Table Of Content
In addition, only 41% of the records conducted some form of investigation into follow-up or maintenance of the given outcome measure(s). This may not be reflective of the long-term effects of the overall positive outcomes. Likewise, generalization was only investigated in 31% of the study records, again prompting the question of whether or not these task- or behavior-specific improvements resulted in overall changes in the child’s skills, function, or behaviors.
Associated Data
[DIR/Floortime) is a framework that helps clinicians, parents and educators conduct a comprehensive assessment and develop an intervention program tailored to the unique challenges and strengths of children with Autism Spectrum Disorders (ASD) and other developmental challenges. The objectives of the DIR®/Floortime™ Model are to build healthy foundations for social, emotional, and intellectual capacities (Greenspan, 2022). A systematic review of the published literature on DIR/Floortime has been published by Boshoff and colleagues in 2020.
Frequently Used ABA (Applied Behavior Analysis) Terms
These included the presence of follow-up, whether interventions assessed mastery or criterion, and whether interventions assessed generalization. Out of the ABA Impact cohort, 41% had some follow-up, 40% had some measure of mastery/criterion, and 31% had some measure of generalization. Among study records that showed improvement within the various outcome measures, use of follow-up measures varied. Records that recorded improvements in cognitive, language, social/communication, and problem behavior outcomes had follow-up measures 47%–59% of the time.
Decreasing classroom misbehavior through the use of DRL schedules of reinforcement.
VCA is based on a theory of motivation known as Self-Determination Theory (SDT). Rather than using external rewards or punishments to shape children’s behavior, VCA seeks to create conditions under which children can develop their intrinsic motivation. VCA utilizes visual supports, prompting and technology such as tablets with specialized software (Shkedy, 2020). Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful responses to social overtures of others.
Finally, in the mixed-age groups, the most commonly studied outcome was language (28%), followed by social/communication (20%) and cognitive (20%). Of these three most studied outcomes, improvement was reported at 61%, 65%, and 62%, respectively. The purpose of the current review therefore is to evaluate the available literature on ABA as an intervention approach in the treatment of ASD in children and youth in an effort to help instruct the scientific community on the most beneficial directions for future research. Moreover, as ABA is commonly recognized at a governmental level as evidence-based, a review of the current ABA literature will help inform other existing and emerging therapies and interventions, researchers, policy makers, and the public of the standard to which established, evidence-based interventions are held. This is accomplished by collecting, compiling, and discussing the available data on the most common outcomes and methods.
The technique can be used with children who do not have speech skills as a way for them to communicate their needs. But it is also used to expand the communication skills of those who can speak and teach them how to express their wants and needs in socially adaptive ways as they progress through increasingly sophisticated vocabulary and sentence structure. Modeling is a technique in which the therapist presents an example of the desired behavior, either personally demonstrating it or providing a video or audio recording of the desired behavior.
Data Coding and Synthesis
Fig.1,1, the record selection process differed slightly between the two searches spanning 1997–2017 and 2018–2020. This is because the diagnostic criteria for the current manuscript were updated to exclude populations that only contained non-ASD diagnoses, and the removal of records satisfying the new criteria took place at different points for each search. Further details on general data coding, as well as outcome coding for ABA Impact, Comparisons of ABA Techniques, and Between-Groups Comparisons can be found in Appendix 2. Extractions for all three sections can be found in Tables S1, S2, and S3, respectively, in Appendix 3. It is advisable to seek a therapist who has had not just extensive training but experience using ABA to treat patients presenting with concerns such as your child’s.
