Introduction
A 2014 report released by the Centers for Disease Control and Prevention (CDC) revealed that 1 in every 68 children, 1% of the world population and more than 3.5 million Americans live with autism (LePage & Courey, 2013). These statistics are disturbing because CDC and the World Health Organization (WHO) have described autism as the fastest growing developmental condition in the world that needs greater attention than is currently given.
The disease is very costly because the government spends more than $200 billion every year to offer services related to its treatment and management. Autism is a neurodevelopmental disorder that alters the normal functioning of individuals by impairing their cognitive faculties that control social interaction, behavior, and communication (LePage & Courey, 2013). The main causes include genetic inheritance and the environment in which a child develops (Keenan, 2006).
There are many treatment remedies for autism. However, research has revealed that applied behavior analysis (ABA) is one of the most effective methods of treating autism. It involves the use of certain techniques to evoke and instill positive changes in behavior. ABA is an effective treatment remedy for children in school because it is easy to change their characters by training them to embrace positive behaviors and retraining them to get rid of unwanted patterns (Granpeesheh, Tarbox, & Dixon, 2009). The purpose of this paper is to prove that ABA is an effective autism treatment method and will review past literature and research studies conducted to establish its effectiveness as a treatment method.
Literature review
As mentioned earlier, ABA is an autism treatment method that involves the use of specific principles and techniques to bring positive behavioral changes. This method has been used successfully among school children because it is easy to change their behaviors by instilling new ones and re-training them to abdicate destructive ones (Keenan, 2006). It is the most commonly applied autism treatment remedy in the United States and several other countries in the world and the major method that schools and therapists embrace and use.
ABA was developed by Dr. Ivar Lovaas who made several contributions to psychology through extensive research and development of theories. He used various concepts of behaviorism to come up with the method that has been very successful in the treatment of autism since its creation (Granpeesheh et al., 2009). Several studies have been used to validate the argument that ABA is an effective method. Treatment includes several techniques and methods such as verbal behavior (VB), incidental training, discrete trial training, pivotal response training, and fluency building (Keenan, 2006).
In discrete trial training, a child is given a clear instruction with the hope that they will ultimately learn to respond accordingly. Incidental training aims to introduce specific behaviors in the child’s daily living. Finally, verbal behavior is used to teach language and communication through reinforcement of the skills that the child possesses.
The main focus of ABA is the specific behavior that a child exhibits and how to change or reinforce it (Granpeesheh et al., 2009). It does not involve going into details regarding the reasons why the child embraces that behavior or what factors or traits evoke it. Instead, the method centers on applying certain principles such as punishment to retrain a child in order to get rid of destructive or unwanted behaviors and strengthen positive behaviors (Keenan, 2006).
Punishment and reward are two of the most common techniques used in the application of ABA. Punishment is applied to get rid of unwanted behaviors while reward is used to reinforce wanted behaviors. In schools that use this treatment method, a detailed curriculum is created for each child depending on the behaviors they exhibit and the interventions needed to eliminate or reinforce them. The various approaches applied aim to instill certain skills in children and thereafter used to create specific behavior patterns. ABA is intensive and takes a long time to yield the intended results (Eikeseth, Smith, Jahr, & Eldevik, 2002).
Therefore, it is practiced both at school and at home. It is important for parents and teachers of children living with autism to cooperate in the application of the treatment methods. Each case of applied behavior analysis should be treated individually because children have different needs and behavior patterns (Schoen, 2003). It is important to apply treatment based on the context of the child’s environment and needs. The behavior that needs eradication or amplification should be observable and measureable in order to enable the teacher or parent track the child’s progress (Schoen, 2003).
There are five major steps that are followed in the application of ABA. First, the behavior is measured directly to determine its intensity and effect on the child. Second, the behavior is monitored and measured daily within the context of the expected outcome (Keenan, 2006). Third, specific procedures are used to modify the target behavior either through elimination or amplification. Different reward and punishment approaches are used in the implementation of this step. Fourth, data related to the child’s progress with regard to the target behavior is recorded. Fifth, the interventionist uses the data to prove that the techniques used were responsible for the observed changes in behavior. ABA is applied in several areas of learning that are challenging to children with autism such as language acquisition, verbal skills, and vocational skills (Schoen, 2003).
The procedure described above aims to modify behavior using the various forms that can be used. Repeat practice methods such as response prompt systems and discrete trial training apply the concept of repetitive actions to weaken or strengthen behaviors (Schoen, 2003).
The efficacy of this method was studied in 1987in a study conducted by Ivar Lovass. The study involved 19 children who underwent through a specific training program created by Lovass for a period of two years (Evans & Daniels, 2006). A follow up study was conducted after the completion of the first one to evaluate its efficacy. The results of the follow-up study revealed that the children had increased their IQ by an average of 19 points each.
