Abstract
There have been significant contributions to the literature on populations with developmental impairments during the last 60 years from applied behavior analysis (ABA). Autism spectrum disorder (ASD) is a particular problem that practitioners and academics have made significant progress in tackling. ABA has enhanced its public image as a result of its focus on autism, which has helped bring attention to the pressing need for greater public understanding of ASD. There is a brief overview of the relevant research contributions, and while the progress in autism is amazing, the educational system is not inclusive of people with ASD. Evidence from both a review of existing research and an original search for new information suggests that ABA has focused on ASD people while overlooking the larger challenges facing society, such as the need to improve general education.
The implementation of Applied Behaviour Analysis (ABA) has witnessed tremendous growth in the recent past in assisting children diagnosed with autism. It functions to reinforce positive desired behaviors and acquire skills that autistic kids cannot attain naturally (Leaf et al., 2021). The general intention is to limit the tendency of these individuals to engage in harmful practices, including self-injury (Leaf et al., 2021). Despite its continued adoption, ABA-based intervention has elicited much controversy emanating from caregivers (parents and guardians) and autism advocates who are at odds with ABA-based intervention methods and their general application by a portion of practitioners for the well-being of autism spectrum disorder (ASD) children. Some pro-ABA individuals argue that the ancient ABA forms for autistic children, referred to as Discrete Trial Training (DTT), were not absolutely premised on beneficial reinforcement for good behaviors (Matson et al., 2012). This is because the initial principle applied in the DTT by Dr. Lovaas featured a combination of positive reinforcement and punishment in reducing self-harm tendency amongst such patients in home-based care (Matson, et al., 2012). Other critics are also skeptical of the effectiveness of ABA-based intervention drawing their justifications from the inclusion of electric shock in the treatment (Roane et al., 2016). It is also a common belief that ABA, as a discipline, has been restricted as most of its efforts are geared towards assisting only autistic individuals while disregarding problems encountered by the immediate family or even the communities where such children are found. On the flipside, promoters of ABA-based intervention hold that the essence of the approach is not concerned with eliminating the neurodiversity of autistic children. Instead, it is founded on the need to ensure a behavior change to enhance independence by various adjustments to the environment of children diagnosed with ASD (Roane et al., 2016). Despite such controversies and accepting the dissent, this paper holds that ABA-based interventions have undergone tremendous transformations. The challenges featured in the traditional models have been adequately adjusted to meet the changing need of persons diagnosed with ASD and therefore have seen a general improvement in its effectiveness. This paper will focus on the exploration of ABA-based interventions’ contribution to autism. The scope will also involve the assessment of the prevailing ABA status, especially regarding how the general public perceives it.
The Methods section should be in this spot
Methods
method of research through a comprehensive review of the existing literature on the status of ABA in ASD care and management, both in clinical and home-based care, in the Journal of Applied Behavior Analysis through relying on PsychINFO through EBSCOhost. The study used the early years 1964-1972 and 2010-2022 by alternating keywords “ASD” and “developmental disabilities.” In the first instance, there were zero articles for the 1964-1972 periods, while in 2010-2022, there were over 40 articles. Such a variation in the result of the articles can be attributed to the language that was used in reference to individuals diagnosed with disabilities prior to 2000, which included “mentally retarded,” or “Mental retardation.” When these two languages were searched in the 1964-1972 search engine, two results were attained- Schroeder (1972) and Ayllon & Kelly. (1972).
In the same 5 years, when ‘autism’ was used as the keyword anywhere in the search, there were no article identified, but for the subsequent periods of 2007-2008, over 50 articles were retrieved. When the keywords “Down Syndrome” were used, only one article that was extracted while zero results were yielded by the use of “Fetal Alcohol Syndrome” and “Emotional Behavioural Disturbances. Further searches of the same journal in the same period of time, while alternating the use of “general” and “general education” as keywords, produced one publication for the recent period but no article for the ancient period.
