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Behavioral Therapies

This category encompasses a wide range of behavioral programs. The goal of these therapies is to build skills in a number of developmental areas and/or to reduce unwanted, undesirable behaviors (e.g., hitting, tantrums, etc.).

Who is qualified to provide behavioral therapies?

BCBAs are the only qualified individuals to develop and supervise ABA therapy plans. Licensed or LLP Master’s or Ph.D. level psychologists are qualified to provide other, non-ABA therapies.

What does a typical behavioral therapy session look like?

There are many different types of therapy that address behavior. The following types of therapy are included in this category:

Applied Behavioral Analysis:

1. Examples of therapy goals/objectives:

a. To reduce unwanted/undesirable behaviors:
b. Interfering sensory behaviors
c. Hitting
d. Tantrums
e. Screaming

2. Increase/improve skills:

a. Sitting to pay attention
b. Using a word to ask for something
c. Imitating an action
d. Social skills
e. Academic skills

3. How is ABA therapy conducted?

a. To reduce unwanted/undesirable behaviors: Difficult and unmanageable behaviors are targeted for change through a process of functional behavioral analysis (FBA). The purpose of FBA is to identify the problem situation or “trigger” and consequences (i.e., what happens after the behavior is displayed) which result in unwanted behaviors and developing a plan to change those “triggers”, replace the undesirable behaviors with newer, more functional and appropriate behaviors, and reinforce the newly acquired skill/behavior. Those who interact regularly with the individual are taught to ignore undesirable behaviors, thereby minimizing the likelihood the behaviors will reoccur in those same situations in the future. Many times, caregivers and those who work with individuals with ASD are not aware of the specific events which trigger difficult behavior and/or how their responses can maintain that behavior. FBA may be conducted in the home, school, or any context where the problem arises (e.g., stores, parks, etc).

b. To increase/improve skills: Children with ASD present with highly varied skills and strengths and challenges across a number of developmental areas. At the beginning of an ABA program, the therapist will analyze the child’s skills to determine which skills are deficient and what will be targeted in therapy. A behavioral plan is then developed and adjustments are made over time as progress data is analyzed. In most cases, a child will make steady progress and the plan will be updated accordingly. When progress is not documented, the plan is modified, perhaps to increase the frequency or intensity of therapy, or to address other needed skills that act as precursors to higher level skills.

4. Traditional ABA (A.K.A. Discrete Trial/Lovaas Therapy) is based on principles of behavioral psychology to include a stimulus, response and consequence. An example includes:

a. Therapist asks child a question (stimulus)
b. The child responds accurately with a word (response)
c. The therapist rewards the child with a reinforcer (toy, candy) (consequence). By reinforcing the behavior, the child is likely to perform successfully again, during another trial.
d. Skills are developed one at a time, and build on each other.
e. Once the skill or behavior is established with the therapist, in the clinic, new activities are introduced to generalize the behaviors and skills with other individuals (caregivers, teachers) in different situations (home, school).

5. There are a number of programs that follow ABA principles, but may vary in the approaches used to modify behavior or build skills. These include:

a. Pivotal Response Therapy (PRT): Based on ABA principles, but differs in that PRT specifically focuses on key pivotal areas of motivation and self-initiation (Koegel et al., 1999).

b. Parent as Therapist ABA: Parents trained by a BCBA to become their child’s ABA tutor.

c. Consultative ABA: The BCBA may work with the child’s teachers or with the parents in the home to develop a behavior plan for those settings. The plan will provide recommendations for identifying antecedent/triggers, understanding the function of a behavior, teaching replacement behaviors, and how to respond appropriately (use of reinforcers), in an effort to reduce or eliminate problem behaviors in the future. Positive Behavior Support is also characterized by these same objectives.

Non-ABA Behavioral Therapies

1. Cognitive Behavioral Interventions: Addresses deficits associated with social cognition, including Theory of Mind approaches which teach identification of the mental state of another person, learning to understand, define, and respond to different emotions, and gaining information about internal (feelings) and external (facial expressions) social cues.

2. Love and Logic: A parenting program designed to teach caregivers with specific discipline strategies and how to respond to their child’s behavior in the context of a loving, supportive relationship.

3. PCIT: Parent Child Interaction Therapy: A data driven parent training program that empowers parents to manage their child’s behavior more effectively with in-vivo coaching by a PCIT trained therapist.