Behavior Analysts' Use of Treatments for Individuals with Autism: Trends within the Field.

Previous surveys revealed the majority of certified behavior analysts reported using applied behavior analysis (ABA) as a treatment for individuals on the autism spectrum. However, some certificants have also reported using treatments without evidence (Schreck et al. Behavioral Interventions, 31(4), 355-376, 2016; Schreck & Mazur Behavioral Interventions: Theory & Practice in Residential & Community- Based Clinical Programs, 23(3), 201-212, 2008). The field of ABA has undergone many changes in the last five years. This survey evaluated trends in the use and variables influencing the use of autism treatments over that time. Results indicated that study participants (N = 921 BCBA-Ds, BCBAs, BCaBAs, and RBTs) were significantly less likely to report current use of ABA and some unestablished treatments (e.g., DIR Floortime, sensory integration therapy) than participants in 2016 (Schreck et al. Behavioral Interventions, 31(4), 355-376, 2016). Participants frequently cited persuasion by others as an influence for their treatment selections. Because behavior analysts' use of unestablished treatments may be detrimental to client outcomes and the reputation and success of the field of ABA, future research is needed to identify methods for increasing behavior analysts' use of empirically supported treatments.

The Ethics of Actually Helping People: Targeting Skill Acquisition Goals That Promote Meaningful Outcomes for Individuals with Autism Spectrum Disorder.

As a field that predominately supports individuals with autism spectrum disorder (ASD), we have an ethical duty as behavior analysts to ensure that the goals we write and interventions we prescribe promote best outcomes across the lifespan. This is critical, given that as it stands now, outcomes in adulthood for individuals with ASD are poor in every area assessed. The Ethics Code for Behavior Analysts can be interpreted to provide support for teaching the right goals, the right way, with respect to inherent rights of those we serve, in order to help affect positive changes in these outcomes. The present article highlights ethical themes that are relevant in order to affect these changes that are supported by the Code, as well as actionable steps to take next. The aim is to provide a resource for practitioners to use in clinical practice and in making ethical decisions that will help to improve outcomes for individuals with autism in adulthood. In addition, recommendations are made about integrating these values and approaches in terms of training, supervision, advocacy, and research.

A Comparison Between Direct Telehealth and In-Person Methods of Teaching Expressive Labels to Children Diagnosed With Autism Spectrum Disorder.

Recent behavior analytic research has demonstrated that the provision of applied behavior analytic services via direct telehealth can be an effective teaching modality for some learners with autism spectrum disorder (ASD). Historically, teaching procedures based on applied behavior analysis (ABA), including discrete trial teaching (DTT), have been provided and evaluated via in-person delivery. This study sought to compare the implementation of DTT via direct telehealth to DTT implemented in-person within and across participants. Specifically, this study evaluated the two delivery modalities in terms of skill acquisition, maintenance, efficiency, and learner responding during teaching sessions. Results of an adapted alternating treatments design nested into a multiple baseline design demonstrated that all three participants diagnosed with ASD met the mastery criteria for the expressive labels taught. Areas of future research, participant prerequisite skills, and clinical implications will be discussed in the context of these results.

Comparing In-View to Out-of-View Stimulus Arrangements When Teaching Receptive Labels for Children Diagnosed With Autism Spectrum Disorder.

One common best practice recommendation for teaching receptive labels to individuals diagnosed with autism spectrum disorder is for the stimulus array to be arranged outside of the view of the learner. Another strategy that may have benefits would be to arrange the stimuli in view of the learner. The purpose of this study was to compare the relative effectiveness and efficiency of arranging the stimulus array in view versus out of view of the learner when teaching receptive labels to three children diagnosed with autism spectrum disorder. The results of an adapted alternating-treatments design demonstrated that both conditions were effective, and all participants reached the mastery criterion on all training sets. However, the in-view condition was more, or equally, efficient with respect to sessions to mastery when compared to the out-of-view condition. The results are discussed with respect to clinical and research implications for best practice recommendations related to teaching receptive language.

Evaluating the Cool Versus Not Cool Procedure via Telehealth.

