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Applied behavioral analysis with autistic children

Applied Behavioral Analysis with Autistic Children

Autism is a severe developmental disorder, which if left unchecked, can usually progress to developmental disabilities at a young age. The causes of this disorder are largely unknown. It includes genetic and environmental factors. Symptoms may be present from, or even before birth, or appear gradually or suddenly after two or more years of apparently normal development. There is some evidence of alerted neurotransmitter levels; some children show slight physical changes, such as the shape of their ears; there is a strong correlation with maleness and non-rightandedness; and there is correlation with certain genes. (www.autismbook.com) There is a one in nine chance that a child will have autism.

Early symptoms may include grossly delayed language or motor development; atypical play; such as spinning, lining up, staring at or feeling toys; lack of peer play or friendships; pronounced fears, crying fits, sleeplessness, or noise sensitivity. (www.autismresources.com) Some autistic children may develop some skills early, such as the ability to recognize letters and signs. People think that children with autism are withdrawn; this is a misconception some autistic children are withdrawn but some children are perfectly friendly with the proper social and communication skills taught.

Older children may develop aggressive, hazardous, a self-injurious behavior to such a degree that they need institutional care. Most children develop language, but it is consistly "echoed" words and phrases. If I were to say what is your name? The autistic child would "echo" what I have said and say, what is your name.

There is strong evidence that many or even most children with autism are actually able to learn as much as typically developing children, when they are given the right environment. Most autistic children have what people call learning "blockage." (www.autismtoday.com) No one really understands why autistic children are the way they are; they don’t understand why their responses to everyday things can be so very strange. The particular excesses and deficits vary so greatly from one child to another that an explanation or strategy that seems to work for one child may not be a total disaster for another.

There are a few things that are actually true about autism. This disorder is uncommon but not rare. The "accepted" incidence is around one per thousand, but many parents in the USA reported a "headcount" in their schools that gives an incidence closer to one in every two or three hundred. (www.autismtoday.com) This disorder is genetically linked in some degree. It is also impairment in learning by social imitation. Spoken language, body language, the rules of playing and friendship, are all typically learned at an early age by a deserving and imitating other behaviors.

There are many different types of disorders in autism. For the purpose of this study "ABA" was chosen.

Applied Behavior Analysis (ABA) is a science, which seeks to use empirically validated behavior change procedures for assisting individuals in developing skills with social value. "Applied," means practice and "Behavior Analysis" may be read as "learning therapy" that, understands what leads to new skills. The procedures used in intensive behavioral intervention programs for children with autism are primarily from research generated by practitioners of ABA.

Typically developing children learn without intervention, the environment that the child is born into provides the right conditions to learn language, play, and social skills.

Children with autism learn much, much less from the environment. They are often capable of learning, but it takes a very structured environment, one where conditions are optimized for acquiring the same skills that typical children learn "naturally." ABA’s function is to establish the rules for setting up the environment to enable children to learn.

Behavior analysis dates back to Skinner, who performed animal experiments showing that food rewards led to behavior changes. (www.naar.com)

ABA does not create "robots", or brainwash people. It does not turn children into little "Pavlov’s Dogs", it is merely a tool to help us understand why certain behaviors occur, and modify these behaviors should they be a problem to something more useful or beneficial to both ourselves and the person with the behaviors. Wouldn’t it be better for example that instead for a child’s hitting people to get their "request", they are taught a "better" way to "request," if it is a methodology that examines behaviors. There are suggestions that analyzing the causes, consequences of behaviors and applying knowledge, skills to overcome those deemed problems.

ABA uses these principles to set up an environment in which children learn. Most learning in schools is from an explanation, what people call "natural" learning. ABA is to teach the prerequisites to make it possible for a child to learn "naturally."

A behavior can be either acceptable or a problem but a behavior doesn’t happen by itself. The setting, social context, and the lead up to the behavior as well as a result must be examined to determine a behaviors acceptability. There are three basic components for a behavior pattern, which is called "ABC". "A", stands for Antecedent, which is the setting of what took place before an event. "B", stands for Behavior, which is for the "event" itself. "C", stands for Consequence, which is what occurred after the event, or result all of "event." (www.abachildren.com)

A child who throws a tantrum to "achieve" something will be more likely to throw a tantrum to "achieve" the same thing in the future. If for example a child did not wish to do the dishes and found by breaking a plate stopped the child from doing the dishes even though they were sent to their room, the child got what they wanted to not do the dishes. They will be more likely to do the same in the future as it worked the first time. There are of course only "so many dishes" one would want broken, so the goal must be to get the child to wash dishes without breaking them this is where ABA comes in.

