*3.12.1. Purpose of the technique*

highly discouraged, as it can lead to unhealthy eating habits and an inability to develop

Therapists using ABA must be cognizant of their surroundings and the influence of all types of reinforcement, applying a variety of positive reinforcement to keep the child focused and on track. Knowledge of what may reinforce poor behavior is as important as knowing what impacts pro-social behavior. For example, if a child seeks attention and receives it every time he or she acts out, then the attention serves to positively reinforce the acting out behavior.

Once the reinforcement is determined, ABA can begin. A commonly used form of ABA is called Discrete Trial Training (DTT). DTT identifies a specific task, then teaches the task by breaking it into its component parts and repeatedly presenting it to the child until mastery is achieved [63]. This is a repetitive process that often involves multiple presentations over days or weeks. Reinforcement occurs each time the child correctly responds, or in the case of

The seminal research for the use of ABA for children with ASD was conducted by Lovaas in 1987. This study specifically investigated DTT on a group of 4 year olds over the course of 2–3 years. Lovaas found that 47% of the children in the ABA demonstrated functional improvements, compared to only 2% in the control group. This study has been replicated numerous times across the years, with similar results, indicating that DTT improves IQ, com-

A systematic review of behavioral and developmental interventions for children with ASD was conducted by Ospina and associates [81]. In regard to ABA, this review specifically examined 31 studies with a total sample of 770 subjects. Findings related to DTT were inconsistent, with motor and functional outcomes trending positively, while speech outcomes trended negatively. High intensity Lovaas therapy was found to be superior to low intensity program-

Virues-Ortega conducted a meta-analysis of ABA and autism in 2010 [82]. The review analyzed results from 22 studies that included a total of 323 subjects in intervention groups that ranged in age from 22.6 to 66.3 months old. Results indicated positive effects in IQ (18 studies), receptive language (11 studies), expressive language (10 studies), and adaptive behaviors (communication, daily living skills, and socialization, 11 studies). The author did note that analysis was difficult due to the varying methodology used, but indicated overall that ABA intervention is associated with medium to large positive effects in IQ, language, and adaptive behavior.

Overall, research has demonstrated that ABA can be an effective therapeutic technique to teach children with ASD specific skills. Therapists utilize this technique in a variety of formats

Social-emotional treatment approaches are gaining in popularity with children with ASD as research reveals the impact of social/emotional development on all other functional areas.

Therapists need to be aware of this and modify reinforcement accordingly.

munication, and socialization in children under 4 years old with ASD [63].

ming, and treatment was consistently found to be better than standard care.

in order to help improve functional outcomes.

**3.11. Social-emotional treatment approaches**

a developing skill, when the response approximates the skill.

other motivating reinforcers [80].

18 Occupational Therapy - Therapeutic and Creative Use of Activity

*3.10.3. Review of literature*

DIR®/Floortime™ is a framework for assessment and intervention that focuses on building social, emotional, and intellectual abilities [84]. This framework seeks to assist children in creating an emotional foundation on which other skills can be encouraged to grow and develop. An important concept of this framework is that is does not seek to teach individual skills in isolation, but rather focuses on the child with ASD as a unique being that is capable of growth by establishing relationships and circles of communication within the environment [84].
