Common Misconceptions about ABA Therapy

Written by Irina Risteska, Team Leader 1:1 ABA Therapy

My inspiration for this months’ blog came from a recent experience of mine. I was invited to a school meeting with various members of my client’s educational team to discuss the findings and recommendations from the Functional Behavioural Assessment (FBA).

We spent some time discussing the results of the assessment and the reason for the recommendation, when a member of the educational team commented their dislike for ABA due to its strict and ‘sitting at the table across from each other’ nature. I was quick to respectfully disagree and comment on what ABA actually involves. The meeting continued without any further discussion on the matter.

As I made my way back home that evening, I realised that there are a number of common misconceptions surrounding Applied Behaviour Analysis (ABA) that I encounter almost on a daily basis. Fortunately for me, I have a platform upon which I can now dispute some if these misconceptions. Below I address the 4 misconception regarding ABA that I most commonly come across.

Four hours of therapy per week is more than enough

ABA is the scientific evaluation and study of behaviour. It examines behaviours, the events that trigger it, and the events that proceed and reinforce it. All behaviour is mediated by a specific purpose, where this is obtaining a desired item, escaping an aversive stimulus, or gaining or escaping a sensory stimulation. ABA looks at when, where, why, how, and how often a behaviour is occurring.

The variables are evaluated separately, against each other and together as a collective. Behaviour change is then possible by modifying one or all of these variables. However it is the modification of these variables that is the most complex aspect of any behaviour change system, and it is this that requires consistency, persistency, and repetition.

It goes without saying, that individuals with ASD have trouble learning new skills or behaviours. How then are they going to learn all that they need to learn in order to i) have a better quality of life, and ii) be active and functioning members of society, if they are not given access to the amount of treatment that they require? How will a child who cannot make eye contact navigate the school playground, make friends and engage in a game of chasey? In short, they cannot.

The child needs to first learn to make and hold eye contact, then they must learn to attend, to listen to instruction, to follow instructions, to take turns and share, to respond to questions or comments made my peers, to approach a peer and ask them to play, and much, much more. This is what ABA does. It teaches these skills and all of the skills in-between, in a manner that is easy for an individual with ASD to understand. It utilises the laws of behaviour (namely positive reinforcement) to increase the future rate of occurrence of that skill, and relies on repetition to not only teach the skill, but also maintain it long after it has been achieved in the 1:1 ABA setting.

To deny an individual the recommended number of hours, is to deny them a medical necessity. After all, if a person were suffering from a migraine, they wouldn’t take half a Panadol. They would take the prescribed amount of their medication with the goal to alleviate their aliment as soon as possible. ABA and Autism work in the same way. Therefore, the hours do matter!

It is also important to note that ABA is not simply a table-top therapy. It is as much about sleeping issues, eloping-running away behaviour/ learning to eat out/ greeting others at the park/ playing gently with smaller siblings/ learning to keep their seat-belt on in the car/ how to negotiate the shopping-centre with its bright lights, noise, its crowds, large spaces, school situations that overwhelm, along with many other everyday circumstances that cause upset and fear.

My child's school does ABA. They give him a toy at the end of everyday if he's been good.

I want to start here as ABA means different things to different people. When parents ask “that” question I ask them to check whether the programs consistently and accurately apply all of the laws of behaviour, collect data for each and every occurrence of a behaviours, analyse the data, and implement behaviour modification strategies that decreases the rate, frequency, duration, or magnitude of the inappropriate behaviours, all the while increasing the rate, frequency, duration, or magnitude of the appropriate behaviour.

Doing ABA is not ABA when only one law of behaviour or another is applied. ABA, is a set of principles based on the science of behaviour which are used to change behaviour. Behaviour change can mean increasing functional skills, such as communication, social skills, or play skills. It can also mean decreasing problematic behaviour, or behaviours which interfere with learning, such as aggression, writhing around, scratching, spitting or screaming. ABA can be used with anyone with a behaviour problem, no diagnosis required.

My child cannot speak. They need speech therapy, not ABA.

This is perhaps one of the most misunderstood and frequently voiced concerns by parents, caregivers, and even teachers of individuals with ASD. There are two main reasons why an individual with ASD does not speak and I will endeavour to explain the difference between the two:
• language delay.
• speech language disorder

A language delay describes a child whose speech and language skills are developing in the appropriate order but at a slower rate than normal. A speech problem can be mild, moderate, or severe. In the main, it is this delay which interferes with our autistic kids’ initial verbal ability, that is, it is not that your child cannot learn to communicate, it simply means they need to be taught how.

