Over the last decade, Applied Behavior Analysis (ABA), especially with autistic children has experienced a return to popularity. Behavioral intervention can be employed positively with a high degree of flexibility. Most importantly, the intervention has proven to be highly effective.

Intensive Behavioral Intervention has been shown to successfully increase children's functioning in areas such as language, play, social, self-help, amongst others. Naturally, however, there is a range in the degree of treatment outcomes. The results of treatment depend upon several factors such as age at onset of treatment and the child's cognitive capacity. Treatment is designed to bring out the child's fullest potential.

Although the tremendous popularity of ABA is recent, ABA is not a new procedure. In fact, ABA is based upon more than 50 years of scientific investigation with individuals affected by a wide range of behavioral and developmental disorders. The research has shown ABA to be effective in reducing disruptive behaviors, such as self-injury, tantrums, non-compliance and self-stimulation. ABA has also been shown to be effective in teaching commonly deficient skills such as complex communication, social, play and self-help skills.

Some children (especially with autism) have difficulty accurately attending to, interpreting and utilizing the feedback that automatically exists in their world. ABA, and subsequent treatments, analyze these interactions and sequences of behavior, making explicit the rules, consequences, and expectations that others understand more automatically, in an effort to teach more adaptive, useful, and maintainable behaviors and skills. Behavioral intervention teaches a child not only to "know" the rules of what is expected, but to use their skills more automatically, modifying behavior and adding new behaviors using well understood and established behavioral principles such as reinforcement, shaping, prompting and prompt-fading, and generalization.

 With this technology, target behaviors are broken into very small, separate components and each skill is taught systematically in a way that is likely to be effective for that child, typically individually at first, utilizing specific prompts and reinforcers (referred to as "errorless learning") until the child reaches a predetermined level of mastery that is designed to increase the likelihood of maintenance and generalization.

 Successes are built upon, with constant systematic modification of the program as the child demonstrates progress, eventually adding a behaviorally sequenced generalization plan to transfer the skills into other settings and situations. The success of any behavioral program rests upon the clarity of target goals and objectives, the purposeful choice of teaching tools and lessons, the appropriate choosing of reinforcement and reinforcement schedules, the appropriate judicious use and fading of prompts and reinforcements, the purposeful inclusion of behavior generalization, and the consistent application of behavioral principles.

Age, Treatment Intensity and Other Considerations

While most research on intensive behavioral treatment has been done exclusively with very young children, experience has demonstrated that older children can benefit substantially from a similar treatment format.

Modifications are applied in the treatment plan according to the age and developmental level of the person, taking into account the need for teaching functional and age-appropriate skills, effectiveness and suitability of reinforcers, severity of disruptive and interfering behavior, and realistic expectations for achievement.

Programs may be applied with people of all ages in a variety of settings including home, schools, vocational and employment services, and residential care and training.

Intervention with older children requires addressing their unique needs, such as development of coping skills to deal with frustration, self-esteem and complex social skills. Additionally, strategies designed to deal with interpersonal issues, such as depression, social problem solving and conflicts with family and friends, are often necessary.

In determining the intensity or number of treatment hours, the child’s daily schedule should be considered in order to determine an appropriate balance between periods of intensive teaching and less intensive (but still structured) activities, as well as allowing for the child's need to have periods of free time.

Besides the number of hours of 1-to-1 teaching, the quality of teaching and the degree of structure provided outside the formal therapy hours has also to be considered. Research shows that many children will do best with 30 or more hours per week of direct instruction. The length of therapy sessions should be adjusted to provide maximum benefit. Generally it is recommended that the sessions last two to three hours. Once a child is spending part of the day in school, it may be advisable to reduce the treatment hours at home.

Teaching Setting

Initially teaching is done in an environment that will lead to early success. In most cases this may mean a controlled environment with reduced distraction. However, teaching must quickly be extended to everyday settings. Not only is this more natural but it also promotes transferring learning to all settings (generalization). Therefore, therapy should occur across the house, as well as outside and within the community (e.g., the park, the market, etc.). If distractions pose a problem, it will be critical that we help the child learn to focus even in the presence of environmental interference. Children must be able to learn in varied environments where distractions naturally occur so as to prepare them for learning in typical settings such as school.

