|
| Therapeutic Orphans of Applied Behavior Analysis |
| Sunday, May 25, 2025 |
| 8:00 AM–8:50 AM |
| Marriott Marquis, M4 Level, Independence E-H |
| Area: AUT/DDA; Domain: Service Delivery |
| Chair: Joe Joseph Wyatt (Marshall University) |
| CE Instructor: Nathan Blenkush, Ph.D. |
| Abstract: In 1965, Harry Shirkey coined term “therapeutic orphans” in reference to drug development for children in the wake of the thalidomide tragedy. Federal amendments resulted in orphaning clauses (e.g. “not to be used in children”) which curtailed the use and development of novel therapeutics for children and other groups. For people with severe problem behaviors, behavior analysis historically was the orphanage; providing and developing treatment for those who did not benefit from traditional therapies. Currently, several orphaning factors are at work limiting individualized treatment and creating therapeutic orphans of applied behavior analysis. Here we discuss orphaning factors related to the uncompromising promotion of assent above all factors; regulatory and research trends that move patients away from behavioral treatments and towards psychiatric care and criminal justice; and other practice trends that subordinate the needs of individual patients. We illustrate the phenomenon of therapeutic orphaning by summarizing real world cases; reviewing regulatory situations in the United States and Canada; and present data regarding an assessment tool to aid behavior analysts in balancing various factors in treatment decision making. |
| Instruction Level: Intermediate |
| Keyword(s): assent, regulations, therapeutic orphans |
| Target Audience: Attendees should have a working knowledge of the factors to consider in risk/benefit analysis and a comprehensive understanding of the BACB ethics code. The BATS tool is designed to help practitioners make informed decisions. Additionally, attendees should have a general sense of the research conducted recent journals and those that receive behavioral services. |
Learning Objectives: 1. List and describe the factors associated with the Behavioral Assent to Treatment Scale (e.g. safety, risk/benefit analysis, behavioral dimensions, socially significant goals, essential/nonessential treatment progress, and legal/ethical obligations).
2. Describe the participants of research described in behavior analytic journals over the last 5 years.
3. Compare and contrast the concept of therapeutic orphans and medicine with orphans of behavior analysis. |
| |
| Therapeutic Orphans of Applied Behavior Analysis |
| NATHAN BLENKUSH (Judge Rotenberg Educational Center) |
| Abstract: In 1965, Harry Shirkey coined term “therapeutic orphans” in reference to drug development for children in the wake of the thalidomide tragedy. Federal amendments resulted in orphaning clauses (e.g. “not to be used in children”) which curtailed the use and development of novel therapeutics for children and other groups. For people with severe problem behaviors, behavior analysis historically was the orphanage; providing and developing treatment for those who did not benefit from traditional therapies. Behavior analysts composed statements preserving treatment rights, labored to distinguish between patients based on problem behavior severity and chronicity, and provided treatments that were preferable to the standard interventions of the time. Examples of current orphaning factors including state regulations that prohibit basic behavioral procedures; lack of research devoted to or acknowledgement of treatment refractory cases; expelling, refusing to treat, or deferring to criminal justice or psychiatric treatments; and policies that subordinate the needs of individual patients. Here, real world data regarding treatment orphans and factors leading to orphaning are presented. Orphaning factors are contrasted with factors promoting individualized treatment based on the individual needs of the patient. |
| |
| The Behavioral Assent to Treatment Scale |
| HALLE APELGREN (Judge Rotenberg Educational Center) |
| Abstract: Behavior analysts are obligated to consider “obtaining assent from clients when applicable” as dictated by the ethics code (Behavior Analyst Certification Board, 2020). Since this addition, there has been an increased interest in assent within the field of behavior analysis. While considering assent is undoubtedly an important practice, prioritizing assent over all other ethical obligations (e.g., providing effective treatment, minimizing risk, consent etc.) can be dangerous and have deleterious effects on treatment progress and quality of life. Additionally, this prioritization has the potential to restrict clinicians’ ability to make individualized treatment decisions, which decreases the effectiveness of ABA, which in turn leads to negative outcomes for our clients and the field. When we are uncompromising in the promotion of assent, we run the risk of delivering ineffective services and abandoning vulnerable individuals who desperately need ABA treatment. To aid clinicians in making this distinction and individualized treatment decisions, an assessment tool called the Behavioral Assent to Treatment Scale (BATS), will be presented that weighs factors such as safety, risk/benefit analysis, behavioral dimensions, socially significant goals, essential/nonessential treatment progress, and legal/ethical obligations. Data for a sample of individuals in residential treatment will be provided as preliminary construct validation for the BATS. |
| |
| Research as an Orphaning Factor |
| RAJVINDER SINGH (McMaster University) |
| Abstract: In medicine, people with rare diseases were therapeutic orphans in the 1970’s because commercial interests did not align with conducting research and developing treatments for such conditions (Swann, 2018). To remedy the situation, the Orphan Drug Act, passed in 1983, created incentives for the development of treatments for rare diseases. An analogous situation exists today in behavior analysis. That is, the field is focused a young children with autism and the argument can be made that older, stronger, and treatment refractory patients are therapeutic orphans. In 2003, Foxx noted that patients with dangerous behaviors were historically undertreated and their conditions under researched. Here, it is argued that patients with treatment refractory aggression and self-injury remain under served and few publications are devoted to patients with treatment refractory problem behaviors. A cursory review of published research shows much attention devoted to outpatient children with less research devoted to young adult or adult clients treated in residential or inpatient hospital settings. |
|
| |