Applied Behavior Analysis for the Treatment of Autism Spectrum Disorder

Autism, a neurodevelopmental disorder that is characterized by social difficulties and inappropriate behaviors, was first identified in 1938, although symptoms describing the disorder stretch back hundreds of years. Investigation in the late 1960s revealed that autism spectrum disorders (ASD), a family of related afflictions, were separate from other mental disorders commonly originating in childhood.

Patients characteristically exhibited an array of symptoms including:

  • Difficulty in developing non-verbal communication skills
  • Delayed development of verbal communication skills
  • Lack of empathic response
  • Extreme focus on certain topics
  • Repetitive behaviors such as hand-flapping or incessant rocking

The Evolution of Treatment for Autism Spectrum Disorder

ASD was poorly understood and many patients with the disorder were misdiagnosed and typically treated with the limited range of therapies common to many mental disorders at the time, including:

  • LSD and other drug therapies
  • Electroconvulsive shock treatments and other aversion therapies
  • Institutionalization in mental institutions
  • Psychoanalysis

Then came Doctor Ivar Lovaas, a Norwegian-American who graduated with a doctorate in clinical psychology from the University of Washington in 1958. Lovaas’ teachers had included a number of early subscribers to B.F. Skinner’s theories of behaviorism, including Montrose Wolf and Sidney Bijou.

When he was hired as a professor at UCLA in 1961, Lovaas was in a unique position to apply those theories in a series of studies in the treatment of autistic children. He established the UCLA Young Autism Project to investigate various therapy techniques rooted in behavior analysis. From this research, he proved the efficacy of a technique that came to be known as Discrete Trial Training (DTT), a highly structured series of steps leading patients toward an eventual behavioral goal.

Lovaas’ work both transformed the treatment of autistic individuals and helped to incontrovertibly establish the profession of applied behavior analysis as a scientifically validated therapy for a variety of behavioral disorders. Lovaas was a major contributor to the founding of the Autism Society of America, a group that continues to advocate for ASD treatment and research today.

Today, autism treatment and applied behavior analysis have become so closely tied together that most are only familiar with ABA in the context of autism therapy.

An Explosion in Autism Diagnosis Brings Prominence to Applied Behavioral Analysis

Although it became widely accepted in psychology circles as a valid treatment method for autism spectrum disorder, ABA remained out of the limelight in the American healthcare industry through the 1970s and 1980s.

Then, for reasons that still remain largely unexplained, the population of ASD patients suddenly exploded beginning in the 1990s. Between 1996 and 2007, for example, in California alone, autism diagnoses increased by eight times.

Suddenly, applied behavior analysis became a critical skill for healthcare providers, special education departments, and private clinics specializing in autism treatment. The Lovaas Method and other ABA techniques have evolved and become mainstream in all of these areas over the last two decades.

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How Applied Behavior Analysts Work With ASD Patients Today

A report commissioned by the Behavior Analysis Certification Board (BACB) in 2015 revealed that more than half of all job postings for ABAs were for positions that involve working with ASD patients. These postings reached across the gamut of industries in which ABAs are employed, including:

  • Healthcare
  • Education
  • Insurance industry
  • Social assistance
  • Private treatment facilities

ABAs primarily work one-on-one with ASD patients, but they may have a high caseload with multiple patient appointments each day. In some settings, ABAs take on supervisory roles, advising other healthcare providers or caregivers on how best to support Behavior Intervention Plans (BIPs), or overseeing assistant applied behavior analysts or registered behavior technicians who are working directly with patients.

When working for insurers or in the education system, ABAs perform case management and reviews, and triage autism patients by conducting Functional Behavior Assessments (FBAs) to determine the specific behavioral issues being exhibited and to gauge the severity of their ASD affliction.

Some of the Many Interventions Used for Treating Autism Spectrum Disorders

Despite the more optimistic claims made by some hopeful people, there is no cure for autism. But ABA offers a new and effective set of interventions for minimizing the secondary effects and symptoms that come with the disorder. BACB’s Guidelines for ASD covers the many interventions used in the treatment of ASD.

