In 2003 I moved to Ireland. It was three years after finishing my Masters in Communication Disorders from the University of Minnesota. Young, free and full of energy, I set off to County Kildare to work in an Applied Behavior Analysis (ABA) autism school in a sheep field. You would think I would have researched public transportation more thoroughly than I did before leaping over the pond. Well, I didn’t. If anyone from Saplings School reads this, they are laughing right now. That is because it took trains, planes and automobiles for me to get to work every, single day. The last stretch started at the shop in Kill. There were no buses going up the road to the school. So I stood on the corner (rain or shine, but mostly rain) waiting for someone from the school to drive by. Whoever got the “lucky” ticket that day, picked me up and drove me up the road. Some days I didn’t get to the corner on time; so they just sent someone from the school to come get me, the drowned-rat lady. They were the most gracious, kind people I have ever met.

In 2004, the Co-Founder of Saplings, Board Certified Behavior Analyst (BCBA), Ken Kerr, took me to the ABA Ireland conference in Belfast. It was very exciting! Bobby Newman was the keynote speaker. This was fifteen years ago and I still remember a joke he told about how the people there often say, “at the end of the day…” instead of “ultimately” or “in the end.” When talking about a client’s behavior, he mistook this as meaning “later in the day” and asked someone “what is his behavior like at the beginning of the day?” You had to be there! It was funny to me as a person who made these types of language errors on a daily basis. Aside from the Bobby Newman joke, I remember another thing someone said there that has stayed with me all this time. It was from a speaker from Scotland. She said, “ABA is not a treatment, it is a science.”

ABA is not a treatment; it is a science

This is such a simple thing, yet complicated. Professionals and parents alike understand this concept to varying degrees. Which is fine. We can’t expect every person to thoroughly know everything about behavior analysis. That is what BCBAs are for! However, using the acronym “ABA” synonymous with autism treatment makes it difficult for people to separate the science from a particular person, organization, or curriculum. Parents looking for services for their children usually think ABA is ABA no matter where they go. If they have a bad experience, parents might think ABA is bad or abusive, when it is the individual who has acted in that way, not the science itself. That would be like a person having a bad reaction to a medication or a doctor and deciding that the entire science of chemistry or biology is bad. If ABA was universally understood as a science like chemistry or biology, people might see things differently and be better equipped to make appropriate treatment choices for their child.

I don’t know the solution to this misunderstanding. As professionals, we can’t exactly go into a whole monologue every day explaining to people the ins and outs of behavior analysis. It is simply more practical to say, “we offer ABA treatment” or “your child needs ABA immediately!” However, there are two things I know for sure. Decades of research supports the effectiveness of using the science of ABA to teach children with autism how to learn, speak and communicate; and not all programs or professionals who utilize this science are the same or appropriate for every child with autism.

There are many options for families

Back when I first started in this field twenty years ago, choices were limited. There were only a few curriculums available and they were mostly geared towards young children. Access to ABA services was scarce. Parents had to fight for it. Waitlists were long. Insurance didn’t pay for it. There was a limited number of well-trained, qualified therapists. I realize in some places, all or some of these issues are still there; but the overall situation has evolved in a positive direction. Nowadays, there are more funding options and trained professionals using ABA principles to improve the lives of children and families. There are curriculums developed to address the time a child is diagnosed through adulthood.

What I see as an issue now is parents figuring out the system in their area to access the available funding sources. I also see that parents don’t know how to determine which program is the best fit for their child, regardless of whether or not it is an ABA program. When my son was diagnosed this year, I struggled a lot with both of these things. I still don’t have it all figured out. I can’t imagine what it is like for the average parent to figure all of this out, handle the day-to-day and grieve all at the same time. The one thing I can say to a parent reading this is that there are options out there for you. Parents can and should shop around and find out what works best for their child and family as a whole.

Effective therapists and educators use behavior analytic principles

You don’t have to be a BCBA to be a good Occupational Therapist (OT), Speech-Language Pathologist (SLP), or teacher. You also do not need to know everything about behavior analysis or all the terms BCBAs use. Whether parents or professionals realize it or not, ABA is everywhere. If a teacher or therapist assesses what skills need to be learned, sets up the environment to be conducive to learning, breaks tasks down into small steps, acknowledges successes of their student or client in a meaningful way, and the student learns, they are using ABA. This is why some children with autism can learn new skills even when they are not in a program that is identified as an “ABA program,” per se. If a professional does not utilize ABA principles, they are likely not as effective as they could be. It is also likely that they do not know why. If a parent or professional wants to get more efficient and effective at teaching new skills, a BCBA is a good resource for that. They have masters-level education and experience in exactly what I described above.

Speech and language work needs to be frequent

Regardless of your opinion of ABA, I think we can all agree that we typically learn in relation to how much we practice. If you were learning to play a new instrument or sport, you would learn faster if you practiced every day versus practicing a few times a month. Same thing with academics. Children go to school every day so they can learn all the things they need to learn to be successful adults. Speech and language skills for a child with autism are no different than any other skill. More practice in speech and language typically means more progress in speech and language skills.

Children with autism who are non-verbal vary in their abilities when it comes to speech and language skills. In my experience, most children who are not talking either have difficulty learning how to learn or have a speech disorder or both. With some children, simply being taught skills such as gross motor imitation (i.e., imitating stomp feet or clap hands) and following instructions (i.e., touch ball) could be enough to get the “learning how to learn” train in motion. From there, speech may follow with use of proper ABA teaching techniques and adequate frequency and intensity of treatment. However, there are other children who require more targeted speech, language and communication work. They may need to learn to communicate through the use of a picture exchange communication system or sign language system to learn the value of communication before he or she will consistently engage with a communication partner. Sometimes that does the trick and sometimes it doesn’t. One solution to this is to break speech down to the smallest unit possible (i.e., phoneme) and build words one-by-one until the child learns to imitate words. Most ABA curriculums fall short in this area. This is when having an SLP on the team is crucial in helping the ABA team develop the program based on the unique speech needs of the child.

Speech and language work needs to be intensive

Sometimes people equate intensive, behavioral intervention to a child sitting at a table all day doing drills. While there are always exceptions to everything, that is not typically the case. The “intensity” means that the child is working on specific goals in a systematic way throughout the therapy week for 25 to 40 hours per week. While working at a table for short periods of time might be necessary as part of a child’s program, modern-day ABA programs incorporate play and social-communication throughout the therapy session. The intensity piece for a child who is non-verbal is particularly important because they need many, many, many trials to practice the building blocks for spoken language.

Think of it this way. If you were going to be a professional football player, simply being athletic or enrolled in a program for athletes is not going to be enough. You would have to practice, practice, practice the specific actions of a football player over and over again for a very long time. The coach would also have to set you up for success by breaking skills down for you into manageable steps and motivate you to do all of that hard work. That is what a well-run ABA program will do for a child who is non-verbal and why it is so important.

If you want to see the research that backs up what I have seen in over 23 years of education and professional practice, take a look at the attached link. If this doesn’t work and you want to see it, let me know and I’ll send it to you directly.   Learn More

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