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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) is a scientific discipline that utilizes the principles of learning based upon respondent and operant conditioning to make socially significant changes in a subject's behavior. ABA is the applied form of behavior analysis. The impact ABA has on meaningful behaviors is a defining feature, and what differentiates it from experimental analysis of behavior, which focuses on basic experimental research.[1]

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, behavior management in classrooms, and acceptance and commitment therapy.[2][3][4]

ABA is controversial, and generally rejected by the autism rights movement. Among other reasons, this is because of a history of suppressing autistic behaviors such as stimming; using aversives, such as physical pain, or in modern forms, withholding stimuli that bring comfort; and because of its weak evidence base and failure to investigate possible harms.

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.[5] The social validity of interventions is what differentiates ABA from experimental analysis of behavior, which focuses on basic experimental research.[6] 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.[7] 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.[8]

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 field of behaviorism originated in 1913 by John B. Watson with his seminal work "Psychology as the Behaviorist Views it.".[9] In it, Watson argued against the field of psychology's focus on consciousness and proposed the field instead focus on the relationship between stimuli and observable behavioral responses (S-R behaviorism).[10]

The field of experimental behaviorism, which was partially based on Waton's work, was founded by B. F. Skinner in the 1930s and 1940s.[11] Skinner is credited with being the first person to describe the principals of operant conditioning and the philosophy of radical behaviorism, which are the foundations of Applied Behavior Analysis. Skinner was also one of the founders of the Journal of Experimental Analysis of Behavior (JEAB) in 1958, which was the first academic journal focused on the publication of research in experimental behaviorism.

The first experiments studying the effectiveness of behavior analysis on human subjects were published in the 1940s and 50s, including B.F. Skinner's "Baby in a box" in 1945 and Paul Fueller's 1949 "Operant conditioning of a vegetative human organism." Jack Michael's study "The psychiatric nurse as a behavioral engineer" in 1959 was the first to utilize the concepts of behaviorism to effect meaningful change in the subject's behavior.[11][12][13] The successful and meaningful use of behavior analysis in human subjects led researchers at the University of Kansas to start the Journal of Applied Behavior Analysis (JABA) in 1968.[14][15]

A group of researchers at the University of Washington, including Donald Baer, Sidney W. Bijou, Bill Hopkins, Jay Birnbrauer, Todd Risley, and Montrose Wolf,[16][17] 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.[18]

From 1960 through 1997, Ivar Lovaas researched the efficacy of ABA techniques on autistic and schizophrenic children. While Lovaas's work was instrumental in establishing ABA as an effective treatment of autism through the Lovaas method, his use of shock treatment has considerable ethical concerns, and the practice has been condemned by the Association for Behavior Analysis Interntational.[19][20]

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.[21]

Characteristics

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7 Characteristics of ABA

Baer, Wolf, and Risley's 1968 article[22] is still used as the standard description of ABA.[15][23] 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.[24]

  • Applied: ABA focuses on the social significance of the behavior studied and works to improve the lives of those receiving ABA services.
  • Behavioral: ABA focuses on behavior, which is defined as the observable and measurable movements of an organism. Definitions of behavior should be written so they can be clearly understood by a third party who is collecting data on the behavior.
  • 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.[1] 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.[1]
  • Conceptually Systematic: Behavior analysis should not simply produce a list of effective interventions; rather, intervention protocols should focus on including technological descriptions as well as theoretically meaningful terms, such as "secondary reinforcement" or "errorless discrimination", to help the reader understand how the concepts could be used in similar protocols.
  • Effective: Interventions must produce behavioral changes that have a large enough effect to make meaningful, positive changes in the client's life.
  • Generality: ABA intervention should focus on selecting and teaching new behaviors so the client can transfer those skills into new environments and stimuli outside of what was directly taught. Behavior analysts should incorporate plans for generalization when creating programs.

Other proposed characteristics

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In 2005, Heward et al. suggested the addition of the following five characteristics:[25]

  • Accountable: 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.[25]: 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.[26]
  • Optimistic: 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.[27][6] Practitioners often use ABA-based techniques to teach adaptive behaviors to, or diminish challenging behaviors presented by, individuals with autism.[28][29] ABA methodologies such as differential reinforcement, extinction, and task analysis, are among the most well-researched evidence-based practices for autism intervention.[30]

History

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Early development of the techniques that would later become the Lovaas method involved use of electric shocks, scolding, and the withholding of food.[31][32] 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.

In 1965, Ivar Lovaas published a series of articles that described a pioneering investigation of the antecedents and consequences that maintained a problem behavior,[33] 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,[34] 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.[33][35]

In 1987, Lovaas published the study, "Behavioral treatment and normal educational and intellectual functioning in young autistic children".[14] 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) with a trained student therapist.[36] The treatment was implemented at home by student therapists. Parents were trained on the teaching techniques to allow near-constant ABA instruction. During episodes of aggressive or self-stimulatory behavior, interventionists used planned ignoring, reinforcing appropriate alternative behavior, and "as a last resort...the delivery of a loud "no" or a slap on the thigh contin- gent upon the presence of the undesirable behavior."[14] 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.[37][38] The "Lovaas Method" went on to become known as early intensive behavioral intervention (EIBI).

