Boyd Law Corporation

At Boyd Law Corporation, we believe every child with autism should be given the best chance for a full recovery. We believe strongly that children with autism can recover from this disorder if they are diagnosed early (preferably under the age of two) and given an optimal treatment plan.  Our goal is to empower families to be able to provide the most ideal interventions possible and to provide families with education, support, advocacy and legal services in order to provide the child with the best possible outcome. It is our experience that most optimal services for these children includes an optimal treatment plan including an intensive, in-home, high quality ABA program and a thorough, customized bio-medical treatment program overseen by a qualified DAN doctor.

It is our opinion that, in order to recover a child from autism, the parents must continually strive to provide the absolute best possible programming and medical treatments. Unfortunately this is a very difficult and sometimes tedious process, but we believe it is a critical component in order to provide the best possible outcome for the child.

View the Website of Heather Anne McIntosh to read about a mom's successful recovery of her children from autism. 

Autism is a severe disruption of the normal developmental processes that occur in the first three years of life. It leads to impaired language, play, cognitive, social and adaptive functioning, and causing children to fall farther and farther behind their peers as they grow older. The cause is unknown, but evidence points to physiological causes such as neurological abnormalities in certain areas of the brain.

Autistic children do not learn in the same way that children normally learn. They seem not to understand simple verbal and nonverbal communication, are confused by sensory input, and withdraw in varying degrees from people and the world around them. They become preoccupied with certain activities and objects that interfere with development of play. They show little interest in other children and tend not to learn by observing and imitating others.

Although children with Autism Spectrum Disorders, or “Autism,” exhibit common behavioral deficits (i.e., communication and social) and excesses of self-stimulatory behaviors, there are tremendous differences among children. For example, although many children with Autistic Disorder may have limited understanding and use of language, there are those children who may be able to understand complex language, express their needs or even converse. Their language deficit may involve difficulties of grammar or speaking in a robotic fashion. Children with Autism also demonstrate a variety of social deficits.

Whereas some children may reject all social contact, there are children who are quite social. However, they may only be social around adults and have no interest in children. Or there are children who are interested in children as well but do not initiate or sustain interactions. Similarly there are tremendous differences among children’s self-stimulatory behaviors. Some children may exhibit repetitive body movement while others may self-stimulate by lining up objects, or repetitively tapping an object or watching the exact same segment of a video tape. Some children may not demonstrate any noticeable self-stimulation but may have complex and obsessive rules.

Applied Behavior Analysis is based in learning theory, which states in essence that the consequences of a particular behavior influence whether that behavior will occur again. In children with autism, it is used to teach skills, minimize problem behaviors, and enhance language, play and social skills.

When designing an ABA program for use in children with autism, the goal is to increase skills in language, play and socialization, while decreasing behaviors that interfere with learning. The results can be profound. Children with autism who have ritualistic or self-injurious behaviors reduce or eliminate these behaviors. They establish eye contact. They learn to stay on task. Finally, the children acquire the ability and the desire to learn and to do well. Even if the child does not achieve a “best outcome” result of normal functioning levels in all areas, nearly all autistic children benefit from intensive ABA programs.

Recent years have seen a surge of interest in applied behavior analysis (ABA) in the treatment of autism. Scores of programs and practitioners claiming to “do ABA” have popped up, some seemingly overnight. Many stories about ABA for autism have appeared in the electronic and print media, and various task forces and committees have undertaken to evaluate published research on ABA and other approaches to autism treatment. Yet misconceptions about ABA – including some that have been around for years – persist, and many treatment programs that claim to be “doing ABA" really are not. How can families, professionals, and funding agencies differentiate genuine ABA programs and practitioners from posers? It is difficult to paint a picture of genuine ABA treatment for autism in words, especially in a limited space, but this article attempts to describe some of its key features.

Behavior analysis is a natural science approach to understanding behavior;

ABA is the use of behavior analytic methods and research findings to change socially important behaviors in meaningful ways. Autism is only one of many arenas in which behavior analysis has been applied successfully. Since the early 1960s, hundreds of researchers have documented the effectiveness of ABA principles and methods for building a wide range of important skills and reducing problem behavior in individuals with autism and related disorders of all ages. Today, bona fide ABA programming for learners with autism often combines many research-validated methods into a comprehensive but highly individualized package. For each learner, skills to be increased and problem behaviors to be decreased are clearly defined in observable terms and measured carefully by direct observation, with independent verification by secondary observers. An initial assessment is done to determine skills that the learner does and does not have. Selection of treatment goals for each individual is guided by data from that initial assessment, and a curriculum scope and sequence that lists skills in all domains (learning to learn, communication, social, academic, self-care, motor, play and leisure, etc.), broken into smaller component skills and sequenced developmentally, or from simple to complex. The overall goal is to help each learner develop skills that will enable him or her to be as independent and successful as possible in the long run.

