by K. Dillenburger, M. Keenan, A.Doherty, T. Byrne and S. Gallagher (2012) in Children & Family Behavior Therapy (Vol. 34, Issue 2, pg 111-129)
Autism Spectrum Disorder (ASD) is the clinical term for specific complex developmental disorders described in theDiagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-IV-TR, 2000) and theInternational Classification of Diseases (ICD-10; World Health Organization, 2007). Childhood autism is defined by: “(a) the presence of abnormal or impaired development that is manifest before the age of three years, and (b) the characteristic type of abnormal functioning in all the three areas of psychopathology: reciprocal social interaction, communication, and restricted, stereotyped, repetitive behavior. In addition to these specific diagnostic features, a range of other nonspecific problems is common, such as phobias, sleeping and eating disturbances, temper tantrums, and (self-directed) aggression” (World Health Organization, 2007). Atypical autism and Asperger’s Syndrome include the same or similar characteristics but differ either in age of onset or intensity of symptoms. ASD is a spectrum disorder insofar as the complexity of atypical behavioral patterns are different for each child and range from those who are high functioning to those who are severely affected (Keenan, Dillenburger, Doherty, Byrne, & Gallagher, 2010). Although estimates diverge somewhat, it is thought internationally that as many as 1:100 individuals may be affected by ASD (National Autistic Society [NAS], 2006). The estimated lifetime cost for an individual with ASD is US$3.2 to US$4.0 million, including cost for care and lost productivity (Jacobson, Mulick, & Green, 1998; Ganz, 2006).
Over the past 40 years, interventions based on the science of Applied Behavior Analysis (ABA) have been highly effective in mitigating some of the challenges and developing adaptive and social behaviors in many populations (Maurice, Green, & Luce, 1996; Swanson & Sachse-Lee, 2000) and are now internationally recognized as the most effective basis for treatment for children with ASD (Larsson, 2005; Perry & Condillac, 2003). A number of cost-benefit analyses have shown the savings that can be achieved by implementation of effective intensive behavioral interventions based in the science of behavior analysis. For example, in Ontario, Canada, Motiwala, Gupta, Lilly, Ungar, and Coyte (2006) estimated that annually CA$45 million can be saved if ABA-based Intensive Behavioral Interventions are made available to all children diagnosed with ASD. In Texas, USA, Chasson, Harris, and Neely (2007) showed that a total of US$208,500 per child could be saved for the education system; while in Pennsylvania, average savings per child were estimated even higher to range from US$274,700 to US$282,690. In fact, Jacobson et al. (1998) estimated over 10 years ago that the savings per individual across their life span range from well over US$1 million to over US$2 million.
However, the scientific discipline of ABA has been widely misconstrued by advocates of other approaches and is frequently confused with a limited number of specific intervention modalities (Freeman, 2003); i.e., the acronym (ABA) frequently is wrongly used synonymous with “Lovaas treatment” or Discrete Trail Training (DTT). Other controversies center on treatment modalities and sources of evidence (Keenan & Dillenburger, 2010; Freeman, 2007). In the context of this article, it is important to understand that ABA is not merely a specific method of intervention for children diagnosed with ASD; instead, ABA is the applied branch of the science of behavior analysis that can be valuable regardless of the developmental level or ability of the behaving “organism” (Chiesa, 2005; Dillenburger & Keenan, 2009).
Provision of ABA-based education and treatment for children diagnosed with ASD remains inconsistent across the globe (Dillenburger, 2011; Simple Steps, 2012). For example, on the basis of the cost-benefit analyses mentioned above, Ontario, Canada has legislated to make these services available for all children diagnosed with ASD (Perry & Condillac, 2003). In the USA, presently 31 States have legislation to ensure that ABA-based interventions are viewed as medically necessary and paid for either through state funding or medical insurance, while in Europe there is no such legislation and government funded ABA-based service provision is not available in the United Kingdom (UK) or Ireland (Dillenburger, Keenan, Doherty, Byrne, & Gallagher, 2010).
As far as staff training is concerned, there is considerable inconsistency. Although the Minister of Education in Northern Ireland, among others, considers ABA as “one of many commercially available interventions” (Ruane, 2009) and suggested that short courses, sometimes only lasting a day or two, are sufficient training in ABA, the appropriate and internationally recognized qualification is achieved through the Behavior Analysis Certification Board’s (http://www.bacb.com) certification process that distinguishes between Board Certified Behavior Analysts-Doctoral (BCBA-D), Board Certified Behavior Analysts (BCBA; i.e., Masters-level graduate training), and Board Certified assistant Behavior Analyst (BCaBA; i.e., Undergraduate-level training). These levels of certification are based on appropriately approved university-based training and extensive supervised professional practice experience (supervised by Board Certified Behavior Analysts) and are not to be confused with certificates from non-regulated bodies.
Despite the fact that eclectic interventions have shown to be less effective than ABA-based interventions (Howard, Sparkman, Cohen, Green, & Stanislaw, 2005; Zachor, Ben-Itzchak, Rabinovich, & Lahat, 2007), most special education schools in the UK and Ireland provide an eclectic mix of interventions (Report of Task Group on Autism, 2002), including Treatment and Education of Autistic and related Communication Handicapped Children (TEACCH; Schopler, Mesibov, DeVillis, & Short, 1981) and sensory integration therapy. Little is known about how parents and professional feel about this state of affairs.
This article is part of a larger study of parental and family needs. Findings regarding diagnosis and forward planning and the impact of ASD on family life are reported elsewhere (Keenan et al., 2010; Dillenburger et al., 2010).
The focus of this article is specifically on the experiences of parents and professionals with regard to educational provision for children diagnosed with ASD. At the center are the differences and similarities in experiences, expectations, and future needs between children who attend education institutions that base their teaching methods explicitly on the science of ABA (i.e., ABA-based schools) and those who are attending eclectic mixed-methods schools and receive ABA-based interventions in home programs, due to lack of availability of ABA-based schools in their locality. Despite the fact that subjective parental experiences and views are at times not in line with quantitative evidence of effectiveness (Boothe & Borrego, 2004), they are crucially important not only as an valuable measure of social validity (Dillenburger, Keenan, Gallagher, & McElhinney, 2004) but also because they do not always concur with the views expressed by professionals (Dillenburger et al., 2010). Parental confidence and, therefore, collaboration between parents and professionals can only be increased through exploration of, and effective response to, parental views (Lamb, 2009). This article aims to contribute to improved parental confidence by reporting parental views regarding ABA-based schools and home programs when compared with eclectic education provision. In common with other inductive research, there was no explicit a priori hypothesis on which this research was based, although, all things being equal, the null-hypothesis would propose that regardless of treatment delivery (home or school, eclectic or ABA-based) or relationship to the child (parental or professionals), views would be similar/the same.
Schools and Educational Provision
Home Tuition Programs
Professional Involvement in Home Tuition Programs
Future Need for ABA-Based Educational Provision
Application of ABA to Areas Other Than ASD
Future Schooling and Educational Needs
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