How ASAT Supports International Behavior Analysts

David Celiberti, PhD, BCBA-D, Sunita Chhatwani, MSc, MEd, Adriane Miliotis, MA, BCBA, LBA, Beatriz Querol-Cintrón, MS, BCBA, LABA(MA)
Association for Science in Autism Treatment

Children and adults with autism spectrum disorder (ASD) live in every part of the globe. Worldwide, it is estimated that one in 36 children are diagnosed with ASD (Maenner, et al., 2023). Decades ago, numerous governmental bodies recognized applied behavior analysis (ABA) as the most widely researched and empirically validated treatment for autism (e.g., US Surgeon General, New York State Department of Health, Maine Administrators of Services for Children with Disabilities, California Department of Education in PDF format). However, outside of the United States and a few other countries, no such official recognition exists (e.g., Dillenburger et al., 2014). To the best of our knowledge, across many parts of the world, access to science-based autism treatment is limited at best and non-existent at worst.

International behavior analysts are undoubtedly aware of the many challenges faced by both practitioners and children with autism and their families. Some of these barriers include scarce professional networking, lack of mentoring and limited coaching opportunities; misconstrued media representations of ASD, its causes, and prognoses, the lack of resources, facilities, and providers in the community; misconceptions about ABA; fewer laws and standards mandating quality and regulating service delivery; and differing sociocultural norms across societies (Celiberti, et al., 2022; Hofstede, 2011; Keenan et al., 2015; Olsen & Kelly, 2020). Unfortunately, poor quality intervention may be commonplace as a function of inexperienced and poorly trained providers pressured to serve beyond their capacity, scope of practice, or competence, as well as competing contingencies when the demand is high (Celiberti, et al., 2022). Amongst these challenges, perhaps one of the largest obstacles to global dissemination of science-based autism treatment is the abundance and proliferation of pseudoscience and fads.

It is beyond the scope of this short paper to discuss these challenges in a more comprehensive manner. Nonetheless, we would like to highlight some of our efforts to promote the global dissemination of science-based autism treatment. Since the Association for Science in Autism Treatment (ASAT) was established in 1998, we have worked toward the adoption of higher standards of accountability in the way that people with autism are treated, educated, and helped. It remains our goal to assure that all individuals with autism, their families, and service providers, regardless of where they live, have information to help them access the best intervention that science can provide, delivered with competence and compassion.

Your role as an international behavior analyst is critically important in helping individuals with autism, their families, and other stakeholders make the best treatment choices. Below, you will find information and links that exemplify ASAT’s initiatives organized around three themes. We hope that some of these efforts will enable communities to seek out and support science-based treatment, and to be less susceptible to the dangerous byproducts of pseudoscience such as potential harm, poor outcomes, and depletion of precious resources.

1. 1. How ASAT promotes the field of applied behavior analysis outside of the United States
   2. How ASAT helps combat the spread of pseudoscience
   3. How ASAT makes its resources accessible around the world

How ASAT promotes the field of applied behavior analysis outside of the United States

ASAT is committed to the promotion of evidence-based practices for all individuals with autism, regardless of where they live. ABA has consistently shown to be an impactful, evidence-based practice with abundant scientific support over several decades. It is part of ASAT’s goal to ensure that disciplines with a high degree of support, such as ABA, are presented in an objective, clear, and user-friendly manner.

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    Photographed by Camps Production (pexels.com)

    We embody the values of objectivity, a commitment to science, transparency, treatment fidelity, and data-based decision-making in all we do. We link these values to the core tenets of behavior analysis and urge members of other disciplines to embrace and embody these same values in their work.

