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The Use of Operant Conditioning in the Form of ABA in Children with Autism
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The Use of Operant Conditioning in the Form of ABA in Children with Autism
Abstract
Early behavioral interventions are crucial to primary care in autism spectrum disorder.
The major focus in the management of ASD is the reinforcement of the desired behaviors.
However, the efficacy of these interventions is mixed. The neurocircuitry that is atypical in ASD
is based on reinforcement learning. Hence, the early interventions are based on neurocircuitry.
Additionally, the early work suggested that operant learning practices; involving behavior
training by use of reinforcement can increase social behaviors such as social interaction,
instruction following, and communication among children with ASD. The reinforcement
learning strategies are grouped into a systematic treatment approach referred to as Applied
Behavioral Analysis (ABA). The ABA interventions use reinforcement learning strategies to
enhance communication and social behaviors while reducing atypical behaviors.
Keywords: autism spectrum disorder (ASD), ABA, reinforcements, operant conditioning
Introduction
This paper discusses how Applied Behavior Analysis, a form of operant conditioning, can
be used in the management and intervention of autism spectrum disorders among children.
According to the world health organization, 1 out of 160 children has autism globally. On a
narrower focus, the Centers for Disease Control and Prevention (CDC) and Developmental
Disabilities Monitoring and Network suggest that about one child in every forty-four children in
the US will have autism in 2021 (Alves et al., 2020). Further, the CDC continues to argue that
autism is not bound by socioeconomic status, racial or ethnic groups of the child. This means that
all children have equal chances of suffering from autism. However, autism is more prevalent in
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boys than girls (four folds high). A study conducted between 2009 and 2017 indicated that about
seventeen percent (1out 6) of children between three and seventeen years were diagnosed with a
developmental disability including cerebral palsy, blindness, hyperactivity disorder, autism,
among others (Fani-Panag, 2015). A recent study has indicated that the approximate expenses for
ABA therapy among autistic children are sixty million dollars annually each for each child.
According to Alves et al. (2020), the cost estimates are based from the moment the child is
diagnosed with autism, mainly the age of three until the school entering age (six or seven) (Alves
et al., 2020). The four-year treatment thus is likely to be $240 000. An hour session of ABA
therapy with a board-certified therapist costs around $120, which is costly for most families. So
how does operant conditioning in the form of ABA help treat and manage autism among
children? How effective is ABA in the treatment of autism?
During the early twentieth century, John B. Watson suggested that the primary concern of
psychology is the study of observable behavior than private internal events. Watson implied that
environmental stimuli influence the behavior of a person. Later on, B.F Skinner explained more
on Watson's ideas by suggesting that the implications of behavior were also essential in
understanding an individual's behavior (Roane et al., 2016). Skinner also expanded on the
influence that punishments and rewards could have on an individual's behavior, just like the
environment could. This school of thought became to be referred to as behaviorism. Later in the
mid-1960s, ABA was created by Ole Ivar Lovaas based on the behaviorist theories to reduce
stimming behaviors such as hand-flapping, teach life skills and language, and decrease self-
injurious behaviors.
Before the 1960s, most academics and psychologists believed that children with autism
could not be self-sufficient or learn. In most cases, the autistic children were made to stay at
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psychiatric facilities that had inhumane conditions. Hence, Lovaas believed that the ABA
approach he had developed would give a chance to autistic kids to live a better life in society. In
his abid to help autistic children live a better life in society, Lovaas taught them life skills by
breaking various components into small groups. For instance, when teaching the children how to
brush their teeth, he could start by showing them how to put the toothpaste in the toothbrush
(DeFilippis & Wagner, 2016). When the child completed the task, Lovaas would reward them
with encouraging words such as an excellent job. In the next session, Lovaas would show them
how to put the toothbrush into the mouth. As a result, children learned each step and would later
complete the task by compiling all the steps together. Since then, most studies have shown that
ABA is effective in improving the skills of autistic kids, with the first experiment on ABA
carried out in 1973 in which twenty autistic children received fourteen months id ABA therapy
(Roane et al., 2016). During the fourteen months of treatment, the children significantly
improved their IQ scores and non-verbal and verbal behaviors. Another study in 1987 indicated
that nine out of the nineteen children who received ABA therapy were able to move to normal
educational settings. Similarly, recent studies have indicated the same results.
