Applied Behaviour Analysis (ABA) is an intensive intervention therapy based on the science of learning and behaviour. Widely used across the United States, it is still somewhat controversial here in the UK so let's deep dive into exactly what ABA is.
Where did ABA Come From?
Applied Behaviour Analysis (ABA) is based on the discoveries of American behavioural psychologist, B.F. Skinner. Fundamentally, ABA uses a system of rewards (positive reinforcement) and 'punishments' to modify behaviour, and was first used on children with autism in the 1960's and 70's. In its early days, practitioners used punishments when children would not engage in an 'appropriate' manner, and although punishments have since been removed from the programme, the early use of them has given ABA a bad reputation. ABA has changed radically since its conception and is now offered at some schools in the UK, many of them being independent.
Too many people use the term ABA without really understanding it properly, thereby propagating misunderstandings and misinterpretations that can hinder its uptake by educational and other helping professions.
How does ABA Work?
One of the first steps of ABA is an assessment of the child and learning what the child likes. This will be vital for establishing what you can use for positive reinforcement at a later date. By learning what a child likes, you are also learning what will motivate a child to engage in an activity or desirable behaviour. With many children, learning what they like can be done via play, exploration and just trying lots of different activities and toys and assessing their response to each of them. The time you spend with a child and engaging in play to learn what they like is also precious time to build a relationship and rapport with them, which is essential to have if you are going to make meaningful progress; you need to be a safe person for them.
You can then also incorporate their likes into a pupil passport.
Positive Reinforcement
Positive Reinforcement is one of the fundamental strategies used in ABA, and it is a principle we are probably all familiar with already. You reward the behaviours you do want to see, and don't reward the behaviours you don't want to see. When a behaviour is followed by something that is valued (i.e. a reward), a person is more likely to repeat that behaviour. Over time, this encourages long-term behaviour modification.
For example, if a child exhibits a behaviour we want to see (let's say signing please/thank you), we reward them with something that is meaningful to them, i.e one of their likes. This could be a toy, access to playground, a video snippet, praise, anything as long as it is personal to them and is motivating enough for continued repetition of that behaviour.
Antecedent, Behaviour, Consequence (ABC's)
The ABC's have become more of a standard practice in autism support, but they have their basis in ABA. Following the ABC's helps us understand a behaviour and, eventually, prevent any challenging ones from happening in the future.
Antecedent - this is what occurs before a behaviour. It could be a verbal (e.g. a command), it could be environmental (e.g. too much noise), or it may be internal (e.g. a feeling or thought).
Behaviour - this is an individual's behavioural response to the antecedent. Again, it could be a physical, verbal or emotional response.
Consequence - this is what comes after the behaviour response. It could be positive reinforcement if the child displayed a 'desirable' response, or no reaction for an 'incorrect' or 'inappropriate' response.
As anyone who has worked with children with autism will know, some children can display challenging behaviour when requested to do something they don't want to do or feel distressed. This behaviour can include acts of physical aggression, crying, screaming, or self-injurious behaviour. The Headteacher at an ABA school states that, "Even if a child is displaying this behaviour in reaction to a demand, it is important that this behaviour does not get them out of doing what was asked of them. It may take 10 minutes, it may take 2 hours but over time, it will get easier."
However, research has been fairly transparent that a high proportion of children with ASD with severe impairments use challenging behaviour as a form of expression, and even if the behaviour is ignored, the child will still engage in self-injurious behaviour in order to try to communicate.
Example ABA Session
I might set up a session where we’re playing with cars, and if I’m working on colours with a child I might have two cars in front of me — one that’s red and one that’s yellow. And he’ll say or sign, ‘Can I have a car?’ And I’ll say ‘Do you want the red car or the yellow car?’ He will then have to expand his language by saying or signing ‘I want the red car.’ And then I’ll say, ‘Which one’s red?’ And he’ll have to identify the colour. So there are ways of manipulating the environment so that kids are more organically learning these skills.
Why is ABA Controversial?
"When people devise interventions, I don't think people really think about the potential harms."
Whenever someone mentions ABA, I often see a sharp intake of breath and a grimace from many people in the room and it is because ABA is quite a controversial topic and methodology for a number of reasons.
I do want to highlight, before going into the difficulties that ABA faces as a general practice, that there are good practitioners and there are bad practitioners. It is important to distinguish between those who genuinely wants to help children learn new skills, and those who want to 'train' the autism and autistic behaviours out of children as the latter will be more damaging for a child.
