What Constitutes a Behavioral Approach to Autism Treatment? Mark

What Constitutes a Behavioral Approach to Autism Treatment? Mark L. Sundberg, Ph.D., BCBA-D

Introduction These are exciting times for behavior analysis Our field is more accepted and appreciated than ever Conferences, workshops, college and internet courses Strong research base and robust current output BCBAs & BCaBAs (20,000) BACB approved training programs (284) Positive press ABAI is growing at a steady rate The “autism effect” (Catherine Maurice, 1993)

Introduction Good News-Bad News Everybody now does ABA .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 usefulness Parallels to B-Mod in education in the 60s and early 70s

Introduction What is applied behavior analysis? How can consumers, funding agencies, schools, etc. know if they really have an ABA program? Main goal of this presentation is to suggest a way of assessing the level of a program’s adherence to the principles and procedures that make up ABA BACB “Guidelines” for Health Care Coverage document (2012) Baer, Wolf, & Risley (1968), “Some current dimensions of applied behavior analysis”

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)

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”

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

BACB’s Guidelines for ABA 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 behavior analyst

“Some Current Dimensions of Applied Behavior Analysis” (Baer, Wolf, & Risley, 1968) 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”

“Some Current Dimensions of Applied Behavior Analysis” (Baer, Wolf, & Risley, 1968) 6) Effective: “The application produce(s) large enough effects for practical value” 7) Generality: “Generalization should be programmed rather than expected or lamented”

ABA Program Evaluation An assessment tool will be presented that was designed to evaluate a program’s adherence to the guidelines suggested by the BACB, and Baer, Wolf, & Risley (1968) Framed by Baer et al.’s 7 dimensions of Applied Behavior Analysis Two levels of the tool will be presented: 1) a quick assessment, 2) a detailed assessment; followed by some data

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 to learning, language, and social skills (VB-MAPP) Problem behaviors (FBA)

Applied: Quick Assessment Likert scale (0-3, None, Poor, Fair, Good); 30 items total Skills assessments completed: language, social, academic, play, functional skills, etc. Behavioral deficits assessments completed: barriers, FBAs IEP goals appropriate and consistent with assessments Daily curriculum in place and consistent with assessments and IEP goals Behavior intervention program consistent with the FBA Structured and intensive ABA style teaching sessions in place

Applied: Quick Assessment 1) Applied: Socially significant behaviors Skill assessments completed: language, social, academic, play, functional skills, etc. Behavioral deficits assessments completed: barriers, FBAs IEP goals appropriate and consistent with assessments Daily curriculum is consistent with assessment and IEP goals Behavior intervention program consistent with FBA assessment Structured and intensive ABA style teaching sessions in place None Poor Fair Good 0 1 2 3

Applied: Detailed Assessment A more detailed assessment (Part 2) contains approximately 70 items Eleven additional applied items are assessed in Part 2, some are: Behavior intervention programs implemented correctly Skill development intervention programs implemented correctly Daily structured classroom schedule in place Staff monitoring system in place Augmentative communication used and correctly implemented if necessary Natural environment teaching sessions in place

Behavioral: “Thoroughly reliable quantification of behavior” Data collection system in place Targets are based on the results of the assessments Targets are definable, observable, and measurable Uses appropriate measurement procedure for each target ABC recording system in place for problem behaviors Binder system in place

Behavioral: Quick Assessment 2) Behavioral: Data system Data collection system in place Targets are based on the assessment results Targets are definable, observable, and measurable Uses appropriate measurement procedure for each target ABC recording system in place for problem behaviors Binder system in place None Poor Fair Good 0 1 2 3

Behavioral: “Thoroughly reliable quantification of behavior” Fourteen additional items are assessed in Part 2, some of them are: Data system is guiding the intervention program Targets, IEP, and data system match Skill acquisition data recorded within teaching sessions Data review system in place Measurement system in place for natural environment Data are graphed when appropriate Staff demonstrate the ability to read and act on data

