Applied behavior analysis (ABA), previously known as behavior modification, is the application of behaviorism that modifies human behaviors, especially as part of a learning or treatment process. Behavior analysts focus on the observable relationship of behavior to the environment without resort to "hypothetical constructs". By functionally assessing the relationship between a targeted behavior and the environment, the methods of ABA can be used to change that behavior.
ABA is defined as the science in which the principles of the analysis of behavior are applied systematically to improve socially significant behavior, and in which experimentation is used to identify the variables responsible for change in behavior. It is one of the three fields of behavior analysis. The other two are conceptual analysis of behavior, or the philosophy of the science; and experimental analysis of behavior, or basic experimental research.
Ole Ivar Lovaas is considered a grandfather of Applied Behavior Analysis and developed standardized teaching interventions based on behavioral principals. Lovaas devoted nearly a half a century to groundbreaking research and practice aimed at improving the lives of children with autism and their families. In 1965, Lovaas published a series of articles that therapeutic approaches to autism. The first two articles presented his system for coding behaviors during direct observations and a pioneering investigation of antecedents and consequences that maintained a problem behavior, a forerunner of what is now called experimental functional analysis. The subsequent articles built upon these methods and reported the first demonstration of an effective way to teach nonverbal children to speak, a study on establishing social (secondary) reinforcers, a procedure for teaching children to imitate, and several studies on interventions to reduce life-threatening self-injury and aggression.
Lovaas was cited in his early career to use low dosages of electroshock therapy to children with extreme self injurious behavior. In 1973, Lovaas published a long-term follow-up for the behavior modification intervention and was dismayed to find that most of the subjects had reverted to their pre-intervention behaviors. After these findings, Lovaas and his colleagues proposed several ways to improve outcomes such as starting intervention during the children's preschool years instead of later in childhood or adolescence, involving parents in the intervention, and implementing the intervention in the family's home rather than an institutional setting. Subsequent articles like the 1987 "Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children" reinforce this proposal of early and intensive intervention—without the use of aversives (such as electric shocks)—paired with continual therapy yields the most effective results for children with autism. Lovaas highly believed that the support and involvement in parents applying therapy at home contributed to a higher success rate. Lovaas dedicated his life to the study of autism and was a strong advocate for people with autism even co-founding what is today the Autism Society of America.
Baer, Wolf, and Risley's 1968 article is still used as the standard description of ABA. It describes the seven dimensions of ABA: application; a focus on behavior; the use of analysis; and its technological, conceptually-systematic, effective, and general approach.
ABA focuses on areas that are of social significance. In doing this, behavior scientists must take into consideration more than just the short-term behavior change, but also look at how behavior changes can affect the consumer, those who are close to the consumer, and how any change will affect the interactions between the two.
ABA must be behavioral, i.e.: behavior itself must change, not just what the consumer says about the behavior. It is not the goal of the behavior scientists to get their consumers to stop complaining about behavior problems, but rather to change the problem behavior itself. In addition, behavior must be objectively measured. A behavior scientist cannot resort to the measurement of non-behavioral substitutes. (Obviously multidisciplinary work within behavior and psychology may include, for example, analysis of cognition or demographics and exploration of the individual as well, where experimental standards are maintained.)
ABA must be analytic, which means that the behavior analyst can control the behavior that is being changed by changing the control behavior. In the lab, this has been easy as the researcher can start and stop the behavior at will. However, in the applied situation, this is not always as easy, nor ethical, to do. According to Baer, Wolf, and Risley, this difficulty should not stop a science from upholding the strength of its principles. As such, they referred to two designs that are best used in applied settings to demonstrate control and maintain ethical standards. These are the reversal and multiple baseline designs. The reversal design is one in which the behavior of choice is measured prior to any intervention. Once the pattern appears stable, an intervention is introduced, and behavior is measured. If there is a change in behavior, measurement continues until the new pattern of behavior appears stable. Then, the intervention is removed, or reduced, and the behavior is measured to see if it changes again. If the behavior scientist truly has demonstrated control of the behavior with the intervention, the behavior of interest should change with intervention changes. Here control may be better called "effect" or "influence", of behavior.
