A response to “Applied Behavior Analysis, autism, and occupational therapy: a search for understanding,” as published in the American Journal of Occupational Therapy by Welch and Polatajko
By
Amy Stango
MS, OTR/L, MS, BCBA
In their (2016) article, “Applied Behavior Analysis, Autism, and Occupational Therapy: A Search for Understanding,” Welch and Polatajko present a literature-based argument for the application of behavior analysis within the practice of occupational therapy. The authors acknowledge that despite the popularity of both occupational therapy and applied behavior analysis (ABA) as treatments for individuals with autism, there has historically been a separation between these fields. However, the authors note that there are many ways that occupational therapy may be enhanced from a behavior analytic approach.
Welch and Polatajko note that ABA has been demonstrated to be the most effective intervention for individuals with autism and that ABA practitioners have reported using sensory integration in their clinical work, although this practice has been discouraged by the behavior analytic literature and organizations such as the Behavior Analyst Certification Board (BACB) (Devlin et al., 2011; Matson et al., 2013; Schreck & Miller, 2010).
Although multiple studies of sensory integration approaches have been conducted by behavior analysts (Moore, Cividini-Motta, Clark, Ahearn, 2015, Sniezkyk & Zane, 2015), there has been little mention of behavior analysis in the occupational therapy literature. Welch and Polatakjo propose that this may be due to misconceptions that some occupational therapists have regarding behavior analysis. One such misconception is a belief that ABA is limited to one teaching strategy widely used with individuals with autism called discrete trial training (DTT), when as an applied science, ABA has a broad scope and a wide range of evidence-based strategies for decreasing problematic behavior and teaching new skills. Another misconception held by some occupational therapists is that behavior analysis does not produce generalization of acquired skills. However, generality is one of the defining characteristics of applied behavior analysis and there have been ample studies demonstrating generalization of skills learned through behavioral programming (Baer, Wolf & Risley, 1968). The third misconception described by Welch and Polatajko is that behavior analysis does not consider the unique desires and interests of clients. However, first, the ABA literature is rich in publications targeting preference assessments (i.e., ways to assess likes and dislikes of clients, from those able to communicate to those who have severe communication deficits). Second, ABA places a great emphasis on social validity of procedures, goals, and outcomes. In fact, social validity is another of the seven dimensions of ABA. The authors note that there are some shared commonalities between occupational therapy and ABA, including an emphasis on building and expanding upon a client’s strengths, consideration of social and cultural contexts, and collaborative decision-making.
Welch and Polatajko conclude by suggesting several ways that occupational therapy outcomes might be enhanced by embracing ABA. They suggest, for example, combining sensory integration procedures and ABA procedures as described in the book, “Is it Sensory or Is It Behavior?” Welch and Polatajko acknowledge how the efficacy of behavioral procedures such as pivotal response training and the extensive empirical literature from the field of applied behavior analysis may have widespread applications to different areas of occupational therapy practice.
This article authored by Welch and Polatakjo is an important contribution to the occupational therapy literature, and the first article of its kind in the American Journal of Occupational Therapy. Applied behavior analysis is a science with many broad applications that may relate to autism and occupational therapy practice. Some of these applications include feeding (Paul, Williams, Riegel, & Gibbons, 2007), toilet training (Azrin & Foxx, 1971), play and leisure skills (Garcia-Villamisar & Dattillo, 2011, Machalicek et al., 2009, Blum-Dimaya, Reeve, Reeve, & Hoch, 2010), social interaction (Weiss & Harris, 2001), safe navigation within the community (Hoch, Taylor & Rodriguez, 2009), and work skills (Hume & Odom, 2007). Behavior analysis can also be utilized to effectively teach individuals with autism to tolerate nonpreferred stimuli (Koegel, Openden, & Koegel, 2004) and to replace repetitive, stereotypic behaviors with more socially appropriate behaviors (Boyd, McDonough & Bodfish, 2012). It should be noted that, given that sensory integration is not an empirically validated treatment for stereotypy (Mason & Iwata, 1990, Moore, Cividini-Motta, Clark & Ahearn, 2015) or challenging behavior (Devlin, Healy, Leader & Hughes, 2011), it is not advisable to attempt to combine sensory integration and behavior analysis. However, applied behavior analysis has many evidence-based alternatives to sensory integration that multi-disciplinary teams can use to assess and treat stereotypic or challenging behaviors. These evidence-based alternatives to sensory integration, along with an understanding of the contingencies of reinforcement that maintain problem behavior, can aid occupational therapists in viewing behavior from a broader lens. Other components of applied behavior analysis, such as operationalized targets, detailed, written treatment protocols, continuous, objective data collection, and the use of within-subject designs to study the effects of a treatment upon an individual’s behavior, may also add value to occupational therapy practice. Collaborative work between behavior analysts and occupational therapists while applying evidence-based practices can provide the consistency needed to produce optimized outcomes for individuals with autism.
References:
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Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, 91-97.
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Citation for this article:
Stango, A. (2017). A response to “Applied Behavior Analysis, autism, and occupational therapy: a search for understanding,” as published in the american journal of Occupational Therapy by Welch and Polatajko. Science in Autism Treatment, 14(1), 34-36.
