Behavior Analysts' Use of and Beliefs in Treatments for People with Autism: A 5‐Year Follow‐up

As autism prevalence rises, parents of children with autism rely upon professionals to recommend the most effective treatment for their children. Historically, these professionals have chosen a range of treatments from empirically supported to nonempirically supported treatments. This study replicated and extended that work by surveying Board Certified Behavior Analysts to determine what treatments they promoted and used. Results showed that although most respondents used evidence‐based, behavioral procedures, many did not. Influential stimuli most likely to contribute to behavior analysts' choices of treatments were beliefs in effectiveness, ease of implementation, and persuasion by others. Self‐reported reinforcers for treatment use included perceived observed success, praise from others, and financial gain. Behavior analysts continue to use a variety of nonscientifically supported treatments, including those that have been deemed ineffective and harmful to people with autism. Future training of Board Certified Behavior Analysts must stress adherence to the ethical code for certified behavior analysts, adherence to data‐based decision‐making, and strict fealty to the scientific process in which all behavior analysts have been trained. Copyright © 2016 John Wiley & Sons, Ltd.     

Behavior analysts' perceptions of the population specificity or comprehensiveness of autism treatments

The basic philosophy of radical behaviorism provides foundations for behavioral intervention applications in applied behavior analysis (ABA) across a variety of populations and human behaviors. However, as ABA increases in popularity for people with autism, many people perceive that ABA resembles other non‐research‐supported interventions which market themselves almost exclusively for autism. This study evaluated the extent to which behavior analysts perceived scientifically supported treatments (e.g., ABA) and non‐scientifically supported treatments as population‐specific or as comprehensively applicable across populations. Behavior analysts (N = 876) completed an online survey which indicated that approximately 3/4 of behavior analysts reported ABA as comprehensively effective for all people. Treatments without scientific support also were ranked more often or as effective as ABA for specific populations (i.e., intellectual and developmental disabilities, autism, severe behavior problems, adults, and children). Results indicated a continuing need to emphasize the education and requirements of radical behaviorism as the scientific foundations of ABA.     

AUTISM TREATMENTS IN PRINT: MEDIA'S COVERAGE OF SCIENTIFICALLY SUPPORTED AND ALTERNATIVE TREATMENTS

Professionals, celebrities, and media frequently suggest to parents the possible treatment options for their children with autism. Some treatment recommendations advocate for scientifically supported treatments whereas others suggest novel, untested interventions, or potentially ineffective or harmful treatments. The current study examined the print media's coverage of applied behavior analysis (ABA) and non‐scientifically supported autism treatments. Over the last 10 years, print media have increasingly published articles referring to autism treatments with little scientific support and a decreased coverage of ABA. Print media's positive statements about non‐scientifically supported treatments also increased over the last decade, whereas positive statements about ABA decreased. ABA received two times as many positive comments as negative; however, non‐scientifically supported treatments as a group received four times as many positive comments as negative. These results could contribute to parents' decisions to implement treatments for their children with autism. To contribute to future positive perception of ABA, we provided suggestions for the dissemination of information to increase positive reporting of ABA in print media. Copyright © 2013 John Wiley & Sons, Ltd.     

How to behave ethically in a world of fads

Although applied behavior analysis (ABA) has significant scientific support for treating people with autism spectrum disorders (ASDs), the field of autism treatment has been plagued with rapidly proliferating fad treatments subjecting people with ASD to various ineffective, pseudoscientific, and antiscientific treatments. To combat this, professionals must learn to make ethical treatment decisions, sometimes before research is conducted or published. Even when research is available negating fads, behavioral professionals must also overcome misperceptions about ABA. The purposes of this paper are to provide behavioral professionals with (a) a mechanism for making ethical treatment decisions (using sensory integration as an example) and (b) a method for responding to potential misperceptions and obstacles to using ABA. Copyright © 2010 John Wiley & Sons, Ltd.     

A comparison of a modified sequential oral sensory approach to an applied behavior‐analytic approach in the treatment of food selectivity in children with autism spectrum disorder

Treatments of pediatric feeding disorders based on applied behavior analysis (ABA) have the most empirical support in the research literature (Volkert & Piazza, 2012); however, professionals often recommend, and caregivers often use, treatments that have limited empirical support. In the current investigation, we compared a modified sequential oral sensory approach (M‐SOS; Benson, Parke, Gannon, & Muñoz, 2013) to an ABA approach for the treatment of the food selectivity of 6 children with autism. We randomly assigned 3 children to ABA and 3 children to M‐SOS and compared the effects of treatment in a multiple baseline design across novel, healthy target foods. We used a multielement design to assess treatment generalization. Consumption of target foods increased for children who received ABA, but not for children who received M‐SOS. We subsequently implemented ABA with the children for whom M‐SOS was not effective and observed a potential treatment generalization effect during ABA when M‐SOS preceded ABA.     