Autistics/individuals diagnosed with autism spectrum disorder (ASD) commonly display qualitative impairments in social behavior that commonly result in the use of interventions directly targeting the development of social skills. The COVID-19 pandemic has highlighted the need for effective social skills interventions that can be delivered directly via telehealth. The Cool Versus Not Cool procedure has continually been documented as effective within the literature. However, its reported use has been limited to in-person delivery. The purpose of this study was to evaluate the effectiveness of the Cool Versus Not Cool procedure conducted via telehealth to teach three children diagnosed with ASD to change the conversation when someone is bored. The results of a nonconcurrent multiple-baseline across-participants design demonstrated that all three participants reached the mastery criterion in four to eight sessions. Responding generalized to another adult for two of the three participants, and all three participants maintained correct responding. Social validity measures indicated the skill was important to teach, the intervention was acceptable and effective, and the telehealth format was an acceptable replacement for in-person intervention for these three participants.

Concerns About ABA-Based Intervention: An Evaluation and Recommendations.

For over 50 years, intervention methods informed by the principles of applied behavior analysis (ABA) have been empirically researched and clinically implemented for autistics/individuals diagnosed with autism spectrum disorder (ASD). Despite the plethora of evidence for the effectiveness of ABA-based interventions, some autism rights and neurodiversity activists have expressed concerns with ABA-based interventions. Concerns have included discontent with historical events and possible harm from the procedures and goals targeted. The purpose of this manuscript is to examine some expressed concerns about ABA-based intervention and suggest productive ways of moving forward to provide the best outcomes for autistics/individuals diagnosed with ASD. The authors represent stakeholders from multiple sectors including board certified behavior analysts, licensed psychologists, parents, and autistics/individuals diagnosed with ASD.

Toward Efficiency and Effectiveness: Comparing Equivalence-based Instruction to Progressive Discrete Trial Teaching.

Research has found equivalence-based instruction (EBI) to be effective and efficient, with recent research extending these finding to individuals diagnosed with autism spectrum disorder (ASD). EBI has also been compared with more traditional approaches to teaching, such as traditional lectures, reading assignments, and video lectures. However, the authors are unaware of any comparisons of EBI to other similar behavior analytic approaches such as discrete trial teaching (DTT). The purpose of the first experiment was to compare EBI to progressive DTT using an adapted alternating treatments design with typically developing adults. Experiment 2 compared the two teaching methods with children diagnosed with ASD. The teaching approaches were evaluated with respect to mastery of trained relations, emergence of untrained relations for the EBI condition, and participant preferences. Results of the two experiments found that both teaching methods were effective, progressive DTT was found to be more efficient for six participants, EBI was found to be more efficient for two participants, and overall progressive DTT was found to be more preferred by participants. Supplementary Information: The online version contains supplementary material available at 10.1007/s40617-022-00687-8.

Collaboration between Behavior Analysts and Occupational Therapists in Autism Service Provision: Bridging the Gap.

Interdisciplinary collaboration is challenging, but necessary, to meet the needs of individuals with autism spectrum disorder. Among the dyadic interactions in interdisciplinary teams, the relationships between occupational therapy practitioners and board certified behavior analysts are uniquely challenging. The disciplines define evidence-based practice differently and approach intervention from different angles. Furthermore, there are fundamental differences in worldview between the disciplines. Both disciplines offer necessary treatment, and successful collaboration between these disciplines is essential for maximizing outcomes. Hence, finding ways to help bridge the gap between these professions, in particular, is essential. Common barriers to developing collaborative alliances include misperceptions of the other discipline, differences in terminology, and unprofessional behavior. This article reviews the history and foundational concepts of both disciplines, and the common approaches associated with each. In addition, models of collaboration are discussed, with suggestions for enhancing interdisciplinary communication and treatment. Successful collaborative treatment is predicated on an understanding of the value and expertise offered by different disciplines, and requires mutual respect and professional dialogue.

A quantitative analysis of accuracy, reliability and bias in judgements of functional analyses.

Functional analysis can be considered a diagnostic assessment that behavior analysts use to determine behavioral function. Such a diagnosis ultimately requires a yes or no decision (i.e., a variable maintains a behavior, or it does not) that is determined by both subjective (clinical judgement) and objective (data) variables. Accurate and reliable identification of function is essential for successful treatment, yet behavior analysts' interpretation of data relies on their ability to detect visual differences in graphed data. Some research indicates that behavior analysts have questionable reliability in their visual analysis. To further examine the reliability, accuracy, and bias in visual analysis of functional analysis graphs, we simulated functional analysis results and surveyed 121 BCBA-Ds experienced in visual analysis. We then examined reliability of responses and used a signal detection theory approach to analyze accuracy and bias. Findings suggest that reliability and accuracy of judgements are questionable, and exploration of decision aids is warranted.

