Integrating ABA and Speech Pathology

I am a speech language pathologist in a school-based program that relies heavily on Applied Behavior Analysis (ABA). What is important to know about this approach and its implications for my role? In what ways can I support this school-based program?

Answered by Barbara Esch, PhD, BCBA, CCC-SLP Esch Behavior Consultants, Inc.,

and

Elizabeth G. Dyer, MA, CCC-SLP

These are important questions and indeed there is much to consider. We invited two speech language pathologists to respond to your questions.

What is important to know about this approach and its implications for my role?

Answered by Barbara Esch, PhD, BCBA, CCC-SLP Esch Behavior Consultants, Inc.

First, kudos to you for your interest in ABA and your desire to be supportive! Speech language pathologists are ideal professionals to be included on an ABA team since its members are focused on providing effective and efficient instruction, much of which is geared toward speech and language acquisition.

Probably the most important issue is to understand what makes an Applied Behavior Analysis (ABA) approach different from more traditional instructional approach. Many people have heard the term “ABA” but aren’t sure what it means or what ABA involves.

A breakdown of the terms is helpful. First, applied simply means that as behavior analysts we select behaviors to teach that are socially significant (language, reading, play and leisure skills, following instructions, and so on) and that we use behavior analytic principles to teach those behaviors. The term behavior refers to responses (teaching targets) that we can observe and measure so we can track when they occur. This way, we know if these important behaviors are increasing as a result of our teaching. It’s not possible to observe and measure fuzzy terms like communication or neatness unless we describe what we mean by these concepts. It IS possible, though, to observe and measure concrete behaviors such as when a child asked for juice or greeted 3 classmates by name or put all toys in toy box so this is why we’re careful to define teaching targets very specifically. Finally, in order to troubleshoot learning difficulties, we use analysis to look at the effect of environmental conditions that occur around a particular target behavior. As behavior analysts, we look at events before the response, such as instructions and prompts, and consequences that occur after the response such as praise, toys, edibles, or access to activities. When we know what happens in the environment before and after the child responds in some way, we have a better idea about how to strengthen those responses we’d like to increase. We also have more information about how to teach new, more appropriate behaviors to replace some that may be less desirable.

The overall goal of a language-based ABA program is to equip students who are not currently learning with specialized instruction (often 1:1) so they can acquire the skills necessary to be successful in more typical classroom settings. Then the goal is to gradually reduce or eliminate the individualized support. In other words, we’re teaching children the foundation skills they need to respond accurately and appropriately in a group setting, skills that most typically developing children already have by the time they enter kindergarten.

How is an ABA program different from typical instruction? If they’re carefully designed, these language-based classrooms are unique in a number of ways:

  1. A commitment to evidence-based teaching means that providers are using methods that have been shown to be effective through published scientific research.
  2. Data based decision making relies on daily data collection and analysis of learning variables to guide teaching and new target selection.
  3. Errorless learning techniques are used to promote rapid skill acquisition. This involves prompting and reinforcing correct responses before errors occur. For example, when teaching a child to name a picture of a horse, the therapist might ask “What’s this?” and then prompt “horse” before the learner gives an incorrect response. Prompts can then be faded as appropriate.
  4. Intensive, individualized instruction provides opportunities for repeated practice and reinforcement of skills each day.
  5. Expressive language is taught across the 4 basic, all-important language functions of requesting, labeling, repeating, and conversing.
  6. Generalization procedures are used to ensure that learned responses are used broadly across language functions, settings, situations, and people.
  7. Positive consequences, based on the student’s current motivation, are systematically used to maximize learning.

Speech language pathologists who have expertise in these 7 areas are highly valuable to ABA programs. Whether working within the ABA classroom or in a separate therapy setting, a therapist with these skills translates into double-benefit for a learner since all of his or her instruction will be similarly focused in these highly effective areas.

