Topic #3 ABA 553 - Assessing Autism Interventions

1. Applied Behavior Analysis & it's Effectiveness for Children with Autism Topic #3 ABA 553 - Assessing Autism Interventions

2. How Can We Use Science to Study What & How a Child Learns? • We have a scientific branch of psychology that has been developing for SEVENTY years • It’s called…. • Applied Behavior Analysis (ABA)

3. What is Applied Behavior Analysis? (Cooper, Heron, & Heward, 1987) 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 • Why?

4. Characteristics of ABA(Baer, Wolf, & Risley, 1968, 1987) • Applied • behavior is selected because it is important to society • Specifically, how immediately important is this behavior or these stimuli to these subjects. • How does the therapist can describe & solve the subject’s problem? • E.g., society has technological illiteracy; how well can the media explain the problem to effectively generate a government solution?

5. 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 he sit still, because he has ADHD. • E.g., Why can’t a child 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.

6. Characteristics of ABA(Baer, Wolf, & Risley, 1968, 1987) • Analytic & Conceptual • functional relationship between the manipulated events and the behavior of interest • Research design • relevance of techniques to principles from which they were derived. This relates to a principle referred to as parsimony. • 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

7. Characteristics of ABA(Baer, Wolf, & Risley, 1968, 1987) Technological • procedures are identified, defined and task analyzed • Individualized programs • dissemination

8. Characteristics of ABA(Baer, Wolf, & Risley, 1968, 1987) • Effective • altering behavior in a socially important manner • How much of that behavior needed to be changed and has that goal been accomplished? • Social validity –the extent to which all consumers of an intervention lit it.

9. 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 

10. Scientifically Validated Intervention for Children with Autism • Applied behavior analysis (ABA) was specifically designed and researched for children with autism • empirically demonstrated to be most effective intervention for children with autism • Research findings have been replicated many times over span of many years • (Lovass, 1960; Fenske, Zalenski, Krantz, & McClannahan, 1985; Smith, 1996; Anderson, Avery, DiPietro, Edwards, & Christian, 1987; Lovaas, 1987; Harris, Handleman, Gordon, Kristoff, & Fuentes, 1991; Birnbrauer & Leach, 1993; McEachin, Smith, & Lovaas, 1993; Perry, Cohen & DeCarlo, 1995; Sheinkopf & Siegel, 1998; Green, 1996, 1999; New York State Department of Health, 1999)

11. Scientifically Validated Intervention for Children with Autism • ABA treats the entire child • Every aspect/dimension of the disorder • Over 500 studies published in peer-reviewed research journals about teaching many specific skills to children with autism using principles of ABA • General skill domains include: gross motor, fine motor, speech and language, reading, math, leisure, social, self-help and independence • Additional teaching procedures continue to be developed and refined

12. Applied Behavior Analysis(a/k/a Behavior Management; Intensive Behavioral Intervention) • “Intensive, behavioral intervention early in life can increase the ability of the child with autism to acquire language and ability to learn.” • “Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior.” • U.S. Surgeon General, David Satcher, M.D., Ph.D.

13. Applied Behavior Analysis • “All programs educating children with autism should include intensive behavioral interventions and year-round education”. • US Dept. of Education and the National Research Council's Report 'Educating Children with Autism‘ • “Since intensive behavioral programs appear to be effective in young children with autism, it is recommended that principles of applied behavior analysis be included as an important element of any intervention program”. • NYS Department of Health Early Intervention: Clinical Practice Guidelines:

14. Common Misconceptions of Applied Behavior Analysis (ABA) “Applied Behavior Analysis and discrete trial instruction are synonymous terms and can be used interchangeably.” • Applied behavior analysis actually uses dozens of teaching procedures; discrete-trial teaching is only one of these.

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

16. Some Teaching Techniques Used in Applied Behavior Analysis • Schedule Following • Independent/Model building/Art script • Audio/Video Modeling • Script/Script Fading Procedures • Small Group Instruction • Imitation • Incidental Teaching • Discrete Trial Instruction • Fluency Training • Task analysis and chaining

17. More Misconceptions of ABA “You just need to attend a few workshops to ‘do’ applied behavior analysis.” • Actually need someone who has been specifically trained in the techniques of applied behavior analysis implemented specifically with children with autism. • Training consists of on-going, hands-on training and supervision ideally by a nationally Board Certified Behavior Analyst (BCBA), preferably at the doctoral level • To become a Board Certified Behavior Analyst, one needs post-graduate coursework specifically in ABA, supervised or mentored experience by another BCBA, and pass a national exam in behavior analysis (www.bacb.com). These are merely minimal requirements that still do not guaranteed expert clinical skills.

