Interview with Dr. Michelle Kelly: Part 2 of 2

An Interview with Michelle Kelly, PhD, BCBA-D, C. Psychol., Ps. S. I., Associate Professor, Counseling, Special Education and Neuroscience Division, at the Emirates College of Advanced Education (ECAE)

Part 1 of this interview can be found here.

Conducted by Lina Slim, PhD, BCBA-D, CCC-SLP

Dr. Michelle Kelly

Lina: The first part of this interview was well received, and we are grateful for the opportunity to learn more about your work. What are some cultural considerations that may hinder or support access to effective science-based treatment in the UAE? How are individuals with autism viewed in the UAE and the region? What is autism treatment like in the UAE?

Michelle: I recently published an article on this topic, namely highlighting the importance for behavior analysts to consider the cultural context and sensitivities in the communities where they are working to effectively disseminate science-based treatment (Kelly et al., 2019). This is made even more challenging in the UAE, which has a very diverse population, of which only 10% are UAE nationals, and the remainder is comprised of expatriates from over 200 countries! This incredible diversity is one of the exciting aspects of working here. It teaches you to be open, non-judgmental, and sensitive to people of all backgrounds.

I recently co-wrote a book chapter with Dr. Pamela Olsen, Acting Executive Director of MRC-NECC, which describes some considerations when working as a practitioner with Arab-Muslim populations and focuses on Hofstede’s (2011) six-dimensional framework for examining cultural factors (Olsen & Kelly, 2020). There are some considerations which may hinder the delivery of effective evidence-based treatment in the UAE. First, most Arab cultures are classified as high context, meaning that speakers rely heavily on implicit meaning and contextual cues, and that more of the meaning of communication will be conveyed through non-verbal means. This can be challenging for behavior analysts who are less likely to be given direct, explicit information about concerns related to their clients with autism (Olsen & Kelly, 2020). Second, as mentioned earlier, the UAE is a culturally and linguistically diverse population where English and Arabic may not be the primary language of caregivers. This can potentially hinder access to effective evidence-based treatment. Even if we are disseminating in English and Arabic, the information still needs to reach caregivers who may not be fully fluent in either of those languages.

Dr. Olsen and I also outlined some practice considerations which would support the delivery of effective, evidence-based treatment in the UAE which included: (i) develop awareness of the principles of Islamic religion; (ii) develop awareness of family dynamics; (iii) develop awareness of the high context communication mentioned earlier; (iv) develop awareness of cultural formalities; (v) find a “cultural insider” who can share knowledge about social norms and may also serve as a language translator for the behavior analyst; (vi) be flexible with time commitments; and (vii) respect gender roles and cultural norms. There are, of course, local variations, and behavior analysts need to be sensitive to these. Within a country, and even within an emirate, there will be variations from family to family, so practitioners must learn about their individual clients’ culture-related practices. Furthermore, practitioners should be able to self-reflect and be aware of the effects of their own personal values and beliefs, acknowledging that they have been influenced by their cultural upbringing and socialization (Olsen & Kelly, 2020). Our Emirati students are already cultural insiders, and once they graduate from our program at Emirates College of Advanced Education (ECAE), they will certainly be incredible ambassadors as we strive to ensure widespread access to effective, affordable services in the UAE.

In this book chapter, we also addressed the question of how individuals with disabilities are viewed within Arab-Muslim culture (Olsen & Kelly, 2020). In the Middle East, disabilities can be highly stigmatized, and a family can face repercussions for having a child with special needs (Kelly et al., 2016). For example, historically, some families might have felt that their social standing could be at risk if anyone was to know that they had a child with a diagnosis of autism. These stigmas can be caused by cultural standards, parents’ lack of understanding, and potentially, misinformation given by doctors. It is therefore important for practitioners to be mindful of this when discussing their clients’ diagnoses (Al-Kandari, 2006), and a necessary mission for the region is to create greater awareness of autism. Since I moved to the UAE over 6 years ago, there has definitely been a positive shift in attitude, and this is due to the continued hard work of parents and other dedicated individuals in the autism community, such as Ms. Nipa Bhuptani, BCaBA, the Autism Support Network, and Mr. Nicholas Orland, BCBA of Dubai Autism Center (Orland, 2020). Additionally, the government has continued to make incredible progress in supporting all people of determination (people with special needs) since His Highness Sheikh Khalifa bin Zayed Al Nahyan issued the Federal Law No. (29) of 2006, which guarantees equal care, rights, and opportunities for people with disabilities in education, health care, training, and rehabilitation.

