Applied behavior analysis (ABA) therapy is commonly recommended for children diagnosed with autism spectrum disorder (ASD). However, recent research suggests ABA may not be the best approach for every child on the spectrum, especially those with lower support needs.
What is ABA Therapy?
ABA is a popular form of behavioral therapy used to treat autism. It focuses on modifying behaviors by providing rewards and positive reinforcement for desired actions.1 The goal is to help autistic children develop skills and behaviors on par with their neurotypical peers.
ABA therapists work one-on-one with children in highly structured sessions that can last up to 40 hours per week.2 Techniques used in ABA include:3
- Discrete trial training: Breaking down skills into small, manageable steps
- Positive reinforcement: Rewarding wanted behaviors
- Shaping: Gradually molding a desired behavior
- Extinction: Withdrawing reinforcement to decrease unwanted behaviors
- Generalization: Helping the child apply learned skills to other environments
For children with more significant support needs, ABA can be tremendously beneficial. It helps them master basic life skills, improve communication, and reduce disruptive behaviors.4 However, some experts argue ABA may not be the best fit for every child on the spectrum.
ABA Concerns for Children With Lower Support Needs
Children with lower support needs, sometimes referred to as “high-functioning,” tend to have milder symptoms of ASD. While they still face challenges, they generally have stronger cognitive, language, and social skills.5
For these higher-functioning children, the intensive nature of ABA may feel overly rigid and restrictive. The highly structured sessions don’t allow much time for typical childhood activities outside of therapy. In addition, some ABA techniques seem better suited for children with more severe skill deficits.
Criticisms of ABA
Some autistic adults view ABA as deeply problematic. They argue its near-exclusive focus on changing behaviors fails to nurture the child’s inherent neurodiversity.6 Techniques like extinction are seen as unethical. And the 40 hours a week standard seems excessive for children with milder challenges.
In one study, autistic adults reported long-term PTSD and trauma from their experiences with ABA therapy. Many felt it prevented them from developing their natural coping skills.7
Developmental Differences
Higher-functioning children tend to develop strong, narrow interests at an early age. ABA often tries to expand these interests, which can feel frustrating and invalidating to the child.8 It may make more sense to nurture these passions while gently exposing children to new activities.
These children also need support understanding social cues and building empathy. But ABA focuses more on outward behaviors than the reasoning behind social interactions.9 Other therapies may better foster social-emotional growth.
The Importance of Play
ABA is conducted in highly structured sessions with a clear agenda. But child-led free play is critical for developing imagination, creativity and emotional intelligence.10 Higher-functioning children still need plenty of time for open-ended play.
Goals of Intervention
For children with severe support needs, the primary goals are often life skills and safety. But higher-functioning kids have less need to “catch up” to peers. Goals should focus more on socialization, emotional growth, flexible thinking and self-regulation.11
Signs ABA May Not be the Best Fit
Consider if your higher-functioning child:12
- Has an intense, narrow interest area they love
- Has rigid routines but can handle small changes
- Enjoys interactive play with others
- Is aware of others’ emotions
- Uses words to communicate
- Can participate in mainstream classes with support
- Has sensory issues but can self-regulate when overwhelmed
If this sounds like your child, ABA may not be the optimal choice. Look into other evidence-based therapies that nurture your child’s unique differences.
Alternatives to ABA for Higher-Functioning Children
Many effective alternatives or complements to ABA exist:
Developmental Play Therapy
This child-led therapy uses play to improve social, emotional and behavioral skills. Children get to explore their own interests at their own pace.13
Speech Therapy
Speech therapists work on communication, conversation and social use of language. This allows for more natural skill-building.14
Occupational Therapy
OT helps children develop better sensory processing and self-regulation skills. Therapists nurture children’s unique regulation strategies.15
Cognitive Behavioral Therapy (CBT)
CBT is a short-term therapy that helps kids understand connections between thoughts, feelings and behaviors.16
Social Skills Groups
Groups let kids learn social skills by practicing with peers in a natural play-based setting.17
Emotional Growth Therapy
This approach helps kids understand their emotions, build empathy, and appreciate neurodiversity.18
Finding the Right Fit
ABA can be incredibly effective for more affected children. But those with milder challenges may benefit more from therapies that embrace their neurodiversity. Look for approaches that nurture your child’s strengths and passions while expanding skills.
