Applied Behavior
Analysis for
Children with
Autism
Jonathan Tarbox, PhD, BCBA, & Bill Roth, PhD, BCBA
Center for Autism & Related Disorders, Inc.
Presentation Outline
• Introduction to CARD
• Brief introduction to ABA and autism
• How to teach: Components of a
comprehensive ABA program for children
with autism
• What to teach: CARD curriculum
• Note: Don’t be afraid to raise your hand with
a question at any time!
Introduction to CARD
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Founded in Los Angeles in 1990 by Dr. Doreen
Granpeesheh
Mission: give top-quality ABA to the maximum
number of children, around the world
15 locations in U.S.A. – newest office is
Berkeley
2 locations outside U.S.A.: New Zealand, and
Australia
Consultation in Asia, Europe, Middle East, and
South America
What is ABA?
• Applied Behavior Analysis
• ABA is the use of scientific principles of learning and
motivation to teach effectively
• The core concept is that the consequences of what
we do affect what we learn and what we will do in the
future
• Positive reinforcement: behaviors that produce a
good outcome are more likely to occur in the future
• People are motivated by what they get out of what
they do
– Examples: money, feeling good for helping someone,
approval from others, satisfaction of a good book, etc.
Positive Reinforcement
• The ABA approach to autism is to identify what
motivates each individual child
• Every child is different
• Teaching must use what is motivating to the
child, not what we think should be motivating
to the child
• Then we teach the child by teaching new skills
in very small steps and rewarding the child
with positive reinforcement when they make an
effort at learning
Accountability and Effectiveness
• ABA assumes that if a child is not learning, it is
NOT the child’s fault, it is our fault
• We must change the way we are teaching
• We must continue to try different ways of teaching
until we find one that works
• ABA is the best method for finding what works
• We never blame the child if learning does not
happen
• We believe it’s our responsibility to figure out how
to teach whatever the child needs to learn
Outcome Research on
ABA for Autism
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Lovaas (1987)
Smith (2000)
Sallows (2005)
Howard (2005)
Cohen (2006)
Eikeseth (2007)
Zachor (2007)
Remington (2007)
Perry (2008)
Support for ABA as a
Treatment for Autism
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Surgeon General
NY State Department of Health
National Academy of Sciences
American Academy of Pediatrics
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“The effectiveness of ABA-based intervention in ASDs has been
well documented through 5 decades of research by using singlesubject methodology and in controlled studies of comprehensive
early intensive behavioral intervention programs in university
and community settings. Children who receive early intensive
behavioral treatment have been shown to make substantial,
sustained gains in IQ, language, academic performance, and
adaptive behavior as well as some measures of social behavior,
and their outcomes have been significantly better than those of
children in control groups.
Outcome Research on
ABA for Autism
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Conclusions of outcome research
– Every published study demonstrated very
large treatment effects
– Replicated across research groups, across
university vs. community settings, and across
continents
– Intensity matters: at least 30 hours per week
of one to one intervention for more than a
year produces best outcomes
– Duration matters: two or more years of
intervention
Comprehensive ABA Programs
• Earliest versions of ABA programs focused
mostly on discrete trial training (DTT)
• Comprehensive ABA programs now include a
variety of behavioral teaching strategies
– DTT
– Natural Environment Training (NET)
– Verbal Behavior
– Challenging behavior
– Data collection
– Programming for generalization
Discrete Trial Training (DTT)
• Breaks down learning opportunities into wellcontrolled, discrete teacher-student
interactions
Instruction → Correct Response → Reward
OR
Instruction → Incorrect Response → Correction
Discrete Trial Training (DTT)
• Provides structure for the learning interaction
• Provides a very large number of learning
opportunities in a small amount of time
• Is proven by hundreds of studies to be an
effective teaching procedure
One Discrete Trial
Many Discrete Trials
Natural Environment Training
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Naturalistic behavioral teaching procedures go by
many names:
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Incidental Teaching, Pivotal Response Teaching,
Basic approach:
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Teach in the natural environment
Set up situations where the child will be motivated (e.g.,
toy out of reach)
Wait for child to initiate
Prompt the correct behavior
Reinforce it
Natural Environment Training
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Much more natural approach than DTT
Less structured
Looks more like typical interactions
Great for teaching play and social skills
Great for establishing generalization of
skills learned in DTT
Some children prefer NET over DTT
Proven by dozens of studies to be an
effective teaching procedure
Verbal Behavior
• B.F. Skinner, Verbal Behavior (1957): Applied
principles of behavior analysis to language
• Separates language into categories by
function
• Reminds us to teach all functions of words
• Teaching one function does not necessarily
lead to learning other functions of the same
word
– Example: if we teach a child how to say “red,” he
may not actually be able to say “red” when he
wants something that is red
Verbal Behavior
• Most comprehensive ABA programs
incorporate Skinner’s analysis of verbal
behavior into their treatment
• Some incorrectly say that “Verbal behavior is
not ABA” or “We don’t do ABA, we do verbal
behavior”
• Verbal behavior is one area within ABA, it is
not seperate
Challenging Behavior
• Examples: aggression, self-injury, selfstimulatory behavior, tantrums
• ABA assumes that children are getting
something they want from challenging
behavior
– Attention
– Escape
– Toys or food
– Sensory stimulation
• Autism is NOT the cause of bad behavior
Challenging Behavior
• First step is to do a “functional assessment”
• This means assess what they child is getting
from their challenging behavior
• The next step is to not give it to them any
more when they have the behavior
(“extinction”)
• AND teach the child a more appropriate
behavior that will get them what they want
– Example: asking for a break, playing with a toy,
asking for attention, etc.