Advances in Our Understanding of Behavioral Intervention: 1980 to 2020 for Individuals Diagnosed with Autism Spectrum Disorder.

There are three branches of science of behavior analysis [i.e., experimental analysis of behavior, behavior analysis, and applied behavior analysis (ABA)]. ABA can be defined as a systematic approach to understanding behavior of social interest. For the past 40 plus years, researchers have evaluated ABA and ABA based procedures (e.g., behavioral intervention) as they relate to individuals diagnosed with autism spectrum disorder (ASD) and have implemented behavioral intervention in clinical settings for individuals diagnosed with ASD. In this paper, we discuss some of the pivotal contributions in the field of ABA in research and clinical practice. Additionally, we provide recommendations for the science and clinical practice of behavioral intervention in the next 40 years.

The Importance of Professional Discourse for the Continual Advancement of Practice Standards: The RBT® as a Case in Point.

The Behavior Analyst Certification Board (BACB®) created a third level of certification, the Registered Behavior Technician™ (RBT®) in 2014. The RBT® was created based upon the requests of stakeholders who wanted to credential those individuals who make direct contact with clients under the supervision of a Board Certified Behavior Analyst®. There has been tremendous growth in the number of RBTs® with over 60,000 individuals certified to date. The BACB® recently sent out a newsletter outlining changes to the RBT® certification, including the processes of training, supervising, and becoming an RBT®. These changes represent a number of potential concerns. The purpose of this paper is to highlight these concerns and to propose solutions to improve the RBT® certification.

Effective remote staff training of objective session notes.

Session notes are a required component of documenting behavior analytic sessions. The direct training of writing objective session notes is important to the success of direct line staff completing adequate documentation and meeting requirements set forth by agencies, certification boards, and insurance funders. However, in-person training is not always immediately available due to contextual restrictions. This study evaluated the effectiveness of implementing the teaching interaction procedure when training staff remotely to objectively document client progress within session notes. Three Registered Behavior Technicians™ (RBT®s) were trained via telehealth to complete session notes objectively. Results showed that all 3 participants met the mastery criterion during probes measuring the objective documentation of home-based behavior analytic sessions. These findings suggest that a training package, such as the teaching interaction procedure, can be effectively implemented remotely when conducting staff training.

Evaluating discrete trial teaching with instructive feedback delivered in a dyad arrangement via telehealth.

Telehealth research in the field of applied behavior analysis (ABA) has focused on the training and supervision of others to implement various behavior analytic procedures. Current guidelines for practicing telehealth suggest that direct telehealth services may be appropriate for some individuals diagnosed with autism spectrum disorder, but more research is needed. This study evaluated the effects of discrete trial teaching with instructive feedback in a dyad arrangement delivered directly via telehealth to teach tact relations to 6 children diagnosed with autism spectrum disorder. All participants and the experimenter were located in different physical locations. All participants learned their primary and secondary targets, and 5 of the participants acquired the observational primary and secondary targets without direct teaching. Areas of future research and clinical implications are discussed in the context of telehealth service delivery.

The Teaching Interaction Procedure as a Staff Training Tool.

The teaching interaction procedure is an evidence-based procedure that has been utilized for the development of social skills. The teaching interaction procedure consists of labeling the targeted skill, providing a meaningful rationale for the importance of the skill, describing the steps of the targeted skill, modeling the skill, and providing feedback throughout the interaction. Although the teaching interaction procedure has been used to teach a variety of social skills to children and adolescents diagnosed with autism spectrum disorder (ASD) and other social and behavioral disorders, its use has not been evaluated for training staff. The purpose of this study was to evaluate the use of a teaching interaction procedure to teach 3 interventionists the skills to implement a teaching interaction procedure to target the development of social skills for children diagnosed with ASD. The results of a multiple-baseline design showed the teaching interaction procedure was effective at teaching all 3 interventionists how to implement a teaching interaction procedure.

Comparing Error Correction to Errorless Learning: A Randomized Clinical Trial.

