Clinical and Organizational Applications of Applied Behavior Analysis Practical Resources For The Mental Health Professional

Clinical and Organizational
Applications of Applied Behavior

Analysis (Practical Resources for the
Mental Health Professional)
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CLINICAL AND
ORGANIZATIONAL
APPLICATIONS
OF APPLIED
BEHAVIOR ANALYSIS
Contributors xvii
David P. Wacker
Center for Disabilities and Development, The University of Iowa, Iowa City, Iowa, USA
Laci Watkins
Department of Special Education, The University of Texas at Austin, Austin, Texas, USA
David A. Wilder
School of Behavior Analysis, Florida Institute of Technology, Melbourne, Florida, USA
Alyssa N. Wilson
School of Social Work, St Louis University, St Louis, Missouri, USA
Douglas W. Woods
Department of Psychology, Texas A&M University, College Station, Texas, USA
Amanda N. Zangrillo
Center for Autism Spectrum Disorders, Munroe-Meyer Institute, The University of
Nebraska Medical Center, Omaha, Nebraska, USA
PREFACE
The origin of this text arose from countless conversations with other pro-
fessionals who generally reported, “I know about applied behavior analysis.
I’ve seen it done before.” Undoubtedly, many of those professionals had
seen a version of applied behavior analysis (or “ABA” as it is often referred
to) conducted with their child, student, or patient; however, it became clear
that others held a relatively restricted notion of ABA. Without doubt, one
of the most notable utilizations of ABA has been within the context of
the interventions relating to skill deficits and behaviors of excess displayed
by individuals with developmental disabilities, specifically autism. Although
numerous procedures and approaches have been presented as potential treat-
ments for the behavioral symptoms of autism, those based on the principles
of ABA have received the most empirical support. As a result, in recent years,
the term “applied behavior analysis” appears to be used quite often as a
synonym for a very specific range of interventions for autism.
Many readers would note that ABA is but a subfield of the broader area
of behavior analysis that also includes: (a) behaviorism, which focuses on
the world view, theory, or philosophy of behavior analysis, and (b) the
experimental analysis of behavior (EAB), which focuses on identifying
and analyzing the basic principles, mechanisms, and processes that explain
behavior. ABA is distinct from EAB in that it is considered a clinical disci-
pline in which the general principles of learning and behavior are applied for
the purpose of addressing socially relevant problems and issues. Thus, behav-
ior analysts who work in ABA conduct research that assists in developing and
evaluating evidence-based practices directed toward the remedy of problems
associated with socially significant behavior. Applied behavior analysts then
use the results of the applied research to create and implement effective
evidence-based procedures in more natural settings such as schools, homes,
and the community. Such work often focuses on behavioral problems that
occur in particular settings, are associated with particular populations (e.g.,
individuals with autism or other developmental disabilities), and those that
are present within larger social contexts (e.g., organizational behavior
management).
In light of the efficacy of ABA-based procedures in addressing behaviors
associated with autism, it is important to note that the principles underlying
this therapeutic approach have been shown to be similarly effective when
xix
xx Preface
applied to other populations, settings, and behaviors. The current text pro-
vides a review of such clinical applications toward the purpose of expanding
the reader’s knowledge related to the breadth of ABA-based applications.
Simply put, the goal is to illustrate the use of ABA beyond the realm of
autism.
The content of this book was identified from an informal survey of ABA
practitioners and researchers on their knowledge of current areas of clinical
practice. In general, an attempt was made to limit the proposed content to
clinical applications which have been divided into four broad areas: child
applications, adult applications, broad-based health applications, and appli-
cations in the area of organizational behavior management. Undoubtedly, as
the field continues to expand its breadth, there are some areas in which ABA
methods are applied to novel areas of study that may have been omitted from
inclusion.
The editors have drawn upon a range of subject-matter experts who have
clinical and research experience in the application of ABA across multiple
applications to serve as contributors to this volume. A great deal of thought
was expended in determining whom we should contact for material on a
given chapter. In many cases, the decision was difficult as there are a number
of subject-matter experts who would have been appropriate. In the majority
of cases, our initial approach to a potential contributor was met with an
enthusiastic acceptance. Consequently, the resulting text includes contribu-
tions from individuals who have served as editors, associate editors, or edi-
torial board members for prominent content-area journals such as the Journal
of Applied Behavior Analysis, the Journal of the Experimental Analysis of Behavior,
the Journal of Organizational Behavior Management, and the Behavior Analyst.
This book is best suited as a primary textbook for coursework in behavior
analysis, psychology, or education. Also, while practitioners and students are
the ultimate targets of this work, other professionals should find the content
and language to be manageable. The hope is that this volume will be infor-
mative in demonstrating the range of application of ABA to various prob-
lems of social significance. We hope the reader finds this book as enjoyable as
it was to edit.
Henry S. Roane
Joel E. Ringdahl
Terry S. Falcomata
CHAPTER 1
Defining Features of Applied

Behavior Analysis
Terry S. Falcomata
Department of Special Education, The University of Texas at Austin, Austin, Texas, USA
INTRODUCTION
Individuals who work in applied behavior analysis (ABA) implement clinical
interventions as well as conduct research to assist in the development of prac-
tices for addressing problems that occur with socially significant behavior.
Applied behavior analysts often conduct applied research and use the results
to create and implement effective, evidence-based procedures in more natural
settings such as the home, schools, and the community. ABA-based research
often focuses on behavioral issues that occur in specific settings, are associated
with particular populations including children (e.g., obesity, autism or other
developmental disabilities, traumatic brain injury, feeding disorders) and adults
(e.g., caregiver training, sports performance, gambling), as well as those within
other social contexts such as various workplace environments (e.g., perfor-
mance management, workplace safety, systems analysis).
Although ABA has an extensive history of effectiveness in application
and research across a diverse number of areas of focus, settings, and popula-
tions, perceptions exist in the media, various disciplines, and the public in
general that ABA is synonymous with procedures for addressing issues
related to autism spectrum disorder and other developmental disabilities
(e.g., discrete-trial training and other procedures to promote skill acquisi-
tion; functional behavioral assessment and treatment of challenging behav-
ior). In fact, the use of ABA-based methods and procedures to address issues
relating to autism is just one of the many examples of the effective applica-
tion of the ABA approach to addressing socially significant behavior. Said
another way, although ABA has been demonstrated to be an effective
approach to addressing issues with autism (e.g., Howard, Stanislaw, Green,
Sparkman, & Cohen, 2014; MacDonald, Parry-Cruwys, Dupere, & Ahearn,
2014; Matson, Tureck, Turygin, Beighley, & Rieske, 2012), this aspect of
ABA represents only one, relatively narrow application.
Clinical and Organizational Applications of Applied Behavior Analysis © 2015 Elsevier Inc.
http://dx.doi.org/10.1016/B978-0-12-420249-8.00001-0 All rights reserved. 1
2 Clinical and Organizational Applications of Applied Behavior Analysis
This chapter provides an overview of the features of ABA within the

