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ABA therapy

post #1 of 9
Thread Starter 

When is ABA therapy used?  Is it just for children with autism or are there other times when it is used?

post #2 of 9

This is a relatively contentious question because ABA covers a HUGE range of therapies though the differences are rarely discussed.

 

ABA began at UCLA in the 70s and was used to treat severely autistic and mentally ill people (schizophrenia, etc).  It was very "behavioral" in that it addressed only behavior and was very much a reward/punishment system.  The idea being that if you rewarded "good" behavior and punished "bad" the person would naturally be more likely to do the "good" behavior more often and the "bad" behavior less.  This is clearly true and behavioral modification is used in a huge variety of places.  A great example is military training - that is behavioral modification to an extreme (i.e. react the right way in specific situations, life saving obviously in military contexts.) 

 

Original/traditional ABA was extremely rigid and required the child to sit at a table for extended sessions where they were strapped down and administered rewards (often candy) and punishments (sometimes electric shocks).  For severely autistic children, this method was very good at altering behavior.  Since then, obviously no one uses electric shocks any more, and even the use of punishment has drastically reduced. 

 

In the last 15-20 years, ABA has moved away from a strict "behavioral" to a more "developmental" approach, i.e. more child led, more play based, etc.  That said, some people trained in ABA are very traditional, very much "Sit the child at the table, reward good behavior" etc.  This approach has been studied in moderate to severely autistic children and has, in study after study, shown improvement.  Especially in specific academic skills and life skills.  Especially for children who lack intrinsic social motivation (so a child who doesn't care if you are disappointed, a child who doesn't learn through imitation, etc).

 

However, some development experts question the long term effect of this traditional ABA - discrete little interactions don't model real world learning very well, and many worry that it is "training" kids to respond correctly in a specific context, but outside that context, doesn't help them generalize skills.  So, for example, a child can look at a yellow flash card and say "yellow" every time, but when you ask what color the school bus outside is, they can't answer.  The skill for identifying yellow is only learned in the context of a flashcard.  Dr. Greenspan is the most famous critic of traditional ABA.  There is also concern that traditional ABA can, in the long run, reduce effective social communication since it is structured in a very non-"natural" way.  So kids learn to respond properly, but aren't developing (arguably) more important skills like negotiating social back and forth interactions, working on social queues in natural environments, etc. 

 

The ABA picture gets even more messy when you consider that few people still practice traditional ABA.  There are new approaches, pivotal-response therapy, etc.  Things are moving away from purely behavioral modification approaches, but when you sigh up for ABA therapy, it is rarely clear exactly what philosophy they will be using, how the therapists were trained, etc.  So you could have an old school, very very behavioral focused therapist, or you could have a therapist that is basically doing floortime (which is sometimes seen as the developmental counterpart/opposite of ABA).

 

To confuse it even more - almost all the studies about the efficacy of ABA therapy are on moderate to severe children.  So there hasn't been much research done on kids with, for example, PPD-NOS (or mild/high functioning autism) so, who knows if it works as well?  Who knows if it is really the best approach for those kids?
 

As you can probably tell, I'm not a huge fan of traditional ABA for kids who aren't fairly severe and lacking social motivation.  Notice I said "traditional" because I do think there are a lot of newer ways to approach ABA that are effective without being too rigid.

 

So your question...I don't know how to answer.  I think it really depends on what your child needs help with.  It also really depends on the therapist.  Many early intervention people seem to believe that ABA is clearly the best therapy for just about anything but I disagree.  Our son, who is not on the spectrum but has a severe language disorder, HATED his ABA preschool.  It shut him down because it was way too rigid and cut him off from the other kids and from genuine open play.  So I think it was actually bad for him.  But, other kids I know who are also not on the spectrum, have gotten a lot from ABA therapy, often in conjunction with other types of therapy.

 

We do floortime (which is generally seen as a therapy geared toward autism) because our son needs help with his pragmatic/social language.  I LOVE floortime, but that's probably because it is right for our son. 