  • We respond to accurate and inaccurate representations of ABA in the media. Approximately half of our Media Watch letters address ABA, and many others relate to ABA outside of the United States, such as in Israel, India, the United Arab Emirates (UAE), Ireland, Canada, Nigeria, Philippines, South Africaand Cuba, to name a few. We also write about other topics related to autism treatment such as in Australia, China, New Zealand, Scotland, Singapore, Canada, and the United Kingdom.
  • We showcase diverse applications of ABA in our Clinical Corner column targeting a wide array of areas such as early detection and intervention, functional communication training, bilingualism, mask wearing, articulation, toilet training, managing feminine hygiene needs, sexuality, attending religious services, catatonia, sleep, teaching telephone skills, and play. We frequently discuss the intervention needs of those autistic individuals with more significant needs (e.g., fading of gastrostomy tubes, food selectivity, safety skills, transition planning and residential placements and tolerating trigger words).
  • We review published research (using single-case designs extensively) as part of our Research Synopsis effort and highlight their relevance and importance within autism treatment. Many of our synopses focus on behavior analytic research and include topics related to access to effective treatment, school-based social skills groups, toothbrushing, and racial and ethnic disparities.
  • We publish treatment summaries almost monthly on both behavior analytic treatments (e.g., Self-management interventions, Direct Instruction, Visual activity schedules, Picture Exchange Communication System (PECS®), Video Modeling), as well as non-behavior analytic treatments (e.g., Early Start Denver Model, Social Thinking, EEG neurofeedback and autism, Dolphin Assisted Therapy, Magnets, Repetitive Transcranial Magnetic Stimulation, Sensory integration theory and Ayres sensory integration)
  • We interview prominent behavior analysts and autism specialists from other disciplines from across the globe around common themes of service delivery, dissemination, and access to behavior analytic treatment. Although most of these individuals reside or work here in the United States, we have published interviews with Mickey Keenan, Dr. Eitan Elder, Erika Gleeson, Dr. Paul McDonnell, Dr. Michelle Kelly, Pooja Panesar, Kaidi Zhou and Julie Liu, Xueyi Deng, Thuong Ho, Molly Ola Pinney, and Dr. Francesca Degli Espinosa as examples. These leaders have shared challenges, as well as strategies that were successful, when promoting ABA in their respective countries.
  • We present the journeys of parent advocates inside and outside the United States. Some of the international parent advocates have included Andrew Kavchak, Beverley Sharpe, Nicole Rogerson, Aboli Jadhav, and Jane McCready.
  • We write about collaboration with related professions and highlight peer-reviewed research from other disciplines. In particular, we have discussed the importance of occupational therapy as a standalone form of treatment alongside its potential effectiveness with ABA, and the efficacy of pairing ABA with speech therapy. We have also interviewed professionals who have successfully applied and embedded interprofessional collaborative practice into their agencies. These articles are particularly important given that international behavior analysts often must build bridges with professionals from other disciplines, many of which are more established in their home countries.
  • We highlight the use of ABA in healthcare service delivery including more successful participation in dental visits, establishing oral hygiene skills, reducing constipation medications, and managing polypharmacy)
  • Our articles often reference and explain the BCBA® credential and refer to behavior analysts as professionals to whom consumers should turn to for various areas of need and support. Although this credential is now only available in a few countries, the content continues to be relevant with respect to a defined role for behavior analysts, particularly as new credentialing bodies have been formed.
  • We write frequently about other matters of relevance to behavior analysts such as mentorship of new behavior analysts and cautions on the exclusive use of standardized assessments in recovery-oriented treatment to name a few.
  • We publish reviews on an array of behavior analytic books (e.g., Responsible and responsive parenting in autism between now and dreams, and Let’s make a contract).
  • We actively support the efforts of behavior analytic teaching faculty through our initiatives and activities for students and are planning to specifically reach out to international faculty members in the months ahead.

How ASAT helps combat the spread of pseudoscience

A Google search for “autism treatments” yields over 13 million results, some with supporting evidence and many more without. Perusing the vast number of treatments available can be both daunting and frustrating for consumers, especially those with little knowledge of autism. One goal of ASAT is to ensure that our subscribers and website visitors, both savvy and inexperienced, have access to appropriate information about evidence-based treatments that all children and adults deserve.

