When looking into applied behavior analysis (ABA) therapy for your child, you will read that this treatment approach is objective and evidence-based. The treatment approach was developed to gather measurable evidence on clients’ success meeting specific treatment goals, but does this mean the program is successful?
Despite some past controversies, the medical research in 2021 shows that modern approaches to ABA therapy are very successful for most people with autism. ABA therapy is affirmed by the American Psychiatric Association, the American Psychological Association, and the U.S. Surgeon General as a valid evidence-based therapy for autism.
ABA Therapy & Autism: Medical Professionals Recommend This Approach to Treatment
Applied behavior analysis (ABA) therapy is a treatment approach based on the scientific understanding of human behavior. It is applied to people who struggle with developmental conditions like autism, to improve their communication, learning, and social skills.
Much of the foundation for behavior therapies like ABA extends back into the early 20th century, starting with a philosophy known as behaviorism. This is the premise that positive changes in behavior can improve the overall human condition.
While behaviorism as a philosophy has no scientific basis, the medical practice of ABA therapy does. People with developmental conditions, like autism, get assistance from ABA therapists to understand maladaptive behavior patterns and make changes using specific techniques based on an overall treatment plan.
ABA therapists create plans with specific goals. They break these goals down into objectively measurable steps for improvement. Therapists can then assess if their client’s behavioral struggles are improving or if they need to find a different approach.
Since ABA relies on measurable objectives, many scientific studies have been conducted in the decades since the therapy was codified to gauge the effectiveness of the overall approach. As more studies have been completed to understand the impact of ABA therapy, approaches to treatment have adjusted over time to increase the therapy’s overall effectiveness.
Study Results on the Success of ABA Therapy
Several studies report how successful applied behavior analysis can be for people with autism.
For example, a 2011 review examined 27 studies across several peer-reviewed publications. The review found that children who received ABA therapy experienced improvements in cognitive abilities, language, adaptive behavior, and social skills. The children also exhibited lower levels of aggression and anxiety.
Therapies based on behavior analysis are so effective that a 2012 publication reported that children on the autism spectrum should have access to at least 25 hours per week of comprehensive intervention with a similar approach. This allows children to address language and nonverbal communication skills, social skills (via playing with others), and other maladaptive behaviors.
Many forms of ABA therapy have been found effective in treating symptoms of autism that can cause distress and emotional harm in the individual. One 2007 report states that five decades of ABA research have helped to hone the process for both children and adults. The research highlights that children who receive early and intensive behavior treatment make more sustained gains in cognition, academics, adaptive behaviors, social behaviors, and language compared to children in control groups.
The Maine Department of Health and Human Services (HHS) and the Department of Education (DOE) reviewed 150 studies with 43 different treatment approaches for people with autism. The meta-analysis used the evaluative method for determining evidence-based practice in autism to assign each intervention a rating based on the amount of evidence involved in the treatment process. The report found that ABA therapy was one of the few that met standards as an established evidence-based therapy.
Short-term intervention is not the best method, but it can work for some children. A 2012 study found that in 48 toddlers with autism, 6 months of ABA therapy starting around 2 years old improved their ability to communicate with others, their cognition, and the severity of their autism symptoms. However, most research suggests that long-term, intensive treatment works better, especially starting at a young age.
Subsets of ABA Therapy Measure Success in Different Areas
Medical practitioners approve of ABA treatment and refer people with autism to therapists who specialize in a subset of ABA.
According to the Centers for Disease Control and Prevention (CDC), there are some popular and measurably effective subsets of ABA therapy.
● Discrete trial training/teaching (DTT): With this approach, the larger treatment plan is broken down into specific, discrete parts. These parts are as simple as possible, so the learning process is very clear. Positive reinforcement is used to reward correct or positive behaviors. Inappropriate behavior choices are ignored.
Discrete trial training uses the ABC method: Antecedent, Behavior, Consequence. Working with this model, therapists can help the person with autism to understand that maladaptive behaviors, as antecedents, lead to reactive behaviors in others — and thus, negative or hurtful consequences. While the ABC method is often applied in other types of behavior therapy, it is specific to DTT.
Research has shown that it can require up to 600 hours of therapy to apply DTT in a progressive way that works for most clients.
● Early intensive behavioral intervention (EIBI): Many studies have shown that ABA therapy can work for all ages, but it works particularly well for young children. In response, EIBI was developed for children who are 5 years old or younger.
This approach to ABA therapy is highly structured, so the child with autism can learn each piece of a larger skill, such as improving social communication by reducing maladaptive behaviors like tantrums, aggression, or self-injury. The teaching occurs in a one-on-one environment, with a therapist leading each session. There is supervision from a trained professional during sessions, to ensure the child’s safety.
A study from the New Zealand Guidelines Group, part of the New Zealand Ministry of Health, published in 2010, found that EIBI should be considered a valuable treatment path for young children on the autism spectrum. While the report found that the evidence in favor was fair rather than good, this rigorous study still shows that the EIBI subset of ABA therapy can work for a wide range of children.
● Early Start Denver Model (ESDM): This approach to treatment focuses on very young children, between 1 and 4 years old. Therapy sessions have structure but use children’s instinct for play as a way to guide the child with autism back toward neurotypical children’s developmental patterns, especially with learning and socializing.
