aba - pediatrics.uci.edu · uci/choc pediatrics –pgy1. outline goal: to have a clear...
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ABA:What is it and how does it help?
Maggie Schweig, MD
UCI/CHOC Pediatrics – PGY1
Outline
GOAL:
To have a clear understanding of the principles and practices behind ABA as a General Pediatrician or subspecialist and be able to communicate this to our patients’ families.
u A bit of history
u What is ABA?
u What is done during sessions?
u Does ABA help?
u What are some other interventions available?
A bit of history…
u Time Magazine 05/07/1965 – “Screams, Slaps, and Love”
u Ivas Lovaas at UCLA; Later joined by Bernard Rimland
u Study with 4 children with “childhood schizophrenia”
u Behaviorism – reward & punishment to change behavior
u Positive reinforcers – food, hugs
u Negative reinforcers – scolding, shaking, electric shock
A bit of history…
What is ABA?
u Applied Behavioral Analysis
u Evidence-based framework from which basic principles of behavior change are applied to socially significant behaviors, to increase desired behaviors and decrease undesired behaviors
u Intensive behavioral intervention
u Based on theories of learning and operant conditioning
What is ABA?
u Goals of therapy:
u Maximize functioning
u Move toward independence
u Improve QOL for child & family
u Improve social functioning and play skills
u Improve communication skills – functional & spontaneous
u Improve adaptive skills
u Decrease non-functional or negative behaviors
u Promote academic functioning and cognition
What is ABA?
u Areas of development:
u Social skills
u Language
u Academics
u Daily living
u Self-care
u Vocational skills
u Specific intervention targets coupled with positive reinforcement and repetition
What is done during a session?
u Adapted to each patient’s needs & goals
u Low student-to-therapist ratio
u Skills are taught through repeated reward-based trials
u Variety of settings – home, self-contained classroom, inclusive classroom, community
u Data collection for monitoring changes to each behavior – frequency, duration, rate & trials to criterion
What is done during a session?
u Tools used:
u A-B-C –Antecedent - Behavior – Consequence)
u Token economy
u Differential reinforcement
u Self-monitoring
u Self-graphing
Does ABA help?
u Difficult to assess due to heterogeneity in ASD
u Diagnosis instruments may not show incremental improvements in core deficits
u Early intervention is critical
u May improve core symptoms of ASD and maladaptive behaviors but should not be expected to lead to neurotypical functioning
u Most gains with high level of intervention (30-40hrs/wkof 1:1 services for 2+ years starting before age 5yrs)
u BUT there is insufficient evidence that ALL patients NEED that much
u Controversy about use for older children & few studies to guide for this age group
Does ABA help?
u Limitations
u Length of time required to see improvements
u Questionable generalizability of learned skills
u Cost & availability
What are some other therapies available?
u TEACCH/Structured Teaching method
u Goal – modify environment & improve skills
u Focuses on – individualized person & family-centered plan, organizing physical environment, predictable activity sequence, visual schedules, flexible routines, structured work & activity systems, visually structured activities
u Developmental & relationship models
u Focus on teaching skills essential to development
u Integrative models
u JASPER (Joint Attention Symbolic Play Engagement & Regulation)
u Interventions for specific behaviors
What are some other therapies available?
u Communication interventions – speech therapy
u Traditional ST
u Behaviorally-based strategies to encourage language
u Augmentative communication strategies
u Visual supports
u Social skills instruction
u Joint-attention interventions
u Modeling
u Peer training
u Story-based intervention
u Occupational therapy
u Sensory integration therapy
Bibliography
u Applied Behavior Analysis, Autism Speaks. https://www.autismspeaks.org/applied-behavior-analysis-aba-0
u Applied Behavior Analysis: A parent’s guide, Autism Speaks. http://www.autismspeaks.org/sites/default/files/2018-08/Applied%20Behavior%20Analysis%20Guide.pdf
u DeFilippis M, Wagner KD. Treatment of Autism Spectrum Disorder in Children and Adolescents. Psychopharmacology Bulletin, 46;2:18-41.
u Helton MR, Alber-Morgan SR. Helping Parents Understand Applied Behavior Analysis: Creating a Parent Guide in 10 Steps. Behavior Analysis in Practice (2018) 11:496-503
u Sanchack KE, Thomas CA. Autism Spectrum Disorder: Primary Care Principles.AAFP.org. (2016) 94;12:972-980
u Weissman L. Autism spectrum disorder in children and adolescents: Behavioral and educational interventions. UpToDate.