Introduction to Autism and ABA

Introduction to Autism Spectrum Disorder (ASD)

What is autism?

The APA published the DSM-IV in 1994, you can find it at Autism Society, and it is used by clinicians in making an Autism diagnosis. And while the training is based on this manual, the APA updated the DSM (version V) in 2013, you can find it here at the Centers for Disease Control and Prevention and this changed the diagnostic criteria for autism. Insight into the updated criteria can be found at AutismSpeaks.com as well as at the end of this page.

Under the DSM-V Autism is a developmental disorder that appears by the age of three and is characterized by: 1) Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions, 2) Deficits in nonverbal communicative behaviors used for social interaction ranging for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication, and 3) Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

How is autism diagnosed?

The DSM-IV specifies that a child must meet 6 criteria from the three different domains in order to be diagnosed.

Social Interaction Domain (Must meet a minimum of 2 criteria)

  • Failure to develop peer relationships: this could mean that a child completely isolates oneself from group settings, or sits close to but does not interact with peers
  • Impairment in use of non-verbal communication: such as eye to eye gaze, facial expression and gestures.
  • Lack of seeking to share enjoyment, interests or achievements with other people: a lack of showing, bringing or pointing out objects of interest.

Communication Domain (Must meet a minimum of 1 criteria)

  • Delay in or lack of spoken language provided that it is not accompanied by an attempt to compensate through alternative methods such as gesture or mime.
  • Or marked impairment in the ability to initiate or sustain a conversation with others.
  • Repetitive use of language or idiosyncratic language: Such as sounds, words or phrases repeated over and over and used out of context
  • Lack of varied, spontaneous make-believe or social imitative play appropriate to the child’s developmental level: A child may not engage in any make-believe play or she may only make-believe with a tea set repeating the same actions over and over

Restrictive Repetitive, and Stereotypic Behavior Patterns (Must meet a minimum of 1 criteria)

  1. Inflexible adherence to non-flexible routines or rituals: Insisting on the same route to the park or the all doors being closed in your house, or eating meals at the exact same time every day)
  2. Repetitive Motor Mannerisms: such as flapping, rocking, etc.
  3. Persistant preoccupation with parts of objects: if a child has a car they may only be interested in the wheels

The prevalence rates of autism

According to data published by the CDC in 2016, ASD effect as many as 1 in 68 children. There are no boundaries in any racial, ethnic or socioeconomic group.  The CDC reports that ASD is about 4.5 times more common in boys than in girls but recent research suggests that this may be a reflection of under-diagnosis in females as girls present different symptoms than boys. To learn more about this possibility, read Maia Szalavitz’s, Autism-It’s Different in Girls.

How autism is defined in terms of behaviors that can be observed

Behaviors are defined in terms of that which can be observed and fall into one of two categories. Deficits (behaviors which typical children engage in but autistic children do not or do not engage in enough) and Excesses (behaviors which all children engage in but in which autistic children engage in too much or excessively)

Deficits Behaviors Include:

  • Language: both expressive (what a child can say) and receptive language (what a child can understand)
  • Play: Some autistic children do not play, others play with repetition doing the same thing again and again.
  • Social Skills: A child may not pay attention to or interact with peers.
  • Perspective Taking (Or Theory of Mind): This refers to the basic understanding that others may have different thoughts beliefs and desires than they do.
  • Executive Function: This includes planning, organization, self-regulation, impulse control, inhibition.
  • Gross Motor Skills: Gross Motor Skills:  Such as throwing a ball or riding a bicycle
  • Fine Motor Skills: Such as coloring, drawing, cutting or handwriting.
  • Self-Help: Getting dressed, eating independently, brushing your teeth.
  • School Skills: Being able to sit and listen to a teacher, following a routine in a classroom, and raising your hand to ask questions

Excessive Behaviors Include:

  • Stereotypy: (STIMS) Self-stimulatory behavior. Repetitive behaviors that they engage in with objects or their bodies, such as hand flapping, staring out of the corner of their eye, or laying on the ground to watch the wheels of a car.
  • Non-Compliance: Failing to do what someone asks you to do. Sometimes autistic children may exhibit non-compliance through ignoring you even than they heard you  and understood what you have said. Other times it is actively protested through whining or failure to move.
  • Tantrums: Aggression in excess, could be towards others, or self-aggression (aka self-injurious behaviors)

Being able to identify these behavior in autistic children  is very important. This is because that which we can be observed we can attempt to change.

