Conversion therapy

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Conversion_therapy

Conversion therapy is the pseudoscientific practice of attempting to change an individual's sexual orientation, gender identity, or gender expression to align with heterosexual and cisgender norms. Methods that have been used to this end include forms of brain surgery, surgical or hormonal castration, aversive treatments such as electric shocks, nausea-inducing drugs, hypnosis, counseling, spiritual interventions, visualization, psychoanalysis, and masturbatory reconditioning.

There is a scientific consensus that conversion therapy is ineffective at changing a person's sexual orientation or gender identity and that it frequently causes significant, long-term psychological harm in individuals who undergo it. The position of current evidence-based medicine and clinical guidance is that homosexuality, bisexuality and gender variance are natural and healthy aspects of human sexuality. Historically, conversion therapy was the treatment of choice for individuals who disclosed same-sex attractions or exhibited gender nonconformity, which were formerly assumed to be pathologies by the medical establishment.

An increasing number of jurisdictions around the world have passed laws against conversion therapy. Conversion therapy may constitute fraud and when performed on minors, a form of child abuse; it has been described by experts as torture, cruel, inhuman, or degrading treatment, and contrary to human rights.

Terminology

Medical professionals and activists consider "conversion therapy" a misnomer, as it does not constitute a legitimate form of therapy. Alternative terms include sexual orientation change efforts (SOCE), gender identity change efforts (GICE)—together, sexual orientation and gender identity change efforts (SOGICE). According to researcher Douglas C. Haldeman, SOCE and GICE should be considered together because both rest on the assumption "that gender-related behavior consistent with the individual's birth sex is normative and anything else is unacceptable and should be changed". "Reparative therapy" may refer to conversion therapy in general, or to a subset thereof.

History

Main article: History of conversion therapy

Sexual orientation change efforts (SOCE)

The term homosexual was coined by German-speaking Hungarian writer Karl Maria Kertbeny and was in circulation by the 1880s. Into the middle of the twentieth century, competing views of homosexuality were advanced by psychoanalysis versus academic sexology. Sigmund Freud, the founder of psychoanalysis, viewed homosexuality as a form of arrested development. Later psychoanalysts followed Sandor Rado, who argued that homosexuality was a "phobic avoidance of heterosexuality caused by inadequate early parenting". This line of thinking was popular in psychiatric models of homosexuality based on the prison population or homosexuals seeking treatment. In contrast, sexology researchers such as Alfred Kinsey argued that homosexuality was a normal variation in human development. In 1970, gay activists confronted the American Psychiatric Association, persuading the association to reconsider whether homosexuality should be listed as a disorder. The APA delisted homosexuality in 1973, which contributed to shifts in public opinion on homosexuality.

Despite their lack of scientific backing, some socially or religiously conservative activists continued to argue that if one person's sexuality could be changed, homosexuality was not a fixed class such as race. Borrowing from discredited psychoanalytic ideas about the cause of homosexuality, some of these individuals offered conversion therapy. In 2001, conversion therapy attracted attention when Robert L. Spitzer published a non-peer-reviewed study asserting that some homosexuals could change their sexual orientation. Many researchers made methodological criticisms of the study, which Spitzer later repudiated.

Gender identity change efforts (GICE)

Gender Identity Change Efforts (GICE) refer to practices of healthcare providers and religious counselors with the goal of attempting to alter a person's gender identity or expression to conform to social norms. Examples include aversion therapy, cognitive restructuring, and psychoanalytic and talk therapies. Western medical-model narratives have historically institutionalized transphobia: systemically favoring a binary gender model and pathologizing gender diversity and non-conformity. This aided the development and proliferation of GICE.

Early interventions were rooted in psychoanalytic hypotheses. Robert Stoller advanced the theory that gender-nonconforming behavior and expression in children assigned male at birth (AMAB) was caused by being overly close to their mother. Richard Green continued his research; his methods for altering behavior included having the father spend more time with the child and mother less, expecting both to exhibit stereotypical gender roles, and having them praise their child's masculine behaviors, and shame their feminine and gender-nonconforming ones. These interventions resulted in depression in the children and feelings of betrayal from parents that the treatments failed.

In the 1970s, UCLA psychologist Richard Green recruited Ole Ivar Lovaas to adapt the techniques of ABA therapy to attempt to prevent children from becoming transsexuals. Deemed the "Feminine Boy Project", the treatments used operant conditioning to reward gender-conforming behaviors, and punish gender non-conforming behaviors. They recruited George Rekers as a behavioral therapist for the project. The project published several studies focusing on one subject and claiming that the child had been "cured" after 60 treatment sessions. However, decades later at the age of 38, the subject died of suicide, with the family blaming psychological trauma from the program.

Kenneth Zucker at CAMH adopted Richard Green's methods, but narrowed the scope to attempting to prevent the child from identifying as transgender. His model used the same interventions as Green with the addition of psychodynamic therapy. In 2015, an Ontario law was passed making conversion therapy illegal to provide to minors, and removing it from public health insurance coverage for adults. As a result of the law, Zucker's clinic was shut down, and he was fired.

Some clinicians have begun using "gender exploratory therapy" as an alternative to gender-affirming approaches for youth with gender dysphoria. Gender exploratory therapy uses talk therapy in an attempt to find pathological roots for gender dysphoria. In a September 2022 review of gender exploratory therapy, bioethicist Florence Ashley found strong similarities to conversion practices.

Motivations

A frequent motivation for adults who pursue conversion therapy is their religious beliefs, especially evangelical Christianity and Orthodox Judaism, that disapprove of same-sex relations. These adults prioritize maintaining a good relationship with their family and religious community. Adolescents who are pressured by their families into undergoing conversion therapy also typically come from a conservative religious background. Youth from families with low socioeconomic status are also more likely to undergo conversion therapy.

Theories and techniques

As societal attitudes toward homosexuality have become more tolerant over time, the most harsh conversion therapy methods such as aversion have been reduced. Secular conversion therapy is offered less often due to reduced medical pathologization of homosexuality, and religious practitioners have become more dominant.