The most common disorder that affects an individual's social integration and growth is an
autism spectrum disorder. There is increasing evidence on the increased prevalence rate of
autism with etiological factors such as environment and genes linked to the same. With the
increased prevalence rate of autism, psychologists and other scientists have intensified their
research efforts on the neuropathological processes associated with autism (DeFilippis &
Wagner, 2016). Although the environmental and genetic factors are essential in understanding
the neuropathological process of autism, their implications can be regulated by several coping
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strategies and mechanisms. Nonetheless, the primary focus of this research is the extent to which
ABA is effective in managing autism in children.
Literature Review
Theoretical Review
Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by
impaired social interactions and communication, restricted interests, and repetitive and
stereotyped behaviors. Although ASD has no known cure, early interventions have improved
adaptive and cognition behavior while altering the way the brain responds to social stimuli. The
treatment and management are mainly done through the use of ABA models. An example of the
ABA model is the Early Intensive Behavioral Intervention (EIBI) (Roane et al., 2016). The
children using the EIBI treatment approach to autism have no significant differences from the
other peers. Also, significant research suggests that EIBI is effective, efficient, and cost-effective
as it saves several thousand for each using the approach. Other ABA-related models include
Treatment and Education of Autistic and Communication-related Handicapped Children
(TEACCH), Initial Denver Classical and Developmental and Individual Difference,
Relationship-based model. The DIR model is a child-oriented process in which the parents,
caregivers, and therapists deliberate to customize an autistic approach that aligns with their level
of functional development (DeFilippis & Wagner, 2016). On the other hand, the TEACCH
model evaluates the strengths and skills of the autistic child and then works on them to promote
the needed development.
Nonetheless, several studies indicate that early treatment of autism in children through
ABA is more feasible if done early (one to one and half months). During the early stage, the
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ABA interventions improve the social and other life skills of the autistic child. Early scientific
research showed that operant learning strategies involving behavior training through
reinforcements could be significantly used in developing social behaviors such as social
interaction and communication. Reinforcements, for instance, are used to ensure that the child
can observe and imitate what they can see the subject do. When the child displays the desired
behavior, the reinforcement motivates them to do better.
Applied Literature
A study by Artoni et al. (2018) investigated how ICT can be used to improve ABA
therapy among autistic children. The ICT technology was used to support the ABA therapists,
teachers, and parents using parents to autistic children and experts to enhance its usability and
evaluate the system's functional conditions. Hence, the study combined ABA programs with
ABCD SW, an open-source web application, and a learning analytics tool. The pilot study was
carried out for nine months involving seven autistic children. The children were assessed before
and after the study using Vineland Adaptive Behavior Scales to evaluate social and personal
skills. By the end of the study, the children showed significant improvement in communication,
behavior, and social skills. The study concluded that the ICT technology and ABCD SW could
be used alongside the ABA therapy to manage and treat autism among children. The major
strength of this study was the use of the ABCD SW is that the parents and caregivers ad
customize it to the needs of the autistic child and is children friendly. However, the study could
have used more participants to enhance its validity and usability.
