Autistic Spectrum Disorders (ASDs) are complex neurobiological disorders of early brain development. The deficits associated with ASDs may affect many aspects of individuals’ lives, including socialization, such as developing relationships, and communication, executive functioning, and activities of daily living. Government statistics suggest the prevalence rate of autism is increasing 10-17 percent annually. Currently, an average of one in 150 children in the United States has an ASD, although recent surveys place New Jersey with the highest prevalence rate of one in 94.

As the incidence of individuals diagnosed with ASD increases, the number of students with an autism diagnosis enrolled within school districts is increasing dramatically as well. The U.S. Department of Education states that the number of students served under the Individuals with Disabilities Education Act (IDEA) category of autistic has risen from 15,580 in 1992, to 192,643 in 2005.

It is critical for educators to understand the behavioral challenges that surround ASDs, such as the ability to initiate or cease actions, or regulate and modify behavior. A student with autism may experience problems with verbal fluency, attention, and differentiated responses, or may be unable to respond appropriately to various questions, tasks, or demands.

Cognitive and communicative abilities among individuals with ASDs may range significantly. One student with autism may experience difficulty in expressive language and social abilities, while another individual with autism may struggle in imitation and receptive language. In order to create an optimal learning environment for individuals with ASDs, individualized educational and instructional plans are essential for academic and behavioral success.

What is ABA?

Applied Behavior Analysis (ABA) is an evidenced-based treatment for improving the functioning of children diagnosed with autism. It addresses the core deficits of ASDs including verbal and non-verbal communication, social interaction, restrictive repetitive behaviors, inflexibility, and peer relationships, to name a few. While it has been successfully used for over 30 years, modifications and improvements of the ABA techniques have created a new look for classroom applications.

Applied behavior analysis was once viewed by many as a “cold” treatment characterized solely by “discrete trials” consisting of one child and one therapist or teacher repetitively engaging in a single activity or task targeting an isolated skill.

Such an early and intensive model of an ABA intervention relied heavily on compliance, external reinforcement (reward), and at times, an aversive (punishment) to decrease any interfering behaviors. Discrete trial teaching incorporates a mixture of mastered material, new material, and errorless learning, and has been reported to be able to bring about new skill sets. However, early models of intensive interventions have been found to present problems and obstacles, such as the creation of a prompt-dependent child who has difficulties integrating and generalizing skills into group or naturalistic settings, and fails to address social and adaptive skills necessary for transitioning into adolescence and adulthood. Thus, broader approaches to the application of Applied Behavior Analysis strategies continue to evolve, with the goal of making meaningful changes in the lives of individuals with treatment strategies supported by empirical evidence.

More recently, there has been a trend to move away from using ABA principles in such highly structured and rigid environments toward naturalistic surroundings (classroom, home, and community). Strategies such as direct observation, antecedent-based strategies, modeling, use of peers, shaping, prompting, positive behavioral support, verbal behavior/functional communication interventions, utilizing the child’s preference for reinforcers and activity choices, and emphasis on adaptive and functional skills allow for treatment methods to generalize across settings and individuals. Thus, the “new look” of classroom applications of ABA includes an individualized approach to assessment interventions, responsive programming that is unique to each child’s needs, characterized by data-based decision making, and utilizes both direct and indirect assessment methods including observation and interview methods. With proper training, teachers, parents, and caregivers can implement ABA strategies in the classroom, home, daycare, and community settings.

Prior to focusing on practical ABA approaches, educators should have an understanding of what constitutes normal and aberrant behavior, and its causes. Behavior can only be exhibited by living organisms, and generally provides a “function,” such as: 1) attention, 2) access to preferred items/tangibles, 3) escape, 4) avoidance and 5) automatic reinforcement (see Table 1).

In order to determine the function of specific behavior(s), a Functional Behavior Assessment (FBA) must be conducted. This entails direct observation of the child in the natural environment where the behavior is occurring, associated with a description and data collection of the “antecedent”, i.e. what happened right before the behavior (within a span of five to 15 minutes), the behavior itself, and the consequence (what happened right after the behavior, such as reprimand, loss of an item, etc.). (See Table 2 to see how a teacher might complete an ABC checklist.)

Tips for teachers

Once the function of the behavior is determined, Applied Behavior Analysis strategies can be appropriately chosen and implemented. This begins with determining what motivates the student. Determine what consequences can follow desirable behavior that will increase the chances of the desirable behavior occurring again and more frequently in the future. Use reinforcers that occur naturally in the environment, such as praise, access to highly preferred item, break from work, or free time with a peer. A reinforcer is a consequence delivered after a behavior and increases the likelihood a behavior will occur again in the future. Be sure to reinforce approximations of the desired behavior, as well. This is defined as shaping. Shaping entails responding to the student’s performance as it occurs throughout the day. As the student demonstrates skills closer to that of the mastered level, increase the expectations.

