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| |    Applied Behavior Analysis: A Well-Studied Therapy for Autism by Robert Needlman, M.D., F.A.A.P. reviewed by Robert Needlman, M.D., F.A.A.P. This article is an introduction to Applied Behavior Analysis (ABA) treatments for autism. The main reason for singling out this approach from the many other nonmedical treatments is that, of all the available therapies, ABA is the most thoroughly studied. Unfortunately, many publications that describe the ABA approach are overly technical and confusing. The basic ideas, though, are rather common sense. ABA is built on the concept that children learn to communicate because they are rewarded for doing so. For typically developing children, the act of communicating is itself tremendously rewarding. Think about a four-month-old baby having a back-and-forth cooing "conversation" with a parent. You can see from the look of interest and joy on his face that there is something deeply gratifying about the act of talking and being spoken to. Over the first year of life, all the minute-by-minute social interactions that go into caring for a baby add up to a tremendous amount of rewarding of social and communicative behaviors. Typically developing children have an instinctual enjoyment of communication that powers their developing ability to convey feelings, and eventually, thoughts. Infants with autism do not get the same positive reinforcement for social interactions. This may be because their brains do not interpret incoming sensory information in the same manner that most children's do. For example, they may find gentle touching and talking extremely uncomfortable. When they respond, reasonably enough, by turning away or stiffening their bodies, they break off the cycle of communication with their parents. And because they do not experience back-and-forth communication as pleasurable, they learn to avoid social contact. What ABA does is to start with finding out what sorts of sensory stimuli are rewarding for a particular child with autism, and then using these rewards to teach the child to communicate socially. This work is very labor-intensive. Typically developing children are rewarded naturally for social interactions that happen throughout the day, so that the give-and-take between child and parent is done almost unconsciously. It follows that children with autism also need a great deal of rewarding, but these experiences have to be consciously planned and carried out by dedicated adults who are trained to deliver specific stimuli in response to a child's beginning efforts to communicate. As a practical measure, parents who institute ABA therapy for their children need training themselves, and then they need to enlist the help of a team of therapists--either volunteer or paid--to spend hour after hour working intensively with their child. The payoff for this huge investment in time, energy, and money often is a remarkable improvement in the child's ability to communicate and connect with others. For more about the ABA approach, see Autism Society of America Information Packages page and click on "Intensive Behavior Intervention."
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