What Actually IS ABA? 

Author: Erin Leif, BCBA-D

I often have people ask me, ‘What actually IS ABA?’ And sometimes, I find this a hard question to answer! While most likely best-known among the public as a therapy for children with autism and developmental disabilities, Applied Behaviour Analysis (ABA) has diverse far-reaching applications. It’s important to note that ABA isn’t a single type of intervention for a specific population (for example, autism). Rather, it’s a branch of science concerned with the application of basic principles of behaviour and learning to solve socially important problems and teach new skills.

Behaviour analysis is a natural science approach to understanding behaviour, learning, language and cognition. As a science, it’s conceptually similar to the disciplines of psychology, biology, chemistry and medical science. It’s comprised of four branches that together form the foundation for research and clinical practice. The first is radical behaviourism, or the philosophy of the science. This attempts to understand all human behaviour, including thoughts, feelings, emotions, cognition and complex language, in terms of person-centred historical variables (i.e., learning) and biological endowment. The second branch is the experimental analysis of behaviour, a natural science approach to the study of basic behavioural processes. The third branch is applied behaviour analysis, in which basic behavioural processes derived from the experimental analysis are applied to improve socially significant behaviour in real-world settings. The scientific method is used to show that behaviour change and learning is due to the careful and specific implementation of the intervention or teaching strategy, rather than an uncontrolled variable. The fourth branch, the professional practice of applied behaviour analysis, involves the delivery of applied behaviour analytic interventions in a range of real-world settings, such as classrooms, clinics, and homes.

I wanted to share some thoughts on what the professional practice of Applied Behaviour Analysis is (since that is what most of us do!), and how we might define it when talking to people who are unfamiliar with our field. I like to talk about ABA as a framework for delivering a variety of teaching and behaviour support strategies. The different strategies that are used within an ABA-based program have all been evaluated in published research and have an evidence-base. However, simply delivering an evidence-based intervention is not enough. Applied behaviour analysis practitioners must be well-versed in the process of evidence-based practice and must be able to draw on peer reviewed published research, their own clinical judgement and expertise, and the values, preferences, strengths, goals, and needs of the person they are supporting when designing a therapy program or intervention. When used in clinical and educational contexts, the ABA framework consists of several important components:

Applied Behaviour Analysis has broad and varied applications. For example, positive behaviour support (PBS) is an approach for supporting individuals with disability who display behaviour of concern that integrates the values of the disability community with the clinical framework of ABA. School-wide positive behaviour support (SW PBS) is a prevention-focused, tiered approach to supporting the social, emotional, and behavioural development of all students in school settings. Early behavioural intervention involves the delivery of comprehensive, evidence-informed early learning and skill building programs to young children with developmental delays and their families. Organisational behaviour management (OBM) uses the ABA framework to assess the effectiveness of various systems to improve employee job performance and create more effective work environments. What these applications have in common is that they use the framework described above to guide the development, delivery, and evaluation of strategies for helping people! 

In our recent survey of ABA practitioners in Australia, we identified the different types of teaching and behaviour support strategies used as part of ABA-based programs. In the graphics below, you can see that practitioners reported using a wide range of strategies, each of which is individualised to meet the needs of the person. 

In our upcoming blogs and practice briefs, we will share more information about what each of these strategies involves, and when they might be used as part of an ABA-based program. 

2021 Conference Announcement 

Let's Get Virtual!

After the postponement of our 2020 annual conference in Sydney due to the COVID-19 pandemic, ABA Australia had high hopes that we would hold our 2021 conference in Sydney as scheduled. About six months ago, the board of directors began discussing the reality of holding an in-person conference in 2021. To better understand our members' thoughts and preferences, we sent out a survey about the 2021 conference.

Members’ Survey

Out of the 84 respondents, most stated they had planned on attending the conference 2020. When asked how likely they would attend an in-person conference: 29.7% said unlikely, 27.4% were unsure, and 45.2% said likely to attend. When asked if the conference should be postponed again: 46.7% were unsure, 20.2% said yes, and 31.2% said no. When asked if the conference needed to be delayed again, what was the virtual format preference? There was a similar preference for either a virtual conference or webinar series. With this information and seeing what has unfolded with citywide and statewide lockdowns, it has become clear that holding a face-to-face conference in Sydney this July might not be possible. The COVID-19 virus is highly unpredictable and can get through some of the world’s strictest quarantine systems, meaning that we could potentially have to cancel the conference last minute due to government restrictions. As always, our top priority is making the annual conference a safe, productive, and enjoyable experience for everyone who attends. In these uncertain times, we have decided the best way to do that is to turn the annual conference into a virtual conference while keeping it in July. We have adjusted the dates a bit, as explained in more detail below.