Nine of them joined the mainstream education system and it was impossible to separate them from their peers by studying their behaviors (Evans & Daniels, 2006). They had improved significantly from the training that they received during the period of the study. Even though the study was widely criticized for its methodology and assessment criteria, ABA is widely recommended as a treatment method for children with autism. The study has been controversial for many years because the assessment of children after the study was partial and could have been skewed to achieve certain outcomes (Keenan, 2006).
Moreover, the treatment group comprised children with high cognitive functions and did not represent the true state of the majority of children with autism. The control group contained more girls than boys and was therefore not equally representative (Keenan, 2006). These anomalies have impelled many psychologists and behavioral scientists to discredit the study.
ABA is an effective treatment method because its focus is on how the learning place occurs and not on the motivation behind certain behaviors. Research has shown that whenever a behavior is followed by a reward, it is reinforced and its probability of recurring increases (Eikeseth et al., 2002). This method uses the techniques that scientists have developed over the years to increasing the likelihood of certain behaviors recurring and lowering the likelihood of others recurring. The efficacy of ABA is founded on the fact that the method instills specific skills that are used throughout childhood and in adulthood (Granpeesheh et al., 2009).
Moreover, the methods can be applied in controlled settings such as classrooms and in everyday situations including interactions with family members. Several research studies have been conducted to examine the benefits of using several ABA techniques. Comprehensive and individualized techniques have been shown to benefit children in school with autism. Comprehensive techniques address several life skills that enable children living with autism handle their daily lives effectively (Eikeseth et al., 2002). Early intervention means that they are applied to children who are below the age of 4 years for better outcomes.
Other studies have shown that ABA techniques are highly successful when applied in an intensive manner. This means that children undergo training for between 25 and 40 weekly for a period of at least one year.
Studies have established that in order to achieve optimal outcomes with ABA, children should be introduced to intensive behavioral treatment early (Evans & Daniels, 2006). The recommended age for commencing treatment is below the age of 4 years because at that stage of development, children have more behavioral and neural plasticity compared to children of older ages (Eikeseth et al., 2002). A study to support that argument was conducted and involved 9 children under the age of 5 years who underwent intensive behavioral treatment. The results of the study revealed that younger children attained better results compared to older children hence the conclusion that early treatment is important (Eikeseth et al., 2002).
These findings were contrary to what Lovass found out in a 1988 study. He did no find any correlation between the age of treatment and the outcome. The main weakness of ABA research studies is that many of them only study its effectiveness without comparing it to other treatment methods hence raising the concern as to whether the remedy is better when used together with other treatment methods (Eikeseth et al., 2002). The benefits of intensive behavioral treatment for children with autism were revealed after a study conducted in 2005. The study involved 24 children who were assigned to different groups overseen by either parents or clinical specialists (Swallows & Graupner, 2005).
Treatment was continued for a period of 4 years and assessment included the evaluation of social, cognitive, language, adaptive, and academic outcomes. The results of the study showed that all children had attained significant improvements in the aforementioned areas by the end of the study period (Swallows & Graupner, 2005). 48% of the participants showed rapid learning skills and participated in regular classroom sessions with their peers who did not have autism.
ABA instills social, verbal, motor, and reasoning skills that children can use in their daily lives (LePage & Courey, 2013). It is specifically used to teach behaviors that people with autism are unable to develop on their own during the process of development. Despite its use in several settings, the method is highly controversial and has been criticized by experts in different fields. When ABA was first developed, it applied certain techniques that were considered unfavorable to children.
For instance, yelling and restraining children was used to force them change their behaviors (Exkorn, 2009). These aversive techniques reinforced negative behaviors instead of reinforcing positive ones. In contemporary society, majority of practitioners avoid using aversive techniques because they are unacceptable after being proven ineffective. There is controversy also as to whether ABA should be used singly or together with other forms of treatment. Practitioners have not reached consensus on this issue. However, they agree that in order for treatment to be successful, it should be done intensively by qualified practitioners for a period long enough to yield the expected outcomes (Eikeseth et al., 2002).
In addition, it should be applied consistently both at school and at home for better results. Critics have rejected ABA by claiming that it does not seek to treat autism but to make children with autism fit the description of normal that is propagated by society (Evans & Daniels, 2006). This rejection is based on the assumption that autism is not a disease but a condition and its treatment using ABA has been likened to training dogs by conditioning them to behave in certain ways. They argue that conditioning children to embrace certain behaviors is not sustainable because in case the rewards or reinforcements are withdrawn, the children are likely to fall back to their old behaviors and ways of doing things (Exkorn, 2009).