The most common distinguishing results of intervention based on Applied Behavior Analysis are discrete trial learning. It is what people most often think of when people say "ABA."

This is how it works the student is given the stimulus a question, a set of blocks, and a pattern along with the correct response or a strong "hint" at what the response should be. The child has been rewarded an M & M or a snack which they like, A piggy- back ride, or something that we know the child enjoys to eat or do. The child is also rewarded for repeating the right answer; anything else is ignored or sometimes corrected very naturally. As the child becomes more reliable, the "clues" are withdrawn until the child can respond independently. This is usually done one-on-one at a table with detailed planning of the requests, timing, wording, and the therapists, paraprofessionals, or teachers’ reaction to the students’ responses. Repetition is an important method for autistic children, but it should not be boring or tedious. In fact, Dr. McEachin says, "that’s our responsibility to make sure it is not tedious." (www.autismtoday.com) Some children require literally hundreds of trails in order to learn a specific concept, but the children will also learn effectively if it is practiced. A skilled at his practiced once a day is not as efficient, and could take months longer to master, then one practices 20 times a day.

ABA is sometimes referred to as "Lovaas treatment" after the professor at UCLA who first packaged these methods and documented children’s success for teaching children with autism. (www.patientcenters.com/autism)

Professor O. Ivaar Lovaas published a landmark study, which is very well known; many people have used the term "Lovaas theory" interchangeable with "intensive behavioral treatment." Only a practitioner who is directly affiliated with Lovaas can properly be said to implement "Lovaas Therapy." (www.patientcenters.com/autism)

Lovaas notes very clearly that a behavioral program is a comprehensive intervention, carried out in every setting and every possible waking moment. (www.patientcenters.com/autism) The skills that are taught so efficiently in discrete trial drills must be practiced and generalized in "natural" settings. A child who does know the difference between "ask" and "tell" may slowly get a higher percentage of right answers during an exercise until the child is considered to have "mastered" the skill; but the child will not go on to use "ask" and "tell" appropriately without additional support in natural situations. It takes trained and supportive people such as parents, teachers, relatives, even peers to help reinforce a wide range of appropriate behavior is in a variety of settings, until the level of reinforcement fades to a typical level.

When behaviors are followed by consequences that the individual fines desirable, those behaviors are more likely to be repeated in the future. This is called reinforcement. When consequences are negative, behavior is less likely to be repeated. In discrimination training, which is a core component of an ABA program, and discrete trial teaching, they learn which response to make in the presence of specific words and environmental stimuli. The teacher arranges consequences that lead to the increase of correct responses and a decrease of incorrect responses. The negative consequences may consist simply of a "no" said naturally.

For a child that has a higher understanding of learning there are the leading positives of problem behavior. Problem behavior methods for reducing the problem seems to be a little more obvious to changing from behavior first then changing in the consequences. Ignoring may be a way of letting the child know that there is no reward coming. The most successful method you can apply is the most difficult to practice. The child wants attention, but it is not a forthcoming thing you are teaching them. There are certain ways they will not get it, in other words a different behavior will be required that is not a "problem." Intensity of the tantrum, screams will probably increase if your child has had success before. To the child this "working model" performed well in the past, but isn’t working now, so the child may try increasing it to see if that works. If the child the self-injurious then intercede to clam them and then repeat the process immediately the "problem" realize th!

e "problem" behavior no longer works. (www.patientcenters.com/autism) You can also give time-out. This tells the chills that there is no "reward" coming. This is similar to "escaping or avoiding" and so should be used with discrete and caution. This method is used when the situation is so disruptive that ignoring is insufficient or difficult, and there is no "reward" to remove. It means putting the child in a situation where the possibility of a "reward" is completely removed for a fixed period of time, no longer than 5 to 10 minutes. It should not be used when we are angry, or don’t know what else to do. If used in all we are doing is rewarding ourselves with the problem being "out of sight, out of mind", but is nothing to stop the child’s "behavior problems" from returning. (www.autismtoday.com)

A key element of this approach is that services are highly intensive, typically 30 to 40 hours a week of potential learning opportunities, the majority of which are conducted on a one on one basis with a trained therapist or paraprofessional. (www.naar.org) ABA’s goal is to minimize the child’s failures and maximize the child’s successes. The therapist must provide the prompts necessary for your child to understand what is expected of them and learn the new skills. The prompt is assistance provided by the teacher to facilitate the correct response.

