With diagnoses of autism continuing their alarming ascent, parents across the country are turning to behavior analysts to help their children master the communication and social interaction skills that are critical to the successful navigation of everyday life. We invited faculty from The Chicago School’s Applied Behavior Analysis Department to discuss how ABA is used in treating this disorder, what challenges face families struggling with autism, and what hopes they have for their clients. Joining Dr. Traci Cihon and Dr. John Smagner for this dialogue was Ann Sturtz, a second-year student in the program.

INSIGHT: What do you think is the greatest myth about the autism diagnosis?
STURTZ: One of the things that people ask me about the kiddos that I work with is ‘Can they play the piano really well?’ or ‘Can you ask them what this date was in 1570?’ One of the greatest myths is that people with autism are very similar to one another. People assume that they all do the same things, and can’t do the same things… they go back to the Rainman analogy. I find that surprising because of the amount of media attention and the increase in programs that address autism.
DR. SMAGNER: There is a common misconception that children are not social and that they don’t like to be touched. I have never personally worked with a child with autism that didn’t like to be touched, though I do believe they exist.
DR. CIHON: Or that they don’t like other people…that they don’t know that other people exist.
DR. SMAGNER: You know, the nature of the disorder is that they have social skill deficits but they are not naturally avoidant or unsocial.
DR. CIHON: I guess the bigger misconception that I come in contact with is not specific to autism, but specific to ABA. The one that I’m responding to quite frequently is, ‘Isn’t ABA just for autism?’ And I have to respond, obviously ‘No, behavior analysis applies to any behavior that an individual exhibits. Autism is getting a lot more attention in the media now and ABA is the most effective intervention that we have empirical support for.

INSIGHT: A child with autism has been referred to you for treatment. Walk me through the mechanics in creating an ABA program for this child.

DR. CIHON: The first thing I’m going to do is gather information. I’m going to talk to people, in particular parents, other individuals involved in the child’s life. Then I’m going to see what is going on in the environment, what the child is doing, and what happens before particular behaviors and what happens after particular behaviors occur. I am going to look for patterns in what I’m recording. I’ll look at the trends before we do anything, before there’s an intervention in place, and then I’m going to try something–not just something I pull out of the air, but that’s been empirically researched and supported, and that I know has this particular effect on the behavior. I am going to watch and see what happens to make sure that the child has the change that we like to see. And if that doesn’t work, I’m going to make a change.
DR. SMAGNER: We think about autism and all the deficits associated with it. I would say the fundamental deficit is language; so when I go into a new home, I want to assess the child’s imitation skills, because I think language development necessitates an imitative repertoire. I’m going to access receptive language, do they follow instructions… very simple instructions… instructions that in the natural environment would keep the child safe, like saying to the child ‘Come here.’
DR. CIHON: The other thing I’d want to know is, how are they getting their wants and needs met? Are they looking, are they reaching, are they pulling someone over?
DR. SMAGNER: Are they tantruming?
DR. CIHON: Right, what things are going on and what’s happening afterwards?
DR. SMAGNER: More often than not, the parent will tell me that the child pulls or tantrums. Sometimes the children will point. But I need to know all that.
DR. CIHON: I think it also depends on where you’re coming in and the range of interventions that have been tried. If it’s a child who’s received some early intervention or is coming in a little later in the game, oftentimes we see some very different skill sets. Sometimes kids are already talking.
STURTZ: The programming doesn’t have to do with the chronological age of the child. You can have an individual who is 9 or 2, and they do the same things…they communicate in the same way, they have the same toileting skills, the same reading level, communication, feeding skills, ability to dress themselves. Their history can make it more challenging—the longer you’ve had things going on, the harder it is to break the habit or the pattern. But I’ve worked with individuals who are 30 who have less functional communication than kiddos that I work with that are 3 or 4.
DR. CIHON: We look at what skills are appropriate for an individual of that age, and the environment that they are in. A 3-year-old may be in a preschool setting. A 21-year-old may be in a functional skills curriculum/ high school setting getting ready to shift into employment. We look at what the natural contingencies of reinforcement and the environment are, and then make sure that the behaviors that we are teaching are going to be maintained.
DR. SMAGNER: A lot of parents feel it’s very important that children go to school to be exposed to their typical peers. And once they start going to school, then they’re not available for treatment as much. And that has sort of driven some of the decisions that I’ve made, like working only with very young children.
DR. CIHON: It’s not necessarily the more time we have, the more progress the child is going to make. It’s what you do with that time. But given that it’s so important to arrange the environmental contingencies in such a way that it’s going to evoke and maintain the behaviors that we want to see, it is easier to do that when there are fewer people involved. And it’s also easier to do that before that long learning history. So, in some respects, it’s easier to start early, and you see more rapid gains more quickly. But I’m interested in also helping the kids who the system has failed.

INSIGHT: Does the potential exist for the autism diagnosis to be removed as a result of ABA treatment?
DR. SMAGNER: There is some convincing data showing that intensive applied behavior analysis….[can make a child with autism] indistinguishable from peers, though there are those who have critiqued that line of research on methodological grounds. I have to say that I am a hopeful person, and so when I enter a home, my goal is for recovery.
DR. CIHON: I have a child right now, we started with him when he was 3 and he didn’t communicate much verbally, he threw tantrums, didn’t stay on task, just moved around in a fury. And now, I can’t pinpoint a new skill to teach him. He is behaving similarly to other 3-year-olds in terms of verbal behavior, as well as pre-academic skills, small group skills. He is going to preschool and is doing fine. In that particular situation, the family doesn’t want to have him reevaluated to determine whether he does or does not have autism. He is still very young, and while that diagnosis doesn’t drive services, it does in a lot of ways. So if you drop the autism diagnosis, then you have to fight again to get speech therapy services, occupational therapy services, applied behavior analytic services. There are a lot of large jumps in skills that are necessary to survive in preschool to kindergarten, from kindergarten to first grade, from fourth grade into fifth and sixth grade, and so on.
STURTZ: I have a similar story. I had a kiddo who started (ABA therapy) when he was 18 months and by his third birthday had mastered out of all of the programs that were written for his age. He probably spoke more clearly and more often than many of the 3-year-olds he was going to school with.

INSIGHT: Is there a common life cycle of treatment?
DR. CIHON: My goal is to work myself out of a job as quickly as possible. It varies, it varies on what the needs of the family are, what the needs of the child are. I have cases that I’ve been involved with since 2001 and I’ve had cases for six months and it wasn’t a good fit, or I had to move…so there are a variety of different variables that can influence it. There are varying levels of involvement too, I think. We’ll fade ourselves out after a while. But every now and then I still get a phone call or an email so there’s still sometimes that level of involvement.
STURTZ: However many hours you spend talking about it, you are never going to get all of the information you want. The more you learn, the more you realize you don’t know. I think it’s important to remember that you’re not going to have all of the answers, and you just have to take one step at a time with one individual at a time.