Applied Behavior Analysis (ABA) has become an incredibly popular treatment for individuals diagnosed with Autism Spectrum Disorder and Developmental Disabilities (Foxx, 2008). ABA is a loaded acronym that includes a long list of skills and techniques all based on the basic science of behavior. Board Certified Behavior Analysts (BCBAs®) are trained to identify behaviors of interest, assess the reason(s) why they occur, and create plans to teach alternative behaviors that are more appropriate.

Those are all great things, but you may observe the BCBA® or technician working with your child and wonder “why are they doing that?” or “what on earth did I sign myself up for?” BCBAs® do things that seem counter-intuitive or just plain strange. Our goal is to demystify some of the stranger practices in ABA and explain our backing in science.

Assessment

The first step in any treatment process is the assessment. Very little you will ever do in the ABA process is more important than this initial assessment. This is the first of many opportunities to ask questions, express concerns, and discuss your hopes and dreams for your child. The BCBA® likely asked numerous questions that were overwhelming. This is normal. A good treatment plan has an exhaustive record of medical, psychological, developmental, educational, and social history. After what probably felt like a grueling conversation, the BCBA starts working with your child pulling out toys, books, and enough laminated/velcroed pictures to cover your walls. The formal testing portion of the assessment is used as a “baseline” or starting point for treatment. This way, the BCBA® can gauge just how much progress was made over time.

Treatment Planning

Once the assessment was done, you likely received a formal treatment plan that looked more like a manuscript for a novel. This treatment plan, only partially written in plain English, is the document that provides your insurance company with information about what the plan is for the next six months. You will likely come across technical jargon that makes no sense. You may find things referencing “manding,” “tacting,” or “stimulus control.” Behavior Analysis, by definition, includes seven core dimensions: one of them focusing on using technological language that ensures continuity between providers, just in case another clinician needs to step in. it is also more efficient in the writing process. However, your BCBA® should make the time to answer any question(s) you have and translate the document from behavioranalyticease to English. Never be shy to question what you are reading and ask for clarification.

Intervention

BCBAs® do strange things when they are working with your child. Technicians will follow plans created by your BCBA® that just seem counter-intuitive. They will stretch their face like a cartoon character over the smallest things and repeat questions and activities over and over. Your BCBA® may ask you to take data about behaviors that might seem insignificant or to do and say things that seem strange. There is a reason for all of these things occurring.

First, and most importantly, behavior analysis thrives on the concept of reinforcement. Reinforcement, simply put, is providing some type of reward for engaging in the correct behavior. Think of this like your paycheck at work. You deserve to be compensated fairly for your time and effort. If you were not going to be paid, would you continue to work? Probably not! Behavior Analytic interventions operate on the same principle. Your child will be expected to complete tasks and engage with the technician, but will receive their own version of a paycheck in a variety of ways like games, music, snacks and other preferred activities and items.

Reinforcement has specific rules. It should only be given, in most cases, when the person has done something correctly. This is why BCBAs® start out small, sometimes with skills your child may already have. The BCBA® may have to teach your child that in order to get something, they have to do something. There is no easier way to teach that skill than having your child complete an activity they are able to do with minimal effort. Teaching procedures use a similar idea. Skills are broken down into small component pieces called “discrete trials” and repeated several times in a row. By breaking skills down they are less intimidating and easier to learn. Most often, these discrete trials are run consecutively five to ten times. Research has shown that when an individual practices the same skill in short bursts like this, sometimes called discrete trial training, the skill is learned faster (Lerman, Valentino, & LeBlanc, 2016).

You may have also noticed that your technician uses very short phrases when working with your child and rarely speaks in full sentences when giving instructions. This is actually incredibly important. Although it may seem odd to speak in short sentences, BCBAs® have found that the shorter the instruction the better the result (Dickenson & Wit, 2003). As the number of words increases, comprehension decreases significantly. By keeping sentences short and to the point, compliance from your child is likely to follow. As your child’s language grows, so will the length of your technician’s interactions. As for the teaching itself, there is lots of hands on practice. And by hands on practice, we mean the technician is guiding your child’s every step. This is something called “errorless learning.” Again, more research has shown that the more errors you make, the more likely you are to do them in the future (Mueller, Palkovic, & Maynard, 2007). By starting with lots of help and slowly cutting it back (fading) we may have better results.

