Children on the autism spectrum are characterised by challenges with social skills, repetitive behaviours, speech and nonverbal communication, as well as by unique strengths and differences.
Unfortunately however, they often get unfairly labelled as lazy, disruptive or dull. “It is important to understand that children on the autism spectrum are teaching challenges. So, the question is not whether they can learn... the question to ask is, ‘Can I teach them in a way they can understand?’” explains Dr Vincent J Carbone.
Dr Carbone, a Board Certified Behaviour Analyst-Doctoral, was the keynote speaker at the Autism Outreach and Training symposium in Doha, conducted by the Child Development Center.
The event was organised to provide evidence-based information to assist professionals, educators, and families with the tools necessary to support children with autism and related diseases.
Dr Carbone, who has over 35 years of experience in designing learning environments for persons with autism and development disabilities, explained how Applied Behaviour Analysis (ABA) has been found to be effective in helping children with autism.
An expert in ABA, Dr Carbone offers behaviour analytic services in the USA and Dubai.
He is a frequently-invited speaker at professional workshops and conferences.
In an exclusive interview with Gulf Times, Dr Carbone spoke on ABA and its benefits, especially when applied to children with autism.
What is Applied Behaviour Analysis (ABA)?
ABA is a set of principles that form the basis for many behavioural treatments.
It is based on the work done by B.F. Skinner, one of the most influential of American psychologists who uncovered the natural laws of human behaviour.
These principles include:
lreinforcement – when a certain behaviour is followed by some sort of reward, that behaviour is most likely to be repeated
lextinction: when good things stop happening after a behaviour, that behaviour decreases
lmotivation – changes in environmental condition can turn things into reinforcers, e.g. not eating for a period of time turns food into a reinforcer; we will increase behaviour that obtains food.
ABA is the application of these and other principles to important human activities.
This includes teaching children with autism important skills such as: functional skills, teaching reading and maths, and may even alleviate the symptoms of mental illness in typically developing persons who exhibit these difficulties.
ABA can also be used in ordinary everyday situations such as improving the performance of employees in the workplace.
In other words, the principles of ABA are in operation wherever human behaviour is involved.
Therefore the intentional arrangement of these principles can help improve the human condition.
How can children with autism benefit from ABA?
A number of important studies have proved that ABA is an effective and safe method for treating persons with autism.
Unlike typical children, many children with autism do not learn language, social skills, behavioural regulation, and self-care skills from the everyday life experiences.
This means they cannot acquire life skills from unplanned learning opportunities unwittingly presented by parents, caregivers, and even other children.
As a result in order to help teach children with autism parents, teachers, therapists, and others must arrange precise learning opportunities for these important skills to be acquired.
Since the principles of ABA account for most of the learning by all of us, it is particularly well suited as a method to overcome the learning difficulties of children with autism.
By precisely and intensely arranging and programming the same type of learning experiences that help typical children to acquire skills, ABA provides a guide and method to help children with autism, thus helping them improve in areas like communication, social relationships, play, self care, etc.
It must be understood that ABA can be applied to teach skill domains to any individual not just children with autism.
Share with us a success story that resulted from applying ABA on an individual with autism.
Success stories in the ABA treatment of children with autism come in many forms.
While we have seen some children progress toward responding like typical children, some of the more inspiring stories involve changes in the child’s behaviour that have led to greater inclusion within the family and community.
For example, we recently provided consultation in our Boston clinic to a child with autism – a family from Europe.
The seven-year-old child has needs in many domains including language, social skills, etc., but in working with him, his challenging behaviour of running off, endangering himself, and screaming tantrums during community activities took priority.
The family was unable to leave their home for fear he would injure himself, become lost in the community, or generally cause disturbances in restaurants, theatres, and other public settings.
We provided training to the parents and the child’s caregivers over several days in the community where these problems occurred.
In these settings we coached the parents on how to apply ABA principles to manage the challenging behaviour.
We have received feedback from the parents that as the result of the ABA intervention, the family were able to travel via airplane to a large metropolitan city in Europe and the child was able to ride the subway in a co-operative and enjoyable way with the family during a holiday.
The parents’ comment was “You have given us our son back”. In reality, it was the parents’ diligent and precise application of ABA principles that gave them their son back.
While this child still requires many hours a day of ABA therapy to overcome his learning difficulties, he now benefits from a more enjoyable and less stressful family life.
What is the rate of success seen with ABA on children with autism?
Autism is a wide spectrum and outcomes are very individualised and difficult to predict.
The rate of progress – like the goals of intervention – varies considerably from person to person depending on age, level of functioning, family goals, and other factors.
In addition, it is seen that children who begin intensive and on-going ABA treatment early, i.e., two years and sometimes younger, have better outcomes than those who begin later.
When well delivered, ABA intervention can help learners with autism make meaningful changes in many areas.
However, changes do not typically occur quickly.
Rather, most learners require intensive and on going instruction that builds on their step-by-step progress.
Overall we know that almost all children will make progress and learn important skills, with some children going on to develop near typical skills.
ABA seems to provide the greatest benefit, when compared to other methods used.
Can a child with autism who has participated in an ABA programme eventually move on to a regular school?
Some children with autism will ultimately improve to the degree that they will benefit from a regular education program with their typical peers.
Most of these children will require some modifications and accommodations within the academic curriculum and will require the additional support of educational staff with specialised training.
In any case, most children with autism benefit as they integrate with typical peers, at some point in their day, within the educational programme.
How early can ABA be introduced?
Some research published recently suggests that children can be diagnosed with autism by 12 months old and sometimes even earlier.
Consequently, as soon as the diagnosis is made, children are candidates for ABA therapy.
The earlier ABA treatment is begun, the better.
Notwithstanding these findings, ABA treatment will benefit children with autism at any age – throughout their life into adulthood.
We all continue to learn new skills throughout our lives and therefore persons with autism are no exception.
Can a parent or caregiver deliver ABA to the individual with autism, under their care?
It is essential that parents and caregivers are active members of the treatment team.
The overall outcome of the treatment is reduced by failure to involve parents and care givers as active providers of the treatment.
Should ABA be accompanied by some other kind of intervention as well?
Other disciplines such as Speech-Language Pathology, Occupational Therapy, and Physical Therapy can all be helpful in the treatment process.
It appears that providers from these other disciplines who also make use of ABA principles will be the most effective members of a treatment team.
Parents who decide to add providers from these other disciplines should determine the extent to which these individuals make use of ABA principles during treatment and just as importantly, verify in the interview process that they rely on evidence-based methods only.
Failure to determine the extent to which the treatment methods of additional providers are consistent with ABA principles, can lead to clashes in philosophy and therefore slow the progress of the child.
Dr Vincent J Carbone working with a child with autism.