We are delighted to see your article and its recognition of the improvements that can be gained for individuals with autism receiving applied behavior analysis (ABA) services. As you point out, ABA is considered the standard treatment for individuals with autism. It is the intensity and adherence to a science-based practice that will provide these individuals with the best improvement in the skills necessary to be independent adults.
Though you mention ABA as the standard practice, it is still not always considered so. It is hard to believe, but oftentimes individuals with autism are exposed to pseudoscientific or outright dangerous methods that have little to no evidence basis behind them. Time spent on these so-called “treatments” puts these individuals in harm’s way, either by delaying access to effective services or exposing them to a potentially dangerous situation, an example of which is chelation therapy.
Your article highlights the importance and benefit of pursuing ABA as a means to a positive outcome for an individual with autism— be it extreme as in Mr. Exkorn’s case, or less pervasive. It is unfortunate that another young man lost skills after therapy; however, it should be noted that this is not necessarily reflective of its “ineffectiveness.” Regression may have been due to a number of factors, the first of which to be considered is the quality of the providers and the fidelity of implementation of recommended strategies. Yet other possible variables include biochemical changes, early cessation of therapy, or lack of programmed generalization of learned skills to remain active in the natural environment once therapy ceases.
We would also like to draw attention to the very restricted examples you have mentioned for goals Mr. Exkorn worked on during those countless hours learning in a chair his mother recalls with such good feelings. It is correct, as your article identifies, that ABA focuses on breaking tasks down into small steps; however, waving and speaking do not encompass by any means the breadth of skills and goals typically targeted when teaching a child how to learn. Because ABA focuses on behavior, anything that a person does is targeted – speaking, walking, shooting a basketball, responding to a teacher’s question, and expressively labeling pieces of money are all examples of what can be taught.
Thank you again for bringing a wonderful “positive outcome” case to your readers while identifying a scientifically successful methodology. We sympathize with and wish the best for the family whose son, even after some intervention, requires intensive support from a residential placement. And we thank you for your honest and ethical approach while presenting case examples of a well-researched and widely implemented treatment method.
Patrick N. O’Leary, M.A., BCBA & Daniela Fazzio, PhD, BCBA-D
Association for Science in Autism Treatment
