Applied Behaviour Analysis (ABA)

What is Applied Behaviour Analysis (ABA)?
Applied behaviour analysis, commonly referred to as "ABA" is a systematic method of supporting and/or altering behaviour. It involves studying behaviour (via observation), analysing the steps involved in producing a behaviour, and then teaching or modifying these steps one at a time. The principles of behaviour therapy have been developed through more than 50 years of scientific research.

Key components of ABA are:

• A "functional analysis" of behaviour. This refers to the observation of current behaviours for their frequency as well as the antecedents and consequences of displayed behaviour
• Breaking down desired skills into manageable steps
• Teaching the steps through repeated presentation of skills (these repeated learning opportunities are sometimes referred to as "discrete trials")
• Collecting data on behaviour to measure quantitative and qualitative changes over time

Examples of ABA applications to a child with autism:

• To teach new skills: Breaking skills into manageable steps to be taught systematically using reinforcement e.g., to teach new functional life skills, communication skills or social skills
• To increase desired behaviours: Positive reinforcement to increase behaviour e.g., rewarding a child to increase staying on-task or to increase their attempts to initiate play in a social interaction
• To reduce inappropriate behaviours: Modification of the child's environment or redirecting the child to a more appropriate activity e.g., ignoring a tantrum and redirecting the child to a functional activity
• Generalisation of new skills: Teaching skills in various environments to ensure the new behaviour is transferred from one situation or response to several e.g., generalising compliant behaviours from the home environment to various public/ community settings

The application of behaviour principles to learning and performance has been used as a basis of treatment on children with autism and other learning difficulties. Although many treatments claim to help people with autism, a review of over 500 studies (Matson, Benavidez, Compton, Paclawskyi & Baglio, 1996) showed that ABA consistently produces scientific evidence that offers positive outcomes. A recent study (Sallows & Graupner, 2005) also indicated positive support for the use of behaviour therapy with children who have Autism. Positive outcomes were specifically noted for peer interactions, classroom behaviour, imitation, self-care, language and daily living skills.

Although behaviour therapy is a method of intervention used for children with Autism, it is also used extensively in the general community. For example, behaviour therapy techniques are used in sports psychology to motivate and train elite athletes, in the teaching of daily skills such as learning how to ride a bike or teaching a child how to brush their teeth, and in the corporate world to enhance staff performance (e.g., workplace incentives or monetary bonuses).

ABA involves the development of individualised programs based on the child's strengths to help target their areas of difficulties. The programs are implemented in collaboration with families and all other health and/or education providers working with the child. Therapy sessions typically involve a well balanced amount of play time and table task time to develop learning, social and communication skills. The play times make therapy sessions much more fun and, therefore, more motivating for the child. Learning is generalised to various natural environments including day care, preschool or school.

ABA Techniques
The first step in any ABA program is to observe the child and develop a plan to change behaviours. The behaviours requiring modification are observed to determine the antecedents and consequences of the behaviour (i.e., what serves to reinforce or keep the behaviour going). Goals are then formulated to determine which particular behaviours will be addressed in intervention and in what order. The new behaviours will be broken down into smaller steps to teach the specific skills necessary to develop them.

A variety of techniques are used within ABA to teach these skills. Discrete trial learning, Natural Environment Training, Task Analysis, Reinforcements, Prompting and various Visual Supports are some of the techniques employed to teach a skill. Following is a brief explanation of each technique:

- Discrete trial learning is a structured method of presenting learning in systematic drills where the goal is purposefully and rapidly attaining mastery on a skill. It consists of the therapist's presentation of an instruction, the child's response, the consequence, and a short pause between the consequence and the next instruction.
E.g.,
Instruction 每 "Come here"
Response 每 Child goes to the person who gave the instruction
Consequence 每 Child gets a hug for complying with instruction
There would then be a pause before another instruction is given.

- Natural Environment Training (NET) is a teaching technique, which uses the skills that your child has gained, often through Discrete Trial Training, and generalises them to the natural environment. The natural environment is that which the child encounters on a daily basis. Therefore, the aim is to teach the child how to learn from their natural setting in the same way that typically developing children might learn. That is, to teach the child to apply and to generalise the skills they learn so that they can successfully interact within their environment in a way that is functional, meaningful and independent.
Natural Environment Training uses the child's interests to consolidate the skills they have learned. All skills taught in a discrete setting can be generalised to the natural environment. Indeed, many skills are taught most efficaciously within the natural environment e.g., play skills, social skills, and social language skills.
E.g., If a child is playing with a preferred toy train, then the therapist may join in play with the child and begin a conversation about the trains (eg "my favourite train is Percy"), whilst prompting the child to maintain eye contact and provide an appropriate verbal response. In this way, the child is taught how to respond to social conversation cues and how to reciprocate interest and communication. When mastered, the child can then extend their use of these skills to settings such as preschool or school where this kind of interaction helps form the basis of successful, reciprocal peer relationships.

- Task analysis refers to breaking complex behaviours down into their small components/ steps. This technique particularly helps in learning complex, chained behaviours and functional skills.
E.g., The behaviour of washing hands involves the following steps:
1. Turn tap on
2. Wet hands
3. Put soap on hands
4. Rub hands
5. Rinse hands
6. Dry hands with towel

- Reinforcement is a technique used to motive a child to learn. It has been found that reinforcers delivered immediately after a child's appropriate response will increase the likelihood of that response. Reinforcements can be anything that may motivate a child to want to learn e.g., physical interactions such as tickles and hugs, or tangible rewards such as lollies, favourite toys, or having a break.