This means that if any other researcher were to read a description of the study, that researcher would be able to "replicate the application with the same results." This means that the description must be very detailed and clear. Ambiguous descriptions do not qualify. Cooper et al. describe a good check for the technological characteristic: "have a person trained in applied behavior analysis carefully read the description and then act out the procedure in detail. If the person makes any mistakes, adds any operations, omits any steps, or has to ask any questions to clarify the written description then the description is not sufficiently technological and requires improvement." This is where the experiment is repeatable.
A defining characteristic is in regard to the interventions used; and thus research must be conceptually systematic by only using procedures and interpreting results of these procedures in terms of the principles from which they were derived.
ABA must be effective, which means that the application of these techniques changes the behavior it seeks to change. Specifically, it is not a theoretical importance of the variable, but rather the practical importance (social importance) that is essential. If the application of behavioral techniques does not produce a large enough effects for practical value, then the application has failed.
ABA must be general, which means that it persists over time, in different environments, and spreads to other behaviors not directly treated by the intervention. In addition, continued change in specified behavior after intervention for that behavior has been withdrawn is also an example of generality. It is a goal to identify behavior stimuli with long-lasting and general effect.
Proposed additional characteristics
In 2005, Heward, et al. added their belief that the following five characteristics should be added:
Accountable: Direct and frequent measurement enables analysts to detect their success and failures to make changes in an effort to increase successes while decreasing failures. ABA is a scientific approach in which analysts may guess but then critically test ideas, rather than "guess and guess again." This constant revision of techniques, commitment to effectiveness and analysis of results leads to an accountable science.
Public: Applied behavior analysis is completely visible and public. This means that there are no explanations that cannot be observed, but of course these are each imposed. There are no mystical, metaphysical explanations, hidden treatment, or magic. Thus, ABA produces results whose explanations are available to all of the public.
Doable: ABA has a pragmatic element in that implementors of interventions can consist of a variety of individuals, from teachers to the participants themselves. This does not mean that ABA requires one simply to learn a few procedures, but with the proper planning, it can effectively be implemented by almost everyone willing to invest the effort.
Empowering: ABA provides tools to practitioners that allow them to effectively change behavior. By constantly providing visual feedback to the practitioner on the results of the intervention, this feature of ABA allows clinicians to assess their skill level and builds confidence in their technology.
Optimistic: According to several leading authors, practitioners skilled in behavior analysis have genuine cause to be optimistic for the following reasons:
Individual behavior is largely determined by learning and cumulative effects of the environment, which itself is manipulable
Direct and continuous measurements enable practitioners to detect small improvements in performance that might have otherwise been missed
As a practitioner uses behavioral techniques with positive outcomes, the more they will become optimistic about future success prospects
The literature provides many examples of success teaching individuals considered previously unteachable.
Behavior is the activity of living organisms. Human behavior is the entire gamut of what people do including thinking and feeling. Behavior can be determined by applying the Dead Man's test:
If a dead man can do it, it isn't behavior. And if a dead man can't do it, then it is behavior.
This is obviously only a simple rubric.
Behavior is that portion of an organism's interaction with its environment that is characterized by detectable displacement in space through time of some part of the organism and that results in a measurable change in at least one aspect of the environment. Often, the term behavior is used to reference a larger class of responses that share physical dimensions or function. In this instance, the term response indicates a single instance of that behavior. If a group of responses have the same function, this group can be classified as a response class. Finally, when discussing a person's collection of behavior, repertoire is used. It can either pertain specifically to a set of response classes that are relevant to a particular situation, or it can refer to every behavior that a person can do.
Operant behavior is that which is selected by its consequences. The conditioning of operant behavior is the result of reinforcement and punishment. Operant conditioning applies to so-called "voluntary" responses, which an organism emits and increase or decrease in frequency as a function of the consequences which follow. The term operant emphasizes this point: the organism's behavior operates upon its environment to produce some type of desirable result. For example, operant conditioning is at work when we learn that toiling industriously can bring about a raise or that studying hard for a particular class will result in good grades, in positive reinforcement.
