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 11. Evidence for Effects of Behaviour Analytic Methods across Ministry of Education Target Behaviour Classifications

This section summarises the evidence concerning behaviour analytic methods for changing behaviours and teaching new skills.

All of the various behaviour analytic intervention types were found to have some measure of scientific support for their effectiveness. The NSP review classifies these methods into 16 intervention types (Table 2) and reports strong scientific evidence for nine and emerging evidence for the remaining seven of these.

It should be noted that although Reductive Packages were classified as having emerging support it is becoming less and less frequent to find such strategies used alone. If they are used then other strategies that promote positive behaviour change would normally be used alongside them. Thus “emerging” might not be the appropriate term to use for these.

The intervention types included in the review cover a wide breadth of behaviour analytic methodology.To illustrate at least some of the behavioural methods a practitioner should know about and should be able to use in order to adopt evidence-based practice, the New Zealand data were examined in more detail.

Interventions with a score or of 2 or more on the SMRS were selected and sorted according to the degree of support for that intervention (strong support for beneficial effects, limited support, unknown, does not support). The reviewers’ descriptions of the procedures involved for those with strong support for beneficial effects were used to summarise the interventions and these are given in Table 6 below. This table illustrates the range of procedures found to be supported in this sub-set of the reviewed studies.

Table 6 shows that a wide range of behaviour analytic procedures needs to be used for evidence-base practice. It should be noted that these summary descriptions do not include mention of every behavioural principle involved in the interventions. For example, reinforcers of some type (e.g., social, tangible, tokens, and/or access to activities) are an integral part of teaching new skills and helping behaviour change but are not always listed in the summary description of the procedure. Also motivating (or establishing) operations are an important aspect of using reinforcers effectively but are also not mentioned in the summary descriptions.

Table 6 shows that effective practice requires the use of appropriate combinations of procedures and that one “intervention” frequently involves the combination of several different procedures. For example, antecedent procedures, such as the use of physical or video prompts, often form only part of an intervention and so are combined with other maintenance procedures and, when they are used, they are also normally combined with some form of reinforcement and often with a fading procedure to be maximally effective.

Table 6. Examples of behaviour analytically evaluated strategies that have contributed to “strong” evidence of efficacy from the NZ reviews.
Interventions with a SMRS score of 2 and above from the subset of reviews carried out in NZ
Examples with Strong Support for beneficial effects
Communication training e.g., 
  • Composite training (tact training, verbal praise, handshakes)
Differential reinforcement (DR), e.g.,  
  • Differential reinforcement of alternative behaviour (DRA) combined with extinction of escape behaviour
  • DRA plus sensory extinction
  • DR in favour of playing with another rather than alone
  • Differential reinforcement of other behaviour (DRO) with stimulus fading
  • DRO with response cost and with prompted relaxation and use of peers
Differential observing responses to increase accuracy on Matching to Sample (MTS) task with words
Direct Instruction
Extinction e.g.,  
  • Extinction through non-contingent exposure to kinaesthetic stimuli
  • Extinction with stimulus fading
Function based intervention package including replacement behaviour training (using picture communication), response modification and environment change with verbal and physical prompts
Functional Communication Training using scripts and response cost
Imitation, e.g., 
  • Reciprocal Imitation Training (imitation plus reinforcement)
  • Imitation training (using modelling, prompting, differential reinforcement using tokens and error correction)
Learn units plus multiple example instruction
Naturalistic Teaching Strategies, e.g.,  
  • Natural language paradigm
  • Incidental teaching and social conditioning
  • Enhanced milieu teaching (EMT) plus voice output communication aid (VOCA)
Non-contingent reinforcement (NCR), e.g.,  
  • NCR and prompts
  • Staff training in NCR use with staff rapport building and prompts and feedback
  • Non-contingent attention
Prompts, e.g.,  
  • Video prompting
  • Prompting incompatible behaviour
  • Prompts plus social stories plus praise
  • Social stories plus prompts
  • Prompts with praise and other reinforcers and extra opportunities to complete task
  • Prompts combined with social and/or other reinforcers
  • Prompts combined with social and/or other reinforcers with the prompts then faded
  • Prompts with fading, and with social and/or other reinforcers plus a correction procedure
  • Simultaneous prompting
  • Physical Prompts plus training of common mands (requests)
Reductive procedures, e.g., 
  • Stopping behaviour occurring by interruption of the behaviour chain
Reinforcement plus non-contingent access to preferred stimuli and with no consequences for target behaviour [followed by fading in interruptions (do requests)]
Schedules, e.g., 
  • Photo activity schedule with prompts and tokens and reinforcers
Scripts, e.g.,  
  • Scripts and then script fading with embedded textual stimuli
Self management, e.g.,  
  • Self management through self reinforcement procedures
  • Self-Regulated Strategy Development
  • Stop-Observe-Deliberate-Act (Social-behavioural learning strategy)
Social stories
Stimulus control, e.g., 
  • Stimulus superimposition and background fading
  • Cues with prompting, feedback, and positive consequences
Task analysis plus backward chaining plus prompting and prompt fading plus reinforcement
Teaching communication e.g., 
  • Composite-spontaneous communication (discrete-trial teaching, prompts, error correction and natural consequences)
Teaching social-behaviour to replace problem behaviours
Using peers as an establishing (motivating) operation
Video modelling, e.g., 
  • Video modelling plus prompting
  • Video modelling combined with self management training
  • Video modelling plus praise and/or other reinforcers
  • Video modelling plus prompts, praise and/or other reinforcers combined with short periods of timeout
Video rehearsal, e.g., 
  • Video rehearsal of task combined with the use of video or photo prompts when doing task
  • Video rehearsal plus praise and/or other reinforcers
Work systems

These examples of skills are, to a large extent, a subset of the general skills that behaviour analytic practitioners (e.g., teachers, carers) need for increasing or decreasing behaviours effectively if evidence-based practices are to be adopted. A fuller range of knowledge, skills and abilities (KSAs) would be expected of those training and supervising practitioners. See Task List for Board Certified Behaviour Analysts Working with Persons with Autism – 3rd ed. (2005). Specialist extra KSAs recommended for behaviour analytic practitioners specialising with ASD populations can be found on the Behaviour Analyst Certification Board website.