Conference Program

We will have several prerecorded and some live presentations (available later on-demand) available across July 2021. We understand that the time spent online has increased over the past year and that ‘Zoom fatigue’ is real. We wanted you to be at your best when listening to our conference program, so we thought it best to let you choose when to watch the presentations.

But what about networking and real connections?

Networking is an essential part of a conference, one of the main reasons we love holding the conference. We are looking to host several small in-person networking events in each state and territory (yes, even you NT!). We will release more information about these events in the coming months. We wanted to provide a way for our members to connect with other local members or ABA nerds without crossing any borders. We are looking to hold these events in September - October 2021. As the requirements for live events change quickly, all we can say is that there will be presentations, roundtable discussions, and a poster session at each event.

What if you want to present?

We are securing several invited speakers worldwide (one of the benefits of a virtual conference). However, we still love to show off our local talent. Submission for presentations can be made on our website.

How much will this cost?

Virtual registration rates will be lower than for one of our in-person conferences. Check out our website for prices as they are based on your membership status. Ticket prices include access to all the recorded events and all BACB CEUs (Whoo Hoo!). There is an early bird discount if you purchase by 31/5. Tickets will go on sale 15/3/2021. We are also offering free tickets to people who live in low-income countries. One of our objectives is to disseminate this amazing science we love so much. As we are going virtual, this allows us to push our dissemination objectives beyond Australia's borders. More information about this is available on our website. Please spread the word about this opportunity!

Sponsors

We have sponsorship options available for our conference. Check out our website for options. Or contact us to discuss a customised sponsorship package.

What if I bought a ticket last year and kept it?

We'll be sending you an email shortly explaining your ticket options. More info here!

Tips for ABA Practitioners assisting in NDIS Tribunal applications

Matthew Cobb-Clark

In the 2018-2019 financial year, over 1,200 people commenced proceedings in the Administrative Appeal Tribunal (Tribunal)’s National Disability Insurance Scheme (NDIS) Division.With increasing demand for access to the NDIS, it seems likely that the number of applications will grow. ABA practitioners are finding themselves assisting their clients in preparing NDIS documentation, as well as Tribunal applications. The purpose of this article is to provide a brief overview of a recent Tribunal decision involving ABA, which gives practitioners a good outline of how the Tribunal approaches cases involving ABA. 

In July 2019 the Tribunal handed down its decisions in FRCT and NDIA and WKZQ and NDIA The cases concerned twin boys with ASD. The applicants each sought funding for:

• 20 hours of ABA therapy per week, comprised of 2 hours of 1:1 therapy with a senior therapist, 4 hours of 1:2 therapy with a junior therapist and 2 hours of social skills group;

• 2 hours per month for ABA clinical meetings;

• 2 hours per month for ABA supervisor sessions;

• 4 hours per week of speech therapy; and

• color="#000000">an annual full speech assessment and summary report.

color="#000000" face="Ubuntu">In contrast, the NDIA offered funding for:

• 110 hours per year of capacity building supports for early childhood intervention through a 'keyworker model'. The ‘keyworker model’ involved a speech pathologist “giving access to a range of therapists”. It is unclear how this was to work in practice, given the different skill sets of speech therapists as distinct from other types of therapists;

• A 6-month transition away from ABA therapy, in the form of gradually-reducing ABA therapy to be done at home; and

• 192 hours per year of a support worker "to support the applicant and the family to access the community and to implement therapeutic activities into the applicant's everyday life and routine".

Among other things, the NDIA relied upon a report of Professors Roberts and Williams from March 2016. That report summarised some of the literature on ABA, which notes that ABA may be effective for children with ASD, but it is not clear that it is effective for all children.  The report stated that early intervention should commence as soon as autism is diagnosed,and it should be for a minimum of 15-25 hours per week. Other than stating that interventions should be evidence-based, the report did not favour one type of intervention over another.

In a supplementary report prepared for the NDIA, Professors Roberts and Williams stated: 

“The recommendation for early intervention in autism…includes working with children in natural environments to maximise the functional development of skills and provide maximum opportunities to interact with peers and develop social communication skills. Different providers define ‘in clinic’ differently, but it is likely ‘in clinic’ is not a natural context and would therefore not be the optimal setting for much intervention, especially once key elements of a desired skill or behaviour are mastered in that setting”

The Tribunal had to consider the requirements of s 34 of the National Disability Insurance Scheme Act 2013 (NDIS Act)were met. In order for funding to be provided for any support, the NDIA (or the Tribunal) must be satisfied that:

1. the support will assist the participant to pursue the goals, objectives and aspirations included in the participant's statement of goals and aspirations;

2. the support will assist the participant to undertake activities, so as to facilitate the participant's social and economic participation;

3. the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support;

4. the support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice;

5. the funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide;

6. the support is most appropriately funded or provided through the NDIS, and is not more appropriately funded or provided through other general systems of service delivery or support services offered by a person, agency or body (e.g. the public health or education systems);

7. the support is not prescribed by the NDIS rules as a support that will not be funded or provided under the NDIS; and

8. the funding of the support complies with the methods or criteria (if any) prescribed by the NDIS rules for deciding the reasonable and necessary supports that will be funded under the NDIS.

