The use of Applied Behavior Analysis (ABA)-based therapies has recently become a point of disagreement in the autism community.
We write this statement to share our strong support for the use of therapies based on the principles of ABA to help those on the autism spectrum, and to provide examples of how the science and research behind ABA indicate that it is safe and effective in improving the functional abilities of people with autism across the spectrum and across the lifetime. We address four main points regarding utility of ABA principles in autism intervention:
- ABA is not a single protocol or technique but rather is an approach or set of techniques tailored to individual’s strengths and challenges.
Applied Behavior Analysis encompasses a wide array of approaches to intervention, including highly structured approaches (e.g., Discrete Trial Therapy) and naturalistic approaches (e.g., pivotal response training or natural environment teaching). The goal of applied behavior analysis is to promote the acquisition of skills needed to participate successfully in daily activities.
- ABA type approaches have changed over time. The type of procedures used in the 1960s are different than what it is used today.
The very first studies around ABA-based interventions were groundbreaking. Previous to those studies which took place almost 60 years ago, parents were told that their children would never live productive lives. These first studies included mostly positive reinforcement with some punishment, using something called discrete trial therapy (DTT). Those early behavioral modification techniques led to children going to school and being able to be more independent. This kept people out of institutions enabled to remain in their communities. But as our scientific understanding of autism changed, so did the techniques used as part of ABA. Over the past 40 years, the term ABA has evolved to include a more holistic approach that incorporates developmental and other learning theories. Today, evidence-based autism therapies that include principles of ABA entail a much broader array of goals, assessments, supports, and accommodations that incorporate a person-led approach and encourage learning through activities that are fun and engaging. It also promotes the use positive, rather than negative reinforcement.
The procedures involved in ABA have become more sophisticated over time and with continual knowledge about autism and how behavioral supports can improve the lives of those on the spectrum, it continues to improve (Justin B. Leaf et al., 2021). Many critics of ABA focus on punishment. Research has shown that positive behavior supports are most effective, and the ABA field has evolved – and continues to evolve – based on a growing body of research (Frampton & Shillingsburg, 2020; Maye et al., 2020; Sandbank et al., 2020; Schmidt, Luiselli, Rue, & Whalley, 2013). ABA-based approaches, especially naturalistic, developmental behavioral approaches, incorporate ideas and practices from many other schools of thought regarding the science of learning, including developmental theory, cognitive theory, and constructivist theories.
- Research has shown that ABA-based interventions help people with autism.
Hundreds of studies, reviews and meta analyses collected over 40 years of research have shown that the principles of ABA, when used correctly, can lead to progress in communication, language ability, cognitive ability, academic skills, adaptive skills, and social interactive behavior in autistic individuals (Helt et al., 2008; Rodgers et al., 2020; Smith & Iadarola, 2015; Weitlauf et al., 2014) While ABA techniques can be used across the lifetime, most of the science conducted so far has focused on use of these techniques prior to age 10 (Howlin, Magiati, & Charman, 2009; Reichow, Hume, Barton, & Boyd, 2018; Rodgers et al., 2020; Schreibman et al., 2015). These changes lead to meaningful gains in quality of life, like developing social connections and friendships (Kasari, Rotheram-Fuller, Locke, & Gulsrud, 2012), maintaining employment (Wehman et al., 2017) and improved independence (Hume, Loftin, & Lantz, 2009).
ABA can also dramatically reduce problem behaviors like aggression, destruction, and self-injury. The Certification Board for ABA therapists recommend positive rather than negative reinforcement such as punishment be implemented in behavior plans.
- The goal of ABA supports and therapies is not to change the essence of who someone is, or to stigmatize non-harmful behaviors, but to lessen disability and help individuals and families with ASD reach their goals.
It is a mistake to throw out an entire canon of techniques and principles based on criticism of past practices. The goal of ABA is to maximize communication skills and minimize challenging behaviors that limit opportunity, not to eliminate neurodiversity. In fact, autistic adults have acknowledged the benefits of certain interventions based on the principles of ABA (Schuck et al., 2021). Additional issues surrounding the controversies around ABA are summarized and addressed in: J. B. Leaf et al., 2021.
The Autism Science Foundation supports the use of interventions based on the principles of ABA to help individuals of all ages across the spectrum lead their best lives possible. Of course, we strongly are against any program or therapy that harms an individual. However, we have concluded that ABA therapy, when properly rendered in an ethical manner, is beneficial to individuals who are impacted by autism.
