Good Behavior: the History and Employment of Applied Behavioral Analysis

Autism Spectrum Disorder or ASD is a developmental disorder that affects behavior, communication, cognition, emotional intelligence, and sensory stimulation. Although one can be diagnosed with Autism at any age, it is considered a developmental disorder because symptoms generally appear and are diagnosed within in the first two years of life (National Institute of Mental Health, 2018). While ASD is very common with 1 in every 59 children being affected by Autism, each case has a unique combination of symptoms (Autism Speaks, 2018b). The list of symptoms associated with Autism is vast, some of the most common traits and actions include: difficulty or lack of interest in communicating with others, repetitive behaviors (such as self-stimulatory behavior “stimming” or echolalia), intense obsessive interests, hypersensitivity to light and sound, delayed accusation or lack of speech, self-injurious behavior, impulsivity, and inappropriate social interaction (Mayo Clinic Staff, 2018) (Rudy, 2018b) (National Autistic Society, 2018) (Edelson, 2000). The DSM-V divides individuals with ASD into three categories based on level of severity: Level 1 “Requiring support”, Level 2 “Requiring substantial support”, Level 3 “Requiring very substantial support” (Autism Speaks, 2018b).

Other common disorders related to or also considered to be under the umbrella of ASD are: Asperger’s syndrome, Tourette's syndrome, Fragile X syndrome, Rhett syndrome, learning disabilities, attention deficit hyperactivity disorder (ADHD), epilepsy, dyspraxia, obsessive compulsive disorder (OCD), sleep problems, and sensory difficulties National Health Service, 2018) (Mayo Clinic Staff, 2018) (Autism Speaks, 2018c). Due to the wide range of symptoms that one can manifest, multilevel diagnostic criteria, and various related disorders that can qualify one for an ASD diagnosis and each individual case is just that, individual. Dr. Stephen Shore, a proud member of the ASD community himself and prominent professor of special education at Adelphi University, famously stated, “If you've met one person with autism, you've met one person with autism” to illustrate just how diverse the Autism spectrum is (Organization for Autism Research, 2018) (The International Board of Credentialing and Continuing Education Standards, 2018).

The focus of this paper is the behavioral aspect of ASD and the most common treatment of inappropriate behavior as a result of Autism, Applied Behavioral Analysis or ABA therapy. ABA therapy is the leading method of treatment for ASD and the most widely endorsed, organizations such as the National Institute of Health, the Association for Science in Autism Treatment, as well as the U.S. Surgeon General all consider ABA the best course of treatment for ASD (Centria Autism Services, 2018). The core of ABA therapy is teaching children new skills by breaking them into smaller actions and positively reinforcing each progression towards the goal action. Success in ABA therapy is described as increasing behaviors that are helpful to the child and decreasing behaviors that are harmful to the child or negatively affect their learning (Autism Speaks, 2018a).

There is no cure for Autism and ABA does not claim to “cure” children but rather aims to enhance their quality of life by teaching them valuable skills in communication, self-sufficiency, and emotional intelligence. The late Dr. Ivar Lovaas is credited as the father of ABA therapy. After earning his PhD in clinical psychology from the University of Washington in 1958 Lovaas began his career in applied psychology as an assistant professor at the University’s Child Development Institute under clinician Sidney Bijou—a student of zeitgeist of behavioralism, Dr. B.F. Skinner—during this time working under Bijou Lovaas developed his idea for a behavior-shaping form of therapy for children with ASD (Devita-Raeburn, 2016). In 1970 Lovaas launched the Young Autism Project and began putting ABA therapy into practice. Lovaas heavily focused on “normalizing” Autistic children and extinguishing behaviors that were considered overtly “Autism-like”. One such behavior his approach harshly discouraged was self-stimulatory behavior, also referred to as “stimming”—a set of repetitive acts such as hand-flapping or other tics that ASD children use to dispel energy and anxiety (Devita-Raeburn, 2016) (Rudy 2018b). A regrettable part of the history of ABA was the corporal manner in which therapists were instructed to eliminate ASD behaviors. In the initial trials of ABA, therapists slapped, shouted at, taunted or even administered electrical shocks to children to reduce unwanted tics (Devita-Raeburn, 2016).

Many opposers of ABA often reference such practices when expressing their dissent of ABA therapy but it is important to note that ABA as well as ethical regulations have both progressed immensely since the inauguration of Lovaas’ studies in the early 1970’s—contemporary ABA omits any type of positive punishment behavior shaping. Despite the unsavory and overly regimented implementation of the therapy, after the first 14 months of treatment his patients exhibited enormous improvements in suppression of inappropriate social behaviors as well as strides in behaviors; such as speech, play, and social nonverbal behavior—improvement in the children’s IQs were also recorded (Devita-Raeburn, 2016). As for my personal connection to the world of ABA therapy, I will be starting training in January to become a Registered Behavioral Therapist or an RBT. This will be my first experience in a professional field and I eager to begin. I have had several positions in which I gained experience working closely with children on the Autism spectrum and I hope to continue with this type of work after graduating. To become an RBT I must first complete 40-hours of training conducted by the Behavioral Analyst Certification Board and pass the RBT exam (Behavioral Analyst Certification Board, 2018). Upon passing I will be able to start working with clients directly, usual sessions are conducted in the home, which is reflective of the hybrid approach the agency I will be working for uses.

At Gateway Learning Group principles of ABA are employed as well as strategies from programs such as Pivotal Response Treatment, Discrete Trial Training, and the Early Start Denver Model (Gateway Learning Group, 2018). As I have been conducting research for this assignment, I have come across multiple viewpoints on Autism treatment and ABA therapy in particular. When I originally came across negative viewpoints, I was worried to align myself with of a problematic type of treatment. After further research I have come to understand the prominent critiques of ABA are that it is marketed as the “only option” to parents and it is an attempt to change children in a derogatory way. To the first point, ABA is the most well-known and extensively peracted form of treatment because it came about fairly early. Before Lovaas, the main form of treatment for ASD was to be sent to an institution (which were very scary places back in 1950s), while Lovaas had a less than perfect approach ethically-speaking he did save generations of children from being sent to the “looney bin”.

Additionally, it is difficult to run trials, and subsequently popularize, new forms of treatment because most parents have little interest in their child being a “guinea pig” for a new study or a be part of a control group and remain untreated. Secondly, I disagree with the claim that ABA is an insulting practice, most of the rhetoric I have come across that asserts such goes on to say that people with ASD should be regarded as “different” but not “atypical”—yet those words are synonyms—and should not be undergo treatment to change their behavior. Personally I have nothing but compassion and respect for all the people in my family, social circle, and work environment with ASD and I do not look down on them or see them as needing to be “fixed” but seeking treatment to improve their social skills, self-sufficiency, and communication are all things that ultimate enrich their overall quality of life by enabling them to form deeper relationships, live more independently, and even obtain jobs to help support themselves.

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