Applied Behavior Analysis (ABA) is a division of psychology dedicated to the science of human behavior. The practice of ABA involves systematic understanding of how the environment impacts socially significant behavior, and designing interventions based on learning principles to help individuals learn new skills which ultimately improve behavior.
Central Concepts of Applied Behavior Analysis
Applied Behavior Analysis is fundamentally dedicated to the improvement of peoples’ lives by changing behaviors that are impacting their functioning. Underlying each behavior of interest are principles of cause and effect—in other words, behaviors are typically not occurring “out of nowhere,” and ultimately happen for a reason. Understanding the reason, or function, for a behavior targeted for change is central to the treatment process itself.
Antecedents, Behaviors, and Consequences
Behavior analysts’ first charge is to fully understand the behavior(s) that they are tasked to change. Just as any other scientist must describe and measure their subject of interest, so too must a clinician decide how to define and measure the behaviors on which they are intervening. Human behavior involves anything that a person can do; so, the intervention process begins by defining the behavioral problem in terms that can be measured.
Questions that are typically asked toward this effort include, “how often does the behavior happen?” or “how long does the behavior last?” These queries are then coupled with behavior observations in order to inform a complete understanding of the target for intervention.
Central to the process of behavior change is understanding how events occurring before and after problematic behaviors impact the behavior itself. The technical term for events that occur prior to problematic behaviors is antecedent, but more broadly the term refers to situations or events that occur prior to the behavior of interest.
The clinician must understand these events as well as the behavior they are treating; in other words, what are the qualities of the environment that can lay the groundwork for the behavior to occur? To some extent, one of the goals of the therapeutic process is to establish the likelihood of a certain behavior occurring given a particular antecedent (e.g., for individuals attempting to curb their overeating, what is the likelihood of consuming high calorie given that they are driving by a fast food restaurant[antecedent]).
Perhaps one of the misused behavioral terms in the everyday literature is consequence. Simply put, a consequence refers to any type of environmental change that follows a behavior of interest. Often, consequences are thought of as punitive in nature, but in fact by definition they are viewed far more objectively. Sometimes situations that follow a behavior have an effect on future behavior, and so the process of understanding the function of a behavior also examines these events.
Another goal of the therapeutic process is to establish the likelihood of a certain behavior occurring in the future if it is followed by a particular consequence. For example, for that same individual with overeating behavior, what is the likelihood of future consumption of a high calorie food [behavior] if they become sick after eating [consequence]?
The complete analysis in ABA examines the effects of events that come before behavior (antecedents) as well as those that come after the behavior (consequences). A clear understanding about these events allows the clinician to make changes to the environment around a behavior in order to modify the behavior itself.
Reinforcement and Punishment
The principles of reinforcement and punishment are the most central components of the work in applied behavior analysis. Reinforcement is defined by the effect that a given situation has on a behavior of interest; specifically, whether an event or situation makes a behavior more likely to occur in the future.
Some events increase the likelihood of behavior because they are added to a situation, much like the employee who is more likely to return to work after they have been paid. That employee’s behavior is said to have been positively reinforced, since adding money into their pocket makes it far more likely that they will return to the office.
Other events increase the likelihood of behavior because they are aversive and taken away from a situation, like the teenager who hits “snooze” on their alarm to go back to sleep. The teen’s avoidance behavior is then said to be negatively reinforced, since they are more likely to push the snooze button to remove the annoying buzzer when they want to keep sleeping. The closer reinforcement occurs to a specific behavior, the more likely the association between the behavior and the reinforcer.
Punishment is a similar concept, in that it is defined by the effect on a behavior of interest. In contrast to reinforcement, punishment refers to whether an event or situation makes a behavior less likely to occur in the future. Some events decrease the likelihood of behavior because they are added to a situation, as in the case where a toddler receives a shock when touching an electrical outlet. That toddler’s behavior is said to be positively punished, as they are less likely to touch the outlet in the future after the shock.
Other events decrease the likelihood of behavior because they are taken away, like the child who can’t play on their tablet after they’ve thrown it on the ground. That child’s behavior has been negatively reinforced, since they will be far less likely to throw their tablet again as a result.
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What Can ABA Help With?
Applied Behavior Analysis is more of an approach to treatment than it is a single intervention.1 As such, its principles can be used to treat almost any type of behavior problem in any clinical population. Areas where the use of these principles have been well established include in education, health and exercise, medical procedures, and parenting.
