Du et al.

BMC Psychology (2024) 12:568 BMC Psychology

https://doi.org/10.1186/s40359-024-02045-5

RESEARCH Open Access

The effectiveness of applied behavior analysis

program training on enhancing autistic
children’s emotional-social skills
Geng Du1, Yuanbing Guo2,3* and Weihong Xu4

Abstract
Background This study focuses on the potential of Applied Behavior Analysis (ABA) to improve emotional and social
skills in children with autism spectrum disorder. ABA is a well-established therapeutic approach that uses behavior
modification techniques to encourage positive behaviors and reduce challenging ones. Despite its widespread use,
further research is needed to better understand its specific impact on emotional and social development in autistic
children.
Objective This research aims to investigate an effective method for improving and enhancing institutionalized
children’s social, communicative, and daily life skills. The study also examines the impact of behavioral analysis on
these children’s social and emotional skills.
Method The research is categorized as applied in terms of objectives and quasi-experimental in data collection. It
involves a control group, an experimental group, and a covariance analysis model. The research population consists
of 100 volunteer boys aged 4 to 11 residing in institutional care in Wuhan during the year 2023. Among them, 60
individuals were selected and divided into control and experimental groups, each comprising 30 participants. Data
for the study were collected using the kindergarten inventory of social/ emotional tendencies (KIST. The applied
behavioral analysis program was implemented individually for the experimental group in eight one-hour sessions
twice a week.
Findings Data analysis was conducted using SPSS-24 software and a multivariate analysis of the covariance method.
The results indicated that the behavioral analysis program significantly impacts institutionalized children’s social and
communicative skills, improving their daily lives (p < .05).

Bordini, D.; Moya, A.C.; Asevedo, G.R.d.C.; Paula, C.S.; Brunoni, D.;
Brentani, H.; Caetano, S.C.; Mari, J.d.J.; Bagaiolo, L. Exploring the
Acquisition of Social Communication Skills in Children with Autism:
Preliminary Findings from Applied Behavior Analysis (ABA), Parent
Training, and Video Modeling. Brain Sci. 2024, 14, 172. https://doi.
org/10.3390/brainsci14020172.
*Correspondence:
Yuanbing Guo
[email protected]
Full list of author information is available at the end of the article

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0
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Du et al. BMC Psychology (2024) 12:568 Page 2 of 10

Conclusion The findings of this study demonstrate that the applied behavior analysis program significantly
improves the social, communicative, and daily life skills of institutionalized children with autism spectrum disorder.
ABA interventions, delivered through structured sessions, effectively enhance emotional and social development,
confirming its value as a therapeutic approach in institutional care settings.
Keywords Behavioral analysis, Autistic children, Social skills, Emotional skills

Introduction that, compared to typically developing children, those

Autism spectrum disorder (ASD) encompasses a wide with ASD exhibit lower proficiency in daily living tasks,
range of conditions, from mild to severe, significantly requiring increased support and intervention from fami-
impacting children’s social interactions and communi- lies and caregivers [17, 18].
cation. Children with ASD often show reduced social Applied Behavioral Analysis (ABA) is a scientific
engagement and indifference to their surroundings approach that focuses on identifying and altering envi-
[1]. ASD typically manifests before the age of three and ronmental factors that influence behavior [19]. Founded
occurs more frequently in boys than in girls. Its defining on B.F. Skinner’s work, ABA emphasizes modifying
characteristics include repetitive behaviors, resistance environmental stimuli and reinforcing desirable behav-
to changes in routine, and atypical responses to sensory iors. Skinner’s research demonstrated that consistent
stimuli [2]. Early views suggested children with ASD were application of ABA exercises by parents could signifi-
untrainable, but this belief changed as specialized pro- cantly improve social behaviors in children with ASD
grams emerged to address their unique developmental [20]. Numerous studies have validated the effectiveness
needs. of ABA in addressing behavioral issues [21], improving
Classified as a neurodevelopmental disorder by the communication [22], and enhancing social skills [23] in
Diagnostic and Statistical Manual of Mental Disorders, institutionalized children. Meta-analyses further support
Fifth Edition (DSM-5), ASD is characterized by deficits its efficacy in promoting cognitive development, lan-
in social interaction, communication, language impair- guage acquisition, and adaptive behavior [24–26].
ments, and restricted, repetitive patterns of behavior [3]. Despite its widespread use, some researchers, includ-
These challenges persist throughout life, affecting multi- ing Ziv [27], argue that ABA may not always significantly
ple domains of functioning from early childhood onward reduce ASD symptoms and could potentially have nega-
[4]. Most children with ASD experience profound diffi- tive effects in certain cases [28]. Additionally, Dixon et
culties in social, emotional, and daily living skills, which al. [18] recommend that ABA should be integrated with
impede their overall development [5, 6]. other cognitive and behavioral strategies to optimize its
Social and emotional skills refer to the awareness, impact.
attitudes, and competencies required for effective inter- The primary goal of ABA for institutionalized children
personal interactions, including managing emotions, is to teach social, communicative, and daily living skills,
decision-making, and problem-solving [7]. These skills while promoting desirable behaviors and reducing unde-
also involve traits such as empathy, flexibility, and per- sirable ones. This is achieved through positive reinforce-
severance [8]. Deficiencies in social and emotional skills ment and creating learning environments that resemble
are among the most significant challenges for individuals natural settings, allowing children to generalize learned
with ASD [9]. Research in this area aims to improve the behaviors across different contexts [29]. Barlow et al. [30]
lives of individuals with ASD and their families by focus- highlighted the importance of ABA, particularly given
ing on enhancing social and communication skills [10]. the high levels of stress faced by parents and the limited
Studies indicate that individuals with ASD often lack self-help abilities of children with ASD. Marshall [31]
the emotional insight needed for effective emotional also emphasized the growing demand for ABA, especially
regulation, which leads to inappropriate emotional in countries like China, where the prevalence of ASD
responses [11, 12]. Children with ASD tend to use fewer continues to rise.
adaptive emotional regulation strategies, such as cogni- Marshall [32] through a review of research on com-
tive reappraisal, and rely more on avoidance techniques munication and emotional skills, concluded that there is
[13]. Therefore, communication skills training is essential an increasing demand for the use of Applied Behavioral
for children with ASD, as it helps them improve social Analysis in the context of institutionalized children due
connections and emotional regulation [14, 15]. to the rising prevalence of spectrum disorders world-
In addition to communication challenges, children with wide, including in China [33].
ASD—especially those who are institutionalized—often This research utilizes several key theories to explore the
struggle with daily living skills, including basic practi- cognitive and behavioral development of institutional-
cal and social competencies [16]. Research has shown ized children with ASD. The primary framework applied
Du et al. BMC Psychology (2024) 12:568 Page 3 of 10

