U.S. Dept. of Education: ABA Not Enough for Autism Treatment.

https://flic.kr/p/9PFmnj

By Todd A. Ward, PhD, BCBA-D

Founding Editor, bSci21.org

Dr. Melody Musgrove, Director of the Office of Special Education Programs (OSEP), within the U.S. Department of Education, recently sent a letter to state officials expressing “concerns within the field” of special education.  Specifically, OSEP received reports that treatments for children with Autism Spectrum Disorder are overly focused on ABA therapy.   She noted that “programs may be including applied behavior analysis (ABA) therapists exclusively without including, or considering input from, speech language pathologists and other professionals who provide different types of specific therapies that are appropriate for children with ASD.”

She specifically cited sections of the Individuals with Disabilities Education Act (IDEA), which outline several domains of child functioning to be assessed, including cognitive, physical, social, emotional, adaptive, and communication skills, in addition to intelligence testing and various medical or physiological assessments.

Dr. Musgrove concluded her letter by noting that “ABA therapy is just one methodology used to address the needs of children with ASD” and cautioned that services should be “made based on the unique needs of each individual child with a disability.”

There are many facets to this issue.  For example, from an academic perspective behavior analysts would be quick to note that individualized treatment is the distinguishing feature of their approach, and that behavior analysis can address all of the domains discussed above.

However, on a practical level, the issue is more complex.  For one, the primary aim of Dr. Musgrove’s letter was to ensure treatment plans adhere to legal practices, and the legal framework – IDEA – rightly recognizes that “behavior” itself is an interdisciplinary subject-matter.  No one science has a monopoly on it.

For related reading on this topic, check out a recent article by bSci21 Contributing Writer Chelsea Wilhite, M.A., BCBA, in which she suggested behavior analysts should increase their efforts to learn from other sciences.

Let us know what you think about Dr. Musgrove’s letter in the comments below, and don’t forget to subscribe to bSci21 via email to receive the latest articles directly to your inbox.

 

Todd A. Ward, PhD, BCBA-D is President of bSci21 Media, LLC, which owns bSci21.org and BAQuarterly.com.  Todd serves as an Associate Editor of the Journal of Organizational Behavior Management and as an editorial board member for Behavior and Social Issues.  He has worked as a behavior analyst in day centers, residential providers, homes, and schools, and served as the director of Behavior Analysis Online at the University of North Texas.  Todd’s areas of expertise include writing, entrepreneurship, Acceptance & Commitment Therapy, Instructional Design, Organizational Behavior Management, and ABA therapy. Todd can be reached at todd.ward@bsci21.org.

25 Comments on "U.S. Dept. of Education: ABA Not Enough for Autism Treatment."

  1. Dr. Musgrave’ letter, regardless of intent, is pejorative to ABA and will decrease parental and child access to the only approach that consistently demonstrates efficacy and efficiency.
    As for “other sciences,” approaches that assume nomothetic criteria do little or nothing to inform about the individual. There are others genres of science, many having very vibrant results and subsequent technologies, Speech and Language, Occupational Therapy, School Psychology have not achieved these outcomes. Musgrave’ letter will only perpetuate there inadequacies and waste valuable time and resources.

  2. As written, Dr. Melody Musgrove’s statement regarding ABA is quiet simply pejorative and fails to acknowledge the efficacy research that supports ABA services for educational programming (e.g., http://www.nationalautismcenter.org/national-standards-project/phase-2) and the inherent inadequacies of nomothetic based human service sciences (Blampied, https://www.youtube.com/watch?v=LcU6nhiTse4) for addressing the individual needs of learners. Such a letter will only embolden school district administrators to diminish, deny or denigrate ABA services solely based on Musgrove’s statement. This is not a matter of eclectic inclusion, which is not how science progresses, it is solely a case of political maneuvering for the purpose of limiting financial liability.

    • Rajesh Sharma | August 6, 2015 at 7:57 am | Reply

      I have spent almost a decade working with school districts in the USA. I completely agree with Richard’s comments “It is solely a case of political maneuvering for the purpose of limiting financial liability and such a letter will only embolden school district administrators to diminish, deny or denigrate ABA services solely based on Musgrove’s statement”. This statement clearly explain why the letter was sent out. I think now the onus is on ABA community to respond to it with a well thought-out and systematic approach.

  3. ABA is also not a methodology. It shows the lack of understanding of our science. Gravity is not a methodology. It exists whether you like it or not.

  4. Marie-France Akinrolabu | August 6, 2015 at 8:51 am | Reply

    Educating consumers of ABA interventions on possible alternative to treatment does not in any way undermine ABA and it science. Casting the right light on the issue is the overall ignorance of school districts and major stakeholders who implement ABA in “stream of consciousness” fashion rather than with treatment integrity. This flat-lines student progress, dulls outright success stories and has far more damaging implications than controlling which methods consumers of ASD products should subscribe to.

