APPLIED BEHAVIOR ANALYSIS TREATMENT FOR
AUTISM SPECTRUM DISORDERS.
Carl Stuart.
Stuart Medical Series.
Abstract.
This paper focuses
on how Applied Behavioral Analysis (ABA) is used to treat and manage autism
spectrum disorders. Thus, the paper appraises ABA, discussing its important
components and how it works. The paper also succinctly discusses about the
autism spectrum disorders. Finally, the paper concludes with an analysis of how
ABA is used to treat autism spectrum disorders.
APPLIED BEHAVIOR
ANALYSIS TREATMENT FOR AUTISM SPECTRUM DISORDERS.
Studies
have shown that one of the most effective modes of intervention in ASD (Autism Spectrum
Disorders) is Applied Behavior Analysis (ABA). ABA is also termed behavioral
treatment or behavioral intervention. According to the research done by Arthur
Wynn and William Groen in 2010, ABA produces comprehensive and long-term
improvements in the most essential skill areas in children who have ASD,
notwithstanding their age (p 809). Trevor Laving (2010) stated that the main
objective of ABA as applied to ASD is to maximize the successes, while
concurrently, reducing the failures (p763). ABA techniques make use of
scientific principles, based on current behavioral learning theorems, to alter
conducts in ASD patients by fostering socially-constructive repertoires and
minimizing the problematical ones. ABA is a structure-based intervention that
places much emphasis on the use of precise high-intensity teaching techniques
to enhance language skills (such as imitation, cooperation and attention), and ensure
that the affected children do obtain a collection of constructive manners (Wynn
& Groen, 2010).
ASD,
also termed as PDD (Pervasive Developmental Disorder), is an intense long-term
developmental disability which normally manifests itself during the early
childhood period. It incorporates a cluster of developmental disorders together
with their associated symptoms that have varying levels of intensity.ASD is
neuro-behavioral in nature, thus, its effects are severe. Usually, ASD is
diagnosed in the child before he or she is three years old. It cause the
effects outlined below. Restricted repetitive patterns of behavior
characterized by obsession with the sensory features of physical entities.
There are impairments in social affinity, with the most common feature being
inability to establish and maintain proper peer relationships. There is delayed
development of cognitive functions, thus cognitive impairment occurs. Also,
there is impairment in communication, both verbal and non-verbal, as evidenced
by absent or delayed development of spoken language (Pearson, 2011).
It
has been postulated that ASD is caused by a neuro-developmental and
neuro-operational dysfunction in the brain, though its correlation with the
associated behavioral manifestations are still unclear. Also, epidemiological
studies have shown a strong correlation between ASD and psychiatric disorders
that are genetic in origin, with the hereditary factor in ASD being greater
than 90%. It affects boys more than girls with a gender disparity ratio of 4:1,
though no scientific model based on genetic studies has been able to explain
this discrepancy. The ASD spectrum encompasses autistic disorder, Rett’s
disorder, Asperger’s disorder, Childhood Disintegrative Disorder and PDD-NOS
(Pervasive Developmental Disorder-Not Otherwise Specified).
The
common comorbidities associated with ASD are intellectual disabilities, lack of
functional speech, behavioral disorders (such as obsessive compulsive disorder,
attention deficit hyperactivity syndrome, tics and self-injurious behaviors),
anxiety, depression and Bipolar disorder. Screening for ASD is done at two
levels; Level I screening with involves developmental surveillance, and Level
II screening which involves diagnostic evaluation and comprehensive
investigations for developmental disorders (Pearson, 2011).
Treatment
for ASD can be categorized into two levels. The first level is the treatment of
core symptoms, and this involves addressing the developmental, educational, and
behavioral requirements of the individual with ASD. The second level of management
involves other forms of treatment, such as physical, speech and occupational
therapies, which are indispensable in the management of autistic disorder but
they do not treat other disorders, for instance, developmental delays (Pearson,
2011).
