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Applied behavior analysis

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Not to be confused with discrete trial training, a teaching method that is a form of the broader science of applied behavior analysis (ABA).

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Applied behavior analysis (ABA), also called behavioral engineering,[1][2] is a scientific discipline that applies the principles of learning based upon respondent and operant conditioning to change behavior of social significance. ABA is the applied form of behavior analysis; the other two are radical behaviorism (or the philosophy of the science) and the experimental analysis of behavior (or basic experimental research).[3]

The term applied behavior analysis has replaced behavior modification because the latter approach suggested changing behavior without clarifying the relevant behavior-environment interactions. In contrast, ABA changes behavior by first assessing the functional relationship between a targeted behavior and the environment, a process known as a functional behavior assessment. Further, the approach seeks to develop socially acceptable alternatives for maladaptive behaviors, often through administering differential reinforcement contingencies.

Although ABA is most commonly associated with Autism intervention, it has been utilized in a range of other areas, including organizational behavior management, substance abuse, behavior management in classrooms, acceptance and commitment therapy, and athletic exercise.[4][5][6]

Definition

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ABA is a field of study that focuses on using the principles of behaviorism to make changes in a client's behavior that are relevant to their everyday life. [7] The social validity of interventions is what differentiates ABA from experimental analysis of behavior, which focuses on basic experimental research.[8] Behavior analysis adopts the viewpoint of radical behaviorism, which states that all behavior occurs for a reason, and the cause can be understood based on the subject's learning history and current conditions.[9] This represents a shift away from methodological behaviorism, which restricts behavior-change procedures to behaviors that are overt, and was the conceptual underpinning of behavior modification.

Behavior analysts emphasize that the science of behavior must be a natural science as opposed to a social science.[10] A

History

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Further information: Radical behaviorism, Experimental analysis of behavior, Behavior modification, Operant conditioning, B. F. Skinner, Charles Ferster, Nathan Azrin, Jack Michael, Donald M. Baer, Montrose Wolf, Sidney W. Bijou, Ivar Lovaas, Robert Koegel, and Steven C. Hayes
Lovaas prompting several young research subjects and using food as a reinforcer, ca. 1965

The beginnings of ABA can be traced back to Teodoro Ayllon and Jack Michael's study "The psychiatric nurse as a behavioral engineer" (1959) that they published in the Journal of the Experimental Analysis of Behavior (JEAB). Ayllon and Michael were training the staff at a psychiatric hospital how to use a token economy based on the principles of operant conditioning for patients with schizophrenia and intellectual disability,[2] which led to researchers at the University of Kansas to start the Journal of Applied Behavior Analysis (JABA) in 1968.[11][12]

A group of researchers at the University of Washington, including Donald Baer, Sidney W. Bijou, Bill Hopkins, Jay Birnbrauer, Todd Risley, and Montrose Wolf,[13][14] applied the principles of behavior analysis to treat autism, manage the behavior of children and adolescents in juvenile detention centers, and organize employees who required proper structure and management in businesses. In 1968, Baer, Bijou, Risley, Birnbrauer, Wolf, and James Sherman joined the Department of Human Development and Family Life at the University of Kansas, where they founded the Journal of Applied Behavior Analysis.[15]

Notable graduate students from the University of Washington include Robert Wahler, James Sherman, and Ivar Lovaas.[11][15] Lovaas established the UCLA Young Autism Project while teaching at the University of California, Los Angeles. In 1965, Lovaas published a series of articles that described a pioneering investigation of the antecedents and consequences that maintained a problem behavior,[16] including the use of electric shock on autistic children to suppress stimming and meltdowns (described as "self-stimulatory behavior" and "tantrum behaviors" respectively) and to coerce "affectionate" behavior,[17] and relied on the methods of errorless learning which was initially used by Charles Ferster to teach nonverbal children to speak. Lovaas also described how to use social (secondary) reinforcers, teach children to imitate, and what interventions (including electric shocks) may be used to reduce aggression and life-threatening self-injury.[16][18]

