Applied Behavior Analysis (ABA) is a widely recognized, evidence-based therapy that is used to teach

new skills and address challenging behaviors, particularly in individuals with Autism Spectrum Disorder
(ASD). In Pakistan, as in other parts of the world, ABA is being implemented with a focus on adapting
strategies to the local cultural context. Applied Behavior Analysis (ABA) is a systematic approach
to understanding and modifying behavior. The techniques are implemented in a structured, step-
by-step manner. Here's a breakdown of key ABA strategies with step-by-step instructions and
examples tailored to a Pakistani cultural context.

1. Functional Behavior Assessment (FBA)

Before any intervention, a thorough assessment is conducted to understand the function of a

behavior. This is a crucial first step.

 Step 1: Define the Behavior. Clearly describe the behavior in observable and
measurable terms.
o Example: Instead of saying, "The child acts out," a therapist would define the
behavior as, "The child throws a toy on the floor, yells, and hits their head with
their hand."
 Step 2: Collect ABC Data. An ABC analysis tracks the Antecedent (what happened
right before the behavior), the Behavior itself, and the Consequence (what happened
immediately after).
o Example: A therapist or parent might record data for a week.
 Antecedent: "Mother asked the child to turn off the TV to eat lunch."
 Behavior: "The child yelled 'nahi!' (no!) and threw the remote."
 Consequence: "The mother, to avoid a bigger tantrum, turned the TV
back on."
o By collecting this data, the team can identify a pattern: the child's behavior is a
way to escape a non-preferred task (turning off the TV) and gain access to a
preferred activity (watching TV).
 Step 3: Formulate a Hypothesis. Based on the ABC data, the team determines the
function of the behavior (e.g., to gain attention, to escape a task, to get an item, or for
sensory stimulation).
o Example: The hypothesis is that the child throws the remote to gain access to the
TV.

2. Discrete Trial Training (DTT)

This is a structured and intensive teaching method where skills are broken down into small,
manageable steps. Each step is taught through a series of trials with a clear beginning and end.

DTT is a structured teaching method used to teach new skills in a controlled environment.

Example: A therapist is teaching a child in Lahore to identify common fruits. In a DTT session,
the therapist might present a picture of an apple and say, "Say 'apple'." When the child says
"apple," they are immediately given a small piece of candy or a favorite toy as a reward. The
process is repeated multiple times to ensure the skill is learned.
  Step 1: Set up the Environment. Choose a quiet, distraction-free space. The therapist
and child sit face-to-face.
o Example: This might be a separate room in the home, away from the hustle and
bustle of a busy Pakistani household. The therapist uses a simple table and chairs
to minimize distractions.
 Step 2: Present the Discriminative Stimulus (SD). This is the instruction or cue. It
should be clear and concise.
o Example: The therapist holds up a picture of a mango and says, "What is this?" in
Urdu: "Yeh kia hai?"
 Step 3: Use a Prompt (if needed). If the child doesn't respond or responds incorrectly,
the therapist provides a prompt to guide the correct response.
o Example: If the child doesn't respond, the therapist might use a verbal prompt,
"Yeh aam hai" (This is a mango), or a gestural prompt by pointing to the picture.
 Step 4: Wait for a Response. The therapist waits a few seconds for the child's response.
 Step 5: Provide a Consequence.
o Correct Response: The child says "Aam." The therapist provides positive
reinforcement immediately: "Shabash!" (well done!), and gives the child a small
piece of mango to eat.
o Incorrect Response: The child says "Apple." The therapist provides a neutral
correction, "Try again," and repeats the SD with a more intrusive prompt.
 Step 6: Record Data and Move to the Next Trial. After each trial, the therapist records
whether the response was correct, incorrect, or prompted. The process is repeated
multiple times to ensure the skill is learned.

3. Natural Environment Teaching (NET)

Unlike the structured DTT, NET integrates learning into the child's natural environment and
daily routines. The lessons are child-led, and the reinforcement is directly related to the activity.

NET is a more play-based, child-led approach where skills are taught within the natural flow of
daily life.

Example: During playtime, a child in Islamabad is playing with their favorite car. The therapist
might hold the car and wait for the child to look at them and gesture or say, "car." When the
child does, they are immediately given the car to play with. This makes the learning a natural and
motivating part of their day.