Targeted skills are broken down into small attainable tasks. When the child does well on these targeted skills, a lot of reinforcement must be provided. The therapy proceeds in small, carefully planned steps that build additional skills. An example of that is one of the first test may be to get the child to sit in a chair. The therapist would provide a physical prompt to put the child in the chair and a sit in the correct position, and immediately after provide a carefully chosen reward for a "reinforcer."

Sometimes working with young children in a home setting is viewed as "restrictive." Dr. McEachin, states, "you have to understand that the approach year is based on, first of all, accelerating development that may be delayed. (www.autismtoday.com) We want to, as quickly as possible, give children language, ability to follow instructions, paying attention, and behavior to learn." He states, "this can best be accomplished, working with children one to one." While the program can be center based, home sometimes has its advantages when working with very young children three to four years of age. The reason for this is that nap time and breaks can be incorporated into the program in this setting. He says that, "although the child may not be in a group setting of children, the fact is that the program definitely does promote development of social behavior." Having first established the underlying skills, they can then transitions to a mainstream setting and "they’ll be able to!

participate at a much higher level and participate much more meaningfully." Having already learned the basics, they can be much more acceptable right from the beginning of the school experience. He gives the examples that, in order to teach soccer, you would typically put any child on the field with some other kids and have them play. They learned by watching and doing. Or he states, "you can spend sometime before going to the playing field teaching the basic skills of how to take a ball, what the rules are, how to dribble, and then put the child with other kids."

The time that a family invests into an applied behavior analysis intervention for the child will depend on the family dynamics, but according to the research, the optimum amount of time is about 40 hours a week. (www.autismresources.com) People think that that is unrealistic when talking about a three-year old, but that time includes nap time, mealtime, and a lot of playtime that can be used for breaks or rewards and the facilitated by someone who can use that time to the child’s advantage. It is not, as people picture in their minds, a child’s sitting at a table responding to questions all day long. The children tend to be more connected to those around them, more tuned into the world.

Most families believe that a program this intense will be very demanding and add a lot of stress to their lives. One must consider that a lot of families feel that the child’s behavior alone adds a lot of stress to the family situation, and improving the behavior can actually reduce the stress. That is a decision that each family must make based upon its own dynamics, abilities, and patience. If you decide to and cannot manage 40 hours, but 25 would be possible, that’s OK, too. There is no "all or nothing" about the program.

It has been rumored that ABA produces "robots" who are unable to think for themselves but that conclusion, says Dr.McEachin, is sometimes based upon the "flat affect" that children with autism inherently have, and should be attributed to the intervention, but to the disorder is self. In fact, he says, ABA can improve the lack of the motion in the voice by teaching a greater range of emotional behavior. You can "train spontaneous behavior sounds like an oxymoron," but Dr. McEachin says that the spontaneity is something that occurs in the absence of obvious outward stimulus. (www.autismtoday.com) Conversation skills can be taught by cueing, then transferring the cue to a stimulus that would occur naturally and then they will be better able to do it on their own. As an example, during a conversation children are taught not just to say, "I don’t like pizza." They are taught to follow it up with "I like chicken", then to follow it up with a question "do you like chicken?" This!

is what a conversation is all about, they give and take, and they have now learned a strategy to achieve that. They teach for components that can happen in a conversation. Initiate the statement, initiate a question; respond to a statement, respond to a question. Learning must take place across different settings and by using different language if it is to be truly useful learning. Therapists don’t just teach "touch your nose"; that language needs to be variable to include "where’s your nose?" "can you find your nose" and "show me your nose", so that they learn to recognize that there are different ways to interest for the same thing.

