Your child has just been diagnosed and you’ve gotten recommendations to seek ABA therapy providers. Naturally, you will probably begin to do some research into what ABA therapy is and how it works. Chances are you will come across terms and methods that aren’t familiar to you and you may be left with more questions. What are these ABA techniques? What does this mean for my child while they are in therapy? What will their day look like when receiving therapy? Here is some information that will help you navigate through these unknowns and continue to become more comfortable with the process.
ABA techniques: Discrete Trial Training
Discrete Trial Training is an ABA teaching method that will take one goal or teaching opportunity and break it down into a systematic, step by step process. Instead of teaching one skill in one overarching lesson, the therapist will take and treat each step of that skill as an individual teaching moment. The end result will be combining all of these individual steps into one cohesive process.
Discrete Trial Training examples
An example of this would be teaching a child to brush his or her teeth. Instead of taking the entire process of brushing your teeth and attempting to teach in its entirety, a therapist may start with having the child pick up the toothbrush and holding it against their front teeth. Once this step is mastered, they would move on to the next step of brushing the front teeth five times. They would then move on to the next set of teeth and so on until the entire skill of brushing teeth was learned. By using this ABA technique, it makes it easier to pinpoint which steps the child is struggling with. If a child is having trouble holding the toothbrush correctly, DTT will make it easier to target this step in the process and work on it until it’s mastered.
Therapists who are using ABA techniques may opt for tangible reinforcers: for example, a piece of candy or time playing with a toy to motivate the child when he or she succeeds with a particular step. The use of tangible reinforcers can build momentum and help a child progress from one step to the next.
While Discrete Trial Training is great, and it will work for certain situations, there is more to ABA than these types of programs. A common misconception with ABA is that sessions consist of strictly tabletop tasks and Discrete Trial Training programs. However, there are other strategies that promote variety when teaching our patients, and this variety is necessary to get the most long-lasting results. Generalization is a necessity when using ABA techniques. The ability for a child to take what they’ve learned and apply it to situations outside of the teaching environment, as well as other behaviors or skills, is an indicator that they’ve fully grasped the skill.
Natural Environment Teaching (NET)
Natural Environment Teaching or NET is a great way to achieve Generalization. What better way to learn a particular skill than to teach its function within the environment it will be used? For example: we display three cards in front of a child. One card being red, one card being blue, and the third card being green. We can teach the child to differentiate these colors with the cards, but that is only one step of the learning process. We can then use Natural Environment Teaching to apply this skill in the real world. While coloring with the child, we can ask “pass me the red crayon” or while playing with toy cars we can ask the child to “race the green car and the blue car.” A child has the ability to memorize different colors and labels, and while that’s a necessary skill to have, the child should also be able to apply the knowledge to things that come up in everyday life.
Response Generalization occurs when the child can take a learned skill or behavior, and have it transfer to other similar skills or behaviors. Teaching a child to put away toys when he or she is done playing with them is a great skill. Being able to take this learned skill and apply it to similar tasks such as putting dirty dishes in the dishwasher after dinner or putting dirty clothes in the hamper at the end of the night would be Response Generalization.
Even after Generalization has been achieved, the skill should remain in the child’s repertoire even after the teaching or intervention has stopped. At times reinforcement, such as a token board, is needed while teaching a child a skill. When learning to wash hands, it may be beneficial for the child to place a token on a board after each completed step as a form of visual reinforcement. After learning the skill, the child should be able to complete each step of washing hands without the use of this token board. This is called Response Maintenance.
The use of reinforcement in ABA techniques is one of the most important aspects of a child’s success. Without proper use of reinforcement and without the necessary information about what types of reinforcement will work for one particular child, therapy will struggle to be effective. As ABA therapists, our primary form of teaching is through the use of reinforcement. It allows us to influence the consequence of an action and therefore influence the probability of a desired action to happen again. ABA, in its simplest form, is a three step process: the Antecedent (events or actions leading to a behavior), Behavior (resulting action), and Consequence (outcome of the action). When we give a prompt to a child, as a therapist we are hoping for a particular behavior from the child. When that desired behavior is performed, a desirable consequence will occur for the child, increasing the likelihood that behavior will occur again.
There are many different forms of reinforcement used in different situations. Positive and Negative reinforcement are two of these, but their actual meanings may be deceiving. Essentially Positive reinforcement is giving something to motivating to the child after a desired behavior, giving the child reason to continue with this behavior.
Negative reinforcement is a little more confusing but should not be associated with Punishment in any way. Negative reinforcement instead will typically remove an aversive circumstance from the environment which, in turn, will encourage the behavior to continue. For example, when your alarm goes off early in the morning to wake you up, chances are you’ll press the button to turn off the alarm. This is taking the aversive, loud beeping sound out of the equation and will increase the chance that you will press the button again when hearing the alarm.