Aversion therapy

See also: Behavior modification

Aversion therapy used on homosexuals included electric shock and nausea-inducing drugs during presentation of same-sex erotic images. Cessation of the aversive stimuli was typically accompanied by the presentation of opposite-sex erotic images, with the objective of strengthening heterosexual feelings. Another method used was the covert sensitization method, which involves instructing patients to imagine vomiting or receiving electric shocks, writing that only single case studies have been conducted, and that their results cannot be generalized. Haldeman writes that behavioral conditioning studies tend to decrease homosexual feelings, but do not increase heterosexual feelings, citing Rangaswami's "Difficulties in arousing and increasing heterosexual responsiveness in a homosexual: A case report", published in 1982, as typical in this respect.^[29]

Aversion therapy was developed in Czechoslovakia between 1950 and 1962 and in the Commonwealth from 1961 into the mid-1970s. In the context of the Cold War, Western psychologists ignored the poor results of their Czechoslovak counterparts, who had concluded that aversion therapy was not effective by 1961 and recommended decriminalization of homosexuality instead. Some men in the United Kingdom were offered the choice between prison and undergoing aversion therapy. It was also offered to a few British women, but was never the standard treatment for either homosexual men or women.

Brain surgery

In the 1940s and 1950s, U.S. neurologist Walter Freeman popularized the ice-pick lobotomy as a treatment for homosexuality. He personally performed as many as 3,439 lobotomy surgeries in 23 states, of which 2,500 used his ice-pick procedure, despite the fact that he had no formal surgical training.

Castration and transplantation

See also: Persecution of homosexuals in Nazi Germany

 

Friedrich-Paul von Groszheim (1908–2006) was spared from a concentration camp after agreeing to castration under pressure in 1938.

In early twentieth century Germany experiments were carried out in which homosexual men were subjected to unilateral orchiectomy and testicles of heterosexual men were transplanted. These operations were a complete failure.

Surgical castration of homosexual men was widespread in Europe in the first half of the twentieth century and was also practiced in the United States. SS leader Heinrich Himmler ordered homosexual men to be sent to concentration camps because he did not consider a time-limited prison sentence was sufficient to eliminate homosexuality. Although theoretically voluntary, some homosexuals were subject to severe pressure and coercion to agree to castration. There was no age limit; some boys as young as 16 were castrated. Those who agreed to castration after a Paragraph 175 conviction were exempted from being transferred to a concentration camp after completing their legal sentence. Some concentration camp prisoners were also subjected to castration. An estimated 400 to 800 men were castrated.

Endocrinologist Carl Vaernet attempted to change homosexual concentration camp prisoners' sexual orientations by implanting a pellet that released testosterone. Most of the victims, non-consenting prisoners at Buchenwald, died shortly thereafter.

An unknown number of men were castrated in West Germany and chemical castration was used in other Western countries, notably against Alan Turing in the United Kingdom.

Ex-gay/ex-trans ministry

OneByOne booth at a Love Won Out conference

 

Main article: Ex-gay

Some sources describe ex-gay and ex-trans ministries as a form of conversion therapy, while others state that ex-gay organizations and conversion therapy are distinct methods of attempting to convert gay people to heterosexuality. The umbrella organization Exodus International in the United States ceased activities in June 2013, and the three member board issued a statement which repudiated its aims and apologized for the harm their pursuit has caused to LGBT people. Ex-gay/ex-trans organizations often overlap and portray being trans as inherently sinful or against God's design, or pathologize gender variance as due to trauma, social contagion, or "gender ideology."

Hypnosis

Hypnosis was used in conversion therapy since the 19th century by Richard von Krafft-Ebing and Albert von Schrenck-Notzing. In 1967, Canadian psychiatrist Peter Roper published a case study of treating 15 homosexuals (some of which would probably be considered bisexuals by modern standards) with hypnosis. Allegedly, 8 showed "marked improvement" (they reportedly lost sexual attraction towards the same sex altogether), 4 mild improvements (decrease of "homosexual tendencies"), and 3 no improvement after hypnotic treatment; he concluded that "hypnosis may well produce more satisfactory results than those obtainable by other means", depending on the hypnotic susceptibility of the subjects.

Psychoanalysis

Main article: Psychoanalysis

Haldeman writes that psychoanalytic treatment of homosexuality is exemplified by the work of Irving Bieber et al. in Homosexuality: A Psychoanalytic Study of Male Homosexuals. They advocated long-term therapy aimed at resolving the unconscious childhood conflicts that they considered responsible for homosexuality. Haldeman notes that Bieber's methodology has been criticized because it relied upon a clinical sample, the description of the outcomes was based upon subjective therapist impression, and follow-up data were poorly presented. Bieber reported a 27% success rate from long-term therapy, but only 18% of the patients in whom Bieber considered the treatment successful had been exclusively homosexual to begin with, while 50% had been bisexual. In Haldeman's view, this makes even Bieber's unimpressive claims of success misleading.

Haldeman discusses other psychoanalytic studies of attempts to change homosexuality. Curran and Parr's "Homosexuality: An analysis of 100 male cases", published in 1957, reported no significant increase in heterosexual behavior. Mayerson and Lief's "Psychotherapy of homosexuals: A follow-up study of nineteen cases", published in 1965, reported that half of its 19 subjects were exclusively heterosexual in behavior four and a half years after treatment, but its outcomes were based on patient self-report and had no external validation. In Haldeman's view, those participants in the study who reported change were bisexual at the outset, and its authors wrongly interpreted capacity for heterosexual sex as change of sexual orientation.

Reparative therapy

The term "reparative therapy" has been used as a synonym for conversion therapy generally, but according to Jack Drescher it properly refers to a specific kind of therapy associated with the psychologists Elizabeth Moberly and Joseph Nicolosi. The term reparative refers to Nicolosi's postulate that same-sex attraction is a person's unconscious attempt to "self-repair" feelings of inferiority.

Marriage therapy

See also: Relationship counseling

Previous editions of the World Health Organization's ICD included "sexual relationship disorder", in which a person's sexual orientation or gender identity makes it difficult to form or maintain a relationship with a sexual partner. The belief that their sexual orientation has caused problems in their relationship may lead some people to turn to a marriage therapist for help to change their sexual orientation. Sexual orientation disorder was removed from the most recent ICD, ICD-11, after the Working Group on Sexual Disorders and Sexual Health determined that its inclusion was unjustified.

Effects

There is a scientific consensus that conversion therapy is ineffective at changing a person's sexual orientation. Advocates of conversion therapy rely heavily on testimonials and retrospective self-reports as evidence of effectiveness. Studies purporting to validate the effectiveness of efforts to change sexual orientation or gender identity have been criticized for methodological flaws. After conversion therapy has failed to change someone's sexual orientation or gender identity, participants often feel increased shame that they already felt over their sexual orientation or gender identity.