Another study by Cohenur et al. (2018) studied the likelihood of ABA renewal among
autism spectrum disorder in which the participants were taught a superficial level response. The
study used three autistic children ages 7, 7, and 9. The participants did not show any physical
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limitations or task refusal that would hinder them from pulling the lever. Each child's physical
ability and compliance were tested using a prescreening gross-motor imitation response. The
child was presented with a "see n say "toy by the ABA therapist while requiring them to "do
this" (modeling how the therapist did). With each session being three minutes, the study used an
A-BCD-BCD experimental design with A being unreinforced baseline, B reinforcement, C
Extinction, D renewal test one-two to evaluate the presence or the absence of AAB renewal. The
study results indicated that the introduction of novel stimuli (buzzer and light) to change the
environment after extension led to increased level pulls among two participants of the study. The
findings can be interpreted to imply that ABB renewal may result in response recovery after
extinction. I would positively critique the study and say that transitional research was its main
strength as it's relevant in showing the importance of researching crucial behavioral processes
among clinically appropriate participants.
Similarly, Calahan et al. (2010) evaluate the social validation survey results. The authors
aimed at demonstrating if service providers such as administrators, parents, teachers, and parents
preferred Training and Education of Autistic and other Communication Handicapped Children or
Applied Behavior Analysis intervention. Again, Callahan et al. (2010) evaluated how ABA and
TEACCH were comprehensively integrated with the government school programs. The study
results indicated that the service providers preferred neither ABA nor TEACCH. The study can
have used more autistic intervention approaches so that the parents, teachers, and administrators
had a wide variety to choose from.
Further, Kimball et al. (2020) investigated ABA operant renewal during differential
reinforcement among twelve participants aged two and eight years. All the twelve participants
had been recently diagnosed with ASD except two of them. The study's inclusion criteria were
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the ability to sit on the table or floor without engaging in other behaviors, absence of response
persistence in a response-maintenance test, and choosing one of the available toys. The study
involved two experiments where the authors compared the operant renewal level in two three-
phase experiments. There was reinforced target responding in context A, while Context B
involved extinguishing responding and redoing the two contexts during the first experiment.
During the second experiment, another response led to reinforcement in Context B and the redo
of context A. The study had three significant findings. One of the findings indicated that
combining differential reinforcement and extinction led to increased disruption of the target
behavior in Context B than when extinction was done independently. Another implication of the
study was increased renewal during extinction alone than when differential reinforcement was
combined with exstinction. Lastly, the study findings implied that ABA renewal was influenced
by the existence of alternative response in Context A. thus, the study findings imply that service
providers and other practitioners should be conscious of the extinction histories as they directly
impact treatment relapse. Nonetheless, the ABA renewal reflected in the study may not reflect
reinforcement conditions and dynamic stimulus in natural environmental settings.
In addition, Suvillan et al. (2018) studied a non-sequential approach to the study of
operant renewal. The study involved nine undergraduate students, seven girls and two males
subjected to sixty minutes of experimental time. The recurrence levels among the students were
compared with the standard ABA renewal procedure and a modified non-sequential ACA
procedure. Generally, the authors compared a sequential ABA renewal to a non-sequential
method similar to the conditions in a typical environment used to treat a severe problem. The
non-sequential renewal was similar to the usual treatment course for problematic behavior. A
response to context A was placed on extinction in c Context B with continued response to the
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reinforcement produced in Context C until the return to Context A. The study found that there
was renewal in non-sequential and non-sequential arrangements after the reintroduction of
context A. however, the study could have also subjected some participants to unequal
reinforcement rates in the sequential and non-sequential arrangements.
Lastly, Tsouri et al. (2012) conducted a study investigating the extent of an intervention
package integrated with parental education could be used to evoke the first words among
children with ASD. The five children in this study had not yet started to talk or had minimal
language communication. The intervention packages used in this research was Rapid Motor
Imitation Antecedent Training (RMIA), a discrete trial program. The intervention was evaluated
using specific goals and results on functional spoken language. The study suggests that using the
RMIA approach alongside the parents' training helps enhance the production and imitation of
verbal sounds among children with ASD and had little or no verbal language. By the end of the
study, three of the children had within the DDT framework started word production. Again, the
three children had begun to achieve the essential milestones in verbal communications.
Discussion
The findings indicate that ABA can be used to treat and manage autism spectrum
disorder. The management and treatment of ASD among children can be managed using ICT
technology. The parents can easily incorporate technology in the ABA approaches as they can
customize it to the unique needs of the child while the approach is also friendly to the babies.
