Wednesday, February 3. 2010

Weakening the Evidence for ABA Therapy - Is it Our Fault?

Posted under: Research

A recent research study by Dawson and colleagues has created both excitement and frustration for some proponents of ABA therapy. The study, conducted in a randomized controlled trial design, was published in the November 2009 issue of Pediatrics and demonstrated that behavioral intervention with toddlers resulted "in significant improvements in IQ, language, adaptive behavior, and autism diagnosis." ("Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model" Pediatrics, November 2009). However, proponents of ABA have pointed out that the New York Times coverage failed to mention that the study uses applied behavior analytic principles (http://www.blogcatalog.com/search.frame.php?term=aba+therapy&id=905ac454e81811bf6f06a9117f2f8761) and that the CNN coverage perpetuated a common misconception about ABA by comparing the pleasing, playful therapy of the study with "ABA, which is delivered at a desk" (http://blog.navigationbehavioralconsulting.com/).

While I find the misinformation unfortunate, I can't help but wonder if we behavior analysts who work with children with autism have done this to ourselves. The number of terms and brands currently in use in applied behavior analysis continues to grow, including: behavioral treatment, intensive behavioral therapy, intensive early intervention using behavior therapy, ABA therapy, Lovaas Model of ABA, Verbal Behavior, ABA/VB, traditional ABA, Pivotal Response Teaching (PRT), DTT, and Early Start Denver Model (ESDM) just to name a few. Further, brand names are sometimes misapplied, websites and conferences present misinformation on one form of behavioral treatment while propping up their own form of behavioral treatment, and new, often ambiguous terminology continues to emerge. Is it any wonder that those reporting on new evidence for ABA therapy don't always get things right?

I don't think branding is always bad. I've worked under the Lovaas Model of Applied Behavior Analysis for the past 15 years. The Early Start Denver Model deserves praise for this recent 2009 study. Branding can be a good thing. Branding of autism interventions provides a general package for delivery, including both a general curriculum and teaching procedures to follow. This general information can serve as a strong foundation for a child's intervention, particularly when there's empirical data to support the brand. However, I suggest the following guidelines for branding.

  1. One general term should be agreed upon (i.e., behavioral treatment, ABA, intensive behavioral therapy, etc.) as a general umbrella term under which all brands fall. When discussing their brand, individuals should always start by disclosing that their brand falls under this general term. For example, in these guidelines I'll use "ABA therapy" as the general term.
  2. Branding can continue for general interventions in ABA therapy (i.e., those interventions with a general curriculum and teaching procedures), but branding should be avoided when talking about specific procedures (e.g., discrete trial teaching vs. natural environment teaching, errorless learning vs. no-no-prompt, etc.) unless that new brand technique is observably and measurably distinct from other procedures, precisely defined, and demonstrated to be of enough significance that the technique deserves a separate name.
  3. Individuals who brand general interventions in ABA therapy need to be careful to clarify what observably and measurably distinguishes one brand from another and what procedures, guidelines, etc. are common to other ABA therapy brands.
  4. Individuals who brand general interventions should be careful not to contribute to the misinformation of other ABA therapy brands by supporting any claims they make about that other ABA therapy brand with observable evidence.
  5. Brand names should not be used in research literature unless the brand itself is actually the focus of the research.

ABA therapy has more research supporting its use with children with autism than any other type of intervention. We should always question whether the terminology we use in our research and our practice is supporting or weakening that fact. I can't help but end by noting that Dr. Lovaas, so famous for his research and methods throughout the years, describes his treatment in the 1987 research study as "behavioral treatment." The 2005 replication research of Dr. Lovaas' work describes treatment as "early intensive behavioral treatment developed at UCLA." The 2006 replication research describes treatment as "early intensive behavioral treatment...based on Lovaas' UCLA treatment model." In fact, no research article describes treatment simply as the "Lovaas method" or even "Lovaas Model of Applied Behavior Analysis." I was present at a meeting when Dr. Lovaas emphasized that his work was only one part of a larger body of research. His humility and understanding in this area is yet another contribution from which we all can benefit.

Vincent LaMarca
Lovaas Institute - Indianapolis

Comments

Excellent blog Vince. I was wondering if you could provide some examples of the "general interventions in ABA therapy" that fit the description/criteria of branding for that intervention? I am just curious what your views might be on this. I also think it is unfortunate that the BACB didn't pass the Autism Track as this might have helped in creating a universal umbrella for our field. I have been participating in a little debate on a Son Rise video on youtube that portrays ABA as being robotic and the one thing that really jumps out at me is that a lot of the parents who are criticizing "ABA" are really criticizing people who have misused ABA or claimed to use ABA without really following the research. Son Rise has an advantage here because it is its own model/protocol so you don't see people running around claiming to do Son Rise that haven't been formally trained. ABA is so broad still that we do have that issue and we need to figure out a way to fix this. Thank you again for the blog. If you would like to view and comment on the youtube video (PLEASE :-) ) you can find it here: http://www.youtube.com/watch?v=N6CWf9H7F8k

I think ABA kind of encompasses it, doesn't it? And I might go so far as to explicitly state Applied Behavior Analysis, just so the 2nd A, "analysis" is highlighted.

I'm somewhat on the fence about an "autism" specific certification, since Applied Behavior Analysis is already misunderstood as being particular to autism or developmental disabilities in addition to the branding problem, although I can see that specifying competency in service delivery for this population might be useful in focussing specific background and relevant experience.

I think Vince makes a valuable point because I wish that I had a dollar for every time that I've heard that xyz is an "improved" ABA - while certainly as a scientific discipline with application it should evolve and build on new information, I still refer to the dimension of conceptual systems, so that nothing is just it's own self-contained bag of techniques that neglects to refer to the entirety of the science as conceptualized in all seven dimensions, or to consider individual characteristics or specific environmental contingencies.

Baer, D.M.., Wolf, M. M., & Risley, T. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1(1), 91-97.

Megan, here are some of the "general interventions in ABA therapy": 1) Verbal Behavior, 2) Pivotal Response Training, and 3) Lovaas Model of Applied Behavior Analysis. One thought I had was to standardize the format all brands have, so that they are all associated with ABA. So, I think we should start referring to the 1) Verbal Behavior Model of Applied Behavior Analysis, 2) Pivotal Response Model of Applied Behavior Analysis, and 3) Lovaas Model of Applied Behavior Analysis. I know on your blog you have had some issues with how the term “Verbal Behavior” is applied (e.g., http://blog.navigationbehavioralconsulting.com/2010/01/06/fixing-inaccuracies-.aspx and http://blog.navigationbehavioralconsulting.com/2009/12/02/my-biggest-pet-peeve-comparing-vb-to-dtt.aspx), so feel free to let me know what you think of my suggestion.

Are there any studies on the children who underwent ABA years ago and are now adults? I can't seem to find them anywhere.


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