Intensive ABA Services News and advice on Autism treatments - The Lovaas Institute

Meeting Point: Latest From Lovaas

Winter 2009

Meeting Point: Latest From Lovaas

The Case for ABA

by Dr. Eric V. Larsson, Ph.D., L.P., B.C.B.A.
Executive Director, Clinical Services, Lovaas Institute – Midwest

In the 1960's, ABA began with some initial crude attempts to help children who were already institutionalized. Since that time, the science of ABA itself has continued to grow and develop. As ABA matures, the methods and results continue to be more impressive and more satisfying to teachers, therapists, parents, and children alike. Contrary to the early critiques of the pioneering efforts, ABA is now characterized by extremely humane, sophisticated, and pleasing methods. In fact, rather than being an artificial and harsh therapy, ABA has come to focus on natural social activities, during which the essential therapeutic feature is the use of highly engaging positive reinforcement. As a result, over the years ABA has repeatedly helped parents advocate for much more humane and progressive human services overall. Now only a few uninformed critics continue to labor under the old misconceptions.

Those who use the knowledge of ABA to help children are called Behavior Therapists. The mission of our Behavior Therapists is to provide the most effective treatment possible to children who have been diagnosed with autism spectrum disorders. To do so we respond to the goals of parents, who are our consumers, and provide the most accountable therapy possible. We provide the most effective therapy by using every method that is proven through ABA research to be objectively effective. We use the intensive model to be effective, because it is based on an analysis of the child's needs rather than being based upon what services we choose to provide. We incorporate all of the research in ABA, rather than using just one brand of ABA. Therefore we fully address the comprehensive needs of children, from their language, to their social lives, to their self-control.

Each child is an individual, who has their own unique learning styles, strengths, and needs. The child affected by autism has needs that are hard to understand without using ABA. If the child's current development is disrupted, then the child is not capable of freely choosing their life's course. If the child cannot talk, the child cannot make a choice whether to speak or remain silent. Our goal is to give the child the skills to make their own choices in life, without being restricted by their disability.

Contrary to popular opinion, ABA has shown that a disability is usually not a fixed trait – the child is not doomed to live with a disability. Rather, the goal of behavior therapy is to develop the skills necessary to overcome any disabling condition and naturalize the child's interactions to the extent that the child no longer needs specialized help to continue life-long development.

To do this, we need a therapy that is designed to analyze a child's current skills and needs and make individualized prescriptions for their treatment. This therapy needs to be suited to dynamic change, because the child is capable of making significant progress every day.

The essential principle found in ABA research is reinforcement. The single most powerful effect of the environment upon a child's behavior is reinforcement. Reinforcement is a process in which a consequence of a child's behavior is "rewarding" enough that the child begins to engage in the behavior more frequently, as a result. Throughout the day, a child is constantly encountering consequences for their behavior. These consequences are either reinforcing the symptoms of autism, or reinforcing adaptive behaviors. The consequences interact with stimuli in the environment to produce complex, observable patterns of stimulus control, which result in the child's development of social, language, and symptomatic behavior.

The behavior therapy starts with an objective, individualized analysis that allows us to identify the best approaches for a child at any point in therapy. There are no set approaches: repetition may be best or variation may be best, correction or shaping, visual or auditory cueing, at any one point in a child's therapy. What we need is to be able to use ABA to understand and implement the best methods in a dynamically changing process as the child develops toward independence.

We also know that early intervention is the best route to remediate significant behavioral deficits. When a behavioral deficit is standing in the way of a child's normal development, it is medically necessary to intervene as early as possible, and remove that deficit using behavior therapy, in order to free the child to develop normally in their young childhood. If the behavioral deficits are not removed early enough, the child will miss out on too many of the normal developmental influences of young childhood to become normal.

Because the therapy is complex and many faceted, we must use a high level of expertise with a significant level of training and supervision. We make regular clinical judgments on a minute-by-minute basis, rather than following a stale written plan. Therefore we emphasize a system which delivers high-quality decision-making. We use complicated information and analysis to make the best choices for the short term and for the long term. We go to great lengths to design the therapy so that staff are effectively trained. These considerations bear on the child's therapy.

We also know that consistent intervention throughout the child's day is necessary for growth. Therefore we must work in all of the child's environments, and emphasize those that they live in the most. These are in their home and community. Because of the challenges that the child's diagnosis poses to learning, we must work with a highly coordinated team to achieve the desired consistency. We must work for many hours and throughout the year in order to move the child forward, rather than letting the child languish, as they are otherwise wont.

The model of ABA puts responsibility for treatment change in the environment. It is the only feature of the child's condition that we can control. Therefore we focus on changing the 24-hour environment, rather than on changing the child. The environment will always determine the child's behavior, even when the child no longer needs specialized assistance in order to develop. So we want to program the child's environment to support and maintain independence. We design the therapy in a way to heavily involve and train the parents, rather than focusing on the child alone.

Because we serve the parents, who are the consumers, we understand what they want and we seek to deliver. The parents want their child to improve in the optimum fashion. They are ready to sacrifice to achieve this goal. We owe them our best efforts. Together, parents and behavior therapists roll up their sleeves and take charge of the situation, moving behavioral mountains to rescue children from autism.

The names of all children in this newsletter have been changed in respect for family confidentiality.

Get the Maid! Try to pick up toys while bending from the waist. Let the child push you over whenever you try to bend over.

Chair Rides! "Fasten your seatbelt! Hold on to the chair!" Begin to lift chair off ground slowly. Then take off like a racecar!

Magic Tricks! Pull a candy out of the child's ear. Transfer a reinforcer magically from one hand to another closed fist (the child doesn't know you had it there already), or even into a sealed container (where it already was).

Chattering Teeth! Get chattering mechanical teeth and throw them on the table by surprise.

What's So Funny! Find a suction toy that will stick to your forehead.

Paul is a 7-year-old. He was telling his instructor Mary that he would be going to Legoland during his spring break and invited her to go with him. When she told him she couldn't go because she was going to hang out with another instructor, Anna, he said Anna could come too. Paul then told Mary the travel arrangements would include his mom, his little sister, Anna, Mary, Lucy, and Karen (all instructors) in one car and his dad, him, and Tracy (his most preferred instructor) in the other car.
- California

Tasha had recently learned to continue a conversation by staying on topic and making a statement similar to a statement that was just made. For example, if someone said, "I like Blues Clues," Tasha would add, "I like Dora the Explorer." With the start of football season, one of Tasha's instructors offhandedly remarked "I like the Colts and the Jets." Tasha chimed in, "I like the helicopters!"
- Indianapolis

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