Structural Family Therapy and Autism Spectrum Disorder: Bridging the Disciplinary Divide

ABSTRACT

Applied Behavior Analysis (ABA) is an evidence-based practice approach for the treatment of individuals with autism. The systemic effects of autism suggest that family therapy would considerably enhance the treatment of individuals with autism. Marriage and family therapy (MFT) training does not routinely include exposure to autism beyond the associated diagnostic criteria. Structural Family Therapy (SFT) is a systemic model that is familiar to those trained in family therapy and appropriate for the needs of families affected by autism. Therefore, the authors have used SFT as a foundation for supervising MFT trainees working in an autism treatment setting.     

The effect of behavioral skills training with general‐case training on staff chaining of child vocalizations within natural language paradigm

This study used behavioral skills training (BST) and general‐case training (GCT) in which the experimenter simulated child performance to teach three staff to conduct NLP and response chaining to increase three‐link vocal chains in three children with autism. Staff increased their correct NLP performance during post‐training in comparison to baseline. Two of three children emitted more vocal chains following training. This study demonstrated that BST and GCT were effective in training NLP and response chaining. When assessing social validity, both Board Certified Behavior Analysts (BCBAs) and teachers did not indicate an increase in staff members' teaching skills. Future research should develop effective technologies to chain vocal behavior and to teach staff and parents to implement response chaining. Copyright © 2009 John Wiley & Sons, Ltd.     

Cultural Influences on Perceptions of Health, Illness, and Disability: A Review and Focus on Autism

This conceptual paper considers the role of culture in shaping family, professional, and community understanding of developmental disabilities and their treatments. The meanings of health, illness, and disability vary greatly across cultures and across time. We use Bronfenbrenner’s ecological model to provide a theoretical framework for examining disability, with special attention to autism spectrum disorders. Cultural beliefs about the cause of a disorder influence families’ decision-making about what treatments to use and what outcomes to expect. Autism provides an example that is especially challenging, as there is no agreed-upon cause. Also, an overwhelming array of treatments is available in the West for autism, including behavioral, cognitive, pharmaceutical, sensory, relational, vitamin, and diet therapies. Other cultures contribute additional views on cause (e.g., Karma, Allah’s will) and treatments (e.g., acupuncture, herbal medicines, Ayurveda). We suggest how a broad cultural view can help us understand treatments and the treatment delivery system of a nation and a culture. For the best course of care, professionals need to understand and respect families’ views of autism and work toward mutually agreeable treatments that may involve a combination of biomedical and cultural practices. Although a family-focused, open teamwork model that aims to acknowledge the context of the child, take into consideration the strengths and limitations of the child and the family, and introduce appropriate, sustainable, and sensitive interventions is regarded as best practice in the United States, it will take sensitive work to find out whether it will suit other cultural groups across the world.     

Cultural Influences in the Aetiological Beliefs of Saudi Arabian Primary Care Patients About Their Symptoms: The Association of Religious and Psychological Beliefs

Objective To develop a self-report questionnaire to measure the beliefs of Arabic primary care patients about the causes of their physical symptoms; to use this to quantify the beliefs of patients consulting their general practitioners (GPs) in Saudi Arabia; and to test whether patients with psychological problems differ from others in their beliefs, particularly religious and supernatural beliefs. Methods Consecutive patients (N = 224) completed a specially developed aetiological beliefs’ questionnaire. Patients were divided into two groups (cases and non-cases of emotional disorder) according to the GHQ-12. Results Religious and supernatural aspects of culture colour patients’ symptom beliefs: that their symptoms were a test or punishment from Allah’ was the most common belief. Even in non-cases, around half the patients also endorsed nerves and stress as a cause of their physical symptoms. Cases were more likely than non-cases to endorse items related to both religious and psychological factors. Conclusion There is no support for the view that Saudi Arabian patients explain symptoms supernaturally as a way of denying psychological factors. GPs and health professionals in Saudi primary care need to understand what patients believe to be the cause of their problems and to appreciate that religious and psychological beliefs are both very common. GPs should address psychological beliefs and concerns even with those patients who present physical symptoms.     