A variety of behavior analytic procedures are used to strengthen existing skills and build those that have not yet developed. That involves explicitly arranging for the learner to have multiple, repeated opportunities to learn and practice skills throughout every day, with abundant positive reinforcement. One way to arrange learning opportunities is for an adult to present a series of trials to the learner, each consisting of a specific cue or instruction from the adult, an opportunity for the learner to respond, and a consequence delivered by the adult depending on the learner’s response. Such arrangements are called discrete trials, and they are essential for building many important skills in learners with autism. But programming that relies exclusively on discrete trial procedures – often referred to as “discrete trial training” or “DTT” – is not state-of-the art ABA, particularly when “drills” are used in a cookbook fashion that is not individualized to each learner. Research has shown that overusing discrete-trial procedures tends to produce skills that do not carry over (generalize) from the training situation to other everyday situations. For that reason, effective ABA programming blends discrete-trial procedures with a variety of other ABA methods, including child-initiated instructional sequences (known as incidental teaching procedures), task analysis and chaining to teach skills involving sequences of actions or steps, instructional trials embedded in ongoing activities, and others. There is a heavy emphasis on making learning enjoyable, and on engaging the learner in positive social interactions.

In a quality ABA program, behavior change procedures are specified clearly. The instructions and prompts, reinforcers (“rewards”), materials, and so on that are used to develop each skill are tailored to the individual learner. There is a written program or set of instructions for teaching each skill; the behavior analyst in charge of the programming trains everyone who works with the learner to implement those programs consistently. It is particularly important for parents to be trained to implement the procedures outside of formal treatment sessions, in a variety of settings (home, playground, community); research has shown that otherwise, the learner’s skills are not likely to generalize. Maladaptive behaviors (such as stereotypic behavior, self injury, aggressive and disruptive behavior) are explicitly not reinforced; appropriate alternative behaviors are taught and reinforced instead. Learner progress is measured frequently, using the direct observational measurement methods mentioned earlier. Data are graphed to provide visual pictures of what is happening with each skill and each maladaptive behavior targeted for treatment. The data are reviewed regularly by the behavior analyst directing the programming so that learning errors can be caught early and intervention methods adjusted promptly if progress is not satisfactory. The behavior analyst also observes treatment and provides feedback to interventionists on an ongoing basis.

Last but certainly not least, a defining feature of ABA programs is that they are directed by professionals with advanced formal training in behavior analysis – at least a master’s degree – as well as supervised experience in designing and implementing ABA programming for learners with autism and related disorders. These professionals have either met the educational, experiential, and examination performance standards of the Behavior Analyst Certification Board and are Board Certified Behavior Analysts (see www.BACB.com), or can document that they have at least the equivalent training and experience. They adhere to the BACB’s Guidelines for Responsible Conduct, and base treatment on the best available scientific evidence. For further information about the training and skills required to direct ABA programming for learners with autism, see the guidelines for consumers developed by the Autism Special Interest Group of the Association for Behavior Analysis in the autism section of the Cambridge Center’s website (www.behavior.org).

Gina Green, PhD, BCBA from San Diego State University and the University of North Texas Board of Trustees, Cambridge Center for Behavioral Studies.

 

A basic summary of the research is as follows:

 

• It is likely 90% of children with autism who do not receive effective early intervention will require special or custodial care throughout their lives.
• Research has shown that effective early intervention for children with autism can reduce or eliminate the need for specialized services later on.
• Early intervention is defined as beginning before a child is 3 years old. Most children over the age of 3 will still benefit from intensive intervention, but the sooner one can start, the better.
• Cost effectiveness studies show that there are substantial cost savings over the long term if children receive effective, early intervention.
• Over 30 years of validated and peer-reviewed research support the efficacy of intensive Applied Behavior Analysis programs for children with autism.
• Intensive early behavioural intervention (more than 40 hours per week of high quality 1:1 ABA therapy for several years) can lead to normal functioning (ie., recovery) for approximately 50% of children (Anderson et al., 1987; Birnbrauer & Leach, 1993; Fenske et al., 1985; Lovaas, 1987; McEachin, Smith, & Lovaas, 1993).
• Other therapies including public school autism and special education classrooms, plus the use of a combination of therapies (DTT, PECS, TEACCH, SI, speech therapy), even if done intensively (up to 30 hours) has been shown to be ineffective for children with autism (Sparkman, 1999).

