Compliment KKH clinical trial for the treatment of Autism through autologous umbilical cord blood (using a child’s own cord blood) reinfusion.
Autism Treatment in Singapore with
Applied Behaviour Analysis (ABA)
What is Applied Behavior Analysis (ABA)?
ABA is probably the best-known, best-researched validated, and the only treatment for children with autism that has produced significant and comprehensive improvements, up to and including recovery.
ABA is a specialised Psychology field. The objective of Applied Behavior Analysis (ABA) is to apply specific psychological principles (e.g., reinforcement, prompting, generalisation, etc.) to issues that are socially important (like autism) to produce meaningful change (Baer, Wolf, & Risley, 1968/1987).
“ABA involves the breakdown of all skills into small, discrete tasks, taught in a highly structured and hierarchical manner. Central to the successful application of this method is the art of differential reinforcement. That is, the therapist or parent learns how to systematically reward or reinforce desired behaviours, and ignore, redirect, or discourage inappropriate behaviours. Also central to any well-run behavioural program is the therapist’s close monitoring of what is working and what is not working. Data on all the child’s learning are recorded regularly and the therapist adjusts the teaching programs and protocol with respect to what the data indicate about the child’s progress.” (Maurice, Green, and Luce, 1996)
In an ABA program, lessons to be taught are broken down into their simplest elements. ABA focuses on teaching small, measurable units of behaviour systematically. At first, the child may be rewarded for doing something close to the desired response. Over time, as the child masters the lesson, expectations are raised and primary reinforcers (like bits of food) are replaced with social reinforcers (hugs, praise, etc.). As the child masters the skill and generalises it, it becomes self-reinforcing. ABA focuses on increasing appropriate behaviours and celebrating successes and minimizing attention and energy wasted on inappropriate behaviours. Creating a positive and fun learning environment facilitates the learning process in all domains including social, play, and language. In this way simple responses are built systematically into complex and fluid combinations of typical, age-appropriate responses.
Why use ABA?
The following paragraphs are abstracts from chapter 3 of the Maurice, Green, and Luce book “Behavioural Interventions for Young Children with Autism, 1996.”
Historically most people with autism have required extensive treatment and supports throughout their lives (Rapin, 1991; Remlin, 1994; Rutter, 1970; Rutter and Schopler, 1987; Szatmari et al., 1989). Today the mainstream position is that autism is a “severely incapacitating lifelong developmental disability.” It is considered treatable; indeed, a wide variety of treatments, therapies, and techniques are claimed to help (or even cure) people with autism and new ones are invented regularly (Autism Society of America, 1995).
Until recently, however, none of those treatments has offered any solid, realistic basis for changing the view that autism is a permanent disability. Several studies have now shown that one treatment approach – early, intensive instruction using the methods of Applied Behaviour Analysis – can result in dramatic improvements for children with autism: successful integration in regular schools for many, completely normal functioning for some (Anderson, Avery, DiPietro, Edwards, and Christian, 1987; Birnbrauer and Leach, 1993; Fenske, Zalenski, Krantz, McClannahan, 1985; Harris, Handleman, Gordon, Kristoff, and Fuentes, 1991; Lovaas, 1987; Maurice, 1993; McEachin, Smith, and Lovaas, 1993; Perry, Cohen, and DeCarlo, 1995). In fact, there is abundance scientific evidence that applied behaviour analysis methods can produce comprehensive and lasting improvements in many important skill areas for most people with autism, regardless of their age. No other treatment for autism offers comparable evidence of effectiveness (Lovaas and Smith, 1989; Schreibman, 1988; Shreibman, Charlop and Milstein, 1993; Smith, 1993).
There is little doubt that early intervention based on the principles and practices of applied behaviour analysis can produce large, comprehensive, lasting and meaningful improvements in many important domains for a large proportion of children with autism. For some, those improvements can amount to achievement of completely normal intellectual, social, academic, communicative, and adaptive functioning.
In fact, a large majority of young children with autism benefit from early behavioural intervention. Most show substantial improvements in many adaptive, useful skill areas and reduction in problematic behaviours. Only a small portion (about 10% of those studied so far) have been found to make few or no improvements despite intensive efforts (e.g. Anderson, et al., 1987; Birnbrauer and Leach, 1993; Lovaas, 1987; McEachin et al., 1993).
There is strong evidence that behavioural intervention is more effective for young children with autism than no intervention, and more effective than typical early education services and assorted other therapies.
How does ABA work?
Maurice (1996) describes ABA as the breakdown of all skills into small, discrete tasks. These tasks are then taught in a highly structured and hierarchical way. As indicated by Maurice (1996) success is heavily reliant on the application of differential reinforcement.
Through the use of differential reinforcement the therapist, parent, or caregiver learns how to consistently reward or reinforce desired behaviours, and ignore, redirect, or discourage those behaviours, which are inappropriate.
ABA programs are modified to suit the individual child. Once the core principles of ABA are learned, they can be applied to all areas of the child’s development, including behaviour management, communication, social interaction, intellectual growth, among other skills.
Is ABA effective?
Perhaps the most often asked question about ABA is “does it work?” Numerous studies in professional journals document that early intensive behavioural intervention can result in unprecedented outcomes for young children with autism spectrum disorders (Maurice et. al. 1996).
The ground breaking 1987 Lovaas study showed that 47% of children who received early intensive behavioural intervention attained normal cognitive and intellectual functioning and were able to complete first grade with typical peers and without special education supports. These children achieved normal intellectual and educational functioning and could not be distinguished from their peers. A follow up study on the children who comprised the 47% revealed that they maintained their gains into adulthood and were indistinguishable from their peers.
In addition, research conducted by the Wisconsin Early Autism Project confirmed that more than one in three children who participated in an extensive home-based ABA program attained the IQ and social functioning of their typical peers. In all, the children in the ABA group averaged a 22-point gain in IQ points in the first year. In contrast, children in typical special education classes showed a 7-point loss in IQ points in the first year (Sallows and Graupner, 1999).
The Surgeon General’s report on mental health stated “Thirty years of research demonstrated the efficacy of ABA in reducing inappropriate behaviour and in increasing communication, learning, and appropriate social behaviour.
While it may be true that the best time to start treatment is at a very young age, most older children also can benefits from intensive behavioural intervention (Leaf and McEachin, 1999).
It should be noted, however, that intensive behavioural intervention is by no means a “cure” for autism. No amount of behavioural therapy can cure the underlying and so far unknown aetiology of autism. Intensive behavioural intervention is effective in re-mediating many symptoms of autism thereby recovering children in that their behaviour may become “indistinguishable from their peers.”