Comprehensive ABA Therapy

Comprehensive ABA therapy differs from Focused ABA Therapy. Comprehensive treatment is designed for children ages 2-18 diagnosed with autism spectrum disorder and other related developmental delays. 

Comprehensive ABA refers to treatment of the multiple affected developmental domains, such as cognitive, communicative, social, emotional, and adaptive functioning. Maladaptive behaviors, such as noncompliance, tantrums, and stereotypy are also typically the focus of treatment. At Cayman ABA, we offer intensive early intensive behavioral intervention where the overarching goal is to close the gap between the client’s level of functioning and that of typically developing peers.

These programs tend to range from 15-40 hours of treatment per week (plus direct and indirect supervision and caregiver training). Initially, this treatment model involves 1:1 staffing and gradually includes small-group formats as appropriate. Comprehensive treatment may also be appropriate for older individuals diagnosed with ASD, particularly if they engage in severe or dangerous behaviors across environments.

Initially, treatment is typically provided in structured therapy sessions, which are integrated with more naturalistic methods as appropriate. As the client progresses and meets established criteria for participation in larger or different settings, treatment in those settings and in the larger community should be provided. Training family members and other caregivers to manage problem behavior and to interact with the individual with ASD in a therapeutic manner is a critical component of this treatment model.

Our Applied Behavior Analytic (ABA) programs are individually developed by our Board Certified Behavior Analysts (BCBA), after a thorough and personalised assessment process that focuses on your child's unique skills and abilities. Intensive Behavioral Intervention has been supported by over 50 years of scientific research, showing its efficacy in improving . Intensive intervention (20+ hours per week) is associated with higher gains in cognitive and adaptive skill development, and is the most widely-supported evidence-based intervention for children with ASD. Extensive research has shown empirically that children who receive early and intensive intervention using Applied Behavior Analysis (ABA) can make significant gains in language, cognitive abilities, adaptive behavior, and social skills, and reducing anxiety and aggression (Dawson 2011). Intensive intervention has also been shown to provide long-term lasting outcomes for children in adaptive skill acquisition (McEachin et al 1993) and children receiving intensive early intervention show significantly higher IQ and adaptive behavior scores than control groups (Cohen 2006).

Our ABA program provides one-on-one therapy programs for children with special learning needs, which take place in the clinic, school or home setting, depending on the individual needs of the family or child.   

Early Intensive Behavioural Intervention (EIBI)

Early Start Denver Model (ESDM)

“At the heart of the ESDM is the empirical knowledge-base of infant-toddler learning and development and the effects of early autism.  ESDM intervention is provided in the home by trained therapists and parents during natural play and daily routines.  ESDM is a relationship-based intervention, and involves the parents and families; An Early Start for your Child with Autism, is a parent's guide to using everyday activities to help kids connect, communicate, and learn. The aim of ESDM is to increase the rates of development in all domains for children with ASD as it simultaneously aims to decrease the symptoms of autism. 

In particular this intervention focuses on boosting children’s social-emotional, cognitive, and language abilities, as development in these domains is particularly affected by autism.  ESDM also uses a data-based approach and empirically supported teaching practices that have been found effective from research in applied behavior analysis. ESDM fuses a behavioral, relationship-based approach with a more developmental, play-based one in order to create an integrated whole that is both individualized and standardized.” (source)

At Cayman ABA, our Case Manager is trained at the Advanced level, and our clinicians are trained at the Introductory level. There is no requirement for certification in ESDM to practice, but it is an approach that focuses on using ABA strategies to work with children ages 12-48 months. Intervention targets:

ESDM’s evidence base is growing, and Cayman ABA offers ESDM in line with our Evidence-Based Practice Policy.

• Research compilation

• Evidence for the Implementation of the Early Start Denver Model for Young Children With Autism Spectrum Disorder

• An Evaluation of the Research Evidence on the Early Start Denver Model

• Outcome for Children Receiving the Early Start Denver Model Before and After 48 MonthsOutcome for Children Receiving the Early Start Denver Model Before and After 48 Months

• A Systematic Review of Early Intensive Intervention for Autism Spectrum Disorders

WHAT IS ABA?

Chances are that if you have a child with Autism you have come across the term Applied Behavior Analysis, often loosely referred to as “ABA.”

ABA is a behavioral therapy approach that focuses on what your child does rather than what they should be doing. During an assessment and observation, a Board Certified Behavior Analyst uses this information to identify the relationships between their behavior and different aspects of the environment.

Every treatment plan is going to differ since there are many variables that come into play when teaching a child with Autism.  Most importantly, no two people are alike. The goal for ABA therapy is to promote positive behavior change, and developmental skill acquisition.

Applied Behavior Analysis is the science of changing socially significant behavior.  It is not a particular type of therapy, but an approach to teaching methods that are based on the scientific understanding of how people learn. 

ABA's origins are rooted in the study of behaviorism, which developed in the early 19th century. A scientist named B.F. Skinner pioneered behaviorist theories, making the observation that everything humans do, including eating, sleeping, breathing, etc., are behaviors.  Skinner took a bold step outside of the psychological approaches of his day, and instead began looking at behavior through objective observation. 

This framework allowed scientists to measure and quantify behavior (defined as anything an organism does), and to study how to effect reliable changes on behavior.