All organisms respond in predictable ways to certain stimuli. These stimulus–response relations are called reflexes. The response component of the reflex is called respondent behavior. It is defined as behavior which is elicited by antecedent stimuli. Respondent conditioning (also called classical conditioning) is learning in which new stimuli acquire the ability to elicit respondents. This is done through stimulus–stimulus pairing, for example, the stimulus (smell of food) can elicit a person's salivation. By pairing that stimulus (smell) with another stimulus (e.g., a light), the second stimulus can obtain the function of the first stimulus, given that the predictive relationship between the two stimuli is maintained. This is also known as "Pavlov's dog's bell".
The environment is the entire constellation of stimuli in which an organism exists. This includes events both inside and outside of an organism, but only real physical events are included. The environment consists of stimuli. A stimulus is an "energy change that affects an organism through its receptor cells."
A stimulus can be described:
Topographically by its physical features.
Temporally by when they occur in respect to the behavior.
Reinforcement is the most important principle of behavior and a key element of most behavior change programs. 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. The addition of a stimulus following an event that serves as a reinforcer is termed positive reinforcement. If the removal of an event serves as a reinforcer, this is termed negative reinforcement. There are multiple schedules of reinforcement that affect the future probability of behavior.
Punishment is a process by which a consequence immediately follows a behavior which decreases the future frequency of that behavior. 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'). Punishment in practice can often result in unwanted side effects. 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.
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. The behavior is then set to be extinguished (Cooper, et al.). Extinction procedures are often preferred over punishment procedures that are frequently 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. Other characteristics of an extinction burst include a) 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
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. 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. 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.
B.F. Skinner's classification system of behavior analysis has been applied to treatment of a host of communication disorders. Skinner's system includes:
Tact (psychology) – a verbal response evoked by a non-verbal antecedent and maintained by generalized conditioned reinforcement.
Mand (psychology) – 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...")
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.
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.
This dimension indicates that each instance of behavior occupies some amount of time—i.e., how long the behavior occurs.
Duration is the amount of time in which the behavior occurs.
Each instance of behavior occurs at a specific point in time—i.e., when the behavior occurs.
Response latency is the measure of elapsed time between the onset of a stimulus and the initiation of the response.
Interresponse time is the amount of time that occurs between two consecutive instances of a response class.
Derivative measures are unrelated to specific dimensions:
Percentage is the ratio formed by combining the same dimensional quantities.
Trials-to-criterion are the number of response opportunities needed to achieve a predetermined level of performance.
Analyzing behavior change
In applied behavior analysis, all experiments should include the following:
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
Functional assessment of behavior provides hypotheses about the relationships between specific environmental events and behaviors. Decades of research have established that both desirable and undesirable behaviors are learned through interactions with the social and physical environment. FBA is used to identify the type and source of reinforcement for challenging behaviors as the basis for intervention efforts designed to decrease the occurrence of these behaviors.
Functions of behavior
The function of a behavior can be thought of as the purpose a behavior serves for a person.
Behavior can serve the following common functions for an individual:
Access to attention
e.g., Child throws toy because it characteristically results in mom's attention. (If this behavior results in mom looking at child and giving him lots of attention—even if she's saying "NO"—he will be more likely to engage in the same behavior in the future to get mom's attention.)
Escape/removal of a demand or aversive event
e.g., Mom tells the child "Go clean up" and child runs to the kitchen because mom historically will not require him/her to complete the task when this behavior occurs.
e.g., Child flaps (or other stereotypic, repetitive movement) because it produces perceptual stimulation/sensory consequences. This also includes pain attenuation via removal of unpleasant stimulation (e.g., toothache, stomach pain, fever)
Access to tangibles (e.g., activities, toys, edibles)
e.g., Child hits mom because s/he wants the toy mom is holding and mom typically delivers it following this behavior.
We can describe behaviors in various ways such as tantrums, noncompliance, inattention, aggression; however all behavior can be classified as serving one or more of the functions above.
Function is identified in an FBA by identifying the type and source of reinforcement for the behavior of interest. Those reinforcers might be positive or negative social reinforcers provided by someone who interacts with the person, or automatic reinforcers produced directly by the behavior itself.
Positive reinforcement – social positive reinforcement (attention), tangible reinforcement, and automatic positive reinforcement.
Negative reinforcement – social negative reinforcement (escape), automatic negative reinforcement.
