ABA Intervention in Family Routines

Simple Ways to Use ABA Intervention in Family Routines

By Meme Hieneman, PhD, BCBA

Applied behavior analysis (ABA) interventions have been proven to be extremely effective for children with autism spectrum disorder (ASD), increasing their skills and reducing problem behavior (National Autism Center, 2015). There are a variety of ways ABA can be provided, but the way it is often delivered, through intensive 1:1 therapy, has come to be viewed as the primary, if not only, option. This article will describe how ABA can be used within typical family routines to improve quality of life for children and families.

Issues with Delivering Intervention

Intensive 1:1 ABA therapy has the advantage of changing behavior quickly under controlled situations. It can, however, have drawbacks for some children and families. First, the skills developed can sometime seem rote or not fir the circumstances. For example, a child may learn specific words or problem-solving strategies that other children do not typically use, setting him/her apart from same-aged peers. Second, some children resist participating in repeated learning trials, resulting in an increase in their problem behaviors. Third, the impact of 1:1 therapy many not "generalize" across time, people, and/or circumstances. A child may

perform well for his/her therapist only. Finally, when poorly planned, ABA therapy can interfere with valued family routines. Parents may find themselves rearranging daily activities to accommodate professional schedules. For these reasons, ABA therapy can increase stress rather than make family lives better. 

It is important that parents understand that ABA strategies can be embedded in typical family routines. This approach can improve day-to-day interactions and activities, thereby improving family quality of life. Current early intervention and family support programs emphasize aligning goals with family values and needs, empowering parents and other caregivers, and focusing on strategies that can be easily maintained in natural settings (Division for Early Childhood, 2017). Recent research in routine-based ABA, also known as "positive behavior support" (Bailey & Blair, 2015; Fettig & Barton, 2013; Lucyshyn at al., 2015; Sears, Blair, Lovannone, & Crosland, 2013), suggests it offers a great alternative or supplement to direct intensive treatment. 

Process of Routine-Based Intervention

The following sections of this article will describe how ABA can be used within family routines, providing an example during sibling play. The process includes identifying goals, assessing patterns, designing strategies, using the plan, and monitoring outcomes. 

Identifying Goals

The ABA process begins with identifying child and family goals, considering ways in which the child's quality of life needs to enhanced, and focusing on the routines the family most wants to improve. A family might choose getting ready for the day, hygiene, meals, playing with siblings or peers, or participating in extracurricular activities, for example. The specific goals of intervention, including skills to develop and behaviors to decrease, are selected based on the routines and goals desired. 

Assessing Patterns

Once the goals are clear, an assessment is conducted to determine patterns that may be affecting the child's behavior within the routine. Specifically, we would want to know what happens before the child's behavior (e.g., who is present, when and where it occurs, what is expected, what is happening), both when he/she is successful and when his/her behavior during the routine is particularly challenging. We would also want to know what the child gets or avoids through his/her behavior such as attention, items, activities, or breaks from the situation. This information is collected with the family through interviews and observations and is summarized to guide interventions. 

Designing Strategies

Using the patterns from the assessment, we can develop strategies that (a) work given the patterns affecting the child's behavior and (b) fit with the family lifestyle. Strategies fall into three categories and the specific strategies chosen are tied to the patterns. Proactive strategies involve preventing problem behavior and prompting positive behavior by rearranging environments or establishing expectations. Teaching strategies focus on building skills a child can use to replace his/her challenging behavior and participate more successfully in the routine. And management strategies focus on consequences, specifically providing reinforcement for positive behavior and withholding it for problem behavior.

Using the Plan

Once the strategies have been developed, it is important to carefully plan how they will be put in place and maintained. If professionals are involved, they should serve as coaches, rather than implementing the interventions themselves when possible so they are building the capacity of the family. If children's skills cannot be established without additional practice, it may be helpful to conduct additional "trials", while continuing to support the routines. Really, the emphasis is on teaching - arranging the environment, prompting skills, and rewarding children for increasing success and independence. 

Monitoring Progress

It is important to objectively track whether children's behavior are improving - making sure that skills are increasing and problem behavior is decreasing, as well as whether overall goals are being met. With objective information, families are more prepared to tweak aspects of plans that are not working - and celebrate successes. Monitoring by behavior specialists and other professionals can be pretty complex, but monitoring progress may be simplified in everyday family life by using something like a rating scale.

The ultimate goal of any ABA program is to improve not only behavior but also the lives of children and their families. By focusing on valued routines and designing strategies that fit in the contexts of the family lives, we can achieve this goal.