• • We help to keep families and other subscribers in the know via Science in Autism Treatment, our monthly publication (we currently have almost 13,000 subscribers).
  • We reinforce the messages of behavior analysts who attempt to steer consumers toward evidence-based practices and away from harmful or ineffective practices. Furthermore, we serve as a reliable and accurate resource for families of newly diagnosed individuals; however, we also are committed to writing regularly for parents of older children and adults on a wide array of lifespan topics. Our content addresses the full range of the autism spectrum.
  • We frequently write about the ethical issues surrounding the selection and implementation of evidence-based treatment, such as the limitations of testimonials, understanding the peer review process, collaborating with non-behavioral service providers, representing autism treatment in the media, and obtaining insurance coverage, which may bear relevance in countries pursuing funding for behavior analytic services.
  • Our written works continually stress the importance of asking questions to assess provider competency, adequate experience, credential verification, and goodness of fit (e.g., the Road Less Traveled, How do we measure effectiveness?, and Questions to ask marketers)
  • We help consumers become well-informed, skeptical, and confident when evaluating various treatment options.
  • We also respond to accurate and inaccurate representations of non-behavior analytic treatment in the media outside the United States. At the end of this short piece, we include a bulleted list of Media Watch letters.
  • We teach consumers to discriminate between science and pseudoscience.
  • We help consumers remain up to date on the latest research in a consumer-friendly manner through our constantly growing library of research synopses.
  • We maintain active Facebook, Instagram, LinkedIn, and Twitter pages to help parents and other family members better understand the scope of what evidence-based practice represents, and participate in a community that shares those values.

How ASAT makes its resources accessible around the world

No discussion of international dissemination would be complete without addressing the importance of recognizing the linguistic culture of the family and community when attempting to communicate with family members and share information about evidence-based practices (Slim & Celiberti, 2022). ASAT takes pride in our efforts to make our content available in the many languages that are spoken around the world, as described below:

• • We promote the field of ABA worldwide by making our website content available in over 100 languages. We provide readers with a step-by-step guide to using Google Translate.
  • With parsimony guiding ASAT’s mission, we explain behavior analytic concepts using nontechnical language in many of our articles (e.g., Clinical Corner).
  • We have flyers showcasing our newsletter and website offerings, translated into over twenty languages (i.e., Arabic, Armenian, Bangla, Brazilian Portuguese, Canadian French, Filipino, French, German, Hebrew, Hindi, Italian, Korean, Malay, Mandarin, Marathi, Polish, Russian, Serbian, Spanish, Swedish, Turkish, and Vietnamese) that can be printed and distributed or shared electronically in both PDF and jpeg formats.
  • We have translated full length articles reflecting some of our most popular content into Spanish, Hindi, Russian, and Vietnamese, with plans to add more articles and languages in the near future.
  • For almost ten years, ASAT has offered a 150-hour Externship program for students, professionals, and interested family members to gain experience in disseminating information about science-based treatment. Each Extern works toward three individualized goals over the course of their experience with us (three co-authors of this piece are graduates of ASAT’s Externship and two are from outside the United States). Aside from the United States, our externs hailed from several parts of the globe, including Canada, Australia, India, Brazil, Ireland, the UAE, Vietnam, and the Philippines. One of our Externship “graduates” (a mother of a young girl with autism) was recently interviewed in Science in Autism Treatment.

How international behavior analysts can support ASAT.

As you read above, there are many barriers to the dissemination and implementation of science-based practice. Simply being aware of these barriers does not mean that one can mitigate them or even has the resources to do so. Nonetheless, when you embrace the notion that it “takes a village,” it compels all of us to assume an active role as agents of change while recognizing the reality that others are needed for science-based treatment to take root.

As international behavior analysts, carrying out your work with compassion, cultural sensitivity, and the highest possible fidelity will build bridges within your communities and pave the way for the next generation of individuals with autism to access the very best that science has to offer. You are also in a unique position to share important information about science-based autism treatment to the stakeholders and professionals with whom you collaborate (i.e., parents, teachers, university professors, allied mental health professionals). In addition, sharing this information with your supervisees and students will support their professional development.