is Applied Behavioral Analysis (ABA), rooted in Skin- Method

ner’s Behavioral Analysis. This theory emphasizes the This research adopts an applied, quasi-experimental
importance of environmental factors in shaping behav- design with control and experimental groups, utilizing an
ior through reinforcement and stimulus control [32–36]. analysis of variance model. The statistical population of
Additionally, the study integrates elements of Cognitive this study consisted of boys aged 4 to 11 living in Wuhan.
Behavioral Therapy (CBT) to address the emotional and To achieve the required sample, autistic children’s moth-
cognitive aspects of ASD. These combined approaches ers were asked through online platforms (emails) to par-
aim to improve social, communicative, and life skills ticipate in a free training program for enhancing social
by targeting both behavioral patterns and cognitive and communication skills specific to these children. In
processes. response to this request, 60 individuals expressed readi-
ness to participate in the sessions, among whom 30,
Rationale of the study meeting the conditions were selected as the experimen-
The rationale for this study stems from the need to tal group. The remaining 30 individuals, matched in age
address the specific challenges autistic children face in with the experimental group, were equally distributed
developing emotional and social skills. While the effec- among the control groups. The inclusion criteria were
tiveness of ABA in managing behavioral issues in individ- having children aged 4 to 11, a diagnosis of autism by a
uals with autism is well-documented, there is a distinct psychiatrist, and residency in Wuhan. A pre-test was
lack of research focused on its impact on emotional and conducted using a screening questionnaire for social and
social development. Autistic children often struggle with emotional disorders in preschool children, completed by
social interactions and emotional regulation, which pro- the mothers of children in both groups. Experimental
foundly affects their well-being and quality of life. By group participants received six weeks of ABA training,
focusing on these critical areas, this study aims to pro- with sessions held twice a week, each lasting one hour.
vide valuable insights into how ABA interventions can During this period, the control group did not receive
enhance emotional and social skills in autistic children. any interventions. At the end of the six-week interven-
Understanding the role of ABA in these domains is not tion, the instrument for social and emotional disorders
only academically significant but also crucial for creating in preschool children was completed by the mothers
more effective, tailored interventions that improve the of children in both groups as a post-test. Additionally,
lives of individuals with autism [37–45]. to address ethical considerations, a behavioral analysis
This study’s significance is twofold, contributing both training session was conducted for the parents of control
to academic research and practical applications. Aca- group children after the intervention, addressing their
demically, it fills a gap in the literature by examining questions regarding raising autistic children.
the specific effectiveness of ABA in promoting emo-
tional and social development in autistic children. This Research instrument
research advances theoretical knowledge on the rela- Kindergarten Inventory of Social/ Emotional Tendencies
tionship between ABA and socio-emotional functioning (KIST)
in autism. Practically, the findings have the potential to This questionnaire was developed by Miller et al. [34]. In
inform intervention strategies for educators, therapists, the original version, the internal consistency coefficient
and families working with autistic children. Successful for the total questionnaire was 0.90, and for its seven sub-
results could lead to improved intervention programs scales ranging from 0.70 (separation anxiety signs) to 0.81
that address the emotional and social needs of autistic (hyperactivity-impulsivity behaviors) was obtained [34].
individuals, thereby supporting their overall well-being It consists of six subscales derived from behaviors related
and social integration [46, 47]. to coping, social skills, communication skills, daily liv-
Ultimately, by addressing the emotional and social ing skills, eating behavior, and signs of separation anxi-
challenges autistic children face through an evidence- ety. The questionnaire comprises 50 items on a five-point
based ABA program, this study aims to contribute to scale (1 = Never to 5 = Always) and is measured in parent
the broader goal of enhancing the overall well-being and and teacher forms. Regarding scoring, each item begins
social integration of individuals on the autism spectrum. with the phrase “My child.” and responses are based on
The research aims to test this hypothesis by evaluating positive and negative behaviors [35]. In this research, the
the impact of ABA interventions on these key develop- reliability coefficient in terms of internal consistency was
mental areas in institutionalized children with ASD. In obtained based on Cronbach’s alpha, which was 0.81. The
sum the following hypothesis is stated: research supervisor confirmed the content validity of the
H = Applied Behavioral Analysis is effective in improv- questionnaire items. The validity and reliability of the
ing both the emotional and social skills of children with questionnaire indicate that it is a suitable tool for assess-
autism spectrum disorder. ing children’s social and emotional skills.
Du et al. BMC Psychology (2024) 12:568 Page 4 of 10