Data Collection
• Good ABA programs take lots of data on the
child’s progress
• Frequency of challenging behavior
• Percent correct on skill teaching
• Data are graphed after every teaching
session
• The percent correct should be increasing
over time if the child is learning
Data Collection:
Teaching If / Then Reasoning
Baseline
Teaching
100
90
80
70
60
50
40
30
20
10
0
-10
Sessions
Data Collection:
Accidents During Toilet Training
Diaper
Frequency of Accidents
3.5
No Diaper
Diaper
No Diaper
3
2.5
2
1.5
1
0.5
0
1
2 3
4 5 6
7 8
9 10 11 12 13 14 15 16 17 18 19 20
Days
Data Collection:
Compliance with Instructions
Antecedent Assessment
Treatment Evaluation
No-Choice
Choice
No-Choice
Choice
100
% Compliance
80
60
40
20
0
1
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5
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9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37
Sessions
Generalization
• Comprehensive ABA programs must
explicitly focus on generalization
• Generalization does NOT occur
automatically
• Generalization is NOT an afterthought or
side-effect
• Generalization is THE central goal of
intervention
Planning for Generalization
• Best way
– Teach skills in many different environments
– Teach with many different teachers
– Teach during many different times of day
– Do NOT do the same thing the same why all of
the time
– When skills are learned in DTT, make sure to
practice them in natural settings
– Parents must practice all new skills as often as
possible
Therapist Training
• ABA therapy is difficult to do
• It’s much more structured than feels natural
• It takes a LOT of training to learn how to do
it correctly
• 20-30 hours of initial classroom training
• Another 30 hours of hands-on training with
children
Supervision
• Good ABA programs provide approximately
2 hours of supervision for every child, every
two weeks
• Supervisors must be experts in ABA, with
several years of experience
• Every therapist that works with the child is
directly observed working with the child
• Every therapist is given specific and
immediate feedback on good and bad
performance
Workshop Model
• There aren’t enough ABA experts in the world to
provide supervision
• Another option is the “workshop” model
• For families who do not live within an hour drive
of an ABA clinic
• A consultant travels out to family’s home and
trains everyone
• Then the family runs the program and manages
the therapists
• Consultant follows up with regular contacts
Overview of CARD
Curriculum
The CARD Curriculum
Academic
Skills
Executive
Cognition
Functions
Language
Play
Social
Skills
Adaptive
Skills
Motor
Skills
A Comprehensive Curriculum
• What needs to be taught in ABA programs
for kids with autism?
• Autism is defined by global deficits…
• If we want to catch kids up to typical
development, we need to teach
EVERYTHING that they are delayed in!
• That is what the CARD curriculum was
designed for
CARD Curriculum
• Every area of human functioning is
addressed in the eight content areas
• Each content area in the curriculum is broken
down into dozens of teaching programs
• Each program is broken down into many (up
to 20 or more) specific instructions along with
the correct child behavior
• Lessons are arranged in the order in which
they emerge in typical development
Language
Language Curriculum
Language
31 Lessons by Emerging Age and Function:
0-12 mos.
• Body Parts
• Echoics
• Following
Instructions
• Gestures
• Sound
Discrimination
1 - 2 yrs.
• Actions
• Basic Mands
• Categories
• Choices
• Functions
• Negation
• Objects
• People &
Relationships
• Prepositions
• Yes / No
2 - 3 yrs.
• Adverbs
• Attributes
• Features
• Gender
• Manding for
Information
• Opposites
• Pronouns
• WhDiscrimination
• Locations
• Plurals
3 - 4 yrs.
• Describe
• Sequences
• Statement Statement
4 - 5 yrs.
• Same / Different
5 - 6 yrs.
• Ask & Tell
Discrimination
• Statement –
Question
• Syntax
6 - 7 yrs.
• What Goes With
Language Curriculum
Language
• Each lesson
– Goes beyond teaching the meaning of
words
– Because we cannot assume that once the
child has learned the meaning of a word
that she will use it in all possible situations
– We need to make sure a child can use a
word in all of its functions
Language Curriculum
Language
Example
• We teach the child to hand us an apple when
we say “Give me apple” (receptive)
• We teach the child to respond “apple” when
shown apple & asked “What is it?”
