So you just got a diagnosis of Autism
Most pediatricians and psychiatrists will recommend Applied Behavior Analysis or ABA services. But what is ABA and how do you know if it is good ABA program? I have heard stories from parents saying that although the doctor highly recommended ABA services to help their child, the doctor could not really say what ABA is.
ABA is the science of modifying behavior through environmental changes. ABA is research-based, meaning the principles, techniques, and protocols have been reviewed by peers in the field to ensure they are effective, safe and ethical. ABA services can help increase skills and behavior (such as language skills or social skills) and can decrease behaviors (such as inappropriate or challenging behaviors). Autism Speaks has a great resource for learning more about ABA: https://www.autismspeaks.org/what-autism/treatment/applied-behavior-analysis-aba.
There are many out there that claim to provide ABA services. The following is a list to use when evaluating a program to determine if they are truly offering ABA services.
1. What are the credentials of the ABA staff?
BCBAs or Board Certified Behavior Analysts are the only qualified individuals able to supervise an ABA program. BCaBAs or Board Certified Assistant Behavior Analysts often help the BCBA manage cases. RBTs or Registered Behavior Technicians are often the direct care staff working with the individual. For more information on these professionals visit www.BACB.com.
2. Is there objective progress monitoring? What does it look like and how often will you receive the report?
ABA relies on data to make decisions about programming, therefore, there must be some form of objective data collection and reporting measures in place. ABA focuses on the objective and observable behaviors that individuals exhibit. For example, “level of anxiety” is not a behavior to measure but “repetitive nail biting and pacing (walking back and forth at least 3 feet)” are observable behaviors that you can define and then track and measure. A good ABA program will have graphs of skill acquisition as well as behavior change. And often, the behavior analysts will be giddy with excitement if you ask to see the graphs!
3. What types of procedures do they use for implementing behavior change? Do they rely on reinforcement or punishment?
The hallmark of ABA programming is to first and foremost exhaust any and all positive reinforcement procedures before turning to punishment (exceptions may include behaviors that impose immediate, serious safety risk). Examples of positive reinforcement include descriptive praise, access to toys or edibles, and token systems. If you take a tour of a program and cannot see a single token board, run!
4. Do they make behavior intervention plans based on the function of the behavior?
Behaviors are changed with procedures that target the function of the behaviors. The functions are sensory or automatic, escape/avoidance, attention, and tangible. You can remember this with the acronym S.E.A.T. Things like frustration and transitions ARE NOT FUNCTIONS OF BEHAVIOR! In order to determine the function, a trained staff member, supervised by a BCBA or BCaBA should conduct a functional analysis (FA) or at least a functional behavior assessment (FBA) which includes many observations of the behavior occurring in the natural environment. These observations should include, you guessed it, DATA!
5. Do they use shaping and chaining to teach new behaviors?
Shaping is the process of reinforcing successive approximations to the target behavior. Simply put, every time you will expect a little more effort and accuracy toward to end goal. Chaining is teaching individual behaviors and then putting them together in a long chain of behaviors. For example, brushing your teeth is a chain of behaviors. To shape brushing teeth, you might be required to only do the last step, wiping your mouth, independently before receiving reinforcement. The end goal is total independence. Often behaviors that are being shaped and/or chained are accompanied by a task analysis visual or, simply put, a visual schedule of each step to follow.
6. Are the skills being taught and the behaviors targeted for change important for the individual to be successful in their current setting, with their family, with their peers, and in their community?
Another foundation of ABA is the idea that we work on skills that are socially valid for that person. If it is important for that person to be included with their family in church services so that the family can access that particular supportive community, then the ABA program should work on skills to allow the individual to be included in that setting to the greatest extent possible. If the learner needs to take medications to help attending but cannot swallow pills, then a shaping procedure should be developed by a trained individual to teach this important skill.
The following are questions to ask to determine if they are a good ABA program:
- Do they offer parent/caregiver training? (They should)
- What is the caseload of the BCBAs? (This should be low, around 12 cases are recommended by the Board for full-time treatment clients.)
- What are their safety procedures and protocols, especially for handling aggressive and other unsafe behaviors? (Do they use Safety Care, CPI, PMAB, etc.?)
- What is their process for treatment planning? Is the programming individualized? (It should be.)
- Do they have a plan for teaching generalization of skills? (They should)
- What are their opportunities for inclusion? (They should have some, if not many.)
- Do they offer transition planning? (They should)
- Will they communicate with other service providers? (They should)
- Do they use prompting and prompt fading to increase independence?
- What type of prompt and prompt fading procedures do they use?
- What does the staff training and supervision look like?
One of the top things to look for in any program with any service provider is transparency. The organization should be happy and willing to share information with you regarding all aspects of their program. If they aren’t sharing this information, that should be a red flag to you. An organization that is transparent with their program will likely be dedicated to the best possible treatment for your loved one.
Nichole O’Donnell is a Board Certified Assistant Behavior Analyst and serves as the Community Outreach Director for Including Kids. Since beginning her work at Including Kids in 2007, Nichole has worked with children, adolescents and adults as a direct-care therapist, inclusion shadow, Case Supervisor, Reading Specialist, Project Manager, and Community Outreach Director. Nichole has a passion for teaching social skills and executive functioning skills and for sharing her knowledge with parents, staff and the community.