Understanding Treatment Options

Dr. Alison Betz, Faculty Supervisor at the Scott Center for Autism Treatment and Associate Professor of Psychology at Florida Institute of Technology discusses the range of treatment options appropriate for people with autism. Evidenced-based treatments, such as Applied Behavior Analysis, or ABA, are the best option. ABA has consistently been shown to be effective for most people with autism. Individuals with autism may also benefit from other therapies such as speech or occupational therapy. People with autism frequently have other conditions too, such as epilepsy. Dr. Betz discusses how to evaluate your situation and options. 

To understand Applied Behavior Analysis, we must first discuss behavior analysis in general. Behavior analysis is an experimental approach, or science, that studies the behavior of organisms. The objective of behavior analysis is to identify principles or laws of behavior. In other words, behavior analysts are interested in figuring out why people behave the way they do. Applied behavior analysis or ABA, is a branch of behavior analysis that uses the principles of behavior to solve practical and socially significant problems. One of the main purposes of ABA is to improve the quality of life of individuals. This is done by teaching appropriate behaviors and skills as well as by reducing problematic ones.

It is a common misconception that ABA is synonymous with autism treatment. However, ABA is much broader than that. Although ABA has been shown to be one of the only evidence-based treatments for autism, there is a large body of literature showing its effectiveness in areas such as organizational behavior, animal training, sports, and education, to name a few. So, although we will be focusing on ABA as a treatment for autism in this toolkit, I want you to remember that ABA is more than just a treatment for autism.

While there is no known cure for autism, research has definitely shown that treatment methods based on the principles of behavior, or ABA, can produce lasting behavior change for most individuals with autism. ABA as a treatment for autism is often referred to as behavioral intervention, early intensive behavioral intervention or EIBI, or behavioral treatment. Regardless of what it is called ABA as a treatment for autism has been endorsed by the U.S. Surgeon General and the New York State Department of Health. In addition, it has become widely accepted among health care professionals and is used in many schools and autism treatment clinics.  To date, no other treatment has comparable evidence of effectiveness. 

Effective behavioral treatment for autism has several common characteristics; however, it is important to emphasize that it is not a "cookie cutter" or "one size fits all" approach. A well-structured behavioral program is an individualized approach to treatment in which a qualified behavior analyst systematically and continually assesses the client's current skills, needs, family preference, and environment to design effective intervention.

In addition to ongoing oversight by a behavior analyst, an effective ABA program will use a variety of behavioral procedures to teach appropriate and desired skills and reduce problematic behaviors.

To teach new skills using behavioral interventions, the target skills are usually broken down into small, manageable steps. Starting with simple steps that are developmentally appropriate for the client, the behavior analyst uses a variety of techniques to teach the client. As the client learns each step, a more complex skill or step is introduced until the target skill is mastered.
One of the most critical behavioral techniques used to teach new skills is positive reinforcement. Positive reinforcement involves presenting a preferred item or activity immediately following the target behavior. Positive reinforcement is used in ABA treatments for autism because learning does not come easy for individuals with autism, so we need to motivate the child to attend and respond to instructions. A good ABA program will often start with more extrinsic rewards such as the child's favorite treat, but then systematically work toward getting him or her to respond in the absence of those treats and under conditions that are more typical.

Another critical component of an effective ABA program is the number of learning opportunities. A good program will incorporate an abundance of opportunities for the individual to practice the target skills across many different environments, with many different people, and with a variety of materials. This is often referred to training for generalization and will help make sure that the individual can use the targeted skills in any situation in which it is needed.

Finally, a good behavioral program will incorporate caregiver training to teach those close to the individual how to support and practice the new skills. 

Despite the overwhelming evidence supporting ABA as a treatment for autism, many parents choose to pursue other intervention methods for their children instead of or in addition to ABA therapy. If you decide to investigate or pursue other interventions methods for your child, it is very important to thoroughly research the treatment to determine whether it is an evidenced-based approach that can support its claims with scientific data. For more information on how to determine whether a treatment is supported by research, go to our Making Sense of Treatment Options toolkit.

Research shows that the earlier you child can begin ABA treatment, the better the outcomes. So, if you suspect your child may have autism, don't wait to get started and contact a qualified licensed psychologist. If your child has already been diagnosed with autism, begin behavioral intervention as soon as possible. If you are not sure if you have a certified behavior analyst in your area, you can ask your pediatrician or visit BACB.com.