The results of the current scoping review are consistent with previous review articles and meta-analyses into the overall trend of positive effects of ABA. For example, there were overwhelming positive improvements in the majority of study records with respect to cognition, language development, social skills and communication, and adaptive behavior, along with reductions in problem behavior (Dawson & Bernier, 2013). In the ABA Impact section of the current review, 63%–88% of study records reported improvement across these same outcome measures, in addition to improvements in emotional and autism symptoms outcome measures (Fig. (Fig.2).2). The results of the current analysis into the demographics of these studies are also consistent with the existing literature, as the majority of the participants were male (48%) or there was a mix of females and males (45%) within multiparticipant studies (Kim et al., 2011; Lai et al., 2014; Miller et al., 2016). Further, the sole diagnosis of ASD was more common than mixed diagnoses, as 76% of study records recorded ASD without other diagnoses or comorbidities, again consistent with previous research into ABA (Dawson & Bernier, 2013).
Antecedent, Behavior, Consequence
In cases where results were reported individually for each subject, they were extracted as such. In larger scale studies where only group results were reported, group results were extracted, so long as the group included only the target population. ABA is commonly practiced as a therapeutic intervention for individuals with autism. According to the Center for Autism, ABA helps people with autism improve social interactions, learn new skills, and maintain positive behaviors.
Nursery, portage, and DIR showed little to no improvement over ABA treatment groups. The CCD studies examined in this review were somewhat homogenous in that the majority used individual contingencies with FR schedules of reinforcement to increase the frequency of a behavior. Future research might benefit from examining or comparing the efficacy of the CCD with other interventions (e.g., self-monitoring) as it is an intervention in itself rather than solely a research tool. Also, future analyses exploring relationships of design components and successful behavior change may be beneficial.
In the mixed-diagnoses category, the most studied outcomes were problem behavior (31%) and language (22%), with 70% and 58% reporting improvements, respectively. As ABA is a broad intervention which includes many different methods and programs, reviews of the entire scope of the current research are uncommon. To our knowledge, a comprehensive review of the current ABA literature that spans all ABA methods and outcomes for children and youth with ASD, and that includes randomized controlled trials (RCT), clinical controlled trials (CCT), and single-case experimental design (SCED) studies, has not been completed. The current literature consists primarily of systematic reviews and meta-analyses that have investigated the quantifiable and qualitative outcomes of ABA on children with ASD, but few of these studies include SCED, and the results across the reviews inconsistently show significant improvement with ABA interventions. One limitation of this review is that all studies that utilized a CCD structure may not have been included in analysis. This may have occurred because the search was limited for practicality to articles labeled as changing criterion design, though other studies may have been structured in a CCD format.
ASD typically presents during the developmental period and includes social communication and interaction difficulties, along with restricted and repetitive behaviors, interests, or activities (WHO, 2020). The prevalence of these disorders has increased over the past 20 years due to many combining factors. The global estimated prevalence in children and youth 18 years of age or younger is 0.62%–0.70% but could be as high as 1%–2% (Elsabbagh et al., 2012; Fombonne, 2009; Idring et al., 2012; Russell et al., 2014).
Due to these prominent endorsements, existing and emerging interventions should be held to the same standard as established ABA interventions. That said, to our knowledge, a scoping review into all of the pertinent scientific evidence surrounding ABA has not yet been undertaken. This may result in knowledge gaps regarding this long-standing and widely used intervention and was the reasoning behind the current scoping review. In addition to having larger sample sizes and more frequent use of validated measurement scales, records in the Between-Groups Comparisons section more often incorporated statistical analyses, approximately 85% of the time compared with approximately 15% of the entire cohort. Although statistical significance was not considered when initially coding the results in order to align with the rest of the sample, an informal review was conducted based on the reported statistical significance of the improvement of one condition over another. Overall, it was found that not all improvements were significant or assessed for statistical significance (Dawson et al., 2010; Dugan, 2006; Howard et al., 2014; Kovshoff et al., 2011).
Teaching was the most commonly compared intervention category across six outcome measures, ranging from 38% to 64%, except for emotional (25%), and autism symptoms (10%). Comparing ABA interventions was the most commonly studied comparison in the emotional outcome (50%; 2 out of 4 comparison records), and subject/setting characteristics was the most commonly studied comparison in the autism symptom outcome (70%; 7 out of 10 comparison records). The improvement of one method over another was not always prevalent (Fig. (Fig.3).3).
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