In 1987, Lovaas published the study, "Behavioral treatment and normal educational and intellectual functioning in young autistic children".[11] The experimental group in this study received an average of 40 hours per week in a 1:1 teaching setting at a table using errorless discrete trial training (DTT).[19] The treatment is done at home with parents involved, and the curriculum is highly individualized with a heavy emphasis on teaching eye contact, fine and gross motor imitation, academics, and language. The use of aversives and reinforcement were used to motivate learning and reduce non-desired behaviors.[11] Early development of the therapy in the 1960s involved use of electric shocks, scolding, and the withholding of food.[20][21] By the time the children were enrolled in this study, such aversives were abandoned, and a loud "no", electric shock, or slap to the thigh were used only as a last resort to reduce aggressive and self-stimulatory behaviors. The outcome of this study indicated 47% of the experimental group (9/19) went on to lose their autism diagnosis and were described as indistinguishable from their typically developing adolescent peers. This included passing general education without assistance and forming and maintaining friendships. These gains were maintained as reported in the 1993 study, "Long-term outcome for children with autism who received early intensive behavioral treatment". Lovaas' work went on to be recognized by the US Surgeon General in 1999, and his research were replicated in university and private settings.[22][23] The "Lovaas Method" went on to become known as early intensive behavioral intervention (EIBI).

Over the years, "behavior analysis" gradually superseded "behavior modification"; that is, from simply trying to alter problematic behavior, behavior analysts sought to understand the function of that behavior, what reinforcement histories (i.e., attention seeking, escape, sensory stimulation, etc.) promote and maintain it, and how it can be replaced by successful behavior.[24] ABA's priority on compliance and behavioral modification over that of an individual's needs can lead to harmful consequences, including prompt dependency, loss of intrinsic motivation, and even psychological trauma. Curtailing of self-soothing behaviors is potentially classifiable as a form of abuse.[25]

While ABA seems to be intrinsically linked to autism intervention, it is also used in a broad range of other areas. Recent notable areas of research in the Journal of Applied Behavior Analysis include autism,[5] classroom instruction with typically developing students, pediatric feeding therapy,[4][5][26] and substance use disorders.[4][5] Other applications of ABA include applied animal behavior, consumer behavior analysis, forensic behavior analysis, behavioral medicine, behavioral neuroscience, clinical behavior analysis,[4][5] organizational behavior management,[4][5] schoolwide positive behavior interventions and support,[4][27][28][29][30] and contact desensitization for phobias.

Characteristics

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7 Characteristics of ABA

Baer, Wolf, and Risley's 1968 article[31]is still used as the standard description of ABA.[12][32] It lists the following seven characteristics of ABA. Another resource for the characteristics of applied behavior analysis is the textbook Behavior Modification: Principles and Procedures.[33]

  • Applied: ABA focuses on the social significance of the behavior studied. For example, a non-applied researcher may study eating behavior because this research helps to clarify metabolic processes, whereas the applied researcher may study eating behavior in individuals who eat too little or too much, trying to change such behavior so that it is more acceptable to the persons involved. It is also based on trying to improve the everyday life of clients that are receiving it.
  • Behavioral: ABA is pragmatic; it asks how it is possible to get an individual to do something effectively. To answer this question, the behavior itself must be objectively measurable and observable. This is designed so that when someone is trying to determine a target behavior, it is able to be observed and understood by anyone. Verbal descriptions are treated as behavior in themselves, and not as substitutes for the behavior described.
  • Analytic: Behavior analysis is successful when the analyst understands and can manipulate the events that control a target behavior. This may be relatively easy to do in the lab, where a researcher is able to arrange the relevant events, but it is not always easy, or ethical, in an applied situation.[3] In order to consider something to fall under the spectrum of analytic, it must demonstrate a functional relationship and it must be provable. Baer et al. outline two methods that may be used in applied settings to demonstrate control while maintaining ethical standards. These are the reversal design and the multiple baseline design. In the reversal design, the experimenter first measures the behavior of choice, introduces an intervention, and then measures the behavior again. Then, the intervention is removed, or reduced, and the behavior is measured yet again. The intervention is effective to the extent that the behavior changes and then changes back in response to these manipulations. The multiple baseline method may be used for behaviors that seem irreversible. Here, several behaviors are measured and then the intervention is applied to each in turn. The effectiveness of the intervention is revealed by changes in just the behavior to which the intervention is being applied.
  • Technological: The description of analytic research must be clear and detailed, so that any competent researcher can repeat it accurately.[3] The goal is to make sure that anyone can implement and understand what is being explained. Cooper et al. describe a good way to check this: Have a person trained in applied behavior analysis read the description and then act out the procedure in detail. If the person makes any mistakes or has to ask any questions then the description needs improvement.[12][34]
  • Conceptually Systematic: Behavior analysis should not simply produce a list of effective interventions. Rather, to the extent possible, these methods should be grounded in the principles of applied behavioral analysis. This is aided by the use of theoretically meaningful terms, such as "secondary reinforcement" or "errorless discrimination" where appropriate.
  • Effective: Though analytic methods should be theoretically grounded, they must be effective. Interventions also must be relevant to the client and/or culture. An analyst must ask themselves if the intervention is working. The intervention must also contain a positive change. If an intervention does not produce a large enough effect for practical use, then the analysis has failed
  • Generality: Behavior analysts should aim for interventions that are generally applicable; the methods should work in different environments, apply to more than one specific behavior, and have long-lasting effects. This generalizability should be implemented from the very beginning of the intervention. When first starting a new intervention, it is a good idea for that to take place in a natural environment for the client.