18. More Misconceptions of ABA “Behavior analysts spend too much time with their cumbersome data and not with the student.” • Data analysis allows the effectiveness of a specific teaching strategy to be evaluated. If a child is not learning, we can modify a teaching strategy until the child does learn. • Data do not need to be collected for every trial • Time sampling • Interval recording • Duration recording • Pre-test/post-test measures

19. More Misconceptions of ABA “Applied Behavior Analysis is too structured for how the world actually works; we don’t always get rewards for what we do.” • Behavior analysts teach a child a variety of functional/useful skills that often lead to engagement in productive activity, meaningful social exchanges, and additional learning opportunities (not necessarily M&Ms!) This may allow a child with autism to have a variety of choices that they previously didn’t have. • The principles of applied behavior analysis are at work everyday in various situations, just like gravity!

20. Applied Behavior Analysis and “Real Life” Functional Relationships: 3-Term Contingency Antecedent Behavior Consequence Wife’s birthday Husband makes dinner Wife says “MMM” Baby’s hungry I feed baby peas Baby gets sick Too many bills work more hours can pay bills

21. More Misconceptions of ABA “Applied Behavior Analysis is just rote teaching and is not functional.” • We teach on a very concrete level initially and then teach the generalization of behaviors to more natural environments • This is accomplished by teaching a variety of skills using various different teaching procedures, across multiple settings under multiple conditions. • Ultimately, these new skills allow children with autism to reciprocate, maintain, and enjoy social exchanges with peers/adults when initially they may have not.

22. More Misconceptions of ABA “Behavior analysts say we should use individual treatment, but if all children get ABA, how individualized is that?” • Principles of treatment are same in that most children with autism initially need their skills task analyzed through discrete trial teaching for maximum learning to occur. • ABA, however, has many levels (as does autism) and levels are individualized accordingly for each child. • Each child has his or her own individualized program that uses principles of applied behavior analysis. • A child’s program is not scripted and will be constantly monitored and adjusted based on the data collected to assess effectiveness.

23. More Misconceptions of ABA “Applied behavior analysis is only necessary for children with autism or those who are ‘severely disabled’.” • When a child is initially diagnosed with autism, it is very challenging to predict how the disorder will manifest as the child ages. • In Lovaas’s research, 47% of the children were mainstreamed into a regular education setting and were indistinguishable from their peers. • Over the past three decades, applied behavior analysis has been shown to be successful in many, many situations (see next slides!)

24. Socially Important Problems(Martin & Pear, 1999) • 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

25. Socially Important Problems(Martin & Pear, 1999) • 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

26. Socially Important Problems(Martin & Pear, 1999) • 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.

27. Socially Important Problems(Martin & Pear, 1999) • 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 • Severe Problems • Developmental disabilities, autism, and schizophrenia

28. More Misconceptions of ABA “Verbal behavior is better than applied behavior analysis.” • B. F. Skinner is responsible for both verbal behavior and behavior analysis. • Verbal behavior is a theoretical approach within ABA • Behavior analysts have been effectively teaching language for 30 years and have developed a variety of behavioral techniques that have been shown to be effective for increasing and improving language and communication in children with autism (e.g., activity schedules, incidental teaching, audio modeling, video modeling, PECS) • All behavior analytic language teaching procedures are influenced by Skinner’s theories on verbal behavior as well as traditional developmental and biological theories

29. More Misconceptions of ABA “Children with autism will not like their behavior analysis sessions. They’re too long!” • A behavior analyst diligently establishes a positive relationship with a child they are teaching and creates a very positive learning environment for that child. • Maximum learning is the behavior analysts goal and maximum learning occurs in a positive learning environment. • A skilled behavior analyst will make it difficult for a child to tell when learning is occurring and when they are just playing.

30. More Misconceptions of ABA “If a child with autism gets intensive early intervention utilizing the techniques of applied behavior analysis, they will ‘recover’.” • Autism is a neurological disorder and no one can predict the extent of the neurological damage in a child diagnosed with autism. • The research indicates that 47%-67% of children with autism with intensive applied behavior analytic intervention will learn a sufficient number of skills to be indistinguishable from their peers. (Fenske, Zalenski, Krantz, & McClannahan, 1985; Lovaas, 1987 McEachin, Smith, & Lovaas, 1993) • It takes several years for a child to make sufficient progress where they will be indistinguishable from their peers

31. More Misconceptions of ABA “Behavior analysts ‘drill’ kids with hundreds of trials.” • A behavior analyst will select a learning goal for each session for a specific child and will teach a particular skill until that goal is obtained. There is no set number of trials. • Teaching is contingent on the child’s learning. • Challenging skills are interspersed with more easily learned skills so the child has an opportunity for lots of reinforcement.

32. More Misconceptions of ABA “Applied behavior analysts teach children to sound ‘robotic’.” • A behavior analyst will always model natural sounding language, maximizing the extent to which the child’s language skills will generalize to other situations. • A behavior analyst may speak to a child with few language skills in a manner that is concise, clear, and direct to increase the likelihood of the child’s comprehension. The inflection and volume of the behavior analyst’s voice, however, will still be natural. • If a child’s inflection does not sound natural, the behavior analyst will develop an individualized program for that specific child to teach prosody.

