The Effectiveness of Aba Therapy Within Children with Autism, Helpful or Harmful

Behavior therapy began in the 1960s. Several studies have shown it to be effective. But controversy surrounds ABA, some feel it causes lasting emotional harm because it forces an individual to perform pointless and uncomfortable tasks in order train them to look less autistic (Delisle, 2018). ABA literature says its ultimate goal is to make individuals diagnosed with autism appear like their peers. Trying to appear neurotypical is a term known as masking or camouflaging.

Continued research has shown it can lead to stress, exhaustion, and depression. “The outward appearance of improvement comes with emotional harm and increased anxiety” (Delisle, 2018). ABA uses strategies intended to decrease problem behaviors and increase desired behaviors by close observation, data collection, and analysis. Triggers and reinforcements are also noted. The data is analyzed and the desired behaviors are broken down into smaller, more achievable, tasks using positive reinforcement. Prompts and rewards are faded out until the behavior becomes natural to the individual. Applied behavior analysis (ABA) works towards changing behaviors by using positive reinforcement and discouraging negative behaviors. It is an evidence-based approach incorporating the science of learning and behavior. ABA teaches new skills and applies them to new situations. ABA also incorporates pivotal response training, discrete trial teaching, early start Denver model, and Lovaas model.

Pivotal response training (PRT) is also incorporated into ABA sessions. PRT is a form of practical ABA, increasing a child’s motivation to learn, check their own behavior, start, and sustain communication with others. PRT works to generalize skills across different settings, circumstances, and environments. Discrete trial teaching (DTT) is when the material being taught is broken down into smaller steps using prompts and rewards for each accomplished step.

Over time the prompts and rewards are faded out for the individual to complete the task without any help or prompts. The Early Start Denver Model (ESDM) is a comprehensive program used with younger children diagnosed with ASD. Emphasis is placed on having fun within a developmental framework. Parent involvement is key to the success of the intervention. The Lovaas Model is a structured technique of early intervention used with children under the age of twelve. It utilizes child-specific reinforcers to increase and reward success. The use of language and imitation are crucial in this teaching model, along with parental involvement (Rogers & Vismara, 2008). ABA is an evolving field, it has gone through many changes and many more to come in the future as it continues to evolve.

When it first began, ABA was structured and adult-directed, held in a clinical setting. In the 70s, painful or demeaning punishments (such as slapping, yelling, and electric shock) were used. Which unethical practices. Modern sessions are child-led and take place in more natural environments, such as the home or out in public, using positive reinforcement and tangible rewards. Some caregivers believe that training individuals to appear neurotypical is an illusion. That ABA will turn their child into a ‘robot,’ repeating acceptable phrases on command because they will blend in with peers . “There is a vast amount of clinical evidence that ABA is effective in helping small children learn new skills and can intervene with behaviors or characteristics that may interfere with progress.” Other types of behavioral therapy may be more appropriate for individuals requiring less support (Devita-Raeburn, 2016). There are different levels of severity, interventions should meet each child’s needs . Early diagnosis of autism spectrum disorder (ASD) and effective intervention will result in the best possible prognosis for a child.

All children with ASD can enjoy early intervention (EI). An effective program that focuses on developing communication, social and cognitive skills is most beneficial. Modern treatments include applied behavioral analysis, occupational therapy, speech therapy, physical therapy, and/or pharmacological therapy. Treatment works to cut the impact of deficits, maximize independence, and improve quality of life. ABA is based on behaviorism theories. Some argue that it ignores the immune, nervous system, detoxification, dysbiosis, and stress/trauma health issues that autism. This can create the challenges of autism behaviors. If edible tangible rewards are used with a child and they have food allergies, sensitivities, or gut issues, a negative reaction may affect that child’s mental, emotional, and physical function as a result of the ‘therapy.” Caregivers are increasing problem behaviors.