 

 

Some Relevant Studies

 

1. Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children, O. Ivar Lovaas (UCLA), in Journal of Consulting and Clinical Psychology, Vol. 55, No. 1, pp. 3-9, 1987
   http://rsaffran.tripod.com/research1.html

Intensive early behavioral intervention (more than 40 hours per week of high quality 1:1

ABA

therapy for several years) led to normal functioning in nine of nineteen young children, compared to zero in a matched control group.

 

1. Long-term outcome for children with autism who received early intensive behavioral treatment, JJ McEachin, O. Ivar Lovaas, Tristram Smith, in American Journal of Mental Retardation, vol. 97, pp. 359-72, 1993
   http://www.tclc.com/research/87study.html

Follow-up to Lovaas 1987, eight children from the intensive intervention group continued to be asymptomatic, along with one from a "low-intensity" control group.

 

1. Replicating Lovaas's Treatment and Findings: Preliminary Results, Glen O. Sallows and Tamlynn D. Graupner
   http://www.londonearlyautism.com/Research/Replicating Lovaas 1999 doc.pdf [PDF document]

Preliminary results from "Lovaas replication" study support the original 1987 findings.

 

1. SUMMARY: Cost-benefit Estimates for Early Intensive Behavioural Intervention for Young Children with Autism
   http://www.behavior.org/autism/index.cfm?page=http://www.behavior.org/autism/autism_costbenefit.cfm
   
   

Investing in high-quality EIBI for children with autism is likely to pay handsome dividends for the various systems that are charged with providing services to these individuals. For the purpose of the present analysis, the initial investment was estimated at just under $100,000 per child ($33,000 per year for 3 years). This was the average cost in

Pennsylvania

in 1996. This figure probably is lower than present costs. Using $150,000, or $50,000 a year for 3 years, the estimated savings are still substantial. In either case, the overall average savings are estimated to range from well over $1 million to over $2 million per individual across the life span.

 

1. A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Howard JS, (Lovaas, 1987; McEachin et al., 1993).CR, Cohen HG, Green G, Stanislaw H. California State University, Stanislaus, Psychology Department, Turlock, CA 95382, USA. jhoward@athena.csustan.edu

 

This study compared the effects of three treatment approaches on preschool-age children with autism spectrum disorders. The results were as follows:

 

 

 

Therapy	Outcome
Intensive ABA :(25-30 h/wk for child under 3 and 35-40h/wk for child over 3)	Children showed significant improvement in virtually all skill domains
Eclectic: Public school autism classrooms, plus a variety of therapies (DTT, PECS , TEACCH, SI, speech therapy) for 25-30 h/wk	Mean scores in skill domains were substantially lower for this group than the first group, and showed losses in some areas over 14 month period.
General: Public school special ed programs for all disabilities, for 15h/wk	Negative change in mean scores in multiple skill domains. No statistically significant difference between 2ndand 3rdgroups.

     *Howard et al, 2004, based on 14 months of intervention

 

 

 

 

 

We have known, spoken to or heard about hundreds of children with autism receiving various forms of ABA, medical treatments, etc. Most do not recover. Most make some progress, but the only children we know who have recovered (which are very few) had an ideal 40 hour quality ABA program from the time they were two years old or less and a very thorough biomedical treatment plan which addressed the child’s individual medical issues using the DAN approach.

We also know a lot of families that have done 30-40 hours of ABA and the child hasn’t recovered. This is because a lot of ABA programs are not implemented correctly, do not move quickly enough, are not reinforcing/ fun for the child - who then becomes bored and “hits a wall” or “plateaus” (also some children are just not capable of recovery no matter what - although we don’t believe that to be the case with Josh). In fact, it is very difficult to run and maintain an ideal ABA program. Below are more details on what it takes to run a high quality ABA program.

 

 

There are many necessary elements that must be in place to make an ABA Program effective. Without any one of these elements, the child will likely not progress as quickly and their changes for recovery will be decreased.

According to the research of Guralnick (1998) and Ramey and Ramey (1998), the program should provide:

• Emphasis on skill development through positive reinforcement;
• Individualized based on the child's current skills and deficits; instructional objectives, teaching methods, pacing, skill sequences, and reinforcers are all customized to the characteristics and needs of each child;
• Addresses all skill domains;
• Uses frequent direct observation and measurement of individual performance to determine if progress is occurring, and adjusts instructional methods accordingly;
• Trains family members to participate in the program;
• Is directed and supervised by individuals with postgraduate training in behavior analysis plus extensive hands-on experience in providing ABA intervention to young children with autism.

