5.1 Applied behavioural analysis

Lovaas’ approach evolved to become Applied Behavioural Analysis (ABA), an intervention for autism in which operant conditioning principles are used to reinforce ‘desirable’ behaviours (e.g. more speech and communication) and reduce ‘undesirable’ behaviours (e.g. aggressive or repetitive behaviours that may be injurious or considered antisocial, such as head banging, destruction of objects or taking clothes off in public).

In ABA the child’s behaviour is analysed into components that are tackled one at a time. If the target behaviour is one that it is identified for the child to learn, for instance uttering a word or phrase, the reinforcement needs to be a positive outcome for the child, such as a favourite snack or some non-edible reward. If the behaviour is something that it is thought should be discouraged, for instance a tantrum, then withholding reinforcement (e.g. by ignoring the behaviour, saying ‘no’ loudly and firmly, removing the child from the context or reinforcing alternative behaviour) should eventually result in the behaviour disappearing.

The first stages of ABA may focus on teaching self-help and receptive language skills (i.e. language understanding), non-verbal and verbal imitation, and the foundations of appropriate play. The second stage emphasises the teaching of expressive language and interactive play with peers. Advanced stages involve the learning of early academic tasks, socialisation skills, cause and effect relationships, and learning by observation. The intervention might seem particularly relevant for young children who are lacking basic communication skills and everyday capabilities. However, children with higher initial intellectual ability and less pronounced autism are also said to make good progress, especially following early behavioural intervention. ABA is also used with some autistic adults.

If at all possible parents are trained to carry out ABA at home, albeit supported by trained therapists and consultants. Classic ABA approaches stipulate that 40 hours per week should be spent on ‘shaping’ the child, making it expensive for parents or local service providers to employ trainers. The commitment for parents is also substantial.