Service Provision for People with Autism: What Does the Evidence Say?

The history of service provision for people with developmental disabilities can be difficult to consume. From groups trying to find a “cure” for autism to professionals misusing intervention strategies resulting in inhumane living conditions, it’s abundantly clear that services have been misused in the past. Indeed, it’s these prior abuses that led to the birth of the Behavior Analyst Certification Board which now oversees the ethical conduct of Board-Certified Behavior Analysts.

As more research is conducted, however, and as the public gains a better understanding of what applied behavior analysis (ABA) service provision is about (including its therapeutic impact for people on the autism spectrum), public trust in ABA service provision is improving. Here’s an overview of some common services for people with ASD, and why ABA is the most commonly used and effective approach.

Common Services for People With Autism

Throughout history, several approaches have been developed to help individuals who identify as autistic. It’s important to note, however, that not everyone with autism needs treatment. ASD is a spectrum, and different individuals have different challenges, needs, and requirements. Service provision is meant to address those specific challenges—not the disorder itself. According to the U.S. National Institute of Child Health and Human Development, the objective of service provision is to help minimize behavioral challenges while maximizing adaptive behavior.

The U.S. Center for Disease Control and Prevention (CDC) breaks down the approaches to service provision for people with autism into seven categories. It should be noted, however, that the categories below are not mutually exclusive. That is, there may be substantial overlap between the categories.

1. Behavioral

The word “behavioral” implies at least two meanings. First, it suggests that approaches to treatment are rooted in the philosophy of science known as Radical Behaviorism, which entails, among other things, that the causes of behavior are found in the environment. Second, it suggests that the focus of treatment should be on what the individual does, that is, their behavior. Behavioral approaches will include targeting behavior for reduction in addition to teaching new skills and more complex skills. Treatments that focus on behavior are meant to address specific problematic behaviors individuals with autism may struggle with. This typically involves evaluating the circumstances that trigger problematic behaviors, and altering the environment to help foster positive behavior patterns. Behavior-analytic services, an evidence-based approach, are the most common behavioral method for service provision.

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2. Developmental

Developmental approaches to treatment focus on challenges such as speech or physical impairments. Speech and language therapy, as well as occupational therapy are common developmental approaches used in the field. The objective is to help individuals with autism who might be experiencing greater challenges than others live as independently as possible. As is the case with other treatments, however, these approaches are used on a case-by-case basis, and don’t only pertain to individuals with autism.

3. Educational

Educational approaches are intended to provide an environment of consistency and visual learning in a classroom setting. For example, the University of North Carolina offers a treatment approach known as the Treatment and Education of Autistic and Related Communication-Handicapped Children (TEACCH). The objective is to provide educational services meant to enhance the quality of life of individuals with autism who may struggle in a traditional classroom environment.

4. Social-Relational

Social-relational approaches to treatment are intended to improve social skills and help individuals with autism who have a harder time forming emotional bonds. Instead of focusing on specific behaviors, these approaches focus on helping individuals who identify as autistic develop conversation skills like understanding nonverbal cues, facial expressions, and other social competencies to help make it easier to build relationships with others.

5. Pharmacological

While there aren’t any medications that treat ASD, some of the symptoms commonly experienced by individuals with autism can be mitigated with pharmaceuticals. For example, individuals who have an inability to focus or struggle with self-harming behaviors can benefit from medication to help more easily manage these challenges. It’s important to remember, however, that these approaches should be carefully considered, and it’s never advisable to prescribe a medication simply because an individual identifies as autistic.

6. Psychological

Individuals who identify as autistic, struggling with anxiety or depression, can greatly benefit from a therapeutic approach. Cognitive-Behavior Therapy (CBT) is one example that involves working with a licensed therapist to change how an individual perceives a situation, and therefore how they respond to it. Once again, however, this therapeutic approach isn’t specifically meant to address ASD, rather the symptoms that individuals with autism may struggle with.

7. Complementary and Alternative

Alternative approaches to treatment are developed on a case-by-case basis. Unlike the other methods listed above, alternative approaches are meant to supplement, rather than act as the prime treatment. Examples include art, animal, music, and, in some cases, chiropractic therapy. As is the case with other treatments, however, these approaches don’t address autism itself, but rather symptoms that some individuals who identify as autistic might find more challenging than others.

The Positive Impact of Applied Behavior Analysis

Out of nearly 500 different treatments for ASD, ABA is the most widely researched and effective method. According to Andrew Bonner, director of the Master of Science in Applied Behavior Analysis program at Northeastern University’s Charlotte campus, ABA is “the most evidence-based, empirically validated approach for teaching people with developmental disabilities new skills.”

ABA is intended to address problematic behaviors that children or adults who identify as autistic might struggle with. Bonner explains that “the mandate for behavior analysts is to enrich and improve people’s quality of life by providing evidence-based services around whatever behavioral excesses or deficits are impacting their lives.”

While ABA is an incredibly effective approach to addressing problematic behaviors, it’s not without controversy. There are several misconceptions that surround it.

Common Misconceptions of Applied Behavior Analysis

Much like other professions that deal with assisting vulnerable communities, ABA has a problematic past that it still addresses to this day. As science and research have evolved, previous techniques have been criticized and condemned. As a result, there are a number of ABA misconceptions that don’t reflect where the industry is today.

For one, behavior analysts are often criticized for training clients to comply with instruction irrespective of that individual’s preferences and autonomy. ABA professionals, however, create individualized plans based on the goals of the client and their family. “We never begin behavior analytic services without first understanding what clients want out of the experience,” says Bonner. Behavior analysts focus on the various ways “they can enrich their client’s life in ways that are consistent with the client’s vision.”

Another common misconception about this field is the application of behavior analysis. Those not directly practicing in the field often assume ABA techniques are robot-like and apathetic, failing to look at the holistic view of the client. In reality, behavior analysts create plans according to closely observed behaviors and influences.

Finding a Career to Work With People With Autism

While ABA is an incredibly effective approach to service provision for people with autism, it’s ultimately only as effective as the individual determining the intervention strategies. That’s why it’s critical that practitioners receive explicit training in behavior-analytic strategies and hold the BCBA credential. BCBAs are governed by a strict ethical code where the clients’ right to effective treatment is paramount and the hippocratic oath to do no harm reigns supreme.

For this reason, it’s more important than ever for individuals hoping to help those with autism learn how to effectively and ethically practice ABA methods to improve quality of life. A program like Bouvé College of Health Sciences’s Master of Science in Applied Behavior Analysis will instill this understanding in students of how to approach ABA the right way.

Want to learn more about why ABA is the industry standard for autism support? Check out Northeastern’s Master of Science in Applied Behavior Analysis program page.