Decades of research suggests ABA to be the most effective treatment for children and adolescents with autism and other developmental disabilities, producing meaningful and significant changes in language, cognition, play, social, daily living skills, and challenging behaviours. For a certain percentage of children, ABA is helpful, but it’s best if other approaches are bolted on. There’s no one-size-fits-all because every child is different.

Early intensive ABA, also called comprehensive ABA treatment, typically consists of 25 to 30 hours per week of one-to-one ABA therapy for children under age three and 30 to 40 hours per week of one-to-one ABA therapy for children age three or older. This comprehensive treatment is designed to teach skills across all developmental domains with the primary goal of closing the gap between our kids’ skill levels and the skill levels of their typically developing peers. For children under the age of five, an intensive ABA program often begins in the home or clinic setting and slowly transitions into a preschool or other group setting as our kids develop skills.

Focused ABA is a non-intensive treatment for children and adolescents of all ages, typically provided for 15 hours or less per week. The goal of focused ABA is to reduce a limited number of challenging behaviors and to teach appropriate communication, social, and/or self-help skills to replace those challenging behaviours.

First developed in California in the 1960s, ABA uses a system of rewards to change children’s behaviour and teach them new skills. It has always been controversial – psychologist Ole Ivar Lovaas, who pioneered the use of ABA on children with autism, used “aversives”, such as striking children or giving them a mild electric shock, when they did not comply. These punishments have long been abandoned, but critics still warn the method is overly demanding – some programmes involve 40 hours a week of contact time – and have likened the approach to “dog training”.

However, ABA has seen a huge rise in popularity and is now widely used in the US as an approach for autism. Online, there is an abundance of ABA success stories, with consultants describing it as a highly effective way to “normalise” children with autism and help them communicate and function in the world.

ABA can be used for anything from improving behaviour to teaching curriculum subjects. The key tactic is to engage the child using individual rewards or “reinforcers”.

A type of ABA known as verbal behaviour or VB, each child is “paired” with an assistant who carries a bag of “rewards” – toys or props the child enjoys using. Whenever they perform a task correctly, or behave as they are being taught to, they get a few minutes with their reward. In one of the older year groups, a teenage boy is treated to five minutes on the Nintendo DS, while another runs a wooden toy up and down his arm. In the nursery, a teaching assistant simply blows bubbles around the room as a reward for her pupil correctly saying his numbers.

It is not all plain sailing either as described here.

Although no one uses the word “punishment”, there are “consequences” for bad behaviour. These could be the denial of access to a reward or an activity a child does not enjoy. In X’s case, to tackle their issues with eating, the teaching assistant would give then a tiny spoonful of regular food, and if they ate it they would immediately get a spoonful of the baby food they liked, as a reward. Slowly, they stopped gagging so much, but their mother admits she came close to stopping the programme.

“I found it upsetting to see them crying and being sick,” she says. “And if they were sick, they weren’t allowed to have their custard afterwards. I found it very harsh and questioned whether it was going to work.” But she persisted. “Something told me to keep going with it, and after about six months they were starting to eat.”

In any argument over ABA, the names Pavlov and Skinner inevitably come up. What Pavlov and Skinner did was operant conditioning, or, the manipulation of behavior by punishment and/or reward. They both demonstrated that an organism can be trained to display a desired behavior as the result of a carefully applied stimulus: an electric shock, a tone, or a food reward. Some of the methods they used are viewed with disgust and horror today, and, in many cases, rightfully so. But what Pavlov and Skinner did was not ABA. They were doing psychological research that was not, nor was ever intended to be, therapeutic. While it is true that many concepts of ABA can be traced back to operant conditioning, to say that the ABA and operant conditioning are the same thing is misinformed at best and out right dishonest at worst.

Vitamin therapy, gluten- and casein-free diets, anti-fungal treatment, auditory integration training, sensory integration, and many other interventions are also proven as effective Alternative Therapies, therefore have a search around before committing to ABA; as stated at the beginning “For a certain percentage of children, ABA is helpful, but it’s best if other approaches are bolted on. There’s no one-size-fits-all because every child is different.”