Often, speech language pathologists working in ABA programs are asked to weigh in on decisions about selecting an appropriate communication mode for a learner. Although speech is by far the most desirable choice (it’s fast, easy, accessible, and cheap), some learners may not easily acquire vocal speech and so other communication systems must be considered. Two of the most common alternatives are sign language and picture communication. From a behavioral perspective, there are pros and cons to each of these and neither system should be recommended wholesale for entire classrooms but, rather, should be carefully determined according to their benefits for each individual learner. For an excellent discussion of the advantages and disadvantages of sign language and picture communication systems, I recommend Sundberg and Partington’s 1998 teaching manual Teaching Language to Children With Autism or Other Developmental Disabilities (chapter 4; see reference below).

For behaviorally oriented speech language pathologists, there are a number of other resources to check out.

For language-related curriculum assessment and teaching, I recommend:

  • The Verbal Behavior Milestones Assessment and Placement Program: The VB-MAPP by Mark L. Sundberg
  • Teaching Language to Children With Autism or Other Developmental Disabilities by Mark L. Sundberg and James W. Partington
  • Assessment of Basic Language and Learning Skills by James W. Partington and Mark L. Sundberg
  • The Verbal Behavior Approach: How to Teach Children With Autism and Related Disorders by Mary L. Barbera
  • Other useful resources:
  • Speech Pathology Special Interest Group (SPABA), Association for Behavior Analysis
  • The Journal of Speech Language Pathology and Applied Behavior Analysis
  • Cambridge Center for Behavioral Studies

In what ways can I support this school-based program?

Answered by Elizabeth G. Dyer, MA, CCC-SLP
Treasurer, Association for Science in Autism Treatment

This is an excellent question, and one which is asked frequently. Although some in my field may harbor some misconceptions about ABA, I believe this type of programming meshes very well and rather easily into what we do as speech language pathologists. Many people assume that ABA is only referring to discrete trial instruction, when in fact it encompasses that plus other teaching techniques which we tend to be much more familiar with, including (but not limited to) incidental teaching, and, yes, promoting the generalization of skills (across settings, people, etc.). Furthermore, the commitment to data collection and analysis that we see within ABA should absolutely be embraced by all providers on a team.

Your level of involvement can be what you and your team choose it to be. Given that the basis of the ABA programming is to develop receptive and expressive language skills and to promote the use of those skills in social contexts, we can be instrumental members of the team. Our training, knowledge and experience lend themselves well to providing input on appropriate speech and language targets. For instance, when a child has an articulation or phonological disorder and he or she also works on “Verbal Imitation” and/or “Phrase Imitation” within the ABA program, it is important that we have input into the sounds/words/phrases being targeted. If the child is not yet ready to be producing the /r/ sound, it would not make sense for words or phrases including that sound to be practiced. Other members of the team may not be as well-versed in sound acquisition and may not be able to make those determinations. Additionally, we can provide the appropriate targets which the child is ready and able to practice and thereby create a situation where the child is not only producing the sounds/words/phrases on a daily basis, but data is being collected on it for us to see across instructors! This is a win-win situation. Other areas where we can also be very helpful is identifying appropriate vocabulary selection, syntactical structures, determining appropriate mean length of utterance (MLU) for sentence imitation, offering input into other expressive language expectations, and generalization of skills across settings and communicative partners (after all, conversing with ABA instructors and conversing with same age peers is not necessarily the same skill set). Finally, we have much to offer with respect to assessment and training related to augmentative communication systems.

It is important to not overlook the benefits we receive from being a part of this type of team as well. Behavior management strategies derived from a functional assessment, systematic approach to skill development, careful selection of prompts and prompt-fading procedures, detailed data collection and analysis of said data all come to mind, along with a myriad of others. I would encourage you to learn as much as you can in those areas.

It is essential that consultation and collaboration be included. Time must be spent discussing goals, progress, instructing and guiding providers so that items are targeted appropriately. It is invaluable having providers attend speech language therapy sessions, and, in turn, observing them during their sessions. Consultation can also focus upon observing the student in the full array of school settings. Having a team of dedicated professionals all on the “same page” is the key to successful programming. With this in place, the sky’s the limit!