framework provided by Baer, Wolf, and Risley (1968) and how those fea-
tures characterize work conducted in various areas of focus, settings, and
populations. Each of the dimensions is described and demonstrated using
examples from various child, adult, and organizational ABA-based research.
DIMENSIONS OF ABA
Baer et al. (1968) provided what they contended were defining dimensions
of ABA. As described by Baer et al., there are seven dimensions of ABA
that must be present to ensure that effective practices are developed and
implemented. According to Baer et al., ABA is (a) applied, (b) behavioral,
(c) analytic, (d) technological, (e) conceptually systematic, (f) effective, and
(g) generalizable. The remainder of this chapter will review the dimensions
described by Baer et al. using applied studies across various populations
and areas of focus as outlined in this text to illustrate how they
characterize ABA.
Applied
The term applied indicates that a particular target behavior of interest is of
social significance. Further, it is the emphasis on social significance that dis-
tinguishes ABA from laboratory analysis. Specifically, applied behavior ana-
lysts select behaviors that are socially meaningful and are currently of
importance to the individual(s) whose behavior is being addressed. At var-
ious times, applied behavior analysts have opportunities to address numerous
behaviors demonstrated by individuals, and it is considered vital that they
prioritize those behaviors in terms of importance. Illustrations of the applied
dimension of ABA are wide-ranging and can be observed in studies across
numerous populations, settings, and areas.
Myriad child-focused studies have been conducted within ABA that
exemplify the focus on social significance. These include (but are not limited
to) studies evaluating treatments for feeding disorders (e.g., Kadey, Piazza,
Rivas, & Zeleny, 2013; Kadey, Roane, Diaz, & Merrow, 2013; LaRue
et al., 2011; Volkert, Vaz, Piazza, Frese, & Barnett, 2011), interventions
for childhood obesity (e.g., Fogel, Miltenberger, Graves, & Koehler,
2010; Van Camp & Hayes, 2012), and issues relating to attention deficit
hyperactivity disorder (ADHD; e.g., Northup, Fusilier, Swanson, Roane,
& Borrero, 1997; Ridgway, Northup, Pellegrin, LaRue, & Hightsoe, 2003).
The ABA-based approach to the assessment and treatment of pediatric
feeding disorders has included a wide variety of behaviors of significant social
Defining Features of Applied Behavior Analysis 3
importance including food refusal (Borrero, Woods, Borrero, Masler, &

Lesser, 2010), self-feeding (Vaz, Volkert, & Piazza, 2011), and swallowing
(e.g., Kadey, Piazza, et al., 2013). For example, Kadey, Piazza, et al. (2013)
addressed the food consumption of a 5-year-old girl who relied on a gastro-
stomy tube for her caloric needs. The authors conducted a texture assess-
ment in which they evaluated various textures, across foods, to determine
the one which the girl could successfully swallow. Through their systematic
process of identifying a texture with which she could be successful with indi-
vidual foods, the authors were able to increase the girl’s consumption of
those foods.
Child obesity is another socially significant area in which several ABA-
based studies have been conducted. Fogel et al. (2010) evaluated the effects
of video game-based exercise (i.e., exergaming) relative to traditional phys-
ical education (PE) with four physically inactive and overweight fifth grade
students. The authors’ purpose was to evaluate whether the physical activity
of the children would increase through exposure to 10 exergames (e.g., Play
Station; Nintendo Wii Boxing, Sports Baseball, Sports Tennis; iTech Fitness
XrBoard). Through the use of the exergaming approach, the authors were
able to substantially increase the physical activity of all four children above
the levels observed during traditional PE.
A third socially significant, child-focused area of study deals with vari-
ables relating to ADHD. Northup et al. (1997) evaluated the effects of stim-
ulant medication on five children with ADHD diagnoses. Specifically, the
authors evaluated the children’s preference for different reinforcers (quiet
time, alone play, and social play) across the presence and absence of stimulant
medications. Although the results of Northup et al. were idiosyncratic across
children, the authors showed that stimulant medication can alter children’s
motivation for types of reinforcement.
Studies conducted in the areas of pediatric feeding disorders such as
Kadey, Piazza, et al. (2013), childhood obesity such as Fogel et al. (2010),
and ADHD such as LaRue et al. (2011) illustrate the emphasis of child-
focused ABA on social significance. Each of the dependent variables, or tar-
get behaviors, in the above studies was meaningful and of practical impor-
tance to the children in the studies and to potential future consumers of the
studies.
Similarly, a large number of adult-focused studies with high social signif-
icance have been conducted within ABA. These include (but are not limited
to) studies evaluating assessment, treatment, and training practices in path-
ological gambling (e.g., Guercio, Johnson, & Dixon, 2012; Nastally, Dixon,
& Jackson, 2010) as well as teacher and caregiver training (e.g., Lerman,
Tetreault, Hovanetz, Strobel, & Garro, 2008; Lerman, Vorndran, Addison,

& Kuhn, 2004).
For example, the dimension of social significance is demonstrated in
adult-focused, ABA-based studies pertaining to the assessment, treatment,
and determination of the variables that contribute to pathological gambling.
Guercio et al. (2012) studied a treatment intended to decrease urges to gam-
ble and actual gambling behavior of three adults with acquired brain injury
who were also indicated as pathological gamblers. The authors implemented
a treatment program that consisted of one-on-one therapy that entailed pro-
viding instruction to the adults about motivating operations (MOs), ante-
cedents, and consequences relating to gambling. Through the application
of the treatment program, the authors demonstrated a reduction in urges
to gamble (based on data collected via self-reports) and gambling behavior
in each of the adults.
Another adult-focused area of study that illustrates the dimension of
social significance in ABA is care provider training. Lerman et al. (2008)
evaluated a training program intended to teach skills to teachers of children
with autism relating to the implementation of preference assessment and
teaching procedures. The training program consisted of a variety of teaching
methods including lectures, discussion, and role-play procedures. The
results showed that the training program resulted in the acquisition of the
target skills by each of the teachers, and follow-up assessment suggested that
those skills maintained over time following training. Similar to the child-
based studies described above, each of the dependent variables evaluated
in adult-based studies was meaningful and of obvious practical importance.
Many studies have also been conducted in the area of organizational
behavior management (OBM) pertaining to safety (e.g., Ludwig & Geller,
1997) illustrating the applied nature of ABA. For example, Ludwig and
Geller (1997) conducted a study in which they evaluated an intervention
aimed at increasing safe driving behavior of pizza delivery drivers. Specifically,
the authors implemented two interventions with two groups of drivers,
respectively. One intervention consisted of goal setting in which the drivers
participated in the setting of the goals. The second intervention consisted of
goal setting but the drivers did not participate in the setting of goals. The
results showed that both interventions were effective at increasing complete
stops at intersections. Further, the results also showed that nontargeted safe
driving behaviors (i.e., turn signal use, safety belt use) also increased during
one of the interventions. The interventions, which were antecedent-based
in nature, utilized by Ludwig and Geller (1997) demonstrated the effective
use of an ABA-based approach to produce positive, socially significant