Problem Behavior

If your child engages in problem behavior you will have likely heard your BCBA® say: “all behavior is communication.” Although true, it is not incredibly helpful at the very beginning. The clinician is likely to first start with asking you questions about what you do when the problem behavior occurs. This may feel invasive, but it is only intended to understand what you normally do in response to problem behavior. Nobody is perfect. More importantly, your BCBA® is not there to judge you for offering a candy bar to keep your child distracted while you go through the grocery store at a dead run. (The author of this blog having done that a few days previously!) In some cases the BCBA® may actually perform an experiment where they want you to give in to the problem behavior. They may ask you to take away the toy they are playing with, provide tons of attention for screaming, or tell them that they do not have to eat that broccoli. It is crazy to think that the BCBA® would be happy to see problem behavior occurring. But their job is to try and find a pattern and sometimes finding that pattern means giving in. We call that a Functional Analysis (Iwata et al., 1994). Once that pattern emerges, it’s time to roll up your sleeves and start intervening.

Then things can get even stranger. Charts start flying everywhere, dollar store stickers come pouring out of the BCBAs® bag, and you are now expected to play interventionists. Your BCBA® is probably looking at you with a wide smile and beaming with enthusiasm for the behavior plan they just created. As the parent, all you may see are ten new things to remember to do on top of the 30 other responsibilities you have. This is normal. You are allowed to be overwhelmed. BCBAs® are trained to not only be effective at changing behavior, but also how to work with families. Speak up and express your concerns if the behavior plan seems overwhelming or complicated.

Your BCBA® may ask you to do any number of ridiculous activities: tell your child maybe later, tell them to clap their hands, have them repeat nonsense syllables three times in a row. Just remember that there is a reason for every intervention. Recall those core dimensions of Behavior Analysis we mentioned earlier? One of them is “effective.” This means that BCBAs® only implement interventions that are proven to work based on research. And that research is peer reviewed, scrutinized, and validated several times over before it is accepted as a practice. Despite the evidence, you may feel like you are wasting your time or that it is not working. That is normal. BCBAs® expect there to be a bit of a lag between when the intervention starts and when progress is more noticeable. You can definitely teach new skills to your child, but it is going to take time. Your child will have to unlearn all of their usual ways to get what they need or what they want in order to make room for the new skills that you are trying to teach. Think about how long it takes you to pick up a new habit. It is the same way for your child.

We Made It!

From the day that you received a diagnosis of ASD for your child, you have been on a journey. That journey may have brought you to the field of ABA. Perhaps you are involved in a treatment regimen now. Maybe you are reading this blog trying to see if ABA would a good fit for you and your family. BCBAs® do a lot of strange things, but all in the name of helping your child grow and have the best developmental experience possible. Additionally, they are here to be a guide on the journey. Speaking as a BCBA®, I have had the honor and privilege of working with some of the most hard working and dedicated families. I have laughed and cried with them. I have joined them in celebrating the major milestones, and shared in their frustration over less than effective interventions. I have written my fair share of strange behavior plans and have had the look of utter bewilderment pass over my parents’ faces. Despite this, we were able to make effective change because we worked together as a team through the ups and downs. We may do strange things, but together they will become great things. In the words of Derice Bannock: “Cool runnings. Peace be the journey.”

References

• https://www.attentivebehavior.com/what-do-we-do-in-aba-therapy/
• Foxx, R.M. (2008). Applied behavior analysis treatment of autism: The state of the art. Child and Adolescent Psychiatric Clinics of North America, 17(4), 821-834.
• Dickinson, A., & Wit, S.D. (2003). The interaction between discriminative stimuli and outcomes during instrumental learning. The Quarterly Journal of Experimental Psychology 56B(1), 127-130.
• Iwata, B.A., Dorsey, M.F., Slifer, K.J., Bauman, K.E., & Richman, G.S. (1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27(2), 197-209.
• Lerman, D.C., Valentino, A.L., & LeBlanc, L.A. (2016). Discrete trial training. Early Intervention for Young Children with Autism Spectrum Disorder, 47-83.
• Mueller, M.M., Palkovic, C.M., & Maynard, C.S. (2007). Errorless learning: review and practical application for teaching children with pervasive developmental disorders. Psychology in the Schools, 44(7), 691-700.