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Applied behavior analysis is a widely used intervention for autistic youth, though its mental health impacts remain under-researched. This study aims to investigate the association between applied behavior analysis therapy and post-traumatic stress disorder, suicidality, mental health hospitalization rates, and length of mental health hospitalizations using a national database of privately insured youth under 18. We matched 17,120 autistic youth who received applied behavior analysis with a control group of autistic youth with no record of applied behavior analysis and clustered them into four applied behavior analysis dose groups using two-stage bisecting k-medians clustering. Then, we used negative binomial regression and logistic regression to compare outcomes for the applied behavior analysis and non-applied behavior analysis groups. Overall, applied behavior analysis receipt was associated with 30% higher odds of experiencing a mental health hospitalization (odds ratio = 1.30, p < 0.001) and a 32% higher incidence rate of these hospitalizations (incidence rate ratio = 1.32, p < 0.001). Our analysis found no relationship between applied behavior analysis dosing and the other tracked mental health outcomes. These results indicate the need for more quantitative analysis with more comprehensive records of applied behavior analysis receipt to fully investigate claims of ABA resulting in adverse adult mental health outcomes.Lay abstractAutistic youth often receive applied behavior analysis (ABA) therapy, but some autistic adults who had ABA as youth say it harmed their mental health as adults. We looked at the relationship between ABA and post-traumatic stress disorder (PTSD), suicidality, mental health hospitalization rates, and length of mental health hospitalizations among autistic youth. We used private health insurance claims data to look at how ABA receipt was related to those mental health outcomes. We divided autistic youth into groups based on how much ABA they received, so we could see if different amounts of ABA had different associations with mental health. There were 17,120 autistic youth in the group that did not receive ABA, and 17,120 autistic youth in the group that did receive ABA. In this sample, ABA therapy was associated with a greater use of acute mental health services; autistic youth in the ABA group had an overall risk that was 30% higher for mental health hospitalizations; and a 32% greater frequency of mental health hospitalizations. These results suggest that there may be a relationship between mental health hospitalizations and getting ABA. However, more work is needed to fully understand the impact of ABA therapy on mental health outcomes.

This study aims to evaluate parental knowledge, acceptability, and involvement in the use of Applied Behavior Analysis (ABA) for the treatment of children with autism spectrum disorder (ASD) in Jordan. A descriptive cross-sectional study was conducted with a sample of 157 parents of children with ASD who had been exposed to ABA. Data were collected using self-administered paper-based and online questionnaires, which included demographic characteristics and instruments measuring parental knowledge, involvement, and treatment acceptability. The majority of participants were mothers (73.5%). A significant proportion of participants' children exhibited problematic behaviors, with aggression being the most common issue (34.3%). Parental acceptability of ABA was generally high, with 96.4% reporting moderate to high acceptance. The study also found a positive correlation between ABA knowledge, acceptability, and parental involvement in ABA programs. Enhancing parents' knowledge of autism and ABA is crucial for effective treatment. To increase parental acceptance and involvement in their child's ABA, practitioners should implement educational programs that provide parents with a deeper understanding of ABA principles and their practical benefits.

Objective To compare and analyze the short-term effect of play-based communication and behavior intervention (PCBI) and applied behavioral analysis (ABA) on the treatment of toddlers with autism spectrum disorder (ASD). Methods Seventy-four ASD toddlers aged from 19 to 30 months were recruited in Nanjing Brain Hospital Affiliated to Nanjing Medical University from November 2017 to May 2018.The toddlers who participated in this study were randomly assigned into PCBI group and ABA group, then they were intervened weekly by PCBI or ABA for a total of 12 weeks.Portage Early Development Checklist and autism treatment evaluation checklist (ATEC) were used to estimate the toddlers′ developmental level and the treatment efficacy respectively.The t-test was used to reveal whether there was significant difference between the 2 groups before and after intervention. Results (1)Compared with the ABA group, there was a significant increase in cognitive scores (ΔPCBI=9.03 scores, ΔABA=4.27 scores, t=3.997) and a significant decrease in social behavior scores (ΔPCBI=8.87 scores, ΔABA=16.91 scores, t=-4.022) of the Portage Early Development Checklist after 12 weeks of intervention in the PCBI group, and there were statistically significant differences(all P 0.05). (2)Compared with the ABA group, after 12 weeks of PCBI intervention, the scores of social contact, perception, behavior of ATEC were decreased, but the difference was not significant (P>0.05); the total score of ATEC scale(ΔPCBI total=14.89 scores, ΔABA total=22.22 scores, t=2.209)and the scores of language subscale(ΔPCBI language=2.89 scores, ΔABA language=6.43 scores, t=2.515)were decreased significantly, and there were statistically significant differences (all P<0.05). Conclusions After 12 weeks of the very early intervention of PCBI, the ASD toddlers all improved in clinical symptoms and developmental level.Compared with ABA intervention, PCBI very early intervention with parental guidance was comparable in short term efficacy, and PCBI was not taking up as much medical rehabilitation resources as ABA. Key words: Autism spectrum disorder; Toddler; Very early intervention; Play-based communication behavior intervention; Efficacy evaluation

