Association for Behavior Analysis International

Community-based interventions grounded in applied behavior analysis (ABA) are common, particularly for children and youth with intellectual and developmental disabilities (I/DD). Many ABA-based interventions are implemented in a tiered model whereby a paraprofessional implements the treatment plan developed by a Board Certified Behavior Analyst or behavioral psychologist. However, this intervention model does not work for every family and is not appropriate for every person. The purpose of this panel is to explore three different behavior analytic intervention models that have been successfully implemented in a community-based setting in the absence of a paraprofessional – RUBI, Caregiver-led ABA, and Compass-Behavioral. Each intervention has a different focus of care, allowing individuals and families to choose an evidence-based treatment that fits their primary reasons for referral (e.g., disruptive behavior, dangerous behavior, communication, adaptive skills, executive functioning) and their personal or family values. This panel will explore each intervention’s implementation model, the primary focus of the intervention, associated clinical training, and outcomes from community-based implementation across ~800 children and youth with I/DD from geographically diverse locations.

The target audience for this panel is BCBAs, BCBAs in training, and other clinicians who work with the I/DD population. The prerequisites for this talk include basic behavior analytic knowledge as well as a basic understanding of the diagnostic criteria for autism spectrum disorder, intellectual disability, and other commonly occurring developmental disabilities such as Down syndrome.

There is a pressing need to close the chasm between intervention efficacy under ideal conditions and community-based effectiveness. The Research Unit on Behavioral Interventions (RUBI) Autism Network developed an 11-session behavior analytic parent-mediated intervention for autistic youth with co-occurring challenging behaviors. As demonstrated by 20+ efficacy trials, RUBI is acceptable to parents and effective in reducing challenging behavior. The current study evaluates RUBI feasibility and effectiveness in clinical practice with caregivers of autistic youth. Analyses included caregivers of 203 autistic children (2-13 years) with challenging behaviors who received >1 RUBI session at the Seattle Children’s Autism Center (SCAC) or Marcus Autism Center (MAC). Data were collected through medical record review. Results from the RUBI clinical trial [RUBI-CT] were used as benchmarks. SCAC/MAC served older [7.2 (±2.2)], more diverse youth compared to RUBI-CT [IQ <70 in 26% RUBI-CT youth vs. 39% at SCAC/MAC; 73% White in RUBI-CT vs. 66% at SCAC/MAC]. Clinical outcomes were comparable [RUBI-CT attrition = 11% vs. 19% at SCAC/MAC; 47.7% reduction in challenging behaviors in RUBI-CT vs. 45.1% at SCAC/MAC; 69% positive response in RUBI-CT vs. 63.6% at SCAC/MAC]. Community-delivered RUBI is acceptable to parents and effective in reducing challenging behaviors, with findings comparable to efficacy trials.

Parent-Mediated applied behavior analysis (ABA) is an evidence-based intervention that focuses on building parenting skills to effectively implement behavioral procedures with their child to teach new skills as well as manage difficult behavior. Parent-Mediated ABA has been shown to produce positive outcomes for autistic children (Anan et al., 2008; Shiri et al., 2020; Sneed et al., 2023) as well as their parents (Simcoe et al., 2024; Sneed & Samelson, 2022). We sought to compare community-based parent-mediated ABA with a comparable tiered, paraprofessional-mediated intervention. We analyzed retrospective clinical data of autistic children in either paraprofessional-mediated (n = 197) or parent-mediated (n = 198) ABA to determine the effect of treatment on adaptive behavior (as measured by the Vineland-3) and goal attainment (as measured by the Goal Attainment Scale; GAS) across three time points spanning 18 months. A two-way mixed ANOVA indicated no significant difference in the adaptive behavior composite nor the socialization, communication, and daily living skills subscales, either between groups or over time. A separate two-way mixed ANOVA showed significant differences in goal attainment between treatment conditions, across time, and with a significant interaction. Overall, the parent-mediated group had significantly higher goal attainment than the paraprofessional-mediated group, although all groups improved significantly over time. The interaction effect indicated that the parent-mediated group improved more and more quickly than the paraprofessional-mediated group. These results suggest that parent-mediated ABA may be an acceptable alternative to paraprofessional-mediated interventions.

Challenges with executive functioning (EF) is a barrier to wellbeing for autistic youth and young adults (Wong et al., 2022). EF skills are mental skills, including manipulation of ideas, planning, preceptive taking, and flexibility (Diamond, 2013). Wellbeing is the measure of overall happiness, satisfaction, and positive outlook on life and is closely related to self-determination (White et al., 2018). Compass-Behavioral is a non-tiered behavioral “coaching” intervention utilizing applied behavior analysis (ABA) to teach EF skills to autistic youth and adults with the goal of improving wellbeing. Autistic individuals work directly with their Compass-Behavioral coach, a BCBA, to set goals around EF skills that are important to their wellbeing. The coach and client meet weekly to review data, goals, and practice EF skills. The purpose of this study was to investigate the effectiveness of Compass-Behavioral at improving EF skills and wellbeing in a community-based setting. A group of 376 autistic youth and young adults underwent the Compass-Behavioral intervention, producing significant improvement in self-reported EF skills, sleep behaviors, and overall wellbeing (ps < .05). Compass-Behavioral is an effective ABA delivery model for autistic youth and young adults seeking to improve EF and wellbeing and may be a suitable alternative to tiered ABA approaches.