Errorless learning and error correction procedures are commonly used when teaching tact relations to individuals diagnosed with autism spectrum disorder (ASD). Research has demonstrated the effectiveness of both procedures, as well as compared them. The majority of these studies have been completed through the use of single-subject experimental designs. Evaluating both procedures using a group design may contribute to the literature and help disseminate research related to the behavioral science of language to a larger audience. The purpose of the present study was to compare an errorless learning procedure to an error correction procedure to teach tact relations to 28 individuals diagnosed with ASD through a randomized clinical trial. Several variables were assessed, including the number of stimulus sets with which participants reached the mastery criterion, responding during pre- and postprobes, responding during teaching, efficiency, and the presence of aberrant behavior. The results indicated that both procedures were effective, efficient, and unlikely to evoke aberrant behavior, despite participants in the error correction condition engaging in significantly more independent correct responses and independent incorrect responses.

The Effects of Standard and Enhanced Data Sheets and Brief Video Training on Implementation of Conditional Discrimination Training.

Grow and LeBlanc (2013) described practice recommendations for conducting conditional discrimination training with children with autism. One recommendation involved using a specially designed datasheet to provide the preset target stimulus for each trial along with counterbalancing the location of stimuli if a three-item array of comparison stimuli. This study evaluated whether the recommended data sheet would lead to higher procedural integrity of counterbalancing trials compared to a standard data sheet (i.e., targets and arrays are not pre-set). Forty behavior therapists from two provider agencies participated. Participants were randomly assigned to either the standard data sheet condition or the enhanced data sheet condition. Participants watched a short video on Grow and LeBlanc's practice recommendations for a matching task and an orientation to the datasheet for the assigned condition, and then implemented the matching task with a confederate serving in the role of the child with autism. The enhanced data sheet resulted in higher accuracy of implementation on counterbalancing than the standard data sheet, with the largest difference for rotation of the target stimulus across trials and for counterbalancing the placement of the correct comparison stimulus in the array.

An evaluation of a comprehensive training package for interventionists providing behavioral intervention for children with autism spectrum disorder.

There has been rapid growth in the number of behavior analysts and interventionists in the world today. With this growth it is imperative to ensure that each behavior analyst and interventionist receives quality training. The training should be comprehensive (i.e. training multiple areas of behavior analysis) and should not conclude until the trainee is able to perform each behavior analytic procedure to a high degree of fidelity. The purpose of this study was to evaluate the effectiveness of a training package to train four participants how to implement multiple behavior analytic procedures. Using a multiple baseline design across participants the results indicate that each participant improved their implementation of behavioral intervention. Additionally, the participants maintained their skills over time.

A randomized clinical trial of three prompting systems to teach tact relations.

Prompts are commonly used during discrete trial teaching for individuals diagnosed with autism spectrum disorder (ASD). Three commonly used prompting systems include constant time delay, most-to-least prompting, and flexible prompt fading. Most of the research demonstrating the effectiveness of these three prompting strategies have been completed through the use of single subject experimental designs. Some within the field of behaviorally based approaches to ASD interventions have called for more randomized clinical trials of these approaches. The purpose of the present study was to compare these 3 prompting systems to teach tact relations for 27 individuals diagnosed with ASD through a randomized clinical trial without a control group with respect to pre-post responding, generalization, sessions to mastery, and responding during teaching. Overall, minimal differences were observed across the 3 systems. The results are discussed with respect to future research and clinical application of the methods evaluated.

Use of a Level System with Flexible Shaping to Improve Synchronous Engagement.

Level systems have been described as a framework which can be used to shape behavior through the systematic application of behavioral principles. Within level systems, an individual moves up and down through various levels contingent upon specific behaviors. Although level systems are commonly used within schools and other settings, they have a limited empirical literature base, and there is debate over the efficacy and overall acceptance of level systems. More especially, there is scant empirical literature on the use level systems to improve socially significant behaviors (e.g., synchronous engagement) with individuals diagnosed with autism spectrum disorder (ASD). The purpose of this study was to evaluate the effectiveness of a level system with a structured, yet flexible approach to movement on improving synchronous engagement with two dyads of children diagnosed with ASD. The results of an ABAB reversal design indicated that the level system was effective at improving synchronous engagement for both dyads. The results are discussed in relation to potential future research difficulties and clinical implications.