changes with meaningful and practical target behaviors.
Behavioral
The term behavioral indicates that ABA concerns itself with the study of
directly observable behavior. Specifically, applied behavior analysts empha-
size the direct observation and manipulation of overt behavior. Indirect
measures of behavior such as self-report, interviews, or checklists, although
often used, are de-emphasized in ABA research in favor of direct methods of
measurement and manipulation. In addition, applied behavior analysts do
not attribute behavior as characteristics of, or based upon, nonbehavioral
constructs or inner qualities (e.g., personality traits). Rather, ABA empha-
sizes the manipulation of environmental variables and the observation of
relations between behaviors of interest and those variables for the purpose
of demonstrating functional relations (i.e., functions of behavior). The
behavioral dimension of ABA is vital because of the importance of precise
measurements of behaviors of interest that, in turn, allow for valid evalua-
tions and demonstrations of functional relations between interventions of
interest and target behaviors of importance (see Section “Analytic”). Fur-
ther, it allows for a systematic analysis of the extent to which applied behav-
ior analysts are addressing the intended target behaviors and not
approximations or nontarget behaviors (i.e., reliability of measurement).
The behavioral dimension of ABA can be illustrated in numerous child-
based studies including those focusing on challenging behavior (e.g., Athens
& Vollmer, 2010; Lustig et al., 2014) and academic skills (e.g., Martens,
Werder, Hier, & Koenig, 2013). For example, Athens and Vollmer
(2010) conducted a study in which they evaluated a treatment of challenging
behavior exhibited by children with autism and ADHD. The authors
focused exclusively on the direct observation of the target behaviors (i.e.,
aggression, disruption, compliance, communicative behaviors). To do so,
the authors established a specific, operational definition of aggression for
the participant (Henry) that consisted of “forcefully hitting and kicking
others resulting in bruising his victims” (p. 573). This definition allowed
for the direct observation and measurement of the presence and absence
of the behavior. This approach can be contrasted with a nonbehavioral
approach that might consist of anecdotal reports, or impressions provided
by care providers regarding the behavior of the child.
Martens et al. (2013) focused on accuracy and fluency exhibited by chil-
dren during oral reading. The authors specifically defined each of these target
behaviors to allow for direct observation and measurement. Specifically, they

established an operational definition of accuracy that consisted of the correct
reading of a particular word, and they established an operational definition of
fluency that consisted of the number of words correctly read per minute.
Establishing these specific, observable operational definitions allowed the
authors to evaluate variables (i.e., an intervention consisting of word training)
impacting their occurrence, or lack thereof, in a systematic way. Without an
emphasis on a behavioral approach, establishment of reliability of measure-
ment would not be possible which would have precluded the authors from
drawing conclusions about relations between their independent and depen-
dent variables (i.e., conclusions about the effectiveness of their interventions
would not be appropriate in the absence of demonstration of reliability of
measurement made possible by the behavioral approach).
The behavioral dimension of ABA is also illustrated in numerous adult-
based studies including those focusing on problem behaviors in gerontolog-
ical populations (e.g., Baker, LeBlanc, Raetz, & Hilton, 2011) and acquired
brain injury (e.g., Lancioni et al., 2012). For example, Baker et al. (2011)
intervened with an individual with Alzheimer’s-type severe dementia
who was engaging in hoarding behaviors. The authors established a defini-
tion of hoarding that allowed for the direct observation and measurement of
the behavior (i.e., putting items in her shirt or pants). This was opposed to a
nonbehavioral approach that might have relied on the feelings of the staff
that worked with her. Thus, by relying on directly observable behaviors,
the authors minimized potential bias and accuracy issues that would likely
impact nonbehavioral approaches (e.g., staff impressions). Subsequently,
the authors were able to systematically evaluate the effectiveness of two
interventions and demonstrate their effectiveness. In another adult-focused
study, Lancioni et al. focused on text messaging skills with individuals with
acquired brain injuries. To systematically evaluate the effectiveness of their
intervention, the authors established operational definitions that allowed for
the direct observation and measurement of target skills related to text mes-
saging including number of messages sent, length of messages, the time
needed to send and receive messages, and number of messages received
and whether the individual read/listened to the message. Whereas this
approach allowed for a systematic, empirical evaluation of the effects of
the intervention, a nonbehavioral approach would not have allowed for a
precise and accurate reflection of positive (or lack thereof) effects.
Many studies that illustrate the behavioral approach of ABA have also been
conducted in the area of OBM pertaining to performance management
(e.g., Fienup, Luiselli, Joy, Smyth, & Stein, 2013; Goomas, Smith, &
Ludwig, 2011). For example, Fienup et al. (2013) evaluated an intervention
intended to improve the performance of staff at a human services organiza-
tion. Specifically, the authors intervened with the purpose of decreasing staff
tardiness for supervision meetings. The authors measured latency from the
scheduled beginning time for meetings until the actual time in which meet-
ings began. This behavioral and observable measurement system minimized
potential inaccurate inferences about the positive effects of the intervention
they employed. Goomas et al. (2011) focused on the performance of
employees at a retail distribution center. The authors directly measured
the amount of time it took employees to complete specific tasks. By estab-
lishing direct measures of behavior, these authors were able to directly eval-
uate potential relations between their intervention and its effects on those
targeted behaviors.
Analytic
The term analytic indicates that ABA emphasizes believable demonstrations
of relations between behaviors of interest and environmental variables,
interventions, and treatments under study. Systematic analyses of behavior
are vital for the demonstration of experimental control with regard to the
effects of independent variables (e.g., interventions and treatments) on
dependent variables (e.g., socially relevant behaviors of interest). An empha-
sis is placed on the analytic nature of ABA because it is vital that applied
behavior analysts base their practical recommendations on “believable dem-
onstrations” (Baer et al., 1968, p. 93) that their interventions were respon-
sible for positive changes in behaviors of interest. Thus, it is important that
the inferences about causal relations between recommended interventions
and positive outcomes should be based on systematic, empirical methods
and demonstrations of experimental control.
Experimental control is achieved when an applied behavior analyst dem-
onstrates a functional, or causal, relation between environmental variables of
interest and behaviors of interest. In ABA, various single-subject experimen-
tal designs are utilized to demonstrate functional relations including (but not
limited to) the reversal, multielement (and alternating treatments design),
changing criterion, and multiple-baseline experimental designs. These basic
designs share three common elements: (a) prediction—anticipated future
levels of behavior, (b) verification—demonstration that the previously
predicted levels of behavior would continue in the absence of a treatment,
and (c) replication—repeating previous changes in behavior via the
reintroduction and subsequent removal of the treatment across time, set-