Significance of ABA-based intervention in autism
ABA-based intervention’s contribution to autistics
The Diagnostic and Statistical Manual of Mental Health Disorders IV-TR (2000) provides the criteria for diagnosing autism and similar disorders. In this manual, autism and related disorders are grouped under Pervasive Developmental Disorders, cumulatively denoted as ASD, owing to the numerous conspicuous functional abilities in persons predisposed to it (Makrygianni, et al., 2018). In this paper, autism and ASD will be interchangeably used. Additionally, ‘developmental disabilities’ will only be applied during publication referencing, especially in journals where the authors failed to distinguish the developmental disability population and autism in their deductions.
Currently, the Centers for Disease Control postulates that 1:110 individuals are affected by ASD, and the disease is a developmental disability, i.e., a condition that is likely to be experienced during the person’s entire life (Makrygianni et al., 2018). Recent studies have also proposed that ASD prevalence is as high as 1:91, even when broad-spectrum is taken into perspective (Yu et al., 2020). Initially, the disease condition was deemed to be linked to a poor prognosis where only 50 percent of affected populations were anticipated to experience a fully developed language (Yu et al., 2020). Generally, ASD individuals feature impaired socialization, non-verbal and verbal communication, and repetitive behavior patterns.
Literature Review
Baer, Wolf & Risley. (1968) is one of the first empirical assessments of the principles that define ABA-based interventions in addressing behaviors portrayed by persons diagnosed with an ASD. In the research, Baer and colleagues evaluated the effectiveness of numerous operant procedures for conditioning, such as shaping, to reduce the tendency of tantrums and promote pro-social behavior frequency for a juvenile’s skills in communication and their reluctance to put on glasses. The study’s result implied that protocols premised on the principles of ABA had a greater positive relationship with the development of diverse skills while suppressing the negative behavior that normally accompanies such a disease condition (Baer et al., 1968). Moreover, after the study, the mother of the study subject (autistic child) also made a report that her child, who was on the verge of permanent loss of vision and institutional placement, continued to put on glasses, experience limited tantrums, had improved sleep experiences, elevated verbal communication and is the new source of the family joy (Baer et al., 1968).
There have also been numerous other studies that followed the Baer, Wolf & Risley (1968) study which advanced the argument on the effectiveness of ABA-based interventions for children diagnosed with ASD. The studies have ranged from discrete trial teaching, pivotal response training and group instruction, interventions in naturalistic behavioral development, training in behavioral skills, and analysis of functions and the cost of response (Stephanie, 2018). Other studies, including Leaf et al. (2011) and Schreibman et al. (2015), have replicated the effectiveness of ABA-based intervention for ASD patients.
In another work that assessed the boundary between abuse and intervention, some reservations were demonstrated by Andreadi et al. (2018) over the result of the ABA-based interventions. The authors, for instance, have leveled criticism against ABA-based interventions for unfairly giving too much value to neurotypical behavior by holding that it strives to transform the action, reaction, or the interaction of an autistic individual (Andreadi et al., 2018). It is further implied, in another study, that the expectation of curing autism, by a majority of the ABA-based interventions, is inconclusive (Babaei-Kafaki & Fakhri, 2018). The reason is that the popular usage of the term ‘cure’ is of greater controversy since, in the medical context, it refers to the fact that the cause of the disorder has not only been established but has also been completely eliminated (Babaei-Kafaki & Fakhri, 2018). The term was also disavowed in the 1970s by Lovaas and instead used “Recovery” in its place.
Another research body, with the mandate of eliminating ASD-related challenges in the diagnosed populations, has also made landmark achievements in targeted populations extending to their care. A study by Lovaas (1987) demonstrated numerous gains that, when maintained, will greatly improve the status of ASD diagnosed children. In a follow-up study on the gains alleged in Lovass. (1987), that focused on the assessment of adaptive functioning and intelligence, undertaken four and half years later, it was indicated that the ‘Early Intensive Behavioral Intervention’ (EIBI) result was superior with regards to the achievements when the experiment group was subjected to minimal treatment. The trends were further affirmed by Matson et al. (2012) when consistent results could be attained through the adoption of parent-directed intensive treatment. The primary contribution of this later study was its ability to affirm the same result even when it eliminated the use of aversive methods applied in the ancient models.