These criticisms and controversies are misleading because various studies have given evidence of the efficacy of ABA in treating and managing autism in children. They ignore the fact that qualified practitioners create individualized and intensive treatment for children depending on their needs (Granpeesheh et al., 2009). Moreover, they ignore the fact that there are several techniques that instill different skills that are necessary for children with autism to live normal lives without victimization from their peers.
An example of the successful application of ABA is Treetops School at Essex in the United Kingdom that uses a technique known as verbal behavior to treat autism. The program involves the pairing of children with assistants who reward them for performing certain tasks correctly (Lambert, 2013). Each child has a unique program depending on their needs. The program commences the training by teaching the children how to make simple requests. The school developed the course after the realization that many children develop problematic behaviors due to the frustration that originates from poor communication. The use of punishment and rewards is an important component of the program.
The institution has been criticized by people who argue that they try to normalize children with autism. In addition, they argue that the program is weak because focusing on children’s conduct and using rewards denies them the opportunity to develop strong decision making skills (Lambert, 2013). The school helps the children transfer their skills to daily living after acquiring them in the program. The management team has responded to widespread criticism by arguing that they do not aim to eradicate autism but to counter the negative effects that autism causes in children’s lives (Lambert, 2013).
They understand that autism will be a lifelong diagnosis for these children but note that they do not have to suffer because of certain aspects of their lives that can be altered. ABA tries to counter the effects of the condition that prevent children from learning and that cause destructive behaviors (Granpeesheh et al., 2009). In other schools, different autism treatment approaches are used together with ABA for better results. The success of ABA and its growing popularity around the world is proof enough that it is effective in treating autism in children.
Discussion
Autism is a condition that affects many people in different age groups across the world. The statistics regarding the prevalence of the condition that have been presented by the CDC and the WHO reveal that it is a serious condition that needs great attention because it is the most rapidly growing disability in the world. Several methods are applied in its treatment and management. However, they vary in their efficacy and effectiveness in normalizing the lives of people with autism.
Applied behavior analysis applies techniques developed by scientists over the years in the field of psychology and behaviorism. It is highly effective among school-going children and as a result it has been included in many schools’ curricula. The main reason for its effectiveness among children is the ease of re-training them and instilling new behavior patterns. Its success depends on the intensity and consistency of application. Research has shown that the method is capable of improving cognitive functions in children with autism and helping them learn and live normally. The success and growing popularity of ABA is proof enough that it is an effective treatment method.
This success has not prevented critics from bashing the treatment remedy by claiming that it applies certain aversive techniques and tries to eradicate autism through processes that resemble dog training procedures. They also argue that by using rewards and punishment to condition children, practitioners, teachers, and parents deny them the opportunity to develop strong decision making skills. These arguments are derived from the assumption that ABA tries to eliminate autism completely.
However, it does not try to eliminate autism completely because its objective is to eradicate the consequences of certain behaviors that emanate from autism and improve victims’ learning abilities that are usually impaired in people living with the disorder. The aforementioned research studies are proof that ABA has been used in many cases to improve the lives of children with autism under different situations and contexts.
It is a very effective autism treatment method that should be encouraged and embraced by schools that deal with children with the condition. The availability of a wide range of techniques is a sign of the method’s versatility and ability to treat children with different needs. It is important for parents and teachers to track the progress of children under behavioral treatment on a daily basis in order to ensure that the technique chosen for treatment is effective and the most appropriate for specific needs.
References
Eikeseth, S., Smith, T., Jahr, E., & Eldevik, S (2002). Intensive Behavioral Treatment at School for 4 to 7-Year-Old Children with Autism. Behavior Modification, 26(1), 49-68.
Evans, R., & Daniels, R. (2006). Essential Guide to Autism. New York, NY: SGC Health.
Exkorn, K. S. (2009). The Autism Sourcebook. New York, NY: Harper Collins.
Granpeesheh, D., Tarbox, J., & Dixon, D. R. (2009). Applied Behavior Analytic Interventions for Children with Autism: A Description and Review of Treatment Research. Annals of Clinical Psychiatry, 21(3), 162-173.
Keenan, M. (2006). Applied Behavior Analysis and Autism: Building A Future Together. New York, NY: Jessica Kingsley Publishers.
Lambert, C. (2013). Is it Right to try to “Normalize” Autism?. Web.
LePage, P., & Courey, S. (2013). Teaching Children with High-Level Autism: Evidence from Families. New York, NY: Routledge.
Schoen, A. A. (2003). What Potential does the Applied Behavior Analysis Approach Have for the Treatment of Children and Youth with Autism? Journal of Instructional Psychology, 30(2), 71-83.
Swallows, G. O., & Graupner, T. D. (2005). Intensive Behavioral Treatment for Children with Autism: Four-Year Outcome and Predictors. American Journal of Mental Retardation, 110(6), 417-438.