Conversion therapy can cause significant, long-term psychological harm. This includes significantly higher rates of depression, substance abuse, and other mental health issues in individuals who have undergone conversion therapy than their peers who did not, including a suicide attempt rate nearly twice that of those who did not. Modern-day practitioners of conversion therapy—primarily from a conservative religious viewpoint—disagree with current evidence-based medicine and clinical guidance that does not view homosexuality and gender variance as unnatural or unhealthy.

A 2022 study estimated that conversion therapy of youth in the United States cost $650.16 million annually with an additional $9.5 billion in associated costs such as increased suicide and substance abuse. Youth who undergo conversion therapy from a religious provider have more negative mental health outcomes than those who had consulted a licensed healthcare provider.

Public opinion

A 2020 survey carried out on US adults found majority support for banning conversion therapy for minors.

A 2022 YouGov poll found majority support in England, Scotland, and Wales for a conversion therapy ban for both sexual orientation and gender identity, with opposition ranging from 13 to 15 percent.

Legal status

Main article: Legality of conversion therapy

 

Map of jurisdictions that have bans on sexual orientation and gender identity change efforts with minors.

  Criminal prohibition against conversion therapy on the basis of sexual orientation and gender identity

  Only medical professionals are banned from performing conversion therapy

  Conversion therapy is banned only in some subnational jurisdictions

  Ban on conversion therapy pending or proposed

  No ban on conversion therapy

Some jurisdictions have criminal bans on the practice of conversion therapy, including Malta, Spain, France, Germany, Albania, Mexico and Canada. In other countries, including Brazil, Ecuador, and Taiwan, medical professionals are barred from practicing conversion therapy.

In some states, lawsuits against conversion therapy providers for fraud have succeeded, but in other jurisdictions those claiming fraud must prove that the perpetrator was intentionally dishonest. Thus, a provider who genuinely believes conversion therapy is effective could not be convicted.

Conversion therapy on minors may amount to child abuse.

Human rights

In 2020 the International Rehabilitation Council for Torture Victims released an official statement that conversion therapy is torture. The same year, UN Independent Expert on sexual orientation and gender identity, Victor Madrigal-Borloz, said that conversion therapy practices are "inherently discriminatory, that they are cruel, inhuman and degrading treatment, and that depending on the severity or physical or mental pain and suffering inflicted to the victim, they may amount to torture". He recommended that it should be banned across the world. In 2021 Ilias Trispiotis and Craig Purshouse argue that conversion therapy violates the prohibition against degrading treatment under Article 3 of the European Convention on Human Rights, leading to a state obligation to prohibit it.

Medical views

Main article: Medical views of conversion therapy

Many health organizations around the world have denounced and criticized sexual orientation and gender identity change efforts. National health organizations in the United States have announced that there has been no scientific demonstration of conversion therapy's efficacy in the last forty years. They find that conversion therapy is ineffective, risky and can be harmful. Anecdotal claims of cures are counterbalanced by assertions of harm, and the American Psychiatric Association, for example, cautions ethical practitioners under the Hippocratic oath to do no harm and to refrain from attempts at conversion therapy.

Mainstream medical bodies state that conversion therapy can be harmful because it may exploit guilt and anxiety, thereby damaging self-esteem and leading to depression and even suicide. There is also concern in the mental health community that the advancement of conversion therapy can cause social harm by disseminating inaccurate views about gender identity, sexual orientation, and the ability of LGBTQ people to lead happy, healthy lives.

Some medical bodies prohibit their members from practicing conversion therapy.

Applied behavior analysis

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Applied_behavior_analysis

Applied behavior analysis (ABA), also called behavioral engineering, is a psychological intervention that applies empirical approaches based upon the principles of respondent and operant conditioning to change behavior of social significance. It is the applied form of behavior analysis; the other two forms are radical behaviorism (or the philosophy of the science) and the experimental analysis of behavior (or basic experimental laboratory research).

The name applied behavior analysis has replaced behavior modification because the latter approach suggested attempting to change behavior without clarifying the relevant behavior-environment interactions. In contrast, ABA changes behavior by first assessing the functional relationship between a targeted behavior and the environment. Further, the approach often seeks to develop socially acceptable alternatives for aberrant behaviors.

Although service delivery providers overwhelmingly specialize in utilizing structured and naturalistic early behavioral interventions for individuals with autism, ABA has also been utilized in a range of other areas.

ABA is controversial, especially among members of the autism rights movement, for a number of reasons. There is a perception that some ABA interventions emphasize normalization, instead of acceptance, and a history of, in some embodiments of ABA and its predecessors, the use of aversives, such as electric shocks. ABA is also controversial due to concerns about its relatively weak evidence base. In the last few years, there have been reforms in some types of ABA interventions to address these criticisms and concerns, especially regarding masking.

Definition

ABA is an applied science devoted to developing procedures which will produce observable changes in behavior. It is to be distinguished from the experimental analysis of behavior, which focuses on basic experimental laboratory research, but it uses principles developed by such research, in particular operant conditioning and classical conditioning. Behavior analysis adopts the viewpoint of radical behaviorism, treating thoughts, emotions, and other covert activity as behavior that is subject to the same rules as overt responses. This represents a shift away from methodological behaviorism, which restricts behavior-change procedures to behaviors that are overt, and was the conceptual underpinning of behavior modification.

Behavior analysts also emphasize that the science of behavior must be a natural science as opposed to a social science. As such, behavior analysts focus on the observable relationship of behavior with the environment, including antecedents and consequences, without resort to "hypothetical constructs".

History

Further information: Radical behaviorism, Experimental analysis of behavior, Behavior modification, Operant conditioning, B. F. Skinner, Charles Ferster, Nathan Azrin, Jack Michael, Donald M. Baer, Montrose Wolf, Sidney W. Bijou, Ivar Lovaas, Robert Koegel, and Steven C. Hayes

The beginnings of ABA can be traced back to Teodoro Ayllon and Jack Michael's study "The psychiatric nurse as a behavioral engineer" (1959) that they published in the Journal of the Experimental Analysis of Behavior (JEAB). Ayllon and Michael were training the staff at a psychiatric hospital how to use a token economy based on the principles of operant conditioning for patients with schizophrenia and intellectual disability, which led to researchers at the University of Kansas to start the Journal of Applied Behavior Analysis (JABA) in 1968.

