Applied Behavior Analysis: A Look at its History, Controversy, and Current Practice

Introduction 

After a child receives a diagnosis of autism spectrum disorder, parents often seek recommendations for the appropriate next steps right away. One of the most commonly recommended behavioral interventions for autistic children is applied behavior analysis (ABA) therapy. ABA therapy is an empirically supported intervention that seeks to increase adaptive behaviors while reducing unsafe, harmful challenging behaviors (e.g., behaviors that result in harm to self, others, or property) in order to help individuals live more independent lives and be able to interact with their environments adaptively. At its core, ABA is based on behavioral principles used to change socially-relevant behaviors (e.g., behaviors that key stakeholders, the autistic community, and society as a whole find to be important; Furman & Lepper, 2018). Current literature suggests that ABA therapy has been effective for a range of individuals on the autism spectrum who have diverse behavioral needs. For more information on different ABA therapy approaches, we encourage you to read our blog, Treatments for Children with Autism.

Families may be hesitant to support ABA therapy because of its historical practice and past methodology, and, therefore, they may seek alternative interventions and treatment options. With this understanding, the purpose of this blog is to discuss the history and origins of ABA therapy, as well as areas of concern with current ABA practice. Lastly, this blog will reference current behavior analytic research to provide caregivers with a list of things to consider when choosing ABA providers.

History of ABA Therapy

Many behavior analysts recognize that the practice of ABA began in 1968 when the first publication of the Journal of Applied Behavior Analysis (JABA) was published; however, the conceptual foundations of ABA were initiated before this time. Prior to the first publication of JABA, prominent psychologists and scientists laid the foundation for ABA, including Ivan Pavlov (1849–1936), Edward Thorndike (1874–1949), John B. Watson (1878–1958), and B. F. Skinner (1904–1990). These researchers (and practitioners today) have discovered and used behavioral principles and procedures to change behavior using the scientific method. Some of these principles of behavior that are often used in ABA therapy today include reinforcement (increasing the probability that the behavior will occur again in the future), punishment (decreasing the probability that the behavior will occur again in the future), and extinction (no longer providing reinforcers for a behavior that has been previously reinforced) (Madden et al., 2021). Although early practices focused on the reduction of challenging behavior only, today’s researchers rely less on punishment-based interventions (which frequently used arbitrary or aversive stimuli to decrease challenging behavior), rather focusing on using reinforcement and extinction strategies (DeWitt et al., in press). Currently, ABA therapy has become one of the go-to, evidence-based therapies for autistic individuals and has become part of the standard multidisciplinary approach to treating autism symptomatology that impedes individuals from living their everyday lives, participating in community activities, learning at school, or holding vocational placements.

Current Concerns of ABA Practice

While ABA continues to develop its practice, the field recognizes that there are still concerns and challenges with its consistent implementation. One concern for ABA therapy relates to the workforce and organizational challenges present within the field. In general, many ABA providers experience a high turnover rate for direct-line professionals (i.e., behavior technicians or Registered Behavior Technicians [RBTs]) which may be due to multiple factors, including the risk of injury, lack of supervisory support, unpredictable hours, and burnout (Novack & Dixon, 2019). Additionally, despite there being a large influx of qualified ABA providers (i.e., Board Certified Behavior Analysts [BCBAs] and RBTs), current research suggests that there are not enough providers to meet the needs of families seeking ABA therapy (Yingling et al., 2022), resulting in waitlists to services or BCBAs/RBTs having larger caseloads than is recommended. Lastly, members of the autistic community have raised concerns about past ABA services they have received, particularly related to rigidity in methodology and concerns about providers training autistic individuals to act neurotypical (Autistic Self Advocacy Network, n.d.). Many ABA practitioners feel that these concerns are valid and that the client, stakeholders, the larger autistic community, and its allies should be consulted in the development of behavioral interventions in order to ensure that the interventions are socially valid (see Wright, 2022 for public discourse on this topic). Further, many behavior analysts actively help to mediate these concerns in order to best serve the individuals’ behavioral needs and teach them skills for success.

Considerations When Selecting an ABA Provider

Just like other mental health professions, not all ABA providers have the same training/supervision, are of the same skill levels, or have the same pressures from their organizations that may affect their ability to adequately serve their clients. To help you find ABA providers who will fit your needs best, we have compiled a list of questions that can help you best decide which provider is correct for your child. Though no research (to the best of our knowledge) directly addresses questions caregivers should ask potential ABA providers, Brodhead and colleagues (2018) have considered several questions BCBAs can ask to help determine if an ABA organization follows best practices. Adapting this list, we suggest that caregivers ask the following to ABA providers:

1. 1. How will you ensure that my child is receiving consistent services? For instance, what will happen if the technician for my child is sick or cannot attend sessions?

• This question aims to look at whether your child will receive consistent services. If they tell you they will cancel your session if the technician is not available, this may lead to inconsistent services.

1. 1. How many hours do BCBAs typically spend with their clients per week? or How much of my child’s services will be supervised by a BCBA?

