Definition of ABA

1. Definition of ABA PS 553: Assessing Autism Interventions

2. Why Does Autism Need Specialized Treatment? • Pervasive Developmental Disorder (PDD) implies that a child with autism is affected along multiple dimensions • (Unlike certain other single dimension problems: learning disability, communication disorder, emotional and behavioral disorders)

3. Why Does Autism Need Specialized Treatment? • Learning deficits • Affects every aspect of child’s education and academics • Language disabilities • Articulation, expressive, receptive, spontaneous, conversation, non-contextual vocalizations • Behavioral disorders • Stereotypic behavior: motor, visual, tactile, • Compulsive behaviors • rigidity of routine, intolerant of change

4. Why Does Autism Need Specialized Treatment? • Attention deficits • Lack of eye contact, unaware of danger • Emotional impairments • Non-contextual emotions, lack of self-concept • Social impairments • Eye contact, gestures, facial expression, greetings, awareness of other children, friendships, • Play skills deficits • Imaginative, pre-occupations with objects/activities, general content knowledge

5. Why Does Autism Need Specialized Treatment? • Sleep disturbances • Going to sleep late, getting up early, getting up during the night • Toileting impairments • Lack of awareness of accidents • Eating disabilities • Texture, appearance, gustatory

6. Introduction to Applied Behavior Analysis

7. B. F. Skinner (1904-1990) • Championed psychology as a science of behavior • One of the most influential and controversial psychologists of the twentieth century • Emphasized the study of behavior and the environmental events preceding and following instances of behavior • Characterized behavior is a function of an individual’s: • Physiology/genetics • Prior experience (learning history) • Current environmental contingencies

8. The Truth About Skinner(Gaynor, 2004) • Myth: humans are a virtual blank slate upon which the environment writes, unfettered by genetics or biology • Actually… • Skinner confused with Watson! • Skinner actually commented on Watson’s “extreme environmentalism, and…coldly detached theory of child care” (Skinner, 1972, p. 558) • Skinner (1957): “A small but important part of the universe is enclosed within the skin of each individual and, so far as we know, is uniquely accessible to him. It does not follow that this private world is made of any different stuff – that it is in any way unlike the world outside the skin or inside another’s skin” (p. 130).

9. The Truth About Skinner(Gaynor, 2004) • Myth: Skinner raised his daughter in a “Skinner box” and she committed suicide • http://www.youtube.com/watch?v=cl7jr9EVcjI&feature=related • Actually: She is in the field and runs his foundation • http://www.juliesvargas.com/ • http://www.youtube.com/watch?v=yhvaSEJtOV8 • http://www.youtube.com/watch?v=X6zS7v9nSpo

10. What is Applied Behavior Analysis? (Cooper, Heron, & Heward, 2007) • Technical definition: the science in which • procedures derived from the principles of learning • are systematically applied to improve socially significant behavior • and to demonstrate experimentally that the procedures used were responsible for the improvement in behavior • What you might say to your Aunt Sally: • a scientific approach to understanding why people do what they do and helping them make meaningful changes in their behavior

11. What is ABA? • Formally began in 1959 with Ayllon and Michael’s paper: The Psychiatric Nurse as a Behavioral Engineer - http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1403907&blobtype=pdf • 1968 – Journal of Applied Behavior Analysis(JABA) • In 1st issue, Baer, Wolf and Risley’s paper: Some Current Dimensions of Applied Behavior Analysis

12. What is Applied Behavior Analysis? (Cooper, Heron, & Heward, 1987; 2007) Applied behavior analysis is the science in which • procedures derived from the principles of learning • are systematically applied to improve socially significant behavior • and to demonstrate experimentally that the procedures used were responsible for the improvement in behavior

13. Characteristics of ABA(Baer, Wolf, & Risley, 1968; 1987) • Applied • behavior is selected because it is socially significant to society • and it will improve one’s life in the areas of: social, language, academic, daily living, self-care, vocational, and/or recreation and leisure • additionally, answers the question: How immediately important is this behavior or these stimuli to these participants?

