Introduction

As ABA (Applied behavior Analysis (ABA) therapy is the golden therapy for children and families who require support for a child with Autism Spectrum Disorder (ASD), or other developmental challenges, it is important to recognize that children with these exceptionalities, can benefit from ABA therapy in various ways including encouraging positive behaviours, life skills, communication, and social skills.

It is important to explore the growing trend in Ontario towards personalized ABA therapy plans that cater to the unique needs of each student, as there is a shift towards individualized interventions in therapeutic and educational settings to provide tailored interventions to children and students’ specific needs.

History of ABA: The Rise to Personalized ABA Therapy

ABA therapy starts off with B.F Skinner’s “operant conditioning” (1950’s) which led to behavioural interventions. Operant conditioning allows people to recognize that behavior patterns can be recognized through what happens before the behaviour and what reinforces that behaviour or the consequence of that behaviour. One of the earlier examples of this approach demonstrated that emotions, such as fear, can be conditioned and modified through behavioral methods.

In the past 40 years, ABA or behaviour therapy became a standardized practice Lovaas (1960s), had shown that Intensive Behavioural Interventions (40+ hours a week) compared to non-intensive (10+ hours a week), were of high importance in that intensive and comprehensive interventions can create a positive and life-altering system for those on the spectrum along with their families. This also showed replication, in studies by many individuals, which showed early interventions, by trained professionals created a more positive outcome for children with ASD.
This implemented a standardized and certifying body (BCBA’s and BCBA-D). Lovaa’s methods for autism and ABA were rigid and highly structured to implement understanding and restructuring of behaviours with constraint trials to develop replacement behaviours.

The functional analysis looks at why the challenge or problem behaviour occurs in a child and looks for ways to replace those negative behaviours and interventions to teach these replacement behaviours. Discrete Trial Training has been used in standardized practices as teaching through one-on-one sessions, with children whose behaviour is broken down into smaller tasks and reinforced by rewards or a token system for a more balanced behaviour, or using the appropriate replacement behaviour.

An example could be a child who throws their pencil when frustrated at work. The trials would be replacing that behaviour of throwing that pencil with placing the pencil in an appropriate spot. Using these methods, kept with the idea that all children with ASD “can be trained.” It was important to recognize here that these are children you are teaching.

Lovaas’s work helped us understand the interventions being implemented for children and individuals on the spectrum, which led to creating a more personalized and not so much of a one-size-fits-all approach. The turning point was to ensure that the individual needs of each child were being met as those on the spectrum have unique strengths, challenges, and preferences. Although DTT is still present, the key was to create individualized plans and understand the child’s unique needs. This leads to a less rigid and more flexible intervention plan.

Tailoring interventions to the specific behaviors and assessing each child’s developmental level, learning style, and social-emotional needs created a more personalized and unique treatment plan for children to be seen as a whole.

What Makes an ABA Therapy Plan “Personalized”?

1. Client-Centered ABA Interventions: Creating person-centered interventions took into account the child’s preferences, motivations, and family dynamics. Naturalistic teaching gives teaching in natural settings a way to generalize skills in the child’s natural environment. Incidental instructions can be provided to children during their playing. For example when learning colours instead of using flashcards, if the child is playing with blocks, working on colours can be implemented by teaching the colour of the blocks.  Functional communication training (FCT) teaches alternative behaviours to harmful ones. For example, if a child wants something from the grocery store and flops, teaching the child to request that item, with pictures or requesting on the tablet, can help minimize that behaviour in real-time. 
2. Positive Behavior Support (PBS): PBS is an approach rooted in ABA  that uses positive reinforcement and support strategies rather than punishment as ABA in the past, has the controversy of aversive behaviour management. PBS looks at respect for the child, social validation, dignity, normalization, and inclusion, as the approach helps to develop person-centred support within the interventions. 
3. Integration of therapeutic models: A wide range of therapeutic models, including developmental psychology, social learning theory, The Early Start Denver Model (ESDM) Acceptance and Commitment Therapy (ACT), Mindful Based Therapy (MBCT), and cognitive-behavioral therapy (CBT) have been incorporated into ABA. By doing so, ABA can take a more holistic approach to addressing behaviour change, emotional development, mental health, mindfulness, and self-regulation in treating the whole child.
4. Evidence-Based Practices: Data-driven approaches and continuous monitoring of progress became increasingly important in ABA during the 2000s and 2010s. By analyzing this data, interventions were tailored and designed based on ABA practices. This includes, 
   1. Collecting the data to understand the frequency, duration, and intensity of behaviours
   2. Analyzing the Data using software tools to look for patterns of behaviour and trends over time
   3. Looking and recognizing any progress to adjust the treatment plan when required. 
5. Focus on clear goals & family care: Families are becoming increasingly involved in the intervention process, with an emphasis on empowering caregivers to play an active role in the treatment process. A trained family member or caregiver helps with accessibility to treatment as well as helps to reduce stress by developing and working on strategies within the home that are most prevalent. 