• • Have your contacts sign up for our newsletter by sharing this link: asatonline.org/newsletter/
  • Share one-page flyers about our newsletter and website in English and almost twenty other languages.
  • Follow us on Facebook, Instagram, LinkedIn, and Twitter and share our content.
  • For teaching faculty, provide your students with time in class to navigate to our website and sign-up for our newsletter. If you would prefer, have students fill out this sign-up sheet in your classes perhaps for extra credit. Please encourage them to write legibly. You can scan completed sheets and send them via email (newsletter@asatonline.org). If they subscribe on their own time, they can forward you our email confirmation that they subscribed.
  • If you are interested in international dissemination in a more direct way, consider applying to our Externship Program. The 150-hour Externship is a personalized, flexible program open to individuals with a wide range of experiences and backgrounds. Many of our Externs have advanced graduate training or have completed their doctorates. Each Extern selects and pursues three personalized goals and at least one of them can address dissemination in one’s native country or more regionally.
  • If you have any suggestions about our website, or any material you would like to see available online, or would like to help with our translation efforts, please write to us at info@asatonline.org.
  • Please keep in mind that World Behavior Analysis Day (March 20) and World Autism Month (April) are wonderful times to engage with your local community to share information about autism and evidence-based treatments.

Although this paper largely showcases ASAT’s efforts, we recognize that dissemination is not a one-way transmission of information. We are open and willing to listen to behavior analysts from around the world regarding their own perspectives and needs, do what we can to address those concerns, and strive to demonstrate cultural humility in all we do, say, and share.

References:

Celiberti, D., Sivaraman, M., & Slim, L. (2022). Standing for science takes a village -an international one. In J. A. Sadavoy & M. L. Zube (Eds.), A scientific framework for compassion and social justice: Lessons in Applied Behavior Analysis (pp. 128-132). Routledge. https://doi.org/10.4324/9781003132011

Dillenburger, K., McKerr, L., & Jordan, J. A. (2014). Lost in translation: Public policies, evidence-based practice, and autism spectrum disorder. International Journal of Disability, Development & Education, 61(2), 134–151. https://doi.org/10.1080/1034912X.2014.905059

Elsabbagh, M., Divan, G., Koh, Y. J., Kim, Y. S., Kauchali, S., Marcín, C., Montiel-Nava, C., Patel, V., Paula, C. S., Wang, C., Yasamy, M. T., & Fombonne, E. (2012). Global prevalence of autism and other pervasive developmental disorders. Autism Research,5(3), 160–179. https://doi.org/10.1002/aur.239

Hofstede, G. (2011). Dimensionalizing cultures: The Hofstede model in context. Online Readings in Psychology and Culture, 2(1), 1–26. http://doi.org/10.9707/2307-0919.1014

Keenan, M., Dillenburger, K., Röttgers, H. R., Dounavi, K., Jónsdóttir, S. L., Moderato, P., Schenk, J. J. A. M., Virués-Ortega, J., Roll-Pettersson, L., & Martin, N. (2015). Autism and ABA: The gulf between North America and Europe. Review Journal of Autism and Developmental Disorders, 2(2), 167–183. https://doi.org/10.1007/s40489-014-0045-2

Maenner M. J., Warren Z., Williams A. R., et al. (2023). Prevalence and characteristics of autism spectrum disorder among children aged 8 years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MMWR Surveillance Summaries 72(No. SS-2):1–14. DOI: http://dx.doi.org/10.15585/mmwr.ss7202a1.

