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| Dosage and Interventions Based in Applied Behavior Analysis: Is More Meaningful? |
| Sunday, May 26, 2024 |
| 10:00 AM–10:50 AM |
| Convention Center, 100 Level, 113 A |
| Area: AUT/DDA; Domain: Service Delivery |
| Chair: Lindsey Sneed (Catalight Research Institute) |
| CE Instructor: Lindsey Sneed, Ph.D. |
| Abstract: Recent research challenges the notion that autistic children require 20-40 hours per week of applied behavioral analysis (ABA) based intervention for meaningful progress. Studies, including a 2021 study by Rogers et al., reveal that 15-25 hours of ABA intervention per week offer similar benefits, with no added advantage to more hours. Additionally, a modular treatment approach of 5-8 hours per week proved non-inferior in this context. Similarly, a community-based study revealed autistic children in a 4–10-hour group made greater gains than 10 or more-hour groups on treatment outcomes.
The increasing prevalence of autism underscores the importance of early diagnosis, but many families, particularly in underserved communities, face obstacles in accessing evidence-based services. To address this, a community-based program partnered with the Part C early intervention system, providing six brief telehealth caregiver coaching sessions. The outcomes demonstrate enhanced caregiver skills, improved child communication, and high satisfaction, especially among historically underserved groups.
These findings collectively challenge the "more hours, better results" ABA paradigm for autistic children. They highlight the potential of shorter, sustainable models to boost caregiver skills and child outcomes. These insights have significant clinical implications, emphasizing the need for outcome-based decisions to determine the appropriate ABA intensity for individual children. |
| Instruction Level: Intermediate |
| Keyword(s): autism, dosage, outcomes |
| Target Audience: The target audience should have a foundational knowledge of the principles of applied behavior analysis and have at least 1-2 years of experience implementing interventions based in applied behavior analysis in a community-based or research setting. |
| Learning Objectives: At the conclusion of this presentation, participants will be able to (1) list three empirical studies demonstrating more hours are not necessarily better for autistic children receiving interventions based in applied behavior analysis, (2) describe at least two factors that significantly predict treatment outcome in applied behavior analysis interventions for autistic children, (3) synthesize the importance of significant caregiver involvement in interventions based in applied behavior analysis. |
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| An Evaluation of Dosage Intensity for Interventions Based in Applied Behavior Analysis |
| LISA WALLACE (Treatment and Research Institute for Autism Spectrum Disorders
Vanderbilt Kennedy Center
) |
| Abstract: While 20-40 hours per week of early intensive applied behavioral Intervention (ABA) has been the typical recommendation for young autistic children for many years, solid research has emerged and continues to emerge indicating that lower therapeutic doses can provide equal benefit for these young children. In research published in 2021, Rogers, et al. found that children benefited equally whether they received 15 or 25 hours per week of ABA intervention. This randomly controlled study compared 87 participants who were randomly assigned to receive DTT or ESDM at an intensity of either 15 or 25 hours weekly. All four groups of children made significant across domains, which suggested no added benefit from the additional hours. In an extension of this study, children were enrolled in one of two treatment models, >15 hours of behavioral intervention, or 5-8 hours/week of a modular treatment approach. Again, outcomes showed that both groups made significant improvements and the modular approach was not inferior. In this presentation, we’ll talk through the implications of these studies for practice including sharing best practices with families so they can make data driven decisions about how much intervention their child receives. More hours is not always better. |
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| Community-Based Interventions Based in Applied Behavior Analysis: A Review of Paraprofessional-Delivered Intervention and Outcomes |
| LINDSEY SNEED (Catalight Research Institute), Doreen Ann Samelson (Catalight Research Institute), Ian Cook (Catalight Research Institute), Brianna Fitchett (Catalight) |
| Abstract: There is a long held-belief in the field of applied behavior analysis (ABA) that a high number of paraprofessional-delivered hours (e.g., 20-40 hours per week) is needed for autistic children to make meaningful progress. Recent research has demonstrated that no more than 15 hours per week may be necessary for autistic children to make significant gains. These researchers set out to understand if the number of paraprofessional hours delivered to 509 autistic children between 2-11 years (M =6.17, SD = 2.3) of age who received community-based ABA was significantly different between three groups, 0-4 hours (n = 118), 4-10 (n=246) hours, and 10 or more hours (n = 145) per week. A mixed-model ANOVA was conducted to assess progress within each group across time as well as between groups. Individuals in the 0-4 group made less mean progress over time. Those in the 4–10-hour group made significantly greater progress on all adaptive behavior domains in comparison to the 10 or more-hour group. The results reveal that fewer hours may produce more optimal benefits than higher amounts of hours in ABA for autistic children and is consistent with more recent research investigating hours and interventions based in ABA. |
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Evaluating a Brief Parent-Mediated Applied Behavior Analysis (ABA) Model With Historically Under-Served Groups |
| KATHLEEN SIMCOE (Vanderbilt University Medical Center) |
| Abstract: As autism prevalence continues to increase the average age of diagnosis is decreasing. A significant benefit of early diagnosis is access to early intervention, however, families caring for young autistic children, especially those in under-resourced communities, often experience barriers to accessing evidence-based services, such as applied behavior analysis (ABA). Under the federal Individuals with Disabilities Act (IDEA) law families can access Part-C early intervention services, but providers within that system often lack specific training in autism or ABA. Working with our state’s Part C system, we developed a partnership providing brief (six sessions) caregiver coaching sessions via tele-health following an autism evaluation. These sessions focus on introducing caregivers to the basic principles of ABA and coaching them to apply these strategies throughout daily routines. Data (n= 234 families) show that caregivers gained skills, children improved their social communication, and provider (n=80) and caregiver satisfaction was high. Group comparisons show that outcomes are consistent across groups (e.g., race/ethnicity, rural/urban location) with some outcomes significantly better for families from historically under-served groups. This community-based program demonstrates the possibility of a brief, sustainable model to increase caregiver skill and improve child outcomes when access to ABA services is delayed or not available. |
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