Statement on Use of Applied Behavior Analysis (ABA) for Autism

The use of Applied Behavior Analysis (ABA)-based therapies has recently become a point of disagreement in the autism community.  

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.  We address four main points regarding utility of ABA principles in autism intervention:

  •  ABA is not a single protocol or technique but rather is an approach or set of techniques tailored to individual’s strengths and challenges.  

Applied Behavior Analysis encompasses a wide array of approaches to intervention, including highly structured approaches (e.g., Discrete Trial Therapy) and naturalistic approaches (e.g., pivotal response training or natural environment teaching). The goal of applied behavior analysis is to promote the acquisition of skills needed to participate successfully in daily activities.  

  • ABA type approaches have changed over time.  The type of procedures used in the 1960s are different than what it is used today.

The very first studies around ABA-based interventions were groundbreaking.  Previous to those studies which took place almost 60 years ago, parents were told that their children would never live productive lives.  These first studies included mostly positive reinforcement with some punishment, using something called discrete trial therapy (DTT).  Those early behavioral modification techniques led to children going to school and being able to be more independent.  This kept people out of institutions enabled to remain in their communities.  But as our scientific understanding of autism changed, so did the techniques used as part of ABA.   Over the past 40 years, the term ABA has evolved to include a more holistic approach that incorporates developmental and other learning theories.  Today, evidence-based autism therapies that include principles of ABA entail a much broader array of goals, assessments, supports, and accommodations that incorporate a person-led approach and encourage learning through activities that are fun and engaging.   It also promotes the use positive, rather than negative reinforcement.

The procedures involved in ABA have become more sophisticated over time and with continual knowledge about autism and how behavioral supports can improve the lives of those on the spectrum, it continues to improve (Justin B. Leaf et al., 2021).  Many critics of ABA focus on punishment. Research has shown that positive behavior supports are most effective, and the ABA field has evolved – and continues to evolve – based on a growing body of research (Frampton & Shillingsburg, 2020; Maye et al., 2020; Sandbank et al., 2020; Schmidt, Luiselli, Rue, & Whalley, 2013). ABA-based approaches, especially naturalistic, developmental behavioral approaches, incorporate ideas and practices from many other schools of thought regarding the science of learning, including developmental theory, cognitive theory, and constructivist theories. 

  • Research has shown that ABA-based interventions help people with autism.   

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 (Helt et al., 2008; Rodgers et al., 2020; Smith & Iadarola, 2015; Weitlauf et al., 2014)   While ABA techniques can be used across the lifetime, most of the science conducted so far has focused on use of these techniques prior to age 10 (Howlin, Magiati, & Charman, 2009; Reichow, Hume, Barton, & Boyd, 2018; Rodgers et al., 2020; Schreibman et al., 2015).    These changes lead to meaningful gains in quality of life, like developing social connections and friendships (Kasari, Rotheram-Fuller, Locke, & Gulsrud, 2012), maintaining employment (Wehman et al., 2017) and improved independence (Hume, Loftin, & Lantz, 2009).  

ABA can also dramatically reduce problem behaviors like aggression, destruction, and self-injury.  The Certification Board for ABA therapists recommend positive rather than negative reinforcement such as punishment be implemented in behavior plans.  

  •  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.  

It is a mistake to throw out an entire canon of techniques and principles based on criticism of past practices. The goal of ABA is to maximize communication skills and minimize challenging behaviors that limit opportunity, not to eliminate neurodiversity.  In fact, autistic adults have acknowledged the benefits of certain interventions based on the principles of ABA (Schuck et al., 2021).  Additional issues surrounding the controversies around ABA are summarized and addressed in: J. B. Leaf et al., 2021.

The Autism Science Foundation supports the use of interventions based on the principles of ABA to help individuals of all ages across the spectrum lead their best lives possible.  Of course, we strongly are against any program or therapy that harms an individual.  However, we have concluded that ABA therapy, when properly rendered in an ethical manner, is beneficial to individuals who are impacted by autism.  