A group of researchers at the University of Washington, including Donald Baer, Sidney W. Bijou, Bill Hopkins, Jay Birnbrauer, Todd Risley, and Montrose Wolf, applied the principles of behavior analysis to manage the behavior of children and adolescents in juvenile detention centers and organize employees who required proper structure and management in businesses. In 1968, Baer, Bijou, Risley, Birnbrauer, Wolf, and James Sherman joined the Department of Human Development and Family Life at the University of Kansas, where they founded the Journal of Applied Behavior Analysis.

Notable graduate students from the University of Washington include Robert Wahler, James Sherman, and Ivar Lovaas. Lovaas established the UCLA Young Autism Project while teaching at the University of California, Los Angeles. In 1965, Lovaas published a series of articles that described a pioneering investigation of the antecedents and consequences that maintained a problem behavior, and relied on the methods of errorless learning which was initially used by Charles Ferster to teach nonverbal children to speak. Lovaas also described how to use social (secondary) reinforcers, teach children to imitate, and what interventions (including electric shocks) may be used to reduce aggression and life-threatening self-injury.

In 1987, Lovaas published the study, "Behavioral treatment and normal educational and intellectual functioning in young autistic children". The experimental group in this study received an average of 40 hours per week in a 1:1 teaching setting at a table using errorless discrete trial training (DTT). The treatment is done at home with parents involved, and the curriculum is highly individualized with a heavy emphasis on teaching eye contact, fine and gross motor imitation, and language. The use of aversives and reinforcement were used to motivate learning and reduce non-desired behaviors. Early development of the therapy in the 1960s involved use of shocks and the withholding of food. By the time children were enrolled in this study, such aversives were abandoned, and a loud "no" or a slap to the thigh were used only as a last resort to reduce aggressive and self-stimulatory behaviors. The outcome of this study indicated 47% of the experimental group (9/19) went on to lose their autism diagnosis and were described as indistinguishable from their typical adolescent peers. This included passing education without assistance and making and maintaining friends. These gains were maintained as reported in the 1993 study, "Long-term outcome for children with autism who received early intensive behavioral treatment". Lovaas' work went on to be recognized by the US Surgeon General in 1999, and his research were replicated in university and private settings. The "Lovaas Method" went on to become known as early intensive behavioral intervention (EIBI).

Over the years, "behavior analysis" gradually superseded "behavior modification"; that is, from simply trying to alter problematic behavior, behavior analysts sought to understand the function of that behavior, what reinforcement histories (i.e., attention seeking, escape, sensory stimulation, etc.) promote and maintain it, and how it can be replaced by successful behavior. This analysis is based on careful initial assessment of a behavior's function and a testing of methods that produce changes in behavior.

While ABA seems to be intrinsically linked to autism intervention, it is also used in a broad range of other situations. Recent notable areas of research in the Journal of Applied Behavior Analysis include autism, classroom instruction with typically developing students, pediatric feeding therapy, and substance use disorders. Other applications of ABA include applied animal behavior, consumer behavior analysis, forensic behavior analysis, behavioral medicine, behavioral neuroscience, clinical behavior analysis, organizational behavior management, schoolwide positive behavior support, and contact desensitization for phobias.

Characteristics

Baer, Wolf, and Risley's 1968 article is still used as the standard description of ABA.  It lists the following seven characteristics of ABA. Another great resource for the characteristics of applied behavior analysis is from a textbook called, “Behavior Modification: Principles and Procedures.” 

• Applied: ABA focuses on the social significance of the behavior studied. For example, a non-applied researcher may study eating behavior because this research helps to clarify metabolic processes, whereas the applied researcher may study eating behavior in individuals who eat too little or too much, trying to change such behavior so that it is more acceptable to the persons involved. It is also based on trying to improve the everyday life of clients that are receiving it.
• Behavioral: ABA is pragmatic; it asks how it is possible to get an individual to do something effectively. To answer this question, the behavior itself must be objectively measurable and observable. This is designed so that when someone is trying to determine a target behavior, it is able to be observed and understood by anyone. Verbal descriptions are treated as behavior in themselves, and not as substitutes for the behavior described.
• Analytic: Behavior analysis is successful when the analyst understands and can manipulate the events that control a target behavior. This may be relatively easy to do in the lab, where a researcher is able to arrange the relevant events, but it is not always easy, or ethical, in an applied situation. In order to consider something to fall under the spectrum of analytic, it must demonstrate a functional relationship and it must be provable. Baer et al. outline two methods that may be used in applied settings to demonstrate control while maintaining ethical standards. These are the reversal design and the multiple baseline design. In the reversal design, the experimenter first measures the behavior of choice, introduces an intervention, and then measures the behavior again. Then, the intervention is removed, or reduced, and the behavior is measured yet again. The intervention is effective to the extent that the behavior changes and then changes back in response to these manipulations. The multiple baseline method may be used for behaviors that seem irreversible. Here, several behaviors are measured and then the intervention is applied to each in turn. The effectiveness of the intervention is revealed by changes in just the behavior to which the intervention is being applied.
• Technological: The description of analytic research must be clear and detailed, so that any competent researcher can repeat it accurately. The goal is to make sure that anyone can implement and understand what is being explained. Cooper et al. describe a good way to check this: Have a person trained in applied behavior analysis read the description and then act out the procedure in detail. If the person makes any mistakes or has to ask any questions then the description needs improvement.
• Conceptually Systematic: Behavior analysis should not simply produce a list of effective interventions. Rather, to the extent possible, these methods should be grounded in the principles of applied behavioral analysis. This is aided by the use of theoretically meaningful terms, such as "secondary reinforcement" or "errorless discrimination" where appropriate.
• Effective: Though analytic methods should be theoretically grounded, they must be effective. Interventions also must be relevant to the client and/or culture. An analyst must ask themselves if the intervention is working. The intervention must also contain a positive change. If an intervention does not produce a large enough effect for practical use, then the analysis has failed
• Generality: Behavior analysts should aim for interventions that are generally applicable; the methods should work in different environments, apply to more than one specific behavior, and have long-lasting effects. This generalizability should be implemented from the very beginning of the intervention. When first starting a new intervention, it is a good idea for that to take place in a natural environment for the client.