Intensity
ABA therapy is done exclusively on a 1:1 basis and often starts very young, usually as soon as a child is diagnosed so this could be as young as 3 years old. Some children can go through up to 40 hours (though it should never be this long, it should be 10-20 hours) of intensive therapy every week - so up to a full working week! Imagine if you made a 3 or 4 year old practice a musical instrument or a new language for the same amount of time every week; you certainly wouldn't receive much praise for it.
Who decides what are 'acceptable' behaviours?
The 'success' of ABA is modelled on the increase or decrease of behaviours that are deemed acceptable or unacceptable. However, what these behaviours are are decided by the neurotypical or non-autistic community. Some have expressed that ABA is simply a way of getting autistic children to behave and appear neurotypical, i.e. they cannot and will not be accepted if they are truly themselves. For example, one of the goals of ABA can be to eliminate or lessen repetitive behaviours, such as hand-flapping or rocking; these behaviours are often referred to as stimming. Some parents are embarrassed by their child displaying these behaviours as they are very public and can clearly mark their child out as being different. However, it is widely expressed within the autistic community that stimming behaviours are calming and can bring them a sense of peace and control when they feel anxious, stressed or confused by the world around them.
Dr Vincent Carbone, BCBA explained that "We are not trying to change the soul or the essence of the child, we are trying to change their behaviour so that have more positive reinforcement in their lives than negative experiences from social communities."
Consent
More often than not, ABA is chosen as a pathway for children by their parents or carers and not something the children opt into knowingly. Whilst it is the child's right to say no to anything they don't want to do, is it not also their right to be able to experience new things and different approaches to life? Sometimes, children may not be aware of what they are saying no to because they have a fear and barrier to new experiences and what they may hold, so some parents opt to show their children what is on offer and then allow them to say no if ABA is not something they want to pursue.
Mental Health
There are many reports from the autistic community that ABA practices result in serious mental health difficulties later in life, including PTSD. Some of the principles behind ABA have caused people who go through ABA to feel like they 'are not enough' and can't be their authentic selves. Some quotes from autistic people who have experienced ABA include;
It has taken years of therapy to undo the trauma caused by ABA...The only thing I got from ABA was self-hatred and crippling anxiety.
I have to remind myself that stimming is okay now and that no one is going to take anything away from me for being autistic
It's taken me a long time to realise that what I experienced was abuse.
This study discusses some of the issues with the underlying theory of ABA in its current application is conducted, especially with regard to “lower functioning” and nonverbal autistic individuals; namely, the curtailing of soothing “stimming” behaviours, opperant conditioning, behaviourist principles that research has continued to prove it is not apt for usage with autistic individuals, as well as the unintended but damaging consequences, such as prompt dependency, psychological abuse and compliance that tend to pose high costs on former ABA students as they move into adulthood.
Again, I want to state that bad practitioners do exist and I have no doubt that many practice ABA in an abusive way, but not all practitioners are like this.
Is ABA an Option for Every Child?
A fundamental question that educators, schools, parents and carers face is whether to accept autistic traits and behaviours, or push the child to learn new skills adapted around their differences.
Dr. Liz Pellicano, from the UCL Institute for Global health, states that there are really 2 options when it comes to how we support children with autism. At its core, autism causes a difference in cognition, learning and people with autism have a different way of perceiving the world. If you believe that there is not one singular correct trajectory that everyone should follow in life and that we should accept autistic differences, then you should support that child in navigating the world around them through their autistic lens.
If, however, you believe that children with autism can be 'fixed' or at least can be made to be somewhat indistinguishable from neurotypical people, then ABA is an option. Some parents also choose ABA when they feel their child has been failed by traditional SEN schools or mainstream schools. Some parents I have worked with have expressed that their children have regressed in traditional schools, where before they could count to 20 for example, but lost this ability despite being in school regularly. They also told me stories of how their children also picked up negative behaviours from other children at school and then imitated these behaviours at home, and therefore the parents took the decision that ABA or home programmes were a better solution.
There is a fine line between knowing when to let children step out of their comfort zone and when not to. Children with autism are often very set in their ways, so it is a careful balancing act to know when to push them to help them experience new things, or when to hold back and allow them to remain within their comfort zone.
Where Can I Find Out More?
One of the best documentaries on ABA, is from Real Stories. It follows a few children who attend the only state ABA school in the UK, Treetops School in Essex.
You can also buy this textbook which is designed for teachers, parents, and other professionals. This book is a much-needed guide for practitioners and parents alike. In a field where much confusion surrounds the very technical elements of what we do, it's incredibly refreshing and encouraging to pick up the book, simply look up a concept, and not only gain a definition, yet also an abundance of examples to make clear what was previously confusing.