Dear Ms. Griswold,
You recently published an article titled “Exercise gives children with autism jump on social skills.” We want to thank you for highlighting the importance of exercise for all children, particularly those with autism spectrum disorder (ASD). In this article, there is a clear distinction made between exercise and applied behavior analysis (ABA), and also it states that the benefits of exercise may replace, rather than enhance, behavior analytic treatment. We at the Association for Science in Autism Treatment (ASAT) would like the opportunity to clarify some of those points.
The article presents a few common misconceptions regarding ABA, as well as a narrow view on the definition and scope of behavior analysis. You quote Dr. Anjana Bhat in describing ABA as “a lot of tabletop activities, sitting at a desk and working on various skills. It doesn’t involve much physical play.” This quote seems to be most focused on Discrete Trial Teaching (DTT), a method of massed trials with clear instructions, repetition, and strong reinforcement to teach new skills, especially for early intervention (Lerman, Valentino, & LeBlanc, 2016). Although DTT remains one of the most effective and empirically supported methods for early intervention, with over 40 years of research, this is only one approach used for modern behavior analytic treatment. DTT is based on the early work of Ivar Lovaas, whose research is widely recognizable to those involved in the field of child development; however, ABA has grown significantly in the decades following his seminal work. Simply put, ABA is the science of socially significant behavior change utilizing systematic interventions, data collection and well-controlled research designs to accurately identify the variables responsible for behavior change.
ABA focuses on a variety of socially significant skills including academics, functional skills such as dressing and hygiene, social skills, play, and yes, exercise! Behavior analytic research has evaluated the effects of exercise to reduce repetitive behavior (Celiberti, Bobo, Kelly, & Harris, 1997; Kern, Koegel, & Dunlap, 1984; Kern, Koegel, Dyer, Blew, & Fenton, 1982; Lang, O’Reilly, Sigafoos, Lancioni, Machalicek, Rispoli…, 2009; Morrison, Roscoe, & Atwell, 2011), the effects of exercise on problem behavior (Bachman, & Fuqua, 1983; Luce, Delquadri, & Hall, 1980), and increasing exercise overall (Andrade, Barry, Litt, & Petry, 2014; De Luca, & Holborn, 1992; Kurti, & Dallery, 2013; Wack, Crosland, & Miltenberger, 2014; Wysocki, Hall, Iwata, & Riordan, 1979), even with children in a classroom setting (Kuhl, Rudrud, Witts, & Schulze, 2015). The volume of research on this topic refutes the idea that “exercise is conspicuously lacking in traditional autism therapies such as ABA.” In fact, a well-rounded behavior analytic program includes any skill important to the individual which may help them to be successful in everyday life.
Part of a good behavior analytic program is identifying and prioritizing skills to target with the individual and their caretakers. It is important for those involved to have stake in these decisions, and to individualize treatment as necessary. The advice that behavior analysts need to “get these kids active so they can gain all the other skills they need” is misleading. The above behavior analytic research demonstrates good experimental control through the use of scientifically sound single-subject research designs, and begins to answer your question of “how broad or consistent the effects of exercise are or what ‘dose’ is necessary for the gain.” These studies address some of the holes in current research, including problems with experimental control in existing studies such as pilot studies, and group designs without comparison groups or randomized assignment, which were included in the reviews you cited. Most importantly, Dr. Bhat’s study comparing music and movement to ABA is not yet complete or published, and has not been peer reviewed, so these findings are entirely based on self-report, and should not be taken as evidence that music and movement interventions are in any way superior to therapies with decades of research support, such as ABA.
We do agree on many points in your article. Exercise is an important and beneficial component of treatment for ASD. Dr. Meghann Lloyd’s recommendations within your article to break down the rules of games into small steps, to use repetition, and to offer reinforcement, are common components to any behavior analytic approach, and we certainly recommend these as well. We are as excited as you are to see stronger future research on the positive effects exercise can have on those with ASD. We hope this clears up a few misconceptions related to ABA, and that we can continue to work together with other disciplines to encourage exercise and other healthy lifestyle choices for all.
Sincerely,
Allison Parker, M.A., BCBA and Elizabeth G. Callahan, M.A., BCBA
Association for Science in Autism Treatment
References
Andrade, L. F., Barry, D., Litt, M. D., & Petry, N. M. (2014). Maintaining high activity levels in sedentary adults with a reinforcement-thinning schedule. Journal of Applied Behavior Analysis, 47, 523–536.doi:10.1002/jaba.147
Bachman, J. E., & Fuqua, R. W. (1983). Management of inappropriate behaviors of trainable mentally impaired students using antecedent exercise. Journal of Applied Behavior Analysis, 16, 477–484.doi:10.1901/jaba.1983.16-477
Celiberti, D. A., Bobo, H. E., Kelly, K. S., Harris, S. L., & Handleman, J. S. (1997). The differential and temporal effects of antecedent exercise on the self-stimulatory behavior of a child with autism. Research in Developmental Disabilities, 18, 139–150.
De Luca, R. V., & Holborn, S. W. (1992). Effects of variable-ratio reinforcing schedule with changing criterion on exercise in obese and nonobese boys. Journal of Applied Behavior Analysis, 25, 671–679.doi:10.1901/jaba.1992.25-671
Kern, L., Koegel, R. L., & Dunlap, G. (1984). The influence of vigorous versus mild exercise on autistic stereotyped behaviors. Journal of Autism and Developmental Disorders, 14, 57–67.
Kern, L., Koegel, R. L., Dyer, K., Blew, P. A., & Fenton, L. R. (1982). The effects of physical exercise on self-stimulation and appropriate responding in autistic children. Journal of Autism and Developmental Disorders, 12, 399-419.
Kuhl, S., Rudrud, E. H., Witts, B. N., & Schulze, K. A. (2015). Classroom-based interdependent group contingencies increase children’s physical activity. Journal of Applied Behavior Analysis, 48, 602–612.doi:10.1002/jaba.219
Kurti, A. N., & Dallery, J. (2013). Internet-based contingency management increases walking in sedentary adults. Journal of Applied Behavior Analysis, 46, 568–581. doi:10.1002/jaba.58
Lang, R., O’Reilly, M., Sigafoos, J., Lancioni, G. E., Machalicek, W., Rispoli, M., et al. (2009). Enhancing the effectiveness of a play intervention by abolishing the reinforcing value of stereotypy for a child with autism: A pilot study. Journal of Applied Behavior Analysis, 42, 889–894.
Luce, S. C., Delquadri, J., & Hall, R. V. (1980). Contingent exercise: A mild but powerful procedure for suppressing inappropriate verbal and aggressive behavior. Journal of Applied Behavior Analysis, 13, 583–594.
Morrison, H., Roscoe, E. M., & Atwell, A. (2011). An evaluation of antecedent exercise on behavior maintained by automatic reinforcement using a three-component multiple schedule. Journal of Applied Behavior Analysis, 44(3), 523–541. http://doi.org/10.1901/jaba.2011.44-523
Lerman D, Valentino A, & LeBlanc L. (2016). Discrete trial training. Early intervention for young children with autism spectrum disorder. Cham, Switzerland: Springer International Publishing.
Wack, S. R., Crosland, K. A., & Miltenberger, R. G. (2014). Using goal setting and feedback to increase running distance. Journal of Applied Behavior Analysis, 47, 181-185.
Wysocki, T., Hall, G., Iwata, B., & Riordan, M. (1979). Behavioral management of exercise: Contracting for aerobic points. Journal of Applied Behavior Analysis, 12, 55-64. doi:10.1901/jaba.1979.12-55