14. Characteristics of ABA(Baer, Wolf, & Risley, 1968, 1987) • Behavioral • treats actual, observable behavior rather than verbal reports of behavior, feeling and/or attitudes • E.g., Why can’t children with autism talk? because they are not processing sounds correctly • Inter-observer agreement data to ensure data are accurate reflections of the subject’s behavior and not recording procedure and that the intervention was accurately and consistently implemented

15. Characteristics of ABA(Baer, Wolf, & Risley, 1968, 1987) • Analytic • Functional relationship between the manipulated events and the behavior of interest • Research design • Conceptually Systematic • Effectiveness of techniques described in terms of the learning principles from which they were derived. • Attribute a child’s behavior to the laws of learning theory • Only use techniques that have been documented in the scientific literature to be effective • Seek the condition under which the intervention has maximal and minimal effectiveness

16. Characteristics of ABA(Baer, Wolf, & Risley, 1968, 1987) Technological • procedures are identified, defined and task analyzed • Individualized skill acquisition and behavior reduction programs • Dissemination Effective • altering behavior in a socially important manner • How much of that behavior needed to be changed to reach social significance and has that goal been accomplished? • Social validity – the extent to which all consumers of an intervention’s life has been enhanced • E.g., teaching a child to hold open a door and examining the effect of this behavior on others

17. Characteristics of ABA(Baer, Wolf, & Risley, 1968, 1987) Generality • behavior change is durable over time and under a variety of conditions or spreads to a variety of related behaviors • How have we helped the child if there is no behavior change at home, at the dentist, at the doctor, in the mall, in the cafeteria, on the playground, in the supermarket?

18. Additional Characteristics of ABA(Heward, 2005) • Accountable • Public • Doable • Empowering • Optimistic

19. ABA’s Track Record • Although ABA is perhaps most well known for its application in intervention for persons with autism, over the past 40 years, applied behavior analysis has been shown to be successful in effecting change across a wide variety of - populations (children and adults with mental illness, developmental disabilities and learning disorders) - interventionists (parents, teachers and staff) - settings (schools, homes, institutions, group homes, hospitals and business offices), and - behaviors (language; social, academic, leisure and functional life skills; aggression, self injury, stereotyped behaviors)

20. Socially Important Problems(Martin & Pear, 2007) • Parenting and Child Management • Increase walking skills, language skills, toilet training, household chores, decrease frequent arguing, failure to comply with parents’ requests • Education: From Preschool to University • Oral reading, reading comprehension, spelling, handwriting, mathematics, English composition, creativity, science concepts. • Clinical Behavior Therapy • Anxiety, obsessive compulsive disorders, stress-related problems, depression, obesity, marital problems, sexual dysfunction and personality disorders

21. Socially Important Problems(Martin & Pear, 2007) • Self Management of Personal Problems • Self control, self adjustment, self-modification • Medical & Health Care • Seizure disorders, chronic pain, addictive disorders, and sleep disorders, improving motor skills, decreasing tremors characteristic of Parkinson’s disease, conducting brain injury rehabilitation, exercise, diet, stress management • Gerontology • Compensating for loss of skills, increase ability to function independently

22. Socially Important Problems(Martin & Pear, 2007) • Behavioral Community Psychology • Controlling littering, increasing recycling, promoting energy conservation, encouraging welfare recipients to attend self-help meetings, helping college student live together, crime • Business, Industry, and Government • Performance management, improve productivity, decrease tardiness and absenteeism, increase sales volume, create new business, improve worker safety, reduce theft by employees, reduce shoplifting, improve management-employee relations.

23. Socially Important Problems(Martin & Pear, 2007) • Sports Psychology • Improving skills of athletes, motivating practice and endurance training, changing the behavior of coaches, “ports psyching “ to prepare for competition • Behavioral Assessment • Functional analysis and functional assessment for a variety of mental disorders • Disorders • Developmental disabilities, autism, and schizophrenia

24. Teaching Techniques in Applied Behavior Analysis • Activity Schedules • Audio/Video Modeling • Script/Script Fading Procedures • Small Group Instruction • Self Management • Imitation • Direct Instruction • Incidental Teaching • Computer Assisted Instruction • Peer-Based Instruction • Reinforcement Systems • Discrete Trial Instruction • Shaping • Task analysis and chaining