33. Common Misconceptions of Applied Behavior Analysis (ABA) “Applied behavior analysis is too much structure; the individual needs to play and ‘get the stims out’.” • Behavior analysts teach a child to play appropriately and break down play to concrete components when necessary. • There is no research demonstrating that allowing a child to engage in stereotypic behavior will subsequently decrease the stereotypic behavior. • The more a child engages in stereotypic behavior, the less likely he or she will engage in appropriate behavior. Also, a child is not available for learning when they are engaging in stereotypic behavior.

34. Common Misconceptions of Applied Behavior Analysis (ABA) “Applied Behavior Analysis is only effective if you want to decrease a behavior.” • Behavior analysts will implement methods to decrease disruptive behavior and implement teaching strategies for teaching skills in all domains: academic, independent, self help, social, fine motor, gross motor, expressive language, receptive language, play, etc.

35. Common Misconceptions ABA “Applied behavior analysts work too much in isolation and alienate more traditional approaches such as those used by occupational and speech therapists. • It is essential for behavior analysts to collaborate with all professionals. Behavior analysts continually learn from various professionals. Consulting a speech and language pathologist, for example, can be extremely helpful in targeting new skills to teach a child. These skills can then be taught using the principles of applied behavior analysis.

36. Common Misconceptions of Applied Behavior Analysis (ABA) “Applied behavior analysts need to work alone and do not work with other professionals.” • Various professionals can work with one child as long as every person on that child’s intervention team is held accountable for the child’s progress. For example, the speech therapist must collect data as behavior analysts do to ensure that what they are doing is effective. • Furthermore, there must be one person coordinating a child’s treatment to ensure that all treatments are working together and not contradicting each other (which can be harmful to a child’s skill acquisition).

37. Common Misconceptions of Applied Behavior Analysis (ABA) “Behavior analysts always use food to reinforce behavior.” • Behavior analysts use whatever the child prefers. • Primary reinforcers are often used to teach new or difficult skills but these are always paired with a conditioned reinforcer such as verbal praise. • The goal is to fade from primary reinforcers, to conditioned reinforcers, to natural reinforcers. 

38. Why Is ABA Effective For Children with Autism? • Techniques specifically designed and researched for children with autism • (Lovass, 1960; 1987; Fenske, Zalenski, Krantz, & McClannahan, 1985; Harris, Handleman, Gordon, Kristoff, & Fuentes, 1991; Lovaas, 1987; McEachin, Smith, & Lovaas, 1993) • Represents a teaching method with tremendous versatility • Breaks complex material into smaller, more teachable units

39. Why Is ABA Effective ForChildren with Autism? • Provides numerous structured opportunities for a child to learn a new skill before advancing to the next skill • Highlights relevant stimuli • Highlights relevant stimuli while simultaneously minimizing extraneous stimuli • Utilizes reinforcement • Contingent reinforcement • Differential reinforcement

40. Why Is ABA Effective For Children with Autism? • Utilizes systematic prompting and prompt fading • Promotes consistency across teachers • Provides data based decision making

41. Research-Based Effectiveness of ABALovaas (1987) • Purpose: • Behavioral-intervention project that sought to maximize behavioral treatment gains by treating children with autism most of their waking hours for multiple years

42. Research-Based Effectiveness of ABA: Lovaas (1987) Method: • Subjects: • diagnosis of autism, less than 40 months if mute and less than 46 months if echolalic • 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 • Subjects were assigned to groups using functional random procedures due to ethical constraints

43. 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, sex, neurological finding

44. Research-Based Effectiveness of ABA: Lovaas (1987) • Experimental group • IQ • 2 had normal IQ, 7 mod retarded range, 10 severely retarded range • Play • No subject had pretend play, 2 had complex play, rest had simple play • Speech • 1 subject had minimal speech, 7 echolalic, 11 mute.

45. 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

46. Research-Based Effectiveness of ABA: Lovaas (1987) • Treatment Control Group: • 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

47. 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

48. Research-Based Effectiveness of ABA: Lovaas (1987) Results • Pre-Treatment Comparison • No significant differences between groups except for chronological age at onset (42 mo vs 46 mo) • Statistical analyses were used to see if CA was related to outcome –it was not. • Related to outcome was: prorated mental age and abnormal speech • Prorated mental age: 18.8 mo in experimental group and 17.1 mo in control group

49. Research-Based Effectiveness of ABA: Lovaas (1987) • Results data • 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 subject passed 1st grade and had an IQ of 99 (2%) • 18 were in aphasia classes average IQ was 70 (45%) • 21 subjects were autism class mean I!Q 40 (53%)

50. 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