I am a BCBA and I will answer questions about ABA

[CertifiedBehaviorAnalyst]

I am a qualified behaviour analyst with years of experience. I have a varied clinical practice, but I do not consult directly with families so have nothing to gain by posting here.

I believe ABA is the most effective treatment for children with ASD and social communication difficulties.

I am happy to give my name if that is allowed.

To begin:

Verbal Behaviour means communication.

Applied Behaviour Analysis is the process of understanding what motivates a person, how they learn best, and then breaking skills down into small units to facilitate learning. Learning is reinforced. Prompts are often used to help learners access reinforcement.

One of the most common applications of ABA is Early Intensive Behaviour Intervention. Children between the ages of 3-7-years-old can make significant gains if they receive between 20-40 hours a week of 1:1 teaching. There is growing evidence that fewer hours of intervention can also be effective. Children on ABA programs typically make greater gains than children who receive standard treatment.

"Verbal Behaviour" is a brand of EIBI program. It is all ABA.

Hi,

Can ABA cover speech and language?should parents focus on that rather than carry on with speech and language therapy

Behaviour Analysts are very good on helping children develop language skills. We determine how to motivate the child to speak, and then break language down into such small steps so the child can be successful at using spoking language. As the child masters the easy steps, we make it just a little bit harder. They may say "b" for biscuit, and that "bis" etc.

Depending on the child, the behaviour analyst may start teaching a child makaton or PECS along side spoken language.

SALTS have a lot of specialised knowledge about language production and phonemes that BA don't necessarily have. In an ideal world, the BA and SALT work together. The SALTS should help determine targets and the BA can help design the programs to help the child master those targets. However, this is not as easy as it sounds. I would recommend ABA over SALT at the beginning of a program. A good behaviour analyst should be able to ask for SALT help when needed.

The language of behaviour analysis is awkward. The term "Negative Reinforcement" is the worst of the jargon. It can be a very useful language once you get your head around it, but it takes awhile.

Skinner wrote a book called "Verbal Behaviour" and, in behaviour analytic terms, "verbal behaviour" means something more complicated than just communication. Technically it means "behaviour whose reinforcement is mediated by a listener." See what I mean about the jargon?

Mark Sundberg published this book in 1998, which suggested that EIBI programs should emphasise language skills. He later went on to design the VB-MAPP which was a curriculum based around language skills. Sundberg's contributions to EIBI are huge. Nearly all behaviour analysts working with young children will prioritise communication.

Verbal Behaviour in the UK somehow came to mean EIBI that is more play based than table based. Some consultants will market themselves as VB, but this distinction isn't meaningful. Any good consultant will design the program that is correct for the child. This may be play based, table based, use discrete trials or not. All programs are bespoke. If there was a one size fits all program, it wouldn't be so hard.

Here is a recent paper that evaluates a low-intensity model:

Eldevik, S., Eikeseth, S., Jahr, E., & Smith, T. (2006). Effects of low intensity behavioral treatment for children with autism and mental
retardation. Journal of Autism & Developmental Disorders, 36,
211–224.

How effective can ABA be in targeting constant noise making in HF ASD/DME in a 7.9 year old in m/s?

What would be needed?

TIA

KeepOnKeepingOn1 ABA can be very useful in that circumstance. It is a common issue with kids with ASD.

The first question is why is s/he making the noise? Is it really constant or does it just seem that way? Is it for attention? Doe s/he make the noise more when work gets hard? When it is noisy? When s/he is bored or confused? My guess is the child has no insight at all into why s/he makes the noise, so a behaviour analyst would need to conduct observations over several days.

When the function is identified, the behaviour analyst should make the child aware of the noises, offer alternatives that may provide the same function, and provide reinforcement (either for engaging in the alternative behaviour or for not engaging in the noises.)

Hi, my 11 year old ds (AS) has lots of challenging behaviour as a result of high anxiety levels - could ABA help or is it too late? Can ABA help overcome anxiety?

1. How does one convince a primary school to accept tutors and/or a consultant in to advise on a child when they LA run courses advising against this.

2. How does one then ensure that the ABA consultant/tutor has the skills to build a good relationship with the school. IMO the UK ABA profession suffer from an arrogance that is not conducive to partnership-working with defensive teachers with a hundred other instructions most of which are bollocks?

OneInEight

Behaviours as a result of anxiety are escape maintained, often the child wants to escape the situation that is provoking the anxiety or just escape the anxious feelings.

