Ethics and Evidence-based Practice
What do the BACB Guidelines for Responsible Conduct suggest regarding evidence-based treatment?
Answered by Mary Jane Weiss, PhD, BCBA-D
Clinical Director, Douglass Developmental Disabilities Center, Rutgers University
One of the hallmark characteristics of Applied Behavior Analysis is its reliance on scientifically-validated treatments. In addition, there are a number of scientific values that permeate the application of ABA intervention for individuals with autism. There is a focus on empiricism, on demonstrating the effectiveness of procedures and on the identification of functional relationships between treatments and effects. Furthermore, ABA focuses on changing socially significant behaviors with procedures that are clearly defined and replicable. Unlike other interventions for individuals with autism, much data exist that supports the effectiveness of ABA in the treatment of individuals with autism. It is important to note that these studies have been published over the course of several decades, by hundreds of researchers worldwide, and many of them have been published in peer reviewed journals. The quality of research available regarding the effectiveness of ABA is vastly superior to that available for any other treatment approach. Studies are rigorous, have controlled for extraneous variables, have been replicated and have demonstrated effects that have generalized and been maintained over time. Many claims are made regarding treatments that are supposedly effective, but only ABA has been scientifically verified as effective to date.
Furthermore, behavior analysts value the provision of effective services. Every effort is made to ensure that the learner’s time is not wasted through the selection and monitoring of operationally-defined targets, systematic collection of data and the careful analysis of those data. In other words, behavior analysts not only utilize procedures that have been demonstrated to be effective, but they also ensure that intervention is effective at the individual level. Data are collected to demonstrate the impact on individual learners. Thus, the commitment to effectiveness occurs at the broad level of implementing empirically-validated treatments and at the local level of analyzing the effectiveness of intervention for the individual learner.
Behavior analysts often struggle with issues related to the effectiveness of treatment. Often in clinical practice, behavior analytic services are offered in combination with interventions that are not empirically validated. Essentially, ABA is often combined with other (non-validated) approaches in an eclectic model of intervention. Such dilution of services often leads to reduced effectiveness. Effectiveness may be reduced in these contexts simply because there is less time allocated to and available for ABA instruction. In addition, there may be inconsistencies between approaches or interactions between treatments with differing philosophies and methods.
Furthermore, many families pursue a wide variety of alternative interventions. Challenges are multiple and progress is slow, even with very effective and excellent intervention. This leads parents to consider adding additional or ancillary treatments. Parents often feel that no stone should be left unturned and pursue interventions that may ultimately be shown to have merit, but which currently lack empirical verification. This is understandable, given what is at stake. But it also may lead to a reduced overall impact of intervention.
Behavior analysts can help parents to evaluate the impact of such interventions by suggesting a way to objectively assess their effect on targeted skills or behaviors. In many cases this may involve some type of single case design. In this way, the potential contribution of an ancillary therapy can be systematically evaluated, and decisions about continuing or extending the treatment can be based on objective information.
Behavior analysts struggle to work collaboratively with consumers and other professionals while maintaining their adherence to the values of scientifically-validated treatment and implementation of effective intervention. It is often difficult for behavior analysts to discern how they should conduct themselves in these contexts. Many behavior analysts struggle with fears of offending or alienating consumers/clients. Behavior analysts approach these dilemmas differently, and often report doubt regarding their choice of action.
The Guidelines for Responsible Conduct developed by the Behavior Analyst Certification Board contain several relevant directives. Section 1.0 (Responsible Conduct of a Behavior Analyst) states that the behavior analyst “must maintain the high standards of the professional organization.” Specifically, Section 1.01 (Reliance on Scientific Knowledge) states that, “behavior analysts rely on scientifically and professionally derived knowledge when making scientific or professional judgments in human service provision, or when engaging in scholarly or professional endeavors.”
The implications of this guideline are that behavior analysts base their recommendations regarding intervention on the available data surrounding the effectiveness of specific procedures. We implement procedures that have been demonstrated to be effective. In addition, we are obligated to inform consumers about the available data regarding the effectiveness of procedures (or lack thereof). In practical terms, this means that we implement ABA strategies that have been documented to be effective. In addition, it means that we inform parents and school personnel about the available data regarding behavioral and non-behavioral approaches to treatment.
Section 2.09 of the Guidelines (Treatment Efficacy) states several relevant points.
Section 2.09(a) states that, “The behavior analyst always has the responsibility to recommend scientifically-supported most effective treatment procedures. Effective treatment procedures have been validated as having both long-term and short-term benefits to clients and society.”
Section 2.09(b) states that, “Clients have a right to effective treatment (i.e., based on the research literature and adapted to the individual client).” This guideline takes our commitment to effective treatment a step further, making access to effective treatment an entitlement for all clients.
Section 2.09(c) states, “Behavior analysts are responsible for review and appraisal of likely effects of all alternative treatments, including those provided by other disciplines.” This may be the most instructive guideline, as it challenges us to use our science to also evaluate the effectiveness of other interventions. We are responsible for ensuring the appropriate and effective implementation of all interventions. In that regard, we should offer our expertise in defining behaviors, analyzing behaviors, evaluating data, and making individualized data-based decisions regarding the effectiveness of (behavioral and non-behavioral) procedures. Behavior analysts who assume these roles and do so in a collaborative, nonjudgmental manner will better serve their clients and likely be more effective in inspiring other professionals to embrace greater accountability and rigor.