Applied Behavior Analysis (ABA)

ABA focuses on antecedents, behaviors, and consequences. An antecedent is an event that occurs before a behavior. This event might be verbal, like a request from a parent or teacher; physical, like a light, sound, or object in the environment that causes a reaction; or internal, like a feeling or thought. Behavior is the response (or lack thereof) to the antecedent. Behaviors might include verbal reactions or physical movements. 

A consequence directly follows a behavior. Desired behaviors are often met with positive reinforcement or a reward, while inappropriate behaviors are typically met with no reaction (but not punishment) from parents, teachers, and therapists. However, the lack of response may be seen as a form of punishment, which can contribute to the controversy behind ABA.

Considering the antecedent, behavior, and consequence may help therapists, teachers, and parents understand why a behavior may occur and how different consequences can affect the likelihood that behavior will happen again. By implementing consequences for behaviors over time, therapists using ABA may help children replace certain behaviors with alternatives.

Behavior through a neurodivergent lens 

It can be crucial to note that what a parent, caregiver, or teacher considers “inappropriate” behavior may be a non-harmful form of coping or comfort for a child. For example, a lack of eye contact may be a more comfortable way for a child or adult with autism to navigate the world, and they may not necessarily benefit from changing this behavior. In addition, being non-verbal may sometimes be more comfortable for an Autistic individual than speaking. Other forms of communicating, such as communicative electronic devices, may be a healthy way to accommodate non-verbal or partially verbal people rather than aiming to change this behavior. 

Studies also show that Autistic people may communicate with other Autistic people with the same effectiveness that neurotypical people have when communicating with each other, which may challenge the way social skills are perceived and improved in therapy. Plus, Autistic children, teens, and adults are diverse, and one approach might not serve all people the same way. 

ABA approaches 

There are multiple approaches to applied behavioral analysis, and some may work better for certain children than others. Some of the standard ABA techniques include:

• Early Intensive Behavioral Intervention (EIBI): EIBI might be effective for developing language and functional skills in children under six. This treatment is one of the more well-established therapies for ASD. Children may attend sessions for as many as 40 hours a week for multiple years, though this intensity level has been a point of controversy around ABA.
• Early Start Denver Model (ESDM): The Early Start Denver Model may be used with younger children between 12 and 48 months. It often focuses on play, shared attention, and social exchanges and might help children improve language, learning, and social skills.
• Joint Attention, Symbolic Play, Engagement & Regulation (JASPER): JASPER uses a combination of behavioral and developmental principles to support the foundations of social communication. It’s used with children between one and eight years old.
• Pivotal Response Treatment (PRT): This treatment is a child-initiated, play-based therapy³ focusing on social behaviors, communication, and self-management. PRT focuses on increasing a child’s motivation during treatment and uses activities chosen by the child to keep them intrinsically motivated.

When learning more about applied behavior analysis (ABA), consider reading the research the Autistic Self Advocacy Network has compiled on ABA’s impacts on children and adults.

Every program and approach to applied behavior analysis (ABA) can be different because each treatment program is tailored to the individual child. The therapist may support the child by helping them manage their symptoms and work on skills to improve their quality of life or increase independence—and in fact, applied behavioral analysis may be most effective when a therapist accommodates each child’s unique needs.

The first step of the process may be to complete a detailed assessment to help the therapist determine suitable goals for the child. These goals are set based on the child's ability and age and can cover various elements, from self-care and social skills to language and communication.

ABA therapists often then create treatment plans that break these skills into minor steps, starting with what is considered “simple” and moving to complex skills. They may gather data during each session to monitor progress and ensure the child is moving toward their goals.

Applied behavioral analysis (ABA) may benefit some children with autism. Autism is a life-long developmental condition and cognitive difference present from birth and is typically diagnosed using a model of three levels of functioning. However, emerging theories of neurodiversity posit that autism may be more multifaceted, with individuals experiencing various functioning difficulties of multiple levels in different areas of life. Some Autistic people may struggle with verbal communication, motor skills, sleep, and other areas of life that can reduce independence in a neurotypical world. Others may struggle more with sensory processing, learning, or socializing with neurotypical peers. 

The therapeutic modality that parents or caregivers choose for their children can be structured to address their unique needs instead of being based on an overall generalization of what autism “should” look like. Because each child is unique, ABA may not be beneficial for all Autistic people. 

Children with ASD who have coexisting conditions may have a more difficult time with learning, social relationships, and behavior management and may be more likely to benefit from ABA. Depending on the approach used, applied behavioral analysis techniques might be effective for children ages one and up and may be completed over at least two years. ABA may also help those with attention-deficit/hyperactivity disorder (ADHD),⁴ depression, obsessive-compulsive disorder (OCD),⁵ anxiety, and challenges with anger management. Depending on your child's symptoms, a therapist may help you determine whether ABA might be beneficial.

Analysis is often carried out at all levels during the treatment process. Before starting treatment, therapists consider the child's baseline behavior and gather and analyze data at every session to ensure goals are being met effectively. 

There are often multiple elements included in this kind of analysis, such as: 

• The overall treatment goals and controlling variables so that the natural environment is replicated as closely as possible in the treatment setting
• All behaviors laid out in the treatment plan, especially behaviors to be changed
• The effects of positive reinforcement to determine if a particular consequence is working or if behavioral changes are automatic or unintentional
• Whether the child is responding to interventions or other variables
• The child’s responses, to ensure they are free from prompts and cues from the therapist and to consider other variables that can explain the child’s behavior during treatment
• Environmental constraints and variables that can affect behavior and treatment

Some research indicates that ABA might be effective in supporting children with autism spectrum disorder (ASD). For example, a meta-analysis of studies on ABA suggests that, while ABA-based treatments may not improve all symptoms of ASD, this type of therapy may improve communication, socialization, and expressive language in some individuals.

There are diverse studies on ABA, showing both positive and negative results. Researching this and other approaches can be crucial before deciding how best to support yourself or your child. According to 2022 research based on years of studies and new knowledge from neurodiversity activists, doctors, and psychologists, ABA may not be effective for everyone and has been associated with various concerns, including potential adverse mental health impacts. 

The study expresses concern over practices that have previously been used or may still be used in ABA, such as punishment, shock, and the intensity and duration of ABA sessions (with some children undergoing over 40 hours of ABA a week). They advocate for Autistic children and adults having the same rights as neurotypical individuals and not being subjected to harmful practices. 

Due to the harmful impacts of punishment and intense practices, the authors recommend alternatives like accommodations, modified ABA that does not involve punishment, and neurodiverse-informed practices. Finally, the authors recommend that ABA should evolve as research and disability activism evolve. Meeting Autistic individuals where they are and ensuring personalized approaches can be crucial to ethical and supportive therapeutic modalities.