FOI 24/25-0514 DOCUMENT 2 Literature Review OFFICIAL For Internal Use Only
Reducing Applied Behaviour Analysis over time
The content of this document is OFFICIAL. Please note: The research and literature reviews collated by our TAB Research Team are not to be shared external to the Branch. These are for internal TAB use only and are intended to assist our advisors with their reasonable and necessary decision-making. Delegates have access to a wide variety of comprehensive guidance material. If Delegates require further information on access or planning matters, they are to call the TAPS line for advice. The Research Team are unable to ensure that the information listed below provides an accurate & up-to-date snapshot of these matters
Research question: Is there substantial evidence that a step-down transition away from Applied Behaviour Analysis (ABA) therapy can provide outcomes and be of benefit? Date: 3/1/24 Requestor: Star s22(1)(a)(ii) - Endorsed by: Naomi s22(1)(a)(ii) - irreleva Researcher: Stephanie s22(1)(a)(ii) - irrelevant mate, Aaron s22(1)(a)(ii) - irrelevant ma Cleared by: Stephanie s22(1)(a)(ii) - irrelevant mat
- Contents Reducing Applied Behaviour Analysis over time ……………………………………………………………… 1
- Contents ……………………………………………………………………………………………………….. 1
- Summary ………………………………………………………………………………………………………. 2
- Previous TAPIB research papers ………………………………………………………………………. 2
- Review of Provided Literature …………………………………………………………………………… 2
- Other sources ………………………………………………………………………………………………… 2
- Literature review table ……………………………………………………………………………………… 4
- References ……………………………………………………………………………………………………. 7
Reducing ABA Page 1 of 7 OFFICIAL Page 10 of 16
FOI 24/25-0514 Literature Review OFFICIAL For Internal Use Only 2. Summary This paper considers the evidence for a step-down model of reducing frequency or intensity of applied behaviour analysis (ABA). No evidence was found regarding the effectiveness of a step-down model. One international ABA accreditation body, the Behavioral Health Center of Excellence, recommends a gradual reduction in hours when concluding ABA therapy. Five papers were attached with the research request. None of the papers directly relate to the efficacy of a step-down model of reducing ABA supports. Previous TAPIB research has found a lack of consensus regarding appropriate intensity and duration of ABA therapy. Recent Australian guidelines on the delivery of supports for children with autism note that supports should be individualised and there is no set number of hours of therapy which are appropriate for every child. 3. Previous TAPIB research papers Previous TAPIB research papers related to ABA include: • RES 246 ABA and positive behaviour support.docx • RES 292 Applied behaviour analysis for adults with ASD.docx
RES 246 found no evidence for appropriate frequency, intensity or timeframe of ABA required to affect a reduction in behaviours of concern, nor any information on reducing intensity of support over time. RES 292 found lack of consensus regarding appropriate frequency, intensity or timeframe of ABA. The studies review in this paper emphasised that an individualised approach to determining frequency, intensity and timeframe of supports is required. 4. Review of Provided Literature Five papers were attached with the research request (refer to 6. Literature Review table for further details). None of the attached papers were directly relevant to the research question. None of the papers reviewed directly addressed the benefits of an extended timeframe of supports or the benefits of slowly reducing ABA support over time. No quality assessment was completed due to lack of relevance to the research question. 5. Other sources The Behavioral Health Center of Excellence (BHCE) is a private organisation that offers accreditation of applied behaviour analysts. They suggest fading out services gradually based on the needs of the client (BHCE, n.d.). However, BHCE provide no evidence on which they base this recommendation.
Reducing ABA Page 2 of 7 OFFICIAL Page 11 of 16
FOI 24/25-0514 Literature Review OFFICIAL For Internal Use Only Autism CRC’s recent National Guideline for supporting the learning, participation, and wellbeing of autistic children and their families in Australia (Trembath et al, 2022), makes the following recommendations around duration of supports: 56 . 1 The amount and duration of support provision should be tailored to the individual needs of the child and family. This includes consideration of the frequency, length, and time of day of support sessions, and variations in support needs over time. 56.3 Practitioners should inform parents that there is no set number of hours per week of practitioner delivered child-directed supports that leads to the best outcomes for all children. 56 . 4 Practitioners should be aware that research evidence does not support the concept that supports delivered in greater amounts consistently lead to better child and family outcomes (Trembath et al, 2022, pp.95-96). The National Guideline does not discuss reducing therapy over time.
Reducing ABA Page 3 of 7 OFFICIAL Page 12 of 16
FOI 24/25-0514 Literature Review
OFFICIAL For Internal Use Only
- Literature review table
The following papers were attached with the research request.