Several studies have shown the ABA renewal in the treatment of autism. ABA renewal means
that the child can show the conditioned response to an extinguished conditioned stimulus even
after time passage since passage. The renewal ability that has been presented in the experiments
shows that ABA is a powerful method to help in the management of autism among children. The
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studies have also shown the importance of the various service providers dealing with autistic
children in their management to evaluate the impact of the extinction histories on the occurrence
of treatment relapse. Similarly, the Rapid Motor Imitation Antecedent Training approach can be
used alongside the ABA model to treat autism among children. The RMIAT helps autistic
children who are yet to develop or have little communication language to develop verbal
communication milestones. Generally, the RMIA approach integration with Aba acts as a
catalyst to speech development. The six studies have indicated the need for ABA as the standard
treatment of autism spectrum disorders as it promotes the development of social, cognitive, and
life skills.
Future Research
Although there is currently no cure for autism, there should be collaborative efforts
between psychologists, caregivers, education officials; with most studies showing the
effectiveness and efficacy of the ABA method in the treatment of autism in children; more
research should be conducted on the effects of the variables on its efficiency. In a world with
fast-rising technological equipment, technological knowledge should be embraced and evaluated
on how it can be integrated into autism treatment. However, with the delicate ad destructive
nature of autistic children, much care should be considered to ensure that they are friendly to the
children. Generally, the findings suggest that autism treatments should focus on improving the
quality of life of both autistic patients and parents. Most autistic activities influence sensory
perception, language, social interaction, and engine control; future treatment options should
focus on the brain model. Also, future research should focus on contextual reasoning based on a
learning environment. Additionally, the studies have shown a need for cooperation between
psychiatry and ABA. Although psychiatry and ABA have conflicting interests, the cooperation
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of the two disciplines will result in better patient care. The evidence from the research studies
has supported the hypothesis that the management of autism among children can be effected
through ABA interventions.
Conclusion
In conclusion, the effectiveness of ABA has been significantly evidenced in the majority
of the studies. Combining ABA with other approaches such as RMIA, TEACHH, and ICT
technology has improved results among autistic children. ABA has become widely accepted as it
promotes positive behavior through reinforcements while discouraging negative behaviors,
enhancing various skills. Early interventions of autism spectrum disorder with ABA use lead to
better results. However, this does not mean that the intervention cannot be applied in later life
stages. Hence, autistic children are likely to benefit more o ABA-focused programs, especially at
an early age.
Assessment of Research Paper Writing Process
Although I knew that it was inevitable for me to do a research paper, I was anxious and
nervous at the start of the assignment. I have learned that research work is an extensive process
that requires commitment and dedication. I have also learned the importance of having an open
mind while beginning and writing research. An open mind has helped me write the research
without bias as I was ready to analyze any results from the various studies. The most valuable
part that I have encountered in the research writing is the literature review section. Analyzing the
literate helps broaden one's thoughts while enhancing their understanding of the concept.
Through the literature review, I have learned that ABA intervention can be used with other
approaches to enhance its effectiveness. From the research paper, I have embraced the use of
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ICT technology and ABA to help manage autism among patients. The use of the ICT technology
helps the caregivers and parents to tailor the program based on the need of the child hence
making it cost-efficient. The final research assignment has enhanced my perception of autistic
children and parents. Learning that there is no known cure for autism despite the fact that its
tremendous impacts on children and the prevalence rate has helped me further my education on
developmental psychology to get better and informed information on developmental stages
facing children.
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References
Alves, F. J., De Carvalho, E. A., Aguilar, J., De Brito, L. L., & Bastos, G. S. (2020). Applied
behavior analysis for the treatment of autism: A systematic review of assistive
technologies. IEEE Access, 8, 118664-118672.
https://ieeexplore.ieee.org/abstract/document/9127441/
Artoni, S., Bastiani, L., Buzzi, M. C., Buzzi, M., Curzio, O., Pelagatti, S., & Senette, C. (2017).