The Tribunal found that both ABA and the NDIA's proposed keyworker model would assist the boys to pursue the goals, objectives and aspirations in their statements of goals and aspirations and therefore s 34(1)(a) was satisfied. In relation to s 34(1)(b) the Tribunal was satisfied that most of the ABA therapy would support the boys to facilitate their social and economic participation, as did the NDIA's proposed keyworker model. However, the Tribunal found that there was insufficient evidence to explain how the 2 hours of clinical meetings and 2 hours of supervisor sessions per month would assist the boys' social and economic participation.

Importantly, the Tribunal found that ABA and the keyworker model were not comparable models of support for the purposes of s 34(1)(c) of the NDIS Act. The NDIA's proposal to transition the boys away from ABA therapy over 6 months was not a genuine alternative to the 12 month program of intensive ABA and speech therapy proposed by the applicants. Additionally, the Tribunal was not satisfied that the NDIA's keyworker model would substantially improve the life stage outcomes for the boys, or be likely to reduce the cost of funding of supports for them in the long term. 

The Tribunal found that the evidence showed very clear and compelling reasons why the boys were participating in ABA therapy and speech therapy (in a clinical setting) at the current point in time. These included their challenging behaviour at home, the lack of ABA therapy providers where the boys lived, and their continuing participation in their community. The Tribunal left open the possibility that the boys may eventually be able to engage in appropriate behaviour in their home and preschool, and possibly be placed in a mainstream school. This would affect the amount of therapy that they would require in future years.

However, the Tribunal was not satisfied that the 2 hours per week of social skills group represented value for money.  The Tribunal was also not satisfied that the ABA clinical meetings and supervisor sessions also represented value for money. 

For completeness, the Tribunal considered whether the NDIA's proposed keyworker model represented value for money. The Tribunal identified a number of problems with the model. In particular, the model did not provide for ABA therapy, which was the therapy preferred by the boys' parents. The NDIA's desire to transfer the boys away from ABA therapy in direct contradiction to the parents' wishes was completely inconsistent with the objects and general principles of the NDIS Act, which reinforce the exercise of choice in the planning and delivery of supports, and acknowledge the role of families in this process. The proposal to decrease ABA therapy was counterintuitive to the evidence that showed the program was having a beneficial effect on the boys' skills development and their behaviour.

This decision is important for ABA practitioners involved in preparing NDIS applications, including Tribunal applications. I consider that it shows the following key points:

• Although practitioners are convinced of the therapeutic merits of ABA, anecdotally the NDIA is reluctant to support it. It is perceived as expensive and proprietary. Practitioners need to be able to demonstrate to the NDIA not just why ABA is good, but why it is better than the other evidence-based forms of treatment for autism. The ABA profession should look to support more empirical research that establishes this.

• The Tribunal emphasised the importance of parent choice in determining the type of therapy to be funded. That means that ABA practitioners need to not just convince the NDIA/Tribunal of ABA’s benefits; they need to be able to convince parents that it is the right choice as well.

• More needs to be done to establish the clinical benefits of group social skills programs – the Tribunal was unconvinced that these represented value for money.

• ABA practitioners may need to do more to make clear that ABA services can be provided in home as well as in a clinical setting. The NDIA's support for the keyworker model was based in part on research that suggests that therapy is more effective in natural settings, but ABA can of course take place in natural settings. 

• Obviously, each child with ASD is different and has different therapy needs. In preparing material for use by the NDIA/Tribunal, ABA practitioners should identify how the proposed therapy meets the criteria in s 34 of the NDIS Act for that particular child.

^[1] Administrative Appeals Tribunal, 2018-2019 at a Glance https://www.aat.gov.au/about-the-aat/corporate-information/annual-reports/2018-19-annual-report/2018-19-at-a-glance

^[2] [2019] AATA 1478 It is common for applicants in the NDIS Division of the Tribunal to be given four-letter pseudonyms.

^[3] [2019] AATA 1480

^[4] J Roberts and K Williams, Autism Spectrum Disorder: Evidence-Based/Evidence-Informed Good Practice for Supports provided to Preschool Children, their Families and Carers (March 2016), available here.

^[5] Roberts and Williams, p 27

^[6] Roberts and Williams, p 34

^[7] Roberts and Williams, p 10