I would suggest that a full functional assessment is done, because again, I doubt the child has any insight into their own behaviour. What kind of anxious situations are likely to provoke the behaviours? I once worked with a non-verbal child who was anxious about the arrangement of furniture, and his program was different that the highly verbal girl who was anxious about how to interact with peers. You can put strategies in place to help them deal with the situations that cause anxiety and these programs will vary widely.

The success of these programs can be variable. I would try a behaviour programme only for at least 6 months. If it is a genuine anxiety disorder, than you may need a behaviour analyst to work alongside a psychiatrist. I

It is never too late! Behaviour analysts work with people of all ages.

StarlightMcKingsThree

I wish I knew! Then there would be ABA for everyone!!

I completely agree. Behaviour analysts have done a very bad job of working nicely with schools. I believe that schools really want what is best for the children, and they believe they are correct to worry about ABA. Here are my thoughts (these are not evidence based):

1. Consultants have to collaborate with schools. If schools want to use P-levels and teach geography than the consultant should find a way to make that work (alongside their other tricks). Teachers are not reinforced by progress on the VB-Mapp.

1. Teachers despise being told how and what to teach. They get enough of that from the government. The behaviour analyst needs to work with the teacher to set goals. The teacher is there every day, and needs to feel some ownership of the program. If the consultant does not do this, the teacher feels un-skilled and devalued and may not support the program. The teacher should feel the consultant is there to help her, not tell her what to do.

1. You cannot import a home program into a school. Schools are different from home. Compromise is necessary. There are so many ways to teach new skills that BA can afford to give a little.

1. We need to shape the school's behaviour. This involves reinforcing successive approximations of the desired behaviour. It won't happen overnight, but consultants and parents need to reinforce the schools. That is a harder job than teaching the child new skills.

I guess you need to find a consultant that has worked in schools before. I think this requires a different skill set than being able to work with parents.

"I would try a behaviour programme only for at least 6 months. If it is a genuine anxiety disorder, than you may need a behaviour analyst to work alongside a psychiatrist. "

This is what really worries me about the ABA approach to so-called high-functioning children or those with AS.

Often, as they get older, these children are more than capable of explaining what causes the anxiety and what makes them feel better.

It seems to me, however, that ABA has very little to offer such children. Instead, it turns to 'functional analysis' to try and discover what is causing the anxiety when it is, with respect, bleeding obvious and particularly obvious if you asked the child, i.e. I can't cope in the class.

But that is not the answer anyone seems to want to hear. So, for example, with a child who has high levels of anxiety at school, six months could be spent analysing and 'obtaining data' to try and find an 'ulterior' motive for the behaviour e.g. he wants to read somewhere quietly and you are reinforcing the behaviour by letting him.

To me, this is where it all gets very 'normalising' particularly when you start mentioning that a 'psychiatrist' needs to be involved if your methods fail.

Why?

Why if your methods fail does a child need a psychiatrist? Why is the problem located in the child? What about promoting diversity and the Equality Act?

Sometimes people are different. If you can find a way of supporting the child by placing the child in the right environment with the right support and you allow the child to develop a sense of their own identity and individuality and let them know it is ok to do things differently, you may end up with a mentally well, empowered adult.

My son was seen by an ABA consultant who was seemingly well-trained by a leading autism charity who runs a specialist autism school. He didn't have a clue about dealing with a child who could speak for himself and didn't spend any time talking to him. His whole agenda was to avoid 'labels' like 'anxiety' but to apply his own negative labels to the 'behaviour' which ended up with a situation where he sat telling my son he had to do as he was told and couldn't pick and choose and it had to listen to the teacher who was trying to force him into class.

I was there and I regret watching this and not doing anything. I sacked the person soon after they produced a £600 report listing all the data someone else could gather and suggested crap like 'speaking time' for my son so he could be taught when he could speak to adults. After we had spent 2 years trying to encourage my son to speak up in school.

It was all centred around what the adults wanted.

Six months later my son is one of the rare children who has a package where he has to be educated out of school because he cannot cope with school.

This is not because he needs 'psychiatric' help but because what is a 'normal' experience for most, is traumatising for him.

Now he is a mentally well, independent child who can develop at his own pace not at someone else's. Time can be spent teaching him what he needs to be the person he should be, not what he needs to keep him quiet and cope with school

Nothing in what you say reassures me about ABA and Asperger's.

And how on earth would you know what is a 'genuine anxiety disorder'? You risk causing untold psychological harm with your dismissive approach.

Hothead don't get me wrong, some people will need psychiatric help for anxiety. There is nothing wrong with that.

