Applied Behavior Analysis Intervention Can Improved Behaviors and Social Skills among Children with Autism

Research Article

Austin Child Adolesc Psychiatry. 2021; 5(1): 1014.

Applied Behavior Analysis Intervention Can Improved Behaviors and Social Skills among Children with Autism

Yousefi M1*, Jafari A2, Khalili M2, Meshkat F3 and Meshkat A4

1Department of Psychology, Islamic Azad University, Urmia, Iran

2Afagh Higher Education Institute, Urmia, Iran

3Urmia University of Medical Sciences, Urmia, Iran

4Dentistry Student, Externship, CUDF, Sivas, Turkey

*Corresponding author: Mahnam Yousefi, Department of Psychology, Islamic Azad University, Urmia, Iran

Received: April 07, 2021; Accepted: May 01, 2021; Published: May 08, 2021


Background: Children with Autism Spectrum Disorders (ASD) are at particular risk of impairment in social interaction, repetitive and stereotyped behaviors, and a poor quality of life. We tested whether applied behavior analysis intervention could, compared to a control condition, reduce repetitive and stereotyped behaviors, and increase social skills and thus enhance the quality of life among children with ASD.

Methods: Thirty children with ASD (mean age: 6.5 years) were randomly assigned either to applied behavior analysis intervention or to a control condition. All participants completed Gareth test on stereotypical behaviors, social communication, and interaction skills at the following time points: baseline, and six months later at completion of the intervention.

Findings: Stereotypical behaviors, social communication, and interaction skills improved over time from baseline to intervention completion, but more so in the applied behavior analysis intervention than in the control group. Compared to the control group, the applied behavior analysis intervention group reported had more positive scores.

Conclusion: The findings suggest that among children with ASD and compared to a control condition, applied behavior analysis intervention has the potential to improve symptoms of autism, thus contributing to their quality of life.

Keywords: Children; Autism spectrum disorder; Applied behavior analysis; Social skills; Stereotyped behavior


Autism Spectrum Disorders (ASD) is a developmental disorder characterized by impairments in social interaction and communication, and behavioral deficits and limited behavioral patterns [1]. Moreover, people with ASD are likely to show a variety of comorbid disorders, including attention deficit and hyperactivity (ADHD), mental and motor retardation, and depression [2,3]. Further, children with ASD show delay in social, language, and symbolic game developments compared to healthy children. The global mean prevalence of ASD in the general population is 10 cases per 10 thousand and the diagnosis is most often made in child age. Moreover, recent study on the prevalence of ASD showed 1 in every 100 births [4].

Compared to the general population, children with ASD have shown behavior deficits such as stereotyped movements, aggression, and self-harm [5]. Further, they are in trouble for understanding and using the rules of social behavior [6,7], interactive gestures and non-verbal behavior [8-10], and motor coordination [9]. High or low sensitivity to auditory, olfactory, tactile, and visual stimuli has often been reported in children with ASD [11]. In addition, children with ASD have a more impaired motor function and are also less physically active than healthy children [12].

Further and based on previous studies, varieties of interventional programs have been used in promoting social development, and decreasing maladaptive behaviors in children with ASD. According to Green and colleagues [13] and Hess and colleagues [14], there are many approaches such as diets and vitamins, speech therapy, and music therapy in reduction of ASD symptoms. Some of these treatments or intervention programs have some positive effects on the development of children with ASD. Multimodal treatments including medication [15], physical activity interventions [16], sensory integration training [17], antidepressants, counseling, physical and occupational therapy are typically employed to alleviate the symptoms of ASD. However, although Applied Behavioral Analysis (ABA) intervention is commonly recommended [18], research regarding their potential as an alternative or add-on treatments is still in an early stage. ABA is derived of principles of behavior therapy, such as operant conditioning. ABA is the framework of a three-term contingency of operant conditioning, which includes the events that precede behavior, the behavior itself, and the stimuli that follow the behavior.

To decrease autistic symptoms, O Lovaas, T Smith and J McEachin [19] developed ABA training in people with ASD with parents engagement, and showed this technique has positive impacts on autistic symptoms. Participation of family members in the program is very important and the essential element of ABA technique [19]. For example, some studies found the effeteness of ABA intervention with parents engagement in children with ASD [20]. Furthermore, Anderson and colleagues showed that ABA training had a positive effect on children with ASD and they showed that more and sustained recovery was created in children who were trained for two years [21]. Previous studies found the positive effects of ABA training on children with ASD for 6 consecutive months compared with the control group. The results showed that this method was effective on symptoms of ASD in these children. However, in the some study, stereotypical behaviors, and social skills were not measured [22]. Therefore, the present study is aimed at behaviors and social skills as output.

In children with ASD, inadequate environmental stimuli and interventional programs were reported as the main reason for social development delays, reduced social engagement and poor behavior skills. Although previous studies have been conducted to improve these skills among children with ASD [14,22,23], further research is needed to determine the effects of intervention programs specifically regarding social and behavioral deficits. Additionally, knowledge of behavioral impairments of children with ASD is important for psychologists and occupational therapists. Most importantly, longterm interventions in children with ASD have been neglected in most studies and usually treatment methods were periodically and in the short-term. Moreover, in most studies children with ASD were not prepared to enter to schools after the intervention [22]. Accordingly, the main purpose of the present study was to examine the effects of a 6-months ABA training on stereotyped behaviors, and social skills in a sample of children with ASD, compared to a control condition.

The following two hypotheses were tested. First, based on previous research [23], we expected that participation in ABA training would be associated with a decrease in stereotypical behaviors over time compared to a control condition. Second, on the basis of previous studies [23] we expected that ABA training would lead to an increase in social skills over time compared to a control condition.

We believe that the ABA training intervention has the potential to help psychologists, parents and coaches improve social skills and motor control of children with ASD.



A total of 30 children with ASD (mean age: 6.5 years; SD=2.17) took part in the present study. Inclusion criteria were: (1) children diagnosed with ASD; (2) age between 4 and 8 years; (3) a diagnosis of poor motor coordination (based on Movement Assessment Battery (MAB) criteria; Manual dexterity total ≤22), (4) the ability to follow a minimum of two-step instructions; (5) Getting a score from 75 to 115 in Gilliam Autism Rating Scale (GARS), (6) the ability to walk 10 meters without assistance and (7) parents signed written informed consent. Exclusion criteria were: (1) neuromusculoskeletal disorders or severe sensory impairments; (2) intake of arousal medications or substances; (3) orthopedic problems (orthopedic surgery one year before intervention); (4) injection of botulism toxin 6 months before intervention; (5) uncorrected visual impairment and (6) absenteeism in educational sessions (more than 2 sessions).


Participants’ parents were fully informed about the aims and the procedure of the study, and the anonymous data handling. They all signed the written informed consent sheet and children gave their assent (verbally or by gesture) to participate in the present study. At baseline, stereotypical behaviors and social communication were tested. Next, the participating children were randomly assigned to one of the following conditions: 1) ABA training, and 2) control condition. The intervention lasted 6 months including three training sessions per week. Participants’ stereotypical behaviors and social communication were tested immediately after completion of the intervention (Figure 1). The Review Board of the Islamic Azad University (Urmia, Iran) approved the study, which was performed in accordance with the ethical principles laid down in the seventh and current edition (2013) of the Declaration of Helsinki.