ABA
is a treatment program that basically makes use of repetitive reinforcements to
teach particular skills to the students, while concurrently, minimizing and/or
eradicating the inappropriate behaviors (Mendelsohn, 2010).
The
nine principles of ABA are outlined below.
First of all, there must be an individual program for each and every
student. Each program must correspond to the strengths and needs of the
student. The second principle is task analysis which involves the assessment
for tasks (or skills) that need to be taught. These tasks are then broken down
into steps that can be easily taught. The third principle is discrete trial and
prompting, which involves teaching each step individually. Fourthly,
reinforcement is used to fortify each step taught. Reinforcement involves
motivating the students by use of rewards. The fifth principle is repetition
and prompts fading. This involves frequent practice of each step until the
student masters the required skills. Skill development is the sixth principle.
It involves integrating each step systematically until the student can complete
the whole task autonomously. The seventh principle is data collection, and this
involves frequent compilation of factual information with the aim of monitoring
the progress of the student, in terms of acquisition of the required skills,
and, the effectiveness of the program as a whole. The eighth principle is
generalization. This involves teaching the student how to perform the whole
task at different times, among different kinds of people and in different
settings. The ninth principle is developmental skill building. Here the learnt
skills are integrated developmentally with the aim of building a strong
foundation that will serve as the basis for inspiration for self-initiated
long-term learning. Thus, ABA describes how to teach (Mendelsohn, 2010).
ABA
has seven characteristics or dimensions which are explained below. The applied
characteristics takes into consideration the short-term behavioral change,
effects of these behavioral change in the person with ASD with regards to
interpersonal interactions between him or her and the family, close relatives,
educators and the general public. The second dimension is behavioral change,
and this behavioral change must be measured using objective parameters and not
non-behavioral substitutes. The analytical dimension in the applied setting is
demonstrated by behavioral control and maintenance of moral ethical standards.
The technological characteristic implies that the descriptions made in ABA
studies or researches are detailed, clear and precise. Hence, such studies can
be replicated by a researcher. The conceptually systematic characteristic
involves the utilization of procedures and interventions; and the interpretation
of the obtained results within the limits of the principles of the procedures
employed. The dimension of effectiveness
analyses the practicability of ABA procedures in treating ASD and achieving the
essential practical or social objectives. Finally, the generality dimension involves
maintenance or continued gradual changes and enhancements of a particular skill
after the behavioral interventions, for that specific skill, has been withdrawn
for a significant period (Mendelsohn, 2010).
ABA
treatment of ASD involves the three step procedure explained below. First of
all, there is the antecedent which involves the use of tact, mand,
intraverbals, autoclitics; or physical/verbal stimulus, for instance, a request
or command. Secondly, there is the response to the stimulus, such as a specific
resultant behavioral response to a specific stimulus or lack of response to
that particular stimulus. Finally, there is the consequence, which is either
the establishment of a positive reinforcement, or lack of response for an
inappropriate behavior. The behavior is
measured using the following parameters: repeatability, temporal extent,
temporal locus and derivative measures (Wynn & Groen, 2010).
The
skills in ABA are divided into small discrete tasks which are subsequently
taught using prompts that gradually fade out as the required skills are
grasped. Positive reinforcement is done using verbal praise or any tangible
object that the student considers rewarding. Punishments are normally
discouraged, but non-injurious methods of punishment such as a light spray of
water on the face, may be used as a mode of intervention in a child who is
engaging in activities that may cause self-injury (Wynn & Groen, 2010).
Individual
programming has two main components: the curriculum and the ABA teaching
methods. The curriculum for students with ASD mostly caters for the areas that
need attention. These areas include communication, difficult behaviors, language
development, independent functioning, life skills, leisure and play skills; and,
social interaction and emotional development. Hence, the ABA teaching methods
encompasses the following strategies: prompt, fading, task analysis, discrete
trail training, shaping and chaining, pivotal response training, modeling,
social scripting or script fading, video instruction, priming, incidental
teaching, and structured peer-play interactions (Mendelsohn, 2010).