Other proposed characteristics

In 2005, Heward et al. suggested that the following five characteristics should be added:

• Accountable: To be accountable means that ABA must be able to demonstrate that its methods are effective. This requires the repeatedly measuring the effect of interventions (success, failure or no effect at all), and, if necessary, making changes that improve their effectiveness.
• Public: The methods, results, and theoretical analyses of ABA must be published and open to scrutiny. There are no hidden treatments or mystical, metaphysical explanations.
• Doable: To be generally useful, interventions should be available to a variety of individuals, who might be teachers, parents, therapists, or even those who wish to modify their own behavior. With proper planning and training, many interventions can be applied by almost anyone willing to invest the effort.
• Empowering: ABA provides tools that give the practitioner feedback on the results of interventions. These allow clinicians to assess their skill level and build confidence in their effectiveness.
• Optimistic: According to several leading authors, behavior analysts have cause to be optimistic that their efforts are socially worthwhile, for the following reasons:
  • The behaviors impacted by behavior analysis are largely determined by learning and controlled by manipulable aspects of the environment.
  • Practitioners can improve performance by direct and continuous measurements.
  • As a practitioner uses behavioral techniques with positive outcomes, they become more confident of future success.
  • The literature provides many examples of success in teaching individuals considered previously unteachable.

Use in the treatment of autism

A large majority of ABA practitioners specialise in autism, although BCBA certification does not require any autism training. ABA-based techniques are often used to teach adaptive behaviors or to diminish behaviors associated with autism, so much that ABA itself is often mistakenly considered to be synonymous with therapy for autism. According to a paper from 2007, it was considered to be an effective "intervention for challenging behaviors" by the American Academy of Pediatrics. A 2018 Cochrane review of five studies that compared treatment vs. control showed that ABA may be effective for some autistic children, but noted that the evidence for this is weak. The effectiveness of ABA treatments for autism may be overall limited by diagnostic severity, age of intervention, and IQ.

Efficacy

2020 onward reviews

Justin B. Leaf and others examined and responded to criticisms of ABA in a 2021 paper.

The results of two studies surveying autistic adults who went through ABA as a child found that a majority perceived ABA to have a detrimental impact on their lives, although in common with most ABA research, the studies had methodological concerns and a risk of bias. Two 2020 reviews found that very few studies directly reported on or investigated possible harms; although a significant number of studies mentioned adverse events in their analysis of why people withdrew from them, there was no effort to monitor or collect data on adverse outcomes.

2010-2019 reviews

In 2011, investigators from Vanderbilt University under contract with the Agency for Healthcare Research and Quality performed a comprehensive review of the scientific literature on ABA-based and other therapies for autism spectrum disorders; the ABA-based therapies included the UCLA/Lovaas method and the Early Start Denver Model (the latter developed by Sally Rogers and Geraldine Dawson). They concluded that "both approaches were associated with ... improvements in cognitive performance, language skills, and adaptive behavior skills". However, they also concluded that "the strength of evidence ... is low", "many children continue to display prominent areas of impairment", "subgroups may account for a majority of the change", there is "little evidence of practical effectiveness or feasibility beyond research studies", and the published studies "used small samples, different treatment approaches and duration, and different outcome measurements".

A preliminary 2014 study indicated that there might be a publication bias against single-subject research studies that show that ABA is ineffective. Publication bias could lead to exaggerated estimates of intervention effects observed by single-subject studies.

A 2019 meta-analysis found some evidence in favour of behavioral interventions, but noted that "methodological rigor remains a pressing concern in this area of research" and, when they limited their scope to RCT designs and outcomes for which there was no risk of detection bias, found no significant effects on any outcome, for any of the approaches they looked at.

2007-2009 reviews

A 2007 clinical report of the American Academy of Pediatrics concluded that the benefit of ABA-based interventions in autism spectrum disorders (ASDs) "has been well documented" and that "children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior". In 2008, Researchers from the MIND Institute published an evidence-based review of comprehensive treatment approaches. On the basis of "the strength of the findings from the four best-designed, controlled studies", they were of the opinion that one ABA-based approach (the Lovaas technique created by Ole Ivar Løvaas) is "well-established" for improving intellectual performance of young children with ASD.

A 2009 review of psycho-educational interventions for children with autism whose mean age was six years or less at intake found that five high-quality ("Level 1" or "Level 2") studies assessed ABA-based treatments. On the basis of these and other studies, the author concluded that ABA is "well-established" and is "demonstrated effective in enhancing global functioning in pre-school children with autism when treatment is intensive and carried out by trained therapists". However, the review committee also concluded that "there is a great need for more knowledge about which interventions are most effective". A 2009 paper included a descriptive analysis, an effect size analysis, and a meta-analysis of 13 reports published from 1987 to 2007 of early intensive behavioral intervention (EIBI, a form of ABA-based treatment with origins in the Lovaas technique) for autism. It determined that EIBI's effect sizes were "generally positive" for IQ, adaptive behavior, expressive language, and receptive language. The paper did note limitations of its findings including the lack of published comparisons between EIBI and other "empirically validated treatment programs". In a 2009 systematic review of 11 studies published from 1987 to 2007, the researchers wrote "there is strong evidence that EIBI is effective for some, but not all, children with autism spectrum disorders, and there is wide variability in response to treatment". Furthermore, any improvements are likely to be greatest in the first year of intervention.

A 2009 meta-analysis of nine studies published from 1987 to 2007 concluded that EIBI has a "large" effect on full-scale intelligence and a "moderate" effect on adaptive behavior in autistic children. A 2009 systematic review and meta-analysis by Spreckley and Boyd of four small-n 2000–2007 studies (involving a total of 76 children) came to different conclusions than the aforementioned reviews. Spreckley and Boyd reported that applied behavior intervention (ABI), another name for EIBI, did not significantly improve outcomes compared with standard care of preschool children with ASD in the areas of cognitive outcome, expressive language, receptive language, and adaptive behavior. In a letter to the editor, however, authors of the four studies meta-analyzed claimed that Spreckley and Boyd had misinterpreted one study comparing two forms of ABI with each other as a comparison of ABI with standard care, which erroneously decreased the observed efficacy of ABI. Furthermore, the four studies' authors raised the possibility that Spreckley and Boyd had excluded some other studies unnecessarily, and that including such studies could have led to a more favorable evaluation of ABI. Spreckley, Boyd, and the four studies' authors did agree that large multi-site randomized trials are needed to improve the understanding of ABA's efficacy in autism.

