Applied Behavior Analysis (ABA) is widely recognized as the gold standard therapy for autism. More than 600 scientific studies have proven its effectiveness in helping children on the spectrum learn age-appropriate behavior, communication, and social skills. ABA is also the only autism treatment endorsed by the U.S. Surgeon General and the American Academy of Pediatrics.
Yet parents looking into ABA will quickly find adults with autism who criticize their childhood experiences with it. Common complaints include ABA using punishment, teaching every child the same skills regardless of his or her needs, not providing real-life learning, and trying to make children on the spectrum seem “normal.”
Parents are understandably concerned about these charges. But parents should also know that ABA has changed dramatically in the last 15 years. Yesterday’s ABA therapy is not today’s reality.
In the past, ABA was a standardized program designed to teach each child the same skills. Today, the goal is to help each child achieve their unique potential, learn age-appropriate behaviors, and provide tools for lifelong learning.
So what has really changed between the “old” and “new” ABA? The most important differences include an emphasis on positive reinforcement, customized therapy programs, broad-based learning, and celebrating individuality.
Positive Reinforcement, Not Punishment
When ABA was adapted for autism in the 1980s, it used a small punishment for wrong answers, such as a light slap on the thigh. Today, ABA primarily uses rewards to encourage desirable behaviors and replace challenging behaviors.
For example, many kids with autism have a hard time sitting for a meal. They would rather wander and nibble. In the past, a therapist might have forced a child to stay in his chair by blocking him in. The child learned to sit at the table, but he also associated it with a bad experience.
Today’s approach is different. An ABA therapist might ask a child to sit at the table for a short time and reward success by letting him get up and graze. Once the child can do this, the therapist will add another small step such as sitting to eat a few bites of food, and then let the child wander. Over time, he learns to eat a meal at the table and associates it with rewards.
The outcome is the same: The child can join the family for a meal. But there’s a huge contrast in how that is taught today versus yesterday. The emphasis on positive reinforcement means kids learn that mastering new skills is fun and rewarding.
A New Take on Negative Consequences
The emphasis on rewards doesn’t mean today’s ABA never uses punishment. However, punishment usually involves taking away something a child finds desirable and is generally reserved for serious or risky behavior.
A child who is aggressive towards her siblings can be dangerous, especially as she gets older. A sticker chart that combines rewards and consequences is a typical way to change this behavior.
A therapist first teaches the child desirable behaviors, such as walking away when she is angry, doing something nice for a sibling, and not hitting or kicking. The child earns a sticker every time she does one of these, and a number of stickers can be traded for a toy, screen time, or other reward.
If the child is mean to a sibling or hits, she loses one or more stickers. This is punishment, because it takes away something the child has worked hard to earn. But the consequence is easily scaled to the behavior (for example, saying something mean results in losing one sticker, hitting results in losing two stickers, and so on). Equally important, a child’s challenging behavior doesn’t eliminate all of her success to date or the incentive to earn rewards by behaving better.
Customized Therapy for Unique Individuals
ABA therapy was originally established with standard programs. A therapist evaluated the age associated with a child’s abilities and taught every child the skills associated with that age. Every child was taught the same skills in the same order, regardless of the specific skills he or she needed to work on.
So the ABA program for an 8-year-old who could name shapes but not dress himself was identical to the program for an 8-year-old who could eat a meal but couldn’t ask for what she wanted and had frequent meltdowns as a result.
Today, ABA is customized for each child. The program is tailored to the child’s skills, needs, and challenges, as well as the family’s priorities. The therapy for a child who can’t get dressed will focus on daily living activities. It will use small steps and rewards to teach the child to put on underwear, then socks, a shirt, pants, and shoes until he can dress himself.
Therapy for a child who can’t communicate might include teaching the child to say the names of favorite items or use pictures to ask for what she wants. As the child learns to communicate, she’ll be less frustrated and meltdown less often.
From Table Training to Real Life Learning
In the past, most ABA therapy took place sitting at a table using flash cards. Not today. The emphasis is on teaching children behaviors where and when they need to use them.
If a child is learning colors, the therapy might start at the table, then quickly move to identifying colors around the house, in the yard, and on the street. When a child is learning to brush his teeth as part of the morning and bedtime routines, the therapist will come to the home in the morning and evening until the child can brush his teeth at the right times. The hallmark of high-quality ABA is that it doesn’t look like work. A parent watching a session will notice the structure, but the activities should look like whatever skill the child is working on, be it getting dressed, taking turns, eating a snack, or going to the doctor.
ABA therapy today also strives for “generalization,” which means teaching children to use a skill beyond the setting where they learn it. For example, a child should be able to put on her coat and mittens at home and at school.
In addition, therapists work closely with parents, teaching the basics of ABA so parents can reinforce the child’s progress, and deal with new behaviors and situations as they occur. Children with autism learn the age-appropriate skills they need for everyday life, and how to use them in familiar and new situations. This requires more flexible therapy and may take longer, but it gives children the foundation for a lifetime of success.
Some adults who had ABA as children say the therapy tried to make them act like neurotypical kids. Today’s emphasis is teaching children appropriate behaviors for various places.
Many children on the spectrum flap their arms, spin, or shout when they get excited. This is fine at home, but it can be disruptive in public. In the past, ABA tried to teach a child to never engage in these behaviors so he or she looked like other kids.
Today, a therapist may teach a child that it’s fine to spin or scream at home, but not at the supermarket or library. Then the therapist will help a child learn a replacement behavior that accomplishes the same function, such as lightly tapping his or her leg.
The message is that the child is welcome to express happiness and excitement in his or her unique way, but that there are different ways to express those feelings in different places. Parents constantly shape children’s behavior in this way, regardless of whether the children have autism. ABA provides the additional help children on the spectrum often need to learn this lesson.
Happy Kids, Happy Parents
ABA therapy has helped countless children with autism learn age-appropriate behavior, communication, and social skills. Today’s ABA uses customized therapy programs and positive rewards to celebrate each child’s unique personality and teach skills for life-long learning.
How kids and parents respond to ABA shows how much has changed. Kids often run to the door when their therapist arrives, excited to start a session. Many parents talk about the joy of seeing their child having fun in therapy, communicating more clearly, trying new experiences, and making friends.
No one therapy is right for every child with autism, and that includes ABA. Parents who understand how much ABA has changed are best equipped to decide what role ABA should play in helping their child achieve his or her greatest potential.