The ABA is a therapeutic program that can enhance using MANCOVA to control for covariates
social, communicative, and learning skills through posi- and assess group differences. The analysis of
tive reinforcement and individualized instruction. Many covariance was employed to interpret the research
experts consider it a standard approach for children with hypothesis, alongside repeated measures where
ASD to improve developmental disorders. It is tailored to applicable, to examine changes over time and across
the child’s behavior analysis in their environment, con- conditions. This combination of methods ensured a
sidering their specific characteristics. The target behavior comprehensive assessment of the experimental data.
for change is consistently assessed and measured. One
successful aspect of this approach is breaking down edu-
cational goals into smaller steps through repetition and Findings
practice, facilitating learning [36]. In this educational Demographic description
program, children receive individualized instruction 30% of the children in the self-retained group were 4 to
from the researcher for one hour twice a week, and data 5 years old, 10% were 6 to 7, 40 were 8 to 9, and 20 were
analysis is conducted using covariance. The significance 10 to 11. The mean and standard deviation of boys’ age in
level for hypothesis testing is set at 0.05 (Table 1). the experimental group was 7.5 (SD = 1.32), while for the
control group, the mean was 7.86 (SD = 1.23). No statis-
Data analysis tically significant difference was observed in the groups’
The data analysis was conducted using SPSS software age. Moreover, the mothers in the control group con-
(Version 24), with a focus on the multivariate analysis sisted of 20 individuals holding a Bachelor’s degree (BA)
of covariance (MANCOVA) to assess the impact of the and 10 holding a Master’s degree (MA). Their mean age
independent variables while controlling for covariates. was 31 years (SD = 3.89). In the experimental group, there
The following steps were employed to systematically ana- were 18 mothers with a BA and 12 with an MA, with a
lyze the data: mean age of 32.1 years (SD = 4).

1. Descriptive Data Analysis: Descriptive statistics, Descriptive statistics

including measures such as means, standard Information related to the mean and standard deviation
deviations, and frequencies, were utilized to of the scores of the studied children in the experimen-
summarize the key characteristics of the sample and tal and control groups, before and after the educational
provide an overview of the variables involved. intervention, is presented in Table 2.
2. MANCOVA: The emotional and social Table 2 presents the means and standard deviations for
characteristics of the participants were analyzed the Adaptive Behaviors, Social Skills, Communication

Table 1 ABA Sessions schedule for children with autism

Sessions Purpose Instructional content Parental tasks
First Pre-test execution self-presentation to the child Teaching the child to introduce them-
preliminary familiarization selves with the therapist’s name and
training how to introduce
themselves to others
Second Increasing patience The practice of patience and Training patient to parents in the face
and tolerance Tolerance for sitting on a chair of the child’s requests
Third Visual-verbal perception Presentation of images, expression of the sentence related Practicing the sequence of events and
to each image, and arrangement of images based on expressing them using pictures of daily
observing the sequence activities.
Fourth Recognizing the pronoun “I,” Using the pronoun “I” in speech skills such as opening Practicing using the pronoun “I “in the
self-care skill and closing the zipper, using a spoon and fork, putting on child’s daily activities, practicing the
clothes, and fastening shoelaces. four mentioned skills in everyday tasks.
Fifth Recognizing emotions and Identify four facial expressions (sadness, happiness, fear, Practice four facial expressions by stat-
facial expressions anger) and perform them by the child. ing their names.
Sixth Practicing social skills Suggesting friendship and how to initiate relationships Practicing companionship for estab-
lishing connections.
Seventh Observing turns and conver- Taking turns in activities (such as playing games), orally Practicing taking turns in daily activities
sational skills expressing a story based on image arrangements and practicing oral storytelling based
on images developed in the class.
Eighth Expressing pain, self-help Oral expression of pain and discomfort pouring skills from Practicing verbal expression of pain in
skills, and conducting a a pitcher into a cup. daily activities, practicing pouring from
post-test a pitcher into a cup.
Du et al. BMC Psychology (2024) 12:568 Page 5 of 10

Table 2 Descriptive statistics of children’s scores in the variables under study in the experimental and control groups (n = 60)
Variable Time Control (M, SD) Experimental (M, SD)
Adaptive Behaviors Before intervention 24.08, 8.79 27.78, 5.32
After intervention 24.00, 7.40 30.60, 4.61
Social Skills Before intervention 22.90, 5.21 21.70, 3.14
After intervention 22.53, 5.40 23.95, 2.22
Communication Skills Before intervention 19.60, 6.25 20.80, 7.89
After intervention 19.10, 6.93 23.50, 7.52
Daily Living Skills Before intervention 16.20, 6.14 11.88, 2.54
After intervention 15.72, 6.31 19.55, 2.25
Nutrition Behavior Before intervention 11.60, 2.27 11.67, 2.53
After intervention 11.70, 1.60 11.55, 2.60
Separation Anxiety Before intervention 14.80, 4.55 14.65, 4.27
After intervention 14.60, 4.23 11.20, 4.42
Total Score Before intervention 137.80, 19.63 128.37, 12.34
After intervention 134.30, 18.70 142.10, 16.01

Table 3 MANCOVA assumptions

Assumption Result
Linearity Linear relationships between covariates and dependent variables confirmed
Multicollinearity No high correlations between dependent variables (r < .85)
Homogeneity of regression slopes No significant interaction between covariates and group factor, p > .05
Equality of covariance matrices Box’s M test non-significant, p > .05
Normality Shapiro-Wilk test for residuals, normal distribution confirmed
Levene’s Test Homogeneity of variance confirmed, p > .05