Modern practices

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In 2018, a Cochrane meta-analysis database concluded that some recent research is beginning to suggest that 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.[39] A 2023 multi-site randomized control trial study of 164 participants showed similar findings.[40]

Applications outside of autism intervention

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Although most research in ABA focuses on 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,[3] classroom instruction with typically developing students, pediatric feeding therapy,[2][3][41] and substance use disorders.[2][3] Other applications of ABA include applied animal behavior, consumer behavior analysis, forensic behavior analysis, behavioral medicine, behavioral neuroscience, clinical behavior analysis,[2][3] organizational behavior management,[2][3] schoolwide positive behavior interventions and support,[2][42][43][44][45] and contact desensitization for phobias.

Animal Welfare

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ABA has been successfully used in other species.[46] Morris uses ABA to reduce feather-plucking in the black vulture (Coragyps atratus).[46][47][48]

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.[49] 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.[15][50] 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 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 the three-term contingency, first, a discriminative stimulus signals to the subject that reinforcement (or, less commonly, punishment) is available. Then, the subject performs a behavior. After performing a behavior, a consequence will occur that either adds (positive) or removes (negative) something that will make the behavior either occur more (reinforcement) or less (punishment) frequently in the future.

Reinforcement

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Main article: Reinforcement

Reinforcement occurs when the consequence of a behavior makes it more likely for that behavior to occur in the future. Reinforcing consequences can be either positive, where something preferred is added, or negative, where something aversive is removed.[51] Reinforcement is the key element in operant conditioning and most behavior change programs.[52][53] There are multiple schedules of reinforcement that affect the future probability of behavior.

Punishment

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Main article: Punishment (psychology)

Punishment occurs when the consequences of a behavior make the behavior less likely to occur in the future.[54] 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').[55] Punishment in practice can often result in unwanted side effects.[56] 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.[57]

Respondent (classical) conditioning

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Main article: Classical conditioning

Respondent (classical) conditioning is based on involuntary reflexes. In his experiments with dogs, Ivan 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).

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.[58]: 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.[58]: 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.[59] 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.[60] 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.[61] 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...")

Measuring behavior

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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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The temporal extent refers to the duration of the response, which is the measure of time from the start to the end of the response. The duration of a response is either the duration of each response or the duration of all responses during a specific timeframe, which is then recorded as a percentage.[63]

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 measures the time between the presentation of a stimulus, such as an instruction, and the first response.[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:


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.[67][68]

Analyzing behavior change

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Experimental control

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In applied behavior analysis, all experiments should include the following:[69]

  • 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).[70] Behavioral scripts often emerge from a task analysis.[71][72] Bergan conducted a task analysis of the behavioral consultation relationship[73] and Thomas Kratochwill developed a training program based on teaching Bergan's skills.[74] A similar approach was used for the development of microskills training for counselors.[75][76][77] Ivey would later call this "behaviorist" phase a very productive one[78] and the skills-based approach came to dominate counselor training during 1970–90.[79] Task analysis was also used in determining the skills needed to access a career.[80] In education, Englemann (1968) used task analysis as part of the methods to design the direct instruction curriculum.[81]

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. [82][83]

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.[84]

Prompting

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A prompt is a cue that encourages a desired response from an individual.[85] 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).[86] 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.[87] 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.[88][89]

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.[68]

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.[90] Periodic thinning that produces a 30% decrease in reinforcement has been suggested as an efficient way to thin.[91] 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).[92]

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.[93] 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.[94]

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.[95]

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.[96][97]

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.[98]

Acceptance and Commitment Therapy

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Acceptance and Commitment Therapy (ACT), is a therapeutic approach based on behavior analytic principles with the theoretical framework of Relational Frame Theory.[99] The primary goal of ACT is to help the client acknowledge negative or unwanted private events described by Skinner, such as thoughts and feelings, and shift their self-identity from one based on psychological phenomenon to one based in self-as-context.[100]

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.[101][102] 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)[103] 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.[104][105][106] 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.[107]

Criticisms

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Neurodiversity Movement

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See also: Autism rights movement

Some Neurodiversity advocates, including some autistic people who have experienced ABA interventions, believe that ABA attempts to eliminate, suppress or reduce autistic behaviors and reinforces 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.[108][109] Masking is generally associated with suicidality and poor long-term mental health.[110][111] 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.[112] The Autistic Self Advocacy Network, campaigns against the use of ABA in autism.[113][114] 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.[115]

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".[116] Another study published in 2023 at Autism, one of the leading journals in autism, found similar results, with evidence of increased masking and causing mental health challenges for some autistic people.[117]

Research Validity

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Conflicts of interest, methodological concerns, and a high risk of bias pervade most ABA studies.[118][119] 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.[120]

Conflicts of Interest in Research

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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.[118]

Quality of evidence

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Low-quality evidence is likewise a concern in some research reporting on the potential harms of ABA on autistic children.[121]

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.[116][122][123][124] Research is also lacking about whether ABA is effective long-term and very little longitudinal outcomes have been studied.[122]

Ethical Concerns

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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.[122][125] Numerous researchers have argued that some forms of ABA interventions can be abusive and can increase symptoms of post-traumatic stress disorder (PTSD) in people undergoing the intervention.[116][122][125][126][127] 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.[125]

Use of aversives

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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,[128] 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."[129]

Skinner's verbal operants were critiqued by the linguist Noam Chomsky who argued that Skinner's view of language as behavior did not explain the complexity of human language.[irrelevant citation][130]

Response to Criticisms

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Justin B. Leaf and others examined and responded to several of these criticisms of ABA in three papers published in 2018[131] 2019,[132] and 2022[133] 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.[134]

See also

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References

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Sources

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Further reading

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Library resources about
Applied behavior analysis
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