References

Frampton, S. E., & Shillingsburg, M. A. (2020). Promoting the development of verbal responses using instructive feedback. J Appl Behav Anal, 53(2), 1029-1041. doi:10.1002/jaba.659

Helt, M., Kelley, E., Kinsbourne, M., Pandey, J., Boorstein, H., Herbert, M., & Fein, D. (2008). Can children with autism recover? If so, how? Neuropsychol Rev, 18(4), 339-366. doi:10.1007/s11065-008-9075-9

Howlin, P., Magiati, I., & Charman, T. (2009). Systematic review of early intensive behavioral interventions for children with autism. Am J Intellect Dev Disabil, 114(1), 23-41. doi:10.1352/2009.114:23;nd41

Hume, K., Loftin, R., & Lantz, J. (2009). Increasing independence in autism spectrum disorders: a review of three focused interventions. J Autism Dev Disord, 39(9), 1329-1338. doi:10.1007/s10803-009-0751-2

Kasari, C., Rotheram-Fuller, E., Locke, J., & Gulsrud, A. (2012). Making the connection: randomized controlled trial of social skills at school for children with autism spectrum disorders. J Child Psychol Psychiatry, 53(4), 431-439. doi:10.1111/j.1469-7610.2011.02493.x

Leaf, J. B., Cihon, J. H., Ferguson, J. L., Milne, C. M., Leaf, R., & McEachin, J. (2021). Advances in Our Understanding of Behavioral Intervention: 1980 to 2020 for Individuals Diagnosed with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 51(12), 4395-4410. doi:10.1007/s10803-020-04481-9

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. J Autism Dev Disord. doi:10.1007/s10803-021-05137-y

Maye, M., Gaston, D., Godina, I., Conrad, J. A., Rees, J., Rivera, R., & Lushin, V. (2020). Playful but Mindful: How to Best Use Positive Affect in Treating Toddlers With Autism. J Am Acad Child Adolesc Psychiatry, 59(3), 336-338. doi:10.1016/j.jaac.2019.09.003

Reichow, B., Hume, K., Barton, E. E., & Boyd, B. A. (2018). Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database Syst Rev, 5, CD009260. doi:10.1002/14651858.CD009260.pub3

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 Technol Assess, 24(35), 1-306. doi:10.3310/hta24350

Sandbank, M., Bottema-Beutel, K., Crowley, S., Cassidy, M., Dunham, K., Feldman, J. I., . . . Woynaroski, T. G. (2020). Project AIM: Autism intervention meta-analysis for studies of young children. Psychol Bull, 146(1), 1-29. doi:10.1037/bul0000215

Schmidt, J. D., Luiselli, J. K., Rue, H., & Whalley, K. (2013). Graduated exposure and positive reinforcement to overcome setting and activity avoidance in an adolescent with autism. Behav Modif, 37(1), 128-142. doi:10.1177/0145445512456547

Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., . . . Halladay, A. (2015). Naturalistic Developmental Behavioral Interventions: Empirically Validated Treatments for Autism Spectrum Disorder. J Autism Dev Disord, 45(8), 2411-2428. doi:10.1007/s10803-015-2407-8

Schuck, R. K., Tagavi, D. M., Baiden, K. M. P., Dwyer, P., Williams, Z. J., Osuna, A., . . . Vernon, T. W. (2021). Neurodiversity and Autism Intervention: Reconciling Perspectives Through a Naturalistic Developmental Behavioral Intervention Framework. J Autism Dev Disord. doi:10.1007/s10803-021-05316-x

Smith, T., & Iadarola, S. (2015). Evidence Base Update for Autism Spectrum Disorder. J Clin Child Adolesc Psychol, 44(6), 897-922. doi:10.1080/15374416.2015.1077448

Wehman, P., Schall, C. M., McDonough, J., Graham, C., Brooke, V., Riehle, J. E., . . . Avellone, L. (2017). Effects of an employer-based intervention on employment outcomes for youth with significant support needs due to autism. Autism, 21(3), 276-290. doi:10.1177/1362361316635826

Weitlauf, A. S., McPheeters, M. L., Peters, B., Sathe, N., Travis, R., Aiello, R., . . . Warren, Z. (2014). In Therapies for Children With Autism Spectrum Disorder: Behavioral Interventions Update. Rockville (MD).

The Autism Science Foundation (ASF), a nonprofit organization dedicated to supporting and funding innovative autism research, today announced its fifth round of COVID-19 Research Grant recipients. The latest grantees are Dr. Allison Shana Nahmias and Dr. Matthew Lerner of Stony Brook University and Dr. Shuting Zheng, University of California San Francisco. 

This new funding will help grantees examine ways to improve mental health services for people with Autism Spectrum Disorder (ASD). One study will examine the efficacy of an online intervention to help autistic adolescents deal with pandemic stress, while another study will examine ways to improve mental health services for autistic adults.

ASF initially launched its COVID-19 grants in early 2020 to support scientists who were struggling to continue their research studies when institutions were shut down. The mechanism then evolved to fund research examining the unique effects of COVID-19 on people with autism, and to study ways to make permanent improvements to diagnoses and treatment based on service gaps the pandemic brought to light.

“The lingering mental health effects of the COVID-19 pandemic continue to impact so many people with autism. Our goal with this latest round of funding is to provide support for people in the short-term, and to examine ways to make lasting improvements to mental health services that will aid people with autism long after the pandemic is over,” said Dr. Alycia Halladay, Chief Science Officer of ASF.

The following projects have received funding:

Allison Shana Nahmias, Ph.D.

Stony Brook University

Title: Evaluating an Online Intervention to Help Autistic Adolescents Deal with Pandemic Stress 

Most mental health interventions require multiple clinician visits, can be costly, and are not feasible for many families from diverse socioeconomic communities.  This project will study the effects of a single-session intervention, successfully utilized with neurotypical adolescents during the COVID-19 pandemic, to see if it is also successful in supporting autistic adolescents. Stressful events have increased during the pandemic, resulting in additional mental health challenges throughout the ASD community.  

Shuting Zheng, Ph.D.

University of California San Francisco

Improving Mental Health Service Delivery for Individuals with Autism

Only about half of autistic adults who reported experiencing symptoms of depression during the pandemic received treatment for their depression due to problems accessing services. This project will expand a longitudinal study of autistic adults reporting their own experiences with mental health care. The goal is to better understand the different factors that support or deter mental health support, learn how autistic adults receive and prefer to receive support, and then improve the services they receive.

NEW YORK — October 12, 2021 — The Autism Science Foundation (ASF), a nonprofit organization dedicated to supporting and funding innovative autism research, today announced the first funding recipients in its ‘Next Gen Sibs’ research project. The goal of this project is to establish a future collaborative network that will help in identification, evaluation and possible diagnosis and intervention for the Next Generation: the children of typically developing siblings of individuals with autism spectrum disorder (ASD). The study will begin at two sites where adult siblings have participated in previous research tracking autism families into adulthood: Emory University (under the direction of Dr. Michael Morrier) and University of California, Los Angeles (under the direction of Dr. Catherine Lord).

This project is based on data from the Baby Siblings Research Consortium (BSRC), which has shown the rate of autism in typically developing non-autistic siblings of those with a diagnosis to be 15x that of those with no family history. Together with the results of a recent ASF-funded study – which showed an increased rate of autism in the children of siblings of autistic individuals – it is clear that future research examining heritability of ASD should expand into the next generation. This next generation needs early recognition, diagnosis and services that can help them live the most fulfilling lives possible, and in order to do that we need a better understanding of their needs. 

“ASF is incredibly proud to be funding this Next Gen Sibs project, which will play an important role in further understanding the genetic role of autism and how we can more quickly diagnose and treat young children who have a history of autism in their families,” said ASF Chief Science Officer Dr. Alycia Halladay. “Siblings who participated in research studies over 20 years ago are now adults and have expressed interest in better understanding why there is a higher rate of diagnoses in their own children, who are the nieces and nephews of autistic adults. The Next Gen Sibs project aims to find the answers these families seek.”

“The Next Gen Sibs project is an example of how ASF strives to address the most urgent questions in the autism community,” said ASF Co-Founder and President Alison Singer. “This new project is a direct result of many conversations we’ve had over the years with autism families and researchers who want to know more about the genetic factors associated with autism, and specifically how they might impact the children of typically developing non-autistic siblings. We are so grateful to our generous donors, who make this important new research project possible.”

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About the Autism Science Foundation

The Autism Science Foundation (ASF) is a 501(c) (3) public charity. Its mission is to support autism research by providing funding to scientists and organizations conducting autism research. ASF also provides information about autism to the general public and serves to increase awareness of autism spectrum disorders and the needs of individuals and families affected by autism. To learn more about the Autism Science Foundation, or to make a donation, visit www.autismsciencefoundation.org.   

Media Contact

Kathy Ehrich Dowd

Forefront Communications for Autism Science Foundation

617-970-5842

kdowd@forefrontcomms.com

10-year study is first to quantify the predictive value of genomic testing for autism

From the SickKids Canada and University of Alberta press department:

One of the key priorities of interventions for autism spectrum disorder (ASD) is starting early, with some evidence showing infants as young as seven months old could benefit. Yet, most children in North America aren’t diagnosed with ASD until they’re over four years of age. New research led by The Hospital for Sick Children (SickKids) and the University of Alberta published on December 5, 2019 in Nature Communications has found testing the DNA of siblings of individuals with ASD may be predictive of a future diagnosis even if symptoms aren’t yet apparent.

