Feasibility and effectiveness of very early intervention for infants at-risk for autism spectrum disorder: a systematic review. J Abnorm Child Psychol. The utility of the Gilliam autism rating scale for identifying Iranian children with autism. Disabil Rehabil. Frank K, Esbensen AJ. Journal of Intellectual Disability Research.
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Virtual-care delivery of applied-behavior-analysis services to children with autism spectrum disorder and related conditions. Behavior Analysis: Research and Practice. Am J Occup Ther. Procedures and compliance of a video modeling applied behavior analysis intervention for Brazilian parents of children with autism spectrum disorders. Chang K, Zaroff CM. Acta Psychopathol.
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Increasing the effectiveness of community mental health center social skills groups for children with autism spectrum disorder: a training and consultation example. Adm Policy Ment Health. Acute behavioral crises in psychiatric inpatients with autism spectrum disorder ASD : recognition of concomitant medical or non-ASD psychiatric conditions predicts enhanced improvement.
Res Dev Disabil. The theme is developed by: Gostaresh Afzar Hamara.
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SBMU Journals. Login Register. Although the articles describing intervention processes include participants, a meta-analysis is not possible due to the lack of comparable inclusion and characterization criteria. Keywords: Autistic disorder; Speech language and hearing sciences; Behavior therapy; Language therapy. Educational and therapeutic proposals directed towards persons with autism spectrum disorders ASD have been the object of debates frequently contaminated by ideology, politics and fads, frequently disregarding or demeaning scientific evidence about their efficiency and social validation 1,2.
Intervention proposals based on the applied behavior analysis ABA model are frequently mentioned as the only proposal with results scientifically proven ABA based programs demand detailed assessment of environmental factors and their interference on the ASD child's behavior aiming to identify determinants of behaviors and factors that will probably lead to their repetition.
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These information are essential to the delineation and follow-up of intervention processes 2,3. Programs frequently include verbal and communication abilities in intensity intervention levels that are similar to those directed toward cognitive and academic abilities and to behavior disorders 2,3. Furthermore the strict use of ABA principles and therapists' consistent and specific training are also considered essential elements to the proposal success 4,5. Parents' involvement, allowing a more intensive stimulation in home environment is frequently mentioned as one of the positive points of ABA intervention proposals 6,7.
Recent studies admit the need for more research about the results of intervention processes directed toward "higher level behaviors" as speech and insistence on sameness 8,9. In this sense, the "cognitive-behavioral" intervention has been proposed as an alternative to the continuity of the strict behavioral intervention The inclusion of "communicative behaviors" as part of the objectives of the ABA based interventions to children with ASD 11 has lead professionals of other areas to propose approaches for speech that are frequently opposed or conflicting with language therapy Therefore, it is relevant to critically review the literature that reports the results of this typo of intervention.
Systematically review the literature about intervention proposals based on ABA with ASD individuals, therefore contributing with evidence-based practice. The first data survey identified papers. The articles published in peer reviewed journals were mechanically selected, resulting in papers. From this point on a manual revision was conducted by reading the title and abstract of each paper.
Exclusion criteria were language including just papers in English, Portuguese and Spanish , the type of article excluding abstracts, letters to the editor and tutorials and the theme excluding articles about treatment funding, health system resources, access to services, services provided to military families, legal issues, animal models and other issues in mental health. In this process repeated papers were also excluded. This selection resulted in 52 papers that were fully analyzed. The articles selected to this review were synthesized on a spread-sheet to the record of information regarding author, journal and date; title; theme and approach; case series; inclusion and exclusion criteria when possible, and conclusions of the study.
The 52 articles analyzed were published in 25 different journals. The distribution of this publication is presented in Chart 1. It is expressively comprehensive, including journals specialized in autism, pediatrics, behavior studies, communication disorders, psychology and even dental health. While the largest identified impact factor is above 9, the smaller of them is below 0. There are 20 papers published on the six journals with IF above 2, four in journals with IF above 1 and 13 articles published in journals with IF below 1.
These results show once more the comprehensiveness and the interest generated by this study field. It can also be observed that there isn't a significant repetition of authors' names or research groups.
