Applied Behavioural Analysis (ABA)
ABA is a behavioural treatment programme sometimes used with children with Autism to address social skills. Behaviours are taught through an intensive skill training system of rewards and consequences (sometimes called ‘discrete trials’). ABA can also be used with other types of developmental disorders.
ABA was first applied to Autism in America in 1987.
Some studies have shown that with many hours of ABA from trained therapists, children’s speech and ability can improve. However, progress varies according to the individual differences of each child, so that what works for one child may not necessarily work for another. Other determinants include the involvement of the family in helping the child. Most experts agree however that the earlier the ABA takes place in the child’s life the better. This usually means between the ages of 1 to 7 years.
The Council’s experience of stand-alone ABA programmes delivered over time is that:
- The focus is on behaviour, and this can be to the detriment of development of understanding and cognition, natural curiosity and exploration.
- The model is based on gaining compliance and assumptions of normative behaviour.
- There is a propensity to produce ‘automatic / autopilot’ behaviour in children, as they are conditioned to behave in a certain way, and often cannot transfer or generalise skills learned to other situations.
- The use of punishment to reduce or eliminate problem behaviour has been of concern. We have also seen punishments become internalised as rewards, e.g. time out.
- ‘Reinforcements’ can also be inappropriately given (e.g. bombardment of praise).
- Evidence suggests that ‘naturalised teaching’ can be more effective than ABA, particularly for improving language. (e.g. the use of language in a typical environment, to allow focus on functions such as requesting, labelling and responding in everyday situations).
- The behaviours that are reinforced and deemed as functional, important or relevant may be chosen by the provider, so not needs led.
- The intensity of programmes is of concern. A programme involves far longer hours per week (typically 40 hours) than most adults would be expected to work, or children be at school.
- ABA clearly does not suit everybody.
- It is a disproportionately expensive intervention, both in terms of financial cost and outcomes achieved.
On this basis, the Islington Partnership would not normally support ABA as a stand-alone approach.
Instead, we recommend and support practice that:
- Takes a holistic and person-centred approach that incorporates an understanding of neuro-divergent sensibility, sensory perceptual differences, cognitive theory, and a social model of disability.
- Builds understanding and communication between all involved.
- Enables access to the community.
- Is ethical in terms of approach and professional competency.
- Is evidence-based.
- Avoids the use of restraint and seclusion.
- Builds on strengths and interests, rather than focusing on perceived weaknesses and absent skills.
- Builds neuro-divergent perspectives into all intervention and interaction.
- Builds on considerable local expertise, communities of practice and multi-disciplinary expertise.
- Places the child / young person with Autism at the centre of considerations.