Since the child’s brain is still in the earliest stages of growth, ESDM aims to adjust the formation of certain pathways. This helps children maintain better cognition, socialization, and communication throughout their lives.
In a 2010 study on ESDM involving 48 toddlers with autism between the ages of 18 and 30 months, the toddlers were assigned either intensive ESDM or community therapy. Children who underwent ESDM showed more improvements in adaptive behaviors, IQ, and their overall autism diagnosis.
A 2011 study that included ESDM in behavior treatments found that the Denver Early Start Model seemed to work best in comparison to other types of therapy. However, the study was clear that the amount of evidence gathered was small.
● Pivotal response treatment: This ABA therapy is for older children, aiming to increase their motivation to learn and monitor their behavior. This helps children continue to improve once therapy sessions end.
Children with autism who participate in PRT learn to initiate communication with others and stay focused on the effects of their behaviors. Positive changes are believed to have widespread positive effects on others.
A study examining neuroimaging of people with autism who underwent PRT found that there were changes in the brain that indicated long-term behavioral change. While the use of neuroimaging is still new, this combination of measuring behavioral change with structural brain changes can help therapists in the future.
A different study found that PRT, when compared to broader approaches used in general ABA therapy, worked better for improving targeted behavioral issues after three months of treatment.
● Verbal behavior intervention (VBI): This form of ABA focuses specifically on verbal skills rather than broader skills like nonverbal communication, cognition and learning, or other areas of life that autism may impact. The focus of VBI is on guiding the child with autism to use words in a specific way to achieve a specific outcome. For example, the goal is for the child to say, “I want a cookie,” instead of using gestures like pointing or showing other signs of understanding the words but not using them.
Finding a Quality ABA Therapy Provider
Because ABA therapy has been established since the 1950s, it is no longer considered by experts to be investigational or experimental. Instead, it is a well-understood treatment approach that allows for customization to individual needs. It uses specific steps to gather evidence and support each child's personal growth.
If you have a child or adolescent with autism and you are interested in pursuing this form of behavior therapy, there are a few different ways to find a qualified therapist. You can work with your child’s doctor — either your child’s pediatrician or another developmental specialist, like a child psychiatrist or psychologist — to get a referral.
You can also work with your health insurance provider to find the nearest ABA therapist who is taking new clients. It’s a good idea to confirm the specifics of your insurance plan. Depending on the state where you live, your insurance provider may be mandated to cover autism-related treatment services. Your provider can give you information on the specifics of your coverage and what you will be expected to pay out of pocket for ABA therapy.
There are other respected organizations that can connect you with resources on ABA therapy:
● The Behavior Analyst Certification Board (BACB) certifies all ABA therapists to practice this type of behavior treatment. BACB holds professionals to a high standard of excellence and education. You can search their BCBA certificant registry to find a local provider.
● Autism Speaks works to improve the world for people on the autism spectrum. They offer a searchable resource guide where you can find information on ABA providers near you. You can narrow down your search to providers who treat particular age groups, allowing you to find an ABA therapist with experience treating clients of your child’s age demographic.
● The Centers for Disease Control and Prevention (CDC) and related government agencies host lists of resources for groups, nonprofits, or medical providers that apply ABA therapy.
The Gold Standard
While many therapies are used to treat people with autism, ABA therapy is considered the gold-standard treatment. It shows high rates of success in helping those on the autism spectrum to achieve more independence, improve communication and socialization abilities, and reduce negative behaviors.
In 2021, there is reason to be hopeful about the success your child can achieve in ABA therapy.
- About Behavior Analysis. Behavior Analysis Certification Board (BACB).
- Evidence for Effectiveness of ABA as a Treatment for Autism. (February 2013). Oregon State Legislature Committee Meeting.
- Management of Children With Autism Spectrum Disorders. (2007). American Academy of Pediatrics.
- Treatment and Intervention Services for Autism Spectrum Disorder. (September 2019). Centers for Disease Control and Prevention (CDC).
- Discrete Trial Teaching: What Is It? (2018). Indiana Resource Center for Autism.
- A Progressive Approach to Discrete Trial Teaching: Some Current Guidelines. (December 2016). International Electronic Journal of Elementary Education (IEJEE).
- Early Intensive Behavioral Intervention (EIBI) for Young Children With Autism Spectrum Disorders (ASD). (May 2018). Cochrane Library.
- Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model. (January 2010). Official Journal of the American Academy of Pediatrics.
- Pivotal Response Treatment for Autism Spectrum Disorder: Current Perspectives. (2017). Neuropsychiatric Disease and Treatment.
- A Randomized Clinical Trial Comparison Between Pivotal Response Treatment (PRT) and Structured Applied Behavior Analysis (ABA) Intervention for Children With Autism. (November 2014). Journal of Autism and Developmental Disorders.
- Which Behavior Therapy Works Best for Children With Autism? (January 2020). ADDitude.
- Homepage. Behavioral Analyst Certification Board (BACB).
- Applied Behavior Analysis. Autism Speaks.
- Accessing Services for Autism Spectrum Disorder. (March 2020). Centers for Disease Control and Prevention.