Technical review of published research on applied behaviour analysis interventions for people with Autism Spectrum Disorder
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 4. Engagement and Flexibility in Developmentally Appropriate Tasks and Play and Later Engagement in Vocational Activities
This category includes articles that NSP had categorised as either Independent Play/Leisure or Vocational. Articles were coded as focusing on “Independent Play/Leisure” if they involved increasing skills in activities that were “non-academic and non-work related activities that [did not] involve self-stimulatory behavior or require interaction with other persons” (Wilczynski & Christian, 2008, p. 53). Examples of dependent variables that may have been included in this category are “functional independent play (i.e., manipulation of toys to determine how they ‘work’ or appropriate use of toys that do not involve pretense) and use of media (e.g., television, computer, radio, games)” (Wilczynski & Christian, 2008. p. 53). Articles were coded as Vocational if they involved increasing skills that allowed a person to “execute semi-independent or independent work” (Wilczynski & Christian, 2008, p. 53). Examples of dependent variables that may have been included in this category include “using a timecard, computer skills, monitoring work quality, accepting feedback, safety in the workplace, securing assistance or requesting a break in the workplace (do not code in communication), and adhering to dress code” (Wilczynski & Christian, 2008, p. 53).
These two NSP categories seem to correspond well with the Ministries’ category, with three possible limitations. The first limitation is the Ministries’ requirement for the focus of the interventions to be on teaching engagement and flexibility. Although a subset of articles will have focused on increasing variation in play skills, this information can not be directly accessed without reviewing every article. The second limitation is that the NSP definitions for the play/leisure and vocational tasks do not require that the targeted skill be developmentally appropriate. However, one of the key characteristics of ABA is the focus on socially significant behaviours. As such, one may reasonably assume that the behaviours that were targeted were of importance to the person and/or their significant others and, therefore, developmentally and/or socially appropriate. The final limitation is that it is unclear if the Ministries required the inclusion of social play in this category. As shown by the definition above, this type of interaction has not been coded in this category; rather articles of this nature are included in the interpersonal category and as such are included in the Ministries’ category of “social development and relating to others”.
Evidence from NSP review
The evidence from the NSP review found that behavioural packages have strong evidence supporting their effectiveness in increasing independent play and leisure skills. ABA interventions that have emerging evidence that they are effective at increasing independent play and leisure skills are peer training packages, naturalistic teaching strategies, modelling, antecedent packages, and pivotal response training.
Additional evidence from New Zealand reviewers
Within this category, between 1998-2007, six research items were published that had been excluded by NSP as they included people with ASD who were older than 21 years, had additional psychiatric or medical diagnoses, and/or were published after their cut-off date. Five of these research items were coded by New Zealand reviewers as having beneficial effects. Of the five beneficial items, four had a SMRS score of 2 and one a SMRS score of 3. Thus these results support NSP findings. Of interest are the two studies that had participants over the age of 21. Both studies showed beneficial effects. One study, focusing on vocational skills, had a SMRS score of 3, while the second study, focusing on leisure skills, had a SMRS score of 2. These results suggest that there is some evidence that ABA interventions are effective for this older age group, however, there is insufficient research to allow for a SECS classification above unestablished.
Evidence from studies published from 1998-2007
Forty research items reviewed by NSP and/or New Zealand reviewers were published during this period and coded for this category. Examination of the SMRS scores for the articles that were shown to have beneficial effects, found that 16 had a SMRS score of 2, and 12 had a SMRS score of 3. There were 12 articles that showed unknown effects, seven had a SMRS score of 2, four had a SMRS score of 3, and one had a SMRS score of 4. None of the articles reviewed for this time period were shown to be ineffective or harmful. It is likely that the strength of evidence for the effects of behavioural interventions for play based on evidence published during these years would be rated as strong.
Summary of this section
This review shows that behavioural packages have strong evidence and a number of other ABA interventions have emerging evidence to support their use in increasing play and leisure skills for children with autism. Even though there is considerable research focused on increasing play and leisure skills, there appears to be very limited research on the application of ABA interventions focused on increasing vocational skills.
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