Regarding autism treatment in the UAE, and similar to the rest of the world, there are far too many non-evidence-based interventions available. These include some culture-specific interventions such as Epsom salt baths to address the reported low levels of plasma sulfate in children with autism and their decreased sulfate capacity, and Hijama (wet cupping), which is believed to detoxify the body (AlBedah et al., 2011). Regarding evidence-based interventions in the UAE, there is a large number of special-needs centers that implement ABA-based programs in order to serve individuals with autism, particularly in Abu Dhabi and Dubai. All of these programs have at least one on-site BACB certificant supervising intervention. Some of these centers also provide ABA support to children through inclusion programs in public and private schools. Although there is no federal policy for the licensing of ABA services or service providers, I am currently chairing a task force of behavior analysts that has been working closely with the Ministry of Education. Our mission is to develop professional standards for applied behavior analysts (ABAs) and support efforts to work towards the development of national licensure for ABAs.

Lina: We certainly appreciate your discussion on cultural considerations that need to be addressed when working as a practitioner with Arab-Muslim populations, as ASAT’s mission is to ensure that effective culturally aware practices address the individual needs of culturally and linguistically diverse families. It is encouraging to know that there are centers implementing ABA. What is the ABA community doing to disseminate evidence-based intervention in the UAE?

Michelle: The ABA community in the UAE has accomplished a lot in this regard.

I am happy to share our most recent achievement, the Association for Behavior Analysis – United Arab Emirates (ABA-UAE) ABA-UAE became an affiliated chapter of the Association for Behavior Analysis International (ABAI) at the end of 2020. As the incoming President of this chapter, I am extremely excited to work with the officers and members to increase efforts to disseminate evidence-based intervention for individuals on the autism spectrum across all Emirates of the UAE.

With respect to trainings, the ABA community in the UAE offers regular English and Arabic trainings to the community, including trainings offered by the Emirates Autism Society, Autism Support Network, Dubai Autism Center, MRC-NECC, and ECAE. Your readers can view recorded Arabic webinars hosted by ECAE, including sessions at our Annual Autism Day event, by following this link.

In addition to our collaborative efforts to develop professional licensure for behavior analysts, the ABA faculty at ECAE is also working closely with the Ministry of Education to offer a series of seven asynchronous “ABA for Teachers” webinars to over 10,000 teachers working in the emirate of Abu Dhabi in 2021. This webinar series will be bilingual and will include student collaborators to focus on the importance of applying evidence-based strategies in the general education classroom. Teachers will learn about how to use reinforcement effectively in the classroom at both the individual and group levels. They will learn about active student responding strategies and how to promote fluency in student learning. Teachers will also learn about the importance of teaching self-management skills as well as collecting data in the classroom. Finally, teachers will learn to identify why their students engage in problem behaviors and strategies for how best to deal with such challenging behaviors.

In 2019, the ABA team at ECAE worked closely with Ms. Khawla Barley to establish an official partnership with the Special Olympics-UAE, which afforded all of our students, staff, and faculty the opportunity to actively participate at the Special Olympics World Games in Abu Dhabi in 2019. This partnership continues as we work together to conduct research and design training for both organizations as well as encourage everyone at ECAE to volunteer for ongoing Special Olympics events. ECAE is also partnered with MRC-NECC, and one component which we are very proud of is our award-winning internship, whereby adolescents with autism from MRC-NECC visit ECAE weekly to work in our library and copy center.

Finally, social media has been a very important vehicle for dissemination. One individual in our ABA community who is extremely savvy with social media (Kelly et al., 2019) is Sharifa Yateem, the first Emirati BCBA. Sharifa has a very active, bilingual Instagram account (@شريفه يتيم @sharifayateem) and regularly features on local and national TV and radio disseminating evidence-based intervention. She was invited to present at a TEDx event in the UAE to speak about inclusion and also featured in “As One: The Autism Project,” a documentary directed by Hana Makki in 2014. Sharifa is an excellent behavioral ambassador and advocate for individuals with autism across the UAE.

Sharifa is also the co-founder of the ABA Journal Club, which aims to review and discuss peer-reviewed articles. The other founders include Manal Mohamed AlAryani and Nusaibah Al Ameri. The fact that the only three Emirati BCBAs created this group to disseminate evidence-based intervention in the UAE is such an inspiration to our students and will hopefully motivate behavior analysts across the country to consider publishing more research. More information can be obtained from their social media (@abajournal_club), and recordings of previous sessions can be viewed here.

Another useful platform has been the Facebook group ABA Middle East which I launched when I moved to Saudi Arabia. It currently has over 6,300 members from across the region and beyond and has been a very effective way to disseminate evidence-based intervention in the UAE. Our members include parents, special educators, mainstream teachers, students, and other allied health professionals.

Lina: Your dissemination initiatives are certainly impactful and overreaching! What are some things an international community of professionals could offer to support your mission and goals?