25. All Teaching Procedures in ABA Have These Features (Lovitt, 1995) • Precise definition and task analysis of the new skill or behavior to be learned • Direct and frequent measurement of the student’s performance of the skill • Frequent opportunities for active student response during instruction • Immediate and systematic feedback for student performance • Procedures for achieving the transfer of stimulus control from instructional cues or prompts to naturally occurring stimuli • Strategies for promoting the generalization and maintenance of newly learned skills to different, non-training situations and environments

26. Reinforcement

27. Small-Group Instruction

28. Turn Taking

29. Turn-Taking Data

30. Musical Chairs

31. Twinkle, Twinkle Little Star

32. Evidence of ABA for Autism TreatmentParts of this ppt have been taken from: Science and Practice in the Treatment of AutismGina Green, PhD, BCBASan Diego, CADecember 2005Applied BehaviorAnalysis in the Treatment of AutismAutism Services and Support ConferenceCamp Pendleton, CAJanuary 18, 2007

33. Early Intensive ABA for ASD • Early: generally, children under age 5 when treatment begins • Intensive: 25-40 hrs/wk, 1-to-1 initially, 1- 4 yrs • Comprehensive: array of ABA techniques -- both adult-directed and child-initiated -- used to build skills in all domains • Usually started in home, but can be done in centers • Intervention provided in multiple environments • 1-to-1 initially; gradually changed to small group instruction • Gradual transition to regular classrooms where possible

34. Research-Based Effectiveness of ABA • Individual teaching methods for specific skills • Video modeling to teach a child with autism to offer assistance • Activity schedules to teach a child with autism to use a napkin • Self-management to teach a child with autism to remain on-task • Many others… • Outcome studies • what happens when these methods are combined into a comprehensive package?

35. Research-Based Effectiveness of ABA: Individual Teaching Methods for Specific Skills • For example, video modeling has been experimentally shown to be effective in teaching: • labeling emotions, independent play, spontaneous greetings, oral communication, conversation cooperative play, social play, brushing teeth, washing face, semantic & pragmatic language skills, following directions, sharing materials, greeting others, reducing tantrum behavior, answering conversations questions, comments during play, social communication, spontaneous requesting, grocery shopping skills, washing hands, time on task, purchasing skills, shaving, making lunch, sort and load laundry, make peanut better and jelly sandwich, hang pants, make bed, cleaning glasses, putting on watch, engaging a zipper, mailing a letter, pet care and setting the table. • For video modeling alone, there are at least 15 studies from 1987 to 2004 across almost 75 individuals published in about 10 different peer-reviewed journals (Ayers & Langone, 2005)

36. Video Modeling and Guitar Hero

37. Research-Based Effectiveness of ABA: Individual Teaching Methods for Specific Skills • Hingtgen & Bryson (1972) reviewed over 400 research articles pertinent to the field of autism • DeMeyer, Hingtgen, & Jackson (1981) reviewed over 1,100 studies from 1970s • Baglio, Benavidiz, Compton, et al. (1996) reviewed 251 studies from 1980 to 1995 • All authors concluded that ABA-based interventions demonstrated the most consistent and beneficial results for persons with autism

38. Research-Based Effectiveness of ABAGroup Outcome Studies • Lovass, 1960; • Fenske, Zalenski, Krantz, & McClannahan, 1985; • Harris, Handleman, Gordon, Kristoff, & Fuentes, 1991; • Lovaas, 1987; • McEachin, Smith, & Lovaas, 1993; • Perry, Cohen, & DeCarlo, 1995; • Sheinkopf & Siegel, 1998

39. Research-Based Effectiveness of ABA: Group Outcomes StudiesLovaas (1987) • Purpose: • Behavioral-intervention project that sought to maximize behavioral treatment gains by treating children with autism most of their waking hours for many years

40. Research-Based Effectiveness of ABA: Lovaas (1987) • Participants • Diagnosis of autism, under 4 years old • Treatment condition • Intensive-Treatment Experimental Group (n=19) • Received minimum of 40 hours of 1:1 treatment per week • Minimal Treatment Control Group (n=19) • Received 10 hours or less of 1:1 treatment/wk • Both groups received treatment for 2 or more years • Participants were assigned to groups using functional random procedures

