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Reducing Applied Behaviour Analysis over time

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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 redacted: s22(1)(a)(ii) -

Endorsed by: Naomi redacted: s22(1)(a)(ii) - irrelevant

Researcher: Stephanie redacted: s22(1)(a)(ii) - irrelevant material, Aaron redacted: s22(1)(a)(ii) - irrelevant ma

Cleared by: Stephanie redacted: s22(1)(a)(ii) - irrelevant mat

1. Contents

Reducing Applied Behaviour Analysis over time ……………………………………………………………… 1

1. Contents ……………………………………………………………………………………………………….. 1

2. Summary ………………………………………………………………………………………………………. 2

3. Previous TAPIB research papers ………………………………………………………………………. 2

4. Review of Provided Literature …………………………………………………………………………… 2

5. Other sources ………………………………………………………………………………………………… 2

6. Literature review table ……………………………………………………………………………………… 4

7. References ……………………………………………………………………………………………………. 7

Reducing ABA Page 1 of 7 OFFICIAL Page 10 of 16

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.

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.

6. Literature review table

The following papers were attached with the research request.

Author / Date	Title	Study aim/objective	Relevance to Current Research Question	Quality of included evidence (high/medium/low/very low)
Camargo et al 2014	A review of the quality of behaviourally-based intervention research to improve social interaction skills of children with ASD in inclusive settings	Whether ABA improves social interactions for children with ASD; whether ABA can be considered evidence based.	Not relevant. Paper discusses behavioural components of some interventions for children with autism but does not discuss frequency/intensity of ABA or reducing therapy over time.	N/A
Steinbrenner et al 2020	Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder	Purpose of report is to “describe a set of practices that have clear evidence of positive effects with autistic children and youth”	Not relevant. Report discusses efficacy of multiple ABA programs but does not discuss frequency/intensity or timeframe of supports.	N/A
Kadar et al 2012	Evidence-based practice in occupational therapy services for children with autism	“identify how occupational therapy practice may have changed over the last decade and to explore what additional	Not relevant. Paper briefly mentions ‘behavioural approaches’ but does not discuss ABA,	N/A

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.