Changes to ABA recommendations in the NZ ASD Guideline

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Image by J_O_I_D via Flickr

This post summarises changes to the recommendations about ABA (applied behaviour analysis), for the NZ ASD Guideline book published by the New Zealand government. (To see an introduction to the book itself, please refer to my previous post.)

These recommendations appear in a paper published in May 2010 (yes I’m a bit late coming to it, but it was the first I’d heard of the paper, so I thought it worth sharing in the likelihood other parents were unaware too.) They are updates to the existing recommendations in the book, which was published in 2008.

The NZ ASD Guideline defines ABA in the following way: “the process of systematically applying interventions based on the principles of learning theory to improve socially significant behaviours to a meaningful degree and to demonstrate that the interventions employed are responsible for the improvement in behaviour”.

In practice, ABA “refers to a collection of methods and techniques designed to increase positive behaviours and decrease negative ones.” Examples of such methods and techniques include reinforcements, establishing stimulus control, and fading prompts. Decreasing negative behaviours requires consideration of the function of the behaviour at issue. Careful considerations are also required around increasing “positive” behaviours, including “the social validity or importance for the individual’s development, its acceptability to the individual and his or her social network (e.g., family, culture).”

Behaviour changes are ideally maintained and generalised beyond the training situation, and behaviour changes must be monitored.

The paper then clarifies that “[i]t has become quite common for highly structured, intensive early invention programmes to be called “ABA” however this is not correct, since ABA refers to a wide variety of techniques and principles.” Then goes on to define what is meant by “early intensive behavioural intervention” (EIBI).

EIBI is not simply the “Lovaas Method”. It has a variety of features, which are listed on page 5 of the paper (it’s a long and detailed list, do click-through if you’d like all the details.) Those features include that the programme is intensive, year-round, and at least 20 hours a week, usually running for two or more years, and usually starting around the age of two or three years-old.

The paper notes that if you do not see progress by the three month mark, then the system used should be modified. They also note that physically aversive procedures should not be used as part of the programme.

One of the new recommendations made is: “Interventions and strategies based on applied behaviour analysis (ABA) principles should be considered for all children with ASD.” They point out that there is a lack of knowledge though about the suitability of ABA for those with Aspergers, and for people over the age of 15.

There is also a new recommendation about EIBI: “Early intensive behavioural intervention (EIBI) should be considered as a treatment of value for young children with ASD to improve outcomes such as cognitive ability, language skills, and adaptive behaviour.” They again though point out a lack of knowledge about its usefulness for Aspergers, and for diverse cultures. There is also uncertainty about the “optimal intensity of hours” and whom it benefits.

The paper also introduces some new “Good Practice Points”: That cultural awareness is important when using ABA, and that ABA interventions can be used before a confirmed diagnosis; there is no reason to delay access to effective treatment: “Services should not wait for the diagnostic process to be completed but should be available as soon as a significant developmental need is identified.”

That is simply my summary of what I take as the key important points from the paper. Again, I encourage you to click-through to the paper itself if you’d like more detail. (You can also access the 2008 NZ ASD Guideline book online.)

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8 Responses to Changes to ABA recommendations in the NZ ASD Guideline

  1. Jack (Wife of Jack) says:

    20 hours per week of intensive early intervention therapy? What a joke! It’s ridiculous that the Government guidelines recommend a course of therapy that they can’t possibly deliver. Why raise parents hopes like this? Most parents can’t afford the private hours of therapy they really do need for their children. The government provided services are a tiny fraction of what they are suggesting as best practice. Does anyone not notice the gaping gap in hours or is it just the elephant in the room that no one wants to talk about? Private and funded therapies for our child stretch to about 4 hours per week if you count private speech therapy, swimming and Gymbaroo. Funded….. 2.5 hours. And of course there are huge gaps when the school holidays role around.

    Perhaps the uncertainty expressed about the “optimal intensity of hours” is the government’s escape clause?