41. Research-Based Effectiveness of ABA: Lovaas (1987) • Assessment • Standardized tests • Bayley, Stanford-Binet, Vineland • Behavioral observations • Stereotypy, play, recognizable words • Parent interview • Recognizable words, toy play, emotional attachment, apparent deficit, peer play, stereotypy, tantrums,toilet training, abnormal speech, age of walking, number of siblings, socioeconomic status, neurological findings

42. Research-Based Effectiveness of ABA: Lovaas (1987) • Treatment Experimental group: • 40 hrs/wk for 2 years by trained therapists and parents in home school & community • 1st year: reducing stereotypy & aggression, building compliance, imitation, toy play, extended treatment to family • 2nd year: expressive & early abstract language, interactive play with peers, extended treatment to community and preschool • 3rd year: emotions, preacademics, observational learned, extended treatment to preschool

43. Research-Based Effectiveness of ABA: Lovaas (1987) • Control Group 1: • Same as experimental group but less than 10 hours of 1:1 treatment • Also received a variety of other treatment provided by small special ed classes

44. Research-Based Effectiveness of ABA: Lovaas (1987) • Control Group 2: • 21 subjects • 42 mo or younger • IQ above 40 at intake • Assessed as control group 1 but not treated

45. Research-Based Effectiveness of ABA: Lovaas (1987) • Results • Experimental group • 18.8 MA (mental age); 83.3 IQ • 9 passed general ed 1st grade and normal IQ (47%) • 8 passed 1st grade in aphasia classes and IQ was mildly retarded (42%) • 2 placed in classes for autistic children and IQ was profoundly retarded (10%) • Control groups 1 & 2 • 17.1 MA, 52.2 IQ • 1 participant passed 1st grade and had an IQ of 99 (2%) • 18 were in aphasia classes average IQ was 70 (45%) • 21 participants in autism class mean IQ 40 (53%)

46. Research-Based Effectiveness of ABA: Lovaas (1987) • Discussion • “Results were consistent with a very large body of prior research on the application of learning theory to the treatment and education of developmentally disabled persons and with the very extensive 100 year old history of psychology laboratory work on learning processes in man and animals” • Unlikely treatment effects could be replicated without highly trained individuals administering the behavioral treatment

47. Strengths of Lovaas (1987) Control groups and TX group were similar before TX Manual was used to standardize treatments Independent clinicians made the diagnoses Multiple intake and follow-up measures were used Long term follow-up data were collected

48. Criticisms of Lovaas (1987) • Lovaas didn’t compare different therapies • But only institutionalization & special ed existed at the time • Lovaas used quasi (or functional), not pure random assignment • Participants were assigned on the basis of therapist availability • Lovaas used 8 different psychological measures to ensure close matching of groups • Pure random assignment is unethical • According to the New York Early Intervention Report “Use of an intervention method is a type of indirect harm if its use supplants an effective intervention method that the child might have otherwise received” • US National Institute of Mental Health (the granting agency supporting the study) approved functional random assignment • Lovaas’s study only worked because of use of aversives • None of the replication studies have used aversives and the results for the treatment groups were still significant and impressive

49. Research-Based Effectiveness of ABA: McEachin, Smith, & Lovaas (1993) • Purpose: • To see if behavioral treatment can produce long-lasting gains

50. Research-Based Effectiveness of ABA: McEachin, Smith, & Lovaas (1993) • Method • 1. Assessed students at a mean age of 11.5 years to see if they maintained treatment gains • 2. Assessed the best outcome students to see if they could be considered free of autistic symptomology, compared them to children with no clinically significant behavioral disturbance: (blind evaluators) • Assessed for deficits in: • idiosyncratic thought patters, mannerisms, and interest; • lack of close relationships with family and friends; • difficulty in getting along with people; • relative weaknesses in cognitive functioning such as abstract reasoning; • not working up to ability in school; • flatness of affect, • absence or peculiarity in sense of humor