Behavioral Artistry: Examining the Relationship Between the Interpersonal Skills and Effective Practice Repertoires of Applied Behavior Analysis Practitioners

Therapeutic Relationships in Applied Behavior Analysis: Current Status and Future Directions

For behavior analytic practitioners, skills related to building a therapeutic alliance (e.g., empathic statements, reflective listening, affirmations) may be as important as knowledge of and skills in implementation of the science of behavior analysis. We surveyed 277 board certified behavior analysts (BCBAs) to learn more about their training, use of these skills, and their perceptions of how their skills might have changed over years of practicing. The findings suggest that behavior analysts may benefit from explicit training in skills required to establish and maintain therapeutic relationships with parents of children with autism. In this article we review recent research in this area and suggest directions for training of behavior analysts. Further, motivational interviewing is introduced as an evidence-based clinical approach that encompasses many of the skills required to build a therapeutic alliance.

Developing the Parent-Coaching Assessment, Individualization, and Response to Stressors (PAIRS) Tool for Behavior Analysts

Parent engagement in early behavioral intervention is essential to achieving meaningful intervention outcomes. However, parents may experience multiple barriers to engagement. The Parent-coaching Assessment, Individualization, and Response to Stressors (PAIRS) was developed to help practitioners assess families' barriers and facilitators, individualize their intervention, and respond to stressors using a contextual, functional approach. An expert panel of Board Certified Behavior Analysts ® (BCBAs) evaluated the content validity of the PAIRS. Average scale values (S-CVI/Ave) were 0.92 for relevance, 0.85 for effectiveness, and 0.91 for appropriateness. The PAIRS was revised, and a follow-up evaluation was conducted to rate the tool's utility. This led to the final version of the PAIRS. Clinical implications and future directions are discussed.

Teaching Compassion Skills to Students of Behavior Analysis: A Preliminary Investigation

Socially valid practices are at the heart of applied behavior analysis and can influence how interventions are experienced by families. However, the training of practitioners of applied behavior analysis is primarily focused on the implementation of technical procedures with little focus on therapeutic approaches. Empathy and therapeutic rapport have been associated with improved outcomes in allied professions (Beach et al., Journal of the American Board of Family Practice, 15(1), 25-38, 2006; Hojat et al., Academic Medicine, 86(3), 359, 2011; Horst et al., Journal of Child & Family Nursing, 3, 5-14, 2000), but have been minimally studied within the field of behavior analysis. In the present study, several sources were utilized to identify and define empathic and compassionate care skills. These skills were divided into three skill areas (i.e., basic interviewing skills, interest in the family, joining with the family) and taught to ABA master's students using behavioral skills training via a telehealth platform. All four participants significantly improved their engagement in compassionate care skills following training and maintained these skills in follow-up probes and with a different experimenter. Several post-study measures of outcome were taken, including social validity measures from participants, ratings of compassion from consumer and professional experts, as well as comparison measures on the Jefferson Scale of Physician Empathy. Participant reports of social validity were high, as were consumer and professional ratings of compassionate behaviors. Improvements on the Jefferson Scale of Physician Empathy were also observed. Implications for training practitioners and for expanding the focus on compassionate care skill development within the field are explored.

Factors Affecting Parent Treatment Decisions for Children with Autism Spectrum Disorders: A Brief Review

Parents and caregivers of individuals with autism spectrum disorders (ASD) are faced with a vast array of treatment options, which vary greatly in evidence-based merits, and it is unclear what factors affect their final selections. Understanding the factors that influence family decisions can shed light on avenues for more effectively communicating the importance of selecting empirically supported treatments. In this article, we conducted a systematic literature review on how parents select evidence-based treatments for their children with ASD. We categorized treatment types using a combination of established resources, such as the National Standards Project (NSP), to determine the validity of research evidence for different ASD treatments. We reported the various treatment types, decision-making factors, and sources of recommendations across the literature, and compared those with earlier systematic literature reviews. The results of the present review indicate that parents' decisions are influenced by the accessibility of treatment, trust of practitioners, and alignment on factors such as parental values and the child's specific needs. We conclude with suggestions for practitioners and researchers on future research and wider adoption of evidence-based treatments (EBTs).

Humble Behaviorism Redux

The need to bring behavior analysis to scale is no more obvious or urgent than now. Collaboration between behavior analysts and healthcare workers, educators, policymakers, mental health clinicians, social workers, and so many other professionals is critical to reaching under-resourced and traditionally marginalized populations. First, however, interprofessional collaboration must be adopted widely and reinforced within the behavior analytic community. Disciplinary centrism and hubris pose barriers to effective interprofessional collaboration, leading one to assume the position that practitioners of the same discipline are better trained and smarter than those of a different field. However, cultural humility (Wright, Behavior Analysis in Practice, 12(4), 805-809, 2019) is an alternative to disciplinary centrism that allows professionals to retain identities born of cultural histories and training (Pecukonis, Journal of Teaching in Social Work, 40(3), 211-220, 2020). Furthermore, cultural reciprocity is a process of self-observation and collaborative inquiry that involves questioning one's own assumptions and forces individuals (and professions) to confront the contradictions between their values and their practices (Kalyanpur & Harry, 1999). In this paper, we revisit the call for Humble Behaviorism first made by Alan Neuringer in 1991 and the recommendations of fellow behavior analysts since. Specifically, we introduce a framework of cultural reciprocity to guide humble behaviorists as they acquire behaviors necessary to establish and maintain productive interprofessional relationships. We encourage them to act on their ethical and moral duties to address social problems of global concern and bring behavior analysis to scale.