The therapist works closely with family members to ensure that the strategies are being implemented consistently at home and that the approach aligns with the values and goals of the family to reduce stress and help improve treatment across varied settings. For example, if the child is having a lot of behaviours at home due to transitions, therapists can engage the family in tracking the behaviours, to understand what happens before and after, then implement replacement behaviours, timers, or transition time to help the family members work on these at home.

ABA Therapists’ Role in Personalizing Treatment Plans and Services

The importance of having collaboration among families, professionals, and community members are all required to have a team-based approach. ABA therapists need to work closely with families, school staff, and other professionals to have a personalized treatment plan in order for the success of the child. Having a collaborative approach helps work on the generalization of the child or student’s goals in various settings.

When working together with families it is important to  ask and discuss: 

1. The child’s strengths and interests
2. Family routines and environment
3. Goals and expectations
4. Challenges and barriers caregivers face
5. Parent Training and Involvement throughout the process

When working with other professionals such as school, occupational therapists, speech therapists, or other professionals it is important to discuss: 

1. Being consistent in treatment – at school, home, and across the community
2. Setting goals in collaboration
3. Observations and things other professionals notice
4. Therapies implemented and a multidisciplinary approach
5. Motivations and reinforcements that work

Customization of Techniques and Strategies

When personalizing treatment plans in ABA settings, it is important to customize different techniques and strategies used in sessions and outside of sessions. What may work in one setting may or may not work in a different setting. Many children receiving ABA therapy also Some children with ASD have co-occurring conditions such as ADHD, anxiety, or sensory processing disorders. Customizing techniques are important in addressing the child’s needs and creating a comprehensive and more holistic way of interventions. Remaining flexible is always important when working with children, but especially important in working with these interventions for children with developmental or co-occurring conditions.

Addressing the Challenges in Implementing Personalized Plans

It is important to note that ABA therapists and professional standards increase access to qualified therapists can decrease, due to the amount of professionals minimized in certain rural areas. There is a need to address this through virtual practices and sometimes personalized treatments in virtual settings can be missed, such as not having access to direct contact, and shaping or reframing challenges in behaviours.

Personalized plans by the school system are harder as the worry of inclusion is something that needs to be addressed. Within schools, there are new implementations for students on the spectrum to be included in the mainstream classroom due to Ontario Regulation 181/98 which requires the school boards to consider placing students with exceptionalities into regular classes. It is important to recognize equity and inclusion, for children with exceptionalities, however, addressing personal and individual needs are also required to set a student with ASD up for success.

The Future of Personalized ABA Therapy in Ontario

Data collection and technological advances look at implementing more personalized plan by having more accurate and ready to be analyzed data that can create a more accurate way for treatment. It is important to think about how technology can be implemented across various settings to be seen by professionals and families in one space. Therapy can be generalized in a quicker manner and understood easier throughout various settings, be more personalized to their goals and implemented in the same manner. Working collaboratively with professionals and family members creates a greater outcome and development in skills for the child.

Conclusion

It is important to explore the growing trend in Ontario towards personalized ABA therapy plans that cater to the unique needs of each student or child. With understanding the rigidity and structure of ABA therapy in the past, it is clear that tailored treatment plans for children on the spectrum are required for the child’s unique needs. Individualized interventions and personalized treatment in therapeutic settings help to reduce stress for families, reduce behaviours, and help children with ASD as a whole. Working collaboratively with various professionals can help work on treatment goals and provide insight in various settings to help clients succeed and generalize their skills.

Call to Action

The Insight Clinic has many therapists who can help you manage stress, anxiety, and treatment plans for yourself or your child. At The Insight Clinic, we can help you manage burnout, depression, anxiety, and financial burdens as well as provide resources for Autism & ABA therapy. If you are a parent struggling with managing the behaviours of a child with autism, are anxious, or are struggling with finding options, The Insight Clinic can provide you with a therapist to cope with the anxieties and struggles by using Acceptance and Commitment Therapy as well Mindful Based Practices, Cognitive Behavioural Therapy or other Interventions.

You can reach out today to book an appointment with our skilled and trained therapists to help you gain understanding and develop healthier coping strategies when you are feeling anxious, or developing these maladaptive thought patterns.

In collaboration with The Insight Clinic, ABA Academy leads with a focus on excellence and focuses on providing individual ABA Interventions for your child’s growth in social, cognitive, emotional, and physical developmental growth and milestones. ABA Academy provides high-quality, individualized & personalized treatment plans that involve you in the process of creating effective services to help your child grow and learn. These services are provided by a fully licensed and qualified BCBA. Reach out today to see if ABA Academy is the right fit for your child’s ABA services and allows better transitions in schools.