- Prompts are used to help children to acquire new skills during the discrete trial learning process. Prompts can be given at the same time as the instruction, during the child's response or after the child's incorrect response to show them the expected response.
Examples of various prompts for turning on a tap:
Verbal 每 "Turn tap on"
Visual 每 Show a picture of the tap
Physical 每Therapist's hand over the child's hand to assist the child to turn tap on
Demonstration/Modelling 每 Having someone demonstrate turning the tap on
Gesture 每 Pointing to tap

- Visual support is especially useful for individuals that are visual learners and have difficulty processing verbal and/or auditory information. Visual tools facilitate expressive language and language comprehension. They also assist individuals in understanding their social and physical environments by providing structure to explain task expectations or daily events.

What are some of the benefits of ABA?
A major strength of ABA is that it is a systematic approach. There are clear sets of expectations and tasks are broken down into small attainable parts. ABA also helps teach skills such as attention. It can help increase socially appropriate behaviour, including complex behaviours like language. ABA targets consistency in the child's environment.

Even though ABA does not lead to a "cure" of autism, the application of ABA principles offer a reasonable probability of gains in functioning in areas such as language, play, social and self-help skills. Naturally, there is a range in the degree of treatment outcomes. Outcomes depend upon several factors including age at onset of treatment, quality of treatment, the child's cognitive capacity and consistency in the home environment. Nonetheless, treatment is designed to bring out the child's fullest potential, to maximise children's functioning so that they can develop meaningful relationships with others and to take better advantage of learning opportunities in their homes, schools, and communities.

What are our philosophies regarding ABA?

At Annie's Centre we believe in a holistic approach to a child's intervention program. We believe strongly in working in collaboration with parents and other professionals to help maximise the child's potential. In our centre, we work closely with our Senior Speech Pathologists, Occupational Therapists and Clinical Psychologists to develop comprehensive and individualised programs for the child.

At Annie's Centre we believe that the child's therapists need to have broad experience and the ability to use a range of learning support approaches. Our Behaviour Therapists have many years of experience and have worked with children with a range of levels of support needs. Whist we maintain a behavioural focus, our therapists have a breadth of experience in using a range of learning facilitation techniques including the Picture Exchange Communication System (PECS), the TEACCH model of learning support, video modelling and structured peer play.

At Annie's Centre we believe that treatment should be fun for children, families and therapists. It is important that therapy is a positive experience for the child. In creating a positive learning environment, the child will be more motivated to participate in therapy sessions and, therefore, to learn and develop skills taught.

At Annie's Centre we believe that parents play a pivotal role in their child's therapy. Therefore, we would like parents to be as closely involved as possible in their child's therapy programs e.g., we believe in training parents to work as therapists with their own child, where possible. This helps parents to gain a better understanding of their child's skills as well as how to support their child's daily development.

Frequently asked questions:

How long does ABA intervention last?
Research has found intervention in infants and preschool aged children enables the most rapid progress. However, the length of treatment varies according to the child. Where necessary, appropriate programs can be put in place to support a child's progress into their early primary school years and beyond.


What if my child hates therapy and cries throughout the session?
At Annie's Centre, we believe in building up a positive and fun environment for children. Our focus is on building rapport with the child and understanding the child's needs before we begin any major interventions. Although the child may be upset or tired at times, the philosophy of making sessions fun and motivating increases the likelihood that the child will enjoy and even look forward to their therapy sessions.

How many hours of behaviour therapy are necessary for the best progress?
The number of intervention hours varies according to the child's needs. Research has suggested that approximately 20 hours of prescribed intensive therapy per week increases the rate of the child's progression of learning. However, this can be a combination of therapies e.g., Speech Therapy, Occupational Therapy, Early Intervention and ABA. Faster learning progress allows children to develop better social skills and independence at a younger age. Therefore, better outcomes tend to be achieved. However, there are many children who may not need a high degree of intensity of intervention. For this reason, the initial intake/ consultation is a critical component in developing an appropriate program that is matched to the child and family's needs. The intensity of the program is regularly reviewed.

Can children still receive other therapies whilst accessing ABA? For instance, can they continue with Speech and/or Occupational Therapies?
Parents may implement any additional treatment they desire. At Annie's Centre, we work closely with our Senior Speech Pathologist, Occupational Therapist and Clinical Psychologists to develop comprehensive but individualised programs for each child. It is also important that you inform your Behaviour Therapists of other treatments your child may be involved in as well as any dietary, vitamin or medication regimes or restrictions.

What are parents' roles and responsibilities?
Parents have an intuitive understanding of their children which is essential in planning treatment. Parents also help to make treatment more effective by attending all clinic meetings, being involved in therapy (e.g., becoming one of their child's therapists), helping their child to generalise skills learned in therapy to other settings, and by regularly discussing any ideas or issues they have with their Senior Behaviour Therapist.

Where and how do I find therapists?
At Annie's Centre, we offer to help parents find therapists. We recruit and train therapists who can then work with your child and family. Alternatively, parents are welcome to find their own therapists if they wish and then we can train those therapists for the family.

Are there any parent support/ ABA groups in Sydney?
"Autism Awareness" is an organisation that helps parents to acquire and share information regarding any questions they may have on Autism and related services within Sydney. They can be reached at www.autismawareness.com.au