This is also the main cause of the major frustration and behaviour issues that results from the lack of being understood and the lack of being able to understand others. The subsequent tasks are among a large number used in an ABA program to teach verbal skills to your child in a combined program. These consist of the following: receptive/ expressive language, pragmatic language, social skills, visual schedules, sensory processing, fine motor skills, gross motor skills, self-care skills, visual perception, cognition, behaviour, anxiety/mood/fears/ phobias, emotion perception, emotional support, voice volume, eye contact, attending skills, cognition, group therapy sessions, and so on.

All of the above can be taught to your child within an ABA therapy program without the additional use of a speech pathologist or therapist. Furthermore, the benefit of having the behavioural component present within this methodology, is to ensure your child has the basic compliance with which to attend to their speech training, without for instance, running-off, jumping around and generally being off task. A language disorder on the other hand, describes children whose speech and language is developing abnormally.

Examples include:
• Stuttering
• apraxia: a motor speech disorder caused by damage to the parts of the brain related to speaking
• dysarthria: a motor speech disorder in which the muscles of the mouth, face, or respiratory system may become weak or have difficulty moving.

In this instance, you would be referred to a Speech Pathologist immediately as this is their real area of expertise. As per autism, children do not grow out of speech or language disorders of any kind, therefore they need to be treated accordingly.

Note: It is important to state, that even with the required specialist support and training, there are a minority group of children with an ASD diagnosis who will not gain speech and language skills.

ABA is too structured and robotic. There is no fun.

ABA is structured, but ABA is also fun. Let’s re-visit the example from point 1 above with the child wanting to play with his peers. How can this child play with his peers if he does not possess the very basic skills, such as eye contact and attention, required in any social scenario? They cannot. First and foremost the child must learn these skills individually. This is done through a procedure called Discrete Trail Training (DTT).

In DTT, a skill or a behaviour is broken down into its simplest units, and each ‘sub-skill’ or unit is taught in isolation, one at a time. Once one sub-skill is taught, the next sun-skill is introduced and taught. As the number of sub-skills acquired increased, the previously acquired skills are mixed in with the new sub-skill to ensure discrimination between skills.

Once all of the sub-skills are taught, the child has acquired a new behaviour. All of this encompasses the theoretical side of ABA. What the child receiving ABA therapy sees is consistency with what they are learning, an abundance of social praise and reinforcement, and comfort and security in their learning environment. Skills can be taught at the table, sitting across from one another, but they are also taught on the mat, outside, on the playground, in the garden, in the bathroom, and so on.

Reinforcement is attained after every correct response. The child is given frequent breaks, and most of the time they do not realise that they are ‘learning’. A previously abstract skill that was once all shades of grey and impossible to understand, is now clear and concise. It is simplified into black and white; there is only one correct answer and only this answer gain access to reinforcement.

For individuals with ASD who seek comfort in routines, in the familiarity and in the predictability of a situation, ABA is the comfort they seek. This is not to say that ABA encourages routines and ritualistic behaviours, it does not, and I emphasise this point most strongly; it simply teaches in a manner that the individual learning understands.

While I can continue on this topic for pages and pages, and cite scientific research and empirical evidence disputing one thing or supporting another that is not my goal. My goal is to simply say this: “Be vigilant, and speak to the experts. The loudest statement isn’t always the correct statement. Have faith in the process. The result may surprise you”.

For individuals interested in a more comprehensive discussion about the misconceptions surrounding ABA, I recommend Dr. Baer’s paper titled “Letters to a Lawyer” (2005).

References
Baer, D. M. (2005). Letters to a lawyer. In W. L. Heward, T. E.,Heron, N. A. Neef, S. M.,
Peterson, D. M. Sainato, G. Cartledge, R. Gardner III, L.D. Peterson, S. B. Hersh and J.C. Dardig (Eds.), Focus on Behavior Analysis in Education: Achievements, Challenges, and Opportunities (pp. 3-30). Upper Saddle River, NJ: Pearson Prentice-Hall.

Common Misconceptions about ABA Therapy