Other proposed characteristics

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In 2005, Heward et al. suggested the addition of the following five characteristics:[35]

  • Accountable: To be accountable means that ABA must be able to demonstrate that its methods are effective. This requires repeatedly measuring the effect of interventions (success, failure or no effect at all), and, if necessary, making changes that improve their effectiveness.
  • Public: The methods, results, and theoretical analyses of ABA must be published and open to scrutiny. There are no hidden treatments or mystical, metaphysical explanations.
  • Doable: To be generally useful, interventions should be available to a variety of individuals, who might be teachers, parents, therapists, or even those who wish to modify their own behavior. With proper planning and training, many interventions can be applied by almost anyone willing to invest the effort.[35]: 205 
  • Empowering: ABA provides tools that give the practitioner feedback on the results of interventions. These allow clinicians to assess their skill level and build confidence in their effectiveness.[36]
  • Optimistic: According to several leading authors[who?], behavior analysts have cause to be optimistic that their efforts are socially worthwhile, for the following reasons:
    • The behaviors impacted by behavior analysis are largely determined by learning and controlled by manipulable aspects of the environment.
    • Practitioners can improve performance by direct and continuous measurements.
    • As a practitioner uses behavioral techniques with positive outcomes, they become more confident of future success.
    • The literature provides many examples of success in teaching individuals considered previously unteachable.


Applications

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Autism Intervention

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Although there are many applications of ABA outside of autism intervention, a large majority of ABA practitioners specialize in autism, and ABA itself is often mistakenly considered synonymous with therapy for autism.[37][8] Practitioners often use ABA-based techniques to teach adaptive behaviors to, or diminish challenging behaviors presented by, individuals with autism.[38][39] ABA methodologies such as differential reinforcement, extinction, and task analysis, are among the most well-researched evidence-based practices for autism intervention. [40]

In 2018, a Cochrane meta-analysis database concluded that some recent research is beginning to suggest that because of the heterology of ASD, there are two different ABA teaching approaches to acquiring spoken language: children with higher receptive language skills respond to 2.5 – 20 hours per week of the naturalistic approach, whereas children with lower receptive language skills need 25 hours per week of discrete trial training—the structured and intensive form of ABA.[41] A 2023 multi-site randomized control trial study of 164 participants showed similar findings.[42]

Applications outside of autism intervention

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Animal Welfare

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ABA has been successfully used in other species.[43] Morris uses ABA to reduce feather-plucking in the black vulture (Coragyps atratus).[43][44][45]


Concepts

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Behavior

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Main article: Behavior

Behavior refers to the movement of some part of an organism that changes some aspect of the environment.[46] Often, the term behavior refers to a class of responses that share physical dimensions or functions, and in that case a response is a single instance of that behavior.[12][47] If a group of responses have the same function, this group may be called a response class. Repertoire refers to the various responses available to an individual; the term may refer to responses that are relevant to a particular situation, or it may refer to everything a person can do.

Operant conditioning

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Main article: Operant conditioning

Operant behavior is the so-called "voluntary" behavior that is sensitive to, or controlled by its consequences. Specifically, operant conditioning refers to the three-term contingency that uses stimulus control, in particular an antecedent contingency called the discriminative stimulus (SD) that influences the strengthening or weakening of behavior through such consequences as reinforcement or punishment.[48] The term is used quite generally, from reaching for a candy bar, to turning up the heat to escape an aversive chill, to studying for an exam to get good grades.

