Technical review of published research on applied behaviour analysis interventions for people with Autism Spectrum Disorder

Publication Details

New Zealand Ministries of Education and of Health requested a technical review of the evidence base on the effectiveness of Applied Behaviour Analysis (ABA) for people with Autism Spectrum Disorders (ASD).

Released on Education Counts: April 2010

Author(s): Oliver Mudford, Neville Blampied, Katrina Phillips, Dave Harper, Mary Foster, John Church, Maree Hunt, Jane Prochnow, Dennis Rose, Angela Arnold-Saritepe, Heather Peters, Celia Lie, Katrina Jeffrey, Eric Messick, Catherine Sumpter, James McEwan and Susan Wilczynski (2009), Auckland UniServices Limited.

Date Published: 15 January 2009 - Revised 16 January 2009

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Results 6. Prevention of Challenging Behaviours and Substitution with More Appropriate and Conventional Behaviours

This category includes all problem behaviours (i.e., challenging behaviours) that have been changed using antecedent manipulations, and those changed using methods that increase incompatible or alternative behaviours. Antecedent manipulations are manipulations intended to prevent challenging behaviours. Incompatible and alternative behaviours are behaviours that are incompatible with or alternative to challenging behaviours and are thus more appropriate and conventional then challenging behaviours. The NSP’s categories of behavioural intervention methods relevant to this section are: Antecedent, behavioural, functional communication training, joint attention training, modelling, and self-management packages. Challenging behaviours were subcategorised (based on Wilczynski and Christian, 2008) as follows: problem behaviours; restricted, repetitive, non-functional patterns of behaviour, interests, or activity; and sensory or emotional regulation (see Table 3).

Evidence from NSP review

There was strong evidence overall in the review for the benefits of antecedent and behavioural treatment packages. However, when items were divided among the three subcategories of challenging behaviour, emerging evidence was found for problem behaviours and sensory and emotional regulation. There was emerging evidence that Functional Communication Training (FCT) and self-management packages produced beneficial results for changing problem behaviours. Considered across NSP categories of challenging behaviour, there was emerging evidence for problem behaviours from antecedent, behavioural, functional communication training, modelling, and self-management packages. Restricted and repetitive behaviours responded to behavioural, joint attention, and peer training interventions at the emerging level of evidence. Likewise, behaviours categorised as difficulties with sensory and emotional regulation responded to antecedent, behavioural, and modelling interventions at the emerging level of evidence.

Additional evidence from New Zealand reviewers

The NZ review added 12 more items. Five of these items would have been excluded from the NSP due to participant ages of 22 years or over and two due to diagnoses of excluded co-morbid conditions. There were 19 participants across these items and all had diagnoses of autism. All items received an SMRS score of 2 and all showed beneficial effects (i.e., they decreased challenging behaviour). The NZ data corroborate the NSP data for those under age 22. Additionally, NZ data for the eight participants aged 22 and over suggest that evidence for the effectiveness of these interventions for those aged > 21 is emerging.

Evidence from studies published from 1998-2007

A total of 75 items that were published between 1998 and 2007 were reviewed by NSP and NZ reviewers. Two items received a SMRS score of 4, seven items received a score of 3, and the remainder scored 2. Both of the items that scored 4 were beneficial. Five of the seven items that scored 3 were beneficial while two of these items involved data that did not allow a firm conclusion to be drawn regarding whether they were beneficial, effective, or adverse. Fifty-one of the items receiving a score of 2 were beneficial while 13 were inconclusive and two were ineffective. Across all 75 items, then, 58 (77%) were beneficial, 15 (20%) were inconclusive, and two (3%) were ineffective. Taking account only of research published during this ten-year period, the evidence that behavioural interventions reviewed in this section are beneficial in reducing challenging behaviours, in general, appears to be strong.

Summary of this section

Overall, there is strong evidence for the benefits of ABA interventions in this section. More fine-grained analysis shows a mix of strong and emerging evidence depending on the type of treatment package reviewed and the ages and diagnostic classification of the research participants. For example, there is stronger evidence for children in the 3-9 years age range and the evidence concerning those diagnosed with autism is stronger than for PDD, with Asperger’s Syndrome findings being weak through limitations in the number of studies. Nevertheless, the NSP review found at least emerging evidence for interventions targeting individuals up to age 21. The few studies reviewed for adults suggest similar (emerging) evidence.