Reinforcement
in ABA is a systematic consequence aimed at increasing the frequency of
desirable behavior, not just using rewards to motivate the student. Thus,
reinforcement must be linked directly to the values of the student, and needs
to be planned and monitored closely. The procedure for reinforcement is as
follows. Initially, the behavior that needs to be modified is selected. Next,
the most potent reinforces that will alter this behavior are selected. The
reinforcements are then made immediately when the behavior under consideration
is manifested. The reinforcement is more effective when the reinforcer follows
the behavior closely. Lastly, data on that specific behavior is collected prior
to, for the duration of and subsequent to the teaching strategy or intervention
that had been put in place for monitoring the progress of the student
(Mendelsohn, 2010).
The
data collection tools of ABA are more useful than the common assessment
methods. The assessment methods used in the teaching strategy include the
following: data collection and graphing, benchmarks, checklists, rubrics, running
records, anecdotal records and video recording. The following measurements are
used during data collection: frequency of demonstration of the required skills,
the number of times these skills were done appropriately, duration of time of
the execution of these skills, measurement of how much prompting is utilized in
skill development, and the ration of correct to incorrect responses. Data is
collected during three occasions; prior to, during and subsequent to teaching.
Prior to teaching data collection is used to establish the baseline for skill
development. Data that is collected during teaching is used to assess the
effectiveness of the materials and teaching strategies used, and the progress
of the acquisition of the required skills. Data collection subsequent to
teaching is used to assess skill acquisition and the maintenance of the
acquired skills, for example, can the student demonstrate the skills several months
after it was taught? The collected data is then recorded (Mendelsohn, 2010).
The
recorded data is used for troubleshooting and decision-making processes.
Troubleshooting involves searching for patterns in various aspects of school
programming and in the school environment that slow down the standard rate of
progress, and initiating the necessary systematic changes (Mendelsohn, 2010).
In generalization,
the educators must frequently change the materials in order for the student to
develop a broader concept of the skill being taught. The standard rule in
generalization is that a skill must be demonstrated or performed in at least
three different settings, with three different individuals and at three
different times using various teaching materials and teaching aids. Also, the
skill is considered to be mastered or leant effectively when the student can
demonstrate the skill correctly and independently in 9 out of every 10 attempts
(Mendelsohn, 2010).
An
effective ABA teaching strategy must put into consideration plans for
transitions. Examples of transition in an individual with ASD includes
transition into a new school setting, between grade levels, between different
activities in different settings, transition from high school life into
adulthood and life transitions in general. An effective plan encompasses the
following two features; identification of the transition challenges for the
student and setting up of clear goals and a teaching stratagem for managing and
addressing these challenges(Wynn & Groen, 2010).
ABA
uses the following strategy to manage transition. Initially, the targeted goal
is decide upon. Next, the necessary transition skills are taught using prompts.
The expected behaviors are then modeled using visual schedules which are utilized
to teach each step chronologically. Then the prompts are gradually faded as the
student acquires the required skills. If the skills are not learnt by this
time, video models are now used. If the skills are still not grasped, the skill
is then broken down into component steps with each step being taught in a
chronological order using forward chaining and if necessary, backward chaining.
Each successful step is reinforced in order to motivate the student to follow
directions. Throughout the transition, data about the progress of the student
is documented in standard records. Finally, the acquired skills are generalized
appropriately (Wynn & Groen, 2010).
References.
Laving, T. (2010).
ABA and ASD in contemporary practice. American
Psychological
Association, 78(9), 757-81.
Mendelsohn,G.
(2010). A brief overview of ABA in the
field of psychology. Psychology review,
45(3), 457-89.
Pearson,J. (2011).
Autism Spectrum Disorders in contemporary medical practice, British
Medical Journal, 133(8), 566-91.
Wynn,A &
Groen,W. (2010). Application of ABA in treating ASD, Canadian Journal of
Psychology, 34(5), 803-23.
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