Association for Behavior Analysis International

1. Participants will describe the basic clinical procedures and designs that are commonly used in behavioral economic-based treatments for ASD.
2. Participants will describe basic principles of behavioral economics.
3. Participants will describe recent research-based extension to the use of behavioral economics in applied settings.

Recent advances in telecommunication technologies make it possible to conduct a variety of healthcare services remotely (e.g., behavior analytic intervention services), thereby bridging the gap between consumers in isolated locations and qualified providers. A growing body of empirical research suggests that many behavior analytic training and treatment procedures can be highly effective when delivered remotely via the latest telehealth technologies. In this symposium, we will bring together a cadre of the field’s leading experts on the remote delivery of ABA interventions using telehealth. Each presenter will describe one or more empirical investigations on the use of telehealth methods to expand access to ABA services. The discussant will review the highlights of each study, identify the general themes and important implications that cut across studies, and provide directions for future investigation.

Estimates indicate that autism affects about 1 in 68 American children. Research has shown that Early Intensive Behavioral Interventions (EIBI) is effective when implemented by appropriately trained and supervised technicians. In additional to services provided by technicians, parents often contribute to their child's EIBI programming by extending teaching opportunities throughout the day. However, few empirically supported programs are available for training parents that include performance-based measures. We are conducting a randomized clinical trial to evaluate a 20-hour, web-based, e-learning program for training parents in EIBI protocols. The two primary dependent variables are the Behavioral Implementation Skills for Play Activities (BISPA) and the Behavioral Implementation Skills for Work Activities (BISWA). To date, 10 participants have completed pre-test and post-test assessments on these measures, three in the treatment group and seven in the control group. Mean component skills implemented correctly on the pre-test and post-test for the treatment and control groups for the BISPA were 4.0%, 6.1%, 89%, and 0%, respectively. For the BISWA, the results were 23.6%, 16.9%, 100%, and 27.3%, respectively. The results provide strong preliminary support for the efficacy of our web-based program, which can be delivered to parents anywhere in the world that has broadband internet access.

Many children with autism spectrum disorder (ASD) have feeding difficulties, such as food selectivity (i.e., consumption of a limited variety of foods by type or texture). Inadequate dietary intake is associated with learning and behavior problems. If left untreated, children with ASD and feeding difficulties also may suffer from weight loss or malnutrition. Currently, treatments for pediatric feeding disorders based on ABA research have the most empirical support (Volkert & Piazza, 2012). However, there are a limited number of clinics and professionals in the country that specialize in the behavioral treatment of pediatric feeding disorders. Telehealth methods allow a professional in one location to provide services to a patient in another location. Research has not yet evaluated the effectiveness of using telehealth methods to treat pediatric feeding disorders using behavioral techniques. In the current study, we compared the outcomes (e.g., levels of acceptance, mouth clean [product measure of swallowing], inappropriate mealtime behavior) of children discharged from an intensive day treatment program who were followed up in the clinic versus via telehealth. The children's parents implemented treatment with both methods. Results suggest that clinically relevant outcomes can be achieved regardless of the location of outpatient follow-up.

This presentation will describe an ongoing project, in which we are attempting to train community mental health workers in Michigan to conduct quality functional behavior assessments, including functional analyses, using web-based technologies for teleconsultation. The procedures we are using will be discussed, and outcome data for selected children as well as summary data for trainees will be presented. Issues, problems, and positive developments from the project will also be discussed.

This presentation will provide a summary of how we have used telehealth to implement functional analyses and functional communication training to assess and treat the severe behavior problems of young children with autism. The participants were 30 children with diagnosed autism spectrum disorders who ranged in age from 21–84 months. All assessment and treatment sessions were conducted by parents in their homes with remote coaching provided by behavior analysts located at a tertiary level hospital. The functional analyses were conducted within multi-element designs and social functions were identified for all children. Functional communication training (FCT) was then implemented by the parents and matched to the identified functions of problem behavior. FCT was most often conducted during 1-hour weekly sessions, with individual cases conducted within a reversal design, and the overall group analysis conducted within a randomized clinical trial (3 month delay for second group). The average reduction in problem behavior was 97% (range=77–100%). Interobserver agreement was conducted on approximately 30% of sessions and averaged over 90%.A description of the telehealth and behavioral procedures conducted in the projectwill be presented withvideotaped case examples.

This session will focus on scaling up implementation of applied behavior analysis. Emphasis will be given to lessons learned from implementing Positive Behavioral Intervention and Supports (PBIS) across 20,000 schools in the United States. Participants will leave with information about the key role of fidelity measures, organizational systems needed to support effective practices, and the linking of coaching with effective training.

Children with autism spectrum disorder (ASD) often exhibit deficits in language development. While typically developing children demonstrate adult-like language production by age 5 (Luinge, Post, Wit, & Goorhuis-Brouwer, 2006), expressing abstract and hypothetical ideas across a variety of topics (Tager-Flusberg et al, 2009), children with ASD often have difficulty with more complex language that has not been directly taught. Further, studies have found that some children with autism do not combine known words at the same time as typically developing peers (Paul, Chawarska, Klin, and Volkmar, 2007; Weismer et al., 2011), pointing to a deficit in generative language. Strategies to promote the emergence of untrained verbal operants are of critical importance for learners with ASD. However, few procedures have been developed to program and test for emergence of untrained skills. Additionally, few studies have addressed remediation strategies when emergence fails to occur. The current presentation will present several lines of research focused on assessing emergence of untaught verbal behavior during treatment as well as strategies to promote emergence and generative language. Specific interventions to promote emergence of listener and tact skills as well as intraverbals will be presented.