Michelle: Most of the issues outlined in “An overview of autism and applied behavior analysis in the Gulf Cooperation Council (GCC) in the Middle East” (Kelly et al., 2016) remain the same for professionals working with individuals with ASD and/or in behavior analytic settings in this region. As the number of individuals diagnosed with ASD continues to rise, more research and educational opportunities are needed, as well as clinical services supervised by appropriately certified behavior analysts.

First and foremost, it would be fantastic to see more high-quality, high-impact behavior analytic research and research about ASD being published in the region. Research should focus on providing evidence that the efficacy of ABA-based intervention for individuals with autism can be generalized to populations across the GCC and the Middle East (Kelly et al., 2016). As stated on ASAT’s website, “An important area for research is to conduct large studies with strong scientific designs to evaluate long-term outcomes of early, intensive ABA and other comprehensive ABA intervention programs.” In order to facilitate this, it would be extremely helpful if our international colleagues could support this endeavor by considering replicating or extending their current investigations with this population and working with behavior analysts (and behavior analysts-in-training) in the region.

Secondly, to ensure that the delivery of effective interventions for individuals with ASD is sustained, the region needs to qualify more local professionals as behavior analysts. Of the 116 BCBAs in the UAE in January 2021, only 2.6% are Emirati (BACB, 2021). We would like to see this percentage rise as the programs at ECAE continue to grow and produce VCS graduates. As per Kelly et al. (2019), there is a paucity of appropriate training courses internationally, including in the Middle East, which has led to the widely circulated dissemination of erroneous information about ABA, especially regarding children on the autism spectrum. There is currently a limited number of ABAI Verified Course Sequences (VCS) and continuing education opportunities available across the GCC. There are VCSs in only two of the six GCC countries (UAE and Saudi Arabia). This continues to limit the number of GCC citizens and residents who are qualified to work in the field of ABA. An international community of professionals could support behavior analysts here by reaching out to colleagues across the region to offer support in the creation of coursework within university degree programs that meet international standards of training and certification (Kelly et al., 2016).

Thirdly, Kelly et al. (2016) suggested that a uniform governing body for autism and ABA-based services be created which would combine the social care, health, and education ministries in each country in the GCC. This governing body could then potentially support the creation of policy and standards for licensing of ABA service professionals. The UAE is certainly making massive strides in its collaborative efforts with the Ministry of Education, in terms of focusing on teacher training and the provision of evidence-based intervention for all students, as well as recognition of BACB certification for the licensing and practice of ABA. That said, international colleagues would undoubtedly be welcome to support these efforts and help establish this dialogue in neighboring countries. Support and advice would also be welcomed from our global colleagues, given that only individuals who live in the USA, Canada, Australia, and the UK may apply for BACB certification beginning in January, 2023 (BACB, 2021).

Dr. Kelly, it is an honor and great pleasure to interview you and learn about your extensive and impressive professional career and journey. Congratulations for your successful international dissemination efforts increasing the global reach and access of the applied science of behavior analysis and effective autism treatment, and for making a significant impact in improving the health and wellbeing of families whose children are diagnosed with autism.

References

AlBedah, A., Khalil, M., Elolemy, A., Elsubai, I., & Khalil, A. (2011). Hijama (cupping): A review of the evidence. Focus on Alternative and Complementary Therapies, 16(1), 12–16. https://doi.org/10.1111/j.2042-7166.2010.01060.x

Al-Kandari, M. T. (2006). Parenting an autistic child in Kuwait: Kuwaiti mothers’ voice and experiences with children labeled autistic. Doctoral dissertation, School of Syracuse University, New York.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

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

Kelly, M. P., Alireza, I., Busch, H. E., Northrop, S., Al-Attrash, M., Ainsleigh, S., & Bhuptani, N. (2016). An overview of autism and applied behavior analysis in the Gulf Cooperation Council in the Middle East. Review Journal of Autism and Developmental Disorders, 3(2), 154-164. https://doi.org/10.1007/s40489-016-0073-1

Kelly, M. P., Martin, N., Dillenberger, K., Kelly, A. N., & Miller, M. M. (2019). Spreading the news: History, successes, challenges and the ethics of effective dissemination. Behavior Analysis in Practice, 12, 440-451. https://doi.org/10.1007/s40617-018-0238-8

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). Taylor & Francis/Routledge.

Orland, N. (2020). Autism Awareness in the Middle East: Adventures in dissemination to school-age children. Science in Autism Treatment, 17(12).

Citation for this article:

Slim, L. (2021). Part 2 of a 2 part interview with Dr. Michelle Kelly. Science in Autism Treatment, 18(3).

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