Function versus topography
Behaviors may look different but can serve the same function and likewise behavior that looks the same may serve multiple functions. What the behavior looks like often reveals little useful information about the conditions that account for it. However, identifying the conditions that account for a behavior, suggests what conditions need to be altered to change the behavior. Therefore, assessment of function of a behavior can yield useful information with respect to intervention strategies that are likely to be effective.
FBA methods can be classified into three types:
Functional (experimental) analysis
Functional (experimental) analysis
A functional analysis is one in which antecedents and consequences are manipulated to indicate their separate effects on the behavior of interest. This type of arrangement is often called synthetic because they are not conducted in a naturally occurring context. However, research is indicating that functional analysis done in a natural environment will yield similar or better results.
A standard functional analysis normally has four conditions (three test conditions and one control):
While the above four conditions are the most widely used functional analysis experimental conditions, using the basic methodology of functional analysis (and experimental analysis in general) it is possible to arrange any combination of antecedents and consequences for behavior to determine what effect, if any, they have on a behavior.
Advantages – it has the ability to yield a clear demonstration of the variable(s) that relate to the occurrence of a problem behavior. It serves as the standard of scientific evidence by which other assessment alternatives are evaluated. It represents the method most often used in research on the assessment and treatment of problem behavior.
Limitations – assessment process may temporarily strengthen or increase the undesirable behavior to gravely unacceptable levels or result in the behavior acquiring new unpleasant functions. Some behaviors may neither be amenable to functional analyses (e.g., those that, albeit serious, occur infrequently). Functional analyses conducted in contrived settings may not detect the variable that accounts for the occurrence in the natural environment.
As with functional analysis, descriptive functional behavior assessment utilizes direct observation of behavior; unlike functional analysis, however, observations are made under naturally occurring conditions. Therefore, descriptive assessments involve observation of the problem behavior in relation to events that are not arranged in a systematic manner.
There are three variations of descriptive assessment: There are several forms of Functional Behavioral Assessments they are generally divided into two categories 1)Informal Assessments: Descriptive Assessments 2) Formal Analyses: Analog Functional Analyses, Trial Based Functional Analyses, and single subject research designs.
Informal Assessments: This is a general term referring to both a procedure (directly observing the behavior as it occurs in the natural environment), and the outcome (a statement or hypothesis of the variable(s) setting the occasion for and maintaining the occurrence of a particular behavior.
The primary elements of a descriptive analysis are the three (A-B-C) and sometimes four term contingency (when Motivational Operations are also considered). 2. A – The Antecedent Condition(s): 3. B - The Behavior of interest (also known as the target behavior) 4. C- The Consequence that follows the occurrence of the behavior(any environmental change that occurs following
Observational data are collected (either on a continuous recording basis or using sampling procedures)on these elements and used to develop an hypothesis of function. This hypothesis can be used to develop an behavior intervention plan or as a basis for a more formal analysis of function (i.e Trial based analysis,or analog analysis)
Scatterplots – a procedure for recording the extent to which a target behavior occurs more often at particular times than others.
This method uses structured interviews, checklists, rating scales, or questionnaires to obtain information from persons who are familiar with the person exhibiting the behavior to identify possible conditions or events in the natural environment that correlate with the problem behavior. They are called "indirect" because they do not involve direct observation of the behavior, but rather solicit information based on others' recollections of the behavior.
Advantages – some can provide a useful source of information in guiding subsequent, more objective assessments, and contribute to the development of hypotheses about variables that might occasion or maintain the behaviors of concern.
Limitations – informants may not have accurate and unbiased recall of behavior and the conditions under which it occurred.
Conducting a FBA
Provided the strengths and limitations of the different FBA procedures, FBA can best be viewed as a four-step process:
The gathering of information via indirect and descriptive assessment.
Interpretation of information from indirect and descriptive assessment and formulation of a hypothesis about the purpose of problem behavior.
Developing intervention options based on the function of problem behavior.
