Applied Behaviour Analysis

Applied behavior analysis (ABA), also called behavioral engineering, is a psychological intervention that applies empirical approaches based upon the principles of respondent and operant conditioning to change behavior of social significance.See also footnote number "(1)" of nd the whole "What is ABA?" section of Where the same definition is given, (or quoted), and it credits (or mentions) both the source "Baer, Wolf & Risley, 1968" (Drs. Donald Baer, PhD, Montrose Wolf, PHD and Todd R. Risley, PhD, (Professor Emeritus of Psychology at the University of Alaska) were psychologists who developed science of applied behavior analysis) and ianother source, called "Sulzer-Azaroff & Mayer, 1991". Beth Sulzer-Azaroff is a psychologist at University of Massachusetts Amherst, Department of Psychology

It is the applied form of behavior analysis; the other two forms are radical behaviorism (or the philosophy of the science) and the experimental analysis of behavior (or basic experimental research).

The name ''applied behavior analysis'' has replaced behavior modification because the latter approach suggested attempting to change 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. Further, the approach often seeks to develop socially acceptable alternatives for aberrant behaviors.

Although service delivery providers overwhelmingly specialize in autism treatment, ABA has also been utilized in a range of other areas, including applied animal behavior, schoolwide positive behavior support, classroom instruction, structured and naturalistic early behavioral interventions for autism, pediatric feeding therapy, rehabilitation of brain injury, dementia, fitness training, counseling, substance abuse, phobias, tics, and organizational behavior management.

ABA is controversial, especially within the autism rights movement, partly due to a perception that it emphasizes normality instead of acceptance, and a history of the use of aversives, such as electric shocks.

Definition

ABA is an applied science devoted to developing procedures which will produce observable changes in behavior. It is to be distinguished from the experimental analysis of behavior, which focuses on basic experimental research, but it uses principles developed by such research, in particular operant conditioning and classical conditioning. Behavior analysis adopts the viewpoint of radical behaviorism, treating thoughts, emotions, and other covert activity as behavior that is subject to the same rules as overt responses. 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 also emphasize that the science of behavior must be a ''natural'' science as opposed to a ''social'' science. As such, behavior analysts focus on the observable relationship of behavior with the environment, including antecedents and consequences, without resort to "hypothetical constructs".

History

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,
which led to researchers at the University of Kansas to start the '' Journal of Applied Behavior Analysis'' (JABA) in 1968.

A group of researchers at the University of Washington, including Donald Baer, Sidney W. Bijou, Bill Hopkins, Jay Birnbrauer, Todd Risley, and Montrose Wolf, applied the principles of behavior analysis to 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''.

Notable graduate students from the University of Washington include Robert Wahler, James Sherman, and Ivar Lovaas. 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, 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.

In 1987, Lovaas published the study, "Behavioral treatment and normal educational and intellectual functioning in young autistic children". 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). 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, and language. The use of aversives and reinforcement were used to motivate learning and reduce non-desired behaviors. Early development of the therapy in the 1960s involved use of shocks and the withholding of food. By the time children were enrolled in this study, such aversives were abandoned, and a loud "no" or a 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 typical adolescent peers. This included passing education without assistance and making and maintaining friends. 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. 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. This analysis is based on careful initial assessment of a behavior's function and a testing of methods that produce changes in behavior.

While ABA seems to be intrinsically linked to autism intervention, it is also used in a broad range of other situations. Recent notable areas of research in JABA include autism, classroom instruction with typically developing students, pediatric feeding therapy, and substance-use disorders. Other applications of ABA include applied animal behavior, consumer behavior analysis, behavioral medicine, behavioral neuroscience, clinical behavior analysis, forensic behavior analysis, increasing job safety and performance, schoolwide positive behavior support, and contact desensitization for phobias.

Characteristics

Baer, Wolf, and Risley's 1968 article is still used as the standard description of ABA. It lists the following seven characteristics of ABA.
* 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.
* 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 measured. 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. 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. 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.
* Conceptually Systematic: Behavior analysis should not simply produce a list of effective interventions. Rather, to the extent possible, these methods should be grounded in behavioral principles. 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. 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.

Other proposed characteristics

In 2005, Heward et al. suggested that the following five characteristics should be added:
* Accountable: To be accountable means that ABA must be able to demonstrate that its methods are effective. This requires the 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.Heward, 205 p. 322
* 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.
* Optimistic: According to several leading authors , 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.

Use in the treatment of autism spectrum disorders

A large majority of ABA practitioners specialise in autism, although BCBA certification does not require any autism training. ABA-based techniques are often used to teach adaptive behaviors or to diminish behaviors associated with autism, so much that ABA itself is often mistakenly considered to be synonymous with therapy for autism. According to a paper from 2007, it was considered to be an effective "intervention for challenging behaviors" by the American Academy of Pediatrics. A 2018 Cochrane review of five studies that compared treatment vs. control showed that ABA may be effective for some autistic children. The effectiveness of ABA treatments for autism may be overall limited by diagnostic severity, age of intervention, and IQ.

