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"It's Okay to be Different" 

Applied Behavior Analysis (ABA) Early Intervention Therapy

Applied Behavior Analysis (ABA) is the science of learning and behavior, designed to analyze and modify specific behaviors in a precisely measurable and accountable manner. ABA has had a significant impact on developmental disabilities and Autism Spectrum Disorder (ASD) by exclusively utilizing evidence-based practices that have been clinically proven effective. Research studies have shown that Early Intervention Therapy or Early Intensive Behavioral Treatment (EIBT), using ABA principles, has resulted in half of the participating children with autism entering the public school system in classrooms with typical peers. Furthermore, the best outcomes occur when Early Intervention based on ABA principles is initiated at an early age (preferably before age 5) and involves 20-40 hours per week.

The fundamental objectives of Early Intervention therapy are to improve the child's current and future lives and those of their families. The early years of development are a critical period for the acquisition of communication skills. Researchers believe that the early social-communicative behaviors of toddlers and infants are the foundation for later language development. Interventions that provide the most direct, individualized, and intensive services can have the greatest benefits. Thus, early intervention, focusing on expanding the child's skill repertoires and building communication with caregivers at home, can improve problem behavior and prevent recurring problems. ABA Intervention, focused on developing skills rather than merely reducing problem behavior, holds the most promise for positively impacting the child's development.

Research indicates that effective intervention programs should result in:

  1. Changes in the individual's social relationships and daily activity patterns.

  2. Increased community inclusion.

  3. Changes in the individual's health status or the need for crisis intervention.

  4. An expansion of skill repertoires.

  5. A generalized reduction in problem behavior.

When providing ABA services to our clients, it is essential for us to offer interventions that are based on scientific research, individualized, effective, and unintrusive. Our early intervention services focus on using high-quality, research-based ABA practices to reduce and teach the replacement of problem behaviors, maintain positive behaviors, increase language and communication skills, improve self-help and social skills, and shape new behaviors. We employ different types of ABA therapy, such as Discrete-Trial Training (DTT) and Natural Environment Training (NET), to enhance our clients' learning experiences and facilitate the generalization/transfer of skills.

Discrete Trial Training (DTT) is one of the most common ABA intervention techniques and is frequently used for teaching new communication skills. It involves breaking down tasks into short, simple trials and reinforcing the behavior. Discrete trial training relies on the ABCs of Applied Behavior Analysis: Antecedent (what happens immediately before the behavior) - Behavior (the observed behavior) - Consequence (the event that immediately follows a response).

A discrete trial consists of four to five steps in behaviorally based instructional routines:

  1. Antecedent (a short, explicit instruction to which the client is to respond)

  2. Prompt (providing a temporary prompt if necessary)

  3. Response (the target behavior or skill occurring)

  4. Consequence (providing the reinforcer)

  5. The inter-trial interval (a brief pause between consecutive trials)

Natural Environment Training (NET)

NET or Natural Environment Training utilizes ABA principles to teach in the child's natural environment, such as at home, in the park, and in the classroom. This approach focuses on teaching through play while following the child's lead and motivation.

For example, the colors blue and green can be taught to the child while they are playing with their favorite Lego set. NET also incorporates the ABCs of behavior and always includes reinforcement of desired behaviors. This method can teach various skills such as communication, joint attention, eye contact, pretend play, and turn-taking. NET enables the child to learn skills in one environment and generalize them to other settings. Furthermore, it is easy to conduct, and parents can implement it with their child when the therapist is not present.

For detailed information in regards to the list of our services, please read below this section.

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Verbal Behavior Therapy

Verbal behavior therapy teaches communication and language. This approach is based on behaviorist B.F. Skinner's theory in which is language should be categorized by the function of expression. Individuals become listeners when they respond to others' vocal verbal speech, and they become speakers when they communicate through various forms (e.g., vocalization, signs, pictures). The verbal behavior goals are based on six-speaker verbal functions, called verbal operants, which are:

  • Mand: Requesting for preferred item or activity (e.g., "car please").

  • Tact: Labeling or naming actions, items, or events (e.g., sees a car and says "car").

  • Ehoic: Exact repetition of someone else's words (e.g., "say, car").

  • Intraverbal: An interaction or conversation (e.g., what do you like to eat? "cookie").

  • Listener Responding: Following simple instructions (e.g., "come here").

  • Motor Imitation: The exact repetition of someone else's movement. It can be accompanied by the instruction "do this" or "copy me." (e.g., parent waves, and then the child waves).

Image by Marcos Paulo Prado

Behavior Management

Behavior management interventions focus on decreasing or potentially eliminating maladaptive behaviors that interfere with functioning or learning, such as:

  • Self-Injurious behavior (SIB)

  • Aggression towards others

  • Non-compliance

  • Self-stimulatory behaviors

  • Crying/tantrums

  • Elopement 

Before creating an intervention plan, we first need to analyze the behavior to understand its function. Once the problem behavior's function is hypothesized, we create and implement an intervention plan that includes replacing the problem behavior with a functionally equivalent behavior (replacement behavior). For example, if a child engages in aggressive behavior to escape from a task, we can teach them to ask for a break instead. 

 

It is always best to select between 2-4 highest priority behaviors to provide the highest quality of intervention while taking data efficiently.