Technologies discovered through ABA research
Task analysis is a process in which a task is analyzed into its component parts so that those parts can be taught through the use of chaining: forward chaining, backward chaining and total task presentation. Task analysis has been used in organizational behavior management, a behavior analytic approach to changing organizations.Behavioral scripts often emerge from a task analysis. Bergan conducted a task analysis of the behavioral consultation relationship and Thomas Kratochwill developed a training program based on teaching Bergan's skills. A similar approach was used for the development of microskills training for counselors. Ivey would later call this "behaviorist" phase a very productive one and the skills-based approach came to dominate counselor training during 1970–90. Task analysis was also used in determining the skills needed to access a career. In education, Englemann (1968) used task analysis as part of the methods to design the Direct Instruction curriculum.
The skill to be learned is broken down into small units for easy learning. For example, a person learning to brush teeth independently may start with learning to unscrew the toothpaste cap. Once they have learned this, the next step may be squeezing the tube, etc.
For problem behavior, chains can also be analyzed and the chain can be disrupted to prevent the problem behavior. Some behavior therapies, such as dialectical behavior therapy, make extensive use of behavior chain analysis.
A prompt is a cue or assistance to encourage the desired response from an individual. Prompts are often categorized into a prompt hierarchy from most intrusive to least intrusive. There is some controversy about what is considered most intrusive: physically intrusive versus hardest prompt to fade (i.e., verbal). In a faultless learning approach, prompts are given in a most-to-least sequence and faded systematically to ensure the individual experiences a high level of success. There may be instances in which a least-to-most prompt method is preferred. Prompts are faded systematically and as quickly as possible to avoid prompt dependency. The goal of teaching using prompts would be to fade prompts towards independence, so that no prompts are needed for the individual to perform the desired behavior.
Types of prompts:
Vocal prompts: Utilizing a vocalization to indicate the desired response.
Visual prompts: A visual cue or picture.
Gestural prompts: Utilizing a physical gesture to indicate the desired response.
Positional prompt: The target item is placed closer to the individual.
Modeling: Modeling the desired response for the student. 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. The most intrusive being hand-over-hand, and the least intrusive being a slight tap to initiate movement.
This is not an exhaustive list of all possible prompts. When using prompts to systematically teach a skill, not all prompts need to be used in the hierarchy; prompts are chosen based on which ones are most effective for a particular individual.
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.
Thinning a reinforcement schedule
Thinning is often confused with fading. Fading refers to a prompt being removed, where thinning refers to the spacing of a reinforcement schedule getting larger. Some support exists that a 30% decrease in reinforcement can be an efficient way to thin. Schedule thinning is often an important and neglected issue in contingency management and token economy systems, especially when developed by unqualified practitioners (see professional practice of behavior analysis).
Generalization is the expansion of a student's performance ability beyond the initial conditions set for acquisition of a skill. 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 his school and then 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.
Shaping involves gradually modifying the existing behavior into the desired behavior. If the student engages with a dog by hitting it, then he or she could have their behavior shaped by reinforcing interactions in which he or she touches 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.
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.
Interventions based on an FBA
Critical to behavior analytic interventions is the concept of a systematic behavioral case formulation with a functional behavioral assessment or analysis at the core. 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) 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. 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.
Efficacy in autism
ABA-based techniques are often used to treat autism, so much so that ABA itself is often mistakenly considered to be synonymous with therapy for autism. ABA for autism may be limited by diagnostic severity and IQ. The most influential and widely cited review of the literature regarding efficacy of treatments for Autism is the National Research Council's book Educating Children with Autism (2001) which clearly concluded that ABA was the best research supported and most effective treatment for the main characteristics of Autism. Some critics claimed that the NRC's report was an inside job by behavior analysts but there were no board certified behavior analysts on the panel (which did include physicians, speech pathologists, educators, psychologists, and others). Recent reviews of the efficacy of ABA-based techniques in autism include:
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."
Researchers from the MIND Institute published an evidence-based review of comprehensive treatment approaches in 2008. 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 Lovaas) 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."
A 2009 paper included a descriptive analysis, an effect size analysis, and a meta-analysis of 13 reports published from 1987–2007 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 1987–2007, 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 1987–2007 concluded that EIBI has a "large" effect on full-scale intelligence and a "moderate" effect on adaptive behavior in autistic children.
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.":ES-9 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.":ES-10
A 2009 systematic review and meta-analysis by Spreckley and Boyd of four 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.
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