Autism Therapies: ABA, RDI, and Sensory Therapies

What is Applied Behavior Analysis (ABA) training?

Many children with autism spectrum disorder (ASD) and related conditions exhibit unwanted behaviors, such as head-banging or slapping others. For parents and other caregivers, trying to reduce these behaviors can be difficult and frustrating. In fact, efforts at discouragement often end up making the behaviors more frequent.

One approach for dealing with these issues is applied behavior analysis, or ABA, training. One of the most widely accepted autism therapies, 32 out of the 50 states in the U.S. have laws that require health insurers to cover it.

ABA is based on the idea that people are more likely to repeat behaviors that are rewarded than behaviors that are not recognized or are ignored. Since the 1960s, researchers have recognized that ABA can help children with autism. ABA does this by helping them develop a number of skill sets while reducing the likelihood of their engaging in problematic behaviors. The technique is endorsed as a treatment for ASD by the American Medical Association, American Academy of Pediatrics, and the U.S. Surgeon General.

How does Applied Behavior Analysis work?

ABA training is usually conducted by a trained therapist. In traditional ABA, the therapist spends 20 to 40 hours per week working one-on-one with a child. Often, though, a therapist will use a version of the therapy known as “modified ABA.” With modified ABA, the therapist spends 10-15 hours per week with the child to allow the child time for other therapies such as speech and occupational therapy. This also allows the child to spend time in a therapeutic social environment. All children with autism are unique and have specific learning needs. Consequently, the therapist will develop an applied behavior analysis program that's tailored to meet those needs .

The treatment begins with an assessment by the therapist. The purpose of the assessment is to determine which skills the child already possesses and where the child has deficits. The therapist next develops an ABA program aimed at increasing the child's skills in many areas. The program will likely include goals related to the child's:

  • Academic development
  • Communication skills
  • Social skills and overall interaction with the environment

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After identifying the goals, the therapist creates a series of steps to help the child reach them. The ABA therapist can employ a number of different procedures to teach the child with autism a given skill.

One commonly used procedure is discrete trial training. The therapist presents the child with a cue. The child then has the opportunity to respond. If the child responds appropriately, the behavior is rewarded. The specific reward is something the child enjoys, so that he or she is motivated to repeat the desired behavior in the future.

Admittedly, the world is not as simple as discrete trial training might make it seem. So, applied behavior analysis programs include a number of other training procedures. These are used to teach the child to generalize the skills being learned to a number of different settings. Procedures might include incidental teaching of skills throughout the day and task analysis. With these procedures, children with autism learn to perform multiple steps to accomplish specific tasks.

Is ABA training right for my child and me?

ABA training is most effective if therapy begins when children are younger than age 5, although older children with ASD can also benefit.

To get the most benefit from applied behavior analysis, your child will need extensive one-on-one therapy for many hours each week. That is expensive. ABA training will also be most effective if you obtain training in ABA yourself. That way, you can teach your child and reinforce positive behaviors all the time. This will help your child generalize the skills being learned. It also will help you minimize the likelihood that your child will engage in unhealthy or negative behaviors.

What is Relationship Development Intervention (RDI)?

Relationship development intervention (RDI) training is a relatively new, trademarked autism therapy. It was developed by a husband-and-wife team of clinical psychologists, Steven Gutstein, PhD, and Rachelle Sheely, PhD.

RDI training aims at teaching children how to engage in social relationships with other people. Typically, RDI training begins by helping children develop relationships with their parents and other family members. It is very similar to other therapies for autism spectrum disorder in that it focuses on the core deficit: social skills and interaction. Parental involvement is key to the success of RDI. RDI teaches parents how to use all opportunities as “teachable moments.” These moments are opportunities to engage the child and build more appropriate social skills.

Since RDI training is relatively new, there is not much clinical evidence to demonstrate its effectiveness. Studies conducted by the developers of RDI, however, have shown significant improvement in children treated with RDI based on two commonly used diagnostic tests for autism.

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How does RDI training work?

RDI training begins with a complete professional assessment of the child. This includes a visit with a neurologist and an evaluation using standardized autism diagnostic scales.

Parents wishing to use RDI are encouraged to either participate in an intensive workshop or watch a special five-hour DVD. The workshop and DVD introduce parents to the principles of Relationship Development Intervention.

An RDI program is built by a certified Relationship Development Intervention program consultant. The objectives set for the child are updated regularly, using feedback from parents and videotapes parents submit. The videotapes document the parents' sessions with the child. In the early stages of therapy, parents have the role of being the child's main coach. The consultant's role is to help parents work with the child as effectively as possible.

The consultant teaches parents to help their child develop a social relationship with them, and ultimately others, through various activities. These activities might include playing games such as "hot potato" or mimicking the expressions in facial images.

Is RDI training right for my child and me?

The RDI developers believe RDI training is most effective when children begin receiving therapy at a young age. They also believe it can be beneficial for people with autism of all ages.

To provide your child with RDI training, you will need to devote time to attending workshops or watching videos. By doing so, you will learn how to provide your child with an effective intervention program. The instruction can be both time-consuming and expensive. You will also need to commit to regular communication with your certified RDI program consultant. That includes regularly videotaping your interaction with your child.

What are sensory integration and related therapies?

Many children with ASD have sensory problems. Some are overly sensitive to stimuli such as lights, noises, and touch. Others are not sensitive enough.

There are a number of sensory therapies that have been shown to improve the sensory problems children with autism have. Although these therapies can help, there is no scientific documentation that sensory therapies are effective in treating autism.

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How does sensory therapy work?

Therapists skilled in conducting sensory therapy for autism work one-on-one with the child. The goal is to help regulate the child's reaction to external stimuli.

For example, if the child is hypersensitive to being touched, the therapist will work to desensitize the child over time to tactile stimulation. The therapist might firmly stroke the child's skin with different textured fabrics. The purpose is to accustom the child to the sensations. The therapist strives to make the activities enjoyable and game-like for the child. That way, sensory therapy does not become overwhelming for the child. The child is not forced to do anything. But the therapist does need to push the child's boundaries to help the child improve.

Various sensory therapies can be used to address a variety of problems that affect children with autism. For example, spinning in a chair can reduce hyperactivity in some children with autism. And deep pressure stimulation may also be calming. One way a therapist may apply this pressure is by safely rolling children up in mats. Other sensory therapies may include swinging, vibration therapy, and aerobic exercise.

Is sensory therapy right for my child and me?

Unlike ABA training and RDI training, sensory therapy for autism does not require a major time commitment from you or your child.

You and your child's therapist may need to experiment with a variety of therapeutic options to determine which ones help your child improve (your developmental pediatrician or neurologist also can provide guidance). If a therapy is going to work, it typically yields results relatively quickly. The degree of improvement that can be obtained by sensory therapy depends upon the child.

WebMD Medical Reference Reviewed by Smitha Bhandari, MD on May 30, 2016

Sources

SOURCES:

Cambridge Center for Behavioral Studies: "Autism and ABA."

National Institute of Child Health and Human Development: "Autism Overview."

Association for Science in Autism Treatment: "Relationship Development Intervention."

Fazlioglu, Y. and Baran, G. Perceptual and Motor Skills, April 2008.

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