What Is Applied Behavioral Analysis (ABA) Therapy for Autism?

ABA can teach skills and change behaviors

Applied behavior analysis (ABA) is a type of therapy that teaches skills and proper behavior through reinforcement. It's commonly described as the "gold standard" for autism treatment.

Many people are advocates of ABA because of its success in helping individuals with autism learn behaviors and skills. Others believe it's too hard on kids and forces them to conform to others' ideas of "normal" behavior.

This article discusses how ABA works and what the benefits and disadvantages are.

Therapist talking to little boy with drawing
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What Is ABA Therapy?

ABA is a type of therapy for autism that helps reinforce desired behaviors and discourage unwanted behavior. To do this, therapists use rewards to encourage communication, language, and other skills.

There are several different types of ABA, depending on the patient's age and goals for therapy. It was created in the 1960s by psychologist Dr. Ivar Lovaas, but the methods used have evolved over the years.

History

Dr. Ivar Lovaas, a behavioral psychologist, first applied ABA to autism. He believed that social and behavioral skills could be taught to children with autism.

His idea was that autism is a set of behavioral symptoms that can be modified or "extinguished." When autistic behaviors were no longer evident, it was assumed that the autism had been effectively treated.

Back then, ABA also included punishments for non-compliance, some of which could be very harsh, including electric shocks. Today, punishments aren't used in ABA and are considered morally unacceptable.

In general, "punishment" has been replaced by "withholding of rewards." For example, a child who does not properly respond to a "mand" (command) will not receive a reward such as a favorite food.

Over time, Lovaas's technique, also called "discreet trial training," has been studied and modified by therapists. Today, therapists aren't looking to cure autism but to help patients learn to live fully and independently. Techniques not only focus on behavior but social and emotional skills as well.

Recap

ABA therapy was first started by Dr. Ivar Lovaas, a behavioral psychologist. The therapy has evolved over the years, eliminating punishments and focusing on rewards for desired behavior.

Types of ABA Strategies

Therapists may use different methods of ABA. Some examples of ABA strategies include:

  • Discrete Trial Training: Lovaas's technique breaks down lessons into simple tasks. Each task is rewarded with positive reinforcement for correct behavior.
  • Early Start Denver Model: For kids ages 12 to 48 months, this therapy includes play and joint activities to help kids with language, cognitive, and social skills.
  • Pivotal Response Training: The main goals are for children to start conversations with others, increase their motivation to learn, and monitor their own behavior.
  • Early Intensive Behavioral Intervention: For children who are younger than 5 years old, this therapy helps build positive behavior and reduce unwanted behavior. Therapy sessions are one-on-one with a trained therapist.

Benefits and Drawbacks of ABA

ABA is recommended by many health professionals for its success in helping people with autism to improve certain skills.

However, the therapy has also faced criticism from some, including parents and autism advocates. The concern is that the therapy doesn't show respect to the individual with autism.

Benefits

Supporters of ABA cite the following benefits:

  • Research shows it helps develop behavioral skills. Studies have shown that ABA therapy is effective in helping people with autism to learn skills. For example, one study found that the Early Start Denver Model helped children improve in IQ and behavior. It also decreased the severity of their autism diagnosis.
  • ABA can be used to teach simple and complex skills. For example, ABA can be used to reward children for brushing their teeth correctly or for sharing their toys with friends.
  • It gives parents strategies for teaching children at home. ABA helps to give parents a guide for teaching and a way to measure progress. For example, it can help parents teach language by breaking it down into syllables rather than full words.
  • It shows that kids with autism are capable of learning. ABA helps to give children with autism a chance to show that they are capable of learning and modifying behaviors. For some, that may include teaching them to sleep through the night or helping them learn to make friends.

Drawbacks

While punishment is no longer a part of ABA therapy, critics say that the therapy can still be too harsh for autistic individuals. Some of the criticism of ABA includes:

  • ABA focuses on behavior problems. Critics say therapists focus more on stopping what they consider problem behaviors rather than developing skills like language.
  • The therapy tries to make kids "normal." Another criticism is that the therapy tries to make kids act like everyone else. By telling kids that their natural behaviors are wrong, like flapping hands or not sitting still, it may be dismissing their own needs.
  • It's limited in what it can teach. ABA is not intended to build emotional skills. For example, ABA might teach a child to shake hands or greet another person with a handshake. However, it won't help that child to feel an emotional connection with another person.

Some of these concerns have led to changes in therapy over the years. For example, ABA therapists focus on changing behaviors, not the person's feelings or thoughts. The goal is to help individuals become as independent as possible, rather than trying to "fix" them.

