Can a Child Be Too High Functioning for Applied Behavior Analysis?

Applied Behavior Analysis (ABA) is often described as the "gold standard" when it comes to autism therapy. But it has its detractors. Some people (particularly high functioning autistic self-advocates) feel that the technique is demeaning and, in many cases, cruel to the child.

Some experts suggest that ABA is really best for children who have more severe forms of autism—and recommend developmental or play therapy instead of ABA. Developmental and play therapy is more focused on interactivity, communication, and emotional growth while ABA (not surprisingly) is focused almost exclusively on behavior.

The reality, of course, is that children can receive both developmental and behavioral therapy, so a choice isn't actually necessary. But is ABA really inappropriate for higher functioning children with autism?

Why No One Is "Beyond" Behavior Modification

Behaviorism, in itself, is simply a way to teach the desired behavior by ​offering rewards for compliance (or consequences for non-compliance, although negative reinforcement has gone out of style in recent years). We use a behavioral approach when we say "you'll get dessert if you finish your peas," or "you can go out with your friends if you clean your room." Workplaces use behavioral techniques when they offer incentives for reaching specific goals.

Behavioral treatment is effective for many children with autism. The goal of behavioral treatment is to help children catch up to the skill level of typically developing peers. The program is individualized to incorporate areas of strength and areas of weakness specific to each child. Therefore, even high-functioning children can benefit from behavioral treatment.

Why ABA May Not Be Offered in a Way That's Right for Your Child

ABA is often offered in the context of an "autism classroom" designed to serve children with relatively severe symptoms. Most children who spend their days in an "autism classroom" spend little or no time in the general education setting. If you have a high functioning child who is intellectually and behaviorally capable of learning in a general education classroom, the "autism classroom" is likely to be a poor fit.

ABA may also be offered in a one-on-one setting. This can be very helpful for a child who is learning very basic skills or who is not yet able to engage with peers on a playground or in another typical setting. For a higher functioning child, however, ABA should be offered in a "real world" setting. If ABA therapists are unable or unwilling to work with your child in a natural setting, ABA may be a poor fit.

According to the Lovaas Institute and many ABA providers, ABA should be offered for many hours a week (as many as 40 hours). At this level of intensity, it is literally impossible for a child to also take part in anything other than therapy outside of school. No sports, no music, no downtime—unless an ABA therapist is actually working with the child during his or her after-school activities. If you have a child who is capable of taking part in typical activities, and ABA would make those activities impossible, ABA may be a poor choice.

How ABA Should Be Customized for a Higher Functioning Child

There is little data available in peer-reviewed, research articles that compare outcomes of behavioral treatment for “low-functioning” and “high-functioning” children. In addition, there are few studies that compare the efficacy of different "brands" of ABA for different groups of children. It is, however, possible to make some specific recommendations for customizing ABA for the needs of a higher-functioning child:

• The goal of behavioral treatment is to help children catch up to the skill level of typically developing peers. Behavioral treatment can be modified to teach complex behaviors and social skills such as recognizing facial expressions and non-verbal behavior of others, development of cooperative social behavior, verbalizations of empathy, and conversing with peers on a variety of topics rather than a restricted range of interests.
• Behavioral therapy may look very different for a “low-functioning” and “high-functioning” child with autism. In addition to discrete trials (one on one therapy for lower-functioning children), other behaviorally sound procedures such as incidental teaching, video modeling, and generalization in the natural environment may be more strongly emphasized.
• Behavioral therapy attempts to help a child so that he can learn in less structured settings in the future (for example, in peer groups). However, even in these less structured settings, the principles of applied behavior analysis are often key to a child’s success. Some of these principles include: 1) defining measurable behaviors for change, 2) investigating the function of inappropriate behaviors, 3) reinforcing appropriate behaviors, and 4) measuring progress routinely.

In summary, parents who dismiss behavioral treatment because they are told their child is already “high-functioning” may miss out on an effective intervention. A reputable organization that specializes in behavioral treatment for children with autism should be able to assess a child and then discuss with the parent's specific objectives and teaching strategies based on their child’s particular strengths and needs. Parents can then decide on the appropriateness of behavioral treatment for their son or daughter.