Even if the child is no longer a preschooler, ABA can work for that child. There is a misconception that this series only apply to young minds. The studies done in the past only involved young children, but that does not conclude that it doesn’t work for the older individuals, in fact, they have experienced substantial improvement for them as well. Different reinforcers are needed for older children and creativity is the key to success. For kids who are not capable academically, there needs to be a focus on self-help and independence skills, such as doing laundry, and going to the grocery store. Reading is one academic skill that needs to take precedence since it is important for many everyday happenings. There needs to be a focus, he says, on parent concerns and long-term prognosis when planning programs for older children.

There are advantages to center or school-based programs, but there are some drawbacks. That might make home-based programs more desirable. Since the school is a large system, they have a great deal of resources that are not available to an individual. The availability of space and materials can sometimes be an advantage, of course, with today’s overcrowded schools and small budgets these things are not necessarily always easy to come by. Peers for practicing socialization skills and access to adjunt therapies such as occupational therapy and speech therapy, language therapy are a consideration, as well as the ability to serve a larger group of students then would be possible in the home. It not only is easier and most cost efficient for a therapist to go to one location rather than several in a day, it makes the transitioning to mainstream classes easier for the children if they can remain in the same space.

Of course, there are obstacles that are inherent in the fact that the school is a system. There is a culture within the system, and that means learning to work within the structure that exists. Money is certainly a major issue, and so are the hiring policies. There are unions and seniority issues to consider sometimes the person best suited for the job is not available, or someone else’s required to fill the position due to hiring hierarchies. In a home-based program where all the control used in the parent’s hands, you can choose whenever you feel would be the best individual and be in control of building the program from the ground up. When a school is responsible for the program, you can depend greatly on the decisions made by others. It is a choice that needs to be made very carefully.

ABA programs contain many if not all of the components of effective treatment approaches found to be most successful in treating children with autism, it consists of individualized instruction tailor made to address the specific needs of the child; behaviorally based on methodology; low student teacher ratio; early treatment; and family involvement.

In ABA therapy, emphasis is placed on acquiring new behaviors. When children have read repertoire of constructive behaviors, problem behaviors often occur less frequently. Therapists are trained to ignore undesired or disruptive behavior but to promote compliance and good behavior "praise the best, ignore the rest". This phrase was something that has always been said to me with all the years working for the Board of education. Reinforcements were chosen to be whatever the child wants the most. Many young children initially respond to tangible or concrete reinforces such as can be, or the chance to play with a favorite toy. Concrete rewards eventually fade and is replaced with "social" rewards such as praise, tickles, hugs, or smiles.

The purpose of intensive behavioral intervention is to teach children how to learn. Whether it is academic skills or behavioral skills. Behavioral methods enhance learning not only by teaching the child but also replacing challenging behaviors with more appropriate ones. The child’s success is closely monitored by detailed data collection. Skills that have been mastered successfully performed, and with some stated frequency placed on maintenance schedule, allows for periodic regressed in them as new tests are introduced. A maintenance schedule consists going back to the first task every once in a while to refresh the child of what was already learned.

ABA programs can be highly tailored to the individual needs of the child; therapy involves the range of different tasks for each child, using a range of locations in which to conduct the therapy in particular strategies to cope with the challenging behaviors where necessary. Newly mastered skills are adapted to ensure that the skills are generalized to different people, settings, and materials. Changes in instruction are made if the numbers from the data collection indicate that modification is needed for the child to achieve successful mastery of the skills.

Depending on the needs and age of the child, ABA can involve the range of placements included in an inclusion classroom, special education, or a completely home-based program. (www.autismtoday.com) For many young children, much of the therapy is often conducted in the home as the natural learning environment for young children, and gradually moves to more educational and community settings as social and communication skills developed. On the other hand, some programs prefer school based options, even during the first year of the therapy, on the grounds that the structure of time involved in running a completely home-based model makes it difficult to incorporate into family life. These programs believe that school-based options can be effective for students, even during the first year of therapy. The necessity of performing at least some of the therapy at home implies a great deal of parent involvement and awareness, which is key to the long-term success of the child, is very important. Whether center or home-based, most instruction remains one-on-one and highly intensive.

While ABA programs are highly structured, young children still need "down-time" and the chance to be a kid. Some programs incorporate ABA principals into structured play and less demanding activities as an important component to the therapy in that learning should be made fun for the child. It is also important to address the child’s need for age appropriate play skills and social behavior. Through play and incidental learning, skills can be generalized to progressively less structured settings and more naturalistic situations.



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