ABA therapy is one of the top treatment options for children with autism. I have worked as an ABA tutor in the homes of multiple children. The recommendation is 40 hours per week of one-on-one therapy for each child with 2-4 tutors. The 40 hours can include speech, OT, and other therapies as long as it follows the ABA pattern and is one-to-one.
Therapists that are certified as Board Certified Behavioral Analysts (BCBA) oversee therapy and train the tutors who are also certified through experience and training. Under this type of program, parents can bill their insurance and get reimbursed for services. The other option currently available is in center treatment where the child is taken to a treatment facility where the same services are provided.
ABA is applied behavioral analysis. It is based on the psychological theory of behaviorism, which focuses on the environment and behavior and ignores or discounts any internal decision making process. All behavior is the result of training or conditioning from the environment. This theory is ideal for working with little children, or anyone who cannot verbalize their problem. It is very structured, measurable, and will work on anyone, not just children with autism.
In ABA therapy, the first thing the therapist looks at is the antecedent or what came before the behavior. A good example is you ask you child to put his shoes on. The next is the behavior – your child starts to cry and complain, and finally they examine the consequence, which for this example will be you put your child’s shoes on.
Now if your child is capable of putting on his shoes, the parent is reinforcing the child crying and screaming by doing the task for him. The crying and screaming gets the child out of the work of putting on their shoes. If the child is incapable of putting on their shoes, the task is too hard or overwhelming, the shoes bother the child, or some other factor is involved, then the crying and screaming comes from a different source, and can thus be modified.
By examining every behavior and breaking it down into steps, the therapist can teach any behavior, or change a pattern of inappropriate behaviors by modifying the antecedent or the consequence. A= Antecedent. B= Behavior and C=Consequence. Behavior analysis focuses on changing either what comes before or after a behavior.
In theory, and in practice, this method is capable of teaching any behavior to any child. In children with autism, it may take months of repetition and tiny steps to conquer a particular task, or overcome a difficult behavior. It is ideal because you do not reason with the child, there is no effort to understand their thought processes, and successes can be measured and charted over time to show that the particular approach is effective. If the data shows that the current method is not working, then the task can be broken down into smaller steps or a different approach can be initiated.
There are three key components that I have used successfully with my son and other children that I’ve worked with that I would like to teach now. The first is the concept of no, no, prompt. For any instruction I give, my son gets two chances to comply or get it right and then I prompt, or help him. This approach, when used consistently, gives the child a predictable pattern and eliminates endless nagging.
There are also very clear consequences. I usually allow less than 5 seconds for him to comply before I repeat the instructions or prompt. Prompting can include anything from telling him the answer, pointing to the correct response, showing him what to do, or physically helping him do the task. It also includes physically removing him from a location if necessary, or performing the desired action hand-over-hand. The goal is to use the least amount of prompting necessary. Ben knows that he has two chances to get it right or do what I ask, and then I will step in. There is no ambiguity, or argument.
The second step I love is the use of a neutral no. If the child doesn’t comply, or gets the answer wrong, you simply state no without getting upset or angry. Then it’s back to the no, no, prompt. Some kids are very sensitive to getting things wrong, and no can be upsetting to them. For those kids, you can shake your head, use almost, or not quite, or try again. The point is you don’t get upset; you are simply stating that the response is incorrect and then you repeat the request.
I have read that when children with Asperger’s are in that heightened emotional state their short-term memory is ineffective. I have seen evidence of that in my own child. This simple no eliminates the frustration of trying to reason with or explain something to an upset and frustrated child, and has saved me a lot of frustration. If the situation warrants it, and the child is developmentally able to understand the reasoning behind a request then that can be done at a later time when everyone is calm.
Finally, I have found that the key to teaching an autistic child, or any child, anything is repetition. It may take a thousand times or more, but eventually they will all learn. I am also a trained Suzuki Violin Teacher, and the Suzuki philosophy is built around the concept that every child can learn to play music, no matter how much natural “talent” he may possess. I have seen this in practice a thousand times over, and I am firmly convinced that I can teach any child any concept, or behavior given a logical, step-by-step approach and enough repetition. With this belief, it just becomes a matter of what needs to be taught, what approach you want to use, and then repeating it enough times until the child has learned the concept.
Granted there are exceptions to every rule, and I would not try to teach violin to a child without hands and feet, but the concept that every child can learn lends great hope to every parent. We all want what is best for our children, and I have found mothers of children with disabilities to be some of the most dedicated, patient, and strong women that I know.
It is not an easy path to break down behaviors and tasks into bite sized pieces and teach them bit-by-bit over and over again. However, our children are not broken. They just think differently. Their brains work differently. In many ways they are brilliant, and loving, and amazing individuals, with unique talents and gifts. I view it as my job to facilitate my son in expressing his unique talents and gifts while also helping him to function in society so that he can be as successful as possible. Each child will reach his or her own level of success and if we compare their efforts and growth and avoid looking at what a neurotypical child would do at whatever stage we will be able to see just how amazing they are.