What Constitutes a Behavioral Approach to Autism Treatment?

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1 What Are the Key Program Elements of an ABA Autism Treatment Program Vincent J. Carbone, Ed.D., BCBA-D NYS Licensed Behavior Analyst Carbone Clinic New York Boston Dubai University of Salerno Salerno, Italy January What Constitutes a Behavioral Approach to Autism Treatment? Mark L. Sundberg, Ph.D., BCBA-D Presented with Dr. Sundberg s Approval 2 1

2 Introduction These are exciting times for the field of behavior analysis Conferences, workshops, college and internet courses Research BCBAs & BCaBAs (18,000+) BACB approved training programs (254) Positive press ABAI is growing at a steady rate The autism effect (Let me hear your voice by Catherine Maurice, 1993) 3 Introduction Good News-Bad News Everybody now does behavior analysis if necessary Health insurance money Private in-home companies Private schools Public schools Widespread dissemination of behavioral techniques, often by unqualified people Simplifying the concepts and procedures beyond recognition Parallels to B-Mod and education in the 60s and early 70s 4 2

3 Introduction What is applied behavior analysis? How can consumers, funding agencies, schools, etc. know if they really have an ABA program? BACB Guidelines for Health Care Coverage document (2012) (www.bacb.com/downloadfiles/aba_guidelines_for_asd.pdf) Baer, Wolf, & Risley (1968). Some current dimensions of applied behavior analysis 5 BACB s Guidelines for ABA This document provides clinical guidelines and other information about ABA as a treatment for ASD (p. 3) written primarily for insurers and health plans (p. 3) ABA is the design, implementation, and evaluation of environmental modifications to produce socially significant improvement in human behavior (p. 4) Health plans and insurers must be able to recognize bona fide ABA treatment (p. 10) 6 3

4 BACB s Guidelines for ABA Three general characteristics (p. 10) An objective analysis of the client s condition by observing how the environment affects the client s behavior as evidenced through appropriate data collection Importance given to the context of the behavior and the behavior s value to the individual and the community Utilization of the principles and procedures of behavior analysis such that the client s health, independence, and quality of life are improved 7 BACB s Guidelines for ABA Ten essential practice elements of ABA (p. 11) 1) Obtain specific levels of baseline 2) Establishing small units of behavior (task analysis) 3) Direct observational data 4) Understanding the current function of target behaviors 5) Manage the treatment environments 6) Detailed behavior analytic treatment plan 7) Ongoing adjustment to the treatment plan 8) Frequent and consistent implementation of the treatment protocol 9) Support and training to family and staff 10) Supervision and management by a BCBA 8 4

5 Baer, Wolf, & Risley (1968) Some Current Dimensions of Applied Behavior Analysis 1) Applied: how immediately important is this behavior or these stimuli to this [child]? 2) Behavioral: thoroughly reliable quantification of behavior 3) Analytic: An experimenter has achieved an analysis of a behavior when he can exercise control over it 4) Technological: Procedures can be described and can be replicated 5) Conceptual systems: Procedures are not only precisely technological, but also strive for relevance to principle 9 Baer, Wolf, & Risley (1968) Some Current Dimensions of Applied Behavior Analysis 6) Effective: The application produce(s) large enough effects for practical value 7) Generality: Generalization should be programmed rather than expected or lamented 10 5

6 ABA Program Evaluation Main goal of this presentation is to suggest a tool designed to evaluate a program s adherence to the guidelines suggested by the BACB, and Baer, Wolf, & Risley, 1968 The tool is simply a task analysis of what constitutes an ABA program Framed by Baer, et al. s 7 dimensions of Applied Behavior Analysis, while incorporating the BACB s guidelines 11 Applied: How immediately important is this behavior or these stimuli to this child? Socially significant behavior (BACB Guidelines, Baer, et al., 1968; Cooper, et al., 2007; Wolf, 1978) Assessment (standardized assessment is insufficient) (see Esch, LaLonde, & Esch, 2010; Spradlin, 1963) Language and social skills (criterion referenced tool) (VB-MAPP, Rethink Autism, New England Center) Academic, play, and functional skills Barriers (VB-MAPP) Problem behaviors (FBA) IEP appropriate and consistent with assessment (priorities identified) Structured curriculum in place (school or home) Daily curriculum consistent with assessment priorities 12 6

