- Applied Behavior Analysis (ABA)
Applied Behavior Analysis (ABA) is considered a gold-standard intervention for children with autism. It is a scientific discipline that applies empirical approaches based upon the principles of respondent and operant conditioning to change behaviours of social significance. ABA utilises teaching techniques including Pivotal Response Training (PRT) and Discrete Trial Training (DTT). ABA is recommended by various organisations incl. the American Psychological Association, the American Academy of Pediatrics, the Autism Science Foundation, the Association for Behavior Analysis International, the Centers for Disease Control and Prevention, the United States Surgeon General, the Association for Science in Autism Treatment, and the National Institute of Mental Health. There is much misleading information disseminated online by neurodiversity proponents/activists regarding ABA (e.g., that it is abusive, leads to PTSD etc). This is unfortunate, especially given the importance of early-intervention for children on the autism spectrum.
- Support for ABA -
- "We write this statement to share our strong support for the use of therapies based on the principles of ABA to help those on the autism spectrum, and to provide examples of how the science and research behind ABA indicate that it is safe and effective in improving the functional abilities of people with autism across the spectrum and across the lifetime."
- "Hundreds of studies, reviews and meta analyses collected over 40 years of research have shown that the principles of ABA, when used correctly, can lead to progress in communication, language ability, cognitive ability, academic skills, adaptive skills, and social interactive behavior in autistic individuals."
- "The goal of ABA supports and therapies is not to change the essence of who someone is, or to stigmatize non-harmful behaviors, but to lessen disability and help individuals and families with ASD reach their goals."
- "ABA-type approaches have changed over time. The type of procedures used in the 1960s are different than what it is used today."
- "Behavioral approaches have the most evidence for treating symptoms of ASD. They have become widely accepted among educators and healthcare professionals and are used in many schools and treatment clinics."
- "A notable behavioral treatment for people with ASD is called Applied Behavior Analysis (ABA). ABA encourages desired behaviors and discourages undesired behaviors to improve a variety of skills. Progress is tracked and measured."
- "ABA is a well-developed scientific discipline among the helping professions that focuses on the analysis, design, implementation, and evaluation of social and other environmental modifications to produce meaningful changes in human behavior."
- "The successful remediation of core deficits of ASD, and the development or restoration of abilities, documented in hundreds of peer-reviewed studies published over the past 50 years, has made ABA the standard of care for the treatment of ASD."
- "ABA techniques have been repeatedly shown to have efficacy for specific problem behaviors, and ABA has been found to be effective as applied to academic tasks, adaptive living skills, communication, social skills, and vocational skills” (American Academy of Child and Adolescent Psychiatry).
- “…ABA is effective in increasing behaviors and teaching new skills….ABA is effective in reducing problem behavior…and also indicates that, when implemented intensively (more than 20 hours per week) and early in life (beginning prior to the age of 4 years), ABA may produce large gains in development and reductions in the need for special services.” (The Association for Science in Autism Treatment).
- "Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior" (The Surgeon General of the United States ).
- “… applied behavior analysis (ABA), [is] a widely accepted approach that tracks a child's progress in improving his or her skills…” (The National Institute of Child Health and Human Development).
- Papers challenging neurodiversity misinformation about ABA -
Concerns About ABA-Based Intervention: An Evaluation and Recommendations - This paper evaluated many of the concerns and criticism leveled against ABA.
- "In whichever area methodologies based upon the science of behavior analysis have been applied, improvements have occurred. This is exemplified in the thousands of studies that have demonstrated positive outcomes of ABA-based interventions and procedures for autistics/individuals diagnosed with ASD."
- "Currently there is a lack of reliable data and research that ABA-based interventions have resulted in a diagnosis of PTSD, anxiety, or depression."
- "Based upon these evaluations, behavior analysts should remain compassionately skeptical when confronted with generalizations and broad statements that ABA is abusive."
- "Based on our review of the concerns highlighted within this manuscript in light of the published literature, there is some validity to some of these expressed concerns (e.g., the collection of social validity measures in the published research) and limited to no validity to others (e.g., all ABA is abuse). Nonetheless, our field is not infallible, and we should continue to improve and progress our interventions."
Is Long-Term ABA Therapy Abusive: A Response to Sandoval-Norton and Shkedy - Another paper challenging the misleading claims made by neurodiversity/neuroaffirmative proponents.
- "Sandoval-Norton and Shkedy (2019) recently published an article, “How much compliance is too much compliance; Is long-term ABA therapy abuse?” They extensively criticized the discipline and practice of ABA, accusing the field and its practicing professionals of unethical behavior, support of punishment, failure to be effective, promoting psychological abuse and trauma..."
Of course "valid and thoughtful criticisms of a field are appreciated if presented in a way that is based on facts; however, Sandoval-Norton and Shkedy’s screed against behaviorism and ABA warrants a larger discussion to address such claims to educate others. Their paper is full of half-truths, cherry-picked information, and unscientific statements, so that to have their paper go unanswered would be a disadvantage to consumers seeking truthful, objective, and scientific information to guide their decisions in terms of assessment, diagnosis, and treatment of ASD."
- "The primary purpose of this paper is to demonstrate that, contrary to the perspectives of Sanvodal-Norton and Shkedy (2019), ABA is scientific approach that identifies environmental variables that influence socially significant behaviors and develop strategies to cause behavior change that is practical and applicable, improve educational outcomes, and provide real-life support for parents and families who are seeking treatment for their loved one with ASD."
- ABA is "a treatment that has been vetted for effectiveness, met that challenge, and stands as a very strong signal of hope for families impacted by ASD."