Recap

ABA research shows that kids with autism can learn behavioral skills. However, critics also say it disrespects kids by telling them that their natural behaviors are wrong.

How ABA Works

The most basic ABA therapy starts with "discrete trials" therapy. A discrete trial consists of a therapist asking a child for a particular behavior, such as picking up a spoon.

If the child complies, he is given a reward. That could be a food treat, a high five, or any other reward that means something to the child. If the child does not comply, he does not receive the reward, and the trial is repeated.

The therapy is based on the individual child, his needs, and his abilities. So a child who is already capable of sorting shapes would not be asked to sort shapes indefinitely for rewards. They would focus on different, more challenging social or behavioral tasks.

The very youngest children (under age 3) receive a modified form of ABA, which is much closer to play therapy. After practicing, therapists will take children into real-world settings to use the behaviors they learned.

ABA can also be used with older children, teens, or even adults. Many therapists also use ABA in natural settings such as playgrounds, cafeterias, and community locations. This makes it easier for patients to immediately use the skills they learn in a real-world situation.

Timeline of ABA Therapy

Your therapist will help you to decide on a plan for therapy sessions, including goals and session length.

The therapist will start with an assessment to look at the patient's medical history and previous treatments. Family members will be interviewed to find out more about their goals for treatment. The therapist will also observe the patient in an initial session. They'll continue to evaluate progress towards goals on a regular basis.

ABA therapy can be done in a number of different settings, including the home, school, inpatient programs, and places in the community. Parents will also be trained to help provide support for the patient in different environments.

The number of therapy hours will depend on the goals for treatment. ABA treatment usually takes about 10 to 25 hours per week. Some programs for severe behavior can take more hours.

ABA treatment can cost $125 per hour for a certified ABA therapist. Check with your insurance company to see if the cost is covered. Some states require that insurers cover ABA therapy.

Patients are usually evaluated every few months to help determine how long treatment should continue. Usually, the program will have a gradual step-down in services before the therapy ends.

Recap

ABA therapy can take about 10 to 25 hours a week. Patients are evaluated regularly to determine how long therapy should continue.

When to Stop ABA Therapy

According to the Council of Autism Service Providers, ABA therapy should be reviewed or stopped in the following instances:

  • The patient has met their goals in the program.
  • The patient doesn't meet the criteria for autism.
  • The patient isn't showing any progress in the program over several periods.
  • The family and provider are unable to resolve important issues related to the treatment plan.

ABA can be helpful for many with autism, but it isn't necessarily the right therapy for everyone. Talk to your doctor or therapist about any concerns you have, and how you can transition to another treatment if needed.

Summary

Research shows that ABA therapy can be effective in reinforcing desired behaviors in those with autism. However, some say it tries to change behaviors without respecting the needs of the person with autism. The therapy has evolved over the years with the focus less on curing autism and more on helping people live independently.

A Word From Verywell

As with many approaches to autism, ABA is certainly worth a trial. Before getting started, be sure your child's therapist is trained and knows how and where they will be working with your child. Work with your therapist to set up measurable goals. Keep a close eye on the process and outcomes. 

Most importantly, be aware of your child's responses to the therapist and the therapy. Is your child excited when working with the therapist? Does your child respond to the therapist with smiles and engagement? Is your child learning skills that are helping in daily life?

If the answers are "yes," you're moving in the right direction. If not, it's time to reassess.

Frequently Asked Questions

  • What are the benefits of ABA therapy?

    ABA therapy can help teach children with autism behavior and social skills. It uses rewards to reinforce desired behaviors and modify unwanted behaviors. Therapists can adapt ABA therapy to fit individual needs and goals.

  • Why is ABA therapy criticized in the autistic community?

    Many autistic adults who underwent ABA therapy as children say the treatment is harmful. It has been described as compliance training that forces children to ignore their instincts. A 2019 study found that people who underwent ABA therapy were 86% more likely to meet the diagnostic criteria for post-traumatic stress disorder.

  • How many hours of ABA therapy does an autistic child need?

    ABA therapy is time-intensive. While the specific therapy changes from child to child, the number of therapy hours typically ranges from 10 to 25 hours a week. The therapist will re-evaluate the child every few months to determine how long therapy should continue.

 

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2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Mohammadzaheri F, Koegel LK, Rezaee M, Rafiee SM. A randomized clinical trial comparison between pivotal response treatment (PRT) and structured applied behavior analysis (ABA) intervention for children with autism. J Autism Dev Disord. 2014;44(11):2769-77. doi:10.1007/s10803-014-2137-3

  2. Kupferstein H. Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis. Advances in Autism. 2018;4(1):19-29. doi:10.1108/AIA-08-2017-0016

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