Table 4 MANCOVA multivariate tests

Effect Value F Hypothesis df Error df Sig. Partial Eta Squared
Intercept Pillai’s Trace 0.962 473.434b 6.000 112.000 0.000 0.962
Wilks’ Lambda 0.038 473.434b 6.000 112.000 0.000 0.962
Hotelling’s Trace 25.363 473.434b 6.000 112.000 0.000 0.962
Roy’s Largest Root 25.363 473.434b 6.000 112.000 0.000 0.962

Skills, Daily Living Skills, Nutrition Behavior, Separation Box’s M test for equality of covariance matrices was also
Anxiety, and Total Score for both the control and experi- non-significant, confirming the assumption of equality
mental groups. Before the intervention, the experimen- of variances. Lastly, residuals were normally distributed,
tal group generally scored lower than the control group and Levene’s test indicated no violations of homogeneity
across most variables (e.g., Adaptive Behaviors: M = 27.78, of variance, which further supports the reliability of the
SD = 5.32 vs. M = 24.08, SD = 8.79). After the intervention, MANCOVA results. The assumptions of MANCOVA are
the experimental group showed improvements in several presented in Table 3.
variables, most notably in Adaptive Behaviors (M = 50.60,
SD = 4.61), Social Skills (M = 23.95, SD = 2.22), and Daily MANCOVA results
Living Skills (M = 19.55, SD = 2.25), suggesting a positive The MANCOVA was conducted followed by a two-by-
effect of the intervention. In contrast, the control group’s two comparison analysis to assess the effects of the inter-
scores remained relatively stable. vention on the experimental group. Pillai’s Trace, Wilks
Lambda, Hotelling’s Trace, and Roy’s Largest Root were
MANCOVA assumptions conducted to evaluate the multivariate effect of the inter-
Table 3 summarizes the results of the assumption tests for vention across the dependent variables (adaptive behav-
MANCOVA. All assumptions required for the analysis iors, social skills, communication skills, daily living skills,
were met. Linearity was confirmed between the covari- nutrition behavior, separation anxiety). These tests indi-
ates and the dependent variables, and no multicollinear- cate whether there is at least one significant difference
ity was detected. The homogeneity of regression slopes between the experimental and control groups across the
assumption was satisfied, as the interaction between dependent variables. Results are shown in Table 4.
the covariates and the group factor was non-significant.
Du et al. BMC Psychology (2024) 12:568 Page 6 of 10

All four tests are significant at the p < .05 level, indi- 0.071). However, no significant effect was found for daily
cating that there is at least one significant difference living skills.
between the experimental and control groups on the The intercept terms showed highly significant effects
combined dependent variables after controlling for pre- across all variables, including adaptive behaviors (F(1,
test scores. This confirms that the intervention had a sig- 23369.58) = 2415.289, p < .001, η² = 0.954), social skills
nificant multivariate effect on the children’s social and (F(1, 4060.054) = 884.724, p < .001, η² = 0.883), and total
emotional development. For further analysis, results of score (F(1, 181165.1) = 748.433, p < .001, η² = 0.865). These
tests of tests for between-subject effects are presented in high intercept values suggest that baseline differences in
Table 5. these variables were strongly influential before account-
The analysis examined the effect of an intervention on ing for the intervention. The large effect sizes (η² ranging
several dependent variables: adaptive behaviors, social from 0.392 to 0.954) across all dependent variables high-
skills, communicative skills, daily living skills, nutrition light that the initial levels were critical in explaining the
behavior, separation anxiety, and the total score. The cor- variance observed in the outcomes.
rected model indicated significant differences between Regarding time and group effects, significant time
the experimental and control groups across multiple effects were found for adaptive behaviors (F (1,
variables. Significant effects were found for adaptive 68.278) = 7.057, p = .009, η² = 0.057), social skills (F(1,
behaviors (F(2, 74.156) = 7.664, p = .001, η² = 0.116), 64.263) = 14.004, p < .001, η² = 0.107), and communicative
social skills (F(2, 56.836) = 12.385, p < .001, η² = 0.175), skills (F(1, 150.621) = 3.921, p = .030, η² = 0.032). Group
communicative skills (F(2, 153.515) = 3.996, p = .021, η² = effects were also significant for most variables, particu-
0.064), nutrition behavior (F(2, 39.150) = 6.987, p = .001, larly for social skills (F(1, 49.408) = 10.767, p = .001, η²
η² = 0.107), and separation anxiety (F(2, 83.302) = 5.083, = 0.084), and adaptive behaviors (F(1, 80.033) = 8.272,
p = .008, η² = 0.080). The total score also showed a signifi- p = .005, η² = 0.066). The intervention had a positive
cant improvement (F (2, 1078.863) = 4.457, p = .014, η² = impact on the experimental group, leading to improved