Technology-enhanced ABA intervention in children with autism: A pilot study.
Universal Access in the Information Society, 17(1), 191-210. doi:10.1007/s10209- 017-
0536-x
Callahan, K., Shukla-Mehta, S., Magee., & Wie, M. (2010). ABA versus TEACCH: The case for
defining and validating comprehensive treatment models in autism. Journal of Autism
and Developmental Disorders, 40(1), 74-88. doi:10.1007/s10803-009-0834-0
Cohenour, J. M., Volkert, V. M., & Allen, K. D. (2018). An experimental demonstration of AAB
renewal in children with an autism spectrum disorder. Journal of the Experimental
Analysis of Behavior. https://doi-org.ezproxy.liberty.edu/10.1002/jeab.443
DeFilippis, M., & Wagner, K. D. (2016). Treatment of autism spectrum disorder in children and
adolescents. Psychopharmacology bulletin, 46(2), 18.
https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5044466/
Fani-Panagiota, R. (2015). Teaching strategies for children with autism. Journal of Physical
Education and Sport, 15(1), 148. http://efsupit.ro/images/stories/nr1.2015/Art
%2024%202015.pdf
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Kimball, R. T., Greer, B. D., Randall, K. R., & Briggs, A. M. (2020). Investigations of operant
ABA renewal during differential reinforcement. Journal of the Experimental Analysis of
Behavior, 113(1), 187-205. doi:10.1002/jeab.577
Roane, H. S., Fisher, W. W., & Carr, J. E. (2016). Applied behavior analysis as treatment for
autism spectrum disorder. The Journal of pediatrics, 175, 27-32.
https://www.jpeds.com/article/S0022-3476(16)30071-3/abstract
Sullivan, W. E., Saini, V., & Roane, H. S. (2018). A non-sequential approach to the study of
operant renewal: A reverse translation. Journal of the Experimental Analysis of Behavior,
110(1), 74-86. doi:10.1002/jeab.456
Tsiouri, I., Tsiouri, I., Schoen Simmons, E., Schoen Simmons, E., & Paul, R., (2012). Enhancing
the application and evaluation of a discrete trial intervention package for eliciting first
words in preverbal preschoolers with ASD. Journal of Autism and Developmental
Disorders, 42(7), 1281-1293. doi:10.1007/s10803-011-1358-y
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Abstracts
Artoni et al (2018) This study investigates whether ICT technology can enhance applied
behavior analysis (ABA) rehabilitation therapy for children with autism. A technology-enhanced
rehabilitation system to support the daily work of ABA tutors, parents and teachers was created,
involving ABA experts and parents of autistic children in the entire design phase, in order to
better understand the system’s functional requirements and enhance its usability. Thus,
combining the ABA programs with a learning analytics tool, an open-source Web application ,
ABCD SW, was implemented for teaching and monitoring learning in low-functioning autistic
children. In a small pilot study the system was tested on seven children with autism enrolled in
an intensive intervention lasting 9Lmonths. The children were assessed before and after the pilot
test, using Vineland Adaptive Behavior Scales to measure their personal and social skills. Test
participants showed improved communication, especially in the expressive category (pL<L0.05).
Subjective feedback from the ABA team involved in the user test confirmed the children’s
improvement in socialization, communication and behavior. ABCD SW expedites the
intervention (thus increasing its efficiency) and makes it more pleasant for the children.
Furthermore, ABCD SW enables caregivers to easily conduct and personalize the intervention,
reducing its cost. The study seems to suggest that ABCD SW, and ICT technology in general,
can enhance ABA rehabilitation therapy for children with autism, encouraging further
investigation of this promising research field.