Frampton, S. E., & Shillingsburg, M. A. (2020). Promoting the development of verbal responses using instructive feedback. J Appl Behav Anal, 53(2), 1029-1041. doi:10.1002/jaba.659
Helt, M., Kelley, E., Kinsbourne, M., Pandey, J., Boorstein, H., Herbert, M., & Fein, D. (2008). Can children with autism recover? If so, how? Neuropsychol Rev, 18(4), 339-366. doi:10.1007/s11065-008-9075-9
Howlin, P., Magiati, I., & Charman, T. (2009). Systematic review of early intensive behavioral interventions for children with autism. Am J Intellect Dev Disabil, 114(1), 23-41. doi:10.1352/2009.114:23;nd41
Hume, K., Loftin, R., & Lantz, J. (2009). Increasing independence in autism spectrum disorders: a review of three focused interventions. J Autism Dev Disord, 39(9), 1329-1338. doi:10.1007/s10803-009-0751-2
Kasari, C., Rotheram-Fuller, E., Locke, J., & Gulsrud, A. (2012). Making the connection: randomized controlled trial of social skills at school for children with autism spectrum disorders. J Child Psychol Psychiatry, 53(4), 431-439. doi:10.1111/j.1469-7610.2011.02493.x
Leaf, J. B., Cihon, J. H., Ferguson, J. L., Milne, C. M., Leaf, R., & McEachin, J. (2021). Advances in Our Understanding of Behavioral Intervention: 1980 to 2020 for Individuals Diagnosed with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 51(12), 4395-4410. doi:10.1007/s10803-020-04481-9
Leaf, J. B., Cihon, J. H., Leaf, R., McEachin, J., Liu, N., Russell, N., . . . Khosrowshahi, D. (2021). Concerns About ABA-Based Intervention: An Evaluation and Recommendations. J Autism Dev Disord. doi:10.1007/s10803-021-05137-y
Maye, M., Gaston, D., Godina, I., Conrad, J. A., Rees, J., Rivera, R., & Lushin, V. (2020). Playful but Mindful: How to Best Use Positive Affect in Treating Toddlers With Autism. J Am Acad Child Adolesc Psychiatry, 59(3), 336-338. doi:10.1016/j.jaac.2019.09.003
Reichow, B., Hume, K., Barton, E. E., & Boyd, B. A. (2018). Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database Syst Rev, 5, CD009260. doi:10.1002/14651858.CD009260.pub3
Rodgers, M., Marshall, D., Simmonds, M., Le Couteur, A., Biswas, M., Wright, K., . . . Hodgson, R. (2020). Interventions based on early intensive applied behaviour analysis for autistic children: a systematic review and cost-effectiveness analysis. Health Technol Assess, 24(35), 1-306. doi:10.3310/hta24350
Sandbank, M., Bottema-Beutel, K., Crowley, S., Cassidy, M., Dunham, K., Feldman, J. I., . . . Woynaroski, T. G. (2020). Project AIM: Autism intervention meta-analysis for studies of young children. Psychol Bull, 146(1), 1-29. doi:10.1037/bul0000215
Schmidt, J. D., Luiselli, J. K., Rue, H., & Whalley, K. (2013). Graduated exposure and positive reinforcement to overcome setting and activity avoidance in an adolescent with autism. Behav Modif, 37(1), 128-142. doi:10.1177/0145445512456547
Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., . . . Halladay, A. (2015). Naturalistic Developmental Behavioral Interventions: Empirically Validated Treatments for Autism Spectrum Disorder. J Autism Dev Disord, 45(8), 2411-2428. doi:10.1007/s10803-015-2407-8
Schuck, R. K., Tagavi, D. M., Baiden, K. M. P., Dwyer, P., Williams, Z. J., Osuna, A., . . . Vernon, T. W. (2021). Neurodiversity and Autism Intervention: Reconciling Perspectives Through a Naturalistic Developmental Behavioral Intervention Framework. J Autism Dev Disord. doi:10.1007/s10803-021-05316-x
Smith, T., & Iadarola, S. (2015). Evidence Base Update for Autism Spectrum Disorder. J Clin Child Adolesc Psychol, 44(6), 897-922. doi:10.1080/15374416.2015.1077448
Wehman, P., Schall, C. M., McDonough, J., Graham, C., Brooke, V., Riehle, J. E., . . . Avellone, L. (2017). Effects of an employer-based intervention on employment outcomes for youth with significant support needs due to autism. Autism, 21(3), 276-290. doi:10.1177/1362361316635826
Weitlauf, A. S., McPheeters, M. L., Peters, B., Sathe, N., Travis, R., Aiello, R., . . . Warren, Z. (2014). In Therapies for Children With Autism Spectrum Disorder: Behavioral Interventions Update. Rockville (MD).