 

Hope that isn't way too much info and that it helps!

 

Please note, I am NOT an expert.  I'm a research scientist, and have done a LOT of reading and research but obviously take my ideas as a mom and researcher.   

post #3 of 9
Thread Starter 

That is a great answer.  Thanks for taking the time to type it all out.  

 

My 20 month old son is going to be starting ABA therapy next week.  Until yesterday I thought he was going to be getting speech therapy, he has a 75% delay in his expressive communication.  It really confused me because I thought ABA was just for autism.  He is going to be getting 4 hours a week ABA thru early intervention although they have made more then a few comments about seeing how it goes and increasing the amount he gets...and no comments about seeing how it goes and decreasing the amount.  

 

I kinda feel like there is an elephant in the room when I am dealing with early intervention, like there is something they are not saying.  The person I dealt with today (The individual managing my sons ABA therapy, he had a masters in applied ABA) kept commenting on his great eye contact today, which felt weird given that eye contact is not even vaguely an issue that early intervention is dealing with.  It is leaving me feeling like they think he is autistic but don't want to tell me or something, you know, like they know something they aren't saying.  

 

I also found out that while they are going to work on him with speech, their focus at first is going to be to teach him signs.  I understand why but it was a blow to realize how far he is from talking and letting me know what is going on with him and what he wants.

 

Making things worse, in the last week or so, I have started getting looks from strangers and acquaintances because of my sons behavior.  He is just so obviously delayed.  He does not raise his arms when he wants to be picked up, he does not point to show me stuff.  People try to interact with him and he just stares at them, he does not smile or act shy or anything.

 

It is hard making sure that my son is getting what he needs when I don't know what is going on in the first place.  I wish someone would be honest with me about what is going on.

post #4 of 9

Sadly Early Intervention isn't really "supposed" to be in the business of giving your child a diagnosis - they are really supposed to be focusing on where your child is, strengths and weaknesses, and work on improving the things that child needs help with.

 

What you are experiencing is very normal, especially in the context of people who spend a LOT of time working with kids on the spectrum.  I've found (as the mother of a child not on the spectrum) that they have a hard time dealing with kids who don't fir the autism mold.  So, if your little one isn't clearly on the spectrum, they might struggle. 

 

If you can manage it, I would HIGHLY, HIGHLY recommend taking your son to a good developmental pediatrician.  No one else is really able to look at all the possibilities going with a child (including medical issues) and it was invaluable for us as we were trying to figure out what our son needed - especially trying to figure out preschool and therapy. 

post #5 of 9
ABA can be used on anyone. I use it to train myself to have better routines in the morning to get out the door and not forget anything. My friend uses it to desensitize her dog to anxiety. And I use it to help my mom become more organized. And at work, I use it to help children from age 2-11 who have many different issues - from autism, to Fragile X, to ADHD.

The previous poster is right about it being a wide continuum based on whose model the practitioners are following. But to give you a very concrete example of what you should look for in an ABA provider and what to avoid, when I was trained many years ago, we used a very traditional approach, which left out the whole "social" part of communication. We trained children to look at us when we said, "look at me" using physical prompts and candy rewards. I would never do that now.

Now, where I work, we teach the children to look at us in order to communicate something and receive social reinforcement and engagement. For example, if a little boy loves putting cars down a big mail tube, I'll roll him one and stop and wait for him to look at me before I finish sending it to him. Or I'll pass a child pieces of a puzzle he's enjoying but hold them up to my face so that he looks at me before I hand him the puzzle. Or I'll play tickle, peekaboo, or bounce a child on a ball and then suddenly stop. And as soon as he looks at me, I'll continue the game. Thus the children quickly learn to add eye contact to their other forms of communication and it's very natural.

Although ABA is thought of as an autism therapy, it is used widely in the world to change people's behavior and teach new skills - breaking a larger skill down into small manageable steps, providing help (prompts) and then fading the help and increasing the task as the person masters each step. I've been using it with children for 15 years, and although it doesn't work for every child I've seen, it does for most, provided that the practitioners are highly interactive, engaging with the children, teaching skills in natural settings as well as in isolation, and making sure a child can generalize a skill before considering it mastered.

