Thank you for inviting me to meet you and give a brief talk. Inevitably, what I am going to say is quite technical in places. To help with this, I will be happy to take all your questions afterwards, and I have also brought a slightly longer version of this talk with me. This is a statement produced in 2011 by the Division of Behaviour Analysis of the Psychological Society of Ireland, whom I am representing today.
I am speaking about ABA, or applied behaviour analysis. ABA is a science-based framework in which procedures derived from the scientific study of principles of learning and behaviour are systematically applied to improve socially important aspects of behaviour. That is, it is a science-based approach to human behaviour problems, derived in turn from a science of behaviour.
I have to start with this rather long definition to make it clear that ABA is not a particular technique, or even a particular package of techniques. Rather, the ABA practitioner, or behaviour analyst, is an applied scientist who draws on knowledge of an extensive range of scientific principles that predict how behaviour will change, in order to devise a method for dealing with a particular problem. She (behaviour analysts are most often women) is also a scientist in the implementation of the chosen method, and behavioural data will be collected before, during and after its implementation to assess whether it is effective in delivering the agreed, socially and personally important objectives. Broadly, ABA consists of the design, implementation and evaluation of instructional and environmental changes to produce meaningful improvements in human behaviour through skill acquisition and reduction of problem behaviours.
You may have noticed that I haven’t mentioned autism, or autistic spectrum disorders, yet. This is because autism is an area of extensive and effective use of ABA, but it is not integral to it. I have been in the field of behaviour analysis for a long time, and thus can remember the time before working with children with autism became the dominant use of ABA. Its use with autism is exciting and important, but I want first to take a moment to mention other areas where ABA is making contributions. If you know of its effectiveness in education with children diagnosed with autism, you may not be surprised to know that it is used very effectively with people with brain injury and people with learning disabilities or developmental delay. However, it may be more surprising to you that it is used effectively in the management of safety in large companies (Including ESB here in Ireland) in OBM (or organisational business management), and in many other “non-clinical” areas.
ABA aspires to help with serious behavioural problems. A serious behavioural problem is one that impairs the quality of life of the person to a significant degree, impacts negatively on the lives of others, is persistent (thus rarely goes away of its own accord), and is not readily removed by some simple or brief treatment or intervention. Some of the problems of many children with autism meet these criteria. If help is not provided or not adequate, their behavioural problems may leave them trailing far behind their peers of the same age in personal, social and educational development. Because the problems are so difficult, the initial report in a major scientific journal in the 1980s that showed real progress in the education of children diagnosed with autism, was greeted with great excitement. This and subsequent related studies involved the systematic and intensive use of ABA procedures, and it was found that a substantial number of the children showed marked improvements and were even able to move into mainstream education.
To maximise effectiveness, it is important that ABA educational programmes for children diagnosed with autism are not only intensive but introduced early in the child’s life, and they are now called early intensive behavioural interventions, or EIBI programmes. There have been a lot of large-scale evaluations of EIBI programmes, and I will come back to these shortly, but before that I want to tell you something about single-case studies of which literally hundreds have been shown to improve the behaviour of children diagnosed with autism. In a typical study (such as published in the science journal, Journal of Applied Behavior Analysis), two children, both boys, were identified from one special school. They varied in age (7 and 9 years), and each had been diagnosed with autism. Prior to this study, each child has had a systematic behavioural assessment to identify all their current educational and personal needs. Most importantly, one particular behavioural need in common had been identified; they both had limited speech and used the well-known Picture Exchange Communication System (or PECS) to communicate with adults. The research objective was to get the two children to communicate with each other using PECS to make requests of each other. An initial baseline period showed that while they made requests of adults using PECS, they never requested anything of each other. In the next phase, changes were made. Adults now briefly ignored any request made of them and prompted the boys to make requests of each other. Under these conditions, both boys started to make a number of independent (unprompted) requests of each other. To check this was a “real effect”, the baseline conditions were returned to for a while, and the behaviour reverted to being adult-directed, but when the new scheme was re-instated the boys again began to interact with each other. Like all other single-case studies in this area, the intervention was tailor-made to deal with a particular social or educational problem. In this case, as in hundreds of others, it was shown to be effective, and checks were included in the study to show that this was a true effect, and not due to some uncontrolled factor. I have taken up some of my limited time with this example, because the strategy of this research is very close to that routinely used in an EIBI programme. An EIBI programme will include a wide range of behavioural objectives, and during the day many of them will be worked on in ways similar to the one described. Across time, it will be shown within the programme that many new skills have been acquired by the child.
In our 2011 statement, which I have circulated, we cited a number of internationally referenced authoritative reviews (actually, 11 in all) of the outcome of EIBI programmes and alternative interventions for children with autism. They all concluded that the best approach available for ameliorating the behavioural problems of children with autism is the use of ABA-derived procedures that comprise an EIBI programme. To take one example, guidelines from the American Academy of Pediatrics state that it is important to prioritise psychosocial over medical approaches and, “The most effective psychosocial treatment for autism in applied behaviour analysis…”. These reviews continue to appear: some recent ones are by authors based in Europe, they review European as well as American studies and the conclusions are the same. It is important to note that these expert reviews, meta-analyses etc., all conclude that ABA is the preferred approach, the one that is a supported by the scientific evidence. Two important features of this conclusion should be mentioned: many of the reviews have concluded that there is no evidence at all for other approaches, including the eclectic model favoured by the Department of Education, and none of these reviews claim that “ABA is a cure for autism”. Rather, they conclude that it is the best option, the best value-for-money, in dealing with a major and increasing problem.
If ABA is to be used effectively in the education of children diagnosed with autism, that is, in schools, it must be done in a comprehensive way. Consideration of the general principle of behaviour analysis, on which ABA is based, tells us that behaviour is influenced throughout the day by many mostly social factors. We must therefore be relentlessly systematic in organising the school environment, so that the benefits of targeted educational programmes are not accidentally undermined by other factors. Those reviews tell us that only when the programme is sufficiently intense (e.g., with tuition by a behaviourally trained teacher on a professionally-managed programme preferably for at least 25 hours per week) is progress likely to be sustained in children with autism. An initial assessment discovers which skills the child does and does not have, and this determines what is in the curriculum for that child. This curriculum is regularly reviewed. If progress is made, the objectives are changed; if progress is not satisfactory, new tactics are considered, again derived from the ABA framework. It is very important that the child has many learning opportunities each day, and there are various ways of arranging this. Because the programme is sophisticated, it is critical that is managed by someone with at least Masters level training in ABA. As well as understanding the science of behaviour analysis, the derived procedures of ABA, how to conduct a behavioural assessment, and how to devise, implement and monitor an ABA programme, such a Masters graduate has extensive training in professional ethics, critical for anyone working with vulnerable children.
A few years ago, Ireland was in the fortunate position of having 12 ABA schools that had been set up and staffed in a way that made possible comprehensive programmes for children with autism. However, the changes implemented from 2010 mean this is far from being the case now. Members of the Division of Behaviour Analysis are either in or in close touch with these schools. They are now termed special schools and, because of the rules they operate under none of them can meet the specifications for an ABA school that I have mentioned (and that are laid out in more detail in our 2011 paper). To us, this seems like wanton destruction of opportunities for children in this community.
My final point was also my first one: rather than being one technique, ABA is an over-arching approach in which it takes many years in which to become proficient, and when used systematically it is the only approach which has been shown to benefit children diagnosed with autism
Thank you for your attention.
Julian Leslie, June 2013