Autism Treatment: Individualized Applied Behavior Analysis Therapy Supports Optimal Outcome
Behavioral Health Insights
By Micah Hoffman, MD, DABPN, FAPA, QME, CIME, CHCQM
AllMed Behavioral Health Medical Director
Autism spectrum disorder (ASD) affects an estimated 1 in 44 children in the United States today, and the diagnosis is on the rise.1 According to government data, the complex condition’s prevalence has increased 10 to 17 percent in recent years.2 As the term “spectrum” indicates, ASD encompasses a wide range of neurodevelopmental disorders that may impact daily functioning. People with autism are an extraordinarily diverse group with a broad range of interests, abilities, and experiences. Their strengths, challenges, and treatment needs can vary significantly based on the type and severity of their symptoms. While some may always require substantial support, others will eventually be able to live independently. Currently, no cure exists, and there is no one-size-fits-all treatment, but research shows that early intervention leads to positive outcomes later in life. Given the increasing frequency of the diagnosis, providers and payers alike are focused on building their awareness of the treatments and levels of care available in communities across the country.
Evidence-based, Best-Practice Treatment
For decades, applied behavior analysis (ABA) has been considered the gold standard for autism intervention. ABA uses a rewards-based motivation system to help people learn new skills and how to generalize those skills to multiple situations. With a substantial amount of research support, ABA is considered an evidence-based best practice treatment by the US Surgeon General and by the American Psychological Association.3
A personalized method, ABA applies what is known about how an individual behaves in real-life situations and adapts that information into techniques that change behaviors. The type and intensity of the intervention vary from case to case based on a complex assessment. This assessment considers many different factors, including the individual’s level of impairment, environment (e.g., does a child go back and forth between two parents’ houses?), and availability, along with whether help in school is permitted in the specific state. ABA-based programs are designed to be dynamic and flexible, changing to meet the goals and needs of the individual and caregivers. Programs are continually evaluated and adjusted when circumstances warrant.
Personalized Programs Target Specific Behaviors
In its focus on reinforcing positive behaviors and discouraging negative behaviors, ABA therapy follows the principles of operant conditioning developed by Dr. B.F. Skinner in the 1960s. The primary goal is to improve overall functioning by targeting social communication, restricted, repetitive behaviors, and maladaptive behaviors. Studies have shown that this type of early intervention can create substantial and sustained improvement in academic performance, adaptive behavior, IQ, language, and social behavior.4 Yet it’s important to keep in mind, given the wide variation in symptoms, that different levels of treatment may be appropriate for different individuals. While children and adolescents with behavior problems and skill deficits in multiple areas clearly are candidates for weekly ABA treatments, those with a relatively mild expression of ASD might be candidates for more time-limited or focused ABA treatments (e.g., 10 hours per week).5
Board-certified Behavior Analysts Design Customized Treatment
A qualified, trained, board-certified behavior analyst (BCBA®) designs and directly oversees an ABA therapy program, customizing it to the learner’s skills, needs, interests, preferences, and family situation. To become a BCBA, an individual must meet strict academic requirements, including earning a master’s degree or PhD in psychology or behavior analysis, and pass a national certification exam.
Practitioners start by doing a detailed assessment of the learner’s skills and preferences and the family’s circumstances and then writes a plan with specific treatment goals. The goals are based on the age and ability level of the person with ASD and may include skill areas such as communication and language, social skills, self-care (such as showering and toileting), play, motor skills, and learning and academic skills.
The plan breaks down each skill into small, concrete steps that a therapist (supervised by the BCBA) teaches one by one, advancing from simple to more complex. The BCBA and therapists measure progress by collecting data in each therapy session. This data helps them monitor progress toward goals on an ongoing basis and allows them to adjust as needed.
Carefully Applied Methods Can Help Individuals Reach Their Potential
Methods of behavior analysis have been used, studied, and refined since the 1960s. Over time ABA has shown a higher success rate than other types of ASD interventions.6 ABA programs that work with real-world situations and include caretaker training tend to be most successful, offering learners with ASD the greatest opportunity to reach their potential.7
At AllMed, our nationwide network of specialists is focused on supporting optimal outcomes for individuals with ASD. Drawing on their deep experience and expertise, AllMed board-certified psychiatrists and psychologists apply the most relevant clinical evidence and standards of care to help payers manage each complex ASD case with care.
- National Institute of Mental Health. Autism Spectrum Disorder. Accessed Jun. 20, 2022. https://www.nimh.nih.gov/health/statistics/autism-spectrum-disorder-asd.
- Cleveland Clinic. Autism Spectrum Disorder. Accessed Jun. 20, 20221. https://my.clevelandclinic.org/health/diseases/8855-autism
- Autism Speaks. What Is Autism? Accessed Jun. 20, 2022. https://www.autismspeaks.org/what-autism
- Cohen H, Amerine-Dickens M, Smith T. Early intensive behavioral treatment: replication of the UCLA model in a community setting. J Dev Behav Pediatr.2006; 27(2 suppl) S145–S155
- Myers, Scott M, Johnson, Chris Plauché. The Council on Children With Disabilities; Management of Children With Autism Spectrum Disorders. Pediatrics November 2007; 120 (5): 1162–1182. 10.1542/peds.2007-2362.
- Weitlauf AS, McPheeters ML, Peters B, et al. AHRQ Comparative Effectiveness Reviews. Therapies for Children With Autism Spectrum Disorder: Behavioral Interventions Update. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014.
- Anagnostou E, Zwaigenbaum L, Szatmari P, et al. Autism spectrum disorder: advances in evidence-based practice. CMAJ. 2014;186(7):509-519.