Prompting is used as sort of a correction tactic during the teach process. Usually utilized after the instruction and before the response, often times it’s used in the beginning stages of learning a new skill. The use of prompting is a more effective technique in ABA therapy than merely correcting a child when a mistake occurs. While the child may be able to eventually find his or her way to the correct response by making mistakes, it would be more beneficial for the child to learn the quickest, most effective path to the correct response. Allowing the child to make the mistakes will increase the likelihood that those mistakes will be present any time the child is required to get to that particular response. By prompting, we are teaching the child how to get that response with the least amount of resistance
The purpose of different forms of prompting
Prompting can take many different forms in ABA, some more intrusive than others. The purpose of having different forms of prompting is so that we can have variety that will fit the needs of the specific child we are working with or the specific lesson we are trying to teach. Examples of Prompts and the different forms they can take are Physical prompts, Gesture Prompts, and Model or Visual Prompts.
There are also different variations to these individual prompts, the uses of which are all determined by the particular learning situation that child is in at the time and the way the lesson is written for that specific child. Fading of the prompts, as well as moving through the prompt hierarchy will also occur as the child progresses with learning the skill or behavior.
If we are teaching a child to build a structure with blocks for example, we will most likely start with a full physical prompt of hand over hand guidance to ensure the child understands the motion necessary to accurately build the desired structure. As the child meets the necessary requirements associated with this prompt, we will fade to a less intrusive prompt, say a gestural prompt of which blocks to place in which order. We will go down the prompt hierarchy as the child shows he or she is making progress in learning the skill ending with just a visual model of what the final block structure, hoping the child will be able to replicate it independent of any prompting. This would be known as a Most-to-Least prompt hierarchy.
Not a one size fits all strategy
Like most aspects of ABA however, prompting is not a “one size fits all” strategy. Some situations will call for that Most-to-Least prompting, but others may call for what is known as Least-to-Most prompting. This is where we start with the least intrusive form of prompting, or no prompting at all, and move up the prompt hierarchy as needed. In these situations, we will give the child an opportunity to succeed with independence. If a mistake is made, we will provide a prompt that lends the least amount of assistance for the child, still trying to promote that independence. If mistakes are still being made, we will move up to a prompt that ensures the child completes the step or instruction correctly.
Data-based decision making
ABA’s reliance on data and information continually coming in is what really solidifies itself as the most effective way of teaching our children. By paying so close attention to the details and having that consistent stream of data to draw from when making decisions, it ensures that the strategies we are using and the changes we may have to make to those strategies are what is best for the child. We have the ability to make changes to any intervention process we utilize by looking at the data and having that up to date visual of what is and what isn’t working.
Removing the guesswork
There is absolutely no guesswork when it comes to ABA therapy. There is always data to back up the decisions we make. At SPBS all therapists and clinicians associated with a particular child will have access to that child’s data. Therapists are encouraged, along with clinicians, to think about changes that could be made to increase the learning of the child based off of the data they have access to. Graphs clearly showing each individual lesson being taught make it easy for everyone involved to see what needs to be changed and what needs to continue to be implemented.
A typical day of ABA therapy
A typical day of ABA therapy will typically start with the therapist building rapport with the child, this is especially the case if the child and therapist are just starting to work together and haven’t had too many sessions together. The reason this rapport building is so important is because the child should feel welcome and comfortable within the environment he or she is learning. Knowing that the session is more than just “work” is an important precedent to set for the child, it has to be understood that there is fun involved in the learning process. Another big part of building the rapport and having some play is to figure out what the child is motivated by, which can change from session to session. A child may have many different reinforcers/leisure items to choose from, but the most preferred item can change on any given day. It is important for the therapist to know what reinforcer will motivate the child as this will make the learning process easier.
Before the session
Before the session even starts however, the therapist will have a plan on what lessons to work on with the child and what ABA techniques to use. This will usually be relatively consistent from session to session. It’s important to continually work on specific lessons or programs to ensure the child is fully grasping what is being taught.
During the session
As the session progresses, the child will be constantly reinforced and praised for desired behaviors and correctly responding to prompts or completing tasks. A good therapist will always find reasons to reinforce the child during a session. If a child is having an off day for any reason, there are always small victories to be had during an ABA session to keep the learning momentum going or getting it back on track. Making the child feel comfortable, happy, and motivated is always at the top of the list of an ABA therapist. Without the ability to develop this relationship, the learning process will not be as effective.
Mixing ABA techniques
Here at SPBS, we try to incorporate different learning methods during our sessions. Even when a child is enjoying leisure/break time, learning opportunities arise and a good therapist will be able to recognize this and teach accordingly. For instance, a child could be learning how to greet people he sees throughout the day. While walking through the clinic to use the bathroom he may see a peer in the hallway, or another therapist. This would be a great teaching moment, having the child greet the person as they pass. In another instance, a child may be playing a game with a peer. Both children see it as their turn with a certain toy and do not want to give it up to the other. This is another great teaching opportunity, emphasizing the importance of sharing and even talking out a solution instead of getting angry with the one another. It is important to note that a day in ABA therapy is all about teaching moments while making the situation enjoyable for the child.
SPBS and our teaching methods
Here at SPBS, we work to adapt to each individual child and their needs. All of these ABA techniques are used in different situations and we will make sure to do the leg work to determine which of these fits with your child. We understand the importance of transparency throughout the process as well, making sure to conduct parent meetings to go over the strategies we have been using, what is working, and what may need to be changed to see better results. Offering both clinic-based therapy and in-home therapy is another added benefit and we see that our parents enjoy the convenience and appreciate the ability for our therapists to work with their children in different settings.