Criticism

Researchers and advocates have critiqued the leniency of the ABA ethical code, discussing how it does not restrict or clarify the "appropriate use of aversives", does not require competency as ABA therapists are "not required to take even a single class on autism, brain function or child development", and its view of the client as the parent meaning that requiring "client consent" only requires parental consent, not the person receiving services. Similarly, because the parent is seen as the client, the goals that are set under the ethical code are according to the client's needs, which often means that focusing on changing autistic behaviors for the benefit of the parent and not the child is considered ethical. Furthermore, studies have shown that ABA may be abusive and can increase symptoms of post-traumatic stress disorder (PTSD) in patients. The Autistic Self Advocacy Network campaigns against the use of ABA in autism.

Another criticism of the Lovaas Method is Lovaas's connection with gay conversion therapy, using his own behavior modification techniques seen in ABA in The Feminine Boy project. Similarities in gay conversion therapy to making boys indistinguishable from their heterosexual peers have been drawn with Lovaas' belief that ABA makes "autistic children indistinguishable from their normal friends." According to social worker and researcher Jake Pyne, ableism is the reason why ABA continues to be practiced in some jurisdictions where conversion therapy is prohibited, despite underlying similarities.

One study revealed extensive undisclosed conflicts of interest (COI) in published ABA studies. 84% of studies published in top behavioral journals over a period of one year had at least one author with a COI involving their employment, either as an ABA clinical provider or a training consultant to ABA clinical providers. However, only 2% of these studies disclosed the COI.

Some bioethicists argue that employing ABA violates the principles of justice and nonmaleficence and infringes on the autonomy of autistic children, and their parents as well.

Another concern is that ABA research only measures behavior as a means of success, which has led to a lack of qualitative research about autistic experiences of ABA, a lack of research examining the internal effects of ABA and a lack of research for autistic children who are non-speaking or have comorbid intellectual disabilities (which is concerning considering this is one of the major populations that intensive ABA focuses on). Research is also lacking about whether ABA is effective long-term and very little longitudinal outcomes have been studied.

One more area of critique has been the "ideological warfare" surrounding ABA and TEACCH, despite the philosophies and practices of the two approaches not necessarily being in opposition. The rhetoric surrounding ABA was criticized by The British Institute of Learning Disabilities, including parents and professionals that claim that ABA "cured" their child's autism, like one parent who "claims that ABA had saved her children's lives, likening it to chemotherapy as a treatment for cancer."

Views of the autistic community

See also: Autism rights movement

The value of eliminating autistic behaviors is disputed by proponents of neurodiversity, who claim that it forces autistic people to mask their true personalities on behalf of a narrow conception of normality. Masking is associated with suicidality and poor long-term mental health. Autism advocates contend that it is cruel to try to make autistic people "normal" without consideration for how this may affect their well-being. Instead, these critics advocate for increased social acceptance of harmless autistic traits and therapies focused on improving quality of life.

A 2020 study examined perspectives of autistic adults that received ABA as children and found that the overwhelming majority reported that "behaviorist methods create painful lived experiences", that ABA led to the "erosion of the true actualizing self", and that they felt they had a "lack of self-agency within interpersonal experiences".

In response to many of the criticisms towards ABA from the autistic community, some behavior analysts have referenced Damian Milton's theory of the double empathy problem, saying that behavior analysts are "just different" and "think differently from most other people", consequently feeling misunderstood and discriminated against by the autistic community.

Use of aversives

Some embodiments of applied behavior analysis as devised by Ole Ivar Lovaas used aversives such as electric shocks to modify undesirable behavior in their initial use in the 1970s, as well as slapping and shouting in a 1987 study. Over time the use of aversives lessened and in 2012 their use was described as being inconsistent with contemporary practice. However, aversives have continued to be used in some ABA programs. In comments made in 2014 to the US Food and Drug Administration (FDA), a clinician who previously worked at the Judge Rotenberg Educational Center claimed that "all textbooks used for thorough training of applied behavior analysts include an overview of the principles of punishment, including the use of electrical stimulation."

In 2010, the UN's Special Rapporteur on Torture described the Judge Rotenberg Center's use of electrical shocks on children as torture. In 2020, the FDA banned the use of electrical stimulation devices used for self-injurious or aggressive behavior and asserted that "Evidence indicates a number of significant psychological and physical risks are associated with the use of these devices, including worsening of underlying symptoms, depression, anxiety, PTSD, pain, burns, and tissue damage." In the same year, the U.S. Court of Appeals for the D.C. Circuit overturned the ban, ruling that the FDA "has no authority to choose what medical devices a practitioner should prescribe or administer or for which conditions" and the school announced that it would resume the use of electrical shocks.

Concepts

Behavior

Main article: Behavior

Behavior refers to the movement of some part of an organism that changes some aspect of the environment. Often, the term behavior refers to a class of responses that share physical dimensions or functions, and in that case a response is a single instance of that behavior. If a group of responses have the same function, this group may be called a response class. Repertoire refers to the various responses available to an individual; the term may refer to responses that are relevant to a particular situation, or it may refer to everything a person can do.

Operant conditioning

Main article: Operant conditioning

Operant behavior is the so-called "voluntary" behavior that is sensitive to, or controlled by its consequences. Specifically, operant conditioning refers to the three-term contingency that uses stimulus control, in particular an antecedent contingency called the discriminative stimulus (SD) that influences the strengthening or weakening of behavior through such consequences as reinforcement or punishment. The term is used quite generally, from reaching for a candy bar, to turning up the heat to escape an aversive chill, to studying for an exam to get good grades.

Respondent (classical) conditioning

Main article: Classical conditioning

Respondent (classical) conditioning is based on innate stimulus-response relationships called reflexes. In his famous experiments with dogs, Pavlov usually used the salivary reflex, namely salivation (unconditioned response) following the taste of food (unconditioned stimulus). Pairing a neutral stimulus, for example a bell (conditioned stimulus) with food caused the dog to elicit salivation (conditioned response). Thus, in classical conditioning, the conditioned stimulus becomes a signal for a biologically significant consequence. Note that in respondent conditioning, unlike operant conditioning, the response does not produce a reinforcer or punisher (e.g., the dog does not get food because it salivates).