(expressive)
• This does not mean the child will now be
able to respond “apple” in other situations or
ask for apples when he/she wants them
Language Curriculum
Function
Matching
Instruction
or Setting
“Put with same”
Listening
“Touch apple”
Vocal
Imitation
Someone says
“apple”
Behavior
apple is matched
with apple
Selects apple
Language
Consequence
(Reinforcer)
Praise
Praise
“apple”
Praise
Request
Hungry and no
apple present
“apple”
Child gets an
apple
Labeling
Apple is present
“apple”
Praise
Conversation
“What is your
favorite fruit?”
“apple”
Praise
Play
Play Curriculum
Play
Domains
Sensorimotor Play
Independent
Task
CompletionPlay
Play
Play Stations
Block Constructions
Constructive
Structure Building
Play
Sand and Water Constructions
Clay Constructions
Arts and Crafts
Audio and Video Play
Computer Play
Electronic
Play
Video Games
Early Social Games
Read-to-Me Books & Nursery Rhymes
Interactive
Music
and Movement
Play Hunt
Treasure
Card and Board Games
Locomotor Play
Peer Play
Functional
Pretend Play
Pretend
Symbolic Play
Play
Imaginary Play
Sociodramatic Play
The CARD Curriculum
Adaptive
Adaptive Curriculum
Adaptive
Personal
Feeding
Toileting
Undressing
Unfastening
Dressing
Preventing Spread of Germs
Bathing
Fastening
Teeth Care
Hair Care
Nail Care
Health Care
Domestic
Pet Care
Setting & Clearing Table
Telephone Skills
Tidying
Meal Preparation
Cleaning
Gardening
Laundry
School Backpack Prep
Making a Bed
Safety
Community
Shopping
Restaurant Readiness
Safety Awareness
Safety Equipment
The CARD Curriculum
Motor
Skills
Motor Curriculum
Motor
Oral
Oral Motor
Visual
Hand Skills
Coloring
Finger Skills
Drawing
Pre-Handwriting
Cutting with Scissors
Fine
Gross
Ocular Motility
Binocular Vision Skills
Visual Perception
Sitting
Standing
Walking
Running
Jumping
Hopping
Crawling / Creeping
Rolling Over
Stairs and Climbing
Balance Beam
Kicking
Catching
Riding Foot-Propelled Vehicles
Rolling / Throwing / Dribbling
Riding a Tricycle / Bicycle
Swinging a Bat / Racquet / Paddle
Physical Education Readiness
The CARD Curriculum
Social
Skills
Social
Social Skills Curriculum
Skills
Social Language
Greetings and Salutations
Non-Vocal
Social ID Questions
Eye Contact
Prosody
Non-Vocal
Imitation
Non-Vocal
Regulating Others
Absurdities
Body Language & Facial Expressions
Conversational Audience
FiguresGestures
of Speech
Social
to Regulate Social Interaction
Social
Interaction
Physical Context
of Conversation
HumorAbsurdities
and Jokes
Language
Apologizing
Listening to Conversation
What’s Wrong?
Assertiveness
Initiating Conversation
Compliments
Joining Conversation
Cooperation
& Negotiation
Maintaining
Conversation
Group
Group Related
Skills
Social
Social
Gaining
Attention
Repairing
Conversation
Related
Responding
in Unison
Introductions
Interaction
Skills Transitioning
Topics
of Conversation
Group Discussion
Skills
Levels
of Friendship
Ending Conversation
Sharing & Turn-Taking
Social Rules
SelfLending
Esteem & Borrowing
Compliance
Dealing with Conflict
Social
Following Rules
Positive
Self-Statements
Self
Esteem
Rules
Community Rules
Social Context Winning & Losing
Social
Politeness & Manners
Constructive
Criticism
Responding to Social
Cues
Context
Learning
Through Observation
The CARD Curriculum
Academic
Skills
Language Arts
Colors
Community Helpers
Handwriting and Penmanship
Writing
Math
Letters
Shapes
Spelling
Money
Print Concepts
Patterning
Literary Genres
Calendar
Decoding & Word Recognition:
Addition
Phonics
Subtraction Sight Reading
Statistics and Data Analysis
Comprehension:
Oral Story Comprehension
Number Concepts:
Reading Comprehension
Numbers
Phonological Awareness:
Counting & Quantities
Phoneme Isolation
Quantitative Concepts
Phoneme Blending & Segmentation
Ordering Numbers &
GroupsMatching
Phoneme
Comparisons
Phoneme Manipulation
Number
Patterns
Word
Discrimination & Segmentation
Rhyming
Time:
Syllables
Time of Day & Daily Activities
Academic Skills Curriculum
Telling Time
Academic
Skills
The CARD Curriculum
School
Skills
Executive
Cognition
Functions
Language
Play
Social
Skills
Adaptive
Skills
Motor
Skills
Conclusion
• ABA is the only treatment for autism that has
substantial science evidence for causing large
improvements in children
• ABA programs should be comprehensive:
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25 or more hours per week of one-to-one
Address all skills areas
Two years or more of treatment
Verbal behavior
Generalization
DTT
NET
Top-quality supervision