Attention seeking behaviors should not be met with attention. When a child is seeking attention there is no difference, negative or positive, to how it is obtained or the consequences that may follow. Allowing children to ‘escape’ from an activity is also giving into what they have sought to achieve. There are hundreds of evidence-based alternative treatments for autism. These treatments can include: osteopathy, craniosacral therapy, yoga, tai chi, occupational therapy, acupuncture, homeopathy, naturopathy, herbalism, oral supplementation, hydrotherapy, lifestyle modification, music therapy, exercise, aquatic therapy, hippotherapy, sunlight, meditation, and the list could continue further. But, “the quality of relationships in our lives is up to four times as restorative of health and up to four times as preventive of further illness. If an ABA therapist leaves a smile on a child’s face and that child looks forward to the interactions, ABA is a lot better than nothing at all” (Quora, n.d.). Social skills consist of training students, alongside their peers, in initiating, responding, interacting, greeting others, conversing, giving or accepting compliments, and sustaining relationships.

Other skills that would be improved are sharing, taking turns, asking for help, helping others, and including others in activities (Kamps, Leonard, Vernon, Dugan, Delquadri, Gershon, Wade, & Folk, 1992). ‘Teachers, and society, in general, are conditioned to view behavior psychodynamic, developmental, and physiological explanations. The lack of acceptance of procedures emerging from the principles of ABA can set up barriers to successful consultation, especially when the consultant is trained (Skinner & Hales, 2010). “Applied behavior analysis is the most used therapy for autism, but some people say the drills and routines are cruel, with misguided aims” (Devita-Raeburn, 2016). It focuses on changing the behaviors of an individual with autism. It attempts to make their behaviors and communication appear less autistic as if there is a ‘normal’ way to behave and act in any given situation. Caregivers believe ABA forces children to hide their true selves to fit into what society deems as appropriate. In 2018, the journal Advances in Autism published a study that found half of children and adults that participated in ABA had post-traumatic stress disorder (PTSD) and were eighty-six percent more likely to experience it than their peers that did not.

There are very few research studies conducted comparing outcomes of behavioral treatment comparing low and high functioning individuals with autism. Few studies compare the efficacy of different types of ABA with any other groups of children (Rudy, 2018). The ultimate goal of any therapy should be to build independence and quality of life for the individual, not force conformity. ABA can be a good thing if it’s used for good and not evil (Delisle, 2018). Regardless of what skills ABA seeks to teach, some believe it is fundamentally flawed and problematic. Some have even called ABA ‘the ultimate segregation,’ because it deprives children of their childhood with all the intensive and consistent sessions of therapy. Whether ABA is helpful or harmful has become a highly controversial topic. The largest misconception with ABA is dated information and assumptions of what the therapy attempts to accomplish.

Many see ABA as trying to normalize a child diagnosed with autism. Is applied behavior analysis the most beneficial and effective intervention for children with autism? The research will compare the effects of ABA therapy to alternative intervention strategies. Theory of mind (ToM) refers to our ability, or rather the inability, to infer what others are feeling or thinking. ‘The ability to form a theory of mind about other people is an important part of what makes humans social creatures, able to function in a shared culture’ (n.d., 2018). Using personal experience, we effectively puzzle together what someone else may be thinking or feeling. We place ourselves in their position and formulated how they may be perceiving the given situation. We attempt to process what we already know and make a hypothesis about their experience. Many disorders prevent individuals from putting themselves in someone else’s shoes. This also affects their ability to feel empathy or communicate effectively when feelings, facial expressions, or body language are involved. ‘Although most of us take for granted the idea that other people have the same general mental equipment and the same ability to perceive, reason, and feel just as we do, philosophers as far back as Descartes realized that the process was not really a simple one’ (n.d., 2018). Some scientists have even theorized that language evolved from the theory of mind. The use of applied behavior analysis (ABA) is becoming a more common form of intervention. ABA is used to train and build skills, including verbal skills, through behavioral reinforcement. This could very well mean, the theory of mind can also be trained in individuals. Applied Behavior Analysis (ABA) is the study of human behavior while striving to achieve a socially valid change in an individual’s quality of life.

