Scientific research has shown that applied behaviour analysis is the way forward for children with autism and other developmental disabilities. Simonne Pace finds out that this therapy is not funded by the Maltese government.
More than 100 children with autism are undergoing applied behaviour analysis (ABA) therapy by behaviour analyst Gabriella Barrientos, who is in Malta to carry out consultation work for HandinHand Malta, an organisation that offers children a range of therapeutic services.
HandinHand Malta managing director Jacqui Abela Degiovnni said the therapy was currently being funded out of the parents’ pockets.
ABA therapy is the only government-funded service in the US that focuses on behaviour and HandinHand is the only organisation that provides it in Malta.
“We hope to get ABA therapy funded by the government in Malta and have it as an accepted practice,” said Ms Barrientos, whose husband is temporarily based at the US embassy in Malta.
“Towards this aim, we will be presenting government with the research behind this therapy – brought about in the 1960s – which sheds light on clients who started intervention as young children and how they’ve progressed into adulthood.”
ABA therapy helps children with various developmental disorders, not just autism. It can be applied across a person’s entire lifespan, from children under three up until adulthood.
“ABA varies according to age, so the types of services opted for depend on the child’s age and functional level. This therapy works because it’s very evidence-based. Actually, it’s the only evidence-based service available for children with developmental disabilities, with around 550 current studies supporting it.”
When a child starts ABA, data is first collected, after which an initial assessment is carried out to determine the child’s baseline, and goals are then implemented. Every six days, these goals are re-evaluated to determine if the child is making progress. The data is then generated into a graph and “what you want to see is improvement. If you don’t, then you make changes to the programme,” Ms Barrientos said.
“I tell families the therapy is very black and white. Nothing is hypothesised.”
Ms Barrientos is slowly meeting up with the 110 children and their families attending HandinHand and offering the therapy.
After an initial consultation with Ms Abela Degiovanni to find out where the child stands, she looks at the data, meets the family and then assesses the child.
“The family is present for this assessment and the actual therapy takes place in the presence of both the child and the parents. ABA teaches children how to fish instead of giving them the fish, so they can fish on their own for the rest of their life. Each family first receives six hours of intensive ABA training – without the child – to be able to deal with the situation. Once they’ve done that, training is individualised per child.”
Ms Barrientos, who is accredited by the Behaviour Analysis Certification Board, compares ABA therapy to a medical prescription.
ABA therapy is very black and white. Nothing is hypothesised
“If you miss sessions, it will affect progress. This is why we offer parents six hours of intensive training – to provide them with the right information and to make them understand that consistency is crucial.”
The therapy looks at their child’s functioning level, their availability to provide the service, their concerns and the appropriate time to practise certain goals.
Applied behaviour analysis can go on until adulthood but the service changes as it goes along. Initially, children under eight receive discrete trial training (DTT), whereby they sit in a one-to-one setting learning rote drills and repetition.
“We then take those drills and generalise them into the community. After the child turns eight, therapy moves from DTT to a much more environmental-friendly type of service, where we look specifically at behaviours and skill deficits and teach those. The therapy is also very much focused on verbal behaviour – we teach the child how to speak vocally and echoically, how to communicate their wants and needs,” said Ms Barrientos, who has taught children and adolescents – whose vocal behaviour wasn’t necessarily through language but adaptive technology – to speak on iPads, use a picture exchange system or sign language as an additional form of communication.
“In the early stages we focus mostly on vocal language and teaching the child to communicate. It’s definitely a lot of work but you see results. That is why we push parent training, because they can help immensely.”
Ms Abela Degiovanni, who will be completing her MSc in Applied Behaviour Analysis next month and will eventually obtain her BCBA certification, said ABA was an all-aspect therapy. “We work in a contained environment but it doesn’t stop there. One of the biggest differences between traditional therapies and ABA is the data collection, upon which all decisions are based.”
The principles of applied behaviour analysis focus mainly on behaviour, “so we’re not in the business of solely removing tantrums or behaviours we don’t want to see. The therapy is also about building skills and looking at the child’s strengths,” Ms Barrientos said.
“Part of the ethics of applied behaviour analysis is educating others, expanding beyond that and building a community base to ensure that all children’s needs are met.”
HandinHand is providing in-home services for children needing ABA therapy and training more professionals to offer the service.
www.handinhandmalta.com/