Newsletter
Volume 30 | 2007 | Number 3
The Critical Importance of Science-Based Treatments for Autism
By Dr. Richard M. Foxx, Pennsylvania State University
The education and treatment of individuals with autism often involves the application of nonscientifically based practices. This is tragic given that a scientifically validated and highly effective treatment, applied behavior analysis (ABA), is available.
The evidence for the effectiveness of ABA with autism is extensive. Consider that: a) individuals of all ages have been successfully educated and treated with ABA for over 40 years and children for over 46 years (e.g., Ferster, 1961); b) one researcher, Ivar Lovaas, has treated children with autism since the mid sixties; c) over 1,000 peer reviewed, scientific autism articles describe ABA successes; d) no other educational or treatment approach to autism has the support of The State of New York Health Department (1999) and United States Surgeon General (1999); e) NIMH has been continuously funding ABA research for over 40 years; f) all individuals with autism benefit from ABA; g) for over 35 years agencies using ABA have provided successful nonresidential and residential services for thousands of school aged children; h) ABA is the only therapy recognized for the treatment of young children with autism; i) no other educational or treatment approach to autism meets the standards of scientific proof that are met by ABA and there are no other scientifically valid treatments for autism that produce similar treatment, educational, or outcome results (Metz, Mulick, and Butter, 2005; Newsom and Hovanitz, 2005); j) competency guidelines regarding the delivery of ABA autism services are well established (ABA International Autism Special Interest Group) and certification of ABA practitioners has existed for a number of years (Behavior Analyst Certification Board) ; and k) investing in early ABA intervention for young children (Lovaas, 1987) is financially worthwhile, whether the results lead to complete or partial effects (Jacobson, Mulick, and Green,1998).
Quality educational programs for children with autism rely heavily on ABA principles since eclecticism is not the best approach (Heward and Silvestri, 2005) and adding ineffective treatment(s) to an effective one can be detrimental (Smith, 2005). Some regard ABA and Positive Behavior Support as highly similar treatment approaches although they are not (Johnston, Foxx, Jacobson, Green, and Mulick, 2006). They differ in the depth and breadth of their scientific base and their political correctness (Mulick and Butter, 2005).
Why Do Fads Occur and Can They Be Categorized?
Many educational and human service disciplines in the autism field do not emphasize scientific training in the preparation of practitioners and professionals (Jacobson, Foxx, and Mulick, 2005). Yet, many of their graduates rise to become influential administrators. As a result, the autism field is permeated by an educational and service delivery system that is often ineffective and at times even damaging because intervention efforts are based on unvalidated, ineffective, inappropriate, ill designed or disproven methods.
Local professionals and early intervention and educational agencies are most likely to recommend the types of services with which they are most familiar. These often are not state-of-the-art or even appropriate treatment or educational options, but rather the most common, mundane, and possibly minimally effective or even damaging ones. Even specialists may simply recommend methods that fall within their range of skills, rather than directing families to more appropriate and better validated alternatives (Jacobson et. al., 2005).
The field of education illustrates these problems quite clearly since it has no unified model and is in a perpetual state of disrepair and reform. Education in the U.S. is not a research-based profession (some graduate training programs offer sterling exceptions). Accordingly, most licensed or certified educators, whose training in the use and interpretation of research is often limited to a single collegiate course or what they can pick up in the media, lack many of the basic skills needed to be effective consumers of professional research reports or to communicate and translate research findings programmatically. This reliance on face validity and “common sense” along with a lack of information on scientific research have led to a growing susceptibility to the adoption of fad treatments that have a patina of apparent effectiveness as well as very negative side effects (Jacobson, et al., 2005).
Fad, dubious, controversial, pseudo-scientific, and politically correct treatments are not readily designated as exclusively faddish or controversial; rather, a treatment may be both faddish and controversial, and politically correct as well.
Fad treatments typically have several characteristics (Jacobson et al., 2005). The most important is that they rapidly increase in use, soon become pervasive for an extended period, and then rapidly decrease over time and are abandoned. They are often promoted or adopted based on testimonials from recognized, authoritative, or prominent professionals in a field. However, these testimonials are never verified by research that can meet any credible standard. The next phase features further adoption and dissemination by well-meaning professionals, paraprofessionals, or parents who do not have the skills, training, background, or inclination to investigate whether supportive research exists. The use of a fad over time may decrease because researchers have successfully demonstrated and conveyed its lack of effects to practitioners and parents. In other cases, a fad treatment may end because it has been succeeded by a more novel and newer one. Unfortunately, fad treatments are never completely abandoned. Either a small group of individuals continue to use them or they resurface because naïve advocates believe them to be novel.
