Applied Behavioral Therapy is a well-evidenced psychological technique that can be used in treating many different issues through the use of specific psychological interventions. It is useful in treating clients with poor social skills, PTSD, substance abuse, obsessive-compulsive disorders, dietary issues and more. ABA is utilized with children as young as 18 months and with adults. It is, however, especially beneficial in treating people in the autism spectrum, and evidence seems to show that it is most effective when it starts in intense therapy before a child is four years old. Because of its success in treating autistic individuals, that is generally the arena where most people think of the therapy.
Define Applied Behavioral Analysis
This technique is also known as “behavioral engineering” and “ behavioral modification and learning therapy.” The American Psychological Association recognizes the efficacy of the technique and points out that it is taught in psychology degree programs as a fundamental tool. It is an effort by clinicians to “improve socially acceptable behavior” in people “who think and learn differently.” The three components of this therapy are assessment to decide which behaviors need to change, goal-setting concerning how much change is expected, and looking at ways to measure success. ABA uses positive reinforcements to teach those behavioral skills. That is an important distinction to make because ABA fell into some disfavor recently when a discussion was opened by a group of adults on the autism spectrum, some of whom had been diagnosed early in their childhoods.
Why it is Controversial
The portion of ABA that is controversial concerns people is its use in autism treatment. In the past, ABA therapy often involved up to 40 hours of intensive therapy per week and clients spent much of that time sitting at a table completing tasks. That was a difficult scenario for clients with autism, especially young children. Additionally, some people question the need for viewing behaviors of autistic children and adults as “socially inappropriate” or maladaptive. They believe that people with autism, just as people with Tourette’s Syndrome, should be seen as “naturally different” instead of people with conditions that need to be “fixed.”
The problem with this approach is that clients with autism can be disruptive in social situations such as classrooms, and that it is difficult for some people. Additionally, ABA offers so much to people who struggle in social situations. It has been shown to increase language skills and communication, enhance focus and memory and decrease behavior problems. These are vital issues for adults who want to get and retain jobs.
An applied behavior analysis (ABA) counseling session can take many different forms depending on the needs of the individual. These sessions are often used to help children and adults with an autism spectrum disorder or similar condition develop essential life and social skills through behavior modification. This type of therapy has proven to be an effective and safe way to address some of the most significant symptoms associated with developmental and learning disorders. Sessions follow a scientific approach that emphasizes repetition and achieving measurable results.
Generally, the therapist introduces a skill and reinforces success with positive rewards. Then he or she introduces a complementary skill that utilizes the behavior and so reinforces it again. An example given by one website was of a child who was learning the sound of the letter “B.” Once the child made the sound of the letter, the therapist reinforced the learning by telling him that “ball” begins with “B.” Then, the client used the skill by touching or pointing to the ball when asked, and by playing with it. Sometimes, there is a circle time when clients and their therapists interact. This simulates a classroom environment. These steps are found in most forms of ABA.
Client-Centered Therapy Model
While there are some typical elements that are commonly seen in ABA counseling, there is no set standard for session structure. Since autism and related disorders take many different forms, this kind of therapy is usually designed around the unique combination of needs of each individual participant. The purpose of the counseling is to address specific behaviors that hinder the person’s ability to communicate with others, form normal relationships or succeed in an academic setting. Sessions are structured to prioritize socially significant behaviors, including basic life skills like reading, cooking and personal hygiene.
Additionally, as much as possible, clients should be allowed to make the choices that affect their lives. If it is appropriate, they should be given the option of which behaviors they want to change. The website Dietitian Connection discusses the ways dietitians use ABA in dealing with dietary issues. One dietician noted that almost none of her clients made the changes she researched and recommended. Using the theory that if people are given the right environments for learning, learning will take place, the dietitians used the clients own perception of what needed to change to design a nurturing environment where success could be reinforced. Of course, small children cannot always do this, but when it is appropriate it has been shown to be highly effective.
The Parental Role in ABA Counseling of Autism Spectrum
Because the foundation of ABA treatment is being consistent, parents play a huge role. They are not expected to implement therapy at home; that is the job of the certified ABA counselor. Instead, the parent’s role is in reinforcing the skills and behaviors that the therapist is introducing to their children. The more a skill is reinforced, the more likely it is to be learned. Parents can take the skills from the therapy room and apply them to other situations. For instance, they can help children learn to care for themselves and do chores at home. They can also address things like manners at the table and playing games with the family. Even eating out can be an opportunity for reinforcing the skills the therapist is working on.
Parents need support as well. The job of helping their children learn can feel overwhelming. When parents abandon their roles, negative behavior can be reinforced, if only by not addressing it. That makes the participation of parents in ABA counseling with their children immensely important.
Discrete Trials and Positive Reinforcement
Discrete trial training (DTT) describes one of the basic techniques used in ABA sessions to produce a desired behavior. Typically, children are rewarded for performing a certain action or behavior in response to a set queue. Discrete trials focus on positive reinforcement and do not punish the individual for failing to exhibit the desired behavior. This method helps the child establish some control and awareness of their actions, and it’s particular useful as a short-term management technique for unacceptable social behavior.
Building Broad Skills
Discrete trials are one of the many building blocks that counselors use to help children develop larger, complex skill-sets that they need to function in life. Many people with an autism spectrum disorder can lead independent and full adult lives, which is why ABA counseling often broadens over time to encourage overall growth. Counselors create scenarios to simulate real life problems or situations so they can guide their client towards positive interaction with their environment. Props and other tools may be used to provide a sense of realism and substance to the experience.
Some other types of APA therapy, according to the New England Applied Behavioral Analysis website are:
The Medical Model
This is the opposite of the client-centered model. It involves the action of the clinician’s perceptions of the problematic behaviors that need to be addressed, assessment of the client’s resources and a diagnosis followed by a treatment or intervention. The treatment usually is in the form of an educational plan. The problem with this model is that clients who have no input can feel powerless and tend not to “buy in” to the program.
Pivotal Response Model
This model addresses several behaviors ( or cues) at the same time instead of dealing with the individually. It is used to reframe low motivation, self-control and other behaviors that occur in a variety of circumstances and allows “collateral” improvement in wide-ranging areas of social interaction.
This method of applying ABA is used for children from 18 months of age to about four. It involves the concepts of “shaping behaviors,” “prompts and fading prompts” and “chaining.” The last concept breaks behaviors into chains where one behavior or skill is linked to another.
This ABA method sets up an economic system based upon tokens like stickers or vouchers. Success in acceptable behavior is rewarded by giving patients or clients whatever token is chosen as the unit of reward. Another version of this, the Voucher-Based Reinforcement Therapy, uses things like vouchers for money and tokens. According to the website applied behavioralanalysisedu.org, the tokens can be used to “purchase” real-world rewards. In treatment of cocaine and heroine addiction, thirty individual studies showed a success rate of 95 percent. The success faded, however, when the program ended, showing that the ABA therapy needed to be combined with other therapies.
Clients who are exhibiting socially unacceptable behavior are asked to “step back.” The clinician tells the client how he or she could have responded to the situation and they are asked to spend some time observing other people with acceptable responses to the same cues. Clinicians don’t always look at the things that brought on the behavior, but at what was happening in the environment at the time to teach clients how to anticipate making adjustments.
Planning, Review and Measurement
ABA counseling relies heavily on the scientific method, which means results must be quantified and compared to previous data to measure success. There are many aspects of human behavior that are difficult to reduce to numbers, but this approach can also distill a complex process to a series of manageable steps. Parents and caregivers are expected to participate in the planning and review process surrounding each session. The counselor also takes careful note of the results of each session so they can track the success of their client and adjust their therapy as needed.
Becoming an ABA Counselor
Anyone can call himself or herself a counselor. There are even some counselor jobs that require only a high school diploma. To work in hospitals, clinics, rehabs and in private practice as an ABA counselor, however, requires becoming licensed. While those requisites vary by state, holding a master’s degree is essential. You can get a bachelor’s degree in another discipline, but you must have a master’s degree in behavioral analysis or a related field. Besides the degree, applicants for licensure must either perform an internship or work as an entry-level psychologist for a set number of supervised hours. People earning an applied behavioral analysis degree can specialize in many different areas. A few of these are: ADD and ADHD, Alzheimer’s and dementia, autism spectrum disorders, behavioral addictions such as gambling and pornography, pain management and eating disorders. Again, however, most ABA counselors work with children and adults who are on the autism spectrum.
Clinicians should also be certified. There are three types of degreed certification. The first ( BCaBT ) is for people with undergraduate degrees and enables the person to work as an assistant therapist. The second is a Board-Certified Behavioral Analyst. Other certifications include the Certified Autism Specialist. This certification requires the applicant to have a graduate degree plus two ears of experience in the field and passing an autism competency exam. There is also a Registered Behavioral Technician certification that requires only a high school diploma and 40 hours of training. These individuals work under the Board-Certified Behavioral Therapist or the Board-Certified Assistant Behavioral Analyst.
While the Bureau of Labor Statistics does not differentiate between counselors, it does give an annual median salary. That is $42,930. Of course, salary depends upon geographic location and upon employer. The highest wages tended to be in metropolitan areas.
Behavioral counseling for children with learning and social impairments is a long-term process that requires commitment from the entire family. While these disorders present many challenges at home and school, they can also be managed with support and concerted effort on the part of the parents. ABA sessions vary greatly depending on the individual, but all of them require consistent involvement and input to achieve best results.
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