It may also be helpful to use built-in prompts throughout the day. Prompts are extra hints that will help the student know what to do in academic and social situations. These cues help the learner engage in desired behavior while avoiding mistakes or incorrect responses. Prompts can include physical guidance in the form of hand over hand, gestures, verbalizations, models, written cues, and pictures. Consider creating a visual schedule using pictures or words. A visual schedule should be easy to use and not a chore, so if your child is not a reader use pictures as your visual.

More structured naturalistic methods of Applied Behavior Analysis include modeling, incidental teaching (IT), and pivotal response training (PRT). Modeling may be a valuable component of ABA if your student is capable of imitation. It can be useful in the initial phases of instruction when a skill is just being acquired. A significant amount of literature exists supporting the role of peer models and their ability to bring about socially appropriate behaviors in children with autism. Typically in a classroom, objects or people can assist in facilitating desired responses. Peers are especially helpful for modeling appropriate behavior. One approach is to identify a peer-helper who can be taught by the teacher to demonstrate play and social skills that the autistic peer can learn to imitate. The purpose of the peer interaction is to bring about spontaneous reciprocations and initiations from the autistic student.

Incidental teaching methods can be used in the natural environment to help students with autism expand their verbal repertoire. Incidental teaching is characterized by initiations by the student and responses from the teacher. The student initiates for an item either verbally or gesturally, and the teacher responds in a manner that requires a second initiation from the student. Following the second request, the student is provided with the desired item. For instance if a child points to a pencil, the teacher may respond by saying, “What do you want?” triggering a second gesture to the pencil or the verbalization, “pencil,” which is reinforced with the desired item.

Pivotal response training (PRT) is a set of instructional strategies that are brief, specific, and focus on tasks chosen by the child. PRT also utilizes contingent reinforcement directly related to the desired behavior and attempts at engaging in the desired behavior. For instance, if a student demonstrates interest in drawing, place materials in his or her view; if he or she requests a “crayon,” provide the crayon and follow through with a drawing activity. PRT has recently been shown to cause significant improvement in toddlers.

Often times negative behaviors or frustration can arise in response to an inability to communicate. Non-verbal strategies, such as the Picture Exchange Communication System (PECS), can be utilized in the natural environment to teach learners how to initiate communication and have their needs and wants met. It utilizes pictures, single words, phrases, and sentences to help bring about appropriate verbal and non-verbal communication skills.

Using technology

Innovative uses of technologies are another “new look” strategy for classroom intervention. One such device, Technology Assisted Classroom Teaching (TACT), developed by The Center for Neurological and Neurodevelopmental Health (CNNH) in Voorhees, NJ, is a teacher-initiated remote behavior capture system with access to professional support and expertise. This technology utilizes a camera and a small computer to efficiently record target behaviors, both antecedents and consequences, and also acts as an aide in teaching new skills. Behavior and teaching can be viewed in real time over Health Insurance Portability and Accountability Act (HIPAA) compliant Internet portals, or can be captured and reviewed at a later date by a behavior analyst or other clinician. Teachers control the device, and data can be collected as needed. Such an approach reduces any “reactance” effects or distractions of an extra observer being physically in the classroom, and is very cost efficient, as there are no travel or other expenses of having a behavioral consultant attend in the classroom—often when the target behavior does not occur. TACT will also allow the Behavior Analyst to take data on a daily basis and provide the necessary feedback fostering behavioral progress and success in the classroom. TACT technology is viewed confidentially and in compliance with laws and regulations.

Applied Behavior Analysis is an empirically-based treatment strategy for children diagnosed with ASDs. The “new look” of ABA involves using the student’s interests and preferences, promoting communication and functional skills, enhancing adaptive and social functioning, and integrating peer-mediated strategies. ABA no longer should be viewed as outmoded discrete trial therapies, but rather as an evidence-based treatment package that includes numerous options that may be utilized alone or in combination, resulting in improved outcomes.

Nicole Pelliciari, M.S., BCBA, Laura O’Donnell, M.A., Patricia Wagner, MSW, Lisa Alberts, PMHNP-BC, and George Niemann, Ph.D. are from The Center for Neurological and Neurodevelopmental Health, Voorhees, NJ. Additional information is available at info@thecnnh.org or thecnnh.org.