tings, and/or individuals.
The analysis dimension of ABA is illustrated in the child-based literature as
reflected by emphasis on, and use of, various single-subject experimental
designs to demonstrate functional relations between the independent variables
(e.g., environmental variables, interventions, treatments) and socially relevant
behaviors of interest. For example, in the study described above, Kadey, Piazza,
et al. (2013) employed a reversal design to systematically demonstrate the
relation between swallowing behavior (i.e., mouth cleans) demonstrated by
a 5-year-old girl with feeding problems and specific texture levels. Using the
reversal design, the authors first implemented a smooth texture level produced
by a specific type of food processer (i.e., a Magic Bullet®) and documented the
percentage of bite trials in which the child swallowed as reflected by mouth
cleans. The authors conducted repeated sessions in this initial condition, and
the child demonstrated high and relatively stable levels of swallowing behavior.
The results of the first condition provided preliminary evidence of a relation
between the child’s swallowing behavior and the texture level of the food.
However, without additional experimental manipulations, it would have been
inappropriate to infer causality between food texture and swallowing. There-
fore, the authors ended the condition and implemented a second condition in
which pureed food was presented that was of a different texture than the food
presented in the previous condition. The authors implemented repeated ses-
sions in the second condition until they observed low and stable levels of swal-
lowing. The results of the second condition provided additional evidence that
the level of texture used in the first condition was responsible for the high levels
of swallowing observed. However, the potential effects of extraneous variables
on swallowing could not be ruled out (e.g., a variable outside of the evaluation
may have coincided with the onset of the second condition and could have
influenced the results). The authors reimplemented the initial condition and
swallowing behavior increased back to levels observed during the initial con-
dition. These results provided additional evidence that the high level swallow-
ing resulted from the texture level rather than extraneous variables. The authors
subsequently conducted an additional reversal (i.e., an additional puree condi-
tion and additional Magic Bullet® condition) and produced similar results.
Thus, the co-occurrence of positive changes in the target behavior (i.e., swal-
lowing) was demonstrated to occur only in the presence of the food texture
produced by the Magic Bullet blender. Therefore, causality between positive
effects observed with the swallowing behavior and the treatment could be rea-
sonably inferred.
Normand (2008) provided an example of the use of a multiple-baseline

(combined with an ABAB design), single-subject experimental design to
demonstrate the functional relation between an intervention package and
physical activity demonstrated by adults. Normand first introduced baseline
conditions to each of four adult participants and measured the total number
of steps taken by each participant. The treatment package (consisting of goal
setting, self-monitoring, and feedback) was introduced with one of the par-
ticipants after stable levels of steps taken were observed; while baseline con-
tinued to be implemented with the other three participants. Positive effects
(i.e., increased levels of steps taken) were observed with the first participant
while concurrently, levels of steps taken continued at consistent levels with
the additional four participants. This result provided preliminary evidence
that the treatment package was effective at increasing steps taken; however,
extraneous variables could not be ruled out without replication of those
effects across participants. Therefore, Normand introduced the intervention
with the second participant while baseline conditions continued with the
other three participants. Similar patterns of behavior were observed with
the second participant as those observed with the first participant with an
increase in steps taken. These results represented a replication of the positive
effects observed with the first participant. Coupled with the continued con-
sistent levels of steps taken with the other two participants during baseline
conditions, evidence accrued suggesting a functional relation between the
treatment package and an increase in steps taken. Normand went on to rep-
licate the positive effects with the additional two participants, demonstrating
three replications of the initial positive effects. Through this process, the
author was able to rule out, to a reasonable degree, the possible effects of
extraneous variables on the observed positive effects. Said another way,
through the demonstration of functional relations, Normand could be con-
fident that it was the treatment package that produced the positive results and
not some other extra experimental variable(s).
Empirical methods that emphasize the demonstration of functional
relations are also emphasized in the area of OBM. For example, Pampino,
MacDonald, Mullin, and Wilder (2004) used a multiple-baseline, single-
subject design to evaluate the effects of an intervention package consisting
of task clarification, goal setting, positive reinforcement, and feedback on
completion of maintenance tasks by workers in a framing and art store.
The authors first collected baseline data prior to the implementation of
the intervention package across two sets of duties. After stable levels of com-
pletion of duties were observed across both sets of duties, the authors
implemented the intervention with one set of duties while continuing to

collect baseline data with the second set of duties. Percentages of completion
of the duties in the intervention condition immediately increased when the
intervention was implemented, while levels of completion of the second set
of duties (i.e., in baseline conditions) remained low. Next, the authors
implemented the intervention with the second set of duties and an imme-
diate increase in completion of those duties was observed; thus, the positive
effects observed with the first set of duties were replicated with the second
set of duties. The systematic methods used by the authors allowed them to
infer causality between their intervention and the observed positive effects.
Technological
In addition to focusing on analysis and emphasizing functional relations
through the use of appropriate experimental designs and the use of behavioral
methods (e.g., precise measurements of target behaviors), ABA emphasizes
thorough and accurate descriptions of procedures within the context of
research and the application of behavioral interventions. Descriptions of
procedures, operational definitions, and procedural integrity data are docu-
mented to allow other applied behavior analysts to replicate studies and eval-
uations in applied settings and research. A review of practically any study
published in a peer-reviewed ABA journal (such as the Journal of Applied
Behavior Analysis) will provide a demonstration of the technological aspect
of ABA.
Conceptually Systematic
The practices utilized in ABA are applied in nature. However, there is a clear
emphasis in ABA that these practices be conceptually systematic. Thus, basic
behavioral principles empirically validated over many years by scientists
and applied behavior analysts who conduct basic and applied research on
the behavioral theories of experimental analysis of behavior underlie the
practices of ABA. For example, intervention components that are based
on conceptually systematic behavioral principles include (but are not limited
to) reinforcement, extinction, punishment, stimulus control, discrimina-
tion, MOs, and schedules of reinforcement. Baer et al. (1968) asserted that
by emphasizing behavioral principles along with precise descriptions of pro-
cedures, ABA would advance at a rate superior to an alternative approach
that could be described as a “collection of tricks” (p. 96).
The emphasis on conceptual systems can be illustrated in the child-based
behavioral literature pertaining to functional communication training (FCT;
Carr & Durand, 1985). FCT involves (a) evaluating and identifying the rein-
forcer maintaining challenging behavior via a functional assessment (e.g., func-
tional analysis; Carr & Durand, 1985; Iwata, Dorsey, Slifer, Bauman, &
Richman, 1982/1994); (b) training a new appropriate communicative behav-
ior (e.g., card exchange, microswitch, sign language) and delivering the same
reinforcer contingent on the response; (c) placing challenging behavior on
extinction (i.e., reinforcement is withheld following occurrences of challeng-
ing behavior; Fisher et al., 1993; Hagopian, Fisher, Sullivan, Acquisto, &
LeBlanc, 1998); and (d) in some cases, applying punishment contingent on
challenging behavior (Hagopian et al., 1998; Wacker et al., 1990). Thus,
the effectiveness of FCT is based on the behavioral mechanisms including rein-
forcement (positive and/or negative) and, in many cases, extinction and pun-
ishment, as well as training procedures such as the use of a time-delay prompt.
The approach of conceptualizing FCT using behavioral mechanisms and
a conceptual system is distinct from a potential approach to the treatment
that might focus on other aspects of the treatment. For example, a clinician
focusing on FCT without considering the underlying conceptual system
may favor conceptualizing the treatment as one that focuses on the utiliza-
tion of technology (e.g., iPad technology, voice-output device) for commu-
nication and mistakenly assume that the effectiveness of the treatment is
based on the provision of technology-based communicative techniques.
Such an approach would be problematic for several reasons. First, without
considering the antecedents and reinforcement contingencies associated
with challenging behavior, while focusing solely on training communica-
tion using technology-based modalities, it is likely the treatment will fail
to effectively treat the challenging behavior because the contingencies con-
trolling the behavior will not have been addressed. Thus, to address the con-
tingencies controlling the behavior, the effective applied behavior analyst
considers the behavioral mechanisms responsible for the challenging behav-
ior as well as the target-appropriate communicative behaviors (technology-
based or otherwise). In addition, as Baer et al. (1968) asserted, without using
a conceptual system when implementing the treatment, it is unlikely the cli-
nician will generalize and apply the treatment effectively in other situations.
Guercio et al. (2012) provided an example of the application of a treat-
ment based on a behavioral conceptual system for adult pathological gam-
blers in individuals with acquired brain injury. As described previously,
the authors implemented a program that consisted of one-on-one treatment
therapy sessions in which they focused on teaching the participants about the
MOs, antecedents, and reinforcers associated with gambling behaviors.
Thus, the treatment was explicitly based on behavioral mechanisms concep-