Efficacy

2020 onward reviews

Justin B. Leaf and others examined and responded to criticisms of ABA in a 2021 paper.

The results of two studies surveying autistic adults who went through ABA as a child found that a majority perceived ABA to have a detrimental impact on their lives, although in common with most ABA research, the studies had methodological concerns and a risk of bias. Two 2020 reviews found that very few studies directly reported on or investigated possible harms; although a significant number of studies mentioned adverse events in their analysis of why people withdrew from them, there was no effort to monitor or collect data on adverse outcomes.

2010-2019 reviews

In 2011, investigators from Vanderbilt University under contract with the Agency for Healthcare Research and Quality performed a comprehensive review of the scientific literature on ABA-based and other therapies for autism spectrum disorders; the ABA-based therapies included the UCLA/Lovaas method and the Early Start Denver Model (the latter developed by Sally Rogers and Geraldine Dawson). They concluded that "both approaches were associated with ... improvements in cognitive performance, language skills, and adaptive behavior skills". However, they also concluded that "the strength of evidence ... is low", "many children continue to display prominent areas of impairment", "subgroups may account for a majority of the change", there is "little evidence of practical effectiveness or feasibility beyond research studies", and the published studies "used small samples, different treatment approaches and duration, and different outcome measurements".

A preliminary 2014 study indicated that there might be a publication bias against single-subject research studies that show that ABA is ineffective. Publication bias could lead to exaggerated estimates of intervention effects observed by single-subject studies.

2007-2009 reviews

A 2007 clinical report of the American Academy of Pediatrics concluded that the benefit of ABA-based interventions in autism spectrum disorders (ASDs) "has been well documented" and that "children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior". In 2008, Researchers from the MIND Institute published an evidence-based review of comprehensive treatment approaches. On the basis of "the strength of the findings from the four best-designed, controlled studies", they were of the opinion that one ABA-based approach (the Lovaas technique created by Ole Ivar Løvaas) is "well-established" for improving intellectual performance of young children with ASD.

A 2009 review of psycho-educational interventions for children with autism whose mean age was six years or less at intake found that five high-quality ("Level 1" or "Level 2") studies assessed ABA-based treatments. On the basis of these and other studies, the author concluded that ABA is "well-established" and is "demonstrated effective in enhancing global functioning in pre-school children with autism when treatment is intensive and carried out by trained therapists". However, the review committee also concluded that "there is a great need for more knowledge about which interventions are most effective". A 2009 paper included a descriptive analysis, an effect size analysis, and a meta-analysis of 13 reports published from 1987 to 2007 of early intensive behavioral intervention (EIBI, a form of ABA-based treatment with origins in the Lovaas technique) for autism. It determined that EIBI's effect sizes were "generally positive" for IQ, adaptive behavior, expressive language, and receptive language. The paper did note limitations of its findings including the lack of published comparisons between EIBI and other "empirically validated treatment programs". In a 2009 systematic review of 11 studies published from 1987 to 2007, the researchers wrote "there is strong evidence that EIBI is effective for some, but not all, children with autism spectrum disorders, and there is wide variability in response to treatment". Furthermore, any improvements are likely to be greatest in the first year of intervention.

A 2009 meta-analysis of nine studies published from 1987 to 2007 concluded that EIBI has a "large" effect on full-scale intelligence and a "moderate" effect on adaptive behavior in autistic children. A 2009 systematic review and meta-analysis by Spreckley and Boyd of four small-n 2000–2007 studies (involving a total of 76 children) came to different conclusions than the aforementioned reviews. Spreckley and Boyd reported that applied behavior intervention (ABI), another name for EIBI, did not significantly improve outcomes compared with standard care of preschool children with ASD in the areas of cognitive outcome, expressive language, receptive language, and adaptive behavior. In a letter to the editor, however, authors of the four studies meta-analyzed claimed that Spreckley and Boyd had misinterpreted one study comparing two forms of ABI with each other as a comparison of ABI with standard care, which erroneously decreased the observed efficacy of ABI. Furthermore, the four studies' authors raised the possibility that Spreckley and Boyd had excluded some other studies unnecessarily, and that including such studies could have led to a more favorable evaluation of ABI. Spreckley, Boyd, and the four studies' authors did agree that large multi-site randomized trials are needed to improve the understanding of ABA's efficacy in autism.

Criticism

One area of critique has been the "ideological warfare" surrounding ABA and TEACCH, despite the philosophies and practices of the two approaches not necessarily being in opposition. The rhetoric surrounding ABA was criticized by The British Institute of Learning Disabilities, including parents and professionals that claim that ABA "cured" their child's autism, like one parent who "claims that ABA had saved her children's lives, likening it to chemotherapy as a treatment for cancer."

Researchers have cri