When pioneering child psychiatrist Dr. Leo Kanner first identified and described autism in 1943, few treatment options existed. Adults placed most children with autism in residential institutions well into the 1960s.
But, science and society’s understanding of the condition have grown. So have efforts to find effective treatment approaches for children and youth with autism spectrum disorders.
Today, Applied Behavior Analysis (ABA) is the most common treatment for autism.
Dr. Ivar Lovaas started developing ABA therapy for autism in the mid-1960s. In a landmark 1987 study, he reported 47% of the children who’d received his rigorous, long-term behavior interventions “achieved normal intellectual and educational functioning.”
Many of Lovaas’ methods remain hallmarks of ABA programs—breaking down complex tasks into smaller ones, giving positive reinforcement when children demonstrate a desired behavior, ignoring problem behaviors, and so on.
The increased prevalence of ASD diagnoses in the U.S. over the past two decades has only intensified demand for effective educational and therapeutic services. But, ABA treatment for autism still raises questions for many families and teachers—and special education administrators.
The Pediatric Therapeutic Services (PTS) behavioral health team sees firsthand how applied behavior analysis makes a positive difference for children with autism and other developmental disorders.
We want to highlight the evidence intervention science is giving educators and families about which practices are most effective.
Advantages and Goals of ABA Treatment for Autism
Applied behavior analysis is the scientific study of human behaviors, aiming to both understand and improve them.
It is built on the insight that all voluntary behavior serves a function. It emphasizes the environmental, experiential factors influencing behavior. When these factors change, behaviors can change. This understanding of behavior enables ABA treatment to increase helpful, desired behaviors and decrease problem behaviors.
In addition to focusing on practical skills, ABA treatment has the advantage of being adaptable and flexible. Therapists can:
- Design and modify intervention plans to meet each person’s unique needs.
- Provide services in a variety of locations—even virtually (though PTS’ behavioral specialists are school-based).
- Work with people one-on-one or, as appropriate, in small groups.
Applied behavior analysis treatment for autism uses positive reinforcement techniques to improve outcomes in these primary areas of concern:
- Communication and Language Skills
ABA can improve production of words and sentences, resolve such issues as echolalia and repetitive speech, increase verbal fluency, and more.
- Social Development
ABA can help children develop skills needed for healthy and positive interactions with others, such as taking turns, using and interpreting body language, managing emotions, and solving problems.
- Learning Skills
ABA can teach such important skills as paying attention, following instructions, making requests, matching, and sequencing.
- Behavior Problems
ABA can reduce behaviors harmful to self or others and, in the school setting, behaviors disrupting or impeding the student’s or their peers’ learning.
What Scientific Research Says About ABA’s Effectiveness
The best approach to treating autism is an evidence-based approach—one that stands up to scientific tests of usefulness, quality, and effectiveness.
The American Psychological Association (APA) “affirms that the practice and supervision of applied behavior analysis are well-grounded in psychological science and evidence-based practice.”
Similarly, the U.S. Surgeon General’s report Mental Health (1999), endorsed ABA as an evidence-based best practice. “Thirty years of research,” the report states, “demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior.”
More than 20 studies show intensive (25-40 hours a week) and long-term (one to three years) therapy using ABA principles improves outcomes for many children with autism. These outcomes include gains in intellectual functioning, language development, daily living skills, and social functioning. Studies of adult ABA interventions, although fewer, point to similar benefits.
In 2009, the National Autism Center released Phase 1 of its National Standards Project. This report reviews 775 applied treatments for autism, giving administrators and educators a guide for developing evidence-based intervention programs.
It identified 11 established treatments “that produce beneficial outcomes and are known to be effective for individuals on the autism spectrum. The overwhelming majority of these interventions were developed in the behavioral literature (e.g., applied behavior analysis, behavioral psychology, and positive behavior support).”
Other reviews of scientific research have similarly concluded ABA treatments for autism produce the best outcomes.
In 1999, for instance, the New York State Department of Health recommended: “principles of applied behavior analysis (ABA) and behavior intervention strategies be included as an important element of any intervention program for young children with autism.”
And in 2000, the Maine Administrators of Services for Children with Disabilities (MADSEC) Autism Task Force concluded, “There is a wealth of validated and peer-reviewed studies supporting the efficacy of ABA methods to improve and sustain socially significant behaviors in every domain, in individuals with autism.”
Addressing Some Concerns About ABA Therapy
Some advocates for people with autism and parents do raise questions about ABA’s methods and efficacy.
The fact that Dr. Lovaas, in the 1960s, used some punishments, including electric shocks for self-injurious behaviors, still causes controversy. Recent headlines about skin shock being used at the Judge Rotenberg Educational Center in Canton, Massachusetts reinforce negative views of ABA as a whole. Quality behavioral specialists use humane, child-appropriate positive reinforcements.
Other critics of ABA charge it as too formulaic. While some ABA programs adopt a “one-size-fits-all” approach, high-quality programs take advantage of ABA’s inherent flexibility to create highly-individualized interventions. A well-written behavior intervention plan is personalized, addressing the specific child’s strengths and needs, and taking into account the family’s situation.
Federal special education law doesn’t specifically mandate ABA services. But, more U.S. students are diagnosed with autism spectrum disorders. And, more judges and hearing officers “are beginning to credit the scientific research supporting intensive ABA therapy over other methodologies,” according to special education attorney Robert Crabtree.
Incorporating applied behavior analysis is only one way you can make your program more responsive to your students’ needs. To find out about others, download your free copy of PTS’ eBook, Creating an Agile School-Based Therapy Program: An Administrator’s Guide.
You’ll discover practical advice on adopting an approach that lets you maximize your program’s impact without maximizing costs.