ABA Therapy 

By Matt Hentschel

What is ABA?

 

Early intensive behavior intervention (EIBI) in children and adolescents with autism spectrum disorder (ASD) has been extensively reviewed as an effective means for improving language, cognition, and social skills [1][2]. In some individuals, EIBI interventions have even bolstered a child or adolescent out of the range of clinical autism [3]. Though an “optimal outcome” is never guaranteed, such results are a testament to the efficacy of EIBI treatment.

 

One such treatment, known as applied behavior analysis (ABA), is a researched-based approach form of EIBI that has yielded cognitive improvement in the ASD population since it’s conception in the late 20th century [4]. Based on the application of regular, diverse forms of reinforcement with preferred items and activities, an individual is more likely to acquire skills and reduce “problem” behavior in a relatively short time.

 

How does it work?

 

ABA therapy can be paid for out of pocket or by some forms of health insurance. Meeting with a Board Certified Behavior Analyst (BCBA) to discuss treatment options is the first step in an ABA intervention plan. The BCBA works with a team of individuals such as Registered Behavior Technicians (RBT’s) to design and implement a data-based plan. After identifying the hypothesized function of a specific behavior, its frequency can be pinpointed for adjustment. ABA sessions can be supplied in office, or even in the client’s home for maximum effectiveness.

 

The ultimate goal of ABA therapy is the generalization of acquired skills in an individual’s natural environment. Essentially, once a child or adolescent has met specific goals laid out during the initial assessment, therapy is no longer needed and a new skill repertoire is established. Because behavior is versatile, ABA intervention can be used across many ages and functionalities.

 

 

[1] Dawson G., “Behavioral interventions in children and adolescents with autism spectrum disorder: a review of recent findings.” Current Opinion in Pediatrics, 2011; Vol 23: pp 616–620

[2] Dawson, G. et al, “Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model.” Pediatrics, 2010; Vol. 125, No. 1: pp 17-23.

                        

[3] Fein, D., et al, “Optimal outcome in individuals with a history of autism,” Journal of Child Psychology and Psychiatry 54:2 (2013), pp 195–205.

 

[4] Lovaas, E, “Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children.” Journal of Consulting and Clinical Psychology 55:1 (1987), pp. 3-9.

Insurance Coverage 

 

Applied Behavioral Analysis (ABA) is a medically necessary form of therapy in nearly every state of the country. Each state has a different policy governing age, insurance type, and maximum monetary coverage for ABA treatment. In Georgia, coverage is limited to $30,000 annually and  requires coverage for children age six and below. However, some insurers such as Medicaid provide coverage into adulthood (21 years of age). ABA therapy must be conducted by or under a Board Certified Behavior Analyst (BCBA) that typically requires a master’s level education in the field.  

 

A state by state breakdown of Autism treatment coverage can be found at: 

https://www.appliedbehavioranalysisedu.org/

Relationship Development Intervention (RDI)

By Disha Srivastava

 

What is RDI?

Relationship Development Intervention, or RDI, is a relatively newer form of treatment developed in aiding children with ASD. Primarily, it focuses on building social relationships with other individuals, specifically family. Children are considered to get the most out of this type of intervention, but it can be beneficial to individuals of all ages. Dr. Steven Gutstein, PhD, whose experience within the field of developmental psychology and autism established that the early interactions amongst parent and child lead to greater social, reasoning and language growth, created the Relationship Development Intervention. At its core, it is meant for parents to support opportunities for their child to be able to respond to in flexible and thoughtful ways, eventually getting them to respond to more challenging problems. These opportunities are incorporated into their personal environment, so that each day, these opportunities are integrated into the child's daily routine.

How does it Work?

RDI is focused mainly on the parent and their involvement with the child. This program aims to equip parents with the proper tools to create meaningful relationships with their child. Knowing the different ways that autism manifests in each individual, this method works to cater to different needs and help parents create a new form of relationship with their child.

Specifically, this treatment begins with a complete assessment of the child with ASD using standardized diagnostic measures, after which, an initial RDI assessment will be conducted by a certified RDI consultant. This second assessment essentially provides a big picture of the family dynamics, with each individuals' strength and weakness analyzed. With this assessment, the consultant is then able to arrange specific activities for the parents and their child, along with comprehensive short-term plan that can help the family start off with. Additionally, the consultant also provides information on the specific activity themes, communication and modifications that would need to take place as well.

During the sessions, it is the parents' job to guide their child through the activities set in place, all under the supervision of the consultant (if present). It is important to note that these activities are specifically created to increase the parent-child bond and help them interact better. It is the idea that if this interaction and bond strengthen, then the child's ability to handle outer real-world relationship also improves.

The consultant is present to guide the parent, through a series of trainings, starting with six days of workshops that teach parents how the intervention works, the principles, components and the theory of RDI. This is then followed by weekly or biweekly meetings with the consultant and an intensive assessment is also conducted every 6 months.

Current Findings

Being relatively new, the research is limited and is primarily conducted by Dr. Gutstein himself. That being said, one study that was conducted, followed 16 children and their families through the RDI program. The study concluded that RDI is actually beneficial when conducted properly, with all data being consistent with the children who participated in the study, being more socially engaged, with increased communication, and behaved in a "dramatically more flexible and adaptive manner". These studies show that RDI has a promising future.

Keep in Mind

Based on what we have covered, it is important to consider the following:

  1. Despite promising studies, it should be noted that research is limited.

  2. This method of intervention is said to be for all ages, yet the studies and processes indicate that it is best when used with younger children.

  3. This is not a short-term process, patience and time is required. RDI aims to offer continuous progress, with relationships strengthening over time.

  4. Parents and family play the main role in this program, so it is also important to note that time and commitment are needed extensively from them.

  5. Compared to ABA therapy, RDI does cost less (primarily because the parent plays a bigger role here).

 

 

References

Gutstein, S. E., Burgess, A. F., & Montfort, K. (2007). Evaluation of the Relationship Development Intervention Program. Autism, 11(5), 397–411. https://doi.org/10.1177/1362361307079603

Dr. Gustein's Blog: https://www.rdiconnect.com/project/articles-by-dr-gutstein/