I am writing to express concerns regarding Schaaf et al.'s article, “A Comparative Trial of Occupational Therapy Using Ayres Sensory Integration and Applied Behavior Analysis Interventions for Autistic Children” (Schaaf et al. 2025). Considering the potential impact this study has on service recommendations, I would like to discuss the concerns that, in my opinion, hinder the conclusions that can be drawn. First, the “Applied Behavior Analysis (ABA)” arm appears to represent a brief, focused behavioral skills training (30 one-hour sessions over several months in a clinic room). This protocol, however, is not a comprehensive, high-intensity ABA model implemented in practice following contemporary practice guidelines (typically 20–40 h per week across settings and domains, Council of Autism Service Providers (CASP) 2024). To extrapolate from this low-dose, limited protocol to what ABA normally enacts in practice is to risk overstating both the scope and the evidence for ABA. Second, the trial was powered only to detect very large effects, yet the non-significant between-group difference on the pre-specified primary outcome (PEDI-CAT Daily Activities) is interpreted as evidence that OT-ASI and ABA achieved “comparable” improvements. According to the CONSORT guidance on noninferiority and equivalence trials (Piaggio et al. 2012), clearly stated, failure to show superiority in an underpowered study does not establish equivalence. Third, the more positive finding in Schaaf et al. relies heavily on Goal Attainment Scaling (GAS), an individualized, caregiver-reported outcome obtained post-treatment. Although valuable, GAS is more vulnerable to expectancy and allegiance effects than the blinded, standardized primary outcome, a limitation that is not emphasized in the discussion. I appreciate the authors' efforts to undertake a complex randomized trial. However, I would encourage a more cautious discussion of the equivalence between OT-ASI and ABA and a broader recognition that the ABA condition as administered in their study is not equivalent to how average ABA programs in clinical practice are delivered. The author declares no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

The development of autistic children both physically, emotionally, intellectually, and psychosocially has a problem that results in the inhibition of children reaching a level of emotional development that is appropriate to their age. Applied Behavior Analysis (ABA) in children with autism includes autistic children providing emotional, social, informational, and practical support. An autistic child will feel that he is loved and wanted if more and more people in the family environment love and care for him. The purpose of the study was to know the effect of Applied Behavior Analysis (ABA) on the emotional development of children with autism. This type of quantitative research uses a Quasi-experiment with the design Pre-test Post-test with Control Group Design. The observation was carried out twice. The first observation is to determine the emotional development of an autistic child before being given Applied Behavior Analysis (ABA) and the second observation after being given Applied Behavior Analysis (ABA). Sampling was done by purposive sampling with the criteria of parents and autistic children aged 6-12 years in the autistic schools of the provinces of Yogyakarta and Ponorogo, East Java. Analyzed analytically using paired t-test and Wilcoxon, with a significant level of p <0.05. the emotional development of children with autism in the experimental group before Applied Behavior Analysis (ABA) was given to most categories were good of only 34 children with autism (73.9%) and after Applied Behavior Analysis (ABA) most categories were good for 44 autistic children (95.7%). In the control group before most were less as many as 28 children with autism (60.9%) and after most good as many as 17 children with autism (37.0%).The experimental group pre-test and post-test with a value of p (sig) 0.000, meaning there is a difference between pre-test and post-test in the experimental group. In the control group pre-test and post-test with p-value (sig) 0.000 meaning there is a difference between pre-test and post-test in the control group. There was an effect of Applied Behavior Analysis (ABA) on the emotional development of autistic children.