The population most commonly linked to ABA interventions include individuals with autism spectrum disorders (ASD) or other developmental disabilities. Interventions most common for individuals with ASD are discrete trial (DT) and natural environment training (NET). During these skill acquisition programs, therapists provide one-on-one instruction where student behavior is cued, appropriate behavior is prompted, and reinforcement is provided for correct responses.
Historically, these programs consist of 35-40 hours of instruction per week,2 combining individualized instruction with generalization to a more natural environment (e.g. regular education classrooms). More recent research suggests that similar outcomes can be achieved with fewer hours of instruction, with strong progress noted with 12-20 hours per week.3 As young children with autism often present with delayed milestones in areas like speech and social skills, the systematic and data-driven approach in ABA is well matched to improve functioning in this population.
The list of behavioral and psychological disorders that respond well to ABA intervention includes:4
- Autism Spectrum Disorder (ASD)
- Attention Deficit/Hyperactivity Disorder (ADHD)
- Disruptive, Impulse Control, and Conduct Disorders: Oppositional Defiant Disorder (ODD), Intermittent Explosive Disorder
- Anxiety Disorders in young children: Separation Anxiety, Specific Phobias, Selective Mutism
The strength of the behavior analytic approach is evident in treatments for specific behavior problems.
Examples of behavior problems that are commonly treated with ABA include:1
- Noncompliance
- Self-injury
- Aggression
- Tantrums
- Impulsivity
- Destructive behaviors
- Feeding issues
- Toilet training
- Sleep problems
Common Applied Behavior Analysis Techniques
Common ABA techniques include direct and frequent assessment of progress, antecedent-based interventions, and consequence-based interventions.
Direct and Frequent Assessment of Progress
The science of behavior analysis requires constant observation and data collection of treatment effects. These data are then graphed and analyzed in order to determine how behavior has responded to prescribed interventions.
In this way, ABA is an extremely accountable practice of psychological intervention: therapists are responsible to monitor progress on a constant basis, and make changes to treatment procedures if sufficient improvement is not observed. Consistency in implementation of intervention strategies is also monitored throughout treatment to ensure that therapists are properly applying recommended procedures.5
Antecedent-Based Interventions
Some of the most important methods in the ABA toolbox involve changing the environment before behavior occurs. There are several strategies commonly used to either make appropriate behavior more likely to occur, or make inappropriate behavior less likely to occur.
Several of these techniques include:
Targeting Motivation
Motivation is central to the reason why people behave in the ways that they do. Said another way, people behave a certain way because it works to get their needs met. Interventions that target motivation attempt to meet individuals’ needs prior to situations that historically trigger problematic behavior.
In that way, providing access to preferred things before a behavior has had a chance to occur will decrease its likelihood of happening (i.e. giving praise prior to attention-seeking interrupting behavior “takes away” the need to interrupt in the first place).
Building on Previous Learning
It is not uncommon for individuals to have different learning histories with different people and in different situations. For instance, many families report that children display certain behaviors in the context of some caregivers and other behaviors in the context of others (e.g., a child listens very carefully to their grandparent but is more noncompliant with their parents).
Behavior interventions can often build on this previous learning by connecting (or pairing) caregivers with good control over behavior to caregivers who experience more problems.
Prompting
Although prompts are typically thought to be vocal reminders, they can also be visual cues in the environment. Visuals are extremely common in community settings to help people know how to behave (i.e. stop signs, walk signals, speed limits). By incorporating similar stimuli in home or school settings, expectations can be clearly conveyed to minimize the likelihood of behavioral errors.
Similarly, visual cues can help individuals understand how they are doing relative to that expectation (e.g., think of the digital speedometer posted on the side of the road to remind drivers about their speed).
Creating Choices
Providing choice-making opportunities, particularly those related to which types of tasks to complete or when to complete them, can lead to significant reductions in challenging behavior. Carefully timing the use of choice allows individuals to have some control over the expectations, which can minimize the aversiveness of required tasks.
Consequence-Based Interventions
Equally as important are methods for responding to behavior after it has happened to change the likelihood that it will either occur or not occur again in the future. Central to many consequence-based interventions is the idea of a contingency, which simply refers to the reliable delivery of a specific reinforcer or punisher after a targeted behavior.