Keep an open mind as your child develops. Be willing to tweak your approach over time as their needs evolve. Work closely with therapists to ensure the therapy fits your child’s learning style and personality.
And remember, no one type of therapy is necessarily the “best” or “gold standard.” Choose the mix that feels right for your unique child.
At Jade ABA Therapy in Maryland, we specialize in customized ABA plans tailored to each child’s needs and strengths. Our passionate therapists focus on nurturing the whole child in the most supportive environment possible. Contact us today at (410) 616-0901 to learn more about our programs.
References
- Leaf, J.B. et al. Applied behavior analysis is a science and, therefore, progressive. Journal of Autism and Developmental Disorders. 2021;51:357-361.
- Virués-Ortega J. Applied behavior analytic intervention for autism in early childhood: Meta-analysis, meta-regression and dose-response meta-analysis of multiple outcomes. Clinical Psychology Review. Jun 2010;30(4):387-99.
- Leaf J.B. et al. Applied behavior analysis: Autism spectrum disorders and beyond. Pediatric Clinics. Apr 2018;65(2):281-292.
- Makrygianni M.K., Reed P. A meta-analytic review of the effectiveness of applied behavior analytic interventions for children with autism spectrum disorder. Research in Autism Spectrum Disorders. Feb 2010;4(2):577-593.
- Noterdaeme M, Wriedt E, Höhne C. Asperger’s syndrome and high-functioning autism: Language, motor and cognitive profiles. European Child & Adolescent Psychiatry. Aug 2010;19(6):475-81.
- Kapp S.K. et al. Deficit, difference, or both? Autism and neurodiversity. Developmental Psychology. Jan 2019;55(1):59-72.
- Kupferstein H. Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis. Advances in Autism. Jan 2018;4(1):19-29.
- Gunn K.C.M., Delafield-Butt J.T. Teaching children with autism spectrum disorder with restricted interests: A review of evidence for best practice. Review of Educational Research. Apr 2015;85(3):408-430.
- Mazefsky C.A., White S.W. Emotion regulation: Concepts & practice in autism spectrum disorder. Child and Adolescent Psychiatric Clinics of North America. Jan 2014;23(1):15-24.
- Bornstein M.H. et al. Play in children with autism: Is it imaginative? Autism. May 2019;23(4):937-949.
- West E.A. et al. Goal attainment scaling as a measure of meaningful outcomes for adolescents with autism. Disability and Health Journal. Apr 2019;12(2):275-283.
- Ospina M.B. et al. Behavioural and developmental interventions for autism spectrum disorder: A clinical systematic review. PLoS ONE. Jul 2008;3(11):e3755.
- Solomon R. et al. The PLAY Project Home Consultation (PPHC) program for children with autism spectrum disorders. Journal of Autism and Developmental Disorders. Aug 2014;44(8):1966-76.
- Schwartz H. Drager K. Training and knowledge in autism among speech-language pathologists: A survey. Language, Speech, and Hearing Services in Schools. Jul 2010;41(3):376-86.
- Schaaf R.C. et al. Occupational therapy using sensory integration to improve participation of a child with autism: A case report. American Journal of Occupational Therapy. Sep-Oct 2011;65(5):547-55.
- Wood J.J. et al. Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry. Mar 2009;50(3):224-34.
- Watkins L. et al. A randomized controlled trial of the social tools and rules for teens program: An immersive socialization intervention for adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders. Mar 2017;47(3):692-704.
- Scarpa A, Williams White S. The application of cognitive behavioral therapy for emotional regulation in youth with high-functioning autism spectrum disorders and anxiety. The Israel journal of psychiatry and related sciences. 2013;50(2):120-129.