The study investigated the learning experiences and perceptions of ABA therapists on intervention of applied behavior analysis. A survey of 84 ABA therapists intervening applied behavior analysis was conducted on learning experience, perceptions and needs. The results of the study are as follows. First, ABA therapists are learning about applied behavior analysis in a variety of ways. Second, ABA therapists recognized the lack of support for team approach, cooperation and environmental system as barriers to intervention of applied behavior analysis. And ABA therapists recognized the budget problems and lack of service providers as barriers to intervention proposals in applied behavior analysis. Although the attitude toward the applied behavior analysis was positive, it was recognized that it took some time to implement the strategy for applied behavior analysis. Third, ABA therapists expected that applied behavior analysis should be intervened early and that intervention would be effective in various areas. In addition, ABA therapists recognized the need for collaboration in relevant fields for effective intervention in applied behavioral analysis. The learning and support needs for intervention of applied behavior analysis were found to have greater demands for individual competence than the environmental system. The results of the study are meaningful as basic data to stabilize the social foundation for intervention of applied behavior analysis and seek qualitative growth measures.

The Pennsylvania Department of Education addressed the need for a competency-based program for trained staff in applied behavior analysis by initiating the credentialing process in behavior analysis. As a result, the development of a training program designed around Functional Behavioral Assessment in public school settings has emerged. A practical tool for school teams, the Functional Behavioral Assessment Worksheet, has been developed using Applied Behavior Analysis principles and procedures. Educational consultants at the Central Instructional Support Center have developed the tool and are currently training Intermediate Unit staff, school district staff, and individual IEP teams in the use of the worksheet within effective behavior assessment procedures and educational programming. The worksheet describes the rationale for functional behavioral assessment and includes an explanation of IDEA requirements for completion of the assessment process for disciplinary changes in placement. The worksheet contains a team interview section, a section on direct observation with data analysis, and a summary section that includes hypothesis formulation. The step-by-step process provides a procedural framework that ensures that the team will conduct systematic and effective assessment. Use of this tool guarantees that teams focus on data collection and analysis and base their decisions on this information. This is a more scientific approach than the sole reliance on informant methods currently in use in public school settings. The worksheet appears below. Appendix A and Appendix B consist of basic data collection materials. For copies of the complete Functional Behavioral Assessment Worksheet, please contact the Central Instructional Support Center. Functional Behavioral Assessment Worksheet Purpose Individualized Functional Behavioral Assessment is typically used only in instances where behavior interferes significantly with the student's learning or that of his/her peers. Effective classroom management approaches embedded within effective instructional design and delivery appropriately address the majority of behavioral issues occurring in classrooms. Process A functional behavioral assessment is a process consisting of information-gathering procedures that result in a hypothesis about the function(s) that the behavior is serving for the student as well as ecological events and the consequences that are maintaining the behavior. First, information must be gathered indirectly through interview(s) of person(s) who has observed the behavior of the student for an extended period of time in a variety of settings and conditions. The purpose of the interview(s) is to review a large number of potential variables and narrow the focus to those variables that are of particular importance to the individual. Information must also be gathered through direct observation of the behavior across settings and times with consideration of a variety of other environmental factors (i.e. other persons present, task demands, changing conditions). Information that was gathered during the interview portion of the functional behavioral assessment is used to narrow the focus of data collection during direct observations. A graphic analysis of the data collected during direct observations together with the interview information results in the following: 1. Development of a specific, clear, description of the behavior of concern 2. Identification of the physical and environmental factors that correspond with occurrences of the behavior 3. Identification of the potential function of the behavior in terms of its maintaining consequences. This information then serves as the basis for the development of a Behavior Intervention Plan that manipulates environmental factors and consequences while providing instruction in the acquisition of new, more appropriate behaviors. …

