Definition of ABA
PS 553: Assessing Autism
Interventions
Why Does Autism Need
Specialized Treatment?
• Pervasive Developmental Disorder
(PDD) implies that a child with
autism is affected along multiple
dimensions
• (Unlike certain other single dimension
problems: learning disability,
communication disorder, emotional
and behavioral disorders)
Why Does Autism Need
Specialized Treatment?
• Learning deficits
• Affects every aspect of child’s education and
academics
• Language disabilities
• Articulation, expressive, receptive, spontaneous,
conversation, non-contextual vocalizations
• Behavioral disorders
• Stereotypic behavior: motor, visual, tactile,
• Compulsive behaviors
• rigidity of routine, intolerant of change
Why Does Autism Need
Specialized Treatment?
• Attention deficits
• Lack of eye contact, unaware of danger
• Emotional impairments
• Non-contextual emotions, lack of self-concept
• Social impairments
• Eye contact, gestures, facial expression, greetings,
awareness of other children, friendships,
• Play skills deficits
• Imaginative, pre-occupations with objects/activities,
general content knowledge
Why Does Autism Need
Specialized Treatment?
• Sleep disturbances
• Going to sleep late, getting up early, getting up
during the night
• Toileting impairments
• Lack of awareness of accidents
• Eating disabilities
• Texture, appearance, gustatory
Introduction to
Applied Behavior
Analysis
B. F. Skinner
(1904-1990)
• Championed psychology as a science of behavior
• One of the most influential and controversial
psychologists of the twentieth century
• Emphasized the study of behavior and the
environmental events preceding and following
instances of behavior
• Characterized behavior is a function of an
individual’s:
 Physiology/genetics
 Prior experience (learning history)
 Current environmental contingencies
The Truth About Skinner
(Gaynor, 2004)
• Myth: humans are a virtual blank slate upon which the
environment writes, unfettered by genetics or biology
• Actually…
• Skinner confused with Watson!
• Skinner actually commented on Watson’s “extreme
environmentalism, and…coldly detached theory of
child care” (Skinner, 1972, p. 558)
• Skinner (1957): “A small but important part of the
universe is enclosed within the skin of each
individual and, so far as we know, is uniquely
accessible to him. It does not follow that this private
world is made of any different stuff – that it is in any
way unlike the world outside the skin or inside
another’s skin” (p. 130).
The Truth About Skinner
(Gaynor, 2004)
• Myth: Skinner raised his daughter in a
“Skinner box” and she committed
suicide
• http://www.youtube.com/watch?v=cl7jr9
EVcjI&feature=related
• Actually: She is in the field and runs his
foundation
• http://www.juliesvargas.com/
• http://www.youtube.com/watch?v=yhvaSEJtOV8
• http://www.youtube.com/watch?v=X6zS7v9nSpo
What is Applied Behavior Analysis?
(Cooper, Heron, & Heward, 2007)
• Technical definition: the science in which
• procedures derived from the principles of learning
• are systematically applied to improve socially
significant behavior
• and to demonstrate experimentally that the
procedures used were responsible for the
improvement in behavior
• What you might say to your Aunt Sally:
• a scientific approach to understanding why
people do what they do and helping them make
meaningful changes in their behavior
What is ABA?
• Formally began in 1959 with Ayllon and Michael’s
paper: The Psychiatric Nurse as a Behavioral
Engineer -
http://www.pubmedcentral.nih.gov/picrender.fcgi?a
rtid=1403907&blobtype=pdf
• 1968 – Journal of Applied Behavior Analysis
(JABA)
• In 1st issue, Baer, Wolf and Risley’s paper: Some
Current Dimensions of Applied Behavior Analysis
What is Applied Behavior Analysis?
(Cooper, Heron, & Heward, 1987; 2007)
Applied behavior analysis is the science in
which
• procedures derived from the principles of
learning
• are systematically applied to improve socially
significant behavior
• and to demonstrate experimentally that the
procedures used were responsible for the
improvement in behavior
Characteristics of ABA
(Baer, Wolf, & Risley, 1968; 1987)
• Applied
• behavior is selected because it is socially
significant to society
• and it will improve one’s life in the areas of:
social, language, academic, daily living,
self-care, vocational, and/or recreation and
leisure
• additionally, answers the question: How
immediately important is this behavior or
these stimuli to these participants?
Characteristics of ABA
(Baer, Wolf, & Risley, 1968, 1987)
• Behavioral
• treats actual, observable behavior rather than
verbal reports of behavior, feeling and/or attitudes
• E.g., Why can’t children with autism talk?
because they are not processing sounds
correctly
• Inter-observer agreement data to ensure data are
accurate reflections of the subject’s behavior and
not recording procedure and that the intervention
was accurately and consistently implemented
Characteristics of ABA
(Baer, Wolf, & Risley, 1968, 1987)
• Analytic
• Functional relationship between the manipulated
events and the behavior of interest
• Research design
• Conceptually Systematic
• Effectiveness of techniques described in terms of the
learning principles from which they were derived.
• Attribute a child’s behavior to the laws of learning
theory
• Only use techniques that have been documented in
the scientific literature to be effective
• Seek the condition under which the intervention has
maximal and minimal effectiveness
Characteristics of ABA
(Baer, Wolf, & Risley, 1968, 1987)
Technological
• procedures are identified, defined and task analyzed
• Individualized skill acquisition and behavior
reduction programs
• Dissemination
Effective
• altering behavior in a socially important manner
• How much of that behavior needed to be changed to
reach social significance and has that goal been
accomplished?
• Social validity – the extent to which all consumers of
an intervention’s life has been enhanced
• E.g., teaching a child to hold open a door and examining the
effect of this behavior on others
Characteristics of ABA
(Baer, Wolf, & Risley, 1968, 1987)
Generality
• behavior change is durable over time and under a
variety of conditions or spreads to a variety of
related behaviors
• How have we helped the child if there is no
behavior change at home, at the dentist, at the
doctor, in the mall, in the cafeteria, on the
playground, in the supermarket?