Various results have also been undertaken on the effectiveness of ABA-based intervention on the attainment of positive educational outcomes. One study, for instance, notes that the early initiation of ABA-based intervention is associated with an experience of lower levels of aberrant behaviors such as shouting, running, or even physical aggression in ASD students. Since these are some of the underlying factors experienced by ASD children, which compete with their level of concentration in class, their general willingness to be available for academic instruction, as well as adhering to requests from adults, will ultimately result in enhanced performance in class as well as in other co-curriculum activities (Tomlinson et al., 2018).
On the flip side, ABA has been criticized for having numerous challenges that instead worsen the negative experience of autism. The procedures explained in Kupferstein. (2018), including the use of shock treatment, are an attestation to the fact that ABA-based intervention might expose the patients to trauma of varying degrees. Through a digital questionnaire involving 460 participants, Kupferstein. (2018) established that almost half of patients exposed to ABA reported posttraumatic stress disorder, with a 72% probability of asymptomatic non-exposed controls. Additionally, ABA-based interventions engage human subjects who often lack the authority and / or ability to consent and are therefore marred by certain bioethical challenges. Wilkenfeld & McCarthy. (2020) suggest that the most prevalent bioethical breaches in studies of such nature include non-maleficence, justice, and above all, the autonomy principles of the person diagnosed with ASD.
Public perception of ABA
Twenty contentions of the significance of behaviorism misrepresentation were identified by Skinner (1974). A portion of the contentions believe that behaviorism disregards consciousness, mental states, and feelings. Instead, it develops behavior to constitute a set of stimuli responses confined to the behavior control and prediction similar to a robot. Such a line of argument is refuted by other studies which don’t believe in the dehumanization of the behavior of human beings. Regarding such dehumanization, the image of ABA has been greatly enhanced by ABA consumers by depicting the professional care providers to be of immense knowledge and expertise in both the delivery of ABA-based interventions and the teaching of it (Liao et al., 2020). Such an optimistic portrayal of ABA can be attributed to the intense engagement of parents through numerous capacity-building endeavors to assist the healthcare providers in limiting negative experiences of ASD in their children. The acquisition of knowledge by ABA practitioners is another way in which the autism population has assisted ABA development. It is noted in Dixon et al., (2007) that the verbal behavior analysis advanced by Skinner. (1957) constituted the first comprehensive account of the acquisition of language from a naturalistic context and was a landmark contribution to the analysis of behavior both empirically and conceptually. Nonetheless, the literature application pertaining to verbal behavior put emphasis on the language deficit of persons who were experiencing developmental disabilities.
In another instance, with prominent women like Mary Lynch Barbera doubling up as role models, caregivers for ASD children have made an immense contribution to the advancement of ASD children. Advocacy of such nature has translated into an improvement in home-based and school services, with families receiving increasing amounts of federal reimbursements.
Criteria for inclusion and exclusion of sources
As the first factor used in excluding articles, the date when the article was published was given much consideration. Most of the articles published in a span of 10 years, from the present period, were included, while those beyond such time were excluded. The reason for this method was to capture some of the current trends in ABA-based interventions in ASD care and management. After attaining a total of 50 articles, they were further subjected to other inclusion and exclusion paradigms. Secondly, since engaging autistic individuals in a study introduces ethical concerns, those studies that directly included such a vulnerable population were excluded from the study. Such a criterion eliminated 11 articles, reducing the number down to 39 articles. Additionally, the review only required peer-reviewed journals, and with the remaining articles comprising of 12 books, 27 articles remained to be used. Moreover, these 27 articles were further differentiated, depending on their objective, since the present study only focused on ABA-based interventions and ASD. This meant that articles which focused on other treatment interventions were excluded, reducing the number of articles to 20 updated peer reviewed articles.
