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research-article2014
AUT0010.1177/1362361314523357AutismStahmer
Editorial
Effective strategies by any other name
In this issue of Autism, we are pleased to continue our
“Myth Busters” series designed to provide a forum for dis-
cussion of common misconceptions in our field. This
month, we examine the idea that applied behavior analysis
(ABA) is synonymous with discrete trial teaching; we will
also explore the false dichotomy between behavioral and
developmental approaches to treating autism spectrum dis-
orders (ASDs).
It is common practice for intervention researchers to
state that ABA has the highest level of evidence of any
intervention to support its effectiveness for children with
autism. This view is supported in recent reviews by the
National Autism Center (2009) and the National
Professional Developmental Center for Autism Spectrum
Disorders (Odom et al., 2010). The National Autism Center
authors concluded that over 90% of the published studies
reviewed relied on intervention strategies or comprehen-
sive models based on behavioral principles (Suhrheinrich
et al., in press). Evidence supporting ABA also has led to
increased coverage for ASD services through both public
service and insurance agencies. In fact, at least 37 states
have laws that mandate coverage of autism services (http://
www.ncsl.org/research/health/autism-and-insurance-
coverage-state-laws.aspx). There are, therefore, urgent pol-
icy implications that necessitate a clear and accurate
understanding of what is included in ABA.
Unfortunately, interpretation of the available research
has led to a very narrow view of what is considered effec-
tive intervention for individuals with ASD and what ABA
means (Dillenburger and Keenan, 2009). In fact, ABA is
not a specific type of teaching but rather a particular
approach to scientific inquiry, characterized by certain
research designs (Cooper et al., 2007). The use of ABA has
identified effective interventions for a wide variety of indi-
viduals to address an even wider variety of behaviors.
Unfortunately, this generality has been all but lost. When
people refer to the intervention received by a child with
ASD as “ABA” or as “applied behavior analysis,” they
typically are referring to a specific, highly structured form
of behavioral teaching more appropriately referred to as
discrete trial training (DTT; Chiesa, 2005). DTT was first
described in the 1960s and was the first specific interven-
tion shown to be efficacious for children with ASD
(Schreibman, 1988). It is more correct, however, to
describe DTT (and other behavioral interventions
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Autism
2014, Vol. 18(3) 211­–212
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DOI: 10.1177/1362361314523357
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subsequently developed) as a product of the science of
ABA. That is, ABA allowed for the identification of the
specific principles that comprise DTT and other behavio-
ral interventions. This misunderstanding and misuse of the
term ABA hinders the ability of service providers, funders,
and parents to fully appreciate the full potential of ABA
and utilize its enduring principles. Just as crucially, it may
limit access to effective interventions for individuals with
ASD.
Fully understanding the range of interventions based on
ABA is essential, as technique should be determined by
the needs of an individual with ASD, the behavior or skill
being addressed, and the context in which the interven-
tion is implemented. Research points to the inadequacy
of one single treatment approach for all areas of learning
for children with ASD (National Research Council, 2001;
Schreibman, 2000, 2005), or for all children with ASD
(Stahmer et al., 2011b).
While DTT was one of the first behavioral interventions
to show effectiveness with children with ASD, the field has
evolved significantly since that time and now includes a
variety of interventions, ranging from highly structured
programs that require one interventionist for each child, to
behaviorally based inclusion programs that involve typi-
cally developing children as models (e.g. Odom et al.,
2010; Vismara and Rogers, 2010). Many of these interven-
tions have been developed (via ABA) to specifically
address short-comings of traditional DTT, including lim-
ited generalization and maintenance of skills. Some ABA-
based programs are distinguishable by “brand names,” such
as DTT and Pivotal Response Training (PRT), while other
programs utilize the principles of ABA broadly. Some pro-
grams address specific behaviors such as toilet training or
aggression while others are comprehensive, intended to
address a range of learning domains or complex behaviors
(e.g. social skills). There has been particular growth in nat-
uralistic behavioral strategies, which use the principles of
behavior analysis but also incorporate techniques influ-
enced by developmental theory.
Similar to the limited view of ABA, there is confusion
in the field regarding the relationship between develop-
mental and behavioral interventions. Traditionally, there
has been minimal communication and even animosity
between developmental and behavioral “camps” around
autism interventions. However, this hard line between
212 Autism 18(3)
approaches appears to be a false dichotomy in many cases.
In fact, although the vocabulary and theory are different,
developmental and behavioral interventions have many
common features in practice. For example, child initiation
of the teaching episode, the use of natural reinforcement,
responding to a variety of behaviors as meaningful com-
munication (loose shaping), and an emphasis on reciprocal
interaction can all be seen in both developmental and natu-
ralistic behavior interventions. As described by Ingersoll
(2010), a lack of understanding of the underlying philoso-
phies and evolution of interventions across fields has lim-
ited potentially fruitful cross-fertilization. This absence of
collaboration and at times outright competition between
advocates on either side has also caused a great deal of
confusion for families and community providers who
implement interventions for children with ASD. In many
cases, this confusion limits access to a full range of inter-
vention options.
A growing number of interventions straddle the divide
and combine techniques from both developmental and
behavioral interventions. Research on these approaches has
shown promising results (e.g. Dawson et al., 2010; Ingersoll
and Wainer, 2013; Stahmer et al., 2011a). These interven-
tions highlight the utility of both models and reveal the
pointless nature of the debate over which side is “best” for
ASD. The heterogeneity and developmental nature of the
disorder make it unlikely that one specific treatment will
ever be best for all children with ASD, or will work for any
one child throughout his or her educational career.
Interventions that combine techniques from both develop-
mental and behavioral backgrounds may offer “the best of
both worlds” and the most comprehensive support for
learning. It is imperative that we, as a field, begin to under-
stand the range of effective interventions available and
learn more about the specific active ingredients necessary
to optimize outcomes based on individual characteristics of
people with ASD, their families, and environments.
Acknowledgements
Special thanks to my colleagues Sarah R Rieth, Laura Schreibman
and David S Mandell for helping to shape this editorial with their
excellent comments and brilliant discussions around this issue.
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Aubyn C Stahmer
Editor