 

 

 

According to the research, an ABA program is more likely to be successful when the following factors are present:

1.    Intensity: Analysis of recent studies shows that there is a correlation between the number of hours of intervention and the outcome of the therapy (Anderson et al., 1987; Birnbrauer & Leach, 1993; Fenske et al., 1985; Lovaas, 1987; McEachin, Smith, & Lovaas, 1993).

The research has shown:

• Programs that are more intensive in hours produce better and longer lasting results.
• Research indicates that 40 hours or more per week is appropriate for the majority of young autistic children.

2.    Learning in a 1:1 environment: Because many young autistic children lack the social and communication skills necessary to be successful in a group environment, the

ABA

provider should begin teaching skills in a one-on-one setting, typically in the home. After the skills are learned in that setting, they are generalized to other settings, such as school and the community.

3.    Program should address all developmental domains: An effective program will address all aspects of the child’s disability. Deficits in communication, attention, social, play, gross motor, fine motor, self-help, cognitive and academic skills, and behavioral challenges are targeted in the child’s individualized curriculum. Targets for each area should be developed based on the child’s individual strengths and deficits in each area.

4.    Emphasis on generalizing skills: Generalization means that the child can perform a particular skill in any environment, with any person, objects or instructions. A quality

ABA

program has a systematic, continuous plan for generalizing skills learned in the therapy room.

5.    Quality supervision: Supervisors should meet at least weekly with the parents and therapists to discuss the child’s progress, identify new areas of strength and weakness, and adjust the program curriculum. Supervisors should have experience and education in

ABA

including either a PhD level psychologist or Board Certified ABA Therapist in order to developing the most ideal program for the child.

6.    Team Communication: It is imperative that all members of the team including the parents, therapists, other care providers and supervisor meet and communicate on a regular basis in order to facilitate quick progress for Jonathan. Communication should include weekly staff meetings, and daily communication between parents, therapists, and supervisors when necessary.

7.    Data analysis:

ABA

is a data-driven treatment. The program should regularly record, review and analyse data related to the child’s progress in the program. The results of this analysis should be used to develop an individualized curriculum and behavioral strategies for the child.

8.    Goal is Recovery: In a quality program, the goal is to increase the skill levels of the child to the extent that the program is no longer required in order to maintain success in a typical setting (i.e., recovery). While this is not a goal that can be realized by all autistic children, the ABA provider and the entire team including the parents should be building skills to achieve independence to the maximum extent possible.

 

 

 

1. The program should quickly work up to 40 hours per week of ABA therapy (one on one time spent with the child and a therapist, at home and at preschool when appropriate). The schedule should work around naps (if applicable) and include weekend shifts.

2. Parent participation in therapy at least 5 hours/week.

3. Weekly team meetings which should include all therapists and the parents lasting at least two hours. In this meeting, the team should discuss any problem behaviors and then run through all the current programs resolving issues and concerns and making sure everyone is consistent while running them. New programs and new goals should be added as the child progresses.

4. Weekly conversations with the supervisor to address any issues that come up at the team meeting.

5. Monthly or bi-weekly clinics with the supervisor to go over all of the child’s programs, add new curriculum for the next month, to resolve any issues and create new goals as the child progresses.

6. A Lead Therapist who maintains a high level of communication between the therapists and the parents writing weekly notes, and “Parent Helper” notes to help the parents generalize skills during off hours.

7. A well-trained, creative, dedicated staff of at least three therapists, the majority should have at least a year of previous experience doing ABA with children at the same age and level as the child in question.

 

 

 

1. Supervisor: PhD or Masters Level person (preferably credentialed with a BCBA) with at least 5 recent years of experience supervising intensive ABA programs with autistic preschoolers. Experience must include running children’s programs of the same level as Jonathan with successful outcome. Supervisor must have a support system in place to answer questions, keep current on new curriculum/research, and help them resolve any issues which arise with speed. Must support staff at weekly meetings and monthly clinics. (This person must meet ASIG Guidelines for ABA Supervision cited in the section below).

2. Lead Therapist: This person must have at least a year’s experience as a senior therapist in at least one intensive ABA program with a child at a similar level to the one in question, and 1-2 additional years of ABA experience. This person will do the day-to-day supervision of all the other therapists, run the team meetings, overlap with other therapists to ensure consistency among the team, make day to day decisions and be the primary liaison between the supervisor and the team.

3. Therapists: Therapists provide will provide the majority of the ABA hours and shadowing in preschool (when appropriate) while continuing to maintain a presence in the home program. All therapists must keep up to date in current ABA practices and attend all staff meetings and clinics.