- Picture Exchange Communication System (PECS)
An augmentative communication system frequently used with ASD children who have a language delay. PECS begins with teaching the child to exchange a picture of a desired item with a communicative partner, who immediately honors the request. After the child learns to spontaneously request for a desired item, the system goes on to teach discrimination among symbols and then how to construct a simple sentence. In the most advanced phases, individuals are taught to respond to questions and to comment.
- Picture Exchange Communication System (PECS) - Wikipedia
- Numerous empirical studies attest to the benefits of using PECS with children with ASD (who have a language delay) - Study 1, Study 2, Study 3, Study 4
- Video Modelling Interventions
Video modelling is a mode of teaching that uses video recordings and display equipment to provide a visual model of a targeted behavior or skill. Children with ASD are taught how to interpret and respond to a variety of social situations. Types of video modelling include basic video modelling, video self-modelling, point-of-view video modelling, and video prompting. Video modelling interventions are most effective when the child is given ample opportunity to apply newly learned social information/behaviours in semi-natural scenarios (e.g., drama, role-playing exercises) before applying it in real-life situations.
- Video modelling - Wikipedia
- Evidence-based practice brief: Video modelling - detailed overview of video modelling for children with ASD, with references to numerous empirical studies.
A meta-analysis of Video Modeling and Video Self-Modeling interventions for children and adolescents with autism spectrum disorders - "Results suggest that video modeling and VSM are effective intervention strategies for addressing social-communication skills, functional skills, and behavioral functioning in children and adolescents with ASD."
- "The Transporters" children's video series
Developed by Prof. Simon Baron-Cohen and colleagues at the University of Cambridge, UK The Transporters is designed to help children with ASD aged between 2 and 8 years old recognise and understand emotions and other social cues. Videos depict vehicles (trains, trucks, boats etc.) with human faces and voices engaging in various social interactions with each other.
- The Transporters - Wikipedia
A number of empirical studies have found that watching episodes of The Transporters regularly over a period of several weeks can significantly improve the emotion recognition skills of young children with ASD - Study 1, Study 2, Study 3 (although note that the programme appears to be somewhat less effective for autistic children with lower cognitive ability/general learning disability, Study 4).
Sample episode of The Transporters
- Peer Mediated Intervention (PMI)
Peer Mediated Intervention (PMI) is an approach in special education where peers of the ASD student are trained to provide necessary tutoring in social, behavioural, and/or educational domains. In PMI, peers may mediate by modelling appropriate behavior themselves, using prompting procedures to elicit appropriate behavior from the target student. The peer tutors are chosen from the target students' classrooms, and are trained to mediate and are closely observed (by a clinician/educationist) during mediation.
- Peer mediated intervention - Wikipedia
- A systematic review of peer-mediated interventions for children with autism spectrum disorder - "PMI is a promising approach to address social skills in children with ASD, and this approach can be conducted in meaningful real-world contexts, such as schools."
- Peer-mediated intervention: Enhancing the social conversational skills of adolescents with autism spectrum disorder - "PMI, as described here, provides a promising approach for improving the conversation skills of high school students with ASD."
- Cognitive Behavioral Therapy (CBT) for comorbid anxiety
Cognitive Behavioral Therapy (CBT) is a form of talking therapy that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders.
- A systematic review and meta-analysis of Cognitive-Behavioral Therapy for anxiety in youth with high-functioning autism spectrum disorders - "Findings suggest that CBT demonstrates robust efficacy in reducing anxiety symptoms in youth with high-functioning ASD."
- Cognitive Behavioral Therapy for autism spectrum disorders: A systematic review - "These findings indicate that CBT may significantly improve the symptoms of ASD and social-emotional problems in children or adolescents with ASD."
- Cognitive behavioral therapy for children with autism spectrum disorder: A prospective observational study - "Results indicate that CBT is an effective therapy for children with ASD."
- Cognitive behavioral treatments for anxiety in children with autism spectrum disorder: A randomized clinical trial - "In this study, CBT was efficacious for children with ASD and interfering anxiety, and an adapted CBT approach showed additional advantages."
- A list of Chartered Psychologists in Ireland who offer Cognitive Behavioral Therapy (CBT) services - PSI Register, Find a Psychologist
Interventions for Autism Spectrum Disorder (ASD): Science vs Pseudoscience
Interventions provided for children with ASD should be evidence-based (that is, their efficacy should be attested to by empirical research). Pseudoscience consists of statements, beliefs, or practices that claim to be both scientific and factual, but are incompatible with the scientific method. According to McDonald and DiGennaro Reed (2018)1, parents should look out for the following warning signs when seeking interventions for their child.
Warning signs for pseudoscientific treatments (interventions) for ASD include:
- Other proven treatments are said to be unnecessary, inferior, or harmful.
- Testimonials, anecotes, or personal accounts are offered in support of claims about the interventon's effectiveness, but little or no objective evidence is provided.
- Promoters of the intervention are working outside of their area of expertise.
- The "theory" behind the intervention contradicts objective knowledge (and sometimes common sense).
- Obscurist language is used and prevents consumers from understanding.
- Promotors resist objective evaluation or scrutiny of the treatment by others.
- Critics and scientific investigators are often met with hostility, and are accused of persecuting the promotors, being "close-minded", or having some ulterior motive for "debunking" the treatment.
- Negative findings from scientific studies are ignored or dismissed.
- There is an evasion of peer review.
- There is an absence of self-correction.
- Catchy, emotional appealing slogans are used in marketing the treatment.
- The intervention is said to be easy to administer, requiring little training or expertise.
1 McDonald, M. E., & DiGennaro Reed, F. D. (2018). Distinguishing science and pseudoscience in the assessment and treatment of autism spectrum disorder. In S. Goldstein & S. Ozonoff (Eds.), Assessment of autism spectrum disorder (pp. 415–441). Guilford Press.
See also page on Criticisms of the Neurodiversity Theory