There are more than 300 tactics described in behavior analytic literature, with this abridged list representing just three techniques that are commonly employed:

Discrete trial training (DTT) is still an important component of the Lovaas Method, which couples it with:

  • Incidental Teaching (immersing patients in an environment that easily fosters their interests and minimizes the presence of disruptive antecedents)
  • Intensive approach, which can involve up to 40 hours per week of direct therapy

For example, an ABA working to improve a patient’s discrete motor skills might have an overall objective of training the patient to pick up and hand them two distinct objects– cards with pictures of particular animals on them, for instance. The DTT approach to achieving this goal might involve breaking the training down into several steps:

  • Recognizing the animals on the cards
  • Identifying and naming the animals
  • Picking up the cards with the named animals on them
  • Handing the cards to the analyst

Each of these steps would consist of 5 parts:

  1. The antecedent, or initial condition to which the patient should respond
  2. A prompt from the analyst as to the correct response
  3. The response itself
  4. A consequence for the correct response or a consequence for an incorrect response
  5. An inter-trial interval between attempts

Token economies are another tool in the behavior analyst’s toolbox. Such systems involve handing out or taking away a token, such as a poker chip or sticker, as an accounting method to reward or punish certain behaviors. The tokens can typically be redeemed at a later time, teaching patience, accountability, and reinforcing positive behaviors.

Pivotal Response Treatment (PRT) is another common ABA tool used in autism treatment. In PRT, analysts focus on identifying a critical behavior point and attempting to influence that point with positive rewards rather than addressing discrete or ancillary behaviors.

For instance, if a child attempts to request a stuffed animal to play with, the therapist might reward the patient with the animal even if other aspects of the behavior were disruptive or problematic. The goal is to encourage the generally appropriate behavior (in this case, a direct communication attempt) to help elevate it over time above the less appropriate behaviors.

Preparing for a Career in Autism Treatment as an Applied Behavior Analyst

Obtaining a master’s degree or higher in applied behavior analysis, special education, or psychology is a general requirement for working in the field with ASD patients. Many such programs today are structured to present training opportunities working directly with ASD patients, and much of the coursework will be devoted to ABA techniques that are directly applied in autism treatment.

The Behavior Analyst Certification Board (BACB) offers the BCBA® (Board Certified Behavior Analyst) certificate, which is commonly required for ABAs working in any industry that deals with autism services. Insurance companies often require BCBA® credentials of service providers who bill for autism-related treatments; in some states the requirement for the credential is written into state laws concerning health insurance reimbursement.

Many states are also beginning to implement licensing regimes, which typically either require a BCBA® or equivalent training and education.

Volunteer opportunities with social services department or private clinical providers of autism treatment are a good way to gain exposure to ABA work with ASD patients before or during graduate work in applied behavior analysis. Many clinics and providers advertise for volunteers to help out in their treatment programs.

Applicants will find a wide array of jobs available across the spectrum of industries. A qualified ABA might choose to work in the school systems with autistic students in special education classes, or in a private practice working with ASD patients at home or in an office setting. Still others will find work in residential care facilities, working with larger healthcare teams to provide 24/7 care for patients. With an estimated 1 in every 68 children currently diagnosed somewhere on the spectrum, there are no shortage of opportunities.

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Additional Resources for Applied Behavior Analysis in Autism

Association for Science in Autism Treatment – A nonprofit organization focused on finding and encouraging scientifically effective methods for treating autism spectrum disorders.

Volunteer Match – An organization that lists volunteer opportunities in a variety of fields, including autism treatment organizations.

Autism Speaks – A research and advocacy group focused on finding the causes for, and treatments of, autism spectrum disorder.

The Autism Society of America – A national non-profit that exists to improve the lives of all autism sufferers through advocacy, lobbying, and research efforts.

Behavior Analyst Certification Board – A national certification and standards body governing ABA practices.

Association of Behavior Analysts International – An international association that performs ABA advocacy and has many resources for job-seekers and active behavior analysts.

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