Behavior and learning are continuously measured. Consistent measurement of program effectiveness for the student allows programs and goals to be adjusted accordingly. ABA curriculum is scientifically proven effective and yielded successful outcomes related to the area of focus. In order for a child to reach a maximum level of success, modifications and individualizations can be implemented. Classrooms are the perfect environment to elicit motivation to learn from multiple opportunities in their natural environment amongst neuro-typical peers. However, it is also beneficial to conduct sessions in other natural environments such as in the home and out in public. Spiraling is a term used to describe newly introduced material, along with mastering targets, to ensure everything taught is generalizing.

Mastered targets are the concepts children have learned and can complete naturally and independently. ABA places a large emphasis on functional responses, reinforcement, and shaping corrections in the future (Greer, Keohane, & Healy, 2002). According to Keller (2013), “ABA-based strategies are used to either increase skills and prevent or decrease maladaptive responses. There is more to the science of ABA, it can be used as a teaching tool or to maintain and generalize skills already learned” (Keller, 2013). Establishing a positive client-therapist relationship is called pairing. Children will be less resistant to complete work if a strong relationship has been built and the therapist has expressed interest in the individual child. Prompts and differential reinforcement are also beneficial to children diagnosed with autism. The process behind shaping skills using differential reinforcement entails reinforcing one set of behaviors and withholding reinforcement for another.

The implementation of gathering data on behaviors and performance allows graphs to be analyzed for patterns and trends. “Data will ensure that effective strategies remain in place and that ineffective practices are discontinued” (Keller, 2013). ABA is recognized as one of the most effective means of reducing developmental delays and problems. “This is the best way of creating an inclusive, whole-child educational setting, and it has the potential to alleviate the constraints and scarcity of resource availability in providing ABA and learning opportunities to all children’ (Vanover, 2016). Applied behavior analysis aids in the acquisition of academic skills and other socially relevant applications. ABA can be used for environment or sustainability issues, behavior management, and speech delays. “Applied behavior analysis is synonymous with discrete trial training (DTT). DTT is a procedure based on the fundamental principles of ABA” (Dib & Sturmey, 2007). In the world of ABA, the behavior is considered any observable and measurable act which is inclusive of social behaviors. ABA programs are comprised of multiple assessment and intervention methods used individually and dynamically to achieve the best results (Steele, Mace, Perry, & Longenecker, 2006). ABA was first introduced in clinical settings. Home- and clinic-based, one on one, intensive ABA programs became popular for young children with autism in the nineties.

Today many professionals and researchers agree that ABA is best implemented in natural environments to include home, school, and community contexts (Leach, 2017). Skills are taught to children individually or in a group setting. Then it is approached in the natural environment to ensure the skill has generalized. ABA works on molding, forming, and/or decreasing socially acceptable behaviors. All children, neuro-typical and those with disabilities, can benefit from behavioral training. ABA is effective in many different environments. It is effective in the home, school, public, and in other natural environments. ‘ABA has the best-documented outcome data supporting their approach as compared with other methods’ (Jacobson, 2000). Behavioral therapy improves language, reduces anxiety, and aggression. It can also improve cognitive abilities, adaptive behaviors, and social skills. ABA would be beneficial for all children as they develop and navigate childhood. ABA has been repeatedly shown to encourage educational gains and reduce challenging behaviors (Grey, Honan, & McClean, 2005). Children’s behaviors can affect their academic performance and vice versa. Therefore, any positive effect on both areas would be beneficial for all involved. Many childhood deficits can be shaped into more desirable behaviors if children are provided the resources in a positive manner.

