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Do Behavior-Based Therapies Work?

by Kimberly on July 6, 2011 · 14 comments

I recently read an interesting article on one of my favorite blogs, Reports from a Resident Alien. In this article the blogger, a college-aged woman with Asperger’s, is complaining about the prevalent use of Applied Behavior Analysis (ABA) as a therapy approach for autism.

(ABA, for those who don’t know, is a highly popular therapy that uses behavior-based interventions and principles to improve “socially significant” behaviors. People who believe in it swear by it.)

I shared her post on Twitter and Facebook and asked others what they thought of the idea that “it’s time to take autism out of 1950s behaviorism.” In return, fellow music therapist Michelle Erfurt asked “Are you going to do a blog post about this? I’d like to hear what you think.”

Here you go, Michelle.

First, a few disclaimers. I fully admit that I am not well-versed in ABA nor do I consider myself an autism expert. But perhaps this is an advantage and give me a fresh perspective on the debate? I’ve outlined below what I believe in at this point in my growth as a therapist.

Let’s see how it stacks up in the ABA debate…

Behaviors are a Form of Communication

I believe that behaviors are a form of communication. As the therapist, why not observe and analyze these behaviors, asking yourself: what is that child is trying to communicate? Are his senses overloaded? Does he need more sensory input? Is something else wrong?

It’s likely not enough to try and change the behavior. That seems too “superficial” to me. Instead, use the behavior to try and understand what’s really going on. It’s like reading someone’s nonverbal cues–you can often better understand how that person really feels through nonverbal cues than through words.

There’s a Place for Behavior-Based Therapy

I believe behavior-based principles have a place. I use them with my own children–positive reinforcement, negative reinforcement, generalization–and can see a place for them when working with other children. Especially when it comes to trying to teach a new skill or behavior.

Extremes Do Not Work

I believe that extremes don’t work. We long ago realized that it’s not nature or nurture…it’s the interaction of the two. Therefore, it’s not all about the behaviors nor is it all NOT about the behaviors. Behaviors have a place in helping us piece together a picture of how our client is doing. But that’s certainly not all there is.

Children are Individuals

I believe that children are individuals. Therefore, a behavior-based treatment may work for some children and may not for others. There is a lot of research supporting ABA and it’s worth it for parents to try it as a treatment approach. Then, if ABA doesn’t work for your child, move on to something else.

In conclusion, I seems I believe that behavior-based treatment may have a place for some children–but it likely won’t be the only thing that works.

Those are my thoughts–what do YOU think? Please leave a comment in the boxes below to share your thoughts on the ABA debate.


{ 14 comments… read them below or add one }

Amanda July 6, 2011 at 12:20 pm

Great post, Kimberly! This is definitely a thought provoking topic! I definitely have to say that I think the amount and level of ABA that is recommended as being therapeutic and needed depends on the child(and their behaviors). Several of the classrooms I work with are ABA classrooms and I have seen amazing results happen over a period of weeks with these students. ABA is definitely not the only therapy for autism out there, but in my experience, it is a very good one to check out if you have a child who has been newly diagnosed with autism and you, as a parent or caretaker are having a lot of difficulties “reaching” him or her.

Kimberly July 6, 2011 at 12:55 pm

What great information to know. Thanks for sharing, Amanda! ~Kimberly

Stephanie July 6, 2011 at 1:02 pm

I’m so glad you did a follow-up post about this! What a great, relevant topic. In my own professional experience, I’ve worked as the music therapist in a private school for kids on the autism spectrum where the treatment of choice was sensory integration– with great results for those kids. I’ve also worked in settings where ABA was the treatment of choice– also with incredible results. When I did home-based MT, some of my families went the diet-control/no med route and saw terrific improvement in their kids. So I completely agree with you, Kimberly, that ultimately it comes down to what works best for an individual child.

Kathy July 7, 2011 at 5:21 am

I agree that there is definitely a place for ABA. I do think that some families have put all their “eggs in one basket” with ABA just because the funding was there, but it was not the best fit for the kids. Part of the reason it works is because they have developed a system where they can train very affordable labor to do the work. If a kid could be in music therapy and speech therapy, etc 30+ hours a week, we’d see great things too. I do think there is not quite as much research to support ABA as what they claim.

Kimberly July 7, 2011 at 9:17 am

@Kathy You bring up some interesting points–I had forgotten how time-intensive true ABA training is supposed to be. @Stephanie Isn’t that the truth! We’re all individuals and what works for one (MT, ABA, etc.) won’t work for all. Thank you both for contributing! ~Kimberly

Erika July 7, 2011 at 9:22 am

Hi Kimberly,

I am a music therapist that predominately works with children pre-school to high school with Autism in a public school setting. I have had several levels of training with traditional ABA and VB (Verbal Behavior.) In both my music therapy and ABA training there was always an emphasis on focusing on what the behavior is telling you about the individual. The classrooms in my district predominately use the VB approach which I observed as looking at the behavior, decoding what the behavior means (i.e. what the child needs), and helping the child to communicate these needs. For example, if a child is exhibiting out of seat behavior during music therapy when the music therapists presents a new instrument, the teacher and I would agree the child probably is excited about the instrument and wants to play the instrument. We re-direct to sit in their seat and verbalize that they want the instrument, either verbally or non-verbally. So, yes we are trying to encourage good “sitting” behavior, but also encouraging the child to communicate their wants and needs. As opposed to just “training” the child to sit in their seat. I agree that a singular approach to therapy is narrow and does not meet every child’s need, but I also believe that more current behavioral therapy techniques are not so narrow that it only looks at changing and ending “bad” behaviors. It seems to me that most teachers and therapists who use behavioral techniques are doing this in conjunction with other techniques.

Jodie July 12, 2011 at 3:24 pm

I was a total skeptic of ABA- until I started working with a six year old boy who had never spoken a word- until he started ABA six months prior to my meeting him. He was also completely unmanageable in a classroom before that- and by the time I was working with him, he was able to make it through most of the day in class. He still had a long way to go in terms of behavior and social skills, but it made an amazing impact. He was still receiving ABA by the time I started working with him, though not as intensely. Because I only worked with him about an hour a week, I don’t think that I could have possibly achieved the same goals in the same amount of time using music therapy (though there were a lot of other important skills I helped him develop). I don’t know if it’s specifically the technique that works per se, but there’s definitely something to be said about a therapy a child gets 40 hours a week.
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Kimberly July 13, 2011 at 1:56 pm

Thank you for sharing your story, Jodie! I think that’s what I’m hearing all around–for some children, ABA works REALLY, REALLY well, but it’s not the be-all-end-all for everyone. I appreciate hearing your point of view–thank you! ~Kimberly

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behaviors are a form of communication: this is really true!
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