The short answer is yes. ABA therapy is scientifically proven to help with speech and language development in children with ASD.
In this article, we will go in-depth into how ABA therapy can help develop and expand language and communication skills in children with autism, including how it integrates with other therapies and how parents. can be involved.
Basics of ABA Therapy
The core philosophy of ABA therapy is that every behavior serves a function, including “negative” behaviors such as aggression and tantrums. The ABA team will use different data collection techniques to identify the function of such behaviors and teach the child a more appropriate way to have that need met. As such, ABA relies on highly individualized interventions for each child, and data-driven treatment decisions are made depending on the progress or regression made by each specific child. Board Certified Behavior Analysts (BCBAs) will update treatment goals depending on the child’s progress and any new concerns that may arise.
A core principle of ABA is caregiver involvement and training. Caregivers are strongly encouraged to participate in therapy sessions by conducting treatment goals in front of the therapists to allow for opportunities to receive feedback. Caregivers will also receive monthly training sessions from a BCBA to allow them the opportunity to ask questions and acquire a better understanding of the treatment plan. This caregiver involvement strengthens the efficacy of the treatment by easily bridging the gap between the child’s everyday life and therapy sessions, allowing the generalization of skills across people and environments.
Before initiating an ABA plan, the BCBA will conduct an extensive assessment, including parent interviews, observations, and rating scales. The results of these help identify and highlight the developmental challenges that the child is facing and develop a treatment plan to help close those gaps.
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Speech Challenges in Autistic Children
Describe common speech and communication challenges faced by children with autism, such as delayed speech development, echolalia, or lack of speech.
One of the most notable symptoms of autism is communication challenges. These can present in a variety of ways, including a speech delay, lack of speech or echolalia. Speech delays are very common with autism, with research suggesting that autistic children typically start talking at 36 months, compared to 12-18 months with neurotypical children.
Nonverbal communication is often delayed, as seen by a lack of eye contact, lack of pointing, lack of looking towards a point, etc. Instead, autistic children may guide caregivers towards items they want, bring items to them, or have challenging behaviors to communicate needs, such as grabbing, throwing, tantrums etc.
Echolalia, which is the repetition of words emitted by others, often without context, occurs in 75% of people with autism and usually disappears by the age of 3 years old. At other times, children may lose previously acquired speech, which may occur around the age of 2 years. Discuss the importance of addressing these challenges early in development.
Addressing these communication deficits and challenges in early development is fundamental for a number of reasons. Firstly, research shows the earlier a child with autism begins therapy, the better the outcome for that child. A meta-analysis compiled data on 334 children in early intensive ABA therapy and found that, compared to controls, the ABA cohort scored higher in IQ, non-verbal IQ, expressive and receptive language and adaptive behavior.
Secondly, behaviors become habits that become harder to break the longer they are left untreated. For example, if a toddler learns that grabbing items or having tantrums is an effective way of having his needs met and is not taught an alternative, this behavior will be strengthened and will become harder to break and replace. The sooner these behaviors are nipped in the bud and functional communication skills taught instead, the more progress the child will make.
ABA Therapy and Speech Development
ABA is an effective therapy to help aid and promote speech development. Usually, therapists will utilise the child’s motivation to evoke a communicative response. Depending on the child’s needs, a therapist will target requesting skills, attention-seeking skills and labelling.
During the therapy session, the child will have multiple opportunities to communicate. If the child engages in a maladaptive or challenging behavior, such as tantrums, grabbing, screaming or hitting as a means to communicate, the therapists will instead teach a more functional alternative.
The alternative will vary from child to child, depending on their abilities. For example, it may be a point, it may be a word approximation, the beginning of the word, or a full word, or they may be prompted to use an Alternative and Augmentative Communication device (AAC).
Therapists will use a variety of strategies to encourage verbal behavior, such as mand training, echoic training, and intraverbal training. Mand training involves teaching requesting skills, echoic training focuses on repeating words and sounds while intraverbal training focuses on answering and asking questions.
Therapists will contrive situations to encourage and motivate the child to communicate. For example, they may use clear containers to store the child’s toys out of reach, creating opportunities for the child to communicate. They may also purposefully ignore the child while prompting them to tap on their shoulder or say their name to teach an appropriate way to gain attention. Depending on the child, the therapist may use books or flashcards to teach new vocabulary and may use role-play scenarios to teach conversational skills.
Benefits of ABA Therapy for Speech
During my time as a therapist and BCBA, I saw numerous children who developed their communication skills as a result of ABA therapy. For example, one child I worked with who engaged in echolalia would only repeat back everything adults said to him without discrimination or context. When they wanted an item, they would immediately take it from whoever had it and would engage in frequent tantrums if they were not able to gain access to the item.
After a few months of early intervention (20 hours/week), the child was rarely grabbing and was able to request items by saying, “I want___”. Furthermore, the child had learned to read a schedule and was able to go over it by saying “First___, Second___ and then ____” so they were aware of when they would get their wanted items. They were also able to answer questions regarding their name, age, where they lived and who was in their family without repeating the question asked. The child could also request for activities to be “all done”, or if they wanted to play longer, they could ask for “1 more minute” independently.
