Applied Behavior Analysis in Verbal Therapy

The field of behavior analysis has a long history with the study of language development. B.F. Skinner, one of the pioneers of modern behaviorism, wrote an entire book around the topic, Verbal Behavior, which sparked significant debate in the field of psychology and continues to provide fertile ground for research and treatment of language-related behavioral issues even today.

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Skinner believed that all human actions were behavior-based, including language and language acquisition. His in-depth analysis of the behaviors leading to language development continue to inform the field of applied behavior analysis today.

Skinner broke language down into five behavioral operants:

  • Mand – A motivating operation, such as a directly stated demand (“I want milk!”) resulting in immediate reinforcement.
  • Tact – An observation or description of the environment.
  • Intraverbal – Responses to prompts (tacts or mands, typically) offered by other people.
  • Echoic – Repetition of the verbal behavior of other people.
  • Autoclitic – A modification of one of the other forms, such as saying “I think I want milk.”

The overriding characteristic of the behavioral approach to language development is the functional nature. ABAs focus on observable, measurable, and modifiable aspects of language development.

The impact of language on behavior and vice versa means that almost all ABAs will deal with language development issues in the course of their careers in the field. Because language development is viewed largely as simply another type of behavior, the tools and techniques they learn in the course of their master’s programs are as useful for teaching language skills as with any other issue.

Language Issues Underpinning Autism Spectrum Disorder Dominate Behavior Analysis Practice

Although it is not necessarily the case that all language development therapies using applied behavior analysis are related to autism spectrum disorder (ASD) patients, it is unquestionably the case that ASD patients often have language development issues. According to a study from Yale University, communication deficits are one of the core symptoms of ASD.

Because language development can be a very specialized field with many contributing factors, including both mental and physical, ABAs can expect to collaborate on language development treatments with other healthcare professionals, including:

  • Doctors
  • Surgeons
  • Speech-language pathologists (SLP)
  • Occupational therapists
  • Physical therapists

A challenge for speech language pathologists working with developmentally disabled patients is determining when a communication problem is the result of speech impediments and when it is due to behavioral issues. This is because behavioral problems impede language learning—a severely autistic patient may have limited capacity to acquire language skills due to acting out during lessons—and in some cases communication problems lead to behavioral problems—a child frustrated at their inability to communicate their needs may act out as a means of reaching out.

Behavior analysts apply their specialized training in these situations to make that determination, and treat any behavioral issues identified using common behavioral analysis techniques. ABAs can contribute their skills in both cases:

  • Behavioral issues impeding language learning – The ABA will typically focus on behavioral impediments to language development while working together with other professionals who help to address any medical issues such as physical deformities or treatable neurological problems.
  • Language issues leading to behavioral problems – The ABA will use the techniques of behavior reinforcement to assist with teaching language and speech patterns to improve communication skills for the patient.

ABAs Work With Language Issues in Schools and Clinics

One of the most common venues where ABAs work with language learning are public and private schools. For many children with developmental disabilities, entry into the school system coincides with their learning to speak. Somewhere between 2 percent and 19 percent of kids between 2 and 7 years of age have language learning delays. These delays have been shown to have significant impact on academic performance later in life.

Consequently, ABAs working with special education programs frequently find themselves helping to address language learning issues. In some cases, they find themselves working with the same age groups but in private clinics specialized in autism treatments.

Special education students each have an IEP, or Individual Education Plan, aimed to address their particular issues in the least disruptive way possible. An ABA frequently has a hand in developing the IEP, using their expertise in creating systems to encourage the development of language-based behaviors.

To make their contribution, the ABA will conduct a Functional Behavior Analysis (FBA) for the student. To diagnose language-specific issues, they will often turn to a pair of specialized assessment tools:

  • VB-MAPP – The Verbal Behavior Milestones Assessment and Placement Program, based on Skinner’s Verbal Behavior theories, which specifically distills achievable IEP goals for the student.
  • ABLLS-R – The Assessment of Basic Language and Learning Skills, Revised, divides skill assessment into repertoire areas that can be reassessed to measure progress periodically.

From the FBA, and in consultation with other caregivers, the ABA will construct a Behavior Intervention Plan (BIP) centered on language development.

Techniques commonly taught in ABA master’s programs that are associated with teaching language skills include:

  • Verbal Behavior (VB) – A functional language approach that ties rewards and motivations to language development; for instance, if ice cream is a reward to the patient, then “ice cream” will be a phrase that the ABA focuses on teaching using repetition and continued rewards for improvement.
  • Picture Communication Training – ABAs have developed a number of non-verbal communication systems to use with patients, among them systems such as PECS (Picture Exchange Communication System), which uses electronic displays and pointing or clicking to convey concepts and establish communication.
  • Pivotal Response Training (PRT) – PRT looks for critical behavior points and rewards progress toward positive developments of those behaviors regardless of ancillary behaviors or imperfect progression. In language development scenarios, this can involve immersion programs where patients are primarily interacted with in the target language, and rewarded for efforts to incorporate it in their own sound production and communication

Each of these methods relies on the so-called ABCs of behavior analysis: Antecedent-Behavior-Consequence.

Using this model, behavior analysis can be used to help teach either language comprehension or production. An antecedent prompt such as “Say ball!” is used to evoke the behavior of actually saying the word, with the consequence that a cookie or other reward is given. Similarly, comprehension can be taught and rewarded by asking the patient to identify an object or perform an action (the antecedent)—if the requested object is identified or the action performed (the behavior), a reward (the consequence) is offered.

Applied Behavior Analysts Help Trauma Victims Re-learn Language

Although ASD and other developmental disabilities generate the lion’s share of language-related problems that ABAs will deal with, they also find themselves working with patients who have suffered language deficits as a result of stroke or traumatic brain injury (TBI).

This category of patients may require different levels of intervention. Since they have previously been functional language users, their frustration levels may be higher at having lost that capability. The degree of injury to their language processing centers, and the lack of plasticity in their (frequently) older brains can also make language re-acquisition more challenging.

Some clinicians have identified motivation as a particular difficulty in recovery in TBI cases, and this is an area in which ABAs can be particularly helpful. Identifying the antecedents applicable to individual patients and molding BIPs to provide the necessary rewards can have impressive effects in language re-acquisition in these cases.

Additional Resources on ABA in Verbal Therapy

Speech, Language, and Applied Behavior Analysis Blog – An ABA blog that focuses on speech and language issue treatment using behavior analysis techniques.

Speech and Language Delay in Children – A handy list of medical and behavioral conditions leading to language deficits, together with causes and treatment options.

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