The following are some strategies used to modify the environment to impact future behavior:
Positive Reinforcement
Perhaps the most well-known term in psychology, positive reinforcement refers to delivering a preferred thing following any instance of a behavior that is desired to occur again in the future. Exactly what that thing is depends on the individual being reinforced—some people are reinforced by attention while others by food.
It should be noted that different behaviors may be reinforced by different things, and these things often change over time (e.g. imagine going to a diner for a specific menu item, only to discover exciting new specials).
Negative Reinforcement
Similarly, negative reinforcement refers to the removal of specific aversive things following desired behavior. This removal often allows an individual to avoid or escape a task or activity that they might not like, and can be a highly effective intervention to encourage persistence in the face of unpleasant activity (e.g. a student who needs to practice piano for 15 minutes in order to be finished for the day).
Token Economy
Tokens are arbitrary tools that have value because they are associated with a commodity (e.g. think about why money is so valuable). They can be useful because reinforcing items are not always readily available to be delivered immediately following a desired behavior. Tokens also help minimize satiation (i.e. no longer being satisfied) with specific items or activities, since they can often be exchanged for a variety of different reinforcers.
Extinction
An important component to any behavioral intervention involves creating contrast between new, appropriate behavior that works effectively for an individual, and problem behavior targeted for change that is no longer efficient. Extinction is a term that describes the elimination of effectiveness for any given behavior targeted for change.
In other words, the best way to change a behavior is to stop it from working for the individual (e.g. think of a soda fountain where one of the heads has an “out of order” sign—no matter how much you want that particular flavor of soda, you are unlikely to attempt to use that fountain head).
Punishment
While punishment often has a negative connotation, it is a naturally occurring contingency in the environment and can aid in effective interventions. Stated simply, punishment procedures teach individuals not to use a specific behavior in order to get their needs met. Practitioner ethical codes mandate the use of reinforcement procedures prior to consideration of the use of punishment, chiefly because punishment doesn’t teach new skills.
One common form of punishment includes removal of access to preferred items or activities following certain undesired behaviors (e.g., time out). When implementing these punishment procedures, it is important to incorporate reinforcement strategies as well in order to ensure skill acquisition.
How to Find a Therapist Who Provides ABA
Similar to other types of therapy, the practice of applied behavior analysis is regulated by a governing body (i.e. BCBA – Behavior Analyst Certification Board),6 and more recently, 31 states have licensed practitioners in the independent practice of behavior analysis above and beyond the certification process.
Finding a therapist who is certified (or licensed, if in a state that has regulated the practice of behavior analysis) to provide behavior analytic services is as simple as searching on the BACB or state licensure board website. Other options include referrals provided by state and local agencies, pediatricians, or school districts.
In order to practice ABA, therapists need to be credentialed at one of four levels:
- RBT (Registered Behavior Technician): A paraprofessional required to practice under close, ongoing supervision. Typically, they are charged with implementing behavior plans written by supervisors. These therapists are required to have a high school level of education.
- BCaBA (Board Certified Assistant Behavior Analyst): A therapist that can provide services under supervision of a licensed, certified professional. These therapists are required to have a bachelor’s level of education.
- BCBA (Board Certified Behavior Analyst): A professional certified to independently practice behavior analysis. These professionals are required to have graduate-level education.
- BCBA-D (Board Certified Behavior Analyst – Doctoral): These professionals are also certified to independently practice behavior analysis. The doctoral designation indicates training in behavior analysis at the doctoral level.
How Much Does ABA Cost?
The cost of behavior analytic services varies greatly depending on the service, region, and type of provider. Recent estimates suggest that Board Certified Behavior Analysts bill an average of $120 per hour, with rates decreasing commensurate with the level of certification of the provider.
However, most health insurance plans will help cover the cost; often this is the case when children are diagnosed with autism spectrum disorders. Other options to help defray the costs of ABA therapy include funding from school districts or grants from nonprofit centers.
When considering ABA, asking the following questions will be helpful in deciding between services and providers:
- What is the assessment process like, and how long will it last?
- What level of certification will providers have who work with my child?
- How and how often will paraprofessionals be supervised?
- What type of ongoing training is provided to paraprofessionals?
- What is the plan for parent/caregiver training?
- What other professionals are a part of the treatment process?
- Will my child have the same team working with him/her throughout the treatment process?
- Can parents/caregivers observe therapy sessions?
- What are the clinical outcomes from previous clients?
