Table Of Content
95] This would suggest that it is not merely enough to effect a behavioral change upon a single occasion. The researchers must show that this change may be repeated, again and again, either within subjects or in a number of subjects. Employment of pre-intervention procedures was recorded as present or absent for intervention training, functional behavioral assessment or functional analysis, and stimulus preference assessment.
Selection Criteria
In general, outcome measures should indicate a true measure of benefit to the child and their family, in addition to providing relevance within practice and the ability to replicate across research (Rodgers et al., 2020). Recent studies have questioned outcome measures such as cognition and adaptive behaviors when evaluating ASD treatments, and a call for standardized outcome measures that are truly reflective of the benefit for the child and family is beginning to grow (Rodgers et al., 2020). Our recommendation is for more rigorous large-scale prospective comparison studies between ABA and emerging interventions, such as DSP interventions, to be conducted in order to develop gold standard treatment options with a defined SoC for children and families with ASD. In summary, the above results can be visualized through a filter of the study records (Fig. (Fig.5).5). Out of the 770 (100%) study records that were reviewed in depth, most showed positive results. When study records that used a method with a potential bias for positive results—such as those that compared one ABA treatment to another or assessed the mastery or criterion of a skill or behavior—were excluded, 361 (47%) study records remained.
Data Coding and Synthesis
The instruction plan breaks down each of these skills into small, concrete steps. The therapist teaches each step one by one, from simple (e.g. imitating single sounds) to more complex (e.g. carrying on a conversation). The goal of any ABA program is to help each person work on skills that will help them become more independent and successful in the short term as well as in the future. Applied Behavior Analysis (ABA) is a therapy based on the science of learning and behavior.
Indiana Resource Center for Autism
Thus, ABA treatments may target development of new skills (eg, social engagement) and/or minimize behaviors (eg, aggression) that may interfere with a child’s progress (Hyman, 2020). The treatment of ASD may take many different approaches, focusing on one or more aspects of the condition being treated. There is no single treatment that has consistently demonstrated benefit at the core symptoms of these disorders.
All articles identified that were published prior to January 2014 were included. A pilot run of this study was conducted with ten articles to better shape data collection and variables to be included. The changing criterion design (CCD) utilizes step-wise benchmarks for manipulating a dimension (i.e., accuracy, frequency, duration, latency, or magnitude) of a single behavior already present in an individual’s repertoire (Cooper et al. 2007). The design has been used with behaviors where an immediate, considerable increase or decrease may be difficult to achieve or undesired; therefore, gradual shifts toward a desired goal are applied.
Some methodological considerations in the design and implementation of behavior therapy research
The purpose of this paper is to examine the CCD research that has been conducted and characteristics of its use and implementation to date. Repeat behavior identification assessment and behavior identification supporting assessment may be needed when indicated by periodic measurements using standardized assessments. Such repeat assessment should be comprised of fewer than 20 hours in a 6 month interval.
For example, receptive labeling tasks were coded under both cognitive and language outcome measures (Grow et al., 2011). In order to assure accurate measurement of progress and outcomes, the treatment plan must utilize measurable goals in objective and measurable terms based on standardized assessments that address the behaviors and impairments for which the intervention is to be applied (Maglione, 2012). The use of standardized assessments in a systematic and repeated manner is critical to the proper and consistent measurement of an individual’s response to treatment. Standardized assessments, as opposed to non-standardized assessments, are important because standardized assessments have been demonstrated to be consistent, reliable, and widely available.
SCEDs are exceedingly valuable within the field of ABA as they inform practitioners of the most effective methods and improve the delivery of ABA services (Tincani & Travers, 2019), in addition to facilitating innovation and detecting changes upon intervention (Smith, 2012). Specific attention can be given to measuring individual changes over time, across differing experimental conditions, in repeated conditions, and with other individuals in order to help establish validity (Perone, 2018). However, this type of study design may not measure statistical significance, lacks generalizability (Tincani & Travers, 2019), and does not assess long-term global effects (Smith, 2012). Although the overall positive results seen across all outcome measures may reflect the individualized impact of ABA, they may not reflect the more global changes or potential impacts on other children or youth with ASD that undergo the same treatment. Given the length of time that ABA has been utilized in treating children with ASD, and its having become the basis for many intervention techniques, it can be difficult to discern whether a particular treatment follows all of the principles of ABA and to what extent. This was seen in a recent review investigating all available interventions for children and youth with ASD (Whitehouse et al., 2020).
