Autism and Applied Behavior Analysis
Autism is a neurodevelopmental disorder that is typically affecting communication, social, and daily living skills, as well as repetitive/restricted behaviors. Research has shown that the most evidenced-based treatments for autism are derived from Applied Behavior Analysis (ABA) approach. According to American Academy of Pediatrics (Hyman, Levy, & Myers, 2020), treatments based on ABA principles are associated with skill acquisition and improved outcome, especially when given early.
ABA treatments vary from highly structured environment to less restrictive environment such as in natural settings. It is important to emphasize that there is no one treatment that fits everyone’s needs. Behavioral treatment should be individualized to the child’s and family’s needs and preferences.
An essential component of ABA intervention is the collection, quantification, and analysis of direct observational data for any targeted behaviors and skills. The process of data collection and analysis allows clinicians to plan or adjust the intervention.
Another critical component of ABA intervention is the number of learning opportunities and implementing the intervention procedures consistently. A good ABA intervention will incorporate an abundance of opportunities. Finally, a good ABA intervention will also involve caregiver training to teach those close to the individual how to support and practice the new skills.
Aside from promoting skill and behavior generalization to caregivers, the intervention should also aim to generalize skills and behaviors into other settings (conditions and locations). Consistent implementation of intervention procedure across settings may yield the best results. Note that each individual’s need is different, and ABA intervention may be delivered different settings, including clinic, home, school, and public places in the community.
Interventions grounded in ABA are considered to be the gold standard of therapeutic and educational interventions for individuals with autism. The success of ABA in addressing core deficits in individuals with autism has been documented in peer-reviewed studies for the past 50 years (BACB, 2012). Different independent bodies in the United States of America endorse ABA-based interventions for individual with autism, such as American Academy of Pediatrics, New York State Department of Health, American Society of Child and Adolescent Psychiatry, United Stated Surgeon General, and National Institute of Mental Health.
American Academy of Pediatrics (2020)
“The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings. Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.”
US SURGEON GENERAL, US Department of Health and Human Services (1999)
“Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior.”
ABA intervention is also recognized to have established evidence for effective treatment and also supported by a number of professional and governmental association in the United States of America, Canada, New Zealand, and Australia.
New Zealand Ministry of Health (2011)
“Interventions and strategies based on applied behaviour analysis (ABA) principles should be considered for all children with ASD.”
“Early intensive behavioural intervention (EIBI) should be considered as a treatment of value for young children with ASD to improve outcomes such as cognitive ability, language skills, and adaptive behaviour.”
Evidence-based Practice
Evidence-based practice is a decision-making process where professionals integrate best available evidence, client values and context, and clinical expertise when providing services to their clients. Evidence-based practice is important because it leads to care that is effective, safe, and efficient.
Best available evidence: Professionals uses procedures that have been studied and reviewed carefully, then published.
Client values & context: Professionals listen and study what is important to the client. So that client’s culture and needs can be included in the treatment.
Clinical expertise: Professionals have the education, training, and experience to deliver effective services. Clinical expertise includes the use of data to guide decisions, ability to apply research to practice, awareness of the need for outside consultation, and ongoing professional development among others.
References
American Psychological Association, Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271–285. https://doi.org/10.1037/0003-066X.61.4.271
BACB. (2012). Guidelines, Health Plan Coverage of Applied Behavior Analysis Treatment for Autism Spectrum Disorder. Behavior Analyst Certification Board.
Hyman, S. L., Levy, S. E., & Myers, S. M. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1).
Ministries of Health and Education. (2011). Guideline Supplementary Paper: New Zealand autism spectrum disorder guideline supplementary paper on applied behaviour analysis.
Missouri Autism Guidelines Initiative. (2012). Autism spectrum disorders: Guide to evidence-based interventions: A 2012 consensus publication. Jefferson City, MO: Author.
New York (State). Dept. of Health. Early Intervention Program. (1999). Clinical Practice Guideline: Autism, Pervasive Developmental Disorders: Assessment and Intervention for Young Children (age 0-3 Years). Report of the guideline recommendations. New York State Department of Health.
Ontario Ministry of Education. (2007, May 17). Policy/Program Memorandum No. 140. http://www.edu.gov.on.ca/extra/eng/ppm/140.html
Slocum, T. A., Detrich, R., Wilczynski, S. M., Spencer, T. D., Lewis, T., & Wolfe, K. (2014). The Evidence-Based Practice of Applied Behavior Analysis. The Behavior analyst, 37(1), 41–56. https://doi.org/10.1007/s40614-014-0005-2
Tweed, M. D., Connolly MPPM, N., & Beaulieu, A. (2009). Interventions for autism spectrum disorders: State of the evidence.
US Department of Health and Human Services. (1999). Mental health: A report of the Surgeon General.
Volkmar, F., Cook, E. H., Pomeroy, J., Realmuto, G., & Tanguay, P. (1999). Practice parameters for the assessment and treatment of children, adolescents, and adults with autism and other pervasive developmental disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 38(12), 32S-54S.