A Posture of Reciprocity: A Practical Approach to Collaboration Between Professionals and Parents of Culturally Diverse Backgrounds

The current emphasis on developing culturally responsive services for families of children with disabilities from culturally diverse backgrounds informs the need for professional self-awareness whereby professionals learn to recognize not only the cultural specificity of personal values and beliefs but also of their professional practice. We describe an approach, the posture of reciprocity, that enables professionals to acquire this level of cultural awareness. Examples to illustrate applications of the posture are provided.     

Exploring Issues of Generalization and Maintenance in Training Instructional Aides in a Public School Setting

In today’s climate, with the ever-increasing demand for competent behavior analytic services, it is necessary for behavior analysts to work across a variety of settings, including home, school, and community, overseeing instructional aide staff as the frontline providers of applied behavior analysis (ABA) services. It is common practice for ABA practitioners to provide the supervision and training to parents, caregivers, and direct-care staff, who may have limited knowledge and experience within the field of ABA. In 2013, the Behavior Analysis Certification Board (BACB^®) initiated an effort to establish standards for the training of instructional aides and direct-care staff in the delivery of instructional and treatment services based on the principles of ABA. This new standard and credential is known as a Registered Behavior Technician? (RBT^®). The purpose of this study was to evaluate the training process outlined by the BACB, focusing specifically on the generalizability and long-term maintenance of newly acquired skills taught through a competency-based approach, to novel opportunities for implementation. Training was conducted through two methods: in vivo training with clients versus role-play with peers. Both these types of staff training approaches are commonly used instructional practices in the field of ABA.     

Clients' beliefs about psychological problems

An investigation of clients beliefs about the causes and treatments of their own psychological problems, using a new instrument, the Opinions about Psychological Problems (OPP). We found that, although the beliefs about the various models were positively correlated, clients made clear overall discriminations between them. For causation, they tended to agree with the four psychological models (Behavioural, Cognitive, Humanistic and Psychodynamic) and the Naïve model, and tended to disagree with the Socio-economic and Organic models. For treatment, they endorsed Behavioural, Cognitive and Humanistic most highly, and again disagreed overall with Socio-economic and Organic. Individual difference variables showed that clients reporting a higher level of psychological symptoms tended to endorse all causation beliefs more highly, and also were more likely to agree with Behavioural, Cognitive, Humanistic and Psychodynamic treatments. The structure of clients' beliefs differed from that found in previous studies. There was a single factor which loaded on the four psychological models, with which the Organic, Socio-economic and Naive subscales were less strongly, but still positively, correlated     

Nigerian Clergy and healthcare professionals’ perceptions of health-seeking behaviours among Nigerian immigrants in the UK

The diversity in patient populations due to immigration in the UK has implications for adequate understanding of a patients’ culture by the clinician as well as patient–clinician cultural matching for enhanced service use and outcome. This qualitative study investigated how Nigerian clergy and health professionals perceived health-seeking behaviours among Nigerians in the UK, while considering the impact of their own beliefs and values as care providers. Six participants were interviewed (clergy, n?=?2; health professionals, n?=?4). Data were analysed using Interpretative Phenomenological Analysis. Results showed that the clergy and health professionals themselves use religious/cultural cure and formal healthcare methods, and believed Nigerian immigrants as predominantly using religious/cultural methods which can affect healthcare utilisation, although differences between the professionals were reported. The potentials for integrating other cure methods into the formal healthcare services were considered, while highlighting the challenges that may arise from such collaborative effort.     

Brief Report: Assessment of Training and Supervision Needs Among Registered Behavior Technicians

We assessed the self-perceived training needs of Registered Behavior Technicians (RBTs) to inform the content and direction of supervision provided by Board Certified Behavior Analysts (BCaBAs). The RBTs identified several training priorities that would improve their delivery of applied behavior analysis (ABA) services. Self-assessment by RBTs combined with direct observation allows supervisors to develop individualized training plans with these paraprofessional providers.     

Contributions of positive behavior support amid lingering questions over its relationship with behavior analysis: A review of Positive behavior supports for adults with disabilities in employment,community, and residential settings by Storey and Post

Positive Behavior Supports for Adults with Disabilities in Employment, Community, and Residential Settings by Keith Storey and Michal Post (2019) presents valuable information for support providers and clinicians working with adults in inclusive settings who display challenging behavior. Numerous examples of challenging behavior encountered in such settings are provided along with a multitude of interventions for addressing the behavior in ways that comport with the values of positive behavior support (PBS). This review highlights contributions of the Storey and Post book and considers the content in regard to the controversial relationship between PBS and applied behavior analysis (ABA). The authors specify ABA as the foundation of PBS, but questions linger about the exact PBS–ABA relationship that will likely affect the book's ultimate contribution. Concern over the relationship is illustrated in regard to qualifications of behavioral professionals whom the authors often refer to as being necessary to help support providers develop and implement PBS interventions.     