Please feel free to ask me any questions you like about ABA in general or as it relates to your child.
post #6 of 9

I prefer relationship-based therapies when working with my caseload of children under the age of three. Whether their diagnosis (or potential diagnosis) is general language delay, apraxia, autism or any other reason their language is delayed, the main focus should be on interaction skills, before talking is even a goal. Various programs target these very important interaction skills including, “Communicating Partners” by Dr. James MacDonald, “Responsive Teaching” by Dr. Jerry Mahoney, “The Hanen Approach” and “Floortime”. They all take into account the prerequisites to speech, before they target talking. Imagine teaching a child to walk if they aren’t even sitting up yet…not possible, right? Well trying to teach a child to talk before they are even showing you items, pointing to what they want or imitating fun simple actions would be the same thing and would be just as unsuccessful! Communication is the physical act of saying a word BUT it is also a social act and a cognitive act. The above programs take all of those aspects into account. When you are fun and interactive and you get into the child's world of actions, sensations and movement, you can be more successful at teaching them how to communicate.

post #7 of 9
Thread Starter 

Well we had a visit with a pediatrician yesterday and she felt that my son is autistic.  He has not been officially diagnosed, the doctor wants to wait 6 months and see how he responds to the therapy first. I don't know how I feel about that. 

 

As far as different therapies go, I would love to have other options but without a diagnosis my insurance wont cover anything and EI is only offering ABA so my options are limited. There are some organizations offering many different things for autistic children locally but once again without a diagnosis he is not eligible.

post #8 of 9

The great thing about relationship-based interventions is that PARENTS can have the most impact on thier kids! They can use the strategies during bathtime, mealtime, playtime... and no specific time has to be set aside to work on "talking". Something else to remember as you are interacting with your child: talking is only one small part of communication. It is a physical act (physically moving your lip, jaw and tongue...to talk) but it is also a social act (they have to have a back and forth interaction with another person and WANT to communicate something) and it is a cognitive act (based on what they know about the world around them and on their experiences). I would definitely look up some information on the therapies I mentioned in the above post (especially Communicating Partners by Dr. James MacDonald).

One more tip: enjoy your child where is is right now because every stage of learning to communicate, even the ones that come before actual talking, are important and should not be ignored or rushed.

Good luck on your journey, and whatever therapy method you choose, I hope you are comfortable with it and believe that it is what is best for your child :-)

post #9 of 9

Three things pop out of this thread for me: 1) Early intervention can't diagnose you child but not pointing or doing "uppy" with his arms are early red flags for spectrum disorders. It sound like they have suspicions, and the ABA won't hurt him if done well. The sooner you can get a developmental consult the better. A private speech consult to check for apraxia also would be helpful for when your child turns three and gets an IEP.

 

2) I don't believe these treatment techniques are an either/ or equation, but that they complement each other. As the mom of child with mild autism, and a severe speech delay, and no suspicion of autism until about 4 (mainly because he "makes eye contact" just reduced) I used ABA techniques and relationally-based Floortime, and had a weekly consult with an expert in each. Teaching him to play with varied objects or themes, or to connect with others in play, necessitated Floortime. To do more practical things, he needed the rote repetition of a motor plan found in the repeated trials of ABA. I taught him to come when called, to get dressed, to put his clothes in the hamper, through ABA. In speech when my little man was your son's age, I used both approaches also, naturalistically: i.e. encouraging him to make the "p" sound when he wanted a push on the swing, and sharing a beloved toy after he made the sound as well, or simply slowing my speech down and saying early sounds (m,p, b) clearly while doing something he loved.

 

3) Regardless of what label they give your son, and what package of techniques are being used, your instincts about what is helping him learn will be most important. So put aside the stress of "knowing" what is wrong, or what treatment is best. Use the sessions and your playtime to observe how he learns, then use what you discover whenever you can all day long.

 

Hugs and luck!

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