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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

The Big Four: Functional Assessment Research Informs Preventative Behavior Analysis

Current practice guidelines suggest that the assessment and treatment of challenging behavior should consist of conducting a functional behavior assessment following the onset of problem behavior. This assessment process can include indirect and direct assessment, as well as manipulation of variables to determine function. The purpose of this article is to outline a proposal that would add prevention practices to early intervention guidelines for problem behavior. Based on decades of research, the suggestion is to proactively teach children at risk for problem behavior to navigate four of the most common conditions that have been demonstrated to occasion problem behavior. Prevention is made a possibility because a large body of research examining the conditions under which challenging behavior occurs has been reliably replicated. Preventative approaches are an emerging phenomenon and reflect a progression in the practice of behavior analysis. Prevention may lead to acquisition of prosocial behavior before problems arise, to expedited and enhanced treatment, to increased access to favorable learning environments, and, we hope, to improvement in the quality of life for many children at risk for the development of problem behavior.

A Preliminary Evaluation of a Token System with a Flexible Earning Requirement

Token systems often involve a predetermined number of tokens required prior to exchange for a terminal reinforcer. The effectiveness of token systems implemented in this manner has been well documented within the literature; however, some have discussed the possibility of a fixed earning requirement creating a context in which the learner no longer emits the desired behavior once the terminal number is achieved. A possible alternative to a fixed earning requirement is selecting the earning requirement based upon learner responding and leaving the requirement unknown to the learner until the moment of exchange. The purpose of this study was to evaluate the effectiveness of a token system with a flexible earning requirement to increase the frequency of comments during snack for 3 children diagnosed with autism spectrum disorder. The results of a nonconcurrent multiple-baseline design demonstrated the flexible token system was effective at increasing the rate of comments in addition to the cumulative number of novel comments.

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.

An Evaluation of a Behaviorally Based Social Skills Group for Individuals Diagnosed with Autism Spectrum Disorder

In this study we evaluated a social skills group which employed a progressive applied behavior analysis model for individuals diagnosed with autism spectrum disorder. A randomized control trial was utilized; eight participants were randomly assigned to a treatment group and seven participants were randomly assigned to a waitlist control group. The social skills group consisted of 32, 2 h sessions. Teachers implemented a variety of behaviorally based procedures. A blind evaluator measured participants' behavior immediately prior to intervention, immediately following intervention, and during 16 and 32-week maintenance probes. Results of the study demonstrated that participants made significant improvements with their social behavior (p < .001) following intervention, and the results were maintained up to 32 weeks after intervention had concluded.

Concerns About the Registered Behavior Technician™ in Relation to Effective Autism Intervention

In 2014, the Behavior Analyst Certification Board (BACB®) initiated a program for credentialing behavior technicians. The new credential, Registered Behavior Technician™ (RBT®), is for providers of behavioral intervention to a wide range of individuals with mental health needs and developmental delays, including individuals diagnosed with autism spectrum disorder (ASD). The RBT® would represent the entry-level position within the range of the BACB® credentials. Despite the increasing acceptance of this newest level of credential from the behavioral community, the authors of this paper have substantial concerns with the RBT® credential as it relates to the delivery of intervention to individuals diagnosed with ASD. The purpose of this paper is to detail these concerns and propose remedies that would ensure that individuals diagnosed with ASD receive effective behavioral intervention.

Instructive feedback embedded within group instruction for children diagnosed with autism spectrum disorder

The present study evaluated the effects of instructive feedback embedded within a group discrete trial teaching to teach tact relations to nine children diagnosed with autism spectrum disorder using a nonconcurrent multiple-baseline design. Dependent variables included correct responses for: primary targets (directly taught), secondary targets (taught via instructive feedback), primary observational targets (directly taught to other members of the group), and secondary observational targets (taught via instructive feedback provided to other members of the group). Results showed that all nine participants reached the mastery criterion for the primary targets, as well as acquired the secondary and observational targets without direct teaching. Clinical implications and areas for future research are provided.

Using the Teaching Interactions Procedure to Teach Social Skills to Children With Autism and Intellectual Disability

This study implemented a modified teaching interaction procedure to teach social skills to 4 children diagnosed with autism spectrum disorder with an intellectual disability. A multiple baseline design across social skills and replicated across participants was utilized to evaluate the effects of the modified teaching interaction procedure. The results demonstrated that the teaching interaction procedure resulted in all participants acquiring targeted social skills, maintaining the targeted social skills, and generalizing the targeted social skills.

An Evaluation of Positional Prompts for Teaching Receptive Identification to Individuals Diagnosed with Autism Spectrum Disorder

In this study, we evaluated the effects of positional prompts on teaching receptive identification to six children diagnosed with autism spectrum disorder (ASD). The researchers implemented a most-to-least prompting system using a three level hierarchy to teach receptive picture identification. Within the prompting hierarchy, only positional prompts were used. The most assistive prompt was placing the target stimulus 12 in. closer to the participant, the less assistive prompt was placing the target stimulus 6 in. closer to the participant, and no prompt was placing the target stimulus in line with the alternative stimuli. A non-concurrent multiple baseline design across behaviors was used to evaluate the effectiveness of the positional prompt. Results indicated that the implementation of positional prompts resulted in participants reaching mastery criterion and maintaining skills at follow-up for the majority of the participants. The results of the study have both future clinical and research implications.