Table 5 Tests of between-subjects effects

Source Dependent Variable SS df MS F p Eta Squared
Corrected Model Adaptive Behaviors 148.31 2 74.156 7.664 0.001 0.116
Social skills 113.67 2 56.836 12.385 0.000 0.175
Communicative skills 307.0 2 153.515 3.996 0.021 0.064
Daily living skills 104.64 2 52.321 1.272 0.284 0.021
Nutrition behavior 78.30 2 39.150 6.987 0.001 0.107
Separation anxiety 166.60 2 83.302 5.083 0.008 0.080
Total 2157.72 2 1078.863 4.457 0.014 0.071
Intercept Adaptive Behaviors 23369.5 1 23369.58 2415.289 0.000 0.954
Social skills 4060 1 4060.054 884.724 0.000 0.883
Communicative skills 3705 1 3705.864 96.460 0.000 0.452
Daily living skills 3096 1 3096.690 75.308 0.000 0.392
Nutrition behavior 1282 1 1282.065 228.812 0.000 0.662
Separation anxiety 3216 1 3216.661 196.295 0.000 0.627
Total 181,165 1 181165.1 748.433 0.000 0.865
time Adaptive Behaviors 68.278 1 68.278 7.057 0.009 0.057
Social skills 64.263 1 64.263 14.004 0.000 0.107
Communicative skills 150.621 1 150.621 3.921 0.030 0.032
Daily living skills 43.008 1 43.008 1.046 0.01 0.009
Nutrition behavior 30.167 1 30.167 5.384 0.022 0.044
Separation anxiety 86.570 1 86.570 5.283 0.023 0.043
Total 979.592 1 979.592 4.047 0.047 0.033
groups Adaptive Behaviors 80.033 1 80.033 8.272 0.005 0.066
Social skills 49.408 1 49.408 10.767 0.001 0.084
Communicative skills 156.408 1 156.408 4.071 0.046 0.034
Daily living skills 61.633 1 61.633 1.499 0.001 0.013
Nutrition behavior 48.133 1 48.133 8.590 0.004 0.068
Separation anxiety 80.033 1 80.033 4.884 0.029 0.040
Total 1178.13 1 1178.133 4.867 0.029 0.040
Du et al. BMC Psychology (2024) 12:568 Page 7 of 10

outcomes in social skills, adaptive behaviors, and other - prerequisites for communication skills - and enhances
variables compared to the control group. their performance in this area. This finding is consis-
tent with the results of Dixon et al. [20] and Samban-
Discussion and conclusion dam et al. [27] but contrasts with the findings of Betting
This research aimed to investigate the effectiveness of & Mass [43]. ABA is a systematic scientific approach to
the ABA program on the social and emotional skills of identifying influential environmental variables on sig-
children with autism. The findings demonstrated that nificant social behavior [44]. In this sense, it is employed
the ABA program effectively improves the social and to understand what happens to create a behavior and
emotional behaviors of children with autism, enhancing what happens afterward that appears to reinforce the
their overall performance. These results align with pre- behavior [44]. The method used in this research involves
vious studies conducted by Peters et al. [28], Samson et removing reinforcing factors for undesirable behav-
al. [15], and Sneed [37]. However, there is a discrepancy ior from the environment and utilizing new reinforcing
with the findings of Mazefsky et al. [12]. In explaining factors to teach the desired behavior. Therefore, exer-
these findings, it can be stated that social and emotional cises focused on familiarization and introduction, self-
development encompasses a set of skills, with some of awareness, communication skills, and offering friendship
the most crucial ones including self-awareness, under- were conducted. These exercises aimed to enhance
standing and recognizing others’ emotions, managing communication skills. Additionally, visual attention to
intense emotions, and constructively expressing them, environmental stimuli and communicative verbal and
organizing one’s behaviors, and establishing and main- non-verbal responses increased by performing visual
taining relationships as cited in Alshurman and Alsreaa perception exercises and verbal and event sequencing.
[35]. The ABA program can contribute to developing Training in understanding the sequence of events was
social and emotional skills through various approaches also carried out through cards depicting short stories
such as breaking down instructional steps, direct teach- with three or four stages to facilitate the development of
ing, response system arrangement, and immediate rein- these skills.
forcement [6]. The main focus of the Applied Behavioral The ABA program is efficacious in improving daily
Analysis method, as both a science and a practice, is on living skills, enhancing their performance in this area.
manipulating environmental variables to improve social This result aligns with the findings of Sandbank et al.
behavior [21]. [42], Fowler and Connor [19], and Di Rezze et al. [45].
In this research, exercises were conducted to create Research has demonstrated that, from the perspective of
calmness in children, focusing on enhancing patience and both parents and individuals with autism, the most sig-
tolerance and training in understanding and performing nificant challenge is difficulty in performing daily activi-
turn-taking skills. Exercises involving the recognition of ties. The ABA method breaks down each task and new
emotions and facial expressions aimed to familiarize chil- skill into smaller components, as it is designed to do.
dren with facial expressions and express their emotional When a requested task is performed correctly, the child
state, while complaint skills training focused on teaching is encouraged to increase motivation for repetition and
the skill of objecting to pain. The research findings indi- compliance. Throughout the instructional sessions, chil-
cated improved social and emotional skills after com- dren with autism are taught skills such as tying knots,
pleting the sessions. According to the findings, the ABA buttoning, pouring into a cup, using utensils, and dress-
program is efficacious in improving the communicative ing. The effectiveness of parental involvement in guided
behaviors of children with autism. It leads to an enhance- exercises using ABA and the generalization of their
ment in their performance in communication skills. This results to the child’s living environment led to positive
finding aligns with the results of studies by Nowell et al. social changes. By consistently and continuously imple-
[38], Lerna et al. [26], Pervin et al. [39], and Filippini [40]. menting this treatment, parents can contribute to behav-
In explaining this result, possessing communication skills ioral and positive life changes for their children.
in a child’s interaction with family members and peers
improves their individual lives. Children with autism Conclusions
spectrum disorder face difficulties in responding to com- In conclusion, this study demonstrates the effectiveness
munication interactions. Therefore, they need support of ABA program in enhancing the social, emotional,
and training to acquire communication skills. By teach- communicative, and daily living skills of children with
ing communication interventions to these children, it is autism. The findings reveal significant improvements in
possible to impart some appropriate skills to them [41, adaptive behaviors, social skills, communicative abili-
42]. ties, and separation anxiety, indicating the program’s
Moreover, in line with the findings, the ABA pro- success in fostering positive behavioral changes in the
gram effectively improves speech and language skills experimental group compared to the control group.
Du et al. BMC Psychology (2024) 12:568 Page 8 of 10

