Dear Ms. Klimas:
The Association for Science in Autism Treatment applauds you for reporting on such a sensitive topic, and for bringing a potentially serious issue to light: incompetent autism treatment providers. While it is important to seek out science-based treatment in autism, it is equally imperative to secure practitioners who are thoroughly trained in and faithful to those validated procedures which enjoy scientific support. This story is disturbing and disheartening, yet shares an essential message: the importance of identifying qualified individuals to deliver autism intervention.
Peer reviewed literature, both long-standing and recent, supports applied behavior analysis (ABA) as the most effective treatment option for autism. Over the past few decades, we have seen an upsurge in the incidence of children diagnosed with autism, highlighting the need to set standards for competency of practitioners. Originating in Florida in the 1990s, the Behavior Analyst Certification Board (BACB) created a rigorous credentialing system, and the number of board certified behavior analysts worldwide has reached nearly 15,000. In fact, many schools, insurance companies, and consulting firms are now beginning to require this credential of their autism treatment providers.
Board certified behavior analysts receive extensive academic training in the scientific theories of human behavior and its applications, and they practice based on a specific and ethical code of conduct. They also complete 1,500 hours of fieldwork under the supervision of a BCBA. The BACB currently designates three levels of certification: the BCBA-D (doctoral level board-certified behavior analyst), the BCBA (board-certified behavior analyst), and the BCaBA (board-certified assistant behavior analyst). Recently, the BACB has developed a fourth designation, the Registered Behavior Technician (RBT), to set a standard for paraprofessionals implementing behavior analysis techniques. Typically, BCBA-Ds and BCBAs work in service delivery oversight, BCaBAs assist with service planning and delivery, and the newly credentialed RBTs will be responsible for implementation of programming. For more information about the specific certification requirements, visit www.bacb.com.
It is important to recognize that a BACB certification does not automatically guarantee competency in autism treatment. Similarly, a lack of BCBA designation does not necessarily warrant a therapist incompetent to provide services. Behavior analysts can specialize across a wide range of areas, from improving processes and employee performance within large corporations to animal behavior, and many clinical psychologists have undergone broad training in autism treatment, but do not necessarily possess a BCBA credential. Thus, parents would be well-advised to request references from a potential therapist, and confirm that the practitioner has had specific training in treating individuals diagnosed with autism. If an ABA provider is not a BCBA, he or she should have a license to practice (e.g., a licensed psychologist or social worker) in addition to proof of clinical experience and basic education in autism treatment (e.g., as evidenced through transcripts, documented experience, continuing education, presentations at ABA conferences, or research publications). If not licensed, he or she should be under the direct supervision of a BCBA, or someone with comparable credentials (e.g., a licensed clinical psychologist with extensive experience in ABA).
It is likely that this news story alarmed a number of parents who receive in-home services for their children with autism. Fortunately, there are some steps that families can take to screen their child’s home teachers. First, as mentioned above, an ABA treatment provider should hold a BCBA credential or be under the direct supervision of a BCBA. A parent can search for and confirm a specific individual’s credential by accessing the Certificant Registry on the BACB website. Furthermore, the practitioner should be forthcoming about his or her education and training. Ideally, a resume would be supplied with references that can be verified. As a consumer of ABA services, the child should be provided with an initial evaluation and ongoing assessment of a treatment program. The process should be fully explained to the parent/guardian and child (if applicable) in terminology that they understand.
Additionally, these procedures should be transparent and consistent across working environments whether or not a parent is present, and data delivered in a timely manner whenever requested by the family. With respect to the recent allegations against the Milwaukee therapist, a parent should not be restricted from attending a child’s treatment session unless therapeutically indicated and agreed upon as part of the behavior intervention plan. In this case, the team could set up a camera or baby monitor, so that the parent is still able to view the practitioner’s interaction with the child, and devise a treatment plan that would gradually begin to include the parent into the live session. Lastly, ABA is empirically validated; multiple well-controlled studies have replicated its effectiveness. This means that within an ABA program, a child would presumably be making measurable gains, as indicated by ongoing data collection and analysis. If progress is not being achieved, a parent should express his or her concerns to the practitioner.
Parents need not risk putting their child in harm’s way in order to access appropriate autism intervention. The treatment demonstrated in the posted video was deplorable, and certainly not a reflection of standard ABA therapy. It may take extra effort, but a little research goes a long way in securing a competent and effective autism treatment provider. For more information, we encourage parents to visit https://www.asatonline.org. Thank you for your attention to the matter of obtaining effective and quality services for children with autism.
Caitlin Reilly, MA and Mary E. McDonald, PhD, BCBA-D
Association for Science in Autism Treatment
References
Behavior Analyst Certification Board: http://www.bacb.com/
Leaf, R. B., Taubman, M. T., & McEachin, J. (2008). Sense and nonsense in the behavioral treatment of autism: It has to be said (49-53). New York: DRL Books.
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