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) Demonstrates prediction and control of skills and problem behaviors Demonstrates that skill acquisition is a function of the teaching procedures and intervention program The sources of control for barriers that impair language, social, and learning skills are identified and ameliorated

Analytic: Quick Assessment 3) Analytic: Prediction and control Demonstrates prediction and control of skills and problem behaviors Demonstrates that skill acquisition is a function of the teaching procedures and intervention program The sources of control for barriers that impair language, social, and learning skills are identified and ameliorated None Poor Fair Good 0 1 2 3

Analytic: “An experimenter has achieved an analysis of a behavior when he can exercise control over it” Four additional items are assessed in Part 2, they are: Demonstrates behavior change with designs (e.g., reversal, multiple baseline) Demonstrates reliability Demonstrates fidelity Demonstrates replication

Technological: “Procedures can be described and can be replicated” Staff demonstrate correct use of basic ABA methodology Reinforcers identified and delivered effectively Staff have established clear instructional control Discrete trial structured teaching (DTT/EIBI) format used Natural environment teaching (NET) format used Negative behavior appropriately prevented and/or consequated

Technological: Quick Assessment 4) Technological: Standard behavioral procedures areused Staff demonstrate correct use of basic ABA methodology Reinforcers identified and delivered effectively Staff have established clear instructional control Discrete trial structured teaching (DTT/EIBI) format used Natural environment teaching (NET) format used Negative behavior appropriately prevented and/or consequated None Poor Fair Good 0 1 2 3

Technological: “Procedures can be described and can be replicated” Thirty-two additional items are assessed in Part 2, some of them are: Effective use of prompting procedures and a prompt hierarchy Effective use of shaping procedures Effective use of stimulus discrimination training (SD/S-Delta) Effective use of behavioral momentum procedures Effective use of token economies Effective use of mand training procedures BCBA/BCaBA supervise program and systematically review progress

Conceptual Systems: “Procedures are not only precisely technological, but also strive for relevance to principle” Staff can identify the relevant concepts and principles that underlie teaching procedures Staff use the concepts and principles of behavior analysis to guide the intervention Staff use behavioral terminology

Conceptual Systems: Quick Assessment 5) Conceptual systems: Procedures are relevant to principles Staff can identify the relevant concepts and principles that underlie teaching procedures Staff use the concepts and principles of behavior analysis to guide the intervention Staff use behavioral terminology None Poor Fair Good 0 1 2 3

Conceptual Systems: “Procedures are not only precisely technological, but also strive for relevance to principle” One additional item is assessed in Part 2: Staff generate intervention procedures for new specific skills, or problem behaviors based on the principles

Effective: “The application produce(s) large enough effects for practical value” The students are acquiring appropriate and meaningful skills Negative behavior is significantly decreasing IEP benchmarks and goals are consistently being met

Effective: Quick Assessment 6) Effective: Effects have sizeable practical value The students are acquiring appropriate and meaningful skills Negative behavior is significantly decreasing IEP benchmarks and goals are consistently being met None Poor Fair Good 0 1 2 3

Effective: “The application produce(s) large enough effects for practical value” One additional item is assessed in Part 2: Valuable and measurable yearly progress is demonstrated (outcome data)

Generality: “Generalization should be programmed rather than expected or lamented” Daily programming for generalization occurs (different settings, people, time, materials, etc.) Systematic stimulus and response generalization after acquisition is in place Parent training program in place

Generality: Quick Assessment 7) Generality: The skills are durable and generalize None Poor Fair Good 0 1 2 3 Daily programming for generalization occurs (different settings, people, time, materials, etc.) Systematic stimulus and response generalization after acquisition is in place Parent training program in place

Generality: “Generalization should be programmed rather than expected or lamented” Four additional items are assessed in Part 2, They are” Systematic natural environment generalization occurs Parent training program in place Parent classroom observation system Parent and family homework activities