Reinforcement

Main article: Reinforcement

Reinforcement is the key element in operant conditioning and in most behavior change programs. It is the process by which behavior is strengthened. If a behavior is followed closely in time by a stimulus and this results in an increase in the future frequency of that behavior, then the stimulus is a positive reinforcer. If the removal of an event serves as a reinforcer, this is termed negative reinforcement. There are multiple schedules of reinforcement that affect the future probability of behavior. "[H]e would get Beth to comply by hugging him and giving her food as a reward"

Punishment

Main article: Punishment (psychology)

Punishment is a process by which a consequence immediately follows a behavior which decreases the future frequency of that behavior. As with reinforcement, a stimulus can be added (positive punishment) or removed (negative punishment). Broadly, there are three types of punishment: presentation of aversive stimuli (e.g., pain), response cost (removal of desirable stimuli as in monetary fines), and restriction of freedom (as in a 'time out'). Punishment in practice can often result in unwanted side effects. Some other potential unwanted effects include resentment over being punished, attempts to escape the punishment, expression of pain and negative emotions associated with it, and recognition by the punished individual between the punishment and the person delivering it. "He would use loud sounds of 100 decibels on two 5-year-old autistic twins" 

Extinction

Main article: Extinction (psychology)

Extinction is the technical term to describe the procedure of withholding/discontinuing reinforcement of a previously reinforced behavior, resulting in the decrease of that behavior. The behavior is then set to be extinguished (Cooper et al.). Extinction procedures are often preferred over punishment procedures, as many punishment procedures are deemed unethical and in many states prohibited. Nonetheless, extinction procedures must be implemented with utmost care by professionals, as they are generally associated with extinction bursts. An extinction burst is the temporary increase in the frequency, intensity, and/or duration of the behavior targeted for extinction. Other characteristics of an extinction burst include an extinction-produced aggression—the occurrence of an emotional response to an extinction procedure often manifested as aggression; and b) extinction-induced response variability—the occurrence of novel behaviors that did not typically occur prior to the extinction procedure. These novel behaviors are a core component of shaping procedures.

Discriminated operant and three-term contingency

In addition to a relation being made between behavior and its consequences, operant conditioning also establishes relations between antecedent conditions and behaviors. This differs from the S–R formulations (If-A-then-B), and replaces it with an AB-because-of-C formulation. In other words, the relation between a behavior (B) and its context (A) is because of consequences (C), more specifically, this relationship between AB because of C indicates that the relationship is established by prior consequences that have occurred in similar contexts. This antecedent–behavior–consequence contingency is termed the three-term contingency. A behavior which occurs more frequently in the presence of an antecedent condition than in its absence is called a discriminated operant. The antecedent stimulus is called a discriminative stimulus (S^D). The fact that the discriminated operant occurs only in the presence of the discriminative stimulus is an illustration of stimulus control. More recently behavior analysts have been focusing on conditions that occur prior to the circumstances for the current behavior of concern that increased the likelihood of the behavior occurring or not occurring. These conditions have been referred to variously as "Setting Event", "Establishing Operations", and "Motivating Operations" by various researchers in their publications.

Verbal behavior

Main article: Verbal Behavior

B. F. Skinner's classification system of behavior analysis has been applied to treatment of a host of communication disorders. Skinner's system includes:

• Tact – a verbal response evoked by a non-verbal antecedent and maintained by generalized conditioned reinforcement.
• Mand – behavior under control of motivating operations maintained by a characteristic reinforcer.
• Intraverbals – verbal behavior for which the relevant antecedent stimulus was other verbal behavior, but which does not share the response topography of that prior verbal stimulus (e.g., responding to another speaker's question).
• Autoclitic – secondary verbal behavior which alters the effect of primary verbal behavior on the listener. Examples involve quantification, grammar, and qualifying statements (e.g., the differential effects of "I think..." vs. "I know...")

Skinner's use of behavioral techniques was famously critiqued by the linguist Noam Chomsky through an extensive breakdown of how Skinner's view of language as behavioral simply cannot explain the complexity of human language. This suggests that while behaviorist techniques can teach language, it is a very poor measure to explain language fundamentals. Considering Chomsky's critiques, it may be more appropriate to teach language through a Speech language pathologist instead of a behaviorist.

For an assessment of verbal behavior from Skinner's system, see Assessment of Basic Language and Learning Skills.

Measuring behavior

When measuring behavior, there are both dimensions of behavior and quantifiable measures of behavior. In applied behavior analysis, the quantifiable measures are a derivative of the dimensions. These dimensions are repeatability, temporal extent, and temporal locus.

Repeatability

Response classes occur repeatedly throughout time—i.e., how many times the behavior occurs.

• Count is the number of occurrences in behavior.
• Rate/frequency is the number of instances of behavior per unit of time.
• Celeration is the measure of how the rate changes over time.

Temporal extent

This dimension indicates that each instance of behavior occupies some amount of time—i.e., how long the behavior occurs.

• Duration is the period of time over which the behavior occurs.

Temporal locus

Each instance of behavior occurs at a specific point in time—i.e., when the behavior occurs.

• Response latency is the measure of elapsed time between the onset of a stimulus and the initiation of the response.
• Interresponse time is the amount of time that occurs between two consecutive instances of a response class.

Derivative measures

Derivative measures are unrelated to specific dimensions:

• Percentage is the ratio formed by combining the same dimensional quantities.
• Trials-to-criterion are the number of response opportunities needed to achieve a predetermined level of performance.

Applied behavior analysis is a goal discipline and spotlights on the dependable measurement and objective assessment of noticeable way of behaving. Without measuring behavior and assessing the information, behavior analysts wouldn't know whether to change the program we are chipping away at, when to switch or add new targets or when to change strategies to gain more noteworthy progress.

Behavior Analysts utilize a few distinct techniques to gather information. A portion of the ways of collect data information include:

Frequency

This technique refers to the times that an objective way of behaving was noticed and counted.

Rate

Same as frequency, yet inside a predefined time limit.

Duration

This estimation alludes to how much time that somebody participated in a way of behaving.

Fluency

This estimation refers to how rapidly a student can give reactions inside a timeframe.

Response latency

Latency refers to how much time after a particular boost has been given before the objective way of behaving happens.

Analyzing behavior change

Experimental control

In applied behavior analysis, all experiments should include the following:

• At least one participant
• At least one behavior (dependent variable)
• At least one setting
• A system for measuring the behavior and ongoing visual analysis of data
• At least one treatment or intervention condition
• Manipulations of the independent variable so that its effects on the dependent variable may be quantitatively or qualitatively analyzed
• An intervention that will benefit the participant in some way (Behavioral Cusp)

Methodologies developed through ABA research

Task analysis

Task analysis is a process in which a task is analyzed into its component parts so that those parts can be taught through the use of chaining: forward chaining, backward chaining and total task presentation. Task analysis has been used in organizational behavior management, a behavior analytic approach to changing the behaviors of members of an organization (e.g., factories, offices, or hospitals). Behavioral scripts often emerge from a task analysis. Bergan conducted a task analysis of the behavioral consultation relationship and Thomas Kratochwill developed a training program based on teaching Bergan's skills. A similar approach was used for the development of microskills training for counselors. Ivey would later call this "behaviorist" phase a very productive one and the skills-based approach came to dominate counselor training during 1970–90. Task analysis was also used in determining the skills needed to access a career. In education, Englemann (1968) used task analysis as part of the methods to design the Direct Instruction curriculum.

