This post is a continuation of “Applied Behavior Analysis: The Scientific Approach to Autism Therapy”. You can read the first part here.
Over the past 40 years, a large body of literature has documented the “successful use of ABA-based procedures to reduce problem behavior and increase appropriate skills.” In fact, more than a thousand studies reporting on ABA-based assessment and treatment techniques have been published. This research includes many studies employing single-case experimental designs, consecutive controlled case-series studies, controlled group studies and some randomized controlled trials. Each design has its own scientific and practical strengths, as well as limitations, and each study is suited to a particular type of question.
- Single-case experimental designs: Many ABA-aligned case studies use this type of design, also known as single-subject design. This type of study is ideal for examining how behavior changes as a function of environmental changes. These designs include between one and four individuals.
- Group designs: Unlike single-case studies, which compare the individual’s behavior during treatment to behavior without treatment, group designs evaluate treatments based on a “comparison of a group of individuals receiving one treatment relative to another similar group of individuals who received no treatment or a different treatment.” This type of study involves fewer observations of each individual in a group, but measure across large numbers of individuals. Group design relies on statistical analysis to determine quality of results.
- Consecutive controlled case series designs: This category of study describes a series of single-case experimental designs. Consecutive controlled studies have better external validity than cases involving fewer participants, partially because they can answer additional questions, such as what characteristics predict positive outcomes.
The following small sample of consecutive controlled case series studies provide support for the effectiveness of ABA intervention. All data is taken from the Journal of Applied Behavior Analysis and the Kennedy Krieger Institute.
- Functional communication training for treatment of problem behavior (1998)
- Participants: 19 impatient cases
- Results: 80 percent or greater reduction in problem behavior in 90 percent of cases
- Function-based treatment for severe problem behavior (2004)
- Participants: 138 inpatient cases
- Results: 90 percent or greater reduction in problem behavior in over 83 percent of cases
- Function-based treatment delivered by care providers (mostly parents) for severe problem behavior (2013)
- Participants: 42 outpatient cases
- Results: 80 percent or greater reduction in problem behavior in 95 percent of cases
- Functional communication training for treatment of severe problem behavior (2013)
- Participants: 50 inpatient and outpatient cases
- Results: 80 percent or greater reduction in problem behavior in 86 percent of cases
In contrast to the evidence-based effectiveness of ABA therapies, there are products and therapies on the market that make misleading claims about treating or curing autism. Because there is no cure for autism, outside of ABA approaches there is little consensus around treatment, leaving parents and caregivers vulnerable to fads and untested approaches. A statement released by the FDA last year identifies some of these unproven and potentially dangerous treatments.
- Chelation therapies claim to cleanse the body of toxic chemicals and heavy metals by “binding to them and removing them from circulation.” These products come in the form of sprays, suppositories, capsules and liquid drops. Though the FDA approves chelating agents for the treatment of lead poisoning and iron overload, they are not approved for the treatment of autism and can result in life-threatening mineral deficiencies.
- Hyperbaric oxygen therapy involves breathing oxygen in a pressurized chamber and has been cleared by the FDA for certain medical uses. It has not been cleared for autism treatment.
- Miracle Mineral Solution (MMS) becomes a “potent chemical that’s used as bleach when mixed according to package directions.” The FDA has received reports of consumers experiencing nausea, vomiting and low blood pressure after using the product.
- Detoxifying Clay Baths are added to bath water and claim to draw out toxins, pollutants and heavy metals. Proponents of this treatment falsely claim dramatic improvement for autism symptoms.
- Coconut kefir and other probiotic products are said to treat autism and gastrointestinal illnesses associated with autism. They have not been proven safe and effective for these advertised uses.
In contrast with the scientifically proven results of ABA therapeutic approaches, these products are untested and unscientific. According to Dr. Paul Wang, Autism Speaks senior vice president and head of medical research, “We know that parents often are desperate to find help for their children. It’s tragic when unscrupulous companies take advantage of these families by pushing so-called treatments that are not only ineffective, but may be costly or dangerous.”
Though applied behavior analysis is a treatment approach in itself, there are also different types of ABA therapies that address diverse areas of behavior, are used for children of different ages and have varying goals. The following are some of the methods used by ABA specialists:
Discrete Trial Training (DTT)
This is a style of teaching that uses a series of trials to teach each step of a desired behavior or response. This enables complex lessons to be broken down into simple, digestible parts. Positive reinforcement is used to reward correct answers and behaviors, while incorrect answers are ignored.