Results
Secondly, the cases of truancy have also been considered as one of the most adjudicated status offense cases associated with the increase in out-of-home placement in ASD patients. However, the policies and procedures that have been adopted by the education stakeholders have not worked in mitigating the detrimental impacts on the cognitive development of autistic children. In fact, these policies tend to assume the hundreds of peer reviewed studies, which go back over four decades, consistently report a greater level of success in the introduction of ABA-based interventions to the curriculum than is actually the case. Such a low opinion on the capacity of ABA in promoting learning in all educational environments, for every student, is also consistent with Heward’s. (2005) findings. The author argues that the only factor that provokes society to respond to certain challenges is when such setbacks rise to the level of being considered an ‘urgent social mission” (p336). This means that the benefits that normally come with the implementation of ABA-based interventions will only suffice when the need for improvement of an educational setting for all students becomes a desperate one.
Additionally, the availability of outdated literature on the feasibility of ABA-based intervention for those with developmental disabilities tends to have created a public perception of the inability of ABA-based interventions in enhancing the well-being of autistic individuals. Most of the studies, for instance, advance the argument that even though such benefits have been confined to autistic individuals, there has been neglect of the general learners, as well as the caregivers, in making such generalizations despite their immense contributions in ensuring that research on ABA-based interventions and autism is a success. In reality, nonetheless, various modern research studies state the contrary. Through a modern quantitative study by Kupferstein. (2018), for instance, reveals that implementation of graduated guidance, positive reinforcement, and interrupting wrong actions would make a tremendous contribution towards enhancing some of the deficits to which ASD patients are predisposed, such as independence, practicing hygiene, and engaging in recreation and work.
Here is where you would add the Limitations of the Research section. Talk about what you noticed about the research that was limited or lacking and then discuss some implications for future research.
Conclusion
The major objective of this paper was to determine whether the adoption of ABA-based intervention has any benefit to ASD patients. From the reviewed literature, there are numerous benefits compared to the shortfalls that the intervention yields to the target population of those who are diagnosed with ASD. These individuals experience massive growth in cognitive development, the reduced experience of ASD-related symptoms, and thus enhanced quality-adjusted lives. Studies also revealed that ABA-based interventions create a greater level of independence, hygiene practice, engagement of recreation, and even improved ability to work with peers.
Recommendation
When a child has been diagnosed with a disability, the parent will definitely experience a mixture of intense confusion and stress. To reduce such anxiety and skeptics with regards to the special services that the parent(s) or guardian(s) need to master, providing an easy-to-understand guide is of great significance as it will give them have first-hand information on best practices, premised on ABA, to reduce the symptoms and assist the child in maximizing their full learning and general development potential. These parents will also require clear information to be presented in the language with which they are most comfortable since an in-depth understanding of the behavioral challenge, and the requisite intervention by a caregiver, will go greater miles in ensuring the success of a child both in school as well as back at home.
+Continued ABA-based interventions development will also play a significant role in enhancing the practitioners’ ability to identify strengths and shortfalls of the therapy. With a breadth of ABA-based knowledge, the practitioner will be motivated to undertake a continuous improvement and refinement of implemented therapy plans. It is also good practice to continue implementing and advocating positive reinforcement-based models for the general well-being of ASD individuals. As a result, there will be enhanced acceptance of ABA-based interventions by the members of the neurodiversity community. The interventions’ intensity, on the other hand, needs to be established depending on the prevailing needs of the ASD person. This implies that the 40 hours per week recommendation in the traditional literature does not need to be the target intensity for every ASD individual, regardless of whether or not they are able to cope with it. Therefore, the intensity of the therapy needs to be customized on a case-by-case basis.
References
Andreadi, R., Charitaki, G., & Soulis, S. G. (2018). The Effect of Applied Behavioral Analysis on the Communication Skills in Children with Autism Spectrum Disorder: Perceptions of Special Educators and Psychologists. Online Submission, 6(6), 1218-1228.
Babaei-Kafaki, H., & Fakhri, M. (2018). The comparison of the effectiveness of Applied Behavior Analysis and Pivotal Response Training on life orientation, unconditional acceptance, and social anxiety in mothers of autistic children. Journal of Clinical Psychology, 10(1), 57-69.
Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of applied behavior analysis, 1(1), 91.
Dennison, A., Lund, E. M., Brodhead, M. T., Mejia, L., Armenta, A., & Leal, J. (2019). Delivering home-supported applied behavior analysis therapies to culturally and linguistically diverse families. Behavior Analysis in Practice, 12(4), 887-898.
Helton, M. R., & Alber-Morgan, S. R. (2018). Helping parents understand applied behavior analysis: Creating a parent guide in 10 steps. Behavior Analysis in Practice, 11(4), 496-503.
Kupferstein, H. (2018). Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis. Advances in Autism, 4(1), 19-29. https://doi.org/10.1108/AIA-08-2017-0016
Leaf, J. B., Cihon, J. H., Leaf, R., McEachin, J., Liu, N., Russell, N., … & Khosrowshahi, D. (2021). Concerns about ABA-based intervention: An evaluation and recommendations. Journal of autism and developmental disorders, 1-16.
Leaf, J. B., Leaf, R., McEachin, J., Cihon, J. H., & Ferguson, J. L. (2018). Advantages and challenges of a home-and clinic-based model of behavioral intervention for individuals diagnosed with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(6), 2258-2266.
Liao, Y., Dillenburger, K., He, W., Xu, Y., & Cai, H. (2020). A systematic review of applied behavior analytic interventions for children with autism in Mainland China. Review-Journal of Autism and Developmental Disorders, 7(4), 333-351.
Louie, W. Y. G., Korneder, J., Abbas, I., & Pawluk, C. (2021). A study on an applied behavior analysis-based robot-mediated listening comprehension intervention for ASD. Paladyn, Journal of Behavioral Robotics, 12(1), 31-46.
Makrygianni, M. K., Gena, A., Katoudi, S., & Galanis, P. (2018). The effectiveness of applied behavior analytic interventions for children with Autism Spectrum Disorder: A meta-analytic study. Research in Autism Spectrum Disorders, 51, 18-31.
Matson, J. L., Hattier, M. A., & Belva, B. (2012). Treating adaptive living skills of persons with autism using applied behavior analysis: A review. Research in Autism Spectrum Disorders, 6(1), 271-276.
Matson, J. L., Turygin, N. C., Beighley, J., Rieske, R., Tureck, K., & Matson, M. L. (2012). Applied behavior analysis in autism spectrum disorders: Recent developments, strengths, and pitfalls. Research in Autism Spectrum Disorders, 6(1), 144-150.
McPhilemy, C., & Dillenburger, K. (2013). Parents’ experiences of applied behaviour analysis (ABA)‐based interventions for children diagnosed with autistic spectrum disorder. British Journal of Special Education, 40(4), 154-161.
Roane, H. S., Fisher, W. W., & Carr, J. E. (2016). Applied behavior analysis as treatment for autism spectrum disorder. The journal of paediatrics, 175, 27-32.
Rodgers, M., Marshall, D., Simmonds, M., Le Couteur, A., Biswas, M., Wright, K., … & Hodgson, R. (2020). Interventions based on early intensive applied behaviour analysis for autistic children: a systematic review and cost-effectiveness analysis. Health Technology Assessment (Winchester, England), 24(35), 1.
Sosnowski, D. W., Stough, C. O., Weiss, M. J., Cessna, T., Casale, A., Foran, A., … & Farber, M. A. (2021). Brief report: A novel digital therapeutic that combines applied behavior analysis with gaze-contingent eye tracking to improve emotion recognition in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 1-10.
Stephanie, T. (2018). Evidence-based interventions for ASD: A focus on applied behavior analysis (ABA) interventions. Психология. Журнал Высшей школы экономики, 15(4), 711-727.
Tomlinson, S. R., Gore, N., & McGill, P. (2018). Training individuals to implement applied behavior analytic procedures via telehealth: A systematic review of the literature. Journal of Behavioral Education, 27(2), 172-222.
Wilkenfeld, D. A., & McCarthy, A. M. (2020). Ethical concerns with applied behavior analysis for autism spectrum disorder. Kennedy Institute of Ethics Journal, 30(1), 31-69.
Yu, Q., Li, E., Li, L., & Liang, W. (2020). Efficacy of interventions based on applied behavior analysis for autism spectrum disorder: a meta-analysis. Psychiatry Investigation, 17(5), 432.
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