Respondent (classical) conditioning

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Main article: Classical conditioning

Respondent (classical) conditioning is based on innate stimulus-response relationships called reflexes. In his experiments with dogs, Pavlov usually used the salivary reflex, namely salivation (unconditioned response) following the taste of food (unconditioned stimulus). Pairing a neutral stimulus, for example a bell (conditioned stimulus) with food caused the dog to elicit salivation (conditioned response). Thus, in classical conditioning, the conditioned stimulus becomes a signal for a biologically significant consequence. Note that in respondent conditioning, unlike operant conditioning, the response does not produce a reinforcer or punisher (e.g., the dog does not get food because it salivates).

Reinforcement

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Main article: Reinforcement

Reinforcement is the key element in operant conditioning[49] and in most behavior change programs.[50] It is the process by which behavior is strengthened. If a behavior is followed closely in time by a stimulus and this results in an increase in the future frequency of that behavior, then the stimulus is a positive reinforcer. If the removal of an event serves as a reinforcer, this is termed negative reinforcement.[51] There are multiple schedules of reinforcement that affect the future probability of behavior. "[H]e would get Beth to comply by hugging him and giving her food as a reward."[52]

Punishment

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Main article: Punishment (psychology)

Punishment is a process by which a consequence immediately follows a behavior which decreases the future frequency of that behavior.[53] As with reinforcement, a stimulus can be added (positive punishment) or removed (negative punishment). Broadly, there are three types of punishment: presentation of aversive stimuli (e.g., pain), response cost (removal of desirable stimuli as in monetary fines), and restriction of freedom (as in a 'time out').[54] Punishment in practice can often result in unwanted side effects.[55] Some other potential unwanted effects include resentment over being punished, attempts to escape the punishment, expression of pain and negative emotions associated with it, and recognition by the punished individual between the punishment and the person delivering it. ABA therapist state that they use punishment is used infrequently as a last resort or when there is a direct threat caused by the behavior.[56]

Extinction

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Main article: Extinction (psychology)

Extinction is the technical term to describe the procedure of withholding/discontinuing reinforcement of a previously reinforced behavior, resulting in the decrease of that behavior.[57]: 102  The behavior is then set to be extinguished (Cooper et al.). Extinction procedures are often preferred over punishment procedures, as many punishment procedures are deemed unethical and in many states prohibited. Nonetheless, extinction procedures must be implemented with utmost care by professionals, as they are generally associated with extinction bursts. An extinction burst is the temporary increase in the frequency, intensity, and/or duration of the behavior targeted for extinction.[57]: 104  Other characteristics of an extinction burst include an extinction-produced aggression—the occurrence of an emotional response to an extinction procedure often manifested as aggression; and b) extinction-induced response variability—the occurrence of novel behaviors that did not typically occur prior to the extinction procedure. These novel behaviors are a core component of shaping procedures.

Discriminated operant and three-term contingency

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In addition to a relation being made between behavior and its consequences, operant conditioning also establishes relations between antecedent conditions and behaviors. This differs from the S–R formulations (If-A-then-B), and replaces it with an AB-because-of-C formulation. In other words, the relation between a behavior (B) and its context (A) is because of consequences (C), more specifically, this relationship between AB because of C indicates that the relationship is established by prior consequences that have occurred in similar contexts.[58] This antecedent–behavior–consequence contingency is termed the three-term contingency. A behavior which occurs more frequently in the presence of an antecedent condition than in its absence is called a discriminated operant. The antecedent stimulus is called a discriminative stimulus (SD). The fact that the discriminated operant occurs only in the presence of the discriminative stimulus is an illustration of stimulus control.[59] More recently behavior analysts have been focusing on conditions that occur prior to the circumstances for the current behavior of concern that increased the likelihood of the behavior occurring or not occurring. These conditions have been referred to variously as "Setting Event", "Establishing Operations", and "Motivating Operations" by various researchers in their publications.

Verbal behavior

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Main article: Verbal Behavior

B. F. Skinner's classification system of behavior analysis has been applied to treatment of a host of communication disorders.[60] Skinner's system includes:

  • Tact – a verbal response evoked by a non-verbal antecedent and maintained by generalized conditioned reinforcement.
  • Mand – behavior under control of motivating operations maintained by a characteristic reinforcer.
  • Intraverbals – verbal behavior for which the relevant antecedent stimulus was other verbal behavior, but which does not share the response topography of that prior verbal stimulus (e.g., responding to another speaker's question).
  • Autoclitic – secondary verbal behavior which alters the effect of primary verbal behavior on the listener. Examples involve quantification, grammar, and qualifying statements (e.g., the differential effects of "I think..." vs. "I know...")