Early Intensive Behavioral Intervention (EIBI)
This type of ABA therapy is specifically designed for very young children with autism spectrum disorders, usually under the age of 5. EIBI helps children learn important skills, such as communication, walking and social interaction with others. Early intervention can be crucial for skill and behavior development, so parents are encouraged to communicate with their child’s physician as soon as possible if an ASD is suspected.
Pivotal Response Training (PRT)
PRT aims to motivate children to learn, monitor their own behavior and initiate communication with others. It is used to teach language, decrease disruptive behavior and increase social and academic skills by focusing on critical (“pivotal”) behaviors that affect many other behaviors.
Verbal Behavior Intervention (VBI)
As its name suggests, VBI focuses on teaching verbal skills. It is designed to motivate a child to learn language by connecting words and values.
When these ABA therapies are delivered in a competent fashion, learners with autism can make meaningful changes in all of the skill areas outlined above. However, these changes do not typically happen quickly; instead, most learners require “intensive, ongoing instruction that builds on their step-by-step progress,” according to Autism Speaks. “The rate of progress — like the goals of intervention, varies considerably from person to person depending on age, level of functioning, family goals and other factors.”
Other therapies that can be part of a comprehensive treatment program for a child with an ASD spectrum disorder include:
- Developmental, Individual Differences, Relationship-Based Approach (DIR; also called Floortime)
- Treatment and Education of Autistic and Related Communication-Handicapped Children (TEACCH)
- Occupational Therapy
- Sensory Integration Therapy
- Speech Therapy
- The Picture Exchange Communication System (PECS)
ABA programs for individuals with autism must be designed and supervised by qualified professionals. These trained ABA specialists include licensed, board-certified clinical psychologist with training in ABA. However, there are a variety of advanced careers available to graduates of accredited ABA programs that go beyond delivering therapy. These types of positions are in high demand, with the Bureau of Labor Statistics reporting a projected 29 percent job growth through the year 2022. Team leaders are responsible for planning, organizing and maintaining the program environment while continuously assessing the effectiveness of treatment interventions. They ensure the accountability of team members and complete weekly reports.
Family consultants provide both in-home and center-based support, education, counseling and referrals. They establish working relationships with the families of children with ASD, assessing the therapeutic needs of the child in the context of his or her environment. Family consultants also serve as a source of advocacy and support. They develop and implement intervention plans and treatment goals, collaborating with the child’s treatment team.
Clinical directors work directly with treatment teams and are the point of contact for families. They also work with regional funding and contracts to develop partnerships within the community. Clinical directors often serve as a mentor to therapists, developing unique programs and leading teams.
Training and development specialists are responsible for structured group training within therapy centers, as well as on-the-job support for ABA therapists. Also known as clinical trainers, these professionals constantly review research and outcomes to improve clinical practices. They also develop impactful education materials, for both internal and family use.
Case supervisors manage teams of interventionists and develop programs for clients. They, along with their clinical team, have the responsibility of creating therapeutic programs that directly affect families. Case supervisors work directly with clients, filling the unique role of front-facing liaison and internal leader.
For these meaningful careers, a graduate education in ABA allows professionals to make an impact through the only effective autism therapy intervention. The Master of Science in Applied Behavior Analysis and Autism offered by Russell Sage Online is one of the only graduate programs in the United States to focus on ABA techniques, and is offered in a fully online format. It features a scientist-practitioner model of training, which means that instruction is grounded in a scientific approach to behavior study. Key areas of study include:
- Research design
- The importance of empirical evidence
- Experimentation to discern causes of behavior
- Thorough training in ABA
Students in the ABA program can choose to pursue an optional clinical supervision track, which is overseen by board certified behavior analysts. Sage’s ABA program aims to prepare students to work with those with autism while providing them with the educational and skill competencies they need to become Board Certified Behavior Analysts (BCBA). The BACB certification, which students can pursue after completing the program, gives them the necessary credential to direct ABA programs and oversee their own teams of ABA therapists.
Because ABA is the only effective therapy for those with autism, there is a real need for qualified professionals who have these behavioral skills. Learn more about how the online M.S. in Applied Behavior Analysis and Autism from Russell Sage Online can help you meet your personal and professional goals.