Too high a functioning for applied behavior analysis?

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Applied Behavior Analysis (ABA) is often described as the “gold standard” in autism therapy. But he has his detractors. Some people (especially high-level autistic self-advocates) find the technique humiliating and, in many cases, cruel to the child.

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Some experts suggest that ABA is really best for children with more severe forms of autism and recommend developmental or play therapy instead of ABA. Developmental and play therapy focuses more on interactivity, communication, and emotional growth, while ABA (unsurprisingly) focuses almost exclusively on behavior.

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

Why no one is “beyond” behavior modification

Behaviorism, in and of itself, is simply a way of teaching desired behavior by offering rewards for compliance (or consequences for non-compliance, although negative reinforcement has gone out of fashion in recent years). We use a behavioral approach when we say “you will have dessert if you finish your peas” or “you can go out with your friends if you clean your room”. Workplaces use behavioral techniques when offering incentives to achieve specific goals.

Behavioral treatment is effective for many children with autism. The goal of behavioral treatment is to help children catch up with the skill level of their developing peers. The program is individualized to incorporate the strengths and weaknesses specific to each child. Therefore, even children who are functioning well can benefit from behavioral treatment.

Why ABA may not be offered in a way that’s right for your child

ABA is often offered as part of an “autism classroom” designed to serve children with relatively severe symptoms. Most children who spend their days in an “autism class” spend little or no time in general education. If you have a high performing child who is intellectually and behaviorally capable of learning in a general education classroom, the “autism class” is likely not to be suitable.

ABA can also be offered on an individual basis. This can be very useful for a child who is learning very basic skills or who is not yet able to engage with their peers in a playground or other typical setting. For a child who performs better, 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 environment, ABA may be ill-suited.

According to the Lovaas Institute and many ABA providers, ABA should be offered several hours per week (up to 40 hours). At this level of intensity, it is literally impossible for a child to participate in anything other than therapy outside of school as well. No sports, no music, no downtime, unless an ABA therapist is actually working with the child during their extracurricular activities. If you have a child who is able to participate in typical activities and ABA would make those activities impossible, ABA may be a bad choice.

How ABA should be personalized for a better functioning child

There is little data available in peer-reviewed research articles that compare behavioral treatment outcomes for “low functioning” and “high functioning” children. In addition, there are few studies comparing the effectiveness of different “brands” of ABA for different groups of children. However, it is possible to make specific recommendations to personalize ABA according to the needs of a better performing child:

  • The goal of behavioral treatment is to help children catch up with the skill level of their developing peers. Behavioral processing can be modified to teach complex behaviors and social skills such as recognizing facial expressions and the nonverbal behavior of others, developing cooperative social behavior, verbalizing empathy, and conversing with others. peers on a variety of topics rather than a narrow range of topics. interests.
  • Behavior therapy can look very different for a “low-functioning” and “high-functioning” autistic child. In addition to discrete trials (individual therapy for infants with poor functioning), other healthy behavioral procedures such as incidental teaching, video modeling, and generalization in the natural environment may be emphasized more strongly.
  • Behavior 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 the 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) regularly measuring progress.

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

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