These results are consistent with prior research and sug- introduces a potential limitation regarding the broader
gest that ABA’s structured, reinforcement-based methods applicability of the study’s outcomes to other cultural
play a critical role in teaching essential life skills to chil- and demographic groups. Caution is warranted when
dren with autism, facilitating their social interaction and generalizing the results beyond the specific context of
emotional regulation. The significant effects observed Wuhan, and further research should aim to include a
in social and communicative skills highlight the impor- more geographically diverse and representative sample
tance of early intervention and targeted training in help- to ensure the robustness and external validity of the find-
ing children with autism navigate their environment ings. Additionally, exploring variations in cultural and
more effectively. Furthermore, the positive impact of the environmental factors could provide a more nuanced
program on daily living skills, though less pronounced, understanding of the applicability of interventions across
underscores ABA’s capacity to break down complex diverse populations.
tasks into manageable steps, thereby enhancing the chil- Given the acknowledged limitations, future research
dren’s ability to perform essential daily activities. Parental endeavors could expand the participants’ age range to
involvement and the generalization of these skills to the encompass a broader developmental spectrum. This
home environment were also identified as key contribu- would contribute to a more comprehensive understand-
tors to sustained behavioral improvements. Overall, the ing of the effectiveness of the Applied Behavioral Analy-
findings provide strong support for the use of ABA as sis (ABA) program across various developmental stages,
an intervention for improving critical life skills in chil- thereby enhancing the generalizability of interventions
dren with autism, offering them greater independence for individuals with ASD. Furthermore, extending the
and social integration. Future research could explore the geographical scope of studies beyond Wuhan to include
long-term effects of ABA and its potential application in diverse cultural and demographic contexts would facili-
other developmental areas. tate a more nuanced comprehension of how cultural fac-
The practical recommendations derived from the tors may influence the outcomes of ABA interventions.
research findings include prioritizing the ABA method Additionally, examining the long-term impact of the
in workshops related to interventions for ASD, ensuring ABA program on individuals with ASD and their fami-
that trainers specializing in ASD acquire the necessary lies could provide valuable insights into the sustainability
expertise in implementing the ABA method, and provid- of the intervention effects over time, guiding the devel-
ing parents with comprehensive training to generalize opment of more enduring and impactful support strate-
ABA teachings to the child’s living environment effec- gies. Finally, to broaden the generalizability and impact
tively. This emphasizes the importance of reinforcing and of the ABA program, the research suggests expanding its
operationalizing ABA principles, enabling children to application to other diverse populations by increasing the
apply learned skills in real-life situations when needed. sample size. Additionally, to enhance the effectiveness of
Through these recommendations, the study aims to con- the ABA program, the study proposes its implementation
tribute to the broader understanding and application of over a more extended duration and a more significant
the ABA program in addressing the unique needs of indi- number of sessions.
viduals with ASD.
Acknowledgements
The author would like to thank all participants, their parents and educators
Limitations and suggestions for further studies who contributed to helped the researchers to manage the experiment.
While this study provides valuable insights, it is impor-
Author contributions
tant to acknowledge certain limitations that impact the Geng Du conceptualized the study. Yuanbing Guo designed the study and
generalizability of the findings. One notable limitation wrote the methodology. Weihong Xu collected and analysed the data. Geng
is the age restriction imposed on the statistical sample, Du wrote the original draft. Yuanbing Guo and Weihong Xu reviewed and
edited the manuscript. All authors agreed to the published version of the
encompassing children aged 4 to 11. While this age range manuscript.
is relevant to the developmental stage commonly associ-
ated with ASD interventions, it restricts the extrapolation Funding
This project is financially supported by Ministry of Education Project of
of results to individuals outside this age bracket. Efforts Research of Humanitarian (19YJC880018), Hubei Province education
were made to mitigate this limitation by carefully coor- development planning project (2020GA050), and Ministry of Education
dinating the samples within the specified age range; how- Project of Ideological and political work innovation and development center
(WHDHSZZX 2023041).
ever, future research should consider including a more
diverse age spectrum to enhance the applicability of the Data availability
study’s findings across different developmental stages. The data will be made available upon the request from the corresponding
author.
Another limitation pertains to the geographic speci-
ficity of the sample, focusing exclusively on children
with autism in Wuhan. This regional concentration
Du et al. BMC Psychology (2024) 12:568 Page 9 of 10

