below: Erika Wilhelm, a second-year ABA student, relies on her clipboard to record behavioral changes in a play-based setting.
A 75-year-old discipline Tracing its roots back to the 1930s and Skinner’s work with operant conditioning, ABA developed from the experimental psychologist’s fascination with the intersection of environment and behavior. All human actions, he came to believe, occur in the presence of environmental stimuli and can be altered by varying those stimuli.
“ABA techniques, when provided consistently and intensively as early intervention, can—and do—virtually eliminate the diagnosis of autism in young children... As dramatic as that sounds, for those of us who do this every day, it’s just an accepted fact.”
The concept of behavior analysis—or radical behaviorism, as Skinner termed it—represented a departure from prevailing psychological theory, which attributed actions instead to internal factors such as emotions and feelings. Fast forward to the 21st century, when 135 universities— including 28 outside the United States—have approved course sequences to prepare behavior analysts, and a national organization oversees the certification of the approximately 6,000 board-certified behavior analysts (BCBAs) and associate behavior analysts (BCABAs). It is a rapidly growing profession that has doubled its number of certificants in the past five years, from 2,838 in 2003 to 5,948 in 2008. Although the field’s growth can be attributed largely to increasing demand for skilled professionals, Dr. Gerald Shook, chief executive officer of the Behavior Analyst Certification Board (BACB) admits that there is not a way to accurately quantify the need. “There is no doubt that we need more BCBAs but exactly how many is a hard question to answer—except to say that there are more people interested in the profession, more people getting certified, and more schools introducing programs to train them. And every single graduate gets a job,” Dr. Shook says. One area of shortage is in the specialty that Dr. Mozzoni practices. Every year, 99,000 Americans receive brain injuries that result in lasting disability; this includes combat veterans (the Veterans Administration estimates that TBI affects 22
percent of military personnel who have been wounded in action) and survivors of motor vehicle accidents, strokes, heart attacks, and near drowning. “There are only between 50 and 100 of us who have been trained specifically to work with brain injury in this country,” Dr. Mozzoni says. “Although more and more people are going into ABA every year, the majority are going in it to work with autism— that’s the area that is getting the most public attention.” One indicator that ABA is receiving increasing recognition as an effective treatment for some areas of disability is changing health insurance laws. “A number of states are now requiring that treatment by a BCBA—particularly for autism and other developmental disabilities—be included among services eligible for insurance coverage,” Dr. Shook says. He cites TRICARE, the health plan that covers military families, which now pays for ABA services for children with autism, as long as providers are BACB certified. One Field, Many Applications One does not need to be institutionalized or disabled to benefit from behavior analysis, which is now used throughout the world. (BACB data shows that the organization certifies professionals in 28 countries and on five continents.) It is used by Fortune 500 companies to improve workplace environment, and by organizations of all kinds to solve management problems. Its use in sports, health, and fitness, which dates back at least to the 1970s, has helped improve golf swings,