Author / Study aim/objective Relevance to Current Quality of included Date Research Question evidence (high/medium/low/very low) 1 Camar A review of the quality | Whether ABA improves Not relevant. N/A go et . a . f of behaviourally-based_ | social interactions for Paper discusses al 2014 intervention research to | children with ASD; whether | behavioural improve social ABA can be considered components of some interaction skills of evidence based. interventions for children with ASD in children with autism inclusive settings but does not discuss frequency/intensity of ABA or reducing therapy over time. 2 Steinbrenner Evidence-Based Purpose of report is to Not relevant. N/A Practices for Children, | “describe a set of practices | Report discusses et al Youth, and Young that have clear evidence of | efficacy of multiple 2020 Adults with Autism positive effects with autistic | ABA programs but Spectrum Disorder children and youth” does not discuss frequency/intensity or timeframe of supports. 3 Kadar et al Evidence-based “identify how occupational | Not relevant. N/A practice in occupational | therapy practice may have | Paper briefly mentions 2012 therapy services for changed over the last ‘behavioural children with autism decade and to explore approaches’ but does what additional not discuss ABA, Reducing ABA Page 4 of 7 OFFICIAL
Page 13 of 16
FOI 24/25-0514 Literature Review
OFFICIAL For Internal Use Only
Author / Study aim/objective Relevance to Current Quality of included Date Research Question evidence
(high/medium/low/very low)
spectrum disorders in developments are required | reducing therapy over
Victoria, Australia in the field” to support time or children with ASD frequency/intensity of supports for children with autism. 4 National Findings and “provide up-to-date Partially relevant. N/A . Conclusions: National information on the Paper discusses
Autism Standards Project, effectiveness of a broad efficacy of behavioural
Center Phase 2. range of interventions for approaches including
2015 ASD” interventions classed
as ABA. Intensity and timeframe of therapy is discussed for Comprehensive Behavioral Treatment for Young Children (CBTYC), often described as ABA. CBTYC is described as an effective evidence-based practice but does not discuss whether the intensity or timeframe of the intervention is
Reducing ABA Page 5 of 7
OFFICIAL Page 14 of 16
Author / Date
OFFICIAL
Title
FOI 24/25-0514
Literature Review
Study aim/objective
For Internal Use Only
Relevance to Current Research Question
Quality of included evidence
(high/medium/low/very low)
necessary to achieve benefits.
Paper did not discuss reducing therapy supports over time
Report states that intensity of therapy is a topic requiring further research and did not discuss frequency or
intensity for other ABA therapies. Ivy & Schreck The Efficacy of ABA for | Editorial/narrative review Not relevant. N/A Individuals with Autism | regarding the efficacy of Paper discusses 2016 Across the Lifespan ABA across the lifespan for | efficacy of ABA but individuals with ASD. does not discuss frequency/intensity of therapy or reducing therapy over time. Reducing ABA Page 6 of 7 OFFICIAL
Page 15 of 16
FOI 24/25-0514 Literature Review OFFICIAL For Internal Use Only 7. References Behavioral Health Center of Excellence. (n.d.). Suggestions for Ethically Fading Out ABA Services. https://www.bhcoe.org/2016/11/suggestions-ethically-fading-aba-services/ Camargo, S. P., Rispoli, M., Ganz, J., Hong, E. R., Davis, H., & Mason, R. (2014). A review of the quality of behaviorally-based intervention research to improve social interaction skills of children with ASD in inclusive settings. Journal of autism and developmental disorders, 44(9), 2096–2116. https://doi.org/10.1007/s10803-014-2060-7 Ivy, J.W. & Schreck, K.A. (2016). The Efficacy of ABA for Individuals with Autism Across the Lifespan. Current Developmental Disorder Reports, 3, 57–66. https://doi.org/10.1007/s40474-016-0070-1 Kadar, M., McDonald, R., & Lentin, P. (2012). Evidence-based practice in occupational therapy services for children with autism spectrum disorders in Victoria, Australia. Australian occupational therapy journal, 59(4), 284–293. https://doi.org/10.1111/j.1440- 1630.2012.01015.x National Autism Center. (2015). Findings and conclusions: National standards project, phase 2. https://www.nationalautismcenter.org/national-standards-project/phase-2/ Steinbrenner, J. R., Hume, K., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., Szendrey, S., McIntyre, N. S., Yücesoy-Özkan, S., & Savage, M. N. (2020). Evidence- based practices for children, youth, and young adults with Autism. The University of North Carolina at Chapel Hill, Frank Porter Graham Child Development Institute, National Clearinghouse on Autism Evidence and Practice Review Team.
V0.0 XX-XX-XXXX Abbreviated Title Page 7 of 7 OFFICIAL Page 16 of 16