It was the assumption that if their 'analysis' showed this was 'genuine' (and I don't know what special powers they think they have to be able to distinguish without even talking to the person concerned) it would inevitably lead to a psychiatric intervention.

What I find dismissive is this idea that a child would need that if it was 'proved' genuine and ABA couldn't 'fix' them. It's very high-handed to think someone's belief in their ability to discern behaviour and causes of it (which. I think is pseudo-science often) trumps an individual's ability to explain for themselves.

Don't get me wrong, I think there is a lot of good in ABA and for some children it is absolutely essential too. For able, highly verbal, anxious Aspies? I've yet to meet an ABA consultant able to admit they haven't a clue how to approach this.

my ds now through aba/vb can now use one words to request, through the errorless technique. However, i'm not sure how to progress this to 2 words together - do i use the same approach? It just feels like he's been on one words for a while now.

Thanks for your answer.

I have another question around compliance if you're happy to answer. Do you think that reinforcing compliance to become 100% makes a child quite vulnerable?

And if you don't insist on 100% compliance, how do you decide the acceptable level of defiance?

Oh my. I am just trying to acknowledge that sometimes we come up against people with medical conditions and behaviour analysts can work collaboratively with medical professionals. I have worked with a child who engaged in severe self injured if the books were out of order on the shelf. Medication helped him a great deal.

Anxiety is a difficult term. It can be used to mean "worry" and it can be used to mean "generalised anxiety disorder (GAD)" which can be a debilitating condition. When I said "genuine," I meant "GAD."

If the child can reflect on their own anxiety, than ABA is probably not the right intervention. CBT has better evidence base than ABA for that situation.

Sometimes behaviour interventions alone work with anxiety, and sometimes they do not. I agree that all steps should be taken before using drugs, and I am very glad your child is doing better without them.

Luckily I am not qualified to make a medical diagnosis or prescribe drugs, so the risk of my untold psychological harm is small. If after 6 months, my assessments and interventions were unsuccessful, I would refer to another professional who would be able to bring a different perspective to the situation. I did not say that the functional analysis would prove if the anxiety was genuine, what I meant is that my ABA tools aren't enough to solve this problem. The doctor and the parents would take the next steps.

PolterGoose

Can you explain 'functional analysis' please.

It is an assessment undertaken to identify the antecedents and consequences that make a behaviour more likely. For example, does the child engage in the behaviour more often when they are given difficult school work to complete? If we give them a break from work, will the behaviour happen again when we give them work? Do they challenge when they aren't getting any attention? For people with learning disabilities, many challenging behaviours function as a kind of communication. If we can understand why the person is engaging in these behaviours, we can teach them better ways to meet their needs.

How closely would you work with OTs, SALTs and other professionals involved with a child?

This varies, but ideally we all work closely together.

How would you deal with extreme sensory defensiveness?

In this situation, I like to work alongside an OT. I can't answer this question easily without knowing the specifics.

How would you deal with tics and stims?

This is tricky. Generally I ignore tics and stims unless they are really getting in the way, and the family wants to reduce the tics and stims. I would never try and make them go away completely, but if they were causing a lot of problems I would try and help the child learn when it is more and less appropriate to engage in these behaviours.

How do you decide which behaviours are the priority to address?

The family and school are consulted. If the child is able to reflect upon this, we will listen to them. I would look for pivotal skills. Can the child communicate, imitate, categorise, follow instructions. Are they safe? What skills would make them happier and their life easier? It is different for every child and every situation.

With a highly verbal articulate child would you listen to their view or make your own judgement on their behaviours?

I always listen to the child's view. Sometimes you can avoid a great deal of assessment by talking to the child. Getting to know the child is one of the first steps.

How do you gain compliance in an older child?

That is a broad question, there are many strategies for different circumstances.

I am going to stop this discussion. I am sorry, My intention was to be available to give factual answers about ABA.

I really can't answer specific questions about programs and children on the internet. Behaviour analysts begin every intervention with direct observations, and these questions are best answered by a BCBA who knows you and your child.

I worry I may do more harm than good by speaking in generalities.

Well thanks for trying. Though I think that disappearing when the more challenging or technical questions are asked means sceptics will become moreso.

Perhaps you underestimated the knowledge and thirst for facts those on this board have. It happens a lot here but also in real life.

Many parents are really fed up with the pat on the head mentality many professionals display which tends to increase the more difficult the questions become or the more transparency the parents seek.

ABA is not currently funded by LAs routinely or without a fight. It's expensive. Parents need to know what they are buying.