Cohenur et al. (2018) Operant renewal is a return of extinguished behavior due to changes in
contextual stimuli that control the occurrence or nonoccurrence of a response. Well-established
in classical conditioning and operant research, renewal presents itself in three forms—ABA,
ABC, and AAB—and poses threats to treatment maintenance where extinction procedures are
utilized. As AAB renewal may be less likely to occur than ABA or ABC renewal, the current
study sought to determine if AAB renewal would occur with three participants with Autism
Spectrum Disorder who were taught a simple lever pull response. Results showed that lever pulls
increased for two of three participants when we introduced novel stimuli (i.e., a light and a
buzzer) to alter the contextual environment after extinction. These findings suggest that AAB
renewal may account for some instances of response recovery after extinction and that the
procedure of this study may be beneficial to the further study of renewal and the variables that
affect its occurrence within a translational model.
Calahan et al. (2010) The authors analyzed the results of a social validation survey to determine
if autism service providers including special education teachers, parents, and administrators
demonstrate a preference for the intervention components of Applied Behavior Analysis or
Training and Education of Autistic and other Communication Handicapped Children. They also
investigated the comprehensiveness of these treatment models for use in public school programs.
The findings indicate no clear preference for either model, but a significantly higher level of
social validity for components inherent in both approaches. The authors discuss the need for
research to define what is meant by comprehensive programming in autism.
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Kimball et al. (2020) Operant renewal is a form of relapse in which a previously extinguished
response recurs due to a change in context. We designed two experiments to examine the impact
of differential reinforcement of alternative behavior on ABA renewal in a translational model of
relapse with 12 children. We compared levels of renewal in two 3-phase arrangements. In one
arrangement, we reinforced target responding in Context A, extinguished responding in Context
B, and returned to Context A while continuing to implement extinction. In a second arrangement,
an alternative response produced reinforcement in Context B and during the return to Context A.
Results across the 2 experiments indicated 3 general findings. First, extinction plus differential
reinforcement disrupted target behavior more consistently in Context B relative to extinction
alone. Second, renewal tended to be greater and more persistent during extinction alone relative
to extinction plus differential reinforcement. Third, the renewal effect appeared to depend on
whether the alternative response had a history of extinction in Context A. We discuss
methodological implications for the treatment of severe destructive behavior.
Suvillan et al. (2018) ABA renewal is a model of treatment relapse that describes the recurrence
of severe problem behavior when behavior learned in one context (e.g., home; A) and treated in a
separate context (e.g., clinic; B) reemerges when the original context is reintroduced (A).
However, in the typical environment and during the usual course of treatment for severe problem
behavior, the target behavior is exposed to the baseline context periodically (e.g., the child
returns home after several hours in a clinic setting). Due to the difficulty of studying what effect
this may have on treatment relapse during ABA renewal in a strictly applied investigation, we
developed a human-laboratory translation to study renewal in a nonsequential manner. Using
undergraduate students as subjects, we directly compared levels of recurrence using the standard
ABA renewal procedure and a modified nonsequential ACA procedure, one modeled from the
typical course of treatment for problem behavior. Both methods produced renewal at comparable
levels, and patterns during nonsequential ACA renewal were similar to those during sequential
ABA renewal. We discuss the implications of these findings in the framework of treatment for
severe problem behavior.
Tsouri et al. (2012) This study evaluates the effectiveness of an intervention package including a
discrete trial program (Rapid Motor Imitation Antecedent Training (Tsiouri and Greer, J Behav
Educat 12:185-206, 2003) combined with parent education for eliciting first words in children
with ASD who had little or no spoken language. Evaluation of the approach includes specific
intervention targets and functional spoken language outcomes (Tager-Flusberg et al., J Speech
Lang Hear Res 52:643-652, 2009). Results suggest that RMIA, with parent training, catalyzes
development of verbal imitation and production for some children. Three of five participants
acquired word production within the DTT framework and achieved milestones of early
functional spoken language use (Tager-Flusberg et al., J Speech Lang Hear Res 52:643-652,
2009). The implications of these findings for understanding the role of discrete trial approaches
to language intervention are discussed.
