Applied Behavior Analysis in Family Therapy
Name of the Strategy or Intervention
Applied Behavior Analysis in Family Therapy
Founded upon the major principles of behaviorists such as Watson and Skinner, applied behavior analysis (ABA) is a therapeutic approach that specifically focuses on increasing quality of life through meaningful and socially relevant behavioral modification. Proponents of ABA posit that problematic behaviors can be changed via a mixture of reinforcement and repetition. ABA is used to treat multiple age groups within a variety of contexts such as education, healthcare, and business management. Due to a considerable body of literature demonstrating its efficacy, ABA is most commonly known as the gold standard approach to working with children with autism (Baer et al. 1968).
ABA has been researched extensively since its inception in the 1960s, with the majority of studies being published in the Journal of Applied Behavior Analysis. The journal currently presents the most recent research on ABA techniques and showcases how behavior analysis applies to socially relevant behavioral change and learning. Among the extensive literature in ABA are the findings that it improves cognitive functioning, reduces problematic behavior, and improves academic performance in autistic children. Further studies show that learned behaviors from ABA interventions are maintained over time (Baer et al. 1968; Lovaas et al. 1973; McEachin et al. 1993).
ABA stems from a group of faculty members and researchers from the University of Washington and the University of Kansas in the 1960s. Members of the group include Donald Baer, Sidney Bijou, Jim Hopkins, Jay Birnbrauer, Todd Risley, Montrose Wolf, and, later, James Sherman. ABA formed as the result of efforts to link interventions to observable changes in behavior and to apply behavior analysis techniques to actual social situations (Baer et al. 1968).
ABA’s roots lie in behavior analysis, which is a field of study concerned with studying the factors that change or modify human behavior. According to the beliefs of behaviorists, observable behaviors can be learned or modified through techniques involving rewards and punishments. Although ABA initially used punishments in its techniques, it now encourages the use of rewards over punishment as it seeks to drive motivation rather than fear. Reward systems such as token economies paired alongside reinforcement techniques make up the bulk of many of the ABA techniques seen today.
ABA therapists study the feedback and outcomes of a behavior change attempt and adjust the approach to the behavior change if needed. Emphasis is placed on the role of the instructor as they work to control environmental factors to produce the target behavior.
Rationale for the Strategy or Intervention
Prior to ABA, treatments for autism included separating children with autism from their parents and later, giving them LSD and removing gluten and casein from their diets. Early studies of ABA applied it to children with autism in Ole Ivar Lovaas’s 1987 “Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children” (Lovaas 1987). In this integral study that came to be known as “The Lovaas Method,” 47% of children who were exposed to 40 intensive hours of 1:1 discrete trial training (DTT) no longer qualified for an autism diagnosis by the end of treatment and were considered to have normal intellectual and educational functioning. Over the course of his life, Lovaas would go on to study ABA and publish several studies that found it to be an effective treatment for children in classrooms. Ultimately, his research popularized the use of ABA in classrooms and spread international awareness of ABA as a treatment for kids with autism. While the intensive Lovaas method is still used, it is one of several ABA interventions that have been researched and found effective as an autism treatment.
ABA is now considered the gold standard for treating children with autism since it has the most research behind it showing its efficacy. ABA works well with children because they respond well to behavioral interventions with interesting external stimuli as opposed to solely verbal interventions. ABA methods teach simple skills such as looking and imitating as well as more complex skills such as reading, conversing, and understanding others’ perspectives. Its safe, effective, and research-backed interventions make ABA the most widely used method for teaching these skills to children with autism.
ABA can be used within family therapy sessions for children diagnosed with autism. In family therapy sessions, ABA-certified therapists teach parents techniques for changing problematic behaviors or learning new behaviors. Parents are encouraged to use ABA in the home and in other naturalistic settings throughout the day to teach social and academic skills across contexts.
Description of the Strategy or Intervention: What Happens during ABA?
In ABA, interventions are intended to reinforce positive social behaviors such as identifying colors, asking for a toy, maintaining eye contact, etc. Interventions can be done in a variety of settings, including in the therapy room, at school, or in the home. Exact techniques used vary on a case-by-case basis only after a period of observation in which behavioral triggers are assessed by a trained behavior analyst. Typically, an analyst works alongside teachers and parents to equip them with specific techniques that target the behaviors intended to be learned or modified.