Skinner's use of behavioral techniques was famously critiqued by the linguist Noam Chomsky through an extensive breakdown of how Skinner's view of language as behavioral simply cannot explain the complexity of human language.[61] This suggests that while behaviorist techniques can teach language, it is a very poor measure to explain language fundamentals. Considering Chomsky's critiques, it may be more appropriate to teach language through a Speech language pathologist instead of a behaviorist.

For an assessment of verbal behavior from Skinner's system, see Assessment of Basic Language and Learning Skills.

Measuring behavior

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When measuring behavior, there are both dimensions of behavior and quantifiable measures of behavior. In applied behavior analysis, the quantifiable measures are a derivative of the dimensions. These dimensions are repeatability, temporal extent, and temporal locus.[62]

Repeatability

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Response classes occur repeatedly throughout time—i.e., how many times the behavior occurs.

  • Count is the number of occurrences in behavior.
  • Rate/frequency is the number of instances of behavior per unit of time.
  • Celeration is the measure of how the rate changes over time.

Temporal extent

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Schirmer, Meck & Penney explore the ‘timing’ of temporal information that seeks out the rhythm and duration of the behavior.[63] Given the expressions of behavior, an emotional meaning is obtained through the duration in correspondence with body and vocal expressions. Using the striatal beat frequency (SBF) model, this highlights the essential role of the striatum’s timing that synchronizes cortical oscillations.[63] At onset of the event, ventral tegmental inputs reset the cortical phase that initiates the timing. During the event, the oscillations are monitored by neurons which is an identifier of the unique phase patterns for different durations of behavior. And when finished, the striatum decodes the patterns to aid in memory storage and comparison of event durations. Researchers discovered socio-temporal processes that attach social meaning to time, allowing the social significance to impact the perception and timing of acts.

Temporal locus

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Latency specifically measures the time that elapses between the event of a stimulus and the behavior that follows. This is important in behavioral research because it quantifies how quickly an individual may respond to external stimuli, providing insights into their perceptual and cognitive processing rates.[64] There are two measurements that are able to define temporal locus, they are response latency and interresponse time.

  • Response latency in children, when being treated with morphine they exhibit a longer time to the response latency in delayed matching of a simple task, and these children seem to have a harder time with social ability. This means that these children require more time to remember things when given the stimulus.[65]
  • Interresponse time refers to the duration of time that occurs between two instances of behavior, and it helps in understanding patterns and frequency of a certain behavior on a period of time.[64] Use of psychiatric medications may reduce the rate of response, but on the other hand lengthen the duration of interresponse time. The usage of these medications effectively reduces interest as the reaction declines as well.[66]

Derivative measures

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Derivative measures are additional metrics derived from primary data, often by combining or transforming dimensional quantities to offer deeper insights into a phenomenon. Despite not being directly tied to specific dimensions, these measures provide valuable supplemental information. In applied behavior analysis (ABA), for example, percentage is a derivative measure that quantifies the ratio of specific responses to total responses, offering a nuanced understanding of behavior and assisting in evaluating progress and intervention effectiveness. Trials-to-criterion, another ABA derivative measure, tracks the number of response opportunities needed to achieve a set level of performance. This metric aids behavior analysts in assessing skill acquisition and mastery, influencing decisions on program adjustments and teaching methods. Applied behavior analysis relies on meticulous measurement and impartial evaluation of observable behavior as a foundational principle. Without accurate data collection and analysis, behavior analysts lack the essential information to assess intervention effectiveness and make informed decisions about program modifications. Therefore, precise measurement and assessment play a pivotal role in ABA practice, guiding practitioners to enhance behavioral outcomes and drive significant change.

Behavior analysts utilize a few distinct techniques to gather information. A portion of the ways of collect data information include:

Frequency

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This technique refers to the times that an objective way of behaving was noticed and counted.[67] In the published article On Terms: Frequency and Rate in Applied Behavior Analysis, the authors state that two major texts, one being the Behavior Analyst Certification Board[68] pair the word "frequency" with two different words—one text pairing with "count" and the other "rate". Despite one major text using the word "count" interchangeably with "frequency", both texts advise readers they should not be using counts of behavior without referencing the time base of the observation. Additionally, when given that context of advice, the count and time information provide data rate. The authors of this article suggest that when looking at applied behavior analysis (ABA) and accessing behavior measurement, you should be using the term "rate" instead of "count" to reference frequency. Any references to counts without information about observation time should be avoided.[69]

In Annals of Clinical Psychiatry article Applied Behavioral Analytic Interventions for children with Autism: A Description and Review of Treatment Research, they point out how frequency is used to keep track of adaptive and maladaptive behaviors. By doing so, ABA therapists and clinicians are able to create a customized program for that patient. The author notes that tracking frequency, in cases specifically looking at frequency of requesting behaviors during play, language, imitation and socialization, can also be a variable to predict treatment outcome.[70]

Rate

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Same as frequency, yet inside a predefined time limit.