Through five decades of research, applied behavior analysis-based intervention has been proven effective (Myers & Johnson, 2007). Applied behavior analysis (ABA) therapy is strongly supported by decades of research and application as a well-established treatment method (McHenry, 2010). Focus is placed on what people do rather than what they say. Physical responses, body language, and facial expressions are important aspects of effective communication. They are also important for reciprocating others thoughts and feelings (Cooper, 1982). Social skill groups train children to initiate, respond, and sustain interactions and relationships. Greeting others, conversing on relevant topics, giving compliments, accepting praise, taking turns or sharing, asking for help, helping others in need, inclusions, and understanding empathetic situations are all behaviors we as a society can improve upon (Kamps, Leonard, Vernon, Dugan, Delquadri, Gershon, Wade, & Folk, 1992). There is a vast amount of research that has been done on ABA, but few studies meet the gold standard of a randomized trial. In fact, the first randomized trial of any version of ABA, after Lovaas’ 1987 paper, wasn’t published until 2010. Most of his results were ‘preliminary but promising.’ There was little evidence to assess other behavioral therapies and information was lacking on what factors might influence the effectiveness and whether or not they would generalize (Devita-Raeburn, 2016). “The relevance of behavioral theory and philosophy to the practice of applied behavior analysis is not always immediately apparent, perhaps especially for those with less exposure to the philosophical and theoretical foundation of applied behavior analysis” (Fryling, 2015). Theory of mind (ToM) requires joint attention, to follows another’s eyes and interest in order to experience the same stimuli. Verbal communication confirms and reinforces the correct stimuli is being shared. It requires imitation, a vast repertoire, and practice.

Experiences to promote growth can ultimately lead to deeper connections with the natural environment (Spradlin, & Brady, 2008). Applied behavior analysis (ABA) itself is the experimental analysis of behavior. A baseline condition is established first. A treatment or intervention for change is introduced. After treatment is removed, generalization into the natural environment is tested. Individual interviews would be conducted using audio and visual recording, after receiving consent. Questionnaire forms created specifically for parents, teachers, and other professionals to record the subject’s behaviors would be used.

Other data would be collected via frequency/event and rate recordings. ABC (antecedent, behavior, consequence) data will be the most crucial to this experiment to compare the changes in behavior. Frequency/event and rate recordings track the number of times a behavior or response occurs. When the recording rate, the number of times is recorded for each individual time frame. ABC data takes data, or information, on the antecedents, behaviors, and consequences of the behavior. This allows caregivers to understand the function of behavior (Gilmore, 2017). ABA strives to strengthen desired behaviors and/or decrease undesired maladaptive behaviors based on observations of the individual. Behavioral interventions can significantly facilitate the acquisition of language, social, and other skills (AACAP, 1999). ABA uses behavioral principles to modify behavior, it is a precise and systematic method. Applied behavior analysis is widely used and funded, but some people say it causes lasting trauma.

Most states cover autism intervention and, because of its reputation, this includes ABA therapy. Parents who want to pursue outside resources for their child must fund it themselves (Devita-Raeburn, 2016). The comparison of two independent observations of a single event can convey different circumstances and behaviors. This can lessen the credibility of the observers.

Two observers can report similar observations about the same behavior, but this does not provide any guarantee that either report is truly accurate to what happened before, during, and/or after the behavior. In most child cases, a primary caregiver would be most sufficient to introduce target behaviors. However, when recording data and tracking progress, this may lead to the most bias results. Indirectly descriptive and inferential methods would be used for observations. Descriptive observations are a fancy way of saying, all observations written in a detailed manner.

Inferential observations allow the observer to write inferred observations in reference to the subject’s body language and behavior. As long as this is done in an educated manner, it can be very useful and effective for the research results. Direct observations could also be conducted, collecting data using a scatter plot tool. A scatter plot can help identify patterns in the number of times behaviors occur. If results have corresponding antecedents with their behaviors, the consequence that is reinforcing the behavior may be identified and then modified in future situations. If the longevity of behavior is the concern, a duration measure may be used. ‘The scatter plot may give information about when a behavior occurs and a duration measure will tell how long a behavior tends to last’ (Webster, 2017). Another helpful tool would be focus groups and case studies. The focus group would gather information and opinions from both perspectives. Case studies are an excellent additional tool to tie the observations and questionnaires together. Case studies allow for research to take on a more “real” aspect, by giving actual examples of individuals that the research has affected.

