Applied Behavioral Analysis (ABA)

About the same time that we were admitting that Hannah wasn’t just a late bloomer but needed help, God orchestrated circumstances to connect us with the resources we (and Hannah) needed.

My neighbor, a mother of an autistic child, and I decided to carpool to a conference on home schooling. We talked during the hour-long drive to the conference center and home again for two days. Through her experienced guidance and a conference workshop on special needs kids, I was encouraged to read Let Me Hear Your Voice: A Family’s Triumph over Autism by Catherine Maurice. That narrative of one family’s experiences with “storming the castle” to bring their daughter back from her own little world gave me hope and a vague idea of ABA therapy.

I determined to learn more about ABA and ordered a how-to manual called Behavioral Intervention for Young Children with Autism edited by Catherine Maurice. (It seems that she had received so many requests for specific how-to’s that she had put together that manual.) That book has become our guide for teaching Hannah all the things that other children usually “catch” on their own. It contains lists of skills (Beginning, Intermediate, and Advanced) as well as practical tips and hints for teaching them step by step. It describes in detail how to use the ABA method of teaching. It starts at the beginning skill of establishing attention, because you must have the child’s attention in order to teach any of the other skills. It also explains how to accurately record each teaching session in order to document the child’s progress and determine when and what to teach next.

Some parents hire professional ABA therapists; we decided to use the methods on our own. Below are more details, as well as an example of ABA and how it looks in our teaching sessions.

How It Works

The skills are broken down into simple steps; they’re called “programs.” You choose which programs to work on during a session. You also determine how often and how long the sessions will be. Some parents hire enough professionals to keep the child interacting for 40 hours a week; some can do only a couple of hours per week. We do one hour per day of formal session work, and try to do a lot of incidental teaching and reinforcing through life experiences during the rest of the day.

The ABA teaching method consists of presenting a simple instruction to the child, waiting briefly for a response, then modeling or physically directing the child to the correct response, and repeating the process until she learns to give the correct response on her own. For example, if you wanted to teach the child the skill of imitating, the first step would be imitating large motor skills, like clapping her hands. First, you would establish attending (“Look at Mommy”) then give the instruction, “Do this,” and clap your hands twice. You would then wait about two seconds. If she didn’t respond, you would gently take her hands and clap them together twice. You would give positive feedback after she did the desired response, whether you helped her or not. Of course, your enthusiasm would probably be greatly increased when she responded correctly by herself! Then you would repeat the instruction and response sequence nine more times; ten tries, or “trials,” per program during a session.

Record keeping is a big part of ABA because the records give an objective standard by which to measure the child’s progress. The records also help remind you of how far you’ve come! Once you get in the habit, the record keeping is not difficult. You simply choose the programs you want to work on during your session and write them on a scorecard-type form. (Several helpful reproducible forms are provided in Behavioral Intervention for Young Children with Autism.) Under each program name is ten spaces in which to keep track of the child’s responses to ten tries (or “trials”). If the child performs the skill correctly with no help or prompting from the teacher, a “+” is recorded beside the number of that trial. If the child performs the skill with prompting or help from the teacher, a “+wp” (“wp” means “with prompt”) is recorded. If the child does not respond or gives the wrong response, a “-” is recorded. At the end of the ten trials, you can quickly and easily figure a percentage score for that program during that session. If the child got six “+” marks, she scored 60% correct for that skill. Once she scores 70% or higher on a skill for three consecutive days, you write the skill on a calendar to remind you to run that program once a week for the next three weeks. If the child continues to score 70% or higher on those three review checks, you consider the skill mastered and move on to another. If she forgets the skill or drops below 70%, you go back to running that program every day until she gets it. You might consider raising the percentage to 80% or higher, depending on the skill.

How It Looks

Our ABA sessions look quite different today than they did that first day! On the first day we started to implement ABA, here is what you would have seen.

Mommy takes Hannah by the hand and walks her, crying, to a spare bedroom where they will be undisturbed for the session. They sit on little chairs, facing each other, about one foot apart. Mommy sits with Hannah’s legs gently couched between her own legs to keep Hannah from running away. Hannah is sitting with her hands over her face and her head bowed.

We start with the first program: Look at Mommy. Mommy holds a small piece of cookie in front of her own face and says firmly but gently, “Hannah, look at Mommy.” Hannah curls up into a little ball and cries. Mommy marks a “-” beside the first trial’s space. She gives the instruction again, holding the cookie piece near her face. Hannah continues to cry and bend over. Mommy marks a “-” beside the second trial’s space. The third time the instruction is given, Mommy gently and firmly lifts Hannah’s face and tries to catch a glimpse of her eyes. When even a fleeting eye contact is made, Mommy praises her enthusiastically and gives her the cookie piece. She marks a “+wp” beside the third trial’s space. The process is repeated for the fourth trial, again with a fleeting eye contact and a “+wp” mark recorded. The fifth and sixth trials result in no eye contact and two more “-” marks. The seventh and eight trials return to the brief eye connections with help from Mommy’s lifting Hannah’s face toward her own; two more “+wp” marks. Then something amazing happens. The tears have slowed to a stop by now. As Mommy is recording the eighth trial’s mark, Hannah recites from a computer game “Mmm, that’s good!” while munching on her cookie piece. On the ninth trial she looks at Mommy of her own initiative. Of course, Mommy smiles and gives her a big hug. On the tenth trial Hannah looks Mommy right in the eyes with a little smile on her face. Mommy happily (ecstatically, really!) marks down two “+” marks for trials nine and ten.

Hannah received only 20% correct for that program, but the sequence of the recorded marks tells the exciting story. That first session continued the process for three more programs, seeking to teach the skills of imitating (“Do this” [clap, clap]), responding to one-step commands (“Stand up”), and pointing to a desired object (“What do you want?” [point to object]).

Today our sessions look different because

  1. Over the past months we have faded out the food incentives, replacing them with lots of encouragement, hugs, smiles, and praise. As Hannah learns more and interacts more in our world, those intangible rewards have become incentive enough.
  2. We use longer instruction statements and substitute similar words sometimes instead of using the same words for every trial. (“Count the apples”; “How many apples are there?”; “How many apples are on the table?”)
  3. We sometimes intersperse the programs, doing one or two trials of one program then switching to another program for a couple of trails and so on. On some days when Hannah has a harder time concentrating, we will do all of one program without interruptions, but when she is having an “on” day we can intermix successfully.
  4. She has progressed to more advanced skills, still accomplished in little steps though. Currently, we’re working on counting, writing, memorizing what sounds the letters make, describing objects that are out of sight, and identifying items that are same and different. One year ago I looked at these programs and thought, “There’s no way she’ll ever be able to do those.” But by taking consistent little steps, she has progressed to this point.
  5. We implement no-error teaching more, in which we try to help her respond correctly as much as possible so the incorrect response doesn’t become a habit. In the beginning sessions I would over-exaggerate a disappointed face and say “no” in a firm tone of voice when she gave the wrong answer, simply because she had not yet comprehended the meaning of correct and incorrect. She was just messing around, playing a game. I needed to use that more drastic response to catch her attention and “bring her up short.” Now that she is motivated by praise and encouragement, it almost breaks her heart if I tell her “no” when she gets the wrong answer. She actually tears up!

Remember that each child will learn at her own pace, whether a neurologically typical child or an autistic child. The ABA method has given us the tool we need to teach Hannah in a way that she can learn.

You might also want to read about the Dietary Changes we made and our RDI therapy comments.