Attributions for physical activity in very old adults: predicting everyday physical activity and mortality risk

Objectives: Although physical activity is recognised as a health-promoting behaviour for older adults, notable barriers exist that may reduce physical activity in this age group. Limited research has explored causal beliefs (attributions) as a barrier to physical activity. Our study assessed associations between older adults’ attributions about physical activity and objective health outcomes. Methods: We examined the role of attributions as a predictor of everyday physical activity (EPA) and subsequent mortality risk over a 10-year period (2006–2016) in a sample of older adults (M_age?=?87, N?=?261). Results: OLS and Cox proportional hazard regression analyses revealed older adults who endorsed more internal and uncontrollable attributions for limited activity (physical incapacity) when feeling unwell had lower subsequent EPA (β?=??0.18), and higher 10-year mortality risk (HR?=?1.46). Other attributions with different dimensional properties (e.g. internal and controllable) were not associated with EPA or mortality. Discussion: Findings suggest that causal beliefs older adults have about their physical activity can influence their future behaviour and longevity. Psychological treatments designed to discourage maladaptive attributional thinking for older populations who face barriers to physical activity may be an important avenue for future research.     

Treating the core features of autism: are we there yet?

A wide variety of nonestablished treatments have been proposed as "cures" for the core features of autism and are used frequently despite having largely escaped scientific scrutiny. In contrast, a growing body of empirical evidence supports the use of a few forms of theory-based and empirically validated treatment for some aspects of the core features of autism. These include behavioral/psychoeducational interventions and specific forms of medication treatment, which can produce significant improvements in communication, social interaction, and problem behaviors that both maintain over time and generalize across settings. While there is no doubt that treatment and educational services for persons with autism have improved over the past 6 decades, it also appears that significant issues remain with respect to (1) the routine application of validated treatments for the majority of cases with autism, (2) the resistance to even validated forms of treatment for a substantial minority of cases with autism, and (3) the extent to which validated treatments effectively treat the specific core features of autism that are most disabling for persons with autism and their families.     

Interpersonal Features and Functions of Nonsuicidal Self‐injury

Etiological models of nonsuicidal self‐injury (NSSI) suggest interpersonal features may be important to understand this behavior, but social functions and correlates have not been extensively studied. This study addresses existing limitations by examining interpersonal correlates and functions of NSSI within a stratified random sample of 1,243 predominantly Caucasian college students (mean age = 21.52, SD = 4.15 years). Participants completed an anonymous online survey assessing NSSI features, perceived social support, and disclosure experiences. Approximately 15% of the students endorsed NSSI. Interpersonal reasons were endorsed proportionally more often for initiating rather than repeating the behavior. Individuals with repetitive NSSI reported significantly lower perceived social support from family members and fewer individuals to seek advice from than single‐act and control participants. Fifty‐nine percent had disclosed their NSSI, but rarely to mental health professionals. Conversations with others about NSSI were rated as being mostly unhelpful. These results emphasize the importance of interpersonal features and functions of NSSI, suggesting treatments should focus on strengthening interpersonal bonds alongside emotion regulation. Improving responses to disclosures of NSSI is needed to promote communication about this behavior and perceived helpfulness of such conversations.     

Trends in Women's Participation at the Meetings of the Association for Behavior Analysis: 1975-2005

We examined women's participation, relative to men's, at the annual meetings of the Association for Behavior Analysis (ABA) between 1975 and 2005. Among our findings are upward trends in female presenters across formats (e.g., posters), types of authorship (e.g., first authors), and specialty areas (e.g., autism). Where women have attained parity, however, they are still often underrepresented, given their percentage of membership. Women also participate less than men as sole and invited authors and discussants and in the domains of basic research and conceptual analysis, but participate more than men in the applied domain. Data from the Journal of the Experimental Analysis of Behavior and the Journal of Applied Behavior Analysis show parallel but delayed trends toward parity in basic and applied research, whereas data from The Behavior Analyst show only modest gains in the conceptual domain. We discuss the gender disparities in ABA's more prestigious categories of participation (e.g., invited addresses) and across its content domains, as well as in science in general, and the role of social and cultural factors in producing the disparities and how behavior analysts might aid in correcting them.