Past and present documents or records would also be collected to contribute to the final results. This is an inexpensive way to gather further information about participants. However, it may include incomplete data sources or bias material. “Assessing accuracy and reliability contributes to the quality of evidence presented through research” (Cooper et al., 2007). The quality of measurements directly relates to the ability of researchers making credible claims regarding the efficacy of treatment (McDermott, 1988). Many researchers already collect data in ways that facilitate both reliability and accuracy by conducting universal procedures, improving the quality of data within the field. Observers’ must also ensure they have operationalized the behaviors, so all observers know the specific behaviors they’re attempting to observe.

This allows for inter-observer reliability. Behavior therapists encounter complex challenges that require both an accurate interpretation of guidelines and a fair amount of independent judgment for the current situation. They have to make quick decisions that are not always black and white. Community standards, laws, prevailing philosophies, and individual freedoms determine ethical procedures in behavior analysis. Behavior analysts frequently deal with behaviors quite severe and complex (Bailey and Burch, 2011). They must abide not only by a universal code of ethics but also by individual family ethics since they usually work within the client’s home. Ethics help the behavior analyst determine what is the morally correct course of action.

Because cultures and rules change over time, they must be self-regulating to stay relevant to changing norms. Behavior analysts must maintain certifications through not only formal training, supervision, and mentored professional practice, but also through continuing education and staying current on new research. Behavior analysts must obtain informed consent prior to providing treatment. To obtain informed consent, the behavior analyst must ensure that the client, or guardian, has the ability to make decisions, provide voluntary consent, and understands the treatment for which consent is being given.

Before providing treatment, they must be confident that the natural environment will support adequate delivery of treatment. Behavior analysts must maintain the confidentiality of every client, protect the dignity of clients by ensuring they make choices, have privacy, a therapeutic environment, and the right to refuse treatment. Throughout treatment, the behavior analyst must be mindful to conflicts of interest. They must be vigilant against developing relationships with clients that extend past professional boundaries (Cooper, Heron, & Heward, 2013). They must attempt to avoid negative client reactions without affecting the progress of treatment. In order to avoid litigation, every behavior analyst needs to act at the height of ethics codes presented to them. There are a number of checks and balances in place for most therapists to ensure the code of ethics is being followed.

Therapists often work for companies that have a system in place to assess the services being provided by the therapist. They might observe a session with a client, talk to those receiving treatment, or monitor overall results in order to ensure that ethical practices are being followed. Employee training occurs prior to seeing clients and is an ongoing process. Certain parts of ethics will never change, but there are items that shift from time to time. The ongoing training helps keep all therapists current.

Therapists can also take reasonable steps in order to see that they are performing in a responsible, competent, ethical manner with every child. There may be a middle ground between the critics and supporters. More focus on teaching rather than normalizing or suppressing behaviors to help them communicate with others could be further researched. The emphasis should be placed on learning to function without changing themselves. This is where people get the past and present confused. ABA started with one goal in mind, fitting a child into a box, a metaphorical envision of a socially acceptable being, taking any measure to accomplish this goal.

But today, ABA focuses on guiding children to behave and alter certain behaviors to appear neuro-typical, while still accommodating their needs. Sensory issues or stimming may be altered from a socially unacceptable, and possibly unhygienic, behavior to a less noticeable and more viable option. In the end, there is no easy, cut and dry answer to this discussion. Parents do the best they can, they want the best for their child, and they will continue to advocate until that happens. The truth of the matter still remains that, disorders and deficits are exhibited differently in each individual and their treatment should be tailored to their individual needs. ABA is effective for many, perhaps most, individuals diagnosed with an autism spectrum disorder. However, there are also individuals that participated in the behavioral therapy with only negative results.

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