Duration

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This estimation alludes to how much time that somebody participated in a way of behaving.

Fluency

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Fluency, is a gauge on how smooth a behavior is performed. Fluency is associated with behaviors that we use over a long duration and be able to perform it with confidence. The three outcomes associated with fluency:

  • The ability to retain the behavior or action
  • Maintain the behavior while there are disruptions
  • The ability to transfer the behavior to other applications[71]

Fluency will increase the response speed and accuracy of a behavior. However, when introduced to a new stimulus different from their usual behavior, there will be a decrease in reaction time or increased response time but with more false alarms.[72][73] Fluency relies on repeated action so the amount of required effort for the behavior is lessened to an extent where the individual could focus more on the other factors of the behavior.[74]

There are two types of approaches to fluency:

  • Unassisted approach - Individual practice of certain behavior. Set a target of response speed and accuracy under a timeframe and readjust accordingly depending on the difficulty.
  • Assisted approach - Behavior assisted by a teacher or an individual.

The unassisted approach would need to perform their reached target behavior to someone. The assisted learning approach have a limitation that it would need an individual to assist them which could be time-consuming for both individuals[75]

Response latency

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Latency refers to how much time after a particular boost has been given before the objective way of behaving happens.[76][77]

Analyzing behavior change

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Experimental control

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In applied behavior analysis, all experiments should include the following:[78]

  • At least one participant
  • At least one behavior (dependent variable)
  • At least one setting
  • A system for measuring the behavior and ongoing visual analysis of data
  • At least one treatment or intervention condition
  • Manipulations of the independent variable so that its effects on the dependent variable may be quantitatively or qualitatively analyzed
  • An intervention that will benefit the participant in some way (behavioral cusp)

Methodologies developed through ABA research

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Task analysis

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Task analysis is the process of breaking down a multi-step instruction into its component parts. The student is then taught to complete a task analysis through chaining. For example, a task analysis of washing hands might include the following steps: Turn on the sink, put hands in the water, put soap on hands, scrub hands, rinse hands, turn off water.

Task analysis has been used in organizational behavior management, a behavior analytic approach to changing the behaviors of members of an organization (e.g., factories, offices, or hospitals).[79] Behavioral scripts often emerge from a task analysis.[80][81] Bergan conducted a task analysis of the behavioral consultation relationship[82] and Thomas Kratochwill developed a training program based on teaching Bergan's skills.[83] A similar approach was used for the development of microskills training for counselors.[84][85][86] Ivey would later call this "behaviorist" phase a very productive one[87] and the skills-based approach came to dominate counselor training during 1970–90.[88] Task analysis was also used in determining the skills needed to access a career.[89] In education, Englemann (1968) used task analysis as part of the methods to design the direct instruction curriculum.[90]

Chaining

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Main article: Chaining

Chaining is the process of teaching the steps of a task analysis. The two methods of chaining, forward chaining and backward chaining, differ based on what step a learner is taught to complete first. In forward chaining, the ABA practitioner teaches the learner to independently complete the first step and prompts the learner for all subsequent steps. In backward chaining, the practitioner prompts all steps except the last step. As the learner begins to respond independently, the practitioner systematically removes the prompts and teaches the next step in the task analysis. [91] [92]

Total task presentation is a variation of forward chaining where the practitioner asks the learner to perform the entire task analysis and provides prompting only when the learner is unable to complete a step independently. [93]


Prompting

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A prompt is a cue that is used to encourage a desired response from an individual.[94] Prompts are often categorized into a prompt hierarchy from most intrusive to least intrusive, although there is some controversy about what is considered most intrusive, those that are physically intrusive or those that are hardest prompt to fade (e.g., verbal).[95] In order to minimize errors and ensure a high level of success during learning, prompts are given in a most-to-least sequence and faded systematically.[96] During this process, prompts are faded as quickly as possible so that the learner does not come to depend on them and eventually behaves appropriately without prompting.[97][98]