tualized as controlling gambling behavior. An alternative conceptualization
of the treatment might minimize or omit the behavioral components of the
approach and instead focus on the format for therapy (e.g., one-on-one ses-
sions, client-centered discussions). Similar to FCT, however, the focus and
reliance on behavioral mechanisms is vital to the effectiveness of the treat-
ment as well as the effective generalization and application of the procedures
by future clinicians.
The use of a behavioral conceptual system is also emphasized in the area
of OBM. For example, Cunningham and Austin (2007) utilized an interven-
tion package consisting of goal setting, task clarification (via modeling), and
feedback (description of performance, praise) via weekly meetings to
improve the performance of hospital operating room employees pertaining
to hands-free operating techniques. The authors conceptualized the behav-
ioral mechanism of the feedback component of the intervention package as
positive reinforcement of the target behavior. An alternative conceptualiza-
tion that would not incorporate an underlying behavioral mechanism might
focus not on the mechanism of reinforcement, but rather the implementa-
tion of weekly meetings to discuss the performance of staff. However, future
attempted applications of the intervention that emphasize elements of the
intervention that were not responsible for the observed positive behavior
(rather than the behavioral mechanism responsible; i.e., positive reinforce-
ment) would be much less likely to be effective. It should also be noted that
although not explicitly stated in the study, the goal setting and modeling
components could be conceptualized as antecedent-based and intended to
increase discrimination and occasion the desired behaviors.
Effective
Effectiveness is a dimension that emphasizes the practical quality of ABA prac-
tices. That is, the effectiveness dimension of ABA focuses on whether the indi-
vidual whose behavior was changed and the family and care providers of the
individual view the behavior change to be practical and significant. Applied
behavior analysts determine the effectiveness of their procedures by evaluating
their data, often through visual inspection using valid single-subject exper-
imental designs (as opposed to the use of statistical procedures to determine if
behavior change is significant). Additionally, ABA emphasizes judgments of
socially acceptable levels of improvement of target behaviors.
An example from the child-based ABA literature pertains to the assess-
ment and treatment of pica. Pica (i.e., the insertion of inedible objects into
the oral cavity or the ingestion of inedible objects; Piazza et al., 1998;
Roane, Kelly, & Fisher, 2003) can be a life-threatening behavior displayed
by children with autism and other developmental disabilities. Falcomata,
Roane, and Pabico (2007) conducted a study that involved the assessment
and treatment of pica in a 12-year-old boy with autism. During the study,
the authors evaluated several treatment approaches by comparing their
effects to each other as well as baseline conditions. The treatments included
enriched environment (i.e., continuous access to highly preferred stimuli)
and enriched environment plus a timeout procedure (i.e., visual screen time-
out). The results showed that both treatments were effective at decreasing
pica in comparison to baseline conditions. However, although the enriched
environment treatment decreased pica relative to baseline (in which a mean
rate of 6.7 occurrences per minute were observed), pica still occurred at a
mean of 1.8 occurrences per minute. Thus, although it could be argued that
the treatment produced an improvement, the dangerous nature of the
behavior dictated that this was not a practical, or effective, level of improve-
ment. An acceptable level of practical improvement (i.e., a demonstration of
effectiveness) with a dangerous behavior such as pica is zero or near zero
occurrences. The results of the study also showed, however, that the second
treatment consisting of enriched environment plus timeout produced near
zero levels of pica. Thus, this was considered a practical outcome, and the
treatment could be deemed effective.
A study conducted by Normand and Osborne (2010) provides an exam-
ple of the demonstration of effectiveness within an adult-focused application
of ABA to healthier food choices demonstrated by college students. The
authors first implemented a baseline condition in which they assessed college
students’ food choices via receipts and food checklists and tracked their daily
calorie intake. Next, the authors implemented an intervention that involved
providing feedback to the students by showing them graphs depicting daily
calorie and fat intake. Additionally, the authors provided information to the
students on recommended daily consumption for food groups as well as
recommended levels of sugar and fat intake. Decreases in calorie and fat
intake were demonstrated with three of the four participants. With each
of the participants for whom clear effects of the intervention were demon-
strated, their intake levels during the intervention condition occurred at or
below United States Dairy Association (USDA) recommended daily guide-
lines. The clear demonstration of an experimental effect within the multiple-
baseline, single-subject experimental design in Normand and Osborne did
not, in and of itself, confirm the effectiveness of the intervention. However,
the USDA recommended daily guidelines provided a benchmark with

which to evaluate effectiveness; the favorable comparison to that benchmark
provided clear evidence of the effectiveness of the intervention.
Lebbon, Sigurdsson, and Austin (2012) provided an example of the dem-
onstration of effectiveness in OBM-based ABA research. The authors eval-
uated an intervention package consisting of training, peer observations,
peer-directed feedback, and graphic feedback. To evaluate the intervention
package, the authors collected data on several dependent variables including
Occupational Safety Health Administration recordable incidents, lost work-
days, and peer observations. The results suggested that the intervention
package decreased the total number of incidents and lost days when com-
pared to preintervention conditions. The authors provided a cost-
effectiveness analysis by comparing the average direct cost of individual
work-related disabling injuries and other injuries to the total cost of the
intervention given the reduction in injuries during the course of the study.
The results suggested that the intervention was clearly cost-effective, pro-
viding evidence of the effectiveness of the intervention.
Generality
The last dimension of ABA places an emphasis on the extent to which gains
are generalizable to other settings, caregivers, or behaviors. Generalization is
important because it is not beneficial to improve a client’s behavior only
in settings (e.g., clinics) outside of the natural environment, particularly if
the client only spends a few hours of his/her week outside the natural envi-
ronment. The behavioral intervention is only beneficial if it improves
behavior across different settings and when it is implemented by different
individuals (e.g., multiple caregivers).
Silber and Martens (2010) provided an example of the application of
child-focused ABA in which the dimension of generality was evident.
The authors evaluated a multiple exemplar approach to a program for gen-
eralized oral reading fluency demonstrated by children in the first and second
grades. Specifically, the authors compared three conditions including a con-
trol, a reading intervention that consisted of teaching key words and sen-
tence structures, and a typical reading intervention consisting of preview
and repeated readings. Following the implementation of each condition,
the authors conducted probes with nontrained reading passages to evaluate
the extent to which the children’s learned skills generalized. The results
showed that both reading interventions were more effective at promoting
generalization of reading skills as evidenced by significantly higher scores
during the generalization probes with untrained readings. By showing the