ABA Program Evaluation Form: Quick Assessment Mark L. Sundberg, Ph.D., BCBA-D 1) Applied: Socially significant behaviors None 0 Poor 1 Fair 2 Good 3 Skill assessments completed: language, social, academic, play, functional skills, etc. Behavioral deficits assessments completed: barriers, FBAs IEP goals appropriate and consistent with assessments Daily curriculum is consistent with assessments and IEP goals Behavior intervention program consistent with FBA Structured and intensive ABA style teaching sessions in place 2) Behavioral: Data system Data collection system in place Targets are based on the assessment results Targets are definable, observable, and measurable Uses appropriate measurement procedure for each target ABC recording system in place for problem behaviors Binder system in place 3) Analytic: Prediction and control Demonstrates prediction and control of skills and problem behaviors Demonstrates that skill acquisition is a function of the teaching procedures and intervention program The sources of control for barriers that impair language, social, and learning skills are identified and ameliorated 4) Technological: Standard behavioral procedures are used Staff demonstrate correct use of basic ABA methodology Reinforcers identified and delivered effectively Staff have established clear instructional control Discrete trial structured teaching (DTT/EIBI) format used Natural environment teaching (NET) format used Negative behavior appropriately prevented and/or consequated 5) Conceptual systems: Procedures are relevant to principles Staff can identify the relevant concepts and principles that underlie teaching procedures Staff use the concepts and principles of behavior analysis to guide the intervention Staff use behavioral terminology Copyright 2015, Mark L. Sundberg v.1.4 www.avbpress.com

ABA Program Evaluation Form: Quick Assessment Mark L. Sundberg, Ph.D., BCBA-D 6) Effective: Large enough effects for practical value None 0 Poor 1 Fair 2 Good 3 None 0 Poor 1 Fair 2 Good 3 The students are acquiring appropriate and meaningful skills Negative behavior is significantly decreasing IEP benchmarks and goals are consistently being met 7) Generality: The skills are durable and generalize Daily programming for generalization occurs (different settings, people, time, materials, etc.) Systematic stimulus and response generalization after acquisition is in place Parent training program in place Score Total tallies Sub-Total scores (multiple number of tallies times point value) F inal Quick Assessment Score : /90 possible points

ABA Program Evaluation Form Mark L. Sundberg, Ph.D., BCBA-D Applied: Socially significant behaviors None Quick Assessment 0 Skill assessments completed: language, social, academic, play, functional skills, etc. Behavioral deficits assessments completed: barriers, FBAs IEP goals appropriate and consistent with assessments Daily curriculum is consistent with assessment and IEP goals Behavior intervention program consistent with FBA assessment Structured and intensive ABA style teaching sessions in place DetailedAssessment Behavior intervention programs implemented Skill development intervention programs implemented Skills and negative behaviors are broken down into small units (task analysis) Poor 1 Fair 2 Good 3 Daily structured classroom schedule in place Structured curriculum in place Staff monitoring system in place Augmentative communication used and correctly implemented if necessary Natural environment teaching sessions in place Sufficient amount of teaching trials Strong focus on social skills and social development Strong focus on language skills and language development 2 Behavioral: Data system Quick Assessment Data collection system in place Targets are based on the assessment results Targets are definable, observable, and measurable Uses appropriate measurement procedure for each target ABC recording system in place for problem behaviors Binder system in place DetailedAssessment Skill acquisition data recorded within teaching sessions Targets, IEP, and data system match Written behavior plan in place, and data correspond with it Systematic focus and measurement of replacement behaviors Effective behavior deceleration data and recorded within teaching sessions Baseline data is obtained Binder review system in place Data system is guiding the intervention program Data demonstrate learning Copyright 2015, Mark L. Sundberg v.1.4 www.avbpress.com