Introduction to Applied Behavior Analysis (ABA)

What is Applied Behavior Analysis (ABA)?

ABA is the application of Principles of Behavior to issues that are socially important, in order to produce practical change.

Principles of Behavior include: 1) Reinforcement, 2) Generalization, and 3) Extinction, and how applying each of these principles can be used to effectively teach children with autism.

Extra Reading: What is ABA: A Parent’s Guide

Extra Reading: Autism Speaks: ABA 

How Can ABA be Applied?

The principles of ABA are employed in a broad range of contexts, examples of socially important areas where ABA can be used are: 1)  Regular and Special Education, the principles of ABA are used to improve on-task behavior in the classroom or to decrease disruptive classroom behavior, 2) Pediatric Medicine, ABA can be used to treat sleep problems in children, to treat children with ADHD as well as other pediatric applications, 3) Treatment of Troubled Teens: ABA can be used to increase behaviors such as school attendance, homework completion and following household rules, 4) Sports Psychology: The principles of ABA have even been used to increase the performance of professional athletes, 5) Business and Service Organizations: ABA can be used to train staff and improve employee performance and 6) Early Intensive Treatment for Children with Autism

What is the Core Principal of ABA?

The consequences that follow a behavior control whether that behavior will increase or decrease.

What is a 3-Term Contingency?

The Behavioral Contingency is referred to as the 3-Term Contingency. It is the unit of analysis in ABA. That means that when trying to increase or decrease any behavior, three pieces must be looked at, the ABC’s of The Behavior Contingency.

  • A = Antecedent. The antecedent is what is happening immediately prior to the behavior
  • B = Behavior. The behavior is what is being said or done
  • C = Consequence. The consequence is what occurs immediately after the behavior

Examples of the 3-Term Contingency are:

A) Lila is at the grocery store with her grandmother, they are in line at the register and there is candy on display. Lila has no candy. Not having candy is the antecedent.

B) Lila cries. (She wants the candy)

C) Grandmother gives Lila the candy. Lila stops crying.

The behavior here, Lila crying, is reinforced by Grandma giving her the candy after crying. This increases the chances that Lila will cry when she wants candy in the future.

Alternately:

A) Lila is at the grocery store with her grandmother, they are in line at the register and there is candy on display. Lila has no candy. Not having candy is the antecedent.

B) Lila asks for the candy. (Or is assisted in asking)

C) Lila receives the candy.

The behavior here, Lila asking, is reinforced by Grandma giving her the candy after asking appropriately. This increases the chances that Lila will ask when she wants candy in the future.

Another alternate:

A) Lila is at the grocery store with her grandmother, they are in line at the register and there is candy on display. Lila has no candy. Not having candy is the antecedent.

B) Lila is crying. (She wants the candy)

C) Lila does not receive the candy.

The behavior here, Lila crying, is reinforced by Grandma not giving her the candy after crying. This decreases the chances that Lila will cry when she wants candy in the future.

Consistency is CRUCIAL to the Behavioral Contingency Model.

To understand this think about this:

A) Milo is running late for an interview.

B) Milo jumps into his car and speeds down the street hoping to make up the time.

C) Milo is pulled over and receives a rather pricey speeding ticket.

So given the Behavior Contingency why do people not stop speeding after receiving a speeding ticket?

Because it is inconsistent.  If everyone received a ticket every time they sped, no one would speed. However, speeding tickets do not occur every time, indeed realistically the odds of getting a speeding ticket are quite low.

What this says is that Consistency is CRUCIAL.

Moreover, consistency requires that EVERYONE, ABA’s, BCBA’s, Parents, Aides, Teachers, Pediatricians must be consistent in working with the child. In order to increase the deficit behaviors and decrease the excessive behaviors.

How to Use the 3-Term Contingency?