spread of the positive effects of the interventions to untrained reading pas-
sages, the authors demonstrated the generality of the interventions.
Stokes, Luiselli, Reed, and Fleming (2010) provided an example of the
emphasis on generalization in the ABA-based sports management literature.
During the study, the authors evaluated the utility of descriptive feedback
alone; descriptive feedback in combination with video-based feedback;
and a combination of descriptive feedback, video-based feedback, and an
audio-based feedback procedure (i.e., teaching with acoustical guidance,
TAG) to improve line pass-blocking skills in high school football players.
After demonstrating the effectiveness of the intervention package consisting
of descriptive feedback, video-based feedback, and TAG with improve-
ments in blocking, the authors assessed improvements during game situa-
tions (with four of the five participants) in the absence of the
intervention. The results showed that all four players demonstrated high
levels of correct blocking techniques during game situations suggesting that
generalization had occurred with the intervention.
The generality dimension of ABA is also illustrated in numerous OBM-
based ABA studies. For example, as described earlier, Ludwig and Geller
(1997) evaluated two approaches to improving intersection stopping by
pizza delivery drivers as well as generalization to nontargeted safe driving
behaviors (i.e., turn signal usage, safety belt usage). Both interventions were
shown to improve intersection stopping. However, significant increases in
nontargeted turn signal and safety belt usage were demonstrated with the
drivers who participated in the goal-setting process. Thus, the results sug-
gested a high level of generality of the intervention.
SUMMARY
Features of ABA include seven dimensions described by Baer et al. (1968)
including applied, behavioral, analytic, technological, conceptually systematic,
effective, and generalizable. Applied behavior analysts, through both applied
work and research, have conducted practice characterized by these dimensions
and features across populations and specific areas of focus for more than a half-
century. In addition, assessment and intervention practices based on the prin-
ciples of ABA have been implemented successfully in educational, clinical,
sports, and business settings to address a wide range of behavioral issues.
This chapter highlighted the wide breadth and diversity of application of
procedures and methodologies based on the discipline of ABA. Despite the
impression that ABA is synonymous with specific assessment and treatment

approaches to autism and developmental disabilities (e.g., Bowman & Baker,
2014), the wide range of studies described in this chapter in terms of popula-
tions, areas of focus, and settings illustrates the actual nature of the impact
and discipline of ABA.
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CHAPTER 2
Applied Behavior Analytic

Assessment and Treatment
of Autism Spectrum Disorder
Wayne W. Fisher, Amanda N. Zangrillo
Center for Autism Spectrum Disorders, Munroe-Meyer Institute, The University of Nebraska Medical Center,
Omaha, Nebraska, USA
Type the word “autism” into any Internet search engine and the abundance of
returned results is overwhelming. The prevalence of autism spectrum disorder
(ASD) has steadily increased, nearly tripling over the last decade (i.e., increasing
from 1 in 150 children to approximately 1 in 50 children; Blumberg et al., 2013;
Centers for Disease Control and Prevention [CDC], 2014). Given this increase,
it is not surprising that caregivers, clinicians, and the general public are generating
considerable discussion about ASD. Eugen Bleuler provided an initial descrip-
tion of the symptoms of ASD in the early 1900s (Klinger, Dawson, & Renner,
2003). Over the past century, research has contributed significantly to the avail-
ability of information regarding diagnosis, assessment, and treatment of ASD.
Unfortunately, not all research is created equal, and consumers are faced with
the daunting task of differentiating empirical research and evidence-based prac-
tice from that which is invalid or pseudoscientific (National Autism Center,
2009). In this chapter, we provide (a) a review of the diagnostic criteria and hall-
marks of ASD and recent changes to the diagnostic criteria; (b) a discussion of the
impact of the disorder in terms of prevalence rates, etiology, and prognosis; (c) an
overview of behavior analytic, evidence-based approaches to assessment and
treatment; and (d) future directions and considerations for practitioners.
A little learning is a dang’rous thing; Drink deep or taste not. . .
Alexander Pope
THE IMPACT OF ASD ON AFFECTED CHILDREN

AND THEIR FAMILIES
The impact of autism on affected children and their families is difficult to
overstate. In the absence of effective intervention, long-term outcomes
for children diagnosed with ASD have generally been poor. For example,
Clinical and Organizational Applications of Applied Behavior Analysis © 2015 Elsevier Inc.
http://dx.doi.org/10.1016/B978-0-12-420249-8.00002-2 All rights reserved. 19
in one long-term follow-up study of adults affected by autism, only 4% lived

independently, only 13% worked independently (primarily in low paying
occupations), and only 26% had one or more friends (Howlin, 2005;
Howlin, Goode, Hutton, & Rutter, 2004). More recent studies on adoles-
cent and adult outcomes for persons with ASD have produced somewhat
more optimistic results; however, many of these studies have focused on
outcomes for a small sample of relatively high-functioning individuals
(see Levy & Perry, 2011 for a review). Finally, parents and siblings of indi-
viduals affected by ASD are at increased risk for developing stress-related
mental disorders (Dumas, Wolf, Fisman, & Culligan, 1991; Feldman
et al., 2007; Lofholm, 2008).
DEFINING FEATURES AND DIAGNOSIS

ASD is a neurodevelopmental disorder that is typically identified in early
childhood, with symptoms often presenting at or before 18 months
(Blumberg et al., 2013). Eugen Bleuler initially conceptualized autism as
a form of childhood schizophrenia; however, ASD differs from schizophre-
nia on all of the factors that define a syndrome, including symptoms, age of
onset, etiology, family history, and response to treatment. Based on the pre-
sentation of the unique symptoms associated with ASD, Leo Kanner and
Hans Asperger later conceptualized autism and Asperger’s syndrome,
respectively, as separate disorders in the early 1940s (Klinger et al., 2003),
and in 2013 the diagnostic label was changed to ASD. Although the specific
naming conventions have changed over the years, the hallmarks of ASD
established in the Diagnostic and Statistical Manual of Mental Disorders 5th
ed. (DSM-5; American Psychiatric Association [APA], 2013a) have gener-
ally remained consistent and are deeply rooted in impairments in social-
communication behaviors (e.g., social interaction, verbal and nonverbal
communication) and restricted and repetitive interests and behaviors in a
variety of contexts, and across many domains (APA, 2013a).
Clinicians use the DSM-5 as a guide to determine if the symptoms dis-
played by an individual meet the diagnostic criteria for ASD diagnosis. The
DSM-5 outlines five key diagnostic criteria that are required for diagnosing
ASD: (a) an individual must display persistent impairments or deficits in
social communication and social interaction; (b) an individual must display
restricted, repetitive patterns of behavior, interests, or activities; (c) the
symptoms must be present in early childhood; (d) symptoms produce clin-
ically significant impairments in current functioning in a variety of contexts
Applied behavior analytic assessment and Treatment of ASD 21
(e.g., home, work, and school); and (e) the symptoms cannot be better
explained by intellectual disability or global developmental delay. Each cat-
egory is evaluated separately, and each criterion specified in the five areas
listed above must be met to provide an individual with a diagnosis of
ASD (APA, 2013a). What follows is a discussion of the observable and mea-
sureable symptoms that are described in the first two areas of the diagnostic
criteria.
Social Communication and Social Interaction