Types of prompts

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Prompters might use any or all of the following to suggest the desired response:

  • Vocal prompts: Words or other vocalizations
  • Visual prompts: A visual cue or picture
  • Gestural prompts: A physical gesture
  • Positional prompt: e.g., the target item is placed close to the individual.
  • Modeling: Modeling the desired response. This type of prompt is best suited for individuals who learn through imitation and can attend to a model.
  • Physical prompts: Physically manipulating the individual to produce the desired response. There are many degrees of physical prompts, from quite intrusive (e.g., the teacher places a hand on the learner's hand) to minimally intrusive (e.g., a slight tap).[96]

This is not an exhaustive list of prompts; the nature, number, and order of prompts are chosen to be the most effective for a particular individual.

Fading

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The overall goal is for an individual to eventually not need prompts. As an individual gains mastery of a skill at a particular prompt level, the prompt is faded to a less intrusive prompt. This ensures that the individual does not become overly dependent on a particular prompt when learning a new behavior or skill.

One of the primary choices that was made while showing another way of behaving is the manner by which to fade the prompts or prompts. An arrangement should be set up to fade the prompts in an organized style. For instance, blurring the actual brief of directing a kid's hands might follow this succession: (a) supporting wrists, (b) contacting hands softly, (c) contacting lower arm or elbow, and (d) pulling out actual contact through and through. Fading guarantees that the kid does not turn out to be excessively subject to a specific brief while mastering another expertise.[77]

Thinning a reinforcement schedule

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Thinning is often confused with fading. Fading refers to a prompt being removed, where thinning refers to an increase in the time or number of responses required between reinforcements.[99] Periodic thinning that produces a 30% decrease in reinforcement has been suggested as an efficient way to thin.[100] Schedule thinning is often an important and neglected issue in contingency management and token economy systems, especially when these are developed by unqualified practitioners (see professional practice of behavior analysis).[101]

Generalization

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Generalization is the expansion of a student's performance ability beyond the initial conditions set for acquisition of a skill.[102] Generalization can occur across people, places, and materials used for teaching. For example, once a skill is learned in one setting, with a particular instructor, and with specific materials, the skill is taught in more general settings with more variation from the initial acquisition phase. For example, if a student has successfully mastered learning colors at the table, the teacher may take the student around the house or school and generalize the skill in these more natural environments with other materials. Behavior analysts have spent considerable amount of time studying factors that lead to generalization.[103]

Shaping

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Main article: Shaping (psychology)

Shaping involves gradually modifying the existing behavior into the desired behavior. If the student engages with a dog by hitting it, then they could have their behavior shaped by reinforcing interactions in which they touch the dog more gently. Over many interactions, successful shaping would replace the hitting behavior with patting or other gentler behavior. Shaping is based on a behavior analyst's thorough knowledge of operant conditioning principles and extinction. Recent efforts to teach shaping have used simulated computer tasks.[104]

One teaching technique found to be effective with some students, particularly children, is the use of video modeling (the use of taped sequences as exemplars of behavior). It can be used by therapists to assist in the acquisition of both verbal and motor responses, in some cases for long chains of behavior.[105][106]

Another example of shaping is when a toddler learns to walk. The child is reinforced by crawling, standing, taking a few steps, and then eventually walking. When a child is learning to walk, they are praised by a lot of claps and excitements.[107]

Interventions based on an FBA

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Functional behavioral assessment (FBA) is an individualized critical thinking process that may be used to address problem behavior. An evaluation is initiated to distinguish the causality of a problem behavior. This interactive evaluation includes gathering data about the ecological circumstances that occur prior to an identified conduct issue and the resulting rewards that reinforce the behavior. The data that is collected is then used to recognize and execute individualized interventions pointed toward lessening problem behaviors and expanding positive behavior outcomes.