Additional Characteristics of ABA
(Heward, 2005)
• Accountable
• Public
• Doable
• Empowering
• Optimistic
ABA’s Track Record
• Although ABA is perhaps most well known for
its application in intervention for persons with
autism, over the past 40 years, applied behavior
analysis has been shown to be successful in
effecting change across a wide variety of
- populations (children and adults with mental illness,
developmental disabilities and learning disorders)
- interventionists (parents, teachers and staff)
- settings (schools, homes, institutions, group homes,
hospitals and business offices), and
- behaviors (language; social, academic, leisure and
functional life skills; aggression, self injury,
stereotyped behaviors)
Socially Important Problems
(Martin & Pear, 2007)
• Parenting and Child Management
• Increase walking skills, language skills, toilet training,
household chores, decrease frequent arguing, failure
to comply with parents’ requests
• Education: From Preschool to University
• Oral reading, reading comprehension, spelling,
handwriting, mathematics, English composition,
creativity, science concepts.
• Clinical Behavior Therapy
• Anxiety, obsessive compulsive disorders, stressrelated problems, depression, obesity, marital
problems, sexual dysfunction and personality disorders
Socially Important Problems
(Martin & Pear, 2007)
• Self Management of Personal Problems
• Self control, self adjustment, self-modification
• Medical & Health Care
• Seizure disorders, chronic pain, addictive disorders,
and sleep disorders, improving motor skills,
decreasing tremors characteristic of Parkinson’s
disease, conducting brain injury rehabilitation,
exercise, diet, stress management
• Gerontology
• Compensating for loss of skills, increase ability to
function independently
Socially Important Problems
(Martin & Pear, 2007)
• Behavioral Community Psychology
• Controlling littering, increasing recycling, promoting
energy conservation, encouraging welfare recipients
to attend self-help meetings, helping college student
live together, crime
• Business, Industry, and Government
• Performance management, improve productivity,
decrease tardiness and absenteeism, increase sales
volume, create new business, improve worker safety,
reduce theft by employees, reduce shoplifting,
improve management-employee relations.
Socially Important Problems
(Martin & Pear, 2007)
• Sports Psychology
• Improving skills of athletes, motivating practice
and endurance training, changing the behavior of
coaches, “ports psyching “ to prepare for
competition
• Behavioral Assessment
• Functional analysis and functional assessment for
a variety of mental disorders
• Disorders
• Developmental disabilities, autism, and
schizophrenia
Teaching Techniques in Applied
Behavior Analysis
 Activity Schedules
 Audio/Video Modeling
 Script/Script Fading
Procedures
 Small Group Instruction
 Self Management
 Imitation
 Direct Instruction
 Incidental Teaching
 Computer Assisted
Instruction
 Peer-Based Instruction
 Reinforcement Systems
 Discrete Trial
Instruction
 Shaping
 Task analysis and
chaining
All Teaching Procedures in ABA Have
These Features (Lovitt, 1995)
1.
2.
3.
4.
4.
5.
Precise definition and task analysis of the new skill or
behavior to be learned
Direct and frequent measurement of the student’s
performance of the skill
Frequent opportunities for active student response
during instruction
Immediate and systematic feedback for student
performance
Procedures for achieving the transfer of stimulus control
from instructional cues or prompts to naturally occurring
stimuli
Strategies for promoting the generalization and
maintenance of newly learned skills to different, non-
Reinforcement
Small-Group Instruction
Turn Taking
Playing Hi-Ho Cherry-O
Turn-Taking Data
Teaching
100
90
70
Pretest
Percent Corect
80
60
50
40
30
20
10
0
0
10
20
30
Days
40
50
60
70
Musical Chairs
Twinkle, Twinkle Little Star
Evidence of ABA for Autism
Treatment
Parts of this ppt have been taken from:
Science and Practice in the Treatment of Autism
Gina Green, PhD, BCBA
San Diego, CA
December 2005
Applied Behavior
Analysis in the Treatment of Autism
Autism Services and Support Conference
Camp Pendleton, CA
January 18, 2007
Early Intensive ABA for ASD
• Early: generally, children under age 5 when treatment
begins
• Intensive: 25-40 hrs/wk, 1-to-1 initially, 1- 4 yrs
• Comprehensive: array of ABA techniques -- both
adult-directed and child-initiated -- used to build
skills in all domains
• Usually started in home, but can be done in centers
• Intervention provided in multiple environments
• 1-to-1 initially; gradually changed to small group
instruction
• Gradual transition to regular classrooms where
possible
Research-Based
Effectiveness of ABA
• Individual teaching methods for specific skills
• Video modeling to teach a child with autism to
offer assistance
• Activity schedules to teach a child with autism to
use a napkin
• Self-management to teach a child with autism to
remain on-task
• Many others…
• Outcome studies
• what happens when these methods are combined
into a comprehensive package?
Research-Based Effectiveness of ABA:
Individual Teaching Methods for Specific Skills
• For example, video modeling has been experimentally
shown to be effective in teaching:
• labeling emotions, independent play, spontaneous greetings,
oral communication, conversation cooperative play, social play
brushing teeth, washing face, semantic & pragmatic language
skills, following directions, sharing materials, greeting others,
reducing tantrum behavior, answering conversations questions
comments during play, social communication, spontaneous
requesting, grocery shopping skills, washing hands, time on
task, purchasing skills, shaving, making lunch, sort and load
laundry, make peanut better and jelly sandwich, hang pants,
make bed, cleaning glasses, putting on watch, engaging a
zipper, mailing a letter, pet care and setting the table.
• For video modeling alone, there are at least 15 studies
from 1987 to 2004 across almost 75 individuals
published in about 10 different peer-reviewed journals
(Ayers & Langone, 2005)
Video Modeling
and Guitar Hero
Research-Based Effectiveness of ABA:
Individual Teaching Methods for Specific Skills
• Hingtgen & Bryson (1972) reviewed over 400
research articles pertinent to the field of
autism
• DeMeyer, Hingtgen, & Jackson (1981)
reviewed over 1,100 studies from 1970s
• Baglio, Benavidiz, Compton, et al. (1996)
reviewed 251 studies from 1980 to 1995
• All authors concluded that ABA-based
interventions demonstrated the most
consistent and beneficial results for persons
with autism
Research-Based
Effectiveness of ABA
Group Outcome Studies
•
•
•
•
•
•
•
Lovass, 1960;
Fenske, Zalenski, Krantz, & McClannahan, 1985;
Harris, Handleman, Gordon, Kristoff, & Fuentes, 1991;
Lovaas, 1987;
McEachin, Smith, & Lovaas, 1993;
Perry, Cohen, & DeCarlo, 1995;
Sheinkopf & Siegel, 1998
Research-Based Effectiveness of
ABA: Group Outcomes Studies
Lovaas (1987)
• Purpose:
• Behavioral-intervention project that sought
to maximize behavioral treatment gains by
treating children with autism most of their
waking hours for many years
•
Research-Based Effectiveness of
Participants ABA: Lovaas (1987)
• Diagnosis of autism, under 4 years old
• Treatment condition
• Intensive-Treatment Experimental Group (n=19)
• Received minimum of 40 hours of 1:1 treatment per week
• Minimal Treatment Control Group (n=19)
• Received 10 hours or less of 1:1 treatment/wk
• Both groups received treatment for 2 or more years
• Participants were assigned to groups using functional
random procedures
Research-Based Effectiveness of
ABA: Lovaas (1987)
• Assessment
• Standardized tests
• Bayley, Stanford-Binet, Vineland
• Behavioral observations
• Stereotypy, play, recognizable words
• Parent interview
• Recognizable words, toy play, emotional attachment,
apparent deficit, peer play, stereotypy,
tantrums,toilet training, abnormal speech, age of
walking, number of siblings, socioeconomic status,
neurological findings
Research-Based Effectiveness of
ABA: Lovaas (1987)
• Treatment Experimental group:
• 40 hrs/wk for 2 years by trained therapists
and parents in home school & community
• 1st year: reducing stereotypy & aggression,
building compliance, imitation, toy play,
extended treatment to family
• 2nd year: expressive & early abstract language,
interactive play with peers, extended
treatment to community and preschool
• 3rd year: emotions, preacademics, observational
learned, extended treatment to preschool
Research-Based Effectiveness of
ABA: Lovaas (1987)
• Control Group 1:
• Same as experimental group but less
than 10 hours of 1:1 treatment
• Also received a variety of other
treatment provided by small special ed
classes
Research-Based Effectiveness of
ABA: Lovaas (1987)
• Control Group 2:
•
•
•
•
21 subjects
42 mo or younger
IQ above 40 at intake
Assessed as control group 1 but not
treated
Research-Based Effectiveness of
ABA: Lovaas (1987)
• Results
• Experimental group
• 18.8 MA (mental age); 83.3 IQ
• 9 passed general ed 1st grade and normal IQ (47%)
• 8 passed 1st grade in aphasia classes and IQ was
mildly retarded (42%)
• 2 placed in classes for autistic children and IQ was
profoundly retarded (10%)
• Control groups 1 & 2
• 17.1 MA, 52.2 IQ
• 1 participant passed 1st grade and had an IQ of 99
(2%)
• 18 were in aphasia classes average IQ was 70 (45%)
• 21 participants in autism class mean IQ 40 (53%)
Research-Based Effectiveness of
ABA: Lovaas (1987)
• Discussion
• “Results were consistent with a very large body
of prior research on the application of learning
theory to the treatment and education of
developmentally disabled persons and with the
very extensive 100 year old history of
psychology laboratory work on learning
processes in man and animals”
• Unlikely treatment effects could be replicated
without highly trained individuals administering
the behavioral treatment
Strengths of Lovaas (1987)
• Control groups and TX group were
similar before TX
• Manual was used to standardize
treatments
• Independent clinicians made the
diagnoses
• Multiple intake and follow-up
measures were used
• Long term follow-up data were
collected
Criticisms of Lovaas (1987)
•
Lovaas didn’t compare different therapies
• But only institutionalization & special ed existed at the time
•
Lovaas used quasi (or functional), not pure random assignment
• Participants were assigned on the basis of therapist availability
• Lovaas used 8 different psychological measures to ensure close
matching of groups
• Pure random assignment is unethical
• According to the New York Early Intervention Report “Use of an
intervention method is a type of indirect harm if its use supplants
an effective intervention method that the child might have
otherwise received”
• US National Institute of Mental Health (the granting agency supporting
the study) approved functional random assignment
•
Lovaas’s study only worked because of use of aversives
• None of the replication studies have used aversives and the results for
the treatment groups were still significant and impressive
Research-Based Effectiveness of ABA:
McEachin, Smith, & Lovaas (1993)
• Purpose:
• To see if behavioral treatment can produce
long-lasting gains
Research-Based Effectiveness of ABA:
McEachin, Smith, & Lovaas (1993)
• Method
• 1. Assessed students at a mean age of 11.5
years to see if they maintained treatment gains
• 2. Assessed the best outcome students to see if
they could be considered free of autistic
symptomology, compared them to children with no
clinically significant behavioral disturbance: (blind
evaluators)
• Assessed for deficits in:
•
•
•
•
idiosyncratic thought patters, mannerisms, and interest;
lack of close relationships with family and friends;
difficulty in getting along with people;
relative weaknesses in cognitive functioning such as
abstract reasoning;
• not working up to ability in school;
• flatness of affect,
• absence or peculiarity in sense of humor
Research-Based Effectiveness of ABA:
McEachin, Smith, & Lovaas (1993)
• Results: Experimental vs. Control Group
• Experimental group preserved it gains over
the control groups
• Out of the 9 experimental best outcome
subjects, 8 were still indistinguishable from their
peers. Out of the 10 in special ed, one went to
a regular ed class
• In the control group, none were in a regular ed
class
Research-Based Effectiveness of ABA:
McEachin, Smith, & Lovaas (1993)
• Discussion:
• Out of the 9 subjects who had been classified as
normal functioning they still exhibited average
intelligence and average levels of adaptive functioning
• Some deviance from average was found on the
personality test and clinical ratings but seemed to be
the result of extreme scores from one subject who was
placed in special ed from regular ed.
Research-Based Effectiveness of ABA:
McEachin, Smith, & Lovaas (1993)
• Safeguards taken to ensure that favorable
outcome of experimental subjects can be
attributed to treatment and not extraneous factors
•
•
•
•
•
•
•
Equivalent assessment
All subject remained in assigned groups
Independent diagnoses
All subjects had comparable diagnoses and intake data
Control group 1 and 2 did not differ in outcome
Consistent socioeconomic status
Treatment has been experimentally demonstrated for 30
yrs and is replicable
• Treatment gains maintained
• Wide range of measures were used
• Blind & quantifiable assessment of effectiveness
Research-Based Effectiveness of ABA:
McEachin, Smith, & Lovaas (1993)
• Addressing validity of results of Lovaas
(1987):
• Assignment to experimental or control group not
random, but unlikely assignment was biased
• Future research:
• Replication by independent investigator
• Use younger children to see if age affects
outcome
• Determine the extent to which early intervention
alters neurological structures
Replicated Success of Lovaas’s Study
• Sheinkopf and Siegal (1998)
•
•
•
•
•
11 children in experimental group all under 3
11 matched children in control group
10-39 hrs per week for 7-24 mos
7 out of 11 pairs showed sig improvement
Problems:
• No measure in specific skill domains
• Not enough description abut the nature of the
intervention
• Not enough about number of hrs per week (although later
said that those receiving 30 had higher IQ than 20)
• Smith et al., (1997)
• IQs of 11 children with children with autism and
mental retardation increased by 12 points and
demonstrated more expressive speech than did
the minimally treated children
Replicated Success of Lovaas’s Study
• Murdoch early Intervention Program
(Birnbrauer & Leach, 1993)
• 9 children (average age 39 mos) in experimental
group
• 5 children in control group
• Assessed by “blind” professionals on standardized
• Ongoing skill acquisition was video taped &
recorded
• 18 hours of intervention per week for 2 years
• 4 out of the 9 children made substantial gains (IQ
80)
• 4 made moderate gain and 1 mild gain
• Increases in communication, play, social, self
help, productive behavior
• Differences from Lovaas?
Replicated Success of Lovaas’s Study
• Sallows, & Graupner, (2005)
• 24 children with autism were randomly assigned to
a clinic-directed group, replicating the parameters
of the early intensive behavioral treatment (EIBT)
developed at UCLA, or to a parent-directed EIBT
group that received intensive hours but less
supervision by equally well-trained supervisors.
• Outcome after 4 years of treatment, including
cognitive, language, adaptive, social, and
academic measures, was similar for both groups.
• Overall 48% of all children showed rapid learning,
achieved average posttreatment scores, and at
age 7, were succeeding in regular education
classrooms.
• Treatment outcome was best predicted by
pretreatment imitation, language, and social
Replicated Success of Lovaas’s Study
• Cohen, Amerine-Dickens, & Smith (2006)
• replicated previous studies of favorable results with early intensive
behavioral treatment (EIBT) for children with autism in community
settings
• compared 2 groups: (1) 21 children who received 35 to 40 hours
per week of EIBT from a community agency that replicated
Lovaas' model of EIBT and (2) 21 age- and IQ-matched children
in special education classes at local public schools.
• A quasi-experimental design was used, with assignment to groups
based on parental preference.
• Assessments were conducted by independent examiners for IQ
(Bayley Scales of Infant Development or Wechsler Preschool and
Primary Scales of Intelligence), language (Reynell Developmental
Language Scales), nonverbal skill (Merrill-Palmer Scale of Mental
Tests), and adaptive behavior (Vineland Adaptive Behavior
Scales).
Replicated Success of Lovaas’s Study
• Cohen et al., (2006) continued
• after treatment, the EIBT group obtained
significantly higher IQ and adaptive behavior
scores than did the comparison group.
• No difference between groups was found in either
language comprehension or nonverbal skill.
• Six of the 21 EIBT children were fully included into
regular education without assistance at Year 3,
and 11 others were included with support; in
contrast, only 1 comparison child was placed
primarily in regular education.
• Although the study was limited by the nonrandom
assignment to groups, it does provide evidence
that EIBT can be successfully implemented in a
community setting.
T able 2. U nc on tro lle d st udie s o f ea rly i n te n sive ABA
S tud y
W e is s (1999 )
n
19
Inten s ive A B A
CA
IQ
Hr s/W k
42m
?
40
D ur
24m
Fe ns k e, Za len s ki,
K ran tz & M cCl annahan
(1985 )
Ande rs on, Ave ry ,
D iPi et ro , Ed w a rds , &
C hri sti an (1987 )
9
9
Lu is e lli , Cannon , E llis &
S is son ( 2000 )
H ar ris , H a nd leman ,
Go rdon , K ris to ff &
Fu ente s (1991 )
H a nd leman , H a rri s,
C eli be rti, L ill eheh t &
To m c hek (1991 )
C a se s tu dies
G reen , B rennan , & Fe in
(2000 )
8
8
9
<36m
>36m
50 m
?
?
68
11 .8
15 .6
?
11 .6m
7 .1m
11m
?
49 m
48
?
9m
1
14m
NT
2
23 -25m
Pe rry , Cohen , &
D e Ca rlo ( 1995 )
14
49 m
101 m
?
?
27 .5
27 .5
46 m
72 m
43 m
57
15 -25
12 -24m
NT
25 -40
39 m
40
24 -30 m
M e as
C h a n ge o r o th e r
Adap t
C A RS
Po s ou tco m e = at
ho m e + reg s choo l
IQ
Lang
+33 .8 (11 /19 a v g range )
-18 .7 (13 /19 non -au ti sti c)
Po s ou tco m e:
<5 y @ e nt ry : 6/9
>5 y @ e nt ry : 1/9
1y
2y
+5 .2
+14 .1
+8 .2
+17 .0
+3 .7
+10 .3
<36 m @ ent ry : +19.8
>36 m @ ent ry : +12.3
+18 .8
+ 8 .0
IQ
LAP
+12
+20
IQ
Lang Ğ R ec
Lang Ğ E x p
Adap t
Po s t: 119
+58
+62
+17
(a ll no rma l)
+42
+18
(bo th no rm al)
IQ
Lang
Adap t
ELAP /LAP
Adap t
Implications of Studies
• Effectiveness
• ABA produces large, lasting improvement
• Larger gains than other treatments to date
• Age for optimal effectiveness
• Optimal between 2-3 (good under 5)
• Nature of Intervention
• Components of treatment: variety of ABA
based teaching procedures
• Intensity: at least 30 hrs per week
• Duration: at least 2 years
• Quality: highly skilled behavior analyst
• Setting: teach in all settings child interacts in
Summary of Research on
Early Intensive ABA
• Professionally directed early intensive ABA produced
• Large gains in multiple skill domains, normal or near-normal functioning in
many children
• Modest or small gains in other children
• Largest gains when treatment was most intensive
• Parent-managed ABA (with “consultants”) produced mixed results:
large gains in some skill domains, small gains in others
• Low-intensity ABA produced smaller gains than intensive ABA, but
larger than typical and eclectic services
• Other treatments (typical special ed/EI, nonintensive ABA + special
ed, intensive “eclectic” treatment) produced negligible gains or losses
in most studies
Summary of Research on
Early Intensive ABA
• Proportions of children who moved from delayed to normal range on IQ
(most also in regular classrooms without specialized services):
• Intensive ABA: 56/120 = 47%
• Typical special ed/EI: 11/58 = 19%
• Intensive eclectic: 4/28 = 14%
• Several uncontrolled studies corroborate these findings
• Estimated savings from investment in early intensive ABA: $2 million+
per individual (Jacobson, Mulick, & Green, 1998)
Science and Politics in Autism Treatment
•
Conclusions about treatment outcome evidence vary
• NY Dept of Health (1999): “Based upon strong scientific evidence, it is
recommended that principles of applied behavior analysis and behavior
intervention strategies be included as an important element of any
intervention program for young children with autism.”
• US Surgeon General (1999): “Thirty years of research demonstrated the
efficacy of applied behavioral methods in reducing inappropriate behavior
and in increasing communication, learning, and appropriate social behavior.”
• Maine Administrators of Services for Children with Disabilities: “Over 30
years of rigorous research and peer review of applied behavior analysis’
effectiveness for individuals with autism demonstrate ABA has been
objectively substantiated as effective based upon the scope and quality of
science.”
• Several independent reviewers reached similar conclusions (Newsom &
Hovanitz, 1997; Olley & Gutentag, 1999; Romanczyk, Arnstein, Soorya, &
Gillis, 2003; Smith, 1996, 1999)
Conclusions
• The science of behavior analysis provides genuine hope that
many people with autism can function successfully and
independently in typical environments, without ongoing
specialized services.
• But widespread adoption of ABA for autism is impeded by many
political obstacles.
• Behavior analysts are in the minority, and are often excluded
from task forces and committees that determine research
funding and public policy.
• ABA treatment is not quick, easy, or inexpensive; requires
expertise that is not available in many education and human
services settings.
• Mainstream autism culture has long been a fertile breeding
ground for pseudoscience, which always sells better than
science.
• Evidence about effects of early intensive ABA go against the
deeply held belief that autism is a severe, lifelong disability
that should be “accommodated.”
Conclusions (cont’d)
•
Scientific research is being defined mainly by social scientists and medical
researchers as randomized clinical trials. But
• Large group design studies are costly, difficult to conduct (especially with
intensive, long-duration treatments)
• Group mean scores may not represent performance or status of any
individual in the group
• Statistically significant differences in group mean scores may not represent
clinically important differences or changes.
• Random assignment to groups poses ethical and logistical difficulties, does
not always result in equivalent groups, does not reflect realities of
treatment selection and provision.
• There are other ways to do science:
• Measure individual behavioral development over time, in real-world
contexts (single-case research methods, growth curve analyses)
• Examine improvements over baseline for individuals who serve as their
own controls
• For group comparisons, match groups or pairs of children on key
variables
Most Teaching Procedures based on
ABA are Evidenced Based Practice
and Established Treatment (NSP)
 Was specifically designed and researched
for children with autism
 (Lovass, 1960; Fenske, Zalenski, Krantz, &
McClannahan, 1985; Harris, Handleman, Gordon,
Kristoff, & Fuentes, 1991; Lovaas, 1987;
McEachin, Smith, & Lovaas, 1993; Perry, Cohen,
& DeCarlo, 1995; Sheinkopf & Siegel, 1998)
 Represents a treatment approach with
tremendous versatility
 Accountability and data based decision
making
 All decisions about a child’s individualized program are
based on objective criteria rather than subjective
criteria.
Why Is ABA Effective For
Children with Autism?
 Is consistent with general principles of
learning:
 Task analysis:
 Breaks complex material into smaller, more teachable
units. Provides numerous structured opportunities for
a child to learn a new skill before advancing to the
next skill
 Stimulus Control:
 Highlights relevant stimuli while
simultaneously minimizing extraneous stimuli
 Prompting and prompt fading procedures
 Errors are minimized while correct responses are
maximized
Why Is ABA Effective For
Children with Autism?
 Is consistent with general principles of
learning:
 Reinforcement
 All students have an individualized motivational
system
 Generalization
 Promotes skills across settings, instructors, and
situations
 Maintenance
 Skills are functional and therefore continually used by
students
Applied Behavior Analysis
Endorsements
• “Intensive, behavioral intervention early in life can
increase the ability of the child with autism to acquire
language and ability to learn.”
• “Thirty years of research demonstrated the efficacy of
applied behavioral methods in reducing inappropriate
behavior and in increasing communication, learning,
and appropriate social behavior.”
• U.S. Surgeon General, David Satcher, M.D., Ph.D.
Applied Behavior Analysis
Endorsements
• “All programs educating children with autism should
include intensive behavioral interventions and year-round
education”.
• US Dept. of Education and the
National Research Council's Report
'Educating Children with Autism‘
• “Since intensive behavioral programs appear to be
effective in young children with autism, it is recommended
that principles of applied behavior analysis be included as
an important element of any intervention program”.
• NYS Department of Health Early Intervention:
Clinical Practice Guidelines:
Alex Before ABA
Alex After ABA
Alex’s Graduation from School
for Children with Autism
Alex’s Friends in First Grade
Alex in First Grade
Recommendations
• Hold ALL interventions to the same high standards;
that is, demand objective evidence from wellcontrolled studies of
•
•
•
•
•
TEACCH
Developmental models (e.g., Floor Time, RDI, play therapy)
Eclectic intervention
Standard special education and early intervention
Non-intensive, “naturalistic” ABA models
• Support efforts to develop and implement evidencebased practice guidelines that use ALL scientific
evidence, from single-case behavior analytic as well as
group-design studies.
• Put science above politics, so that all people with
autism may some day have access to genuinely
effective intervention.
State-of-the-Art Comprehensive
ABA for Learners with ASD
•
•
•
•
•
•
•
Directed by professionals with advanced training in behavior analysis
and specific experience in autism (best – Ph.D., BCBA)
Behavior analyst designs intervention program for each learner, trains
and supervises those who provide intervention, reviews learner’s
progress and adjusts intervention procedures frequently
Teachers, college students, parents, and/or paraprofessionals deliver
intervention to learner
Guided by curriculum derived from research in behavior analysis,
development, autism and related disorders
All skill domains addressed -- learning readiness, social, cognitive,
communication, academic, play, motor, self-care, etc.
Skills broken into small components, defined in observable, measurable
terms
Written programs for developing each component skill
State-of-the-Art Comprehensive
ABA for Learners with ASD
• Each learner’s strengths and weaknesses assessed by direct
observation and measurement
• Multiple, repeated learning opportunities arranged, in both
structured and naturalistic situations
• Little unstructured time for practicing nonfunctional behaviors
• Various research-validated techniques used to arrange learning
opportunities and enhance motivation: discrete trials, incidental
teaching, activity-embedded instruction, task analysis and
chaining, prompts and prompt-fading, child choice, etc.
State-of-the-Art Comprehensive
ABA for Learners with ASD
• All aspects of intervention tailored to individual needs and
preferences
• Simple skills built systematically into more complex repertoires
• Emphasizes teaching the child how to learn, developing warm
relationships, and making learning fun
• Problematic behaviors are not reinforced; alternative adaptive
behaviors are
• Data reviewed by behavior analyst at least weekly to evaluate
progress and "fine tune" intervention procedures
• Goal: develop skills that enable successful, independent
functioning, both short and long term
Common Misconceptions of
Applied Behavior Analysis (ABA)
“Anyone can ‘do’ behavior analysis.”
• Anyone who has been specifically trained in the
techniques of applied behavior analysis implemented
specifically with children with autism.
• Training consists of on-going hands-on training and
supervision by a nationally board certified behavior
analyst preferably on the doctoral level
• To become a board certified behavior analyst one needs
post-graduate coursework specifically in applied
behavior analysis, supervised or mentored experience
by an board certified behavior analyst, and pass a
national exam in behavior analysis (www.bacb.com )
Common Misconceptions of
Applied Behavior Analysis (ABA)
“Behavior analysts spend too much time with their
cumbersome data and not with the student.”
• It is only through the use of data analysis that the
effectiveness of a specific teaching strategy can be
evaluated. If a child is not learning, we can modify
a teaching strategy until the child does learn.
• Data do not need to be collected for every trial
•
•
•
•
Time sampling
Interval recording
Duration recording
Pre-test/post-test measures
Common Misconceptions of
Applied Behavior Analysis (ABA)
“Applied Behavior Analysis is too
structured for how the world actually
works”
•
•
Behavior analysts teach a child a variety of
functional/useful skills that often lead to engagement
in productive activity, meaningful social exchanges,
and additional learning opportunities. This may allow
a child with autism to have a variety of choices that
they previously didn’t have.
The principles of applied behavior analysis are at
work everyday in various situations
Applied Behavior Analysis
and “Real Life”
Functional Relationships: 3-Term Contingency
Antecedent  Behavior  Consequence
Wife’s birthday Husband makes dinner Wife says
“MMM”
Baby’s hungry
I feed baby peas
Need to pay bills I go to work
Baby
gets sick
I get paid
Common Misconceptions of
Applied Behavior Analysis (ABA)
“Behavior analysts say we should use individual
treatment, but if all children get ABA, how
individualized is that?”
 Principles of treatment are same in that most children with
autism initially need their skills task analyzed through
discrete trial teaching for maximum learning to occur.
 ABA, however, has many levels (as does autism) and levels
are individualized accordingly for each child.
 Each child has his or her own individualized program that
uses principles of applied behavior analysis.
 A child’s program is not scripted and will be constantly
monitored and adjusted based on the data collected to assess
effectiveness.
Common Misconceptions of
Applied Behavior Analysis (ABA)
“Applied behavior analysis is only necessary for
children with autism who are ‘severely disabled’.”
• When a child is initially diagnosed with autism, it is
very challenging to predict how the disorder will
manifest as the child ages.
• In Lovaas’s research, 47% of the children were
mainstreamed into a regular education setting and
were indistinguishable from their peers.
• Over the past three decades, applied behavior
analysis has been shown to be successful in many,
many situations.
Socially Important Problems
(Martin & Pear, 1999)
• Parenting and Child Management
• Increase walking skills, language skills, toilet training,
household chores, decrease frequent arguing, failure to
comply with parents’ requests
• Education: From Preschool to University
• Oral reading, reading comprehension, spelling,
handwriting, mathematics, English composition,
creativity, science concepts.
• Clinical Behavior Therapy
• Anxiety, obsessive compulsive disorders, stress-related
problems, depression, obesity, marital problems, sexual
dysfunction and personality disorders
Socially Important Problems
(Martin & Pear, 1999)
• Self Management of Personal Problems
• Self control, self adjustment, self-modification
• Medical & Health Care
• Seizure disorders, chronic pain, addictive disorders, and
sleep disorders, improving motor skills, decreasing
tremors characteristic of Parkinson’s disease,
conducting brain injury rehabilitation, exercise, diet,
stress management
• Gerontology
• Compensating for loss of skills, increase ability to
function independently
Socially Important Problems
(Martin & Pear, 1999)
• Behavioral Community Psychology
• Controlling littering, increasing recycling, promoting
energy conservation, encouraging welfare recipients to
attend self-help meetings, helping college student live
together, crime
• Business, Industry and Government
• Performance management, improve productivity,
decrease tardiness and absenteeism, increase sales
volume, create new business, improve worker safety,
reduce theft by employees, reduce shoplifting, improve
management-employee relations.
Socially Important Problems
(Martin & Pear, 1999)
• Sport Psychology
• Improving skills of athletes, motivating practice and
endurance training, changing the behavior of coaches,
“ports psyching “ to prepare for competition
• Behavioral Assessment
• Functional analysis and functional assessment for a
variety of mental disorders
• Severe Problems
• Developmental disabilities, autism, and schizophrenia
Common Misconceptions of
Applied Behavior Analysis (ABA)
“All children in applied behavior analysis settings
will engage in lots of tantrums”
• If a child engages in disruptive behavior, the behavior
analyst will immediately identify why that behavior is
occurring and design strategies to prevent the disruptive
behavior from occurring
• The behavior analyst will use effective teaching
strategies to increase the child’s success rate and their
opportunity for reinforcement, thus decreasing the
likelihood of tantrums.
Common Misconceptions of
Applied Behavior Analysis (ABA)
“Children with autism will not like their
behavior analysis sessions.”
• A behavior analyst diligently establishes a
positive relationship with a child they are
teaching and creates a very positive learning
environment for that child.
• Maximum learning is the behavior analysts goal
and maximum learning occurs in a positive
learning environment.
Common Misconceptions of
Applied Behavior Analysis (ABA)
“If a child with autism gets intensive early
intervention utilizing the techniques of applied
behavior analysis, they will ‘recover’.”
• Autism is a neurological disorder and no one can
predict the extent of the neurological damage in a child
diagnosed with autism.
• The research indicates that 47%-67% of children with
autism with intensive applied behavior analytic
intervention will learn a sufficient number of skills to
be indistinguishable from their peers.
Common Misconceptions of
Applied Behavior Analysis (ABA)
“Behavior analysts ‘drill’ kids with hundreds of
trials”
• A behavior analyst will select a learning goal for each
session for a specific child and will teach a particular
skill until that goal is obtained –there is no set number
of trials.
• Teaching is contingent on the child’s learning.
• Challenging skills are interspersed with more easily
learned skills so the child has an opportunity for lots of
reinforcement.
Common Misconceptions of
Applied Behavior Analysis (ABA)
“Behavior analysts always use food to
reinforce behavior.”
• We use whatever the child prefers
• Primary reinforcers are often used to teach new
or difficult skills and are always paired with a
conditioned reinforcer such as verbal praise.
• The goal is to fade from primary reinforcers to
conditioned reinforcers to natural reinforcers.
Common Misconceptions of
Applied Behavior Analysis (ABA)
“Applied Behavior Analysis is only
effective if you want to decrease a
behavior.”
 Behavior analysts will implement methods to decrease
disruptive behavior and implement teaching strategies
for teaching skills in all domains: academic,
independent, self help, social, fine motor, gross motor,
expressive language, receptive language, play.
Common Misconceptions of
Applied Behavior Analysis (ABA)
“Verbal Behavior is Better than ABA”
• Skinner’s analysis of verbal behavior is a theoretical
approach to language acquisition. It theorizes that
language is a behavior and can be taught when its
function is considered. It uses terms unique to this
interpretation: mand, tact etc. It is based on the
principles of behavior analysis.
• All effective ABA programs are consistent with this
approach in that they teach language based on its
function. They may or may not use Skinner’s
terminology. Examples of these programs are PCDI,
SHLI, IEA, Garden and REED Academy.
Common Misconceptions of
Applied Behavior Analysis (ABA)
“Applied Behavior Analysis is just rote
teaching and is not functional.”
• Many skills first taught are rote responses; however, childre
who have no language must start somewhere.
• We teach on a very concrete level initially and generalize th
responses to more natural environments
• This is accomplished by teaching language using various
different teaching procedures, across multiple settings unde
multiple conditions.
• Ultimately, these new skills allow children with autism to
reciprocate, maintain, and enjoy social exchanges with
peers/adults.
Common Misconceptions of
Applied Behavior Analysis (ABA)
“Applied behavior analysts teach children to sound
‘robotic’.”
• A behavior analyst will always model natural sounding
language, maximizing the extent to which the child’s
language skills will generalize to other situations.
• A behavior analyst may speak to a child with few language
skills in a manner that is concise, clear, and direct to increase
the likelihood of the child’s comprehension, however, the
inflection and volume of the behavior analyst’s voice will stil
be natural.
• If a child’s inflection does not sound natural, the behavior
analyst will develop an individualized program for that
specific child to teach prosody.
Common Misconceptions of
Applied Behavior Analysis (ABA)
“The individual needs to play and ‘get the stims out’.”
• Behavior analysts teach a child to play appropriately and break
down play to concrete components when necessary.
• There is no research demonstrating that allowing a child to
engage in stereotypic behavior will subsequently decrease the
stereotypic behavior.
• There is research in the opposite, however:
• The more a child engages in stereotypic behavior, the less
likely he or she will engage in appropriate behavior. Also, a
child is not available for learning when they are engaging in
stereotypic behavior.
Common Misconceptions of
Applied Behavior Analysis (ABA)
“Applied behavior analysts work too much in
isolation and alienate more traditional
approaches such as those used by
occupational and speech therapists.
 It is essential for behavior analysts to collaborate with
all professionals. Behavior analysts continually learn
from various professionals. Consulting a speech and
language pathologist, for example, can be extremely
helpful in targeting new skills in which to teach a child.
These skills can then be effectively taught using the
principles of applied behavior analysis.
Common Misconceptions of
Applied Behavior Analysis (ABA)
“Applied behavior analysts need to work alone
and do not work with other professionals.”
 Various professionals can work with one child as long
as every person on that child’s intervention team is held
accountable for the child’s progress.
 E.g., the speech therapist must collect data as behavior analysts
do to ensure that what they are doing is effective.
 Furthermore, there must be one person coordinating a
child’s treatment to ensure that all treatments are
working together and not contradicting each other
which can be harmful to a child’s skill acquisition.
 E.g., the physical therapist must also require the child not to
engage in stereotypic behavior and practice good attending
skills throughout the session, as the behavior analyst does; the
behavior analyst must require the child to effectively use
specific motor skills, as the physical therapist does.
Resources - Articles
•
•
•
•
•
•
•
Eikeseth, S., Smith, T., & Eldevik, E. (2002). Intensive Behavioral Treatment at School for 4to 7-Year-Old Children with Autism. Behavior Modification, 26, 49-68.
Fenske, E. C., Krantz, P. J., & McClannahan, L. E. (2001). Incidental teaching: a not-discretetrial teaching procedure. In C. Maurice, G. Green, and R. Foxx (Eds.), Making a difference:
Behavioral intervention for autism (pp. 75-82). Austin, TX: Pro-ed.
Fenske, E. C., Zalenski, S., Krantz, P. J., & McClannahan, L. E. (1985). Age of intervention
and treatment outcome for autistic children in a comprehensive intervention program.
Analysis and Intervention in Developmental Disabilities, 5, 49-58.
Green, G. (1996). Evaluating claims about treatment for autism. In C. Maurice, G. Green, and
S. Luce (Eds.), Behavioral intervention for young children with autism (pp. 15-28). Austin,
TX: Pro-ed.
Green, G. (1996). Early behavioral intervention for autism: What does research tell us? In C.
Maurice, G. Green, and S. Luce (Eds.), Behavioral intervention for young children with
autism (pp. 15-28). Austin, TX: Pro-ed.
Howard, J. S. , Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H. (2005). A
comparison of intensive behavior analytic and eclectic treatments for young children with
autism. Research in Developmental Disabilities, 26 (4), 359-383.
Jacobson, J. W. (2001). Early intensive behavioral intervention: Emergence of a consumerdriven service model. The Behavior Analyst, 23(2), 149-171.
Resources - Articles
•
•
•
•
•
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual
functioning in young autistic children. Journal of Consulting and Clinical
Psychology, 5, 3-9.
McClannahan, L. E. & Krantz, P. J. (2001). Behavior analysis and intervention for
preschoolers at the Princeton Child Development Institute. In J. Handleman and S.
Harris (Eds.), Preschool education programs for children with autism (pp 191-213).
Austin, TX: Pro-ed.
McEachin, J. J, Smith, T., & Lovaas, O. I. (1993). Long term outcome for children
with autism who received early intensive behavioral treatment. American Journal
on Mental Retardation, 97(4), 359-372.
Sallows, G. O., & Graupner, T. D. (2005). Intensive behavioral treatment for
children with autism: Four-year outcome and predictors. American Journal on
Mental Retardation, 110 (6), 417-438.
Smith, T. (1996). Are other treatments effective? In C. Maurice, G. Green, and S.
Luce (Eds.), Behavioral intervention for young children with autism (pp. 45-59).
Austin, TX: Pro-ed.
Resources - Books
• Handleman, J. S., & Harris, S. L. (2001). Preschool education programs
for children with autism. Austin, TX: Pro-Ed.
• Harris, S. L., & Weiss, M. J., (1998). Right from the start: Behavioral
intervention for young children with autism. Bethesda, MD: Woodbine
House.
• McClannahan, L. E., & Krantz, P. J. (1999). Activity schedules for
children with autism: Teaching independent behavior. Bethesda, MD:
Woodbine House.
• Newman, B. Reeve, K. F., Reeve, S. A., & Ryan, C. (2003).
Behaviorspeak: A glossary of terms in applied behavior analysis. NY:
Dove & Orca.
Resources - Books
• Leaf, R., & McEachin, J. (Eds.). (1999). A work in progress:
Behavior management strategies and a curriculum for
intensive behavioral treatment of autism. New York: DRL
Books.
• Lovaas, O. I. (2002). Teaching individuals with developmental
delays: Basic intervention techniques. Austin, TX: Pro-Ed.
• Maurice, C., Green, G., & Fox, R. M. (Eds.). (2001). Making a
difference: Behavioral intervention for autism. Austin, TX: ProEd.
• Maurice, C., Green, G., & Luce, S. C. (Eds.). (1996).
Behavioral intervention for young children with autism. Austin,
TX: Pro-Ed.
Resources - Websites
• NY State Guidelines
• www.health.state.ny.us/community/infants_chil
dren/early_intervention/autism/index.htm
• Behavior Analyst Certification Board
• www.bacb.com
• General Information about Autism
• www.asatonline.org
Descargar

Increasing Spontaneous Language in Individuals with …