Olsen, P. M., & Kelly, M. P. (2020). Applied Behavior Analysis with Arab-Muslim populations: The importance of cultural awareness. In B. M. Connors & S. T. Capell (Eds.), Multiculturalism and diversity in applied behavior analysis: Bridging theory and application (pp. 140-163). Routledge. https://doi.org/10.4324/9780429263873

Slim, L., & Celiberti, D. (2022). Culturally aware practice: Cultural considerations for delivering effective treatment. In J. A. Sadavoy & M. L. Zube (Eds.), A scientific framework for compassion and social justice: Lessons in Applied Behavior Analysis (pp. 128-132). Routledge. https://doi.org/10.4324/9781003132011

Citation for this Article:

Celiberti, D., Chhatwani, S, Miliotis, A., & Querol-Cintrón, B. (2023). How ASAT supports international behavior analysts. Science in Autism Treatment, 20(9).

Other Related ASAT Articles:

• Clinical Corner: What are some language considerations when working with bilingual families?
• Clinical Corner: What are some ethical and practical considerations when collaborating with nonbehavioral service providers?
• Autism Awareness in the Middle East: Adventures in dissemination to school-age children
• Bringing out the best in aspiring behavior analysts
• Parents of newly diagnosed children
• Making the most of Google Translate on asatonline.org
• Translated flyers
• Artículos en Español /Articles in Spanish
• Los 12 temas principales con artículos para leer durante COVID-19 para apoyar la vida familiar y hogareña
• हिंदी में लेख / Articles in Hindi
• Các bài báo bằng Tiếng Việt / Articles in Vietnamese
• ASAT Webinars: The heart of applied behavior analysis: Harnessing existing capacities, recognizing new opportunities (October 2021)

International Media Watch Responses (Letters)

ASAT addresses the autism coverage in international media with the aim of accurate portrayal and dissemination and the list of non-exhaustive examples is as follows:

• Media Watch: ASAT responds to Hindustan Times: World Autism Awareness Day: Social acceptance helps reduce impact of autism in kids
• Media Watch: ASAT responds to Australian Broadcasting Corporation’s Mother ‘distressed’ by mental health services proposal to send autistic son to detention center
• Media Watch: ASAT responds to The National UAE’s Dubai mother campaigned for special needs center guaranteeing a place for everyone
• Media Watch: ASAT responds to The Indian Express’s Enacting Shakespeare’s play helps autistic kids in developing communication skills
• Media Watch: ASAT responds to Gulf News’ Reality of living with autism in UAE
• Media Watch: ASAT responds to The Hans India’s Stem cell therapy breathes life into 12-year-old autistic girl
• Media Watch: ASAT responds to aa.com.com.tr’s South African mother battles stigma over autism
• Media Watch: ASAT responds to smh.com.au’s Adjunctive therapies providing positive results for autism and other conditions
• Media Watch: ASAT responds to Scotsman.com’s How dogs are helping children with autism in Scotland
• Media Watch: ASAT responds to Au.tv.yahoo.com’s Classroom cages
• Media Watch: ASAT responds to Irish Times’s French film ban raises autism issue
• Media Watch: ASAT responds to News.com.au’s Cost of autistic children cripples parents up to $50,000 a year
• Media Watch: ASAT responds to Calgary Herald’s Autistic boy receives love and help from trained dog
• Media Watch: ASAT responds toTheJournal.ie’s HSE staff member accused of feeding their child bleach solution ‘to cure’ autism
• Media Watch: ASAT responds to Channel News Asia’s Commentary: Does the word ‘autistic’ make you uncomfortable? It shouldn’t, says the community
• Media Watch: ASAT responds to Abc.net.au’s Horses, scientists and the search for effective autism treatment
• Media Watch: ASAT responds to Theglobeandmail.com’s Facing down autism: The unconventional (and somewhat controversial) therapy that’s led to recovery
• Media Watch: ASAT responds to Macleans.ca’s The battle over the ‘cure’ for autism
• Media Watch: ASAT responds to Irish Times’ French film ban raises autism issue
• Media Watch: ASAT responds to niyitabiti.net’s net’s I was called a witch and my husband quickly divorced me – Oritoke Aluko – Olukun
• Media Watch: ASAT responds to CNN Philippines’s Med Talk/Health Talk: Autism spectrum disorder
• Media Watch: ASAT responds to The Nation Thailand’s Therapy dogs offer companionship to children with autism In China

 

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