In the field of autism and ‘special needs’ children, therapies derived from Applied Behaviour Analysis (ABA) have major advantages over other treatment methods. ABA’s main strengths include:
a) clearly measurable outcomes
b) the ability to be closely tailored to the needs of the individual
c) strong foundations in the basic science of how humans learn from and interact with their world.
As mentioned in Chapter 17, ABA programmes basically treat autism as a skills deficit. The autistic child typically has major deficits in most or all of the following areas: thinking skills, language/communication skills, play skills, social skills and attention skills. The therapists help the child to develop these skills by breaking them down into tiny simple steps, and practising them over and over, with massive amounts of encouragement and reward. The best researched and most widely disseminated ABA programme is the ‘Lovaas Program’. About 90 per cent of autistic children make significant improvements with this programme. Better still, 50 per cent of these children improve so much they reach normal intellectual and educational functioning, with an average or above-average IQ, and are indistinguishable from their peers to an outside observer.
Not surprisingly then, ABA is considered best practice by those professionals who are committed to using evidence-based approaches. Indeed, in 2010, the American Academy of Pediatrics proclaimed ABA as the only treatment for autism with strong evidence to support its effectiveness. It is very sad that most governments in the world today do not realise the enormous benefits to their country that would come from publicly funding ABA programmes. The one exception I know of is Canada. The Canadian government funds ABA for all autistic children up to age seven; on average, it costs the government half a million dollars per child, but it saves them about four million dollars in long-term health costs. You don’t need to be a mathematical genius to see the implications of these figures.
However, ABA is not without its opponents and critics. Sadly, most of these people base their criticisms on what ABA used to be like forty years ago. I personally find this bizarre; imagine criticising the treatment of a modern-day doctor based on what her predecessors did forty years ago! The opponents of ABA seem to be unaware that the programmes have changed enormously over the decades, and they no longer resemble the programmes of yesteryear. In particular, they no longer include any use of ‘aversives’ (unpleasant stimuli to reduce unwanted behaviour) and the skills training is now often carried out in a naturalistic manner across many different environments (as opposed to keeping the child ‘glued’ to the table top).
Nonetheless, some criticisms of ABA are fair; the undeniable truth is, despite its effectiveness, ABA has had its drawbacks. Until very recently, practitioners were unable to write programmes based on ABA principles that could effectively target theory of mind, inferential thought, perspective-taking, emotional aware ness, compassion and empathy; nor could they generate the extraordinary speed of language learning we see in normal children. All this has now changed with the development of RFT (Relational Frame Theory). RFT is a revolutionary theory of language and cognition, which is too complex to explain quickly and simply in an appendix. However, in the last twenty years, more than 180 articles on RFT have been published in top scientific journals: an impressive body of scientific evidence by any standard.
RFT adds a new level of analysis that now allows ABA practitioners to write programmes that effectively target the issues mentioned above, while also maintaining ABA’s scientific rigour, solid evidence base, and measurable evidence of out -comes. As a result of RFT analysis, we can now see deeper into a child’s developmental needs and design interventions that are faster, more efficient and have much greater impact. More importantly, RFT and the ‘third wave’ behavioural interventions (such as ACT) have articulated what the requirements of normal develop ment are: the capacity and skills to be flexible, experi -entially aware, and empowered to move in valued direction.
Any ABA therapist wishing to learn about RFT and its applications to autism would do well to start with the introductory textbook Learning RFT: An Introduction to Relational Frame Theory and Its Clinical Application by Niklas Törneke. Then, once the basics of RFT are understood, you could move on to Derived Relational Responding Applications for Learners with Autism and Other Developmental Disabilities by Ruth Anne Rehfeldt and Yvonne Barnes-Holmes.
Psychologist Darin Cairns is arguably the world’s leading expert on the use of RFT with autism; he can be contacted at: darincairns@gmail.com.