In some cases unproven treatments are recognized by virtually everyone but those trained in the discipline that most commonly uses them. The culprits in this case are the training programs and professors in academia that continue and propagate these treatments.
Pseudo-scientific treatments and practices are based on: a) inadequate research designs that cannot substantiate the claimed effects, or b) a rationale that is stated in scientific terms, but not grounded in relevant scientific research (Jacobson, et. al., 2005). Pseudo-scientific practices persist when practitioners adhere to outmoded methods that have been disconfirmed by research that occurred after they left graduate school. In some cases, practitioners knowingly pursue and support practices that are lucrative but ineffective and baseless.
Politically correct treatments are disseminated and adopted because their: a) alleged rationale and effects resonate with ideological perspectives or b) use contributes to the realization of other socially progressive service delivery goals. Individuals promoting these treatments can achieve financial and professional gains in the form of large governmental grants and the establishment of a new field (Johnston, et al., 2006). Despite being in sync with political reasoning, these treatments seldom resonate with either scientific findings within a discipline or field or with thoughtful and critical common sense. However, when they do, they can be beneficial and politically correct. Unfortunately, because political and social acceptance is the end goal rather than the achievement of known or identifiable benefits for the individuals being treated, supporters of politically correct treatments are quite prone and highly motivated to disregard or derogate research findings that refute or contest their positions.
When professionals waste public and private resources through the perpetuation of fad, dubious, controversial, ineffective, non-beneficial, politically correct, and sometimes damaging or depriving treatments, or advocate for disuse of effective treatments, they claim to be unacceptable on political or other grounds, they diminish themselves as trusted professionals, their professions, and the individuals with autism they would purport to serve (Jacobson, et. al, 2005).
References
Autism Special Interest Group, Association for Behavior Analysis International.
Behavior Analyst Certification Board. www.BACB.com
Ferster, C. B. (1961). Positive reinforcement and behavioral deficits of autistic children. Child Development, 32, 437-456.
Heward, W. L., & Silvestri, S. M. (2005). The neutralization of special education. In J. Jacobson, R. M. Foxx, & J. Mulick (Eds.), Controversial therapies for developmental disabilities: Fads, fashion and science in professional practice (pp. 193-214). Mahwah, NJ: Lawrence Erlbaum Associates.
Jacobson, J. W., Foxx, R. M., & Mulick, J. (Eds.), Controversial therapies for developmental disabilities: Fads, fashion and science in professional practice. Mahwah, NJ: Lawrence Erlbaum Associates.
Jacobson, J. J., Mulick, J. A., & Green, G. (1998). Cost-benefit estimates for early intensive behavioral intervention for young children with autism-General model and single state case. Behavioral Interventions, 13, 201-226.
Johnston, J. M., Foxx, R. M., Jacobson, J. W., Green, G., & Mulick, J. A. (2006). Positive behavior support and applied behavior analysis. The Behavior Analyst, 29, p. 51-74.
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.
Mulick, J. A., & Butter, E. M. Positive behavior support: A paternalistic utopian delusion. In J. Jacobson, R.M. Foxx & J. Mulick (Eds.), Controversial therapies for developmental disabilities: Fads, fashion and science in professional practice (pp. 385-404). Mahwah, NJ: Lawrence Erlbaum Associates.
Newsom, C., & Hovanitz, C. A. (2005). The nature and value of empirically validated interventions. In J. Jacobson, R. M. Foxx, & J. Mulick (Eds.), Controversial therapies for developmental disabilities: Fads, fashion and science in professional practice (pp. 31-44). Mahwah, NJ: Lawrence Erlbaum Associates.
New York State Department of Health Early Intervention Program (1999). Clinical Practice Guidelines; Autism/Pervasive Developmental Disorders, Assessment, and Intervention for Young Children (Age 0-3 years). Albany, NY.
Smith, T. (2005). The appeal of unvalidated treatments. In J. Jacobson, R. M. Foxx, & J. Mulick (Eds.), Controversial therapies for developmental disabilities: Fads, fashion and science in professional practice (pp. 45-60). Mahwah, NJ: Lawrence Erlbaum Associates.
U.S. Surgeon General’s Report on Mental Health - Autism Section (1999).
Skinner, B. F. (1971). Humanistic behaviorism. The Humanist, 31(3), 35.