Room adapted for therapy: In order to guarantee the initial controlled and structured conditions, it is agreed with the family, that therapy should begin in a reserved area, either in the house or at school. This room/division must have at least a table and two chairs, a structure to keep the material organized and at hand, and a few motivational items. The conditions should be entirely manipulated by the therapists to fit in with the program and the child’s necessities.

NET Training: As the child acquires new skills and abilities, the teaching surroundings must be broadened to the household, school, neighborhood, etc. Only this way does the student have the possibility to generalize her knowledge and the therapist the possibility to “test” the student in real life situations, where unfavorable conditions might persist, just as in normal day to day activities.

Material

In order to apply any program, appropriate teaching materials are fundamental. Most families choose to be an active part of the preparation of the hardware necessary, but knowing the difficulties they may encounter due to scarceness of sources; a never ending list of new material which increases weekly; or the lack of time, our team offers their services in this area too.  (ERASED)

The Treatment Process

Family: The involvement of the family is critical in the treatment process. No one knows the child better nor cares more for his welfare than do his parents, and they are the ones most affected by the child’s disorder. Parents spend a great deal of time with the child and are in a position to carry over teaching goals into everyday living situations. They can also provide some structured teaching sessions to the child. However, it is important to realize that living with an autistic child takes a heavy emotional toll and coordinating the treatment team is already a large undertaking.

The majority of intensive teaching should be provided by paid staff, volunteers or school personnel. This allows parents to have some respite and the remaining time spent with their child can be more enjoyable and productive. Parents can utilize the child’s "free time" to augment intensive teaching time, in developing play, social and self-help skills. Bath time, dinner, getting dressed, and feeding the family pet are just a few examples of everyday routines that offer opportunities for teaching. Outings to the park, (erased) shopping, mailing a letter and visits to a relative's home are opportunities to generalize skills and work on improving behavior. In this way the child's entire day becomes part of the treatment process and the parents become an integral part of the team.

Team Charactarestics: ABA based intervention emphasizes a positive and systematic approach to teaching functional skills and reducing behavior problems. The creativity and flexibility of these programs enable to capitalize on the resources available for each individual child.

While certain teaching techniques have been found to be consistently effective, it should be recognized that each person working with a child has their own style and unique contribution to make to the educational treatment process. In the initial treatment phases, it is important that all members of the team adhere consistently to the smallest details of the teaching plan. As the child masters skills, it becomes important to deliberately increase variability in order to facilitate generalization to all people and settings in the child's natural environment.

It is rare to find an experienced staff member who can step in and start working with your child on the first day. While experience is a plus there are many other factors that determine whether a person will be a good behavioral interventionist. We look for people who are enthusiastic, eager to learn, reliable, and able to accept and incorporate feedback. Completion of a degree in psychology or special education is highly desirable. It is recommended that a team ranges from 2-4 therapists, who can each work between 6 and 12 hours per week.

Lead Therapist: To coordinate all parts involved, the team of therapists has a lead therapist. Directly related to the team, the lead therapist is responsible for coordination between all people involved in the intervention (parents, teachers, and other professionals), problem solving, presenting the program and evaluating the progress.

The program’s evolution depends on constant data collection by the therapists (erased) in order to accompany the child’s development. Based on the data, the lead therapist changes the program and increases the list of material. Although the program is evaluated constantly, a more comprehensive reevaluation is performed quarterly.

Finally, the lead therapist is the main bond between all significant members of the child’s life, including team of therapists, family and school, and must guarantee a constant flow of information to secure a good relationship that can only help the intervention.

The rest of the team members have the biggest responsibility of all – applying the program. Based on an individually designed program and specific strategies to deal with behavior, therapists must guarantee consistency and efficiency in order to promote ideal conditions for the child to learn or perfect skills and abilities.

Supervision: A qualified person should lead the team. It takes years of training and experience to be able to train and supervise others in the implementation of behavioral programming. While there are common elements in the treatment of most (erased) children, each child presents a unique challenge in designing and guiding the optimal learning process. The level of supervision necessary is based on a number of factors, including skill level of staff and parents, stage of treatment, complexity of programs required, number of treatment hours, etc. It is important that a qualified supervisor be involved on a regular, and as needed basis.