    Fortunately for us our son is enrolled in a quality program so the benefits have been very apparent from the very beginning. Other parents I have spoken to have not been so fortunate. We are lucky we can afford some to the extras that contribute to his ongoing progress.

    • Hi Wife of Jack,

      I understand your upset and frustration.

      For what it’s worth (and I’m not saying it’s worth a lot), I understand the recommendation to be in support of those parents and professionals who have chosen or are contemplating taking part in that type of therapy – a reassurance that such a decision is well-grounded and not harmful – rather than the view that it is a necessity for the advancement of our children. I harboured many doubts that the intensive therapies I’d heard about were really in the child’s best interests; for people like me this reduces some of those concerns and doubt. It also perhaps opens the door for future government funding and research into the utilization of such potential services, which is a good thing.

  2. Nidreya says:

    Even if the parents put in half the hours, and we assume (perhaps wrongly) that adults need less ‘assistance’, we would still need something in the region of 1 in 10 people helping for 1 to 2 hours each per week.

    That’s assuming you have 1-on-1 attention. 1-on-many attention has a fatal flaw: It gives an artificial situation where more than 1 in 110 (or whatever) is autistic so it doesn’t count as true social experience.

    Sorry I should have qualified my position: total inclusion with support in real classrooms and in real life social situations.

    Give it another 50 years and we will know what we are doing 😉

  3. Sharon says:

    Harri does 8 hours a week (2 a day) at one centre, and one 2 hour session at home. Thats 10 a week and we have seen great progress. Perhaps the focus should not be on hours but on quality and individual need. I’m really puzzled about the Aspergers references. Why would there be no benefit for them? Whilst their speech may be better than most on the spectrum, their use of language can be problemmatic, social skills can be lacking, restricted and repetitive interests can be prevalent, as is anxiety and also often sensory issues. All these issues can be assisted by ABA intervention. Can’t they?

    • Hi Sharon,

      We saw significant benefits from our son only attending a couple of hours a week of ABA; it taught us the skills to use the same methods at home, which is always a major piece of the puzzle: No sense introducing changes in behaviour if they are contradicted or not reinforced in the home situation. I think that is part of why they separated out ABA from the question of EIBI; you can have ABA without it having to be done professionally 20 hours a week, and still see great results.

      The Aspergers reference wasn’t that there was no benefit per se, just that there was a “lack of knowledge” about the benefits. I’m assuming that’s because the research and experience with these therapies is classically focused on the more extreme cases of autism; specifically those where verbal instruction is potentially meaningless, so more intensive behavioural modification is required to teach the kids (and the parents are willing to pay for it’s ridiculous costs considering how difficult their lives can be with these kids). Just a thought anyway; the important bit there is the difference between “no benefit” and “lack of knowledge”.

  4. nostromoswife says:

    ABA therapy has been truly invaluable to our family, it provides a scientific method by which skills can be taught to our son and challenging behaviours can be reduced. The most important skill he has learnt would be to communicate using pictures. As he is non-verbal, this is his only method of communication and having this ability has hugely reduced tantrums and meltdowns. We have 2 sometimes 3 therapists who come to our home and work with James for 2 – 3 hours daily. This also gives us well needed respite as well as the knowledge that we are not solely responsible for his progress – his therapists are able to implement suggestions from other professionals.

  5. Alexandra says:

    Beware of political bullshit.
    In Ontario, Canada, the government made the same distinction between EIBI and ABA so that they could avoid funding therapists in schools. The position of the school boards/government is that anyone can do ABA because, unlike EIBI, it is not “therapy.” The result is a lot of unqualified education assistants and teachers who are doing more harm than good and the general public and many parents are fooled into thinking that their children are getting the help that they need in classrooms. There is NO DISTINCTION between ABA and EIBI, this is purely semantics. The Lovaas study and its replicants all involved a minimum of twenty hours per week by fully trained therapists. Children with autism deserve no less.

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