Now, to be clear, Skinner was an experimental scientist, testing theories of learning in the lab. He coined the term "operant conditioning," while working in the lab.  But he wasn't yet sure about how his discoveries might apply to humans.  While Skinner was working on understanding how behaviors are established in the lab, the field of Applied Behavior Analysis was beginning to expand to applications outside of the lab.

“A failure is not always a mistake, it may simply be the best one can do under the circumstances. The real mistake is to stop trying.

— B.F. Skinner

It wasn't until 1987, when Dr. Ivar Lovass and his team published a groundbreaking study on his work with children with Autism, that the field we currently know as ABA began to emerge.  At the time, Autism was considered an unchangeable condition, which required institutionalization in most cases.  It was not considered possible for children with autism to make significant gains in their lives.

Lovaas’ study included 59 children ages 3 and under, and compared three groups of subjects: participants in high quality intensive ABA Therapy, participants in high quality less intensive ABA Therapy, and typical special education services but no ABA Therapy. The results of the study were astonishing: nearly half of the children in the first group (receiving high quality intensive ABA Therapy) were indistinguishable from same age peers when they were re-evaluated post intervention, and in follow up studies this group of children maintained these gains well into adolescence.   

Replication studies since then repeated these results over, and over….and over again. Additionally, advancements in technology and further scientific discoveries have fine-tuned ABA into a highly sophisticated tool for effective and long-lasting behavior change.

The official definition of ABA is that applied behavior analysis is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior (Baer, Wolf & Risley, 1968; Sulzer-Azaroff & Mayer, 1991).

Today, ABA appears in a variety of different fields:

• environment and sustainability

• organizational behavior management (OBM)

• higher education / teaching behavior analysis

• behavioral medicine and health

• economics and consumer habits

ABA, when it applies to teaching children with autism and other pervasive developmental delays, incorporates a variety of teaching techniques to increase skill sets and decrease maladaptive behaviors.  Some of these techniques include incidental teaching, natural environment teaching, discrete trial training, and pivotal response teaching, to create an enriching and fun learning environment for children.

Applied behavior analysis is the broad, scientific application of the principles of learning in a variety of applications and environments. It has a long-standing history of being applied to educational programs (Greer 1997, Handleman and Harris 2000, Heward 2005, Cooper 2009).

“The way positive reinforcement is carried out is more important than the amount.

— B.F. Skinner

The seven dimensions of Applied Behavior Analysis differentiates ABA from other methodologies:

1. Applied — This refers to the types of problems targeted for intervention. To qualify as "applied," we must deal with problems of demonstrated social importance.

2. Behavioral — Applied interventions deal with measurable behavior (or reports if they can be validated).

3. Analytic — We don’t just look at behavior, we analyze behavior and must be able to provide an objective demonstration that the procedures caused the effect. This means we must convincingly demonstrate the controlling variables of which behavior is a function. We achieve the latter through our unique time-series research designs (e.g., multiple baseline, reversal, alternating treatments design, etc…).

4. Technological — Technological refers to techniques. We must make sure our techniques, or procedures, are sufficiently described well enough that they can be implemented by anyone with training and resources.

5. Conceptual Systems — Interventions are based on scientific literature, rather than a set of tricks, so to speak.

6. Effective — Applied interventions must produce pragmatic behavior change. However, ABA has the additional requirement that the change be sufficiently large as to produce socially significant results for the individuals impacted by the intervention.

7. Generality — What good is an intervention for a science of behavior if it only works one time with one individual and never again? Generality means that the skills/behaviors acquired will occur in environments other than where they were discretely taught.

ABA is not one-size-fits-all…

Each child's program is developed individually, and based on multiple assessments that identify their unique strengths and weaknesses, as well as their particular preferences, needs, and environment.

WHAT DOES THE RESEARCH SAY ABOUT ABA?

ABA Therapy is one of the most extensively researched and supported interventions for individuals with autism spectrum disorder. Explore some of the research below:

• Association for Science in Autism Treatment

• National Standards Project

• Multiple scholarly sources

• Evidence for the Effectiveness of ABA as a Treatment for Autism

• Kennedy Krieger Institute

““Because ABA currently has substantially more scientific support than any other behavioral or educational intervention for children with ASD, ASAT recommends that families and professionals strongly consider implementing ABA and be cautious about other approaches. ASAT further recommends that professionals describe other behavioral and educational interventions as untested and encourage families who are considering these interventions to evaluate them carefully.

— the Association for Science in Autism (ASAT)

““Intensive behavioral intervention (IBI) is the only empirically validated treatment for ASD. Based on the principles of applied behavior analysis (ABA), IBI is conducted at a high intensity, typically between 30 and 40 hours per week, for multiple years. Evidence suggests that greater treatment intensity leads to superior outcomes. Evidence also indicates that IBI is more effective if initiated in early development; however, services initiated at any age are beneficial for the acquisition of valuable skills.Studies have shown that ABA is effective in teaching new skills and reducing problem behavior (Goldstein, 2002; Odom et al., 2003; McConnell, 2002; Horner et al., 2002). Other studies have found that intensive ABA implemented more than 20 hours per week and begun early in life, prior to the age of 4, produces large gains in development and reduces the need for special services (Smith, 1999).

— Center for Autism and Related Disorders

““Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning and appropriate social behavior.

— United States Surgeon General