In general, ABA refers to methodologies based in operant conditioning theory and presumes that antecedent stimuli and consequences influence acquisition and continuation of behaviors. Objective assessment of observable and measurable behaviors and ongoing evaluation of the behavior change is inherent in treatment success. Particularly in the field of autism, terminology has often become muddled over the years. Many particular methodologies are equated to the whole of ABA, as opposed to being one tool or method within this rubric.
Specific methodologies enveloped within the field of ABA include Lovaas therapy or discrete trial teaching (Lovaas, 1987) and incidental teaching (McGee et al., 1999). Although based on the principles of ABA, these specific methodologies should be viewed as distinct interventions within the general framework of ABA.
Several behavioral strategies have been shown to be effective in decreasing severe aggression and self-injury (Kahng et al., 2001). Since intervention methods are best employed on a consistent and daily basis, parental involvement is very important (Briesmeister and Schaefer, 1998). In fact, parents and other caregivers are often a primary focus of training in ABA methods. There are many challenges in providing this training, as well as ensuring consistent implementation of treatment intervention, particularly for behaviors such as aggression.
Follow-up visits to coach the caregivers and ensure protocol fidelity are often infrequent. In addition, caregivers working in naturalistic settings with these children face inherent multiple challenges and competing time pressures on a daily basis. Providing prevention techniques that will prevent or limit the development of maladaptive behavior is more realistic in these settings (McClannahan and Krantz, 2004).
In addition, there has been documented success of parent and staff training interventions based in ABA to improve the caregiver's abilities to provide all levels of prevention, treatment intervention and skills acquisition. In particular, Harris et al. (in press) have completed a comprehensive review of the methods and strategies considered most useful for consistent and effective treatment implementation. Included are instructions, modeling/role-playing and corrective feedback, as well as ongoing consultation.
While much single-case research supports ABA intervention, randomized control trials have not thoroughly evaluated the efficacy of a standardized behavioral intervention program. The difficulty in doing so is inherent in the particular strength of behavioral analytic techniques to individualize the treatment to the characteristics and interests of the particular child. The National Institute of Mental Health recently funded three Research Units on Pediatric Psychopharmacology (RUPP) that are focused on autism and related pervasive developmental disorders (PDDs). The RUPP Autism Network has begun a controlled investigation into the use of a standardized behavioral intervention, targeting severe behaviors such as aggression and self-injury. Although the behavioral programming is not specific to the principles of ABA and will not prove the particular success of such an intervention with this population, the investigation will provide some input as to the benefit of incorporating general behavioral methods along with psychopharmacological intervention. Furthermore, it will provide a basis for manualizing a behavioral intervention so therapists without extensive experience with children with autism will have some guide to appropriate intervention strategies.
Pharmacotherapy
Several drug classes, including antipsychotics, serotonin reuptake inhibitors, mood stabilizers, psychostimulants and adrenergic agonists, have been evaluated in studies where aggression was a primary target in children with autism.