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The name of just one author appears in four papers; another researcher is the author of three articles and other four names are among the authors of two papers each. It suggests, still once again, the comprehensiveness of the theme and of the research groups involved with this proposal. Although several studies point out to the meaning of parents' contribution to the application of ABA principles in home environment 2,4,5,8,13 , this literature review has found few scientific results of this proposal.
One research 9 with 53 parents of ASD children reported that all of them were positive about the results of a two-year intensive intervention proposal. A recent study 14 assessed the opinion of parents and siblings of ASD children regarding the results of a home intervention program. The author concluded that the results were mostly neutral, with the parents more optimistic than the siblings regarding the proposal's results, but even they didn't report gains to the siblings that could be associated to the behavior intervention with the ASD children.
The other revised paper 7 reports the experience of six mothers that opted to study the ABA methodology in depth and became accredited therapists in the field; but it is not possible to generalize the meaning of this experience to all of them neither anticipate this meaning to other parents that make the same choice. The papers about professional education focus on distance learning, adaptation of programs to different linguistic contexts, use of video samples for behavior modeling and supervision.
A total of professionals therapists and educators participated in all these studies but the only point that may be generalized is the value of specialized training 3,7. Questionnaires and interviews are the main data gathering strategy but there is few information about how the research groups were determined.
The second largest group of papers includes those that made literature reviews. Two of them present metanalyses that total participants, and both conclude that there is no clear evidence that ABA has any relevant advantage over other intervention proposals 1.hukusyuu.com/profile/2020-09-01/whatsapp-zwei-graue-haken-gelesen.php
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A third study 15 revised five metananlyses studies about intensive behavior intervention and identified limitations due to inconsistent description of the participants, methods, inclusion criteria and intervention process on the researches that were being reported. The positions that result from the literature reviews that were analyzed in the present study are also inconsistent. Results of the intervention processes are reported by seven papers as expensive and dependent of external factors such as environment, amount of training provided and interaction with medication.
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These papers also point out to the need for more controlled studies about the results of these intervention processes 2, Three other reviews 10 present positions that are clearly contrary to the use of ABA as the main intervention program provided to ASD individuals, considering this approach as inefficient and lacking in scientific support. The first aspect that was considered was the number of participants of each study. It varies from case studies with just one subject with ASD 16,17 to another that reports the results of intervention conducted with participants Although these articles include a total of participants, a metanalyzes is not possible due to the lack of comparable inclusion criteria or even a more detailed description about characteristics such as age, specific diagnostics and developmental level of the participants.
In regard to the participants' age, there is a large variation, including participants under 36 months and adolescents. Besides that, this characteristic is also described with different degrees of specificity; while some papers describe age ranges as "between 2 years and 4 months and 6 years and 2 months" 11 , others refer just to "children" 19 or "adolescents" In some studies the inclusion criteria are detailed and specific, using developmental measures, diagnostic protocols and social-demographic characterization In other studies, however, participants were included in the intervention processes according to convenience criteria, as attending a certain school or being enlisted in some intervention program provided to the children of a certain community Certainly to determine evaluation criteria to verify the results of intervention that may be efficient to assess processes that are so different is a challenge that still isn't solved.
This same diversity may be observed in what regards to the time involved in the intervention program. It is possible to observe on Chart 2 that the described processes may take 12 weeks; eight months; one or two years in programs with one or 30 or even 36 hours per week. The training processes took place mostly in the school 21 at the child's classroom or in some silent room , in clinics 8 or at the participant's home.
The purposes of the intervention programs ranged from motor imitation 11 to adaptation abilities 19 ; toilet training; motor, social and linguistic abilities 5,9,20, Some papers report successful results using ABA approaches, with relevant progress to all participants, in different areas, especially with early intensive intervention programs. However, most of these studies do not include control-groups.
Studies comparing programs with ABA framework with "naturalistic" or "comprehensive" models 8,11,19,19,21 concluded that there is no relevant difference on the results of both types of intervention, especially in what refer to the severity of the symptoms of autism. The direct association between the number of training hours and the results of the intervention program, related as successful, is mentioned by 12 papers, with a total of participants. Just one study 22 with six participants concluded that an intervention program with one hour per week produced satisfactory results.
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