The Behavior Analyst Certification Board (BACB) has been certifying and developing professional standards for behavior analysts since it emerged in 1999 from the state of Florida's behavior analyst certification program, which had been in operation for two decades earlier. In 2007, the BACB's Board Certified Behavior Analyst (BCBA) and Board Certified Assistant Behavior Analyst (BCaBA) credentials were accredited by the National Commission for Certifying Agencies (NCCA). The NCCA accredits certification programs that adhere to the best practices of the credentialing and testing industries, including highly prescribed procedures for establishing and revising key standards. This presentationwill describe the evolution of certification standards in behavior analysis over the decades, including the systematic NCCA-mandated procedures the BACB has followed to develop and revise its standards over the years. This process has been akin to shaping and has allowed behavior analyst certification to grow and flourish alongside consistently increasing standards towards an eventual steady state. Special focus will be paid to standards where the steady state appears to have been reached. Concluding remarks will describe how BACB certification standards align with the licensure of behavior analysts in approximately two dozen states.

Autism spectrum disorder (ASD) presents as a major public health concern. In addition to the core features of ASD, available evidence suggests that as many as 70% of children with ASD exhibit disruptive behaviors such as tantrums, noncompliance, aggression, and self-injury. Such behaviors can significantly limit the child's ability to make use of educational and other services, thereby interfering with the acquisition and performance of daily living skills as well as the exacerbation of social isolation. Given the rising prevalence of ASD and inadequate accessibility of specialists adequately trained in the disorder, our multisite network determined that the development of an exportable and cost-effective intervention was essential. Parent training (PT) has already been well-established and empirically supported as an intervention for children with disruptive behavior uncomplicated by ASD but not in those with ASD. Single-subject designs have established that behavior modification can be effectively trained to parents to reduce the behavioral problems of children with ASD. This presentation will describe more about the premise for the multisite development and testing of the manualized and potentially exportable PT model as a stand-alone intervention for young children with ASD and disruptive behaviors.

For the past several years, ABAI has been working with the American Medical Association (AMA) to establish new billing procedures for ABA-related services for children and youth with autism. Recently, the AMA adopted Current Procedural Terminology (CPT) Category III codes. The AMA codes recognize that applied behavior analysis is an empirically supported and medically necessary intervention. Dr. Travis Thompson, who was instrumental in the approval of these codes, is the instructor for this training, which will explain the how the new codes define procedures and services performed by behavior analysts. These codes will improve access to ABA services for families of children with autism and severe behavior disorders and reduce financial burdens on these families. Additionally, these codes will result in systematic and standardized valuation of ABA services and will simplify and streamline the billing and collection processes for ABA services (e.g., facilitate electronic billing).

Over 25 years ago, the Picture Exchange Communication System (PECS) was developed and used a training protocol that incorporated Skinner's analysis of verbal behavior to help rapidly establish manding and other key verbal operants in students with autism spectrum disorder (ASD) and other developmental issues. Many research reviews describe PECS as an evidence-based practice, including a recent publication in Pediatrics. In that 2012 publication, which supported the strong evidence in support of ABA, it also noted that there was as yet no evidence for the effectiveness of "AAC devices." However, with the advance of technology involving the use of speech generating devices (SGDs) and iPad apps, many parents and professionals are convinced that the technological advances and the voice associated with such devices will help lead to better communication skills as well as speech. This talk will review recent research regarding such devices as well as apps; it will also review why the PECS protocol is effective with regard to the rapid development of verbal behavior under the stimulus control of the audience (or listener). A similar analysis will then be usedto review whether some of the uses of SGDs and apps ensures that verbal behavior is being established.Finally, the presentation will point out some simple ways to demonstrate whether an electronic device is being used as a toy or as part of a communication strategy.

This symposium will discuss applied behavior analysis as it relates to autism globally.

TBD

This presentation will use Stokes and Baer's 1977 seminal article on generalization and Wolf's 1978 paper on social validity as platforms to discuss why behavior analysts should consider a public health framework for dissemination of ABA principles in the treatment of autism globally and correcting some of the misconceptions of behavior analysis. Strategies and tactics for promoting acceptance, implementation, and dissemination of evidence-based practices in low-resource settings will be reviewed. Theories of why global acceptance of ABA has not occurred and more importantly why behavior analytic fallacies still exist in the world will be examined. Strategic planning steps for students, families, practitioners, researchers, and organizations to influence public health policy and educational reform will be outlined. The need for both single-subject design research and randomized-controlled trials will be proposed in evaluating low-intensity/large scale programs, and the training of non-specialist facilitators in low-resource settings to meet the treatment gap needs of individuals and families affected by autism spectrum disorders.

The need for community-viable evidence-based intervention strategies for toddlers with autism spectrum disorder (ASD) is a priority with earlier diagnosis. The Early Social Interaction Project (ESI) uses the SCERTS curriculum to teach parents of toddlers with ASD how to embed evidence-based intervention strategies and supports in everyday activities in natural environments to promote their child's active engagement. Research findings from the randomized controlled trial of ESI, funded by Autism Speaks and NIMH, will be presented. Plans for rolling out Autism Navigator, a collection of web-based courses and tools that uses extensive video footage to bridge the gap between science and community practice will be highlighted.