One study compared the communication skills of children in America who receive ABA services vs those in Europe who receive a more eclectic approach. Parents in America reported better outcomes than European parents in regard to communication and speech, suggesting ABA is an effective therapy to improve communication skills in children with autism. Another study looked at the long-term effect of early intervention on 39 children with autism. After 2 and 6 years, the children in the early intervention ABA group exhibited fewer “core symptoms” of autism, including improved communication and speech. The early intervention group still maintained this improvement even when receiving fewer services than the control group.
Integrating ABA with Other Speech Therapies
ABA therapists often collaborate closely with speech therapists to ensure there is consistency across goals. Typically, there will be a comparison examining what goals are being run and how they are being implemented. Often, there is a high degree of overlap between the two. Furthermore, integrating ABA and speech teams can be beneficial for training purposes. For example, if a child requires an AAC device or a specific type of prompting to promote speech, which the ABA therapist is not trained in, they can receive support and feedback on how to best help the child. This is beneficial to reduce the likelihood that the child becomes confused or unsure of how to proceed due to differences in teaching procedures.
Speech and ABA therapists often use similar approaches during their sessions. For example, speech therapists often rely on visuals, such as schedules, icons, modified materials, etc, to help increase vocabulary. Furthermore, speech therapists use techniques similar to ABA therapists to contrive situations and encourage speech production and communication. Both will also break down goals into small achievable steps and will work out which communication type will work for your child, whether that be vocal or non-vocal language.
Parental Involvement in ABA Therapy
In all ABA programs, consistency between treatment teams and caregivers is key to the child’s success. If parents do not follow through on the programs, the child will behave certain ways with the therapists and will resort to different methods of having their needs met with their parents. This can cause confusion for the child if expectations from different adults in their lives are inconsistent.
During sessions, parents are encouraged to observe the therapists running the speech goals and how they create opportunities for communication. At times, therapists will ask parents to observe specific goals and then demonstrate those skills with their children. Furthermore, during home sessions, parents can benefit by following suggestions from the BCBA to arrange the environment in ways that encourage communication.
Outside of sessions, parents should try to follow the suggestions from the home therapists as much as they can. Some general tips include:
- Always reinforce an appropriate mode of communication first. For example, if a child points, approximates a word, says one word, etc., praise them for this so they are aware that that was a good thing to do. If their goal is to say “I want___” but they only said one word, first praise and then correct.
- Do not give your child preferred things for challenging behaviour, such as hitting, grabbing, tantrums, etc. Instead, lower the demand and give the item for them asking appropriately. For example, if the child’s goal is to point, but they are having a tantrum, just prompt them to touch the item instead, as pointing may be too difficult. Once they have done this, praise the touching and deliver the item.
- Write down questions and queries you have while interacting with your child so you can consult with your team during the next sessions. Ask them to show you how to carry out goals, and if you feel comfortable, do the goals in front of the therapists. Ask for feedback to ensure you are doing it correctly.
Choosing the Right ABA Provider
When selecting an ABA therapist, as with any provider, it is useful to know their expertise and background. Inquire about the therapists’ previous experience in working on speech and communication goals and ask for specific examples of how they helped a child, including names of approaches so you can follow up with your research on your own time.
Another important question to ask is how the therapist will ensure your child’s discomfort is kept to a minimum and how they will pivot and modify the treatment plan if the child is struggling to communicate. Finally, discuss with the BCBA if they have experience with using AAC devices and whether they are open to working in a multidisciplinary team, including speech therapists.
Potential Challenges and Considerations
Teaching speech and communication goals can sometimes cause challenges. Often, these problems are teething problems that resolve themselves once the child becomes more accustomed to the approach. For example, a child who is used to grabbing items they want will initially be confused and struggle when prompted to point and wait for an item to be handed to them. This may lead to challenging behaviors, such as tantrums, screaming, aggression, etc. However, these emotional reactions are usually short-lived as long as the team is consistent and the communicative responses being taught to them are achievable.
With that, speech programs are often modified frequently, especially at the start of a program. Clients should be pushed every day to replace their old, challenging communication behaviors with functional communication while keeping their discomfort and frustration low. To ensure the child is learning at an appropriate pace while maintaining ethical considerations, the increments with which programs are taught may be modified. For example, instead of starting at a full word request, the BCBA may change the program to accept a word approximation instead and work towards a full word.
Conclusion
ABA therapy can help children develop speech and communication by teaching them more functional alternatives to meet their needs. ABA therapy can help develop speech by teaching children a variety of communication approaches, such as requesting basic needs, such as rest, food, water, and bathroom; advocacy skills, such as saying “no” or “all done”; attention seeking skills; and conversational skills. ABA therapists will train caregivers to ensure they are able to implement the program and encourage speech across settings and people.
Helping your child to communicate is the most powerful tool you can give them. Communicating helps us feel empowered and important and is an essential part of being human. However your child communicates, ABA techniques can help strengthen and develop these necessary skills to interact with the world and the people in it.