Brushing Teeth

Functional Living Skills

The functional living skills program is designed to help our clients become functionally independent. We develop and implement interventions that are age-appropriate and based on the results of the initial assessment. The parent's highest priority also determines program goals. The inability to perform functional living skills independently can result in the dependence of other individuals, and our goal is to make our clients as independent as possible.

Some examples of functional living skills are:
·   Dressing
·   Toileting
·   Grooming
·   Health, safety
·   Bathing
·   Nighttime routines

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Parent Training

Parent-training is one of the main aspects of an early-intervention program. Consistency and following treatment protocols are the keys to successful therapy. Therefore, it is imperative to ensure that parents are involved in the programming. Parents play an essential part in the child's therapy's success and can also increase the chances of maintenance and generalization of their child's skills.
 
The goal is to support parents, help them understand the function of their child's behavior, and increase their knowledge about ABA interventions. Furthermore, it is crucial for us to help parents learn how to teach new positive behaviors and address challenging behaviors such as non-compliance, self-injury, aggression, tantrums, and other problematic behaviors. The training can be implemented in the client's home, community, or via Telehealth. ABA parent training programs are individualized, and the hours vary based on the family's needs and health insurance requirements. Training can be conducted in a group setting with all the family members present or one-on-one with a parent.

Girl Eating a Meal

Feeding Therapy

Feeding therapy programs are implemented for children who show signs of food selectivity, food aversion, limited diet, and other food-related problems. Food selectivity can significantly impact the child’s health, growth and be associated with malnourishment. It can also create problematic behaviors during mealtimes. Prior to planning an intervention, it is essential for us to gain information about our client’s medical history, allergies, and other critical medical issues. Parent’s training and sometimes the involvement of an occupational therapist is mandatory for successful programming. We utilize various evidence-based strategies such as shaping, antecedent-based interventions, prompting, and differential reinforcement to help our clients reach their feeding therapy goals.

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Social Skills

Many children with Autism Spectrum Disorder (ASD) lack social communication skills such as initiating conversation or responding to social cues.

Some example of social skills include:

  •  Initiating conversation

  • Conversational skills

  • Joining ongoing activities

  • Taking turns

 

We use several strategies to increase social skills and social interaction, which are:

  •  Modeling

  • Scripts and scripts fading

  • Social stories

  • Role plating

  •  Video modeling

  • Differential reinforcement

Meeting

School Consultation

To help our clients reach their full potential, we collaborate with teachers, paraprofessionals, and other professionals in school settings to help them gain more understanding about ABA principles. Our Board-Certified Behavior Analysts (BCBA) develops behavioral intervention plans based on the staff and students' needs to help them implement effective teaching practices. Our goal is to create a positive and safe classroom environment for both staff and our students.

Our school consultation services include:

  • Functional Behavior Assessments (FBA) or Functional Analysis (FA)

  • Individualized Educational Evaluation (IEE)

  • IEP goal development

  • Positive Behavior Support Plans

  • Paraprofessionals supervision and training on using ABA principles for teaching academic skills

  • Staff training on behavior reduction, positive behavior supports, and precise data taking

  • Visual and communication system implementation

In the Classroom

Pre-Acadamic Skills

To help our clients reach their full potential, we collaborate with teachers, paraprofessionals, and other professionals in school settings to help them gain more understanding about ABA principles. Our Board-Certified Behavior Analysts (BCBA) develops behavioral intervention plans based on the staff and students' needs to help them implement effective teaching practices. Our goal is to create a positive and safe classroom environment for both staff and our students.

Our school consultation services include:

  • Functional Behavior Assessments (FBA) or Functional Analysis (FA)

  • Individualized Educational Evaluation (IEE)

  • IEP goal development

  • Positive Behavior Support Plans

  • Paraprofessionals supervision and training on using ABA principles for teaching academic skills

  • Staff training on behavior reduction, positive behavior supports, and precise data taking

  • Visual and communication system implementation

Job Interview

ABA Student Supervision

Due to the lack of BCBA’s in rural areas and other countries, we provide ABA supervision remotely to individuals interested in becoming certified by the Behavior Analyst Certification Board.

Please review www.bacb.com to make sure you meet the requirements of BCBA and BCaBa supervision. We also provide ABA training to individuals interested in working with individuals with disabilities and would like to gain more knowledge about using ABA principles effectively.

For all supervision, the following are required:

  • Working with a client in a natural environment

  • Consent from on-site supervisor or employer

  • Consent from the client to be recorded by you and observed by the BCBA

  • Access to high-speed internet, microphone, webcam, or any other video conferencing format

  • Payment made before each supervision

For detailed BCBA supervision requirements for 2022, please click here.

References

Dunlap, G., & Fox, L. (1996). Early intervention and serious problem behaviors: A comprehensive approach. In L. K. Koegel, R. L. Koegel, & G. Dunlap (Eds.), Positive behavioral support: Including people with difficult behavior in the community (p. 31– 50). Paul H. Brookes Publishing Co.

Hall, J. L. (2012). Autism spectrum disorders: from theory to practice. United States, New Jersey: Pearson.

Mayer, R. G., Sulzer-Azaroff, B., & Wallace, M. (2014). Behavior Analyisis for Lasting Change. United States, NY: Sloan.

McConachie, H., & Diggle, Tim. (2007). Parent implemented early intervention for young children with autism spectrum disorder: a systematic review. Journal of Evaluation in Clinical Practice, 13(1), 120-129.

www.autismspeaks.org

https://autismpdc.fpg.unc.edu/evidence-based-practices

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