By Audra Jensen
He was 18 months old with big, piercing eyes when we went to our pediatrician with concerns. He wasn’t using words and we thought he might be deaf. She told us, “Boys just develop later.” But she recommended an evaluation that took four months to get. The diagnosis: Autism. It was devastating at the time.
Fast-forward 15 years. That boy is now a young man, driving (although I wouldn’t say well) and going on his first date this weekend. It has been a long, hard road—one that is far from over. While autism will always be a part of our lives, I have come to accept it and embrace it. I am grateful for the many therapists that have come into our lives over the years, and the direction they gave me as a parent and now a professional.
The Centers for Disease Control (CDC) report an increasing prevalence of autism, now 1 in 88 up from 1 in 10,000 in the 1980s. Today, almost everybody at least knows someone with a child on the spectrum, and many in a personal way. There is much discussion on the reasons behind the increased prevalence. The CDC reports the increase may be attributed to an increased awareness, but even they admit that something else may be contributing to the rise.
Research shows that early detection and intervention for autism creates the best opportunity for growth and development. Early treatment can create the best opportunities for children to live up to their potential—whatever that potential may be!
When my own son was diagnosed in 1999, the best piece of advice I got was, “The more, the earlier, the better.” We immediately called my husband’s uncle, a renowned child psychiatrist, and asked for advice. In addition to his recommendations, he advised us to look into a therapy that was just beginning to gain traction.
At the time, he referred to it as Lovaas therapy, referring to the psychologist who, in the 1950s and 1960s, helped bring the idea of Operant Conditioning into the field of children with developmental disabilities. This early therapy involved aversives such as electric shock; however, the results were the first strong research to prove that children with autism could be taught and could learn. Previous to that, people with autism were typically sent to institutions and parents were told to “forget about them.”
I was glad to find out that aversives were done away with as the field matured over the years. I was even more pleased to find out that the research continued to show clear evidence that children with autism could learn, develop and grow. We found a wonderful group of therapists who loved my son and played with him—even when he was difficult (which was often!), they wanted to keep coming back! And the progress was amazing.
The treatment now goes by the name Applied Behavior Analysis, or ABA for short. ABA is becoming the most prominent and widely accepted treatment of autism spectrum disorders. One of the reasons is that it strives to increase desirable behavior and decrease maladaptive behavior. ABA gives the child a way to get his or her needs known and met in a way that is not only more socially acceptable, but, more importantly, easier for him or her to access.
ABA assesses a student’s current abilities and what skills are missing developmentally, and then prioritizes which are most important to the family and child to work on. The therapy also sets measurable goals and breaks them down into manageable milestones that are taught through a system of positive reinforcement.
However, many people within the autism community still have lingering memories of the old aversives or have witnessed a misapplication of ABA. As such, misconceptions that “ABA isn’t for my child” or “ABA doesn’t work” have created many misnomers about what ABA is and what it is not.
Here are a few:
ABA is NOT:
- Only done at the table in a rote, repetitive manner. People often confuse Discrete Trial Training (DTT) with ABA. DTT is only one tool in a very large toolbox and can have its place in a good ABA program, especially for early learners or those who need more structure or more repetitive practice to learn certain skills. However, a good ABA program will be highly individualized which may or may not include DTT in its program.
- Negative or aversive. Corrective procedures are put in place at times to decrease maladaptive behavior, but should always be done in conjunction with a plan to increase positive behaviors that will help the child access what he or she wants. For the most part, a good ABA program is full of fun and giggles and play and rewards. A child in a good ABA program should want to have therapy and should be happy to see the therapist. If not, we as the professionals are doing something wrong. Don’t get me wrong! We certainly hear our share of complaints when boundaries are pushed, but there should always be a trend towards the “happy place.”
- Only for people with autism and especially only for the highly impacted and the young child. I have seen a good ABA program applied to a variety of disabilities, across a life span, and for any level of functioning. A good ABA program simply shows evidence of progress and does so in a fun and individualized manner for that one person.
- Only applied to “behavioral” problems. ABA seeks to not only address challenging behavior, but to really develop skill sets that will help that child improve his or her quality of life across all facets of life: physical, emotional, academic, social and behavioral.
- All the same. If you have seen one ABA program in action, you have seen one ABA program. Not every provider is going to administer its ABA program the same way. While we all pride ourselves in making data-based decisions and providing evidence-based services, our application may be a little different. And that’s OK! It is your right as a parent to find the right person for you and your child. It is important that whomever is working with your child is someone you feel comfortable with, and you feel is going in the direction you want to go.
- Something anyone can “do” with a little training. When I started in the ABA field, I thought “I can do this!” While I could apply many of the principles, I had no idea the extent of the education and experience that would be required. I was required to know such a wide array of needs and be able to analyze and make effective decisions for a variety of students. There is a lot to it! While a background in special education or experience in an ABA program is helpful, therapists are overseen by a regulatory body, such as the Behavior Analyst Certification Board (BACB), and having that oversight is essential to the development of a results-oriented program.
- A producer of “robots.” This misnomer probably came from observing students with limited skills implementing something they are just learning. Highly impacted students often need repetition and practice to learn a new skill, and until it is natural, it may come across as “robotic.” I think that’s OK! Our goal is to give them skills they didn’t previously have to help improve their quality of life. And, for the most part, new skills become familiar skills and begin to look and become more natural. For the more socially and behaviorally capable student, many of their new skills become “natural” quickly as they gain more social acceptance using them.
Audra Jensen is a Board Certified Behavior Analyst and the director of Autism Behavioral Consulting in Vancouver and Portland. She is an author, social cognitive specialist as well as an attendee of the Michelle Garcia Winner’s mentorship program in 2009.