CEPA’s Services are informed by decades of research in the behavioral sciences and are delivered using a variety of methods and techniques to support individuals with Autism Spectrum Disorders (ASD) and their families. While no two programs are exactly the same, there are several underlying principles that are characteristic of effective ABA service delivery and which are supported by research. It is helpful for parents and caregivers of children with autism to have a good understanding of these basic principles so that they have a realistic understanding of the quality of ABA services they are receiving and so that they have a solid understanding of how children with autism develop over time.
Reinforcement: the Engine That Drives Learning
In ABA, reinforcement is the backbone of changing behavior, but its effective use requires consideration of several critical variables.
Positive reinforcement does not have to mean constant praise and treats. First, the adult must know what motivates individual children. For some kids it might be the chance to play with a favorite toy or book. Other kids might be motivated by social interaction, the sound of verbal praise, or other things. Some children are motivated by tangible things (e.g. stickers, stars on a chart), others by activities (e.g. watching a movie, playing a game), or by privileges (e.g. choosing the story to read before bed).
Timing of reinforcement is a critical variable in the learning process. Generally, the sooner reinforcement is delivered after a target behavior occurred, the more likely the child is to make the connection between the behavior and the resulting consequences. This may mean pulling out a preferred item or toy within seconds of a child completing a task. As a child masters a skill, the therapist can then gradually increase the interval between the child’s correct behavior and its reinforcement, ultimately delaying reinforcement to the point at which a child will use the skill in the absence of any reinforcement and respond to the natural consequences of his or her behavior.
In addition to punishment, there is another discipline strategy which is frequently confused with it. This is negative reinforcement. With negative reinforcement, something unpleasant or unpleasantness is removed in order to increase desired behavior. As long as a child does his work to avoid having to do something he dislikes, negative reinforcement is obviously at work.
Even experienced professionals have limited success generalizing approaches to individual children. This is particularly true in Behavioral Health Work with children and youth, because what serves as a powerful reinforcer for one child may be a neutral or even aversive stimulus for another child. In preparation for therapeutic sessions, we complete preference assessments for each child and use the resulting results to identify effective reinforcers. For older youth, we frequently update these assessments as their preferences change.
Data Collection Drives Decisions
One thing that’s different about ABA development programs from most other development programs is that a large emphasis is placed on collecting data. Data is collected on every single aspect of the child and the child’s therapy sessions: even data is kept on the child’s losses (it’s easy to focus only on gains, but there is a lot to be learned from a child’s losses as well). This information is used to make adjustments to the child’s program as a whole, as well as to determine how to use rewards and methods of positive reinforcement effectively. It also informs therapists about which goals would be most helpful for their patients.
Typically when working with clients, therapists record 3 aspects of a target behavior: frequency (how often does it occur), duration (how long does it last), and intensity (how severe is it). In this video, Dr. Bailey models three different methods for collecting data on the frequency of clients’ correct responses to learning trials, challenging behaviors, and independent performance of tasks to complete daily living goals. Typically, each unit of data is recorded in real time using a tally or an app on the therapist’s phone/computer or by writing on a sheet of paper.
Quality providers typically offer the parents of children with autism that receive ABA therapy in Boston frequent summary data of each child’s progress. We strive to provide our clients with the highest quality services.
Task Analysis and Skill Building
One way that task analysts ‘de-complex’ a complex skill is to break down the task into teachable steps or elements. Putting toothpaste in your mouth requires a lot of steps. First, you get toothpaste on the toothbrush; second, you brush all surfaces of teeth; and third, you spit out toothpaste and then wash up with water and dry with towel. Each step can be taught individually to a child, then finally ‘chained’ together to form the complete skill.
Skill practice works best when skills are broken down into steps allowing children to experience many successes along the way. Mastering each step enables children to grow in confidence and competence. After all the steps have been learned, practice can progress by linking the steps together to work on the full skill.
Generalization Across Settings
The skills that a child learns in a therapy session must generalise across places, people and situations and therefore most autism programs include training across settings, people and situations. An example of this could be that a child learns the skill of saying “help” in order to get into a car and as part of a typical autism program he would practice this skill in a number of different scenarios such as with a number of different therapists in different therapy rooms with all of the toys and materials that are in the toy room and with all of the toys and materials that he would have in a playroom at home.
Even if all of these excellent steps are followed to teach a child to use learned skills perfectly, if nothing is done to have the child generalize (use these skills in other places and situations), then even “perfect” use in the ‘therapy room’ will not generalise to other places such as the child’s home, pre-school or public school. The inclusion of generalisation in children’s programmes is a major component and must be tackled from the beginning not left until all perfect use has been achieved in the ‘therapy room’ and then forgotten and left to chance.
The transition from a rigid therapeutic program to more typical community behaviors and activities poses significant challenges. Families need assistance and support to carry out a home based program and teachers need to be informed about the child’s emerging strengths and deficits which will generalize to the school setting.
Individualization Based on Assessment
No two ABA programs will look exactly the same because no two children with autism are exactly the same either. For this reason, at the beginning of an ABA program a comprehensive assessment is done of the child, including an identification of the child’s deficits and excesses in skill. A personalized set of goals are then established for treatment, and the program is designed to be as unique and individualized as the child is.
Program planners considered assessments of social skills, readiness for academic programming, health behaviors, and behavioral issues.
All of our ABA-based programs are continually developed and updated to meet the individual needs of each child. As the children grow and develop, the goals, methods of teaching, and methods of maintaining and generalizing newly acquired behaviors change. An effective ABA provider is always on-trend and continually evaluating and updating the services that he or she provides.