Declarations directions. Volume 29. Child and Adolescent Psychiatric Clinics of North
America; 2020. pp. 527–42. 3.
Ethics approval and consent to participate 14. Conner CM, Golt J, Righi G, Shaffer R, Siegel M, Mazefsky CA. A comparative
Informed consent was taken from parents and/or legal guardians of all study of Suicidality and its association with emotion regulation impair-
participants for study participation. for inclusion before participating in the ment in large ASD and US Census-Matched samples. J Autism Dev Disord.
study. The study was conducted by the Declaration of Helsinki, and the IRB of 2020;50(10):3545–60.
Wuhan Sports University (Number: 2022/ 1872)approved the protocol. 15. Samson AC, Phillips JF, Parker KJ, Shah S, Gross JJ, Harden AY. Emotion dys-
regulation and the core features of autism spectrum disorder. J Autism Dev
Consent for publication Disord. 2014;44(7):1766–72.
Not applicable. 16. Stanislaw H, Howard J, Martin C. Helping parents choose treatments for
young children with autism: a comparison of applied behavior analysis and
Competing interests eclectic therapies. J Am Association Nurse Practitioners. 2020;32(8):571–8.
The authors declare no competing interests. 17. Jones L, Hastings RP, Totsika V, Keane L, Rhule N. Child behavior problems
and parental well-being in families of autistic children: the mediating role of
Author details mindfulness and acceptance. Am J Intellect Dev Disabil. 2014;119(2):171–85.
1
Department of Sports Training, Wuhan Sports University, Wuhan, 18. Rieffe C, O’Connor R, Bülow A, Willems D, Hull L, Sedgewick F, Blijd-Hoogewys
Hubei 430079, China E. Quantity and quality of empathic responding by autistic and non-autistic
2
Hubei Superior Discipline Group of Exercise and Brain Science from adolescent girls and boys. Autism: Int J Res Pract. 2021;25(1):199–209.
Hubei Provincial Department of Education, Wuhan Sports University, 19. Fowler K, O’Connor C. I just rolled up my sleeves’: mothers’ perspectives on
wuhan, China raising. Girls on the autism spectrum. Autism. 2021;25(1):275–87.
3
College of Sports Science and Technology, Wuhan Sports University, 20. Dixon MR, Paliliunas D, Barron BF, Schmick AM, Stanley CR. Randomized con-
Wuhan, Hubei 430223, China trolled trial evaluation of ABA content on IQ gains in autistic children. J Behav
4
Department of Physical Education, Wuhan Sports University, Wuhan, Educ. 2019;30:455–77.
Hubei 430079, China 21. Yi Z, Dixon MR. Developing and enhancing adherence to a telehealth aba
parent training curriculum for caregivers of children with autism. Behav Anal
Received: 20 February 2024 / Accepted: 29 September 2024 Pract. 2020;14(1):58–74.
22. Sklad M, Diekstra R, De Ritter M, Ben J, Gravesteijn C. Effectiveness of school-
based universal social, emotional, and behavioral programs: do they enhance
students’ development in the area of skill, behavior, and adjustment? Psychol
Sch. 2012;49(9):892–909.
23. Ratcliffe B, Grahame V, Wong M. Emotion-based social skills training (EBSST)
References
for children with autism spectrum disorder and mild intellectual disability.
1. Gies L. Joint attention and social imitation skills in children with autism spec-
Sydney, Australia: The Children’s Hospital at Westmeath; 2010.
trum disorder. Doctoral Dissertation. Psychology Department, The Ohio State
24. Reichow B, Volkmar FR. Social skills interventions for individuals with autism:
University, (2019).
evaluation for evidence-based practices within best evidence synthesis
2. Kemp CW. Understanding autism: we know so much more; we still know so
framework. J Autism Dev Disord. 2010;40(2):149–66.
little! Advising preservice teachers through narratives from students with
25. Williams TA, Porter MA, Langdon R. Social approach and emotion recognition
disabilities. Pennsylvania, IGI Global; 2022. pp. 69–93.
in fragile X syndrome. Am J Intellect Dev Disabil. 2014;119(2):133–50.
3. Leaf JB, Cihon JH, Leaf R, McEachin J, Taubman M. A progressive approach to
26. Lerna A, Esposito D, Conson M, Massagli A. Long-term effects of PECS on
dis- Crete trial teaching: some current guidelines. Int Electron J Elementary
social communicative skills of children with autism spectrum disorders: a
Educ. 2016;9(2):361–72.
follow-up study. Int J Lang Communication Disorders. 2014;49(4):478–85.
4. Yates K, Le Couteur A. Diagnosing autism/autism spectrum disorders. Pediatr
27. Sambandam E, Rangaswami K, Thamizharasan S. Efficacy of ABA program for
Child Health. 2016;26(12):513–8.
children with autism to improve general development, language and adap-
5. Tiwari R, Shandilya M, Charak S. Assistive technology to support children with
tive behavior. Indian J Posit Psychol. 2014;5(2):192–5.
autism spectrum disorder. In assistive technologies for assessing and recover-
28. Peters-Scheffer N, Didden R, Korzilius H, Sturmey P. A meta-analytic study on
ing neurological Impairments, (2022). (pp. 25–47). Pennsylvania, IGI Global.
the effectiveness of comprehensive ABA-based early intervention programs
6. Fombonne E. The rising prevalence of autism. J Child Psychol Psychiatry.
for children with autism spectrum disorders. Res Autism Spectr Disorders.
2018;59(7):717–20.
2011;5(1):60–9.
7. Coelho VA, Sousa V, Marchante M. Development and validation of the Social
29. Ziv Y, Hadad BS, Khateeb Y. Social information processing in preschool
and emotional competencies evaluation questionnaire. J Educational Dev
children diagnosed with autism spectrum disorder. J Autism Dev Disord.
Psychol. 2015;5(1):139–47.
2014;44(4):846–59.
8. Mazza M, Pino MC, Vagnetti R, Filocamo A, Attanasio M, Calvarese A, Valenti
30. McGill O, Robinson A. Recalling hidden harms: autistic experiences of child-
M. Intensive intervention for adolescents with autism spectrum disorder:
hood applied behavioral analysis (ABA). Adv Autism. 2020;7(4):269–84.
comparison of three rehabilitation treatments. Int J Psychiatry Clin Pract.
31. Parner ET, Thorsen P, Dixon G, de Klerk N, Leonard H, Nassar N, et al. A
2021;25(1):28–36.
comparison of autism prevalence trends in Denmark and Western Australia. J
9. Durlak JA, Weissberg RP, Dymnicki AB, Taylor RD, Schellinger KB. The impact
Autism Dev Disord. 2011;41(12):1601–8.
of enhancing students’ social and emotional learning: a meta-analysis of
32. Marshall AP. Graduate training in school psychology: applied behavior analy-
school‐based universal interventions. Child Dev. 2011;82(1):405–32. https://
sis and autism spectrum disorder. Doctoral Dissertation. Fordham University.
doi.org/10.1111/j.1467-8624.2010.01564.x.
(2022).
10. Ip HH, Wong SW, Chan DF, Byrne J, Li C, Yuan VS, Wong JY. Enhance emotional
33. American Psychiatric Association. Diagnostic and statistical manual of mental
and social adaptation skills for children with autism spectrum disorder: a
disorders. 5th ed. Arlington, VA, USA: American Psychiatric Publishing; 2013.
virtual reality enabled approach. Volume 117. Computers & Education; 2018.
34. Miller DC, Micgie A, Miller MA. Kindergarten inventory of social/ emotional
pp. 1–15. 25. https://doi.org/10.1016/j.compedu.2017.09.010.
tendencies (KIST). New York: Kindergarten interventions and diagnostic
11. Wing L, Gould J, Gillberg C. Autism spectrum disorders in the DSM-V: Better
services; 1997.
or worse than the DSM-IV? Res Dev Disabil. 2011;32:768–73.
35. Alshurman W, Alsreaa I. The efficiency of peer teaching of developing non-
12. Mazefsky CA, Herrington J, Siegel M, Scarpa A, Maddox BB, Scahill L, White
verbal communication to children with Autism Spectrum disorder (ASD). J
SW. The Role of emotion regulation in autism spectrum disorder. Journal
Educ Pract. 2015;6(29):33–8.
of American Academy of Child & Adolescent Psychiatry, (2013). 52(7):
36. Lacava PG, Rankin A, Mahlios E, Cook K, Simpson RL. A single case design
679-688.2013.05.006.
evaluation of a software and tutor intervention addressing emotion recogni-
13. Beck KB, Conner CM, Breitenfeldt KE, Northrup JB, White SW, Mazefsky CA.
tion and social interaction in four boys with ASD. Autism, (2010).14:161–178.
Assessment and treatment of emotion regulation impairment in autism
37. Sneed L. Treatment Efficacy of Parent-Led ABA for Children with autism and
spectrum disorder across the life span: current state of the science and future
their parents. Doctoral dissertation. Walden University. (2022).
Du et al. BMC Psychology (2024) 12:568 Page 10 of 10