What to Expect from Your First ABA Therapy Appointment
As behavior analytic therapy is firmly grounded in data collection and behavioral observation, it is likely that your first several appointments will involve some type of evaluation. Exactly what might be covered during the assessment phase depends in large part on the type of problem being addressed and the professional in charge of addressing it.
It is likely that the following areas will be covered:
- Developmental history, including milestones (i.e. first words, motor skills, toilet training)
- Medical history, including information about pre-, peri-, and postnatal complications
- Family history, including information about family mental health issues
- Educational history, if applicable
- Current adaptive skills, including the client’s ability to perform activities of daily living
- Ability to communicate, including how the client gets his/her needs met
- Any current behavior concerns
In addition to an interview format, your therapist will likely be interested in observing different behaviors in order to get a sense of how they might be helpful. These observations can be conducted in a variety of different ways, ranging from naturalistic observations to more contrived situations designed to evoke certain responses.
All of the information gathered during the assessment phase should be prepared in a report, outlining findings and making specific recommendations for the therapy itself.
Is ABA Effective?
In a large study evaluating the effectiveness of applied behavior analytic procedures on skill acquisition in 344 children with autism spectrum disorders,7 researchers found significant improvement in ABA intervention groups vs. control groups receiving other treatments.
Specifically, children who received intensive ABA therapy improved in areas related to adaptive behavior, communication, daily living skills, and socialization. In fact, no other educational or treatment approach meets the same standard of scientific validation than ABA in the treatment of behaviors associated with developmental disabilities.8,9
Regarding the broader effectiveness of behavior analysis in the treatment of challenging behavior, data suggest that ABA procedures are both highly efficient and effective. Specifically, a study examining treatment outcomes of 138 individuals with a variety of different presenting concerns (disruptive, aggressive, self-injurious, and destructive behaviors) across the spectrum of functioning levels (i.e. ranging from developmentally disabled to neurotypical) found behavior reductions of 90% or greater for a majority of participants in an average of 10 days.10
Other types of therapies that have been reviewed for their effectiveness in addressing challenging behavior and were subsequently not recommended due to a lack of evidence include sensory integration therapy, Floortime, facilitated communication, music therapy, touch therapy, hormone therapy, attachment therapy, boot camp interventions, vitamin therapies, and special diets.8,11
Criticisms of Applied Behavior Analysis
Dating back to the 1960’s, the earliest forms of ABA emphasized behavior change for individuals with autism spectrum disorders using a variety of reinforcement and punishment procedures. Many criticisms that have amassed over the long history of behavior analytic techniques include emphasis on “robotic behavior,” skills acquired do not generalize outside of therapy, rote learning, and unemotional therapists.
However, modern ABA has expanded, and its transparency is much improved. Behavior analytic practice is centered on building a relationship with the client while teaching new skills in a fun and natural environment.12 While there may be ABA therapists who are overly demanding of their clients, this is more of a reflection of the teacher and less on the practice itself.
How Is ABA Different than Other Therapy Techniques?
Ultimately, behavior analytic principles are the foundation for many established types of mental health treatment, including Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), Parent-Child Interaction Therapy (PCIT), and Parent Management Training (PMT).
Many of these interventions employ procedures described in this article, including reinforcement, extinction, and punishment contingencies. Thus, it is challenging to separate how these various therapies are different from applied behavior analysis; suffice it to say that those interventions which adhere best to the systematic and data-driven practices supported in ABA often report the best outcomes.
History of Applied Behavior Analysis
The practice of psychology at the turn of the 20th century was focused primarily on consciousness, dream interpretation, and introspection. Beginning with John Watson, psychological science took a new direction by focusing on observable behavior.
The trend towards behavioral psychology continued upward with B.F. Skinner and The Behavior of Organisms in 1938, which differentiated between respondent and operant behavior. Perhaps best known for his work with eliciting responding in dogs, Ivan Pavlov documented pairings between stimuli and involuntary respondent behaviors.
However, Skinner found that stimulus-response pairing was insufficient to explain human behavior. His pursuit of a different type of relationship between the environment and responding led to his theory on operant behavior, which emphasizes the connection between a behavior and its consequences.
The Journal of Behavior Analysis was first published in 1968, which was the first opportunity for scientists to publish applied work using methods from the experimental analysis of behavior. That same year, the seminal work entitled “Some Current Dimensions of Applied Behavior Analysis” by Baer, Wolf, and Risley became a guiding document for the practice of ABA.3