Critical to behavior analytic interventions is the concept of a systematic behavioral case formulation with a functional behavioral assessment or analysis at the core.[108][109] This approach should apply a behavior analytic theory of change (see Behavioral change theories). This formulation should include a thorough functional assessment, a skills assessment, a sequential analysis (behavior chain analysis), an ecological assessment, a look at existing evidenced-based behavioral models for the problem behavior (such as Fordyce's model of chronic pain)[110] and then a treatment plan based on how environmental factors influence behavior. Some argue that behavior analytic case formulation can be improved with an assessment of rules and rule-governed behavior.[111][112][113] Some of the interventions that result from this type of conceptualization involve training specific communication skills to replace the problem behaviors as well as specific setting, antecedent, behavior, and consequence strategies.[114]

Criticisms

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Neurodiversity Movement

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See also: Autism rights movement

Some Neurodiversity advocates, including some who have experienced ABA interventions, believe that ABA attempts to eliminate or suppress autistic behaviors and forces autistic people to mask their true personalities in order to imitate neurotypical behaviors (e.g. eye contact, body language) and conform to an overly narrow conception of normal behavior.[115] [116] Masking is generally associated with suicidality and poor long-term mental health.[117][118] Instead, these critics advocate for increased social acceptance of harmless and sometimes adaptive autistic traits and interventions focused on improving well being and quality of life.[119] The Autistic Self Advocacy Network, campaigns against the use of ABA in autism.[120][121] The European Council of Autistic People (EUCAP) published a 2024 position statement expressing deep concern about the harm caused by ABA being overlooked. They emphasize that most surveyed autistic individuals view ABA as harmful, abusive, and counterproductive to their well-being. EUCAP advocates for a variety of support methods and the inclusion of autistic individuals in decision-making processes regarding their care.[122]

A 2020 study examined perspectives of autistic adults that received ABA as children and found that the overwhelming majority reported that "behaviorist methods create painful lived experiences", that ABA led to the "erosion of the true actualizing self", and that they felt they had a "lack of self-agency within interpersonal experiences".[123] Another study published in 2023 at Autism, one of the leading journals in autism, found similar results.[124]

Research Validity

[edit]

Conflicts of interest, methodological concerns, and a high risk of bias pervade most ABA studies.[125][126] A 2019 meta-analysis noted that "methodological rigor remains a pressing concern" in research into ABA's use as therapy for autism; while the authors found some evidence in favour of behavioral interventions, the effects disappeared when they limited the scope of their review to randomized controlled trial designs and outcomes for which there was no risk of detection bias.[127]

Conflicts of Interest in Research

[edit]

One study revealed extensive undisclosed conflicts of interest (COI) in published ABA studies. 84% of studies published in top behavioral journals over a period of one year had at least one author with a COI involving their employment, either as an ABA clinical provider or a training consultant to ABA clinical providers. However, only 2% of these studies disclosed the COI.[125]

Quality of evidence

[edit]

Low-quality evidence is likewise a concern in some research reporting on the potential harms of ABA on autistic children.[128]

Another concern is that ABA research only measures behavior as a means of success, which has led to a lack of qualitative research about autistic experiences of ABA, a lack of research examining the internal effects of ABA and a lack of research for autistic children who are non-speaking or have comorbid intellectual disabilities.[123][129][130][131] Research is also lacking about whether ABA is effective long-term and very little longitudinal outcomes have been studied.[129]

Ethical Concerns

[edit]

Opponents of ABA have denounced the ABA ethical code as too lenient, citing its failure to restrict or clarify the use of aversives, the absence of an autism or child development education requirement for ABA therapists, and its emphasis on parental consent rather than the consent of the person receiving services.[129][132] Numerous researchers have argued that ABA is abusive and can increase symptoms of post-traumatic stress disorder (PTSD) in people undergoing the intervention.[123][129][132][133][134] Some bioethicists argue that employing ABA violates the principles of justice and nonmaleficence and infringes on the autonomy of both autistic children and their parents.[132]

Use of aversives

[edit]

Lovaas incorporated aversives into some of the ABA practices he developed, including employing electric shocks, slapping, and shouting to modify undesirable behavior. Although the use of aversives in ABA became less common over time, and in 2012 their use was described as inconsistent with contemporary practice,[135] aversives persisted in some ABA programs. In comments made in 2014 to the US Food and Drug Administration (FDA), a clinician previously employed by the Judge Rotenberg Educational Center claimed that "all textbooks used for thorough training of applied behavior analysts include an overview of the principles of punishment, including the use of electrical brain stimulation."[136]

Response to Criticisms

[edit]

Justin B. Leaf and others examined and responded to several of these criticisms of ABA in three papers published in 2018, 2019, and 2022, respectively,[137][138][139] in which they questioned the evidence for such criticisms, concluding that the claim that all ABA is abusive has no basis in the published literature. Others have published similar responses.[140]


See also

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References

[edit]
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Applied behavior analysis
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