ABA Program Evaluation Form Mark L. Sundberg, Ph.D., BCBA-D System for data review in place Measurement system in place for natural environment generalization, and new skill acquisition Home involvement data system Data are graphed when appropriate Staff demonstrate the ability to read and act on ABC data Analytic: Prediction and control Quick Assessment Demonstrates prediction and control of skills and problem behaviors Demonstrates that skill acquisition is a function of the teaching procedures and intervention program The sources of control for barriers that impair language, social, and learning skills are identified and ameliorated DetailedAssessment Demonstrates behavior change with designs (e.g., reversal, multiple baseline) Demonstrates reliability Demonstrates fidelity Demonstrates replication Technological: Standard behavioral procedures are used Quick Assessment Staff demonstrate correct use of basic ABA methodology Reinforcers identified and delivered effectively Staff have established clear instructional control Discrete trial structured teaching (DTT/EIBI) format used Natural environment teaching (NET) format used Negative behavior appropriately prevented and/or consequated DetailedAssessment Systematic ABA staff training program in place Conditioned reinforcers are established and used Effective use of intermittent reinforcement procedures Effective use of differential reinforcement procedures Motivation (MOs) strong when consequences are delivered Effective use of pairing procedures Appropriate use of prompting procedures and hierarchy Effective use of fading procedures Effective use of correction procedures Effective use of shaping procedures Effective use of chaining procedures Effective use of stimulus discrimination training (SD/S-Delta) Copyright 2015, Mark L. Sundberg v.1.4 www.avbpress.com

ABA Program Evaluation Form Mark L. Sundberg, Ph.D., BCBA-D Effective use of extinction procedures Effective use of punishment procedures Effective use of interspersal procedures Effective use of behavioral momentum procedures Effective use of maintenance procedures Effective use of token economies Treatment integrity checked through frequent staff monitoring BCBA/BCaBA supervise program and systematically reviews progress Staff meet regularly to analyze progress Systematic language instruction program in place Effective use of mand training procedures Effective use of tact training procedures Effective use of echoic training procedures Effective use of imitation training procedures Effective use of intraverbal training procedures Effective use of matching to sample procedures Effective use of listener training procedures Systematic social skills program in place Systematically teaching verbal interaction with peers ABA teaching methodology used across the day and skills Conceptual systems: Procedures are relevant to principles Quick Assessment Staff can identify the relevant concepts and principles that underlie teaching procedures Staff use the concepts and principles of behavior analysis to guide the intervention Staff use behavioral terminology DetailedAssessment Staff generate intervention procedures for new specific skills or problem behaviors based on the principles 6) Effective: Large enough effects for practical value Quick Assessment The students are acquiring appropriate and meaningful skills Negative behavior is significantly decreasing IEP benchmarks and goals are consistently being met DetailedAssessment Valuable and measurable yearly progress is demonstrated (outcome data) Copyright 2015, Mark L. Sundberg v.1.4 www.avbpress.com

ABA Program Evaluation Form Mark L. Sundberg, Ph.D., BCBA-D 7) Generality: The skills are durable and generalize Quick Assessment Daily programming for generalization occurs (different settings, people, time, materials, etc.) Systematic stimulus and response generalization after acquisition is in place Parent training program in place DetailedAssessment Systematic natural environment generalization is occurring Parent classroom observation system Parent homework activities Score None 0 Poor 1 Fair 2 Good 3 Total tallies Sub-Total scores (multiple number of tallies times point value) F inal Total Assessment Score : Copyright 2015, Mark L. Sundberg v.1.4 /288 possible points www.avbpress.com

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Conclusion The language, learning, social, and behavior problems presented by autism are often quite complex ABA programs must be correspondingly complex, and any simplification invites the charge that behavior analysis is impoverished, or ineffective The BACB Guidelines and Baer, Wolf, & Risley (1968) provide us with a framework that ensures all the critical components of ABA are addressed in a given program

Conclusion It is hoped that this ABA program evaluation will guide autism service providers in their efforts to improve their programs, and implement state-of-the-art ABA treatment A need for field-testing data A need for program intervention strategies A need for the further refinement and measurement, as well as consensus, of what constitutes a behavioral approach to autism treatment