How does ABA therapy work?
Another review found that approximately half of the comparison articles investigated found that one method was better than the other(s), and the other half of the sample indicated that the methods were equally effective (Shabani & Lam, 2013). Thus, this result indicated that only half of the comparisons analyzed truly contributed to the best practices of ABA (Shabani & Lam, 2013). In the current review, this was showcased through cognitive and language outcome measures, which found that only 38% and 37% of the comparison records, respectively, reported greater improvement with one method over the other.
The BCBA and therapists measure progress by collecting data in each therapy session. Data helps them to monitor the person’s progress toward goals on an ongoing basis. Treatment goals are written based on the age and ability level of the person with ASD. Within the cohort of study records, 41% had some follow-up measure, 40% had some criterion or mastery measure, and 31% of publications had some generalization measure. An ABA therapist is a licensed mental health professional who has additional training and experience in ABA. Most states now have regulations requiring specific licensure for ABA therapists.
Some are directed by the instructor and others are directed by the person with autism. Good ABA programs for autism are not "one size fits all." ABA should not be viewed as a canned set of drills. Figure Figure44 shows the distribution of the number of participants across the whole sample, ABA Impact, Comparisons of ABA Techniques, and Between-Groups Comparisons cohorts. The highest number of participants in a study record was 332, whereas the lowest was 1.
A further 34 were excluded at this stage as they were preference assessments, functional analyses, or were concerned with training response hierarchies or conditioning reinforcers, leaving 815 study records. When the diagnostic inclusion criteria were revised, any remaining records containing only non-ASD diagnoses were excluded. Discrete trial training (DTT), which is usually conducted in a one-on-one session with a therapist, breaks skills into small (discrete) units, and teaches them one by one, with the appropriate reinforcement as each unit is mastered.
Among other outcomes, generalization measures ranged from 14% for emotional improved outcomes, 24%–29% for problem behavior, adaptive behavior, and cognitive improved outcomes, and 39% and 46%, respectively, for language and social/communication improved outcomes (Table S7). Approximately 40% of the study records measured success in the given treatment through the assessment or attainment of some level of mastery or criterion for the desired skill or behavior (Grannan & Rehfeldt, 2012; Grow et al., 2011; Toussaint et al., 2016). Because study methods frequently continue until mastery or criterion in order to solidify behaviors and promote better maintenance (Luiselli et al., 2008; McDougale et al., 2020), positive improvements occur organically as subjects attain these desired measures. However, this may not accurately indicate the ability of a participant to maintain such a skill, particularly if the mastery criterion is low (McDougale et al., 2020; Richling et al., 2019). In some instances, criterion parameters and/or experimental procedures were altered in order to reach the desired measure (Charlop et al., 1985; Valentino et al., 2015). Thus, discretion should be taken when evaluating outcomes reliant on the mastery or extinction of skills or behaviors (McDougale et al., 2020).
A clinical report published by the American Academy of Pediatrics (AAP) (2020) indicated that the prevalence of ASD in the United States is 1 in 59 children. ASDs, under the DSM-5-TR paradigm, are classified by Severity Level (see Table 2 below). Level 1, “Requiring support,” is considered the least severe classification and includes individuals with mild deficits in social communications (as seen in individuals formerly diagnosed with Asperger’s syndrome). Level 3, “Requiring very substantial support,” is considered the most severe classification and includes individuals with no or extremely limited communication abilities. The diagnosis of ASD can be complex and difficult due to the diversity of the presentation of symptoms and their severity. Due to the multitude of possible causes and potential confusion with other conditions, many tests exist to diagnose ASD that may or may not be appropriate.
The use of standardized assessments early in the course of treatment, preferably before initiating treatment and at regularly scheduled intervals thereafter, provides information about any impact of treatment on developmental trajectory, especially documenting improvement. Examples of widely accepted and used standardized assessments include the VB-MAPP and the Vineland. These types of assessments usually consist of multiple sets of questions focusing on a variety of different developmental areas including, physical, language, social, and learning, and are intended to provide a clinical picture of an individual at a particular point in time. ASD is a spectrum of diagnosable neurodevelopmental disorders that include pervasive developmental disorders (PDD), Asperger’s syndrome (AS) and autism.
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