ABA therapy aims to improve communication, teach social skills, and reduce distressing behaviors.
Therapists often use applied behavior analysis (ABA) when working with autistic children and kids with Down syndrome. That said, it can help people of all ages and skill levels — not only those with developmental challenges.
However, despite producing “desired” behaviors, there are controversies about ABA therapy, with some saying that teaching autistic people “non-autistic” behaviors can mean they hide who they are to fit in and appear “normal.”
The main aims of ABA are often to:
- improve language and communication
- teach social skills
- reduce challenging or distressing behaviors
- improve school performance
- teach practical life skills
ABA therapy uses the power of positive reinforcement to help you learn beneficial skills. Reinforcement involves rewarding desired behaviors while discouraging undesirable behaviors.
While early versions of ABA included punishment to deter behavior, modern methodologies have moved away from this approach.
“ABA relies on the use of positive reinforcement to increase higher rates of behavior targeted for increase as opposed to using punishment to decrease behaviors targeted for decrease,” explains Danielle Wetherald, a board certified behavior analyst (BCBA) from Albany, Georgia.
ABA isn’t just about generalized “good” and “bad” behavior, however.
Wetherald explains it’s an in-depth process of data collection on each individual. Information from each session is incorporated into clinical graphs to help a behavior analyst pinpoint which areas require ABA intervention.
“By reviewing these graphs, a BCBA is able to shape behaviors by making small changes that allow the client to receive reinforcement for each attempt toward the desired outcome,” she says.
ABA can be utilized at any point in your life and is considered effective at any age, helping you evolve your skills as your life circumstances change.
You may benefit from ongoing therapy, or you may find short-duration treatments are the most helpful — it all depends on your unique needs and any medical conditions you’re experiencing.
Types of ABA therapy
There are many different forms of ABA therapy, including:
- Discrete trial training (DTT): A practitioner breaks a skill down into small parts and teachers them one by one.
- Pivotal response training (PRT): A practitioner focuses on one important development or “pivotal” area. Pivotal areas are: motivation, responding to multiple cues, managing yourself, and initiating action by yourself.
- Natural environment teaching (NET): A practitioner uses the child’s familiar or preferred environment in their methods, such as their own toys.
- Early start Denver model (ESDM): A practitioner uses joint play to teach important skills in a fun way.
What is positive reinforcement?
Positive reinforcement is the act of adding a consequence to increase the likelihood of the desired behavior happening again — for example, giving a child some extra money for taking on a demanding chore.
ABA is a division of science that examines why people — and other living things — do what they do.
As a therapy, it’s guided by several key principles. Chana M. Geldzahler, BCBA and clinical director of Empirian Therapy in Lakewood, New Jersey, explains these below.
“The core principles of ABA involve what we call the ABCs, or the three-term contingency,” she says.
- Antecedent: The setting that’s present before a behavior occurs.
- Behavior: Any reaction the person has.
- Consequence: The events that follow the reaction or behavior.
Changing the antecedents or consequences, says Geldzahler, can lead to desired changes in the behavior.
“ABA also very heavily relies on data, which is taken on the ABCs and the ABA therapy itself, then analyzed and used to adjust the ABA therapy according to the client’s needs and abilities,” she adds.
Dimensions of ABA therapy
Geldzahler says that to ensure ABA therapy addresses socially significant and measurable behaviors, the therapy follows seven dimensions of evaluation:
- Applied: Behaviors are relevant to the individual.
- Behavioral: Only scientifically measurable behaviors are addressed.
- Analytic: Decisions are data-driven.
- Technological: Methods are clearly defined and replicable.
- Conceptually systematic: Research supports the chosen intervention.
- Effective: Progress is monitored and maintained.
- Generality: Behaviors should persist across multiple environments, not just where they were learned.
Following these ABA dimensions means the practitioner can keep track of:
- what behaviors, and whose behaviors, are being addressed
- how the behavior being changed
- what caused the change in behavior
- whether the behavior change process is replicable and is derived from the behavior
- whether the change is practical and significant
- whether the behavior change is lasting across time and circumstances
ABA therapy can come in many forms, and practitioners may use multiple techniques based on your needs and goals.
“A session typically starts with pairing with your client in the form of preferred play,” explains Wetherald. “This is a great time to implement the use of natural environment teaching (NET).”
She gives the example of helping a child with color identification and waiting skills.
“The registered behavior technician (RBT) might state ‘Throw the red ball when I say ‘go.’ Ready, set, go.’ This has then targeted color identification, following one-step commands, and waiting skills while the client is simply enjoying play in the ball pit.”
NET time might be followed by discrete trial training (DTT) where you work on larger skills by breaking them into smaller, more achievable components.
“The client will typically alternate between NET and DTT several times throughout the session depending on the average attentiveness of the client without engaging in maladaptive behaviors,” says Wetherald.
At the end of the session, the practitioner will review goals and progress along with at-home strategies to support the ABA therapy work.
ABA therapy isn’t limited to one condition, age group, or ability level says Geldzahler.
Many people may benefit from building their skills with ABA therapy, including people managing the following:
- Down syndrome
- developmental disorders
- brain injury
- aging processes
- mental health conditions
- substance use disorders
ABA therapy can also help people with their career performance, including people working in:
- environmental sustainability
- public health
ABA therapy is considered an evidence-based treatment by the United States Surgeon General and the American Psychological Association (APA).
The APA state that “the practice and supervision of applied behavior analysis are well-grounded in psychological science and evidence-based practice.”
“When delivered properly, in accordance with the current research, ethics policies, and the seven dimensions, ABA is highly effective,” states Geldzahler.
A 2014 review notes ABA as an evidence-based treatment and reports evidence to support its effectiveness.
There is significant controversy over ABA therapy, and not all present-day experts believe the therapy always has the autistic person’s best interests in mind.
Many experts and autistic people say ABA therapy methods can be too intense for young children, involving long hours and historically involving punishment to produce the desired results.
Another controversy is that ABA therapy aims to make children behave “normally” and remove autistic traits. Therapy doesn’t “cure” autism, but it might encourage autistic people to mask their autistic traits to make others more comfortable while causing them extra distress and shame around these traits.
A debate around ABA treatment says that neurodivergent people needn’t be expected to conform to societal standards; they should be allowed to function in their own way, free of performance pressure.
A 2017 study found that children who underwent ABA therapy for autism in early childhood had a higher likelihood of posttraumatic stress disorder (PTSD) symptoms as adults. However, the empirical validation of this article or research methods could lead to a natural bias against ABA therapy and should be viewed with caution.
There are several ways you can find an ABA therapist to meet your needs:
- asking a doctor or pediatrician about ABA
- contacting a health insurance company for a list of approved providers
- reach out to your state department of licensure for local resources
ABA therapy uses positive reinforcement to help you develop beneficial behaviors, such as communication and social skills. While it’s primarily used in treating autism, anyone of any age who wants to improve behavioral outcomes can use ABA therapy.