Barriers to Receiving Applied Behavior Analysis Services in Children With Autism Spectrum Disorder.

Introduction Applied behavior analysis (ABA) is commonly used to treat children with autism spectrum disorder (ASD). The objective of this study is to evaluate barriers to ABA treatment in ASD. Methods A voluntary 51-question survey, including demographics, socioeconomic status, parental assertiveness/self-advocacy, and parent perceptions, was provided to caregivers of children aged one to eight years old diagnosed with ASD. The survey consisted of a series of yes/no, five-point Likert scale, multiple-choice, and text field questions. Results A total of 540 surveys were completed. The median time since ASD diagnosis was three to five years ago. Respondents were identified as receiving ABA (r-ABA) vs. not receiving ABA (n-ABA). Respondents were from Florida (60%; r-ABA = 61.7%; n-ABA = 57.0%), Pennsylvania (18%; r-ABA = 21.3%; n-ABA = 12.8%), Delaware (17%; r-ABA = 11.7%; n-ABA = 26.8%), and New Jersey (5%; r-ABA = 5.3%; n-ABA = 3.4%) (p < 0.001). Caregiver belief in ABA treatment, empowerment, and comfort level were greater for r-ABA (4.20 ± 0.72; 3.19 ± 0.93; 4.35 ± 0.72) compared to n-ABA (4.06 ± 0.83; 2.90 ± 1.00; 4.03 ± 0.91), respectively (mean ± SD). Conclusion Barriers to accessing ABA services are a multifactorial issue. Location, income, education of the caregiver, time since ASD diagnosis for the child, as well as caregiver empowerment, belief in treatment, and level of comfort in accessing services most likely contribute to children with ASD not receiving ABA. Empowering parents on their impact on their child's treatment may improve ABA use.

Evaluation of a Graduated Exposure Procedure to Teach Extended Mask Wearing in Various Settings to Children With Autism.

During the COVID-19 outbreak, the Center for Disease Control (CDC) recommended that everyone 2 years and older wear a face mask while in a community setting. However, children with autism may be reluctant to wear a mask, particularly for extended durations. In the current study, we implemented a graduated exposure procedure to teach mask wearing for a minimum of 1 hour in an early intensive behavioral (EIBI) intervention clinic to three children diagnosed with autism. We subsequently probed mask wearing, and if necessary implemented the graduated exposure procedure, in each participant's home and in a mock physician's office. Finally, we collected probe data on mask wearing in another community setting and 1 month post-treatment maintenance data in the EIBI clinic. During baseline, participants wore masks for 0 second to 5 minutes. After treatment, all participants wore the mask for at least 1 hour in each setting, with maintenance probes indicating 4 to 5 hour mask tolerance.

The effects of stimulus magnitude and duration during pretrial delivery of preferred items to increase compliance.

Previous research has suggested that the response-independent delivery of preferred stimuli can increase compliance to low-probability instructions, although these results have been mixed. Two variables that might affect compliance during this procedure are the magnitude and duration of access to the stimuli. In the current study, we evaluated stimulus magnitude and duration of access during pretrial delivery of preferred items on compliance among children with autism. In Experiment 1, we compared high and low magnitude edible stimuli. In Experiment 2, we compared long and short durations of access to leisure stimuli. Results show that high magnitudes and long durations of access to preferred stimuli delivered once immediately before a low-probability instruction increased compliance more than low magnitudes and short durations of access to preferred stimuli. We discuss the implications and possible mechanisms responsible for these results.

The use of auditory feedback and edible reinforcement to decrease toe walking among children with autism.

We replicated and extended previous research on the use of auditory feedback to decrease toe walking exhibited by 3 children with autism. After pretreatment screening analyses suggested that toe walking occurred independent of social consequences, we attached squeakers to the heels of each participants' shoes. The squeakers provided auditory feedback when participants walked appropriately (i.e., with a heel-to-toe gait). For all participants, the auditory feedback itself produced increases in appropriate walking. For 1 participant, this feedback was sufficient to reduce toe walking to clinically acceptable levels; however, for 2 other participants, delivery of edible items paired with the auditory feedback was necessary. Intervention effects maintained when the schedule for edible delivery was thinned for all participants. In addition, for 2 participants, effects maintained when the intervention was implemented in a different setting and with a different person with no edibles or a thin schedule of edibles.