 Step 1: Identify a Learning Opportunity. The therapist or parent observes the child's
interests and identifies a teachable moment.
o Example: A child is playing with toy cars. The therapist sees an opportunity to
teach the child how to ask for a preferred item.
 Step 2: Create a Motivating Situation. The therapist might "sabotage" the game by
holding onto the favorite car. This creates a clear motivation for the child to
communicate.
 o Example: The therapist holds the red car, which the child wants to play with.
 Step 3: Prompt the Desired Behavior. The therapist waits for the child to make a
communication attempt (e.g., reaching, making a sound, or saying a word). If they don't,
the therapist prompts them.
o Example: The therapist prompts the child by asking, "Which one do you want?"
and models the word "Laal" (red).
 Step 4: Reinforce Immediately. When the child correctly communicates ("Laal car"),
the therapist immediately gives them the car. The reward is directly related to the
communication and makes the learning meaningful.
o Example: The therapist says, "Yahan hai laal car!" (Here is the red car!), and
gives it to the child. The child gets to play with their favorite toy, reinforcing the
new communication skill.

4. Functional Communication Training (FCT)

This strategy focuses on teaching a child a more appropriate way to communicate their needs and
wants, replacing challenging behaviors.

FCT is used to replace challenging behaviors with more appropriate communication skills.

Example: A child in Peshawar often throws toys when they want a break from an activity. An FCT plan
would involve teaching the child a new, functional way to express this need, such as using a picture card
that says "break" or learning to say "bus" (enough). When they use this new skill, they are immediately
given a break, and the toy-throwing behavior is no longer reinforced

 Step 1: Identify the Behavior and its Function. As determined by the FBA, the child's
hitting behavior is used to escape homework.
 Step 2: Choose a Replacement Behavior. A simple and easy-to-use communication
method is chosen.

Example: The child is taught to say "Bas" (enough) or "Chutti" (break) when they feel frustrated
with homework. For a non-verbal child, a picture card with an image of a break is chosen.

 Step 3: Teach the Replacement Behavior. The therapist or parent prompts the child to
use the new communication skill right before the challenging behavior would normally
occur.

Example: When the child starts to show signs of frustration with their homework, the parent
proactively prompts them, "Chutti?" and helps them use the picture card.

 Step 4: Reinforce the New Behavior and Ignore the Old.

o New Behavior: When the child uses the "Chutti" card, the parent immediately
gives them a short break. This positively reinforces the new skill.
o Old Behavior: If the child starts to hit, the behavior is ignored (as long as it is
safe to do so), and the child is redirected back to the task or to using the
communication card.
Positive Reinforcement: This is a fundamental principle of ABA. It involves providing a reward or
positive consequence immediately after a desired behavior occurs. The goal is to increase the likelihood
of that behavior happening again in the future

Example: A child in Karachi is learning to say "pani" (water) to ask for a drink. Each time they
correctly say the word, their mother immediately gives them a small sip of water and says,
"Shabash!" (well done). Over time, the child learns that saying "pani" results in getting water.

Discrete Trial Teaching (DTT): This is a structured and intensive teaching method where skills
are broken down into small, manageable steps. Each step is taught through a series of trials with
a clear beginning and end.

Example: A therapist is teaching a child in Lahore to identify common fruits. In a DTT session,
the therapist might present a picture of an apple and say, "Say 'apple'." When the child says
"apple," they are immediately given a small piece of candy or a favorite toy as a reward. The
process is repeated multiple times to ensure the skill is learned.

Antecedent-Behavior-Consequence (ABC) Analysis: This is a core tool in ABA for

understanding the "why" behind a behavior. It involves analyzing what happens before the
behavior (antecedent), the behavior itself, and what happens after the behavior (consequence).
This analysis helps in designing effective interventions.

Example: A child in Faisalabad starts to hit their head (behavior) whenever their mother asks
them to stop watching cartoons on TV (antecedent). The mother's typical response is to give the
child the TV back (consequence). An ABC analysis would reveal that the head-hitting is a way
for the child to get what they want. The intervention would then focus on teaching the child a
better way to respond to the antecedent, such as using a "first-then" strategy ("First, we will turn
off the TV, then we can have a snack").

Prompting and Fading: Prompts are cues or hints that help a child perform a new skill.
Fading is the gradual reduction of these prompts until the child can perform the skill
independently.

Example: A therapist is teaching a child in Karachi to correctly use a spoon to eat. Initially, the
therapist might use a hand-over-hand prompt to guide the child's hand (most intrusive prompt).
As the child becomes more proficient, the therapist might move to a gentle touch on the child's
wrist, then a verbal cue, and eventually no prompt at all.

Cultural Adaptation in Pakistan

 Language and Social Skills: ABA can be used to teach social skills relevant to Pakistani
customs, such as how to greet elders by saying "Salam" or "Adaab," or how to sit
respectfully at a family gathering.
 Reinforcers: Reinforcers are chosen based on the child's preferences, which might
include favorite Pakistani snacks (like pakora or jalebi), listening to a favorite naat, or
getting to play a popular game.
 Parental Involvement: Given the strong family structure, parents are often key players
in the therapy. Training parents and family members to use these techniques at home is
essential for the child's success. This is often done through parent training sessions and
home visits.