 

 

 

 

Workshop Model:

 

• In the “Workshop” model, the parent is responsible for hiring therapists rather than an agency. The parent is also responsible for setting schedules, making sure the therapists get paid (usually through a Regional Center or School District), holding weekly staff meetings, etc.
• Parents determine how often the staff meets and communicates.
• In some “Workshop” models, the parents work with an agency that provides supervision for the program. Agencies vary greatly in the amount of supervision provided.
• “Workshop” models vary greatly in their quality and intensity.

 

Clinic Model

 

• In the “Clinic” model, the agency runs the entire program. The agency hires, trains, and pays the individual therapists. The agency sets the schedule (and it is usually more rigid than a workshop model - for example, many agencies do not provide weekend hours).
• Parents attend a “review” meeting, usually held monthly.
• Again, agencies vary greatly in the amount of supervision they provide, their quality and their intensity.

 

 

The quality of an ABA program is not determined by whether it is “Workshop” or “Clinic” based, but rather by other factors such as the quality and training of the therapists, the intensity of the hours, the amount of parental involvement, the amount of supervision and ongoing training, and the quality and frequency of the supervision.

 

 

 

 

 

Report of the MAINE Administrators of Services for Children with Disabilities

 

“Over 30 years of rigorous research and peer review of applied behavior analysis’ effectiveness for individuals with autism demonstrate ABA has been objectively substantiated as effective based upon the scope and quality of science.”

 

“Early interventionists should leverage early autism diagnosis with the proven efficacy of intensive ABA for optimal outcome and long-term cost benefit.”

 

“The importance of early, intensive intervention for children with autism cannot be overstated.”

 

“Furthermore, early, intensive, effective intervention offers the hope of significant cost/benefit.”

 

 

Maine Administrators of Services for Children with Disabilities (1999). Report of the MADSEC Autism Task Force. MADSEC,

Manchester, ME

 

Clinical Practice Guideline Report of the Recommendations for Autism and Pervasive Developmental Disorders by the New York State Department of Health

 

“Based upon strong scientific evidence, it is recommended that principles of applied behavior analysis and behavior intervention strategies be included as an important element of any intervention program for young children with autism.”

 

“Based upon the panel consensus opinion, it is recommended that all professional and paraprofessionals who function as therapists in an intensive behavioral intervention program receive regular supervision from a qualified professional with specific expertise in applied behavioral approaches.”

 

“Based upon strong scientific evidence, it is important to include parents as active participants in the intervention team to the extent of their interests, resources, and abilities.”

 

“Based upon strong scientific evidence, it is recommended that training of parents in behavioral methods for interacting with their child be extensive and ongoing and include regular consultation with a qualified professional.”

 

New York State Department of Health Early Intervention Program. (1999). Clinical Practice Guideline Report of the Recommendations for Autism/Pervasive Developmental Disorders. New York State Department of Health, Albany, NY

 

Practice Parameters Consensus Panel of the following Professional Organizations and Agencies

 

 

American Academy

of Neurology

 

American Academy

of Family Physicians

 

American Academy

of Pediatrics

American Occupational Therapy Association

American Psychological Association

American Speech-Language Hearing Association

Society for Developmental and Behavioral Pediatrics

Autism Society of

America

 

National

Alliance

for Autism Research

National

Institute of Child

Health & Human Development

National Institute of Mental Health

 

“The press for early identification comes from evidence gathered over the past 10 years that intensive early intervention in optimal educational settings results in improved outcomes in most young children with autism, including speech in 75% or more and significant increases in rates of developmental progress and intellectual performance.”

 

“However, these kinds of outcomes have been documented only for children who receive 2 years or more of intensive intervention services during the preschool years.”

 

“Autism must be recognized as a medical disorder, and managed care policy must cease to deny appropriate medical or other therapeutic care under the rubric of “developmental delay” or “mental health condition.”

 

“Existing governmental agencies that provide services to individuals with developmental disabilities must also change their eligibility criteria to include all individuals on the autistic spectrum, whether or not the relatively narrow criteria for Autistic Disorder are met, who nonetheless must also receive the same adequate assessments, appropriate diagnoses, and treatment options as do those with the formal diagnosis of Autistic Disorder.”

 

Filipek, P.A. et al. (1999). The screening and diagnosis of autistic spectrum disorders. Journal of Autism and Developmental Disorders. 29, 439-484.

 

 

Practice Parameters for Autism by the

American Academy

of Child and Adolescent Psychiatry

 

“At the present time the best available evidence suggests the importance of appropriate and intensive educational interventions to foster acquisition of basic social, communicative, and cognitive skills related to ultimate outcome.”