• This question aims to assess how much overall supervision your child’s technician will receive. The more hours supervised by the BCBA, the better. We recommend looking for a company in which the BCBA will be present for at least 10% of your child’s scheduled hours per week. For example, if your child gets 20 hours of services, the BCBA would be with your child for 2 hours per week.

1. 1. How many clients do your Registered Behavior Technicians (RBTs) typically have on their caseloads?

• This can vary a lot, but typically a well-trained RBT has more than 1 client on their caseload to prevent burnout. If the RBT has a lot of clients, this could also potentially affect their availability.

1. 1. How many clients do your BCBAs typically have on their caseloads?

• Recommended caseloads for BCBAs in intensive treatment (32+ hours per week) are 6-12 clients and for less intense treatment (<32 hours per week) are 10-15 clients. More than this could negatively impact your child’s services due to the BCBA being too busy. 

1. 1. Describe the systems that are in place to help your employees engage in ethical behavior and decrease/avoid unethical behavior.

• For this question, we are looking to see if they have any formal answers/systems in place to help their providers behave ethically. If they do not have one in place or do not have an answer, this would be concerning. 

1. 1. How does your organization collaborate with other providers to create continuity of care?

• Just as above, you are looking to see that they have systems in place for or a history of communicating with other providers (e.g., doctors, occupational therapists, physical therapists, psychologists, social workers, etc.).

1. 1. How will our cultural background be accommodated in services?

• This question aims to see if they will consider your values and culture in your child’s goals, and how they will incorporate them.

1. 1. How are the electronic health records managed?

• For this question, you are looking for an answer that indicates that they use a HIPAA-compliant platform and follow HIPAA practices.

Conclusion

As autism diagnoses are becoming more prevalent, there is a push for effective and ethical treatment options. ABA has become one of the most utilized behavioral interventions for ASD, and it continues to develop its approach. Common concerns about ABA may be attributed to high turnover, a deficit in qualified providers, and a lack of autistic voices informing treatment goals. It is our suggestion that caregivers of children with an ASD diagnosis be diligent in choosing an ABA provider that is ethical and will meet their child’s needs.

Additional Resources

For more information on alternative behavioral interventions to ABA, we encourage you to take a look at our additional blogs: 

• Blog: Effective Treatments for Children with Autism 
• Blog: Beware of Fringe Therapies for Autism 

References

Autistic Self Advocacy Network. (n.d.). What we believe. Retrieved October 13, 2022, from https://autisticadvocacy.org/about-asan/what-we-believe/

Ayllon, T., & Michael, J. (1959). The psychiatric nurse as a behavioral engineer. Journal of the Experimental Analysis of Behavior, 2, 323–334. https://doi.org/10.1901/jeab.1959.2-323

Brodhead, M. T., Quigley, S. P., & Cox, D. J. (2018). How to identify ethical practices in organizations prior to employment. Behavior Analysis in Practice, 11(2), 165–173. https://doi.org/10.1007/s40617-018-0235-y

DeWitt, S. C., Stephens, A. M., & Briggs, A.M. (in press). Applied behavior analysis: Conceptual foundations, defining characteristics, and behavior change elements. In J. L. 

Matson (Ed.), Handbook of Clinical Child Psychology: Theory to Practice.

Furman, T. M., & Lepper, T. L. (2018). Applied behavior analysis: Definitional difficulties. The Psychological Record, 68(1), 103–105. https://doi.org/10.1007/s40732-018-0282-3

Heward, W. L., & Cooper, J. O. (1992). Radical behaviorism: A productive and needed philosophy for education. Journal of Behavioral Education, 2(4), 345–365. http://www.jstor.org/stable/41824018

Madden, G. J., Reed, D. D., & DiGennaro Reed, F. D. (2021). An introduction to behavior analysis. Wiley-Blackwell.

Novack, M.N., Dixon, D.R. (2019) Predictors of burnout, job satisfaction, and turnover in 

behavior technicians working with individuals with autism spectrum disorder. Rev J Autism Dev Disord, 6, 413–421. https://doi.org/10.1007/s40489-019-00171-0

Rakos, R. F. (2013). John B. Watson’s 1913 “Behaviorist manifesto”: Setting the stage for Behaviorism ‘s social action legacy. Revista Mexicana de Análisis de la Conducta, 39(2), 99–118. https://doi.org/10.5514/rmac.v39.i2.63920

Thorndike, E. L. (1911). Animal intelligence: Experimental studies. Macmillan Press. https://doi.org/10.5962/bhl.title.55072

Wright, P. (2022, March 1). Public discourse: ABA and autism. Behavior Science Dissemination. Retrieved October 13, 2022, from https://science.abainternational.org/2022/03/01/public-discourse-aba-and-autism/

Yingling, M. E., Ruther, M. H., & Dubuque, E. M. (2022). Trends in geographic access to Board Certified Behavior Analysts among children with autism spectrum disorder, 2018–2021.Journal of Autism and Developmental Disorders, 1–8. https://doi.org/10.1007/s10803-021-05402-0