The category of social communication and social interaction is divided into
three distinct subdivisions. The first subcategory includes skills related to
social-emotional reciprocity. An individual experiencing marked delays
or deficits in this subcategory may (a) rarely initiate conversation with others,
(b) fail to look at or acknowledge others when his or her name is called or
when others enter the room, and (c) intrude on what is typically called
another individual’s “personal space.”
The second subcategory describes deficits or impairments in social inter-
actions involving nonverbal communicative behaviors (e.g., deficits in coor-
dinated use of verbal and nonverbal communication, eye contact). The third
subcategory includes deficits or impairments in developing, maintaining,
and understanding relationships (e.g., adjusting behavior to fit social con-
texts, absence of interest in peers). An individual must present with impair-
ments or deficits in all three subcategories in order to meet the criteria for a
diagnosis of ASD.
Restricted, Repetitive Patterns of Behavior, Interests,

or Activities
The category of restricted, repetitive patterns of behavior, interests, or activ-
ities is also divided into four distinct subdivisions. The first subcategory
includes stereotyped or repetitive (a) motor movements (e.g., hand flapping,
toe walking, spinning in circles), (b) use of objects (e.g., repeatedly dropping
objects and watching them fall, lining up objects), and/or (c) speech (e.g.,
pedantic or overly formal speech, idiosyncratic words or phrases, echolalia).
Behaviors that are included in this subcategory may vary depending on the
cognitive level and vocal abilities of the individual. The second area includes
insistence on sameness, inflexible adherence to routines, and/or ritualized
patterns of verbal or nonverbal behavior (e.g., rigidly following rules, insist-
ing on wearing the same shirt each day). The third area includes highly
restricted, fixated interests that are abnormal in intensity or focus (e.g., only
talking about one topic, significantly restricted food preferences, preoccu-

pation with a limited range of toys or activities). The last area includes
hyper- or hyporeactivity to sensory input or unusual interest in sensory
aspects of the environment (e.g., extreme responses to specific sounds, tex-
tures, changes in the environment, indifference to exposure to pain or tem-
peratures). An individual must display marked impairment in at least two of the
four subcategories noted above to meet the diagnostic criteria for restricted,
repetitive patterns of behavior, interests, or activities.
The defining features of ASD (previously discussed) exist along a contin-
uum and may manifest differently in each individual. Specific characteristics
may develop over time (i.e., as the child matures and social interactions
become more complex), change form or topography, and/or increase or
decrease in intensity or level of impairment of daily functioning (i.e., follow-
ing exposure to environmental consequences or early intervention services;
APA, 2013a). Individuals diagnosed with ASD may also present with a variety
of features that are not included as hallmarks of the disorder, but are associated
features. These associated features include disturbances in feeding and sleeping
(see Kodak & Piazza, 2008), delayed toilet training (Kodak & Grow, 2011),
genetic and medical conditions (e.g., intellectual disability, seizure disorders,
fragile-X syndrome; Klinger et al., 2003; Kodak & Grow, 2011), severe self-
injury, and/or other related behavior problems (e.g., aggression, pica, elope-
ment, tantrums, etc.; Jones, Lerman, & Laechago, 2014).
MODIFICATIONS TO THE DSM

In 2013, the APA published the DSM-5, which included a number of revi-
sions to the diagnostic criteria in the DSM-IV-Text Revision (TR; 2000)
that have been somewhat controversial. The DSM-5 collapsed several of
the DSM-IV-TR diagnoses (e.g., autistic disorder, Asperger syndrome) into
a single disorder (i.e., ASD). In addition, Rett syndrome was considered a
pervasive developmental disorder in DSM-IV-TR, but with DSM-5, a
child with Rett syndrome would receive a diagnosis of ASD only if the
new diagnostic criteria are met, in which case the diagnosis of Rett syn-
drome would be considered a “specifier” (e.g., ASD associated with the
genetic condition called Rett syndrome; APA, 2013b). These changes have
been controversial due to concerns that the new diagnostic criteria may be
less sensitive than the prior version, which would result in fewer children
being diagnosed with an ASD and receiving associated treatments (APA,
2013b). For example, a recent meta-analysis of studies comparing the
DSM-5 and DSM-IV-TR criteria found that the former reduced the num-
ber of diagnosed cases of ASD by an average of 31% (Kulage, Smaldone, &
Cohn, 2014). However, other studies have applied diagnostic criteria spe-
cifically developed for the DSM-5 and found high levels of selectivity (per-
centage of “true” or actual cases of ASD identified) and specificity
(percentage of noncases of ASD correctly identified as such; Carrington
et al., 2014; Kent et al., 2013). Additional research will be needed before
this controversy is satisfactorily resolved.
DIAGNOSTIC ASSESSMENT
A variety of etiological factors have been associated with increased risk of
ASD (e.g., high paternal age: Kolevzon, Gross, & Reichenberg, 2007;
fragile-X syndrome: Kaufmann et al., 2004), but none have shown a
one-to-one correspondence with the behavioral syndrome; thus, clinicians
must rely on indirect and direct observations of the measurable dimensions
of an individual’s behavior (as opposed to biological or genetic determi-
nants) to render a diagnosis. Routine medical evaluations, such as well-
child doctor visits, play a key role in early detection and access to treatment
for many children and families. Examples of screening tools aimed specif-
ically at identifying the hallmarks of ASD include the Checklist for Autism in
Toddlers (CHAT; Baron-Cohen, Allen, & Gillberg, 1992), Modified Check-
list for Autism in Toddlers (M-CHAT; Robins, Fein, Barton, & Green,
2001), and Screening Tool for Autism in Toddlers (Stone, Coonrod, & Ousley,
2000; see Taubman, Leaf, & McEachin, 2011 for a review). Pediatricians or
caregivers may request additional referrals for assessment from clinicians
with specialized training in diagnostic assessment with young children to
determine if the current presentation meets the diagnostic criterion
for ASD.
With regard to diagnostic assessment, the specific indirect and direct
assessment methods used vary from clinic to clinic. It is important to note
that no one assessment tool or method should be used alone to assess an indi-
vidual. Many diagnostic evaluations use multimethod (e.g., indirect and
direct methods) and multidisciplinary approaches during the diagnostic
assessment process. For example, a clinician may use caregiver interviews
and rating scales (such as the tools listed above), in combination with neu-
ropsychological assessments, speech and language evaluations, assessments of
adaptive functioning (e.g., Vineland Adaptive Behavior Scale-Second Edition;
Sparrow, Cicchetti, & Balla, 2005), direct observation, and standardized
assessments aimed at assessing the defining features of ASD. Tools that have
been empirically validated for the diagnosis of ASD include Autism Diagnostic
Interview—Revised (e.g., ADI-R; Rutter, Le Couteur, & Lord, 2003),
Childhood Autism Rating Scale-Second Edition (CARS2; Schopler, Van
Bourgondien, Wellman, & Love, 2010), Gilliam Autism Rating Scale (GARS;
Gilliam, 2006), and Autism Diagnostic Observation Schedule, Second Edition
(ADOS-2; Lord, Rutter, DiLavore, & Risi, 2001).
ESTIMATES OF THE PREVALENCE OF ASD