 

“Early and sustained intervention appears to be particularly important, regardless of the philosophy of the program, so long as a high degree of structure is provided. Such programs have typically incorporated behavior modification procedures and applied behavior analysis.”

 

“These methods build upon a large body of research on the application of learning principles to the education of children with autism and related conditions.”

 

“It is clear that behavioral interventions can significantly facilitate acquisition of language, social, and other skills and that behavioral improvement is helpful in reducing levels of parental stress.”

 

“Considerable time (and money) is required for implementation of such programs, and older and more intellectually handicapped individuals are apparently less likely to respond.”

 

Volkmar, F., Cook, E.H., Pomeroy, J., Realmuto, G. & Tanguay, P. (1999). Practice parameters for the assessment and treatment of children, adolescents, and adults with autism and other pervasive developmental disorders. Journal of the

American Academy

of Child and Adolescent Psychiatry, 38 (Supplement), 32s-54s

 

 

Mental Health: A Report of the U.S. Surgeon General

 

"Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior."

 

"A well-designed study of a psychosocial intervention was carried out by Lovaas and colleagues (Lovaas, 1987; McEachin et al., 1993). Nineteen children with autism were treated intensively with behavior therapy for 2 years and compared with two control groups. Follow-up of the experimental group in first grade, in late childhood, and in adolescence found that nearly half the experimental group but almost none of the children in the matched control group were able to participate in regular schooling."

 

Satcher, D. (1999). Mental health: A report of the surgeon general.

U.S.

Public Health Service.

Bethesda, MD.

 

 

 

 

 

Revised Guidelines for Consumers of Applied Behavior Analysis Services

to Individuals with Autism and Related Disorders

 

Revision Adopted September 15, 2004

Original Version Adopted May 23, 1998

 

The Autism Special Interest Group (SIG) of the Association for Behavior Analysis asserts that all children and adults with autism and related disorders have the right to effective education and treatment based on the best available scientific evidence. Research has clearly documented the effectiveness of applied behavior analysis (

ABA

) methods in the education and treatment of people with autism (e.g., Matson et al., 1996; Smith, 1996; New York Department of Health, 1999; U.S. Surgeon General, 1999).

 

Planning, directing, and monitoring effective

ABA

programs for individuals with autism requires specific competencies. Individuals with autism, their families, and other consumers have the right to know whether persons who claim to be qualified to direct

ABA

programs actually have the necessary competencies. All consumers also have the right to hold those individuals accountable for providing quality services (e.g., to ask them to show how they use objective data to plan, implement, and evaluate the effectiveness of the interventions they use). Because of the diversity of needs of individuals in the autism spectrum and the array of specific competencies amongst the pool of potential service providers, consumers also need to focus on the match between their needs and the specific competencies of a particular provider.

 

Formal credentialing of professional behavior analysts through the Behavior Analyst Certification Board (BACB) can provide some safeguards for consumers, including a means of screening potential providers, and some recourse if incompetent or unethical practices are encountered. Unfortunately, there continues to exist a tremendous gap between the supply of qualified behavior analysts and the demand for

ABA

services. Nonetheless, as with any other credentialed professionals, consumers should exercise caution when working with individuals who have, or claim to have, credentials in behavior analysis. Although a formal credential in behavior analysis is evidence that a professional has met minimum competency standards, it does not guarantee that the individual has specific expertise in autism, nor that s/he can produce optimal treatment outcomes. Furthermore, the credentialing of professional behavior analysts has only been in place on an international level since 2000 and there may be some competent service providers who are still in the process of applying for BACB certification.

 

The Autism SIG recommends that consumers seek to determine if those who claim to be qualified to direct

ABA

programs for people with autism meet the following minimum standards:

 

I. Certification by the Behavior Analyst Certification Board as a Board Certified Behavior Analyst (BCBA), or documented evidence of equivalent education, professional training, and supervised experience in applied behavior analysis. Standards for certification as a BCBA, which can be found at www.BACB.com (Consumer Information Section), include: at least a master’s degree in behavior analysis or a related area; 225 hours of graduate level coursework in specific behavior analytic content areas (as of the deadline for Spring 2005 applications); 18 months of mentored experience or 9 months of supervised experience in designing and implementing applied behavior analysis interventions; and a passing score on a standardized examination. Consumers are urged to check the BACB website as these requirements may change from time to time. An individual’s BACB certification status may be verified by going to www.BACB.com, clicking on “Consumer Information,” and then clicking “Registry.”

 

Note that there is also a lower level of BACB certification, Board Certified Associate Behavior Analyst (BCABA), for individuals who have a bachelor’s degree, 135 hours of classroom instruction in behavior analysis (effective for Spring 2005 applications), 12 months of mentored experience or 6 months of supervised experience in implementing applied behavior analysis interventions, and a passing score on a standardized examination.