Criticisms of applied behavior analysis (ABA) from the autistic community continue to intensify and have an appreciable impact on research, practice, and conversation in stakeholder groups. ABA providers aspire to increase quality of life for autistic people; thus, it is imperative for providers to listen with humility and openness to the population we serve. Autistic individuals have unparalleled expertise in their own lives and their own communities. The concerns raised by the autistic community cannot, morally or ethically, be swept aside. There may be a misguided and harmful tendency to devalue concerns due to the speaker’s identification as autistic or due to their difference in professional credentials. The concept of neurodiversity can help the ABA field respond to these concerns and collaborate with the largest stakeholders of our services, the autistic clients we serve. This article summarizes some of the key criticisms that autistic advocates raise concerning ABA, discusses the social model of disability and the neurodiversity paradigm, and proposes practical guidance to help the field of ABA integrate neurodiversity and thereby evolve our research and practice. By openly acknowledging the criticisms against ABA and recognizing how we can do better as a field, we believe we can take practical steps towards a profession and a society that more fully embraces inclusion.

The current chapter will present an overview of current effective teaching methods for children with autism. Applied behavior analysis has been referred to as the treatment of choice for those with autism (United States Surgeon General, 1999; New York State Department of Health, 1999a, 1999b, 1999c). At its core, applied behavior analysis is the dataand research-based application of behavioral principles to socially relevant behavior (Baer, et al., 1968; Cooper, et al., 2007; Wolf, 1978). Additional key components of applied behavior analysis are generalizability, conceptually systematic, technologically sound, practical, and effective (Baer, et al., 1968). These key components will be described below. Due to the pervasive nature of autism that results in dramatic impairments in communication and social behavior, along with restricted and repetitive behavior — the primary goals of treatment are to improve the child’s communication and social behavior as well as reduce the occurrence of restricted and repetitive behavior (American Psychiatric Association, 2000). Applied behavior analysis has been demonstrated to be the treatment of choice for students with autism based on over 40 years of supportive evidence in improving social behavior and communication and reducing levels of problem behavior (Lovaas, 1987). The methods used in applied behavior analysis focus on targeting specific behavior, defining the behavior, designing an intervention to meet the goal of behavior change, implementing the intervention, analyzing the effectiveness of the intervention, and continuing the intervention or designing a procedure to maintain the behavior change (Cooper et al. 2007). Research approaches for teaching students with autism have been effective across social, communication, and problem behavior areas (Smith, 2001). Teaching methods will be reviewed in the current chapter along with staff training methods for building effectiveness and competency with those who teach students with autism (Reid & Green, 1980; Ryan & Hemmes, 2005, Ryan, et al., 2008).

Background Autism is a disorder characterized by pervasive delays in the development of language and socialization, and the presence of stereotyped, repetitive behaviors or nonfunctional interests. Although a multitude of treatments for autism exist, very few have been the subject of scientific research. The only treatment that has been supported by substantial empirical research is treatment based on applied behavior analysis (ABA). Methods This article describes components of comprehensive ABA treatment programs, reviews research on effectiveness, and discusses issues related to collaboration between ABA and psychiatry. Results ABA has been supported by several hundred single case experiments and an increasing number of between-groups studies. Comprehensive ABA treatment programs are comprised of multiple intervention procedures, such as discrete trial instruction and natural environment training, and are founded on basic principles of learning and motivation, such as positive reinforcement, extinction, stimulus control, and generalization. Clinicians in the fields of ABA and psychiatry have similar goals regarding client outcome, and several ABA measurement and analysis procedures produce information that may be useful to psychiatrists. Conclusions ABA treatment programs for individuals with autism are supported by a significant amount of scientific evidence and are therefore recommended for use. Patient care would likely benefit from a greater degree of collaboration between practitioners in the fields of ABA and psychiatry.

Background: Autistic is a developmental disorder that affects some aspects of how children see the world and how to learn through experience. Children with autistic disorder usually less able to feel the social contact. Children with autism tend to be aloof and avoid contact with the surrounding environment. One method that is famous for teaching behavioral therapy is applied behavior analysis (ABA) therapy use a system that gives special training in children by providing positive reinforcement (reward / praise). Purpose: To determine the influence of ABA methods to social interaction skills of children with autism. Methods: Type of this research to be conducted in this study were pre-experimental research. With One group pretest posttest design. The population in this study were students from kindergarten to elementary school classes in the School of Autism BinaAnggita Yogyakarta as many as 10 children. This study uses total sampling technique. Respondent data collected using observation sheet ATEC. Analysis of the data used is using a paired t-test. Results: The results of this study are significant infuence that ABA therapy has an effect on the ability to interact socially autistic children. With the result that sig is 0,001 <0,05. Based on these results it is concluded that H0 is rejected and Ha accepted.