Chaining

Main article: Chaining

The skill to be learned is broken down into small units for easy learning. For example, a person learning to brush teeth independently may start with learning to unscrew the toothpaste cap. Once they have learned this, the next step may be squeezing the tube, etc.

For problem behavior, chains can also be analyzed and the chain can be disrupted to prevent the problem behavior. Some behavior therapies, such as dialectical behavior therapy, make extensive use of behavior chain analysis, but is not philosophically behavior analytic.

There are two types of chain in the ABA world: forward chain and backward chain. Forward chain is when you start with the first step and continue until you get to the final step. While backward chain is when you start with the last step and move backward until you reach the first step.

Prompting

A prompt is a cue that is used to encourage a desired response from an individual. Prompts are often categorized into a prompt hierarchy from most intrusive to least intrusive, although there is some controversy about what is considered most intrusive, those that are physically intrusive or those that are hardest prompt to fade (e.g., verbal). In order to minimize errors and ensure a high level of success during learning, prompts are given in a most-to-least sequence and faded systematically. During this process, prompts are faded as quickly as possible so that the learner does not come to depend on them and eventually behaves appropriately without prompting.

Types of prompts Prompters might use any or all of the following to suggest the desired response:

• Vocal prompts: Words or other vocalizations
• Visual prompts: A visual cue or picture
• Gestural prompts: A physical gesture
• Positional prompt: e.g., the target item is placed close to the individual.
• Modeling: Modeling the desired response. This type of prompt is best suited for individuals who learn through imitation and can attend to a model.
• Physical prompts: Physically manipulating the individual to produce the desired response. There are many degrees of physical prompts, from quite intrusive (e.g., the teacher places a hand on the learner's hand) to minimally intrusive (e.g., a slight tap).

This is not an exhaustive list of prompts; the nature, number, and order of prompts are chosen to be the most effective for a particular individual.

Fading

The overall goal is for an individual to eventually not need prompts. As an individual gains mastery of a skill at a particular prompt level, the prompt is faded to a less intrusive prompt. This ensures that the individual does not become overly dependent on a particular prompt when learning a new behavior or skill.

One of the primary choices that was made while showing another way of behaving is the manner by which to fade the prompts or prompts. An arrangement should be set up to fade the prompts in an organized style. For instance, blurring the actual brief of directing a kid's hands might follow this succession: (a) supporting wrists, (b) contacting hands softly, (c) contacting lower arm or elbow, and (d) pulling out actual contact through and through. Fading guarantees that the kid doesn't turn out to be excessively subject to a specific brief while mastering another expertise.

Thinning a reinforcement schedule

Thinning is often confused with fading. Fading refers to a prompt being removed, where thinning refers to an increase in the time or number of responses required between reinforcements. Periodic thinning that produces a 30% decrease in reinforcement has been suggested as an efficient way to thin. Schedule thinning is often an important and neglected issue in contingency management and token economy systems, especially when these are developed by unqualified practitioners (see professional practice of behavior analysis).

Generalization

Generalization is the expansion of a student's performance ability beyond the initial conditions set for acquisition of a skill. Generalization can occur across people, places, and materials used for teaching. For example, once a skill is learned in one setting, with a particular instructor, and with specific materials, the skill is taught in more general settings with more variation from the initial acquisition phase. For example, if a student has successfully mastered learning colors at the table, the teacher may take the student around the house or school and generalize the skill in these more natural environments with other materials. Behavior analysts have spent considerable amount of time studying factors that lead to generalization.

Shaping

Main article: Shaping (psychology)

Shaping involves gradually modifying the existing behavior into the desired behavior. If the student engages with a dog by hitting it, then they could have their behavior shaped by reinforcing interactions in which they touch the dog more gently. Over many interactions, successful shaping would replace the hitting behavior with patting or other gentler behavior. Shaping is based on a behavior analyst's thorough knowledge of operant conditioning principles and extinction. Recent efforts to teach shaping have used simulated computer tasks.

One teaching technique found to be effective with some students, particularly children, is the use of video modeling (the use of taped sequences as exemplars of behavior). It can be used by therapists to assist in the acquisition of both verbal and motor responses, in some cases for long chains of behavior.

Another example of shaping is when a toddler learns to walk. The child is reinforced by crawling, standing, taking a few steps, and then eventually walking. When a child is learning to walk, they are praised by a lot of claps and excitements.

Interventions based on an FBA

Functional behavioral assessment (FBA) is an individualized critical thinking process for tending to address problem behavior. An evaluation is led to distinguish the reason or capability of a problem behavior. This evaluation interaction includes gathering data about the ecological circumstances that go before the issue conduct and the resulting rewards that reinforce the way of behaving. The data that is collected is then used to recognize and execute individualized interventions pointed toward lessening issue ways of behaving and expanding positive ways of behaving.

Critical to behavior analytic interventions is the concept of a systematic behavioral case formulation with a functional behavioral assessment or analysis at the core. This approach should apply a behavior analytic theory of change (see Behavioral change theories). This formulation should include a thorough functional assessment, a skills assessment, a sequential analysis (behavior chain analysis), an ecological assessment, a look at existing evidenced-based behavioral models for the problem behavior (such as Fordyce's model of chronic pain) and then a treatment plan based on how environmental factors influence behavior. Some argue that behavior analytic case formulation can be improved with an assessment of rules and rule-governed behavior. Some of the interventions that result from this type of conceptualization involve training specific communication skills to replace the problem behaviors as well as specific setting, antecedent, behavior, and consequence strategies.

Careers in Applied Behavioral Analysis

There is a wide range of job opportunities someone can get in the field of applied behavior analysis. These fields also require a range of schooling which can be beneficial for many people seeking a job in this field.

• Behavior Technician – A behavior technician is someone who can provide clinical instruction to children or adults with developmental disabilities. This therapy can be provided in a school, home, clinic, or community setting.
• Clinical Director – A clinical director is someone who oