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

Applied behavior analysis (ABA) is a type of therapy that teaches skills and expected behavior by using reinforcement. Some experts claim that it's the “gold standard” for autism treatment.

Advocates of ABA therapy cite its success in helping autistic people learn behaviors and skills. Those who are against it say that ABA is hard on autistic kids and forces them to conform to other people's ideas of “normal” behavior.

This article discusses how ABA works. You will learn about the possible benefits of ABA therapy, its disadvantages, and the controversies surrounding it.

What Is ABA Therapy?

In ABA therapy, a therapist reinforces desired behaviors and discourages unwanted behavior in a patient. Therapists use rewards to encourage a patient to develop communication, language, and other skills.

There are several different types of ABA. Which type is used depends on the patient’s age and goals.

History of ABA

ABA was created in the 1960s by a behavioral psychologist named Dr. Ivar Lovaas, but the methods have evolved over the years. Dr. Lovaas first applied ABA to autism because he believed that social and behavioral skills could be taught to autistic children.

Lovaas' 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—for example, the use of electric shocks.

In recent history—March of 2020—the Food and Drug Administration (FDA) banned electric shock devices in aversion therapy. However, a federal appellate court appeal overturned the ruling in 2021.

Most punishment in ABA has been replaced by the withholding of rewards.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 changed by therapists. Today, therapists are not looking to "cure autism" but to help autistic people learn to live fully and independently. The techniques focus on behaviors as well as social and emotional skills.

Types of ABA Strategies

Therapists may use five different strategies to enforce ABA, including:

• Discrete trial teaching: Lovaas’s technique breaks down lessons into simple tasks rewarded after successfully employing a cue-and-response structure.
• Naturalistic teaching: This aspect of teaching allows the student to set their own learning pace throughout the day based on the context of their regular routines.
• Pivotal response training: This student-directed teaching improves motivation, response to more than one cue, social setting structure, and self-regulation.
• Token economy: This strategy rewards or removes a token based on predefined behaviors. Also called condition reinforcers, tokens are similar to actual-world currency exchange.
• Contingent observation: The last learning strategy is used in a group of peers. After showing a child that their behavior is unacceptable, the child is instructed to observe their peers performing a task successfully.
  

ABA Benefits, Drawbacks, and Controversies

ABA therapy is recommended by many health professionals to help autistic people improve certain skills.

However, the ABA has also been criticized by caregivers and autism advocates. The main concern is that the therapy does not show respect for autistic people and that it may even harm them.

Benefits of ABA

Supporters of ABA therapy cite the following benefits:

• Helps develop behavioral skills. Studies have shown that ABA therapy is effective in helping autistic people 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.
• 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.
• 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.
• Shows that autistic kids are capable of learning. ABA helps to give autistic children 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.

ABA Drawbacks and Controversy

While the use of electric shock therapy is pending because of the federal appellate ruling, critics say that ABA can still be too harsh for autistic people.

Drawbacks of ABA include:

• Focuses on behavior problems. Critics of ABA therapy say that therapists focus more on stopping what they consider "problem behaviors" rather than developing a child's skills (like language).
• Tries to make kids “normal.” Another criticism is that ABA therapy tries to make neurodivergent kids act like everyone else. For example, telling kids that flapping their hands or other stims are wrong when they are a child's natural behaviors dismisses their needs.

These concerns have led to some changes in ABA therapy. Now, therapists focus on changing behaviors rather than an autistic person’s feelings or thoughts. The goal is to help autistic people live as independently as possible, not try to “fix” them.

The ABA Therapy Process

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

The therapist will start with an assessment to look at your child's medical history and previous treatments. Your family members will be interviewed to find out more about their goals for treatment.

The therapist will also observe your child during an initial session and continue to evaluate your child's 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 are also trained to help provide support for the child 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 behaviors need 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.

Children 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.

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 does not meet the criteria for autism.
• The patient is not showing any progress in the program over time.
• The family and provider are unable to resolve important issues related to the treatment plan.

ABA can be helpful for some autistic children but it may not be the right therapy for your child. Talk to your child's provider or therapist about any concerns you have. They can help your child transition to another treatment if needed.

Summary

Applied behavioral analysis (ABA) therapy aims to reinforce desired behaviors in autistic people. It can help some autistic people, but the treatment is not without drawbacks and controversy.

Autism advocates often feel that ABA tries to change behaviors without respecting the needs of the autistic person and that it may even harm them.

ABA therapy has evolved over the years. Today, the focus is not on "curing" autism; rather, it's helping autistic people live independently.

A Word From Verywell

You might want to see if ABA can help your autistic child gain skills. Before getting started with ABA, be sure that the therapist you are seeing is trained and knows how and where they will be working with your child. Your therapist will set measurable goals for your child and 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.