Wednesday, June 12, 2013

The Lovaas Legacy in Autism Treatment

The autism community continues to mourn the loss of pioneer Dr. Ivar Lovaas. Realizing that Skinner’s systematic approach using reinforcement could be instrumental in teaching functional skills to children with autism , Lovaas was one of the pioneers in the implementation of  Applied Behavior Analysis (ABA) principles and procedures in the treatment of autism, and in doing so helped thousands of children across the globe. The Lovaas Method of ABA starts with "discrete trials therapy” often referred to as DTT. A discrete trial consists of a therapist asking a child to perform a particular behavior. For example, “Timmy, name the animals in this picture.” If the child complies, he is given a "reinforcer" which is usually a desired prize or reward that is meaningful to the child in order to increase motivation, often times an area of deficit in children in the spectrum. The reinforcer could be a food treat, a high five, stickers in a chart towards earning play time, or anything else that has meaning for the child. If the child does not comply, he does not receive the reward, and the trial is repeated. Prompts are added as necessary to ensure the trial ends in success.  Since ABA is a data-based decision making process, data collection and analysis is warranted in order to continue a specific program or make changes.  

It's important to note that ABA interventions are single-subject designs: the specific content of the discrete trials therapy is based on an assessment of the individual child, his needs, and his abilities. So for example a child who is already capable of sorting shapes would not be asked to sort shapes indefinitely for rewards. Instead his therapy would focus on different, more complex functional skills.

As children master specific programs, therapists will start to take them out of the therapy or home setting and into more natural environments, where they can practice their learned skills in the real world. This is the meaning of “Applied” in Applied Behavior Analysis, which differentiates ABA from other therapies that are implemented only in a contrive setting where the therapist has full control over the variables in place. In simple words, we consider that a skill is mastered when the child is fluent in the real world. This often presents a challenge because the therapist does not have control over the environment when at the groceries store, a restaurant or a play-date at the park. However, research shows that this is the only way to achieve generalization of gains across settings and maintenance across time.   

Additionally, ABA therapists are required to keep detailed records on their outcomes. This means that ABA has been extensively researched and replicated. As such, ABA has a reputation for being the most scientifically researched form of successful therapy available for autistic children.                     

As I said in a previous blog (see “Common misconceptions about Applied Behavior Analysis) I fell in love with ABA when I learned all that. The more I learn, the more passionate I am. ABA gives me the answers I need to do my job effectively.  Everyone who jumps on the ABA bandwagon gets hooked. Have you ever thought about why?


Daniel Adatto, BCBA


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