  5. It is high time that such a letter was published, and I am pleased that Dr. Musgrove has made this statement. ABA has been looked at as the only solution to Autism for too long, with the idea that somehow it is all-encompassing and no other therapy is necessary. Autistic children in public education have been tremendously disserved by not having alternatives and specific therapy that is geared to their individual needs, as opposed to a cookie cutter approach. Parent choice must come into play and parents must be offered the real options out there, instead of only the ones that are the most popular. More effective, evidence-based, cost-effective, and respectful therapy is available and parents must be made aware. Additionally, to think that ABA can simply take the place of specific disciplines is simply ludicrous and a terrible, frankly unethical disservice to children on the Spectrum.

    The commenter above notes:
    “As for “other sciences,” approaches that assume nomothetic criteria do little or nothing to inform about the individual. There are others genres of science, many having very vibrant results and subsequent technologies, Speech and Language, Occupational Therapy, School Psychology have not achieved these outcomes.”

    It is almost laughable that this poster feels that an ABA practitioner can take the place of a licensed speech pathologist, a licensed occupational therapist, or a licensed school psychologist. Moreso, how does ABA inform about the individual? Data points certainly do not provide information on the true core challenges of the individual, on their state of regulation, on their individual differences, and on their ability to engage and relate with others. When in the world did ABA practitioners become all knowing and all able? This kind of narrow minded thinking is most disturbing and is exactly what it seems Dr. Musgrove is trying to steer away from. Bravo Dr. Musgrove

    • Your statement is powerful and on the mark. I agree with your perspective. I predict that there will be a major public and professional backlash against ABA practitioners in the future. I’m a licensed clinical psychologist with a background in behavior analysis. A certified behavior analyst told my sister that the only reason her autistic son bangs his head is because she doesn’t control the contingencies of reinforcement. She sought other treatment services, and her son, my nephew, no longer bangs his head, is able to speak, is sociable, and goes to school.

    • I am sure that you’ll have no problem pointing us toward the evidence base for your assertions? If you believe Behaviour Analysis is merely “one among many” alternatives I suggest you look more closely at the science and philosophy behind it. Radical Behaviourism and Functional Contextualism provide our world view. S&LT and Occup. therapy and so on are derived from different philosophical contexts. They are, in my opinion anyway, incompatible with behaviour analysis on a fundamental level.

      You may believe that there are better alternatives but I’ve seen the literature out there and I don’t believe there are. Behaviour Analysis is the only consistent approach. As for the dignity and respect argument, unfortunately we will always be talking at cross purposes so I won’t go into it.

  6. Karen McQuarrie | August 21, 2015 at 6:54 am | Reply

    Dr. Musgrove is obviously not in the classroom. In my 20+ years of experience, trying to get teachers and administrators to recognize the importance of ABA in a student with autism’s program is more of an issue then using it as the only treatment for a student. It is more difficult to get everyone on the same playing field and working collaboratively.

    • I have been fighting our school district for the last year to allow his ABA therapist to work with him at school or to provide a BCBA to work directly with him. I believe ABA is essential to his success at school. They have provided behavior support services in the form of their attempting to train aides with very little education. Without the skillset from formal training in ABA, I do not believe most the aides will be able to effectively implement ABA-based strategies/behavior intervention plans at school.

      • Spring Schafer | September 8, 2017 at 2:37 pm | Reply

        My apologies. I seem to have left out the first sentence of my reply post about my son having autism and needing ABA at school.

  7. Perhaps we should be inclusive and include crystal therapies and moon-chanting provisions just so we can meet all the “unique” needs?

    One alternative is that Dr. Musgrove is being defensive because ABA therapy violates her more cherished beliefs about the epistemic and metaphysical foundations of child development which, no doubt coloured by her personal and political philosophy, do not allow for a that special “personhood” to be explained by something as vulgar as science.

    An alternative to this of course is that she is, like so many “professionals” merely ignorant of what Behaviour Analysis does and is and relegates us to a specific therapy that can make a kid eat some carrots or sign for toilet. Shunting us into this simplistic model is a soothing balm to those other professionals whose areas of expertise we are forever encroaching on.

  8. I have a child on the spectrum. ABA is laughable at best. We tried. Doesn’t work. Know of many other families who also agree. I had a classroom teacher also try it with my son and nope. Not happening. One size does not all especially spectrum cases.

    • I’m sorry to hear that! Be sure you get a Board Certified Behavior Analyst to deliver services. I love to see my clients language abilities explode after working with them only a short time.

  9. I would love to see the research that shows that 30 minutes per month of speech consultation and 30 minutes of OT consultation per month show drastic improvements for children with Autism! I agree, OT, PT, and Speech all have their place, but the only thing I have seen to reduce to core symptoms of Autism is ABA. Some children fair better than others, but most if not all gain functional skills that help them not only to function in the moment but have the ability to learn new skills in the future. This letter does seem to be merely an attack on ABA to skirt financial liabilities, and that is what is not fair to our kids in the special education system.

  10. I agree. Aba helped when my son was 4 or 5 but is not flexible enough to address mental health derived behavior issues. RDI and more relationship therapies and life space crisis intervention do a much better Jon with my 13 year old now. ABA is too rigid and only addresses the behavior, not the cause. When they get too old for clicks and tokens or when the therapist is not bonded to the child and shares no interest with the child then it fails. We wasted years and thousands of dollars throwing money at ABA like beating a dead horse and it just made our son stressed out, alienated, and aggressive. He is in residential treatment now, it frustrates me that ABA is the only recommended and pushed for therapy because it is not right for us. Armies of young girls with no kids of their own armed with clipboards can not help build empathy and lessen OCD and anxiety in our kids. Our kids are not lab rats. They are not data driven.

    • Thanks for this, Joanna. I am a parent with a 6 year old on the spectrum, and I hold two degrees in psychology (one in experimental psychology). I would never jump on a bandwagon for treatment without empirical support. I am a strong proponent of ABA (when the therapeutic alliance you described is present–otherwise it is futile). I have found ABA to be much more helpful than speech or OT (not to say these have no merit) when it comes to overcoming challenging behaviors and increasing my son’s speech/communication. That being said, I also believe neurology and biochemistry cannot be overlooked and am currently seeking solutions to some extremely challenging behaviors that I believe have basis in biology.

  11. As a behavior analyst who works closely with occupational therapists and speech language pathologists, it is important to look at all the possibilities of a collaborative treatment team. When I first started working, the behavior analyst I worked for told parents, “I can do speech therapy” and completely undermined other service providers. Now, I work with therapists from other professions collaboratively to coordinate on goals and assess progress. For example, I had a situation where I thought the child’s articulation was an issue and speech language pathologist disagreed and said it was an issue with the rate of speech. Modifying the target outcome then impacted the child to make very quick results. This did not mean that the EIBI program changed from 20 hours a week ABA to SLP, that is a narrow perspective. Much of the issue some have with behavior analysis come from the actions of behavior analysts themselves. If we can’t collaborate, these pejorative perspectives will only increase.

  12. I have spent over 30 years working as a Behavior Analyst (BCBA) for 18 years. I truly a Skinnerian but I also value others evidenced-based practices such as Direct Instruction and Precision Teaching. Plus, I have learned the value of collaborating with other disciplines (e.g., SLPS and OTs). I learned early on in our field that if we come on as the “expert”, we are less likely to be able to ever influence other disciplines. In addition, I learned an awful lot from the paraprofessionals. BCBAs are NOT the only ones who know anything. If we continue down this path, we will not continue to learn what to help put in place for our learners to be successful.

  13. Amanda Williams | August 6, 2017 at 5:39 am | Reply

    I have spent the last 6 years as a special education teacher. I have worked with children from K-6 in a range of regular education classrooms, self contained classrooms and clinical (ABA driven) programs. I also have a MS in Psych with a focus on ABA. I am in preparation to take the BCBA exam currently. That all being said, I can completely understand collaboration with other service providers and how important that aspect is to the progress that is made. This is an important part to a successful and individualized program. However, years of research also provides the backing for the use of ABA. That being said it is vitally important that the interventions are applied with fidelity. Individuals applying these interventions must be trained and supervised. I have seen first hand in my experiences that staff or even BCBAs themselves have created these types of situations above where families are not positively impacted by services because things are not being handled properly. This was part of my motivation to move forward with my own knowledge base of the field. I do stand that ABA is effective, but it has to be done the right way and with each different child / individual in mind.

    • Spring Schafer | September 8, 2017 at 1:34 pm | Reply

      YES!!!! Thank you, Amanda. The fidelity of implementation of interventions and the training/supervision are of utmost importance. Not all therapists are created equal, and we have had some “doozies.” Do you believe it is possible to train classroom aides (my son has 1:1 all day) to effectively/consistently implement ABA interventions the way a BCBA would?

      • Tristan Daeley MS BCBA | September 10, 2017 at 1:10 pm | Reply

        Spring Schafer. I do believe that classroom aides are capable of delivering high level of services to individuals receiving 1:1 services. At times it can be difficult to compete with other environmental stimuli when providing prompts or reinforcement as planned, but if there is consistency within the classroom than a behavior plan can help lead to significant improvements in on task working time and other desirable classroom behaviors.

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