 

A complete list of skills and knowledge covered on the Behavior Analyst Certification Board examinations is available at www.BACB.com. Both BCBAs and BCABAs must renew their BACB certification annually, participate in continuing education activities that must meet BACB standards, and adhere to the BACB’s Guidelines for Responsible Conduct (also available at www.BACB.com).

 

With respect to BCABAs, the Behavior Analyst Certification Board explicitly states that

 

The BCABA designs and oversees interventions in familiar cases (e.g., similar to those encountered during their training) that are consistent with the dimensions of applied behavior analysis. The BCABA obtains technical direction from a BCBA for unfamiliar situations. The BCABA is able to teach others to carry out interventions once the BCABA has demonstrated competency with the procedures involved under the direct supervision of a BCBA. The BCABA may assist a BCBA with the design and delivery of introductory level instruction in behavior analysis. It is strongly recommended that the BCABA practice under the supervision of a BCBA, and that those governmental entities regulating BCABAs require this supervision.

 

The Autism SIG does not consider BCABAs, or individuals with equivalent or less training and experience, to be qualified to independently design, direct, and guide behavior analytic programming for individuals with autism. They may deliver behavior analytic intervention, and may assist with program design, but should be adequately supervised by BCBAs or the equivalent. The Autism Special Interest Group encourages consumers to request the name and contact information of the BCABA’s supervisor and check to see that the supervisor is a BCBA or equivalent, as well as the information about the amount and type of supervision he/she provides.

 

The Autism SIG asserts that certification as a BCBA or documented equivalent training and experience is a necessary but not sufficient qualification to direct programming for individuals with autism. Consumers should be aware that the discipline of applied behavior analysis is broad and varied, and that many individuals who hold certification as a BCBA have little to no experience directing or delivering ABA programming to individuals with autism. Therefore, the Autism SIG considers the following training and experience, in addition to certification as a BCBA or the equivalent, to be necessary to competently direct

ABA

programming for individuals with autism:

 

IIa. At least one full calendar year (full-time equivalent of 1000 clock hours [25 hrs/wk for 40 weeks]) of hands-on training in providing ABA services directly to children and/or adults with autism under the supervision of a Board Certified Behavior Analyst or the equivalent with at least 5 years of experience in ABA programming for individuals with autism. The training and supervision should assure competency in the following areas:

 

• Experience in assuming the lead role in designing and implementing comprehensive ABA programming for individuals with autism. The experience should involve designing and implementing individualized programs to build skills and promote independent functioning in each of the following areas: "learning to learn" (e.g., observing, listening, following instructions, imitating); communication (vocal and nonvocal); social interaction; self-care; school readiness; academics; self-preservation; motor; play and leisure; community living; self-monitoring; and pre-vocational and vocational skills.
• Providing ABA programming to at least 8 individuals with autism spectrum disorders who represent a range of repertoires and ages.
• Employing an array of scientifically validated behavior analytic teaching procedures, including (but not limited to) discrete trial instruction, modeling, incidental teaching and other "naturalistic" teaching methods, small group instruction, activity-embedded instruction, task analysis, and chaining.
• Incorporating the following techniques into skill-building programs: prompting; error correction; reinforcement and manipulation of motivational variables; stimulus control (including discrimination training); preference assessments; and choice procedures.
• Employing a wide array of strategies to program for and assess both skill acquisition and skill generalization.
• Modifying instructional programs based on frequent, systematic evaluation of direct observational data.
• Conducting functional assessments (including functional analyses) of challenging behavior and becoming familiar with the array of considerations that would indicate certain assessment methods over others.
• Designing and implementing programs to reduce stereotypic, disruptive, and destructive behavior based on systematic analysis of the variables that cause and maintain the behavior and matching treatment to the determined function(s) of the behavior.
• Incorporating differential reinforcement of appropriate alternative responses into behavior reduction programs and efforts to teach replacement skills, based on the best available research evidence.
• Modifying behavior reduction programs based on frequent, systematic evaluation of direct data.
• Providing training in ABA methods and other support services to the families of at least 8 individuals with autism.
• Providing training and supervision to at least 5 professionals, paraprofessionals, or college students providing ABA services to individuals with autism.
• Collaborating effectively with professionals from other disciplines and with family members to promote consistent intervention and to maximize outcomes.
• IIb. Additional training in directing and supervising ABA programs for individuals with autism that involves:

 