38. Nowell SW, Watson LR, Boyd B, Klinger LG. Efficacy study of a social commu- 44. Yo JP, Zhang XW, Liu YJ, Wang XF, You CX, Hao YJ. ABI5 regulates ABA-induced
nication and self-regulation intervention for school-age children with autism anthocyanin biosynthesis by modulating the MYB1-bHLH3 complex in apple.
spectrum disorder: a randomized controlled trial. Lang Speech Hear Serv Sch. J Exp Bot. 2021;72(4):1460–72.
2019;50(3):416–33. 45. Di Rezze, B., Duku, E., Szatmari, P., Volden, J., Georgiades, S., Zwaigenbaum, L.,
39. Pervin M, Ahmed HU, Hagmayer Y. Effectiveness of interventions for children … & Pathways in ASD Study Team. Examining trajectories of daily living skills
and adolescents with an autism spectrum disorder in high-income vs. lower- over the preschool years for children with autism spectrum disorder. Journal
middle-income countries: an overview of systematic reviews and research of Autism and Developmental Disorders. (2019); 49:4390–4399.
papers from LMIC. Front Psychiatry, (2022). 13, 834783. 46. Eckes T, Buhlmann U, Holling HD, et al. Comprehensive ABA-based
40. Flippin M. Using father-mediated intervention to increase responsive paren- interventions in the treatment of children with autism spectrum disorder
tal behaviors and child communication in children with autism spectrum – a meta-analysis. BMC Psychiatry. 2023;23:133. https://doi.org/10.1186/
disorder: a pilot study. J Clin Translational Sci. 2018;2(Suppl1):50. https://doi. s12888-022-04412-1.
org/10.1017/cts.2018.192. 47. Shokoohirad M, Rahim Zadeh S. The effectiveness of an Applied
41. Lai M, Anagnostou E, Wiznitzer M, Allison C, Baron-Cohen S. Evidence-based Behavior Analysis Program on Autistic Children’s emotional and social
2020 support for autistic people across the lifespan: maximizing potential, skills. J Appl Psychol Res. 2023;14(1):115–28. https://doi.org/10.22059/
minimizing barriers, and optimizing the person–environment fit. Lancet japr.2023.337714.644173.
Neurol. 2020;19(5):434–51.
42. Sandbank M, Bottema-Beutel K, Crowley S, Cassidy M, Dunham K, Feldman
JI, Crank J, Albarran SA, Raj S, Mahbub P, Woynaroski TG, Project AIM. Autism Publisher’s note
intervention meta-analysis for studies of young children. Psychol Bull. Springer Nature remains neutral with regard to jurisdictional claims in
2020;146(1):1–29. published maps and institutional affiliations.
43. Beiting M, Maas E. Autism-centered therapy for Childhood Apraxia of Speech
(ACT4CAS): a single-case Experimental Design Study. Am J Speech-Language
Pathol. 2021;30(3S):1525–41.