Applied
Behaviour Analysis (ABA) is a treatment approach that is synonymous to the
field of autism. There are many reasons for this including wide research
support for the efficacy of ABA in supporting individuals with autism learn
skills and overcome challenges. To date, ABA is funded in more than 40 states
in the United States through state funding and insurance funding.

It is important however, to recognise that this treatment approach is not an autism
specific treatment approach. The use of ABA is varies from parenting tips for
typically developing children to gerontology.

Whilst
there is a lot of for the use of ABA as a treatment approach for individuals
with autism, there are also some concerns as well as criticisms against ABA as
a treatment approach.

Here, we
will go through the 6 common criticisms of ABA. We will also undertake a
discussion on how we have overcome these. This article is intended to create a better
understanding of ABA and its efficacy as a treatment approach. It is not
intended to deny other treatment approaches, although we maintain that a
treatment approach must meet ethical standards of clinical best practice before
implemented with individuals with autism.

1. Aversive Strategies

When Dr. Ivar Lovaas initially commenced his research study on using ABA
to support individuals with autism, the use of aversive strategies was trialled
and practiced as part of the programme. This has to date been a point of
contention for many including ourselves as practicing ABA professionals.

We feel it is important to note that the practice of aversive strategies
is an outmoded aspect of ABA. The reflection of such ABA practices is further
compounded by references to traditional ABA. For this reason, we caution
you-tubing ABA videos as these may not be the accurate representation of the
treatment approach.

We stress that ABA is a science and like many sciences in the world, it
has evolved over time according to current research findings. We now note that
the use of aversive strategies is no longer effective in teaching desired
behaviours. It is interesting to note as well that in the original Lovaas
research, a commitment to reduce the use of aversive was made reflecting an
early understanding that it is not effective as a teaching method.

To add to the above, current regulatory frameworks that controls and/or
prohibits the use of aversive strategies. These include both legal regulatory
frameworks as well as code of ethics by professional credentialing bodies.

Despite the field of autism being a young field in Malaysia, we at EAP
believe in ethical and responsible practice. It is our policy that we do not
practice aversive strategies as part of our programme. It is additionally our
policy as well that we do not condone aversive practices. As such, where we do
observe these practices we will take the necessary measures to advice and equip
on effective strategies. In extreme circumstance of continued use of aversive
strategies, the decision to terminate services will be considered.

2. Robotic, Rigid and Poor Generalization

Another common criticism of ABA is that it results in robotic and rigid
ways of behaving. One of the founding basis of this criticism is the
association that many parties have made between the practice of ABA and operant
conditioning of training animals (i.e. Pavlov experiment). We note as well that
the use of the commonly misinterpreted table top teaching principle; Discrete
Trial Teaching (DTT) can further compound this belief that ABA results in
robotic and rigid learning and behaving.

The above however is a poor representation of the practice of ABA.
Whilst operant conditioning is a component of the practice of ABA it is not the
entirety of it. Whist the DTT is a component of the practice of ABA, again it
is not the entirety of it. It is important as well to note that the application
of both the principles of operant conditioning and DTT as well would differ
depending on the individual child. In other words, these are principles that
are then individualized in its implementation depending on the child.

A comprehensive ABA programme will reflect incorporation of natural learning
opportunities away from the table and structured learning environments. A
comprehensive ABA programme will also include a generalization mastery. BACB
guidelines note that a comprehensive ABA programme should include steps for
generalization (fluid practice of skills). Confusion however may stem if one
were to observe poor quality ABA sessions. Confusion may also stem if one were
to observe sessions where the individual has not completed the necessary steps
for a particular skill to be considered mastered.

Other aspects of the practice of ABA to overcome robotic, rigid learning
and poor generalization is family participation. This is something that is
highly encouraged so that families learn the same strategies and apply these in
other environments as well to support generalization of skills.

Here at EAP, we pride ourselves in providing high quality individualized
ABA programmes. To ensure that we do not shape robotic, rigid learning and
hinder the generalization process, generalization mastery is part of our
curriculum. We note as well that generalization mastery is part of each
programme that is introduced for our children.

3. Intensive Hours

You would come across criticism that ABA treatment can be very
intensive. It requires high commitment of hours.

We stress that this is not a criteria of the ABA practice but rather
reflective of research findings on supporting individuals with learning/
special needs. The need of intensive hours is beneficial for all individuals
with learning/ special needs irrespective of diagnosis as well as irrespective
of treatment approach.

Here at EAP, we pride ourselves in ensuring our clinical practice is up
to date with current research findings. Our recommendation for intensive hours
is in keeping with clinical recommendations put forth by many institutions
including National Institute of Mental Health, CDC as well as supported by
various policies across countries/ governments. The rational for intensive
hours is to provide the child with the best opportunity to catch up on skills
to the best of their individual ability.