The goal is to increase appropriate behaviors and to decrease inappropriate behaviors . In order increase deficits such as language, play, social skills, perspective taking, executive function, motor skills, self-help, and school skills or to decrease excesses such as stereotypy, non-compliance, tantrums, and aggression the ABA manipulates the antecedents and consequences to shape the behavior.

The increase of of deficit behaviors is part of the Skill Repertoire Building component of the ABA program, and the decrease of excessive behavior is part of the Behavior Management component of the program.

When applying ABA to the treatment of autistic children we manipulate the antecedents and consequences to increase or decrease the child’s behaviors. For example we can manipulate to increase deficit behaviors, increasing deficits is the Skill Repertoire Building component of the program.

*In general the behavioral therapist will not design the intervention itself. The BCBA will design the intervention and then instruct the behavioral therapist on how to implement the change.

Introduction to Early Intensive Behavioral Intervention (EIBI)

What is EIBI?

In the 1970’s Ivar Lovaas published data that suggested treatment effects can be maximized if the treatment is 1) initiated early in a child’s life, 2) intensive, encompassing most of the child’s waking hours, and 3) comprehensive, addressing all of the child’s skill deficits and behavioral excesses. The application of this treatment to young children is called Early Intensive Behavioral Intervention (EIBI). This has been known over the years as: Intensive Applied Behavior Analysis/ABA Programming, or Early Intensive Behavioral Treatment: EIBT. These all refer to the same treatment.

What are the components of EIBI programs?

There are 10 major components that all EIBI’s should contain in order to ensure both quality and effectiveness.

 1. Treatment Should Begin Early:

Research has demonstrated that children make the most gains when they start as young as possible. It is recommended that children start prior to the age of 4 and even earlier if diagnosed. Research has further shown that children between the ages of 4 and 7 benefit from EIBI.

 2. Intervention Should be Intensive:

This is perhaps one of the most critical components of EIBI. Initially, it should be one to one treatment and it should be of sufficient intensity to maximize benefits. It is suggested that 30-40 hours per week are most effective. So children should start off with one-to-one treatment of at least 30 hours per week.

3. Intervention Must be Behavioral:

All procedures implemented must be based on principles of behavior analysis. These procedures must be used to build appropriate behaviors and reduce problem behaviors so that they can function appropriately in daily life.

4. Treatment is Individualized for each child:

Skill deficits and behavior excesses are identified and treated and specific to each child’s characteristics and are modified based on the child’s response to the intervention.

5. Treatment must be Comprehensive:

All skill areas must be assessed and treated for each child. This should include: language/communication, play, social, perspective taking, gross motor, fine motor, adaptive, academic, and planning and self-management skills according to whatever deficits the child exhibits. Additionally, all problem behaviors that interfere with a child’s ability to succeed in their natural environment should be addressed.

6. Treatment Should Occur in the Child’s Natural Environments:

Most young children spend a large amount of their time in their homes and if applicable their pre-school. As a child progresses the environment can expand to include community settings, such as local parks, restaurants and businesses.

7. Active Parent Involvement:

Parents are a critical part of a child’s development. Active parent involvement is integral to a child’s success. Parents are taught how to modify their child’s problem behaviors as well as how to teach their child new skills and how to use new skills taught in therapy sessions in their everyday life.

8. Opportunity to Learn and Interact with Typical Peers:

The child needs opportunities to learn from and interact with their peers. As the child acquires basic communication and social skills it is imperative that they be given the opportunity to interact with their peers and use these skills with typical peers. These opportunities should be provided as early as possible in the treatment program.

9. Duration of Treatment:

Research shows that two or more years of EIBI is necessary to achieve optimal outcomes. Most children receive at least three years of treatment. Others require a longer duration and others may finish earlier and move into a more traditional classroom setting earlier.

10. Treatment Supervision is Only Provided by Individuals with Experience in Autism and Advanced Training in ABA:

Supervisors should be Board Certified in behavior analysis with specific experience in autism. Or should be directly supervised by someone who has had ample experience in the field.

What proof that it works?

Studies:

Measurement Tools:

Support of Efficacy of EIBI:

Learn More…

Introduction to Skill Repertoire Building

 

 

Leave a Reply

Your email address will not be published. Required fields are marked *