ABA breaks down behaviors into the “Three ABC’s of ABA”: the antecedent, the behavior, and the consequence. These principles are rooted in behaviorism and are applied in various forms across the numerous techniques stemming from ABA. Studying the ABC’s of a behavior of interest in ABA is often one of the first steps in planning its development or change. The antecedent (A) focuses on what happens before the behavior occurs; in other words, what cues and instructions appear to be triggering the behavior? The behavior, (B), is observation of the behavior of interest. Finally, the consequence (C) looks at the events happening immediately after the behavior. Within ABA, consequences typically result in rewards such as food or verbal praise for a correct behavior and a correction if the target behavior is not done. After the behavior is observed through the ABC’s, ABA therapists, teachers, and parents can choose from several techniques to teach the participant the target behavior.
Over the years, numerous behavioral techniques have been developed for use in ABA. Two of the more popular evidence-based interventions include discrete trial training (DTT) and pivotal response treatment (PRT). In DTT, whole skills are broken down into smaller sub-steps of (1) antecedent, (2) prompt, (3) response, (4) consequence for response, and (5) interval between trials (Smith 2001). If the client successfully completes the task, they are positively reinforced with a reward. If the task is done incorrectly, the instructor will show the correct way to do the task, and the task will be repeated again in a new trial with the goal of reaching the target behavior. DDT has been found to be most effective with teaching new behaviors to children with autism such as new speech sounds or motor movements. It is also used to teach discriminatory skills such as responding accurately to different requests (Smith 2001).
Pivotal response treatment (PRT) focuses on building upon “pivotal” skill areas such as language acquisition, behavior regulation, and social engagement. Created by Koegel et al. (1987), the approach was initially designed to teach language acquisition to nonverbal children with autism. PRT posits that development of these areas will improve other aspects of children’s lives across social, behavioral, and academic contexts and settings. Important to PRT is the idea that children must become inherently motivated to engage within these pivotal areas in order to successfully use them in real-life scenarios. Emphasis is placed on children being self-motivated as this drives them to use learned skills in other contexts. Because of this, PRT interventions are shaped by the interests of the participant and ideally take place in naturalistic settings such as parks or regular education classrooms. For example, a therapist can ask a child to pick from a variety of toys to play with in a normal education classroom, and the therapist can teach social engagement skills by requesting the child to ask for the toy before playing with it. If the child is able to do so, he or she is rewarded with the toy, and in turn, the requesting behavior is reinforced.
Franky is a 5-year-old boy who is diagnosed with severe autism. He is currently in family therapy with his mother Helen and his father Tom. Franky also attends an alternative school with ABA-certified teachers who use ABA techniques in classroom settings with Franky throughout the school day. The family therapist is trained in ABA and is using DTT to teach Franky social skills. The target behavior for today is for Franky to maintain eye contact with someone for 3 s when they say his name. In order to reach the target behavior, Franky’s trials are broken down into successively approximate steps toward the target behavior in a method known as “shaping.”
In a family session, the therapist demonstrates and explains DTT to the parents. The therapist first gives Franky a piece of popcorn. This establishes the popcorn as the reward that Franky will be working toward during his trials. Then, the therapist shows Franky another piece of popcorn and says Franky’s name while putting the popcorn behind his own head. Franky looks in the direction of the therapist’s head and is rewarded with the popcorn and verbal praise for doing so as this is a step toward the target behavior. If Franky does not look in the direction of the therapist, the popcorn reinforcement will be withheld and he will be guided toward the correct behavior until he is able to look again in the direction of the therapist’s head or display a behavior further along in the behavior sequence such as making eye contact. After a few more trials, Franky briefly makes eye contact with the therapist when his name is said. Again, he is rewarded with both popcorn and verbal praise for doing so. Now that Franky is making eye contact, the therapist works to maintain the contact for a longer amount of time. The popcorn and verbal reinforcement is now withheld until he is able to make eye contact for more than 1 s and then 2 and 3 s.
The therapist encourages Helen and Tom to work with their son at home every day to extend Franky’s eye contact to up to 5 s and then gradually phase out the popcorn reinforcement. The therapist explains how the DTT format can be used to teach other social skills as well such as saying “thank you” or “excuse me” and that family participation in this process helps to create lasting change over time.