Ongoing, Explicit, and Direct Functional Assessment is a Necessary Component of ACT as Behavior Analysis: A Response to Tarbox et al. (2020)

Tarbox et al. (2020) offered preliminary functional analyses and practical guidelines for incorporating acceptance and commitment therapy (ACT) within the scope of practice of applied behavior analysis (ABA). Although we agree that this is a needed goal, the approach taken by the authors gives rise to important conceptual, ethical, and practical concerns that warrant further discussion. In particular, we propose that explicit functional assessment of behavior (FA) is necessary in any intervention said to be ABA, and we wonder about the apparent omission of explicit FA throughout the article. We question what we read as the authors' tacit assertion that the functions of verbal stimuli can be inferred based on behavioral topography, that the function of verbal behavior can likewise be inferred based on form, and that behavior-behavior relations are both causal and predictive of behavior, irrespective of context. Furthermore, we consider whether a number of procedures for functional assessment presented in the article under consideration are consistent with established ABA best practices. Finally, we discuss the extent to which ACT interventions absent explicit FA in ABA interventions introduces the possibility that the interventions may do harm, arguing that further discussion around competence and scope of ethical practice for behavior analysts who wish to incorporate ACT into their work is needed.

A Preliminary Assessment of the Qualities and Behaviors of Exemplary Practitioners: Perspectives From U.S.-Based Behavior Analysts

Individuals with credentials (Board Certified Behavior Analyst-Doctoral and Board Certified Behavior Analyst) from the Behavior Analyst Certification Board throughout the United States were asked to identify the characteristics and corresponding behaviors of individuals they consider to be exemplary in the profession. From these responses, a list of 35 characteristics and attendant behaviors was compiled into the Exemplary Behavior Analyst Checklist. This checklist contains a number of characteristics that are traditionally representative of the field (e.g., analytical, applied, conceptually systematic, technological) and relate to technical and conceptual skills. Respondents also identified a number of characteristics associated with compassion and support of clients/individuals (e.g., client centered, culturally competent, empathetic, positive/encouraging). A "top 10" list of the qualities and behaviors of exemplary behavior analysts identified by participants is presented, and a discussion regarding the implications for the training of credentialed professionals is provided.

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.

Preliminary Assessment of a Novel Continuum-of-Care Model for Young People With Autism Spectrum Disorders

Because of limited intermediate-care services, patients with autism spectrum disorders (ASDs) are increasingly being treated in emergency departments (EDs) and psychiatric hospitals. To address this growing problem, the authors developed a mobile outreach program, called Access to Psychiatry through Intermediate Care (APIC), for young (≤26 years) patients with ASD at risk for involvement with emergency medical services or the legal system. In its initial year, the average program duration per patient was 264.5 days. Clinical and Family Distress Scale scores indicated significant improvements for participating patients and caretakers. In the first year, among 40 patients with sufficient data for comparison, 13 (33%) went to the ED, and lengths of stay decreased up to 77% from pre- to postintervention. Given a cost per APIC-enrolled patient of $1,700, the net saving for the cost of ED treatment was $2,260-$2,559 per patient. The feasibility and cost-effectiveness of the APIC model has attracted additional state and county funding.

“Recalling hidden harms”: autistic experiences of childhood applied behavioural analysis (ABA)

Purpose

This paper aims to investigate the long-term impacts autistic adults experienced from childhood participation in the applied behavioural analysis (ABA).

Design/methodology/approach

Possible participants were recruited through advertisements on social media and autism and ABA organisations. Possible participants were given the choice between an online or face-to-face interview or an anonymised online questionnaire.

Findings

Reflections from 10 participants were indicative of a predominantly detrimental impact of ABA. Reflections gave rise to a core theme “recalling hidden harms of childhood experiences of ABA”. Outcomes are discussed in relation to the impact on autistic identity, current research and progressing understanding of the impacts of early intervention from the autistic perspective.

Research limitations/implications

The practical implications of ABA are discussed alongside recommendations for future practice and research with the involvement of autistic individuals within interventive processes.

Originality/value

This is the first paper to take an in-depth, qualitative approach to autistic experiences of ABA. The findings themselves are driven to conceptualise and give voice to the core impacts which carried through participants’ exploration and understanding of self.

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.