skills and decreased problem behaviors. However, it is important to note that this type of therapy is controversial because it has been seen as disrespectful and even dehumanizing.

How ABA Therapy Works

ABA therapy is rooted in the principles of behaviorism, particularly operant conditioning and the use of rewards and consequences to mold behavior. During the 1950s and 1960s, mental health professionals began utilizing principles like token economies in the treatment of conditions such as schizophrenia and developmental disabilities. 

Later, Ivar Lovaas, PhD, adapted ABA to treat autism. His approach was that behavioral and social skills could be taught while other behaviors could be extinguished by applying rewards and consequences. 

The earliest forms of ABA therapy often utilized negative reinforcement and punishment when children failed to display the desired behaviors. 

More recent perspectives emphasize that autism is a form of neurodivergence. This means that it represents a difference in how the brain processes information and suggests that autism is a disorder only because society expects people to behave in neurotypical ways. 

Types of ABA Therapy

A number of different types of interventions can be used as part of ABA therapy.

Discrete Trial Training (DTT)

Discrete trial training (DTT) involves breaking a skill down and teaching it step-by-step. The three components of this process include:

• The antecedent (a cue that triggers the behavior)
• The behavior (the response to the cue)
• The conclusion (what happens after the response)

When the behavior has been successfully produced, the individual will receive positive reinforcement, but will not be rewarded if they do not successfully produce the desired response.

Early Intensive Behavioral Intervention (EIBI)

This approach may be used in young children to teach social, adaptive, communication, and functional skills. It is usually highly individualized, intensive, and comprehensive.

Early Start Denver Model (ESDM)

This technique is based on applied behavior analysis and is often used for children with autism between the ages of 12 and 48 months. It utilizes play activities to help foster cognitive, social, and language skills.

Natural Environment Training

After people have acquired skills through discrete trial training, they then begin learning and practicing those skills in more natural environments. For example, a child may learn a specific skill and then begin practicing it at home or in school.

ABA therapy is also often delivered in two different ways. It can be used as a comprehensive program that provides intensive intervention in many environments and situations. Or, it can be part of a more focused program that may involve only specific behaviors or situations.

Comprehensive ABA Therapy

This approach delivers treatments that usually last for several hours each day. A therapist or behavior technician works with the individual for at least several hours each week and often in different contexts, such as in both home and school settings.

Focused ABA Therapy

This type of treatment may focus on helping an individual in a specific situation where they are facing difficulty. It may also focus on specific skills that an individual needs to work on. The individual often works one-on-one with a therapist, but they may also practice these skills in small groups or in community settings.

Techniques Used in ABA Therapy

ABA therapy usually involves a few different steps. Treatment plans are tailored to the needs of the individual.

Assessment

Assessment is the first step of ABA therapy. During this stage, the child or individual will meet with a therapist, who asks questions about strengths, weaknesses, needs, and goals. From this information, the professional will develop a treatment plan.

Treatment

Treatment will involve using different techniques to work toward the individual's goals. Treatment sessions can sometimes be as short as an hour, but they often last for several hours at a time. 

Caregiver Training

Caregiver training involves offering support and training to parents and other caregivers and family members. Therapists teach parents and family members skills and strategies that will help maintain desirable behaviors in the home, school, and community settings.

What ABA Therapy Can Help With

While ABA therapy is often discussed as an intervention for autism, it can be used for a variety of conditions. Some of these conditions include:

• Anxiety disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Autism spectrum disorders
• Borderline personality disorder (BPD)
• Developmental disorders
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Sleep problems
• Substance use disorders

Benefits of ABA Therapy

ABA therapy doesn't "treat" autism but it can be used to teach desirable behaviors and to reduce or extinguish undesirable ones.

For example, ABA may be used in autism to reduce tantrums, teach a child to sit quietly, or use words to make requests. It can also be used to reward a child for simple and complex skills, like brushing their teeth correctly or sharing a toy with a friend. 

Some ways that ABA therapy can impact an individual's life include:

• Acquiring and practicing social skills
• Decreasing problem behaviors
• Developing memory and cognitive abilities
• Improving emotional connections with other people
• Improving language and communication skills
• Improving attention and focus
• Learning daily living skills
• Managing feelings of aggression and anxiety

Effectiveness of ABA Therapy

ABA therapy has become a widely used treatment approach in the treatment of autism and other conditions. It has been linked to improvements in key areas including language, social skills, and adaptive skills.

• One study found that long-term comprehensive ABA treatment could help autistic children improve their daily living skills, language development, social abilities, and intellectual functioning. 
• A 2011 review of 27 studies found that ABA interventions were effective for improving social skills, adaptive behaviors, language abilities, and cognitive skills. These interventions were also helpful for reducing aggression and anxiety in children and adolescents.
• A 2012 study suggested that children with autism spectrum disorder should have access to a minimum of 25 hours per week of comprehensive ABA therapy, which has been linked to improvements in play skills, behaviors, language, and social communication.

Drawbacks and Criticisms of APA Therapy

However, ABA therapy also has drawbacks that should be considered. Critics suggest that it focuses too much on modifying behaviors that are seen as problems rather than focusing on helping people develop their strengths and skills.

Things to Consider

ABA is not the only approach to treatment, so it's important to listen and look at how a person is responding in order to determine which treatment is right for their needs.

While ABA is widely used today, it's not without controversy. In the past, this type of treatment involved hours of treatment each day, often done in rigid environments. Failures to produce desired behaviors were often addressed with harsh punishments, which were considered both disrespectful to those in therapy and often dehumanizing.

More recent approaches focus on either applying or withholding reinforcement and do not involve punishments. Rather than sitting at a desk doing discrete trials for hours each day, treatment is now often delivered in natural settings, including the home, school, and community settings. 

ABA therapy is often focused on getting people to engage in "typical" behaviors. Today, there is a greater appreciation and value for neurodiversity.

How to Get Started

If you are ready to try ABA therapy for yourself or your child, there are some steps that you can take to help find the best treatment for your needs.

• Get a referral. Talk to your doctor or child's pediatrician for a referral to an ABA provider. You can also search online for local service providers.
• Check with your insurance. ABA therapy is often covered by insurance, so check with your policy provider about coverage, and contact your therapy provider to be sure that they take your insurance.
• Find the right therapist. Start by checking that your therapist is a board-certified behavioral analyst (BCBA). Early ABA sessions often focus on building a rapport with the therapist, so pay attention to whether it seems like a good match.

As with other types of therapy, trying it and keeping an eye on how things go can be helpful. If you notice good outcomes over time, sticking with it over the longer term may be a good idea. If you or your child struggles with treatment or does not achieve good progress over time, it may be a good idea to switch to a different treatment approach.