Estimates of the prevalence of ASD have varied widely over time and
across studies. The latest reports from the CDC estimate the prevalence
of ASD at 1 in 68 children (CDC, 2014), whereas the median estimate
for prevalence studies worldwide since the 1960s is about 1 in 162
(Elsabbagh et al., 2012). In addition, Elsabbagh et al. found that the world-
wide prevalence estimates have shown a statistically significant increase
over time (r ¼ 0.4; p < 0.01). Moreover, a small number of recent, well-
designed studies (Baird et al., 2006; Kawamura, Takahashi, & Ishii,
2008; Kim et al., 2011) that have employed more vigorous case-
ascertainment methods (i.e., using systematic, population-wide screening
and diagnostic procedures rather than simply counting cases that have been
identified and diagnosed clinically) reported prevalence estimates as high as
1 in 38 children (or 2.6% of the childhood population). Although some
authors have argued that the increase in the reported prevalence rates of
ASD over time represents a true increase in the number of affected chil-
dren, the observed increase is probably due to (a) more inclusive diagnostic
criteria, (b) increased recognition and diagnosis of the disorder, and
(c) diagnostic substitution (i.e., children who may have received other
diagnoses in the past are more likely to be diagnosed with ASD today;
Elsabbagh et al., 2012). Finally, the results of the recent, well-designed
studies that have used more aggressive case-ascertainment methods suggest
that the observed prevalence of autism may continue to rise for some time
going forward.
ETIOLOGICAL FACTORS IN ASD

Early accounts of the etiology of ASD varied between those that attributed
the disorder to emotionally cold and distant parenting practices (the so-
called refrigerator-mother hypothesis; Bettelheim, 1967; Kanner, 1943)
to those that described it as primarily a biological condition (Rimland,

1964). Leo Kanner, who first applied the label of autism to this group of chil-
dren, reportedly oscillated multiple times between the two views, calling it
an “inborn” condition in his original paper (Kanner, 1943), attributing the
disorder to parental inadequacies in a later publication (Kanner, 1954), and
then vacillating between these two positions later on (see Rapin, 2011 and
Sanua, 1990 for more detailed discussions). Today, ASD is viewed as having
primarily a neurobiological basis due to (a) higher than expected concor-
dance rates among monozygotic twins and among close family relatives
(Folstein & Rutter, 1977); (b) frequent co-occurring clinical features
associated with neurobiological conditions, such as seizures (Deykin &
MacMahom, 1979) and genetic conditions (e.g., fragile-X syndrome: Harris
et al., 2008); and (c) a wide variety of brain-imaging studies showing anom-
alies of brain structure (Stanfield et al., 2008), function (Pelphrey & Carter,
2008), and connectivity (Wass, 2011).
HISTORY OF BEHAVIORAL TREATMENT OF ASD

Jean-Marc-Gaspard Itard (1801), a French physician, treated a feral boy named
Victor who lived on his own in the wild for 5 years or more until he was
approximately 12 years old. Victor was described as having a number of symp-
toms of ASD, including a lack of communication and interest in social inter-
action and stereotypic motor responses. However, there has been considerable
debate as to whether the symptoms resulted from his social isolation in the
wild or whether his caretakers may have abandoned him due to a congenital
behavior disorder, such as ASD (Frith, 1989; Lane, 1976). Itard’s approach to
treatment included (a) individualized instruction, (b) beginning with the
child’s current level of performance and then introducing increasingly more
difficult material, (c) imitation training, and (d) delivering immediate rewards
for correct and appropriate responses, procedures that remain highly relevant
to the treatment of ASD today. After about 5 years of intervention, Victor
could read and follow simple spoken or written sentences, request preferred
items or activities using gestures or simple written phrases, and discriminate
basic emotions expressed by others, but he never learned to emit spoken lan-
guage. If Victor was on the autism spectrum, then Itard’s description of his
work with this boy represents the first detailed account of a child with
ASD as well as the treatment of the symptoms of this disorder (Thompson,
2013). Little, if any progress was made in the treatment of ASD between
Itard’s time and the early 1960s.
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DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)
The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.
NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.
MAKONDE LOCK AND KEY AT JUMBE CHAURO

This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]
MODE OF INSERTING THE KEY
With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
“We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
BRAZIER
Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT
SMOOTHING WITH MAIZE-COB
CUTTING THE EDGE

FINISHING THE BOTTOM
LAST SMOOTHING BEFORE

BURNING
FIRING THE BRUSH-PILE

LIGHTING THE FARTHER SIDE OF
THE PILE
TURNING THE RED-HOT VESSEL
NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK
DRAWING THE BARK OFF THE LOG
REMOVING THE OUTER BARK

BEATING THE BARK
WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT
MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN

Clinical and Organizational Applications of Applied Behavior Analysis Practical Resources For The Mental Health Professional

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Clinical and Organizational Applications of Applied Behavior Analysis Practical Resources For The Mental Health Professional

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Clinical and Organizational

Applications of Applied Behavior

Defining Features of Applied

This chapter provides an overview of the features of ABA within the

importance including food refusal (Borrero, Woods, Borrero, Masler, &

Tetreault, Hovanetz, Strobel, & Garro, 2008; Lerman, Vorndran, Addison,

use of an ABA-based approach to produce positive, socially significant

behaviors to allow for direct observation and measurement. Specifically, they

reintroduction and subsequent removal of the treatment across time, set-

Normand (2008) provided an example of the use of a multiple-baseline

implemented the intervention with one set of duties while continuing to

Thus, the treatment was explicitly based on behavioral mechanisms concep-

the USDA recommended daily guidelines provided a benchmark with

during the generalization probes with untrained readings. By showing the

impression that ABA is synonymous with specific assessment and treatment

Applied Behavior Analytic

THE IMPACT OF ASD ON AFFECTED CHILDREN

in one long-term follow-up study of adults affected by autism, only 4% lived

DEFINING FEATURES AND DIAGNOSIS

Social Communication and Social Interaction

Restricted, Repetitive Patterns of Behavior, Interests,

talking about one topic, significantly restricted food preferences, preoccu-

MODIFICATIONS TO THE DSM

ESTIMATES OF THE PREVALENCE OF ASD

ETIOLOGICAL FACTORS IN ASD

to those that described it as primarily a biological condition (Rimland,

HISTORY OF BEHAVIORAL TREATMENT OF ASD

Newala, too, suffers from the distance of its water-supply—at least

The water-supply of New Newala is in the bottom of the valley,

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAKONDE LOCK AND KEY AT JUMBE CHAURO

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

Some consolation was afforded me by a brassfounder, whom I

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

LAST SMOOTHING BEFORE

FIRING THE BRUSH-PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

MANUFACTURE OF BARK-CLOTH AT NEWALA

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