In 1987, Dr. Ole Ivar Lovaas, a Norwegian-American clinical psychologist and professor at the University of California, published a study on “behavioral treatment and normal education and intellectual functioning in young children with autism”.
The study demonstrated that following intensive applied behavior analysis (ABA) treatment, where the experimental group received up to 40 hours per week in a 1:1 teaching setting at a table using errorless discrete trial training, 9 out of 19 children – 47% of the group – went on to lose their autism diagnosis, acquired typical communicative speech, increased IQs by 30 points on average, and were placed in regular education classrooms.
The treatment was done at home with parents involved in every aspect of the treatment, and the curriculum was highly individualized with a heavy emphasis on teaching eye contact, fine and gross motor imitation, and language skills. The principles of applied behavior analysis were used to motivate learning and reduce maladaptive behaviors.
A follow up study 6 years later, in 1993, found that 8 of the children had maintained their gains and were “indistinguishable from their typically developing peers”, scoring within the normal range of social and emotional functioning. In 1999, the United States Surgeon General, David Satcher, endorsed the 1987 study, asserting: “Thirty years of research has demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior”.
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Dr. Lovaas is considered a pioneer of what is now called applied behavior analysis due to his development of discrete trial training and early intensive behavioral intervention. Lovaas founded the Lovaas Institute and co-founded the Autism Society of America. His work greatly influenced how autism is treated today and he received several awards recognizing his contributions to the autism community during his lifetime.
Prior to Lovaas, B.F. Skinner was an American psychologist, behaviorist, inventor, and social philosopher. He was a professor of psychology at Harvard University from 1958 until his retirement in 1974. Skinner used the term “operant behavior” to refer to any “active behavior that operates upon the environment to generate consequences.”
Operant behaviors are behaviors that are “learned” or “selected” over time because they meet our needs. ABA attempts to modify behavior by assessing the functional relationships between the target behavior, its consequences, and the environment in which those consequences are available. Skinner was the first to define the 3-term contingency: Antecedent, Behavior, and Consequence. The ABC’s of behavior, also known as operant conditioning, is used in ABA therapy to alter the frequency of behavior.
Through his experimental analysis of behavior, Skinner demonstrated that reinforcing consequences increased the future frequency of behaviors they followed, while punishing consequences decreased the future frequency of behaviors they followed, in the same environmental contexts in which those consequences were available. Meaning, a consequence paired with a person, place, or thing (A,C) that signals the availability of that consequence because of its contingency history (A,B,C), has a behavior-altering effect (B).
This explains why all typical humans are more and less likely to engage in certain behaviors in different environments and in the presence of different people, when our behaviors operate under contingencies where and when we are more or less likely to be reinforced.
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At PRISM Learning Center, we practice the discipline of intensive behavioral treatment and discrete trial teaching of Lovaas, and we are solidly grounded in Skinner’s philosophy of positive reinforcement.
We design treatment plans that are highly individualized to the learner’s specific needs. The learner receives 1:1 teaching, and our interventions are conceptually systematic and represent the principles of applied behavior analysis. Furthermore, we involve parents and family every step of the way.
We address skill deficits by breaking them down into their smallest components, and we reward correct responding through reinforcement-based contingencies.
Reinforcement-based contingencies are integral to the therapeutic relationship from when the “pairing” process between the therapist and the learner is first initiated. The therapist “pairs” themselves with positive reinforcement in the form of behavior-specific praise, positive energy, and tokens. The tokens then become conditioned with other rewards the learner can exchange for the tokens contingent on correct responding.
Since the early 1970s, behavioral therapy has been reliably demonstrated to improve language and communication skills, daily living skills, social skills, coping skills, interpersonal relationship skills, play and leisure skills, fine and gross motor skills, and domestic skills, as well as decrease stereotypy, self-injury, scripting, echolalia, elopement, aggression, and other restrictive, repetitive, and maladaptive behaviors.
According to the Centers for Disease Control and Prevention (CDC), it costs an estimated $17,000 more per year to care for a child with autism compared to a child without autism. For a lower-functioning child with more severe autism, costs increase to over $21,000 more per year.
As society continues to broaden its awareness and education surrounding the diagnosis and treatment, states are taking steps to recognize and meet the needs of the autism population. In 2009, a New Jersey law began to require “specified health insurance policies and health benefit plans to provide coverage for expenses incurred in screening and diagnosing autism… when the covered person is under 21 years of age and the person’s primary diagnosis is autism, coverage must be provided for expenses incurred for medically necessary behavioral interventions based on the principles of applied behavioral analysis and related programs, as prescribed through a treatment plan.” As of June 8, 2017, 46 states and the District of Columbia have laws that require insurance coverage of ABA services to treat autism.
Research indicates that early diagnosis and treatment is critically important and make all the difference. ABA therapy is the number one recommended treatment for children on the spectrum and related disorders by the US Surgeon General, the American Psychological Association, the American Academy of Pediatrics, and healthcare advocates nationwide.
ABA therapy is an outcomes-focused approach that has significantly enhanced the lives of individuals on the spectrum and their families for over 50 years. It continues to advance global research, awareness, and advocacy on behalf of the autism community.