4. Reliance on External Rewards

There is criticism on the use of external rewards in the practice of
ABA. The question of will the child still engage in desired behaviour in
absence external rewards is frequently posed. There is also the contention that
we are bribing or forcing the child to learn.

We maintain that rewards play a pivotal role in shaping desired
behaviours. We maintain as well that research shows that we learn behaviours/skills through the gradual shaping of successful practices. Take this example:

Studying for Exams

1st Practice: Child is prompted to study and scores well.
Child gets an ice cream treat. Child gets praise by Daddy.

2nd Practice: Child forgets to study and does not score well.
Child does not get a reward. Child is prompted to study for next exam by Daddy.

3rd Practice: Child studies because is prompted. Child scores
well. Child gets a new toy. Child gets praise by Daddy.

4th Practice: Child has learnt from earlier experiences,
studying helps in scoring well and getting positive outcomes. Child makes
decision to study on his own. Child gets praised by Daddy and is rewarded.

We note in the example above that we have used rewards accurately to
shape the desired behaviour. The next step in a comprehensive ABA practice is
to taper these rewards so that the it is less frequent. The challenge to
obtaining rewards is also increased. Good quality ABA programme will also
include systematic process to transfer reliance on external rewards to internal
social rewards (e.g. social practice).

The use of rewards thus is important and necessary in shaping the
desired behaviour. It is stressed that emerging skills needs to be practiced to
fluency until it self maintains because these lead to success in the child’s
environment. We recap that a comprehensive ABA programme will include the
following steps to reduce reliance on external rewards throughout.

• Systematic tapering of reward
  schedule
• Pairing of external rewards with
  social praise
• Reward schedule contingent on
  increased effort

5. Sessions are conducted on a 1:1 basis, which hinders socialization              

Another criticism of ABA is that it is conducted on a 1:1 basis which
hinders the individual’s socialization. A common question that would be asked
is why do we not do group learning?

We note that individuals on the autism spectrum have delays in certain
skill sets. We also know that individuals with autism may not learn at a rate
that is at par with typically developing individuals. As such, where a
typically developing child may be able to observe and pick up from their
environment, a child on the autism spectrum may not be able to do so. Teaching
in a 1:1 setting thus provides for a successful learning environment. This
however is not the end goal and a comprehensive ABA programme will include a
systematic transition plan to transition from 1:1 setting to small groups then
bigger groups.

The concern of 1:1 sessions hindering socialization is also not
reflective of a comprehensive ABA programme. We note that 1:1 sessions here
refer to 1:1 support which can take place in a variety of settings including
learning time at the tables and during peer play sessions. As such, we can
continue to target socialization however with provision of 1:1 support. We
argue as well that this level of support is necessary for an individual with
autism who may be less inclined to interact with others. Having 1:1 support
provided ensures that these individuals are not left on the fringes in a group
but is prompted and guided to interact with others. This makes for a successful
experience for the individual with autism.

6. Too Expensive

One last common criticism of ABA is that it can
be costly. Due to this, there may be some families who may opt for treatment
that is less frequent and thus more cost effective.

One reason for the high cost of an ABA
programme is that it is conducted typically on a one-to-one basis. It is noted
through research that this allows for more intensive and focused teaching
providing the child with the best opportunity to catch up on their skills.

In many countries like the United States and
United Kingdom, it is noted that where children with autism had the opportunity
to receive ABA treatment from an early age, this significantly reduced the cost
of services they require across their lifetime.

The question that we put forth is this. Should
we:

Spend more on a treatment proven to
be effective but for a short timeframe?

OR

Spend less on non-intensive
treatment and/or multiple treatment but for a longer timeframe?

We must also take into
consideration that the longer we wait, the bigger the skill gap becomes. Time is always of essence for children
with autism. Time in addition to finances is a resource that must be used wisely when
supporting individuals with autism. It is because ABA has been proven to be effective that many
governments and insurance companies in the United States and United Kingdom
provide coverage for it. It is because the benefits of ABA supersedes the cost
of not providing effective treatment to individuals with autism.

References List

1. Applied Behavioural Analysis (ABA). (2016). Retrieved from https://www.autismspeaks.org/what-autism/treatment/applied-behavior-analysis-aba
2. Applied Behavioural Analysis Treatment of Autism Spectrum Disorder: Practice Guidelines for Healthcare Funders and Managers. (2014). Behaviour Analyst Certification Board. Retrieved from http://www.apbahome.net/pdf/BACB_ASD_Gdlns.pdf
3. Hastings, R. (2012). Autism Evidence 3. What is ABA for children with autism? Retrieved from http://profhastings.blogspot.my/2012/12/autism-evidence-3-what-is-aba-for.html
4. Lovaas Approach. (2016). Retrieved from http://www.lovaas.com/about.php
5. Yeaton, M. (1982). A critique of the effectiveness of Applied Behavioural Analysis Research. Advanced Behaviour Therapy, (4), 75-96. BACB ABA Practice Guidelines for Healthcare Funders and Manager