7 Applied: How immediately important is this behavior or these stimuli to this child? Skills are broken down into small units (task analysis) Daily classroom or home schedule consistent with assessments Behavior intervention program consistent with FBA assessment and consistently implemented Augmentative communication used when appropriate and correctly implemented Structured teaching sessions (e.g., DTT, ABA, EIBI) Natural environment teaching sessions (e.g., NET, PRT, incidental) Sufficient amount of teaching trials Major focus on language skills and language development Major focus on social skills and social development 13 Behavioral: thoroughly reliable quantification of behavior Data collection system in place Baseline data are obtained Targets are based on the assessment results Targets are definable, observable, and measurable Targets, IEP, and data system match Uses the appropriate measurement procedure Appropriate skill acquisition data are recorded within sessions ABC recording system in place for problem behaviors Staff demonstrate the ability to read and act on ABC data Written behavior plan in place, and data correspond with it Appropriate behavior deceleration data and recorded within 14 teaching sessions 7

8 Behavioral: thoroughly reliable quantification of behavior Systematic focus on, and measurement of, replacement behaviors Binder system in place Binder review system in place Data system is guiding the intervention program Data demonstrate learning System for data review in place Measurement system in place for natural environment generalization, and new skill acquisition Caretaker/home involvement data system Data are graphed when appropriate 15 Analytic: An experimenter has achieved an analysis of a behavior when he can exercise control over it The ultimate aim is the prediction and control of verbal behavior. (Skinner, 1957, p. 12) Demonstrate prediction and control of targeted skills Able to demonstrate that skill acquisition (DV) is a function of the teaching procedures and intervention program (IV) Experimental control (reversal, multiple baseline, reliability) Staff are able to identify the target source of control (function) of verbal and nonverbal skills Skills are developed under the correct source of control Source of control for language, social, and learning barriers are identified and ameliorated (e.g., rote responding, side bias, impaired mands, delayed echolalia, sensory defensiveness, self-stim) 16 8

9 Technological: Procedures can be described and can be replicated Systematic staff training program in place Staff demonstrate correct use of basic ABA methodology ABA teaching methodology used across the day and across skills Staff have established clear instructional control Discrete trial structured teaching format used (e.g., DTT, EIBI) Discrete trials used in the natural environment (e.g., NET, PRT) Reinforcers identified and effective Appropriate management and delivery of reinforcers for skill development Differential reinforcement procedures Appropriate use of intermittent reinforcement procedures 17 Technological: Procedures can be described and can be replicated Appropriate use of DRO and DRI reinforcement procedures Does not reinforce negative behavior Motivation (MOs) strong when consequences are delivered Appropriate use of pairing procedures to establish conditioned reinforcers Appropriate use of prompting procedures and prompt hierarchy Appropriate use of fading procedures Appropriate use of correction procedures Appropriate use of shaping procedures Appropriate use of chaining procedures Appropriate use of stimulus discrimination training (S D /S-Delta) 18 9

10 Technological: Procedures can be described and can be replicated Appropriate use of extinction procedures Appropriate use of punishment procedures Appropriate use of interspersal procedures Appropriate use of behavioral momentum procedures Appropriate use of maintenance procedures Appropriate use of token economies Treatment integrity checked through frequent staff monitoring BCBA/BCaBA supervise program and systematically review progress Staff meet regularly to analyze progress 19 Technological: Procedures can be described and can be replicated Systematic language instruction program in place Appropriate use of mand training procedures Appropriate use of tact training procedures Appropriate use of echoic training procedures Appropriate use of imitation training procedures Appropriate use of intraverbal training procedures Appropriate use of matching to sample procedures Appropriate use of listener training procedures Systematic social skills training program in place Systematic play, leisure, and independence program in place Systematically teaching verbal interaction with peers 20 10

11 Conceptual Systems: Procedures are not only precisely technological, but also strive for relevance to principle The importance of behavioral vernacular Use of behavioral terminology by staff Staff can identify the relevant concepts and principles that underlie teaching procedures (Michael, 2004) Buy-in to a behavior analytic view This can have the effect of making a body of technology into a discipline rather than a collection of tricks (Baer, et al., 1968, p. 96) 21 Effective: The application produce(s) large enough effects for practical value Socially significant behavior change ( Social validity Wolf, 1978) The child is acquiring meaningful skills as measured by the data collection system Negative behavior is decreasing as measured by the data collection system IEP benchmarks and goals are being met Measurable yearly progress is demonstrated (outcome data) 22 11

12 Generality: Generalization should be programmed rather than expected or lamented Daily programming for generalization occurs Systematic stimulus generalization after acquisition is in place Systematic response generalization after acquisition is in place Systematic natural environment generalization occurs Parent training program in place Parent classroom observation system Parent homework activities Parent communication system in place 23 DISCUSSION OF THE CHECKLIST 24 12

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