What is applied behavior analysis (ABA)?
- ABA is a type of therapy that provides evidence-based treatment to teach functional skills, decrease interfering or problem behaviors, increase socially appropriate behaviors, and increase overall quality of life.
- ABA therapy is used to encompass a wide-range of skills including: social skills, communication, safety skills, visual perceptual skills, attending, following directions, classroom readiness, gross motor and fine motor skills, hygiene, grooming, potty training, domestic capabilities, and eventually job competence.
What does ABA therapy look like?
- Direct ABA therapy will be provided by a Registered Behavior Technician (RBT). RBT’s implement all of the goals written by the BCBA and will often work with a child 1:1 from 10-40 hrs. a week. ABA therapy sessions usually range from 2 hrs.-8 hrs. per day. ABA is very data driven; the RBT will be collecting data throughout their entire session on each goal they implement to determine how independent the child is in each skill being targeted. Therapy can be completely play-based, structured, or a mix of both.
- The Board Certified Behavior Analyst (BCBA) completes the assessment, develops the treatment plan and goals, and implements ongoing RBT training and supervision, parent education, and ongoing updates and revisions of goals. The BCBA analyzes the data taken by the RBT to determine when goals are mastered and when to update and change programs.
- Therapy can be conducted in the home, school, clinic/center, community, or any combination of settings.
How does a child qualify for ABA?
- If you are interested in ABA for your child, we must receive a referral from a developmental pediatrician, psychologist, neurologist, or psychiatrist in order to get authorization from your insurance to bill for ABA services.
- ABA can work for anyone and everyone! However, most research in ABA has been on treatment for autism; therefore, most insurance companies will require an autism (or “at risk”) diagnosis to approve ABA services.
- Private pay may be an option for those without insurance coverage.
Common tools and strategies used in ABA:
- Positive reinforcement: Positive reinforcement is one of the key components of ABA. By determining what motivates the child, we can use reinforcement to teach and reward positive behaviors.
- Visuals: Many children will respond much better to visual cues than verbal cues. Visuals are commonly used to aid in compliance and task completion. Visuals can include: written or picture schedules, step by step instructions or pictures showing how to complete a task, first/then boards, token boards, calendars, checklists, etc. (Choice Maker app is awesome for creating visual schedules)
- Token boards: a child receives tokens which can be in the form of: points/stickers/stamps/check marks/etc. for each correct response or every few correct responses they engage in. Once the token board is full or pre-determined number of tasks is complete, they earn the agreed upon reward of their choosing. This serves as a visual reminder to show the child how many tasks are left before earning a break or reward and helps motivate the learner.
- Timers: Using a timer and/or a verbal countdown is a great strategy to use for kids that struggle with transitions or giving up preferred items. Even when using a timer, I will usually provide a few verbal warnings of how much time a child has left with an activity before the timer goes off to better prepare them for the transition.
- Chaining: Chaining uses a task analysis to break complex tasks into a sequence of smaller steps or actions. We will teach one step at a time until each step is mastered and the child is able to complete the whole sequence independently. (Commonly used for: dressing, hand washing, teeth brushing, tying shoes, etc.)
- Establishing routines with clear expectations: When children know exactly what is expected-they will have better outcomes. Go over the rules or expectations before starting the activity or event and intermittently reinforce/praise the appropriate behaviors you see them engaging in.
- Choices: Allow your child some choices if you’re able to. Children are more likely to comply and engage in appropriate behaviors if they have been given some choice. Ex: Do you want to brush your teeth or get dressed first? (they are still completing the tasks you need them to, but you give them a choice in how or when it is completed)
- First/Then: Have the child routinely complete a task before they get access to a preferred item or activity. Get in the habit of using “first, then” language. This will help teach the child that they aren’t given things just because. For example: Have the child finish their first task or a sequence of tasks BEFORE they get a break on the iPad. (“First put your toys away, then you can have 20 minutes on the iPad). Schedule of reinforcement will vary based on the learner. Some kids need reinforcement after one or two tasks and some can wait until the end of the day, week, or even month for the reward.
- Environmental Arrangements: Set activities up that promote success. Avoid “set ups” and “set offs” if possible. For example:
1. Your child gets very distracted while doing homework at the kitchen table and often plays with items on the table and gets up multiple times to get drinks and snacks in the kitchen in order to avoid homework. Consider designating a special table or desk that is clear of all distracting items in a quieter less stimulating room to complete homework. You may present less work or present only one page at a time so that the task appears less daunting and the child can earn breaks after completing an agreed upon amount of work if necessary. (i.e., “Complete one page, then you get a 5-minute break”)
2. The child usually hits his brother when sitting in the waiting room for therapy. The parent or caretaker can bring in an activity or activities to keep the siblings occupied while waiting and start sitting in between the two children ensuring they are not seated alone together unsupervised.