Brodhead, M. T., Cox, D. J., & Quigley, S. P. (2018). Practical ethics for effective treatment of autism spectrum disorder. Elsevier/Academic Press.
Reviewed by Chante Stoeckley, MEd, BCBA, LBA
Association for Science in Autism Treatment
What comes to mind when you hear the word “ethics”? For some, it’s boring mandatory company trainings on billing policies, dress codes, and compliance with regulatory bodies. For a few, it brings to mind esoteric philosophical debates in college classes about the nature of right and wrong. For many in the field of behavior analysis, it is synonymous with the Behavior Analyst Certification Board’s Professional and Ethical Compliance Code for Behavior Analysts (2014). Ethical matters are important for a wide range of clinicians, and they play a crucial role in decisions regarding autism intervention, such as what skills should be addressed, how people should be treated during interventions, and whether intrusive interventions are justified. Given the significance of ethics in this field, a deeper and more thoughtful discussion of ethics is necessary and will improve the quality of autism treatment.
In Practical Ethics for Effective Treatment of Autism Spectrum Disorder (2018), Matthew Brodhead, David Cox, and Shawn Quigley attempt to expand the scope of ethics discussions. In their words, they hope to “add to our understanding of ethics and behavior analysis by highlighting several relevant, reoccurring, and seldom discussed ethical topics behavior analysts face in helping individuals with autism” (Brodhead et al., 2018, p. xiii). Besides broadening the conversation, they also deepen it by bringing in ethical concepts and principles beyond the Behavior Analyst Certification Board’s (BACB) ethical code, exploring the grey areas and contradictions inherent therein, and relating ethics to real everyday struggles. The result is an informative, thought provoking and enjoyable read applicable to a wide audience.
While the intended audience for the book is suggested in the title to be practitioners treating autism spectrum disorder (ASD) and stated in the introduction to be primarily behavior analysts, I believe the book could benefit a wider audience. While many of the examples are specific to ASD, the underlying concepts and even many of the examples apply equally well to other populations. And while the book specifically speaks to the field of behavior analysis, other service providers who follow similar ethical codes may benefit from this approach to ethics as well.
The first two chapters cover the basics of ethics and decision making.
- Introduction to ABA, Ethics, and Core Ethical Principles:
Chapter 1 is an overview of the primary theories and principles of ethics followed by a brief history of how they’ve been combined into ethical codes. While tedious tomes could be, and have been, written about these topics, the authors provide just enough for the reader to understand how the different theories can cause contradictions within an ethical code, and how the principles can be used to identify how and why a particular ethical decision is made. - Contextual Factors that Influence Ethical Decision Making:
Building on this foundation, Chapter 2 discusses how decisions are made from a behavior analytic perspective. While covering the basics of schedules of reinforcement, it also dives deeper into how delayed and probabilistic outcomes impact decisions. Using an example of how falsifying billing results in a fairly immediate and certain reward (cash flow), compared to the more remote and less likely consequence of being caught for insurance fraud. Finally, they discuss the factors that influence ethical decision making, such as showing that having more information (perhaps by conducting a more thorough assessment) and more time in which to make a decision, ultimately improves the quality of that decision.
With these basics covered, the next five chapters address different ethical topics behavior analysts face.
- Creating Behavioral Systems to Support Ethical Behavior in Autism Treatment:
Chapter 3 provides an overview of how to improve ethical decision making at an organizational level through Behavioral Systems Analysis. While there is not enough detail to guide someone in implementing the technique, the examples of how it can be applied to solve real problems may be enough to convince a reader to turn to the references for more information. - Identifying your Scope of Competence in Autism Treatment:
Chapter 4 shares a framework for identifying a behavior analyst’s scope of competence based on what was studied in coursework, their setting (e.g., someone with experience in home early intervention may not be qualified to work in schools), their supervision during practicum and field experience, and the areas in which they’ve achieved successful outcomes independently. Then, they provide guidance on common dilemmas related to scope of competence such as how to broaden one’s scope and how to make decisions about clients who are outside of one’s scope. - The Decision-Making Process of Evidence-Based Practice:
Chapter 5 goes into the topic of evidence-based practice as a decision-making model. After describing the different definitions of evidence-based practice (one being a list of treatments that are supported by research and the other being the model of decision making under discussion), the authors break down how to synthesize the latest research, clinical expertise, and client considerations into an effective and ethical treatment. - Interdisciplinary Collaboration:
Interdisciplinary collaboration is the topic for Chapter 6. While balancing the best interests of the client with the need to play nicely on a team can be a challenge, the authors discuss the ethical implications and provide numerous recommendations. Two examples of their recommendations are the need to educate yourself on the culture of the other discipline and the legal and policy constraints they face. - Common Errors and Mistakes Made during Ethical Analyses and Application:
Finally, the book ends with a chapter on common errors to avoid in ethical decision making. They discuss logical fallacies such as an appeal to authority (“because – insert autism intervention expert – said”) and decisions made based on incomplete information (“based on a 3-sentence description of the problem, I think you should…”). These errors apply to any of the previous chapters and tie the book together nicely.
Three aspects make Practical Ethics for Effective Treatment of Autism Spectrum Disorder really stand out to me. First, the way the principles and theories introduced in Chapter 1 are interwoven throughout all of the chapters clearly illustrate how ethical dilemmas can be analyzed in more ways than just the BACB’s compliance code. Second, the examples that have been chosen are consistently relevant to clinical practice, interesting and original, and never shy away from grey areas. Third, the discussion questions at the end of each chapter do not feel like “comprehension questions” for students but like thought-provoking conversation starters for a book club. Combined, these features turned the book into one that I would read again and recommend to colleagues.
Despite my appreciation for the approach taken in this book, I was left with one disappointment: I wanted more! Almost every chapter left me wishing it was more in-depth, and there are a number of current hot topics (such as the use of aversives and interventions to decrease self-stimulatory stereotypy) on which I thought the authors could have shed more light. However, I realize that for each person like me, there is probably another busy person who would be less likely to read it if it were longer. So instead, I’ll hold out hope for a second volume and hope that this book drives the field forward and encourages other behavior analysts to engage in thoughtful discussions of ethical issues.
In Practical Ethics for Effective Treatment of Autism Spectrum Disorder, Brodhead, Cox and Quigley are resoundingly successful in meeting their aim of expanding the discussion of ethics in autism treatment. It should be required reading for every behavior analyst and would be an unbeatable jumping off point for a book club or series of discussions about ethics within an organization. Grab some co-workers, put on some coffee, and prepare for some thought-provoking discussions about ethics.
References
Brodhead, M. T., Cox, D. J., & Quigley, S. P. (2018). Practical ethics for effective treatment of autism spectrum disorder. Elsevier/Academic Press.
Behavior Analyst Certification Board. (2014). Professional and ethical compliance code for behavior analysts. Retrieved from https://www.bacb.com/wp-content/bacb-compliance-code.
Citation for this article:
Stoeckley, C. (2020). A review of Practical ethics for effective treatment of autism spectrum disorder, Science in Autism Treatment, 17(6).
#BehaviorAnalysts #TrainingAndSupervision