Applied Behavior Analysis (ABA) is a widely recommended intervention for autistic children, but it has recently been criticized because of its potential negative effects on mental health. This study aims to map experiences with ABA and related techniques in the Netherlands by investigating different types of ABA interventions, experiences and satisfaction levels, and explores variations across techniques and stakeholders. An exploratory sequential mixed methods design was employed, beginning with qualitative focus groups (n = 22) followed by a quantitative online survey (n = 219). Participants included autistic adults, parents/legal representatives, and healthcare professionals. Focus groups revealed six main themes: diverse interpretations of ABA, variations in its application, positive experiences, concerns about overburdening and psychological impacts, criticisms of the healthcare system, and quality control issues. Survey results indicated that satisfaction with ABA interventions varied, with autistic adults being less satisfied than parents and healthcare professionals. Positive outcomes included improved communication and independence, while negative experiences involved trauma and concerns about ethical application. Better quality interventions were associated with higher satisfaction levels. The study reveals diverse experiences and interpretations of ABA. Participants raised significant concerns that merit attention alongside the noted benefits of ABA. Improving training and ensuring ethical practices are crucial to maximize ABA's potential to positively impact the lives of autistic individuals. Future efforts should focus on enhancing regulation, standardization, and incorporating autistic perspectives to optimize outcomes.

The term positive behaviour support (PBS) is used to describe the integration of the contemporary ideology of disability service provision with the clinical framework of applied behaviour analysis (ABA). Assent, the participation consent of those not legally able to consent, has gained recent popularity in the fields of ABA and PBS. The goal of assent-based ABA and PBS is a person-centered approach to assessment, intervention, and all other decision-making. In this model, the learner’s assent withdrawal for participation is honored, whether it be a vocal ‘no’ or a non-vocal expression of verbal behaviour. There is currently a limited subset of studies that mention or utilize assent with learners in ABA or PBS. The lack of published research can make assent-based practices seem to be a choice of the practitioner. The authors of this manuscript seek to further define assent, illuminate the necessity of assent-based practices, and offer assent-based procedures in ABA- and PBS-based intervention.

Acceptance describes mediating behaviors in which an individual reduces escape and avoidance behaviors in response to unwanted private events while also encouraging increased appetitive control. Given the recent resurgence of interest in acceptance and commitment therapy/training (ACT) in applied behavior analysis (ABA), a review of this core treatment process is warranted. Acceptance has strong empirical support within the psychological and contextual behavioral science literatures, with treatment outcome studies, self-report measures research, and behavioral laboratory tasks all supporting the process. A review of select publications in behavior-analytic journals found that acceptance also has preliminary evidence of effectiveness across a variety of populations and problem behaviors in ABA. An application of acceptance in an ABA context is discussed, and recommendations for a more functional approach to acceptance and other ACT processes are offered. Acceptance interventions fall within the scope of practice of ABA in several contexts and are of relevance to mainstream ABA practitioners.

Expanding the field of behavior analysis allows empirically validated practices to be more accessible for children impacted by autism, developmental disabilities, and behavioral challenges. However, even with the global advancement of applied behavior analysis (ABA) getting the science into the area where children spend most of their time, schools, can be a challenge. Professional development for teachers in the area of ABA has been previously investigated. However, incorporating ABA coursework into pre-service teacher training does not have a strong research base. Looking specifically at teaching ABA coursework in English to a group of speakers of English as a second language is even more novel. Therefore, the aim of this investigation was to use an alternating treatments design in an undergraduate pre-service teacher ABA elective course to evaluate the effectiveness and social validity of information delivery in two different formats: in-person lecture and online recorded lecture. The findings of the study did not show a difference in student course performance based on delivery method, but did show variations in preferences. Overall, the blended model of instruction proved effective in disseminating ABA to pre-service teachers in their nonnative language with promising reports for future usage.