• Formal training and/or self-study to develop knowledge of the best available scientific evidence about the characteristics of autism and related disorders, and implications of those characteristics for designing and implementing educational and treatment programs, including their impact on family and community life.
• Formal training and/or self-study to develop knowledge of at least one curriculum for learners with autism consisting of: (a) a scope and sequence of skills based on normal developmental milestones, broken down into component skills based on research on teaching individuals with autism and related disorders; (b) prototype programs for teaching each skill in the curriculum, using behavior analytic methods; (c) data recording and tracking systems; and (d) accompanying materials.
• Formal training and/or self-study to develop skills in using scientifically validated methods to assess and build vocal-verbal and nonverbal communication repertoires in people with autism, consistent with the principles and practices of behavior analysis. This includes augmentative and alternative communication systems for individuals with limited vocal repertoires that are matched to the individual needs of the learner.
• Accrual of continuing education in the best available research from behavior analysis and other scientific disciplines as it informs autism treatment. The Autism SIG encourages consumers to ask prospective directors of ABA services for evidence that they have participated recently in continuing education activities relevant to the treatment of individuals with autism like those they will be serving (e.g., preschoolers, adults, individuals with limited vocal-verbal repertoires, etc.).

 

 

The Autism SIG urges consumers to ask prospective directors of

ABA

services (including those who use titles such as “consultant”) to provide evidence of their qualifications in the form of:

 

• Certification as a Board Certified Behavior Analyst (BCBA), or documented equivalent qualifications;
• Information about the amount and type of supervision they provide to all those who deliver intervention directly to individuals with autism and monitoring of the level of involvement/responsibilities and certification status of their supervisees (i.e., BCABAs are not qualified to independently design, direct, and oversee programming);
• Membership in the Association for Behavior Analysis (ABA);
• Membership in an affiliated chapter of ABA (e.g., CalABA, NYSABA, TxABA, FABA, NJABA);
• Undergraduate, graduate, and post-graduate training in behavior analysis specifically, as differentiated from non-behavior analytic study in psychology, special education, education, or other disciplines;
• Letters of reference from employment supervisors and/or families for whom they have directed ABA programming for similar individuals with autism (with appropriate safeguards taken to ensure privacy and confidentiality); and
• Publications of behavior analytic research in peer-reviewed professional journals.
• Consumers should be aware of the following:

 

• Attending or giving some workshops, taking some courses, or getting brief hands-on experiences does NOT qualify an individual to practice applied behavior analysis effectively and ethically. Unfortunately, there may be some individuals who misrepresent themselves when describing their skills and experiences to consumers.
• Evidence of attendance and active participation in professional meetings and conferences in behavior analysis (e.g., the annual meeting of the Association for Behavior Analysis) is certainly desirable. Such activities by themselves, however, do not constitute training in behavior analysis, and conference presentations are not equivalent to publications in peer-reviewed professional journals because conference presentations typically are not reviewed carefully by a number of other behavior analysts, and do not have to meet scientific standards. Therefore, it is important for consumers to differentiate presentations at conferences and workshops from publications in peer-reviewed journals.
• Consumers who have concerns about the ethical behavior of individuals providing ABA services are strongly encouraged to contact the Behavior Analyst Certification Board in the case of a BCBA or BCABA, and discipline-specific licensing boards in the case of those holding professional licensure (such as psychologists, speech-language pathologists, physicians, social workers).
• DISCLAIMER: This document suggests guidelines for consumers to use in determining who may be qualified to direct applied behavior analysis programs for individuals with autism, as recommended by the Autism Special Interest Group of the Association for Behavior Analysis International. It does not represent the official policy, position, or opinions of the Association for Behavior Analysis, its members, or its Executive Council.

 

Selected Resources

 

Behavior Analyst Certification Board – www.BACB.com

 

Matson, J. L., Benavidez, D.A., Compton, L.S., Paclawskyj, T., & Baglio, C. (1996).

Behavioral treatment of autistic persons: A review of research from 1980 to the

present. Research in Developmental Disabilities, 17, 433-465.

 

New York State Department of Health Early Intervention Program (1999). Clinical

Practice Guideline Quick Reference Guide: Autism/Pervasive Developmental

Disorders-- Assessment and Intervention for Young Children (Age 0-3 Years). Health

Education Services,

P.O. Box 7126, Albany, NY 12224

(1999 Publication No. 4216).

 

Smith, T. (1996). Are other treatments effective? In C. Maurice, G. Green, & S. Luce

(Eds.), Behavioral intervention for young children with autism: A manual for parents

and professionals (pp 45-59).

Austin, TX

: PRO-ED.

 

U.S. Surgeon General’s Report on Mental Health – Autism Section (1999)