The Effects of the Cool Versus Not Cool Procedure to Teach Social Game Play to Individuals Diagnosed with Autism Spectrum Disorder

This study evaluated the utility of the cool versus not cool procedure for teaching three structured indoor games to eight children diagnosed with autism spectrum disorder (ASD). The study took place as part of a social skills group for individuals diagnosed with ASD, and this study was one component of that group. The cool versus not cool procedure consisted of the teacher demonstrating each game the cool (i.e., appropriate) and not cool (i.e., inappropriate) way and having the participants provide a rationale as to why the demonstration was either cool or not cool. This was followed by giving the participants the opportunity to role-play the game in front of the group. The teachers utilized unprompted performance probes with no programmed reinforcement to create opportunities for the participants to display the targeted behavior (s). A multiple baseline design across behaviors and replicated across participants was utilized. The results indicated that seven of the eight participants mastered each of the games taught.

Social Thinking®: Science, Pseudoscience, or Antiscience?

Today, there are several interventions that can be implemented with individuals diagnosed with autism spectrum disorder. Most of these interventions have limited to no empirical evidence demonstrating their effectiveness, yet they are widely implemented in home, school, university, and community settings. In 1996, Green wrote a chapter in which she outlined three levels of science: evidence science, pseudoscience, and antiscience; professionals were encouraged to implement and recommend only those procedures that would be considered evidence science. Today, an intervention that is commonly implemented with individuals diagnosed with autism spectrum disorder is Social Thinking®. This intervention has been utilized by behaviorists and non-behaviorists. This commentary will outline Social Thinking® and provide evidence that the procedure, at the current time, qualifies as a pseudoscience and, therefore, should not be implemented with individuals diagnosed with autism spectrum disorder, especially given the availability of alternatives which clearly meet the standard of evidence science.

Evaluation of multiple-alternative prompts during tact training

This study compared 2 methods of fading prompts while teaching tacts to 3 individuals who had been diagnosed with autism spectrum disorder (ASD). The 1st method involved use of an echoic prompt and prompt fading. The 2nd method involved providing multiple-alternative answers and fading by increasing the difficulty of the discrimination. An adapted alternating-treatments design showed that both procedures were more effective than a no-intervention control condition. Providing multiple alternatives did not increase error rates or teaching time, and better maintenance was shown for tacts taught with the multiple-alternative prompt.

Comparing the teaching interaction procedure to social stories: a replication study

This study compared the teaching interaction procedure to social stories implemented in a group setting to teach social skills to three children diagnosed with autism spectrum disorder. The researchers taught each participant one social skill with the teaching interaction procedure, one social skill with the social story procedure, and one social skill was assigned to a no intervention condition. The teaching interaction procedure consisted of didactic questions, teacher demonstration, and role-play; the social story procedure consisted of reading a book and answering comprehension questions. The researchers measured participants' performances during probes, responses to comprehension questions, and responding during role-plays. The results indicated that the teaching interaction procedure was more efficacious than the social story procedure across all three participants.

Comparing the teaching interaction procedure to social stories for people with autism

This study compared social stories and the teaching interaction procedure to teach social skills to 6 children and adolescents with an autism spectrum disorder. Researchers taught 18 social skills with social stories and 18 social skills with the teaching interaction procedure within a parallel treatment design. The teaching interaction procedure resulted in mastery of all 18 skills across the 6 participants. Social stories, in the same amount of teaching sessions, resulted in mastery of 4 of the 18 social skills across the 6 participants. Participants also displayed more generalization of social skills taught with the teaching interaction procedure to known adults and peers.

Observational effects on the preferences of children with autism

Children with an autism spectrum disorder (ASD) may play with limited objects or toys, making it difficult for teachers to identify reinforcers to use in teaching new skills. The goal of this study was to alter children's preferences from highly preferred toys to toys that were originally less preferred using an observational pairing procedure. Child participants observed a preferred adult playing with toys that were initially less preferred by the child. This intervention resulted in a shift in preference toward the item manipulated by the adult. Maintenance of the changed preference was idiosyncratic across participants. Results suggest a procedure for expanding the range of items that students with ASD will select.

The Effects of the Time-In Procedure on Decreasing Aberrant Behavior

This case study evaluated the effects of a time-in procedure for decreasing aberrant behavior for one adolescent diagnosed with autism. The time-in procedure consists of having the learner wear a visual stimulus and providing reinforcement for the absence of aberrant behavior. If the learner, however, engaged in the aberrant behavior, the visual stimulus was removed and a consequence was provided. An alternating treatment design compared rates of aberrant behavior during periods of time when the time-in procedure was being implemented and periods of time when the time-in procedure was not being implemented. Results of this study indicated that the participant engaged in less aberrant behavior when the time-in procedure was being implemented, as compared with times when the time-in procedure was not being implemented.

Comparison of simultaneous prompting and no-no prompting in two-choice discrimination learning with children with autism

This study compared no-no prompting procedures to simultaneous prompting procedures for 3 children with autism. Using a parallel treatments design, researchers taught rote math skills, receptive labels, or answers to "wh-" questions with both prompting systems. Results indicated that no-no prompting was effective in teaching all skills. By contrast, simultaneous prompting was effective in teaching only one pair of skills to 1 participant in the same amount of teaching time and trials. Researchers conducted a preference assessment to determine which of the two prompting procedures the 3 participants preferred. The participants showed mixed preferences for the two procedures.