ASD refers to a group of neurodevelopmental conditions resulting in challenges related to communication, social understanding and behaviour. Studies show families who have a child with ASD have a 6.9 to 19.5 per cent chance of another child having ASD and a 30 to 40 per cent chance of another child having atypical development.

Genomic factors linked to ASD-related traits

According to Dr. Stephen Scherer, Senior Scientist and Director of the Centre for Applied Genomics (TCAG) at SickKids, Director of the McLaughlin Centre at the University of Toronto and principal investigator of the study: “Genetic factors are the most likely reason we see a clustering of ASD related traits in families. We wanted to investigate the possible benefits of genetic testing for infants whose older sibling had already been diagnosed with ASD. If we can identify those children early, we may be able to enrol them earlier in therapies.”

The researchers looked for the presence of genetic alterations that have been linked to ASD called copy number variations (CNVs) in over 288 infant siblings from 253 families. By age 3, 157 siblings were either diagnosed with ASD or developing atypically. DNA testing revealed CNVs in genes relevant to ASD in 11 (7 per cent) of the 157 siblings who were eventually diagnosed.

The study found that the presence of an ASD-relevant CNV in a sibling had a high likelihood of predicting a future diagnosis of ASD or atypical development. This marks the first time that scientists have been able to quantify the predictive value of CNVs in determining these diagnoses.

Early identification could lead to earlier intervention

“These findings add to a growing body of evidence that biomarkers might be helpful in identifying pre-symptomatic infants who are likely to develop ASD or other developmental challenges,” says Dr. Lonnie Zwaigenbaum, Professor of Pediatrics, Stollery Children’s Hospital Foundation Chair in Autism and Stollery Science Lab Distinguished Researcher at the University of Alberta.

“At this point, we can’t fully determine the anticipated severity of a child’s future symptoms. What we can say is that it’s important to closely monitor their development and start therapeutic interventions early to support their skill development and address emerging functional impairments related to ASD.”

The research team has confirmed similar findings in a separate group of 2,110 families having one child with, and a second child without ASD. Their next step will be to look beyond CNVs and determine how newer technologies – like whole genome sequencing – might increase the early genetic detection rate.

YOU CAN DOWNLOAD THE ENTIRE STUDY HERE: https://www.nature.com/articles/s41467-019-13380-2

The families who participated in the primary study are from the Baby Sibling Research Consortium (BSRC). Additional families that participated in replication testing are from the Simons Simplex Collection. This work was supported by Autism Speaks, Autism Speaks Canada, the Simons Foundation Autism Research Initiative, National Institutes of Health (NIH), National Institute of Mental Health (NIMH), Canadian Institutes of Health Research (CIHR), Canada Foundation for Innovation (CFI), Genome Canada, Ontario Genomics, Kids Brain Health Network, Canadian Institutes for Advanced Research (CIFAR), Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute at the University of Alberta, Ontario Brain Institute, the Government of Ontario, the McLaughlin Centre at the University of Toronto, and SickKids Foundation.

About The Hospital for Sick Children (SickKids)

The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is a founding member of Kids Health Alliance, a network of partners working to create a high quality, consistent and coordinated approach to paediatric health care that is centred around children, youth and their families. SickKids is proud of its vision for Healthier Children. A Better World.

About the University of Alberta Faculty of Medicine & Dentistry

The Faculty of Medicine & Dentistry at the University of Alberta is a leader in educating and training exceptional practitioners and researchers of the highest international standards. The faculty’s mission is to advance health through excellence in teaching, research and patient care. It is home to one of the top 100 ranked medical schools in the world. For more information, please visit www.ualberta.ca/medicine.


Media contacts:

Jessamine Luck 
Communications Advisor 

The Hospital for Sick Children (SickKids)

jessamine.luck@sickkids.ca

416-813-7654 ext. 201436


Ross Neitz                                                                  

Communications Associate                                                    

University of Alberta                                      

rneitz@ualberta.ca
780-492-5986                                                              


In Scientific American, ASF CSO Dr. Alycia Halladay discusses how autism research gets covered and suggests way to improve the reporting to make sure the news that goes around is legitimate and significant. Read the op-ed here.

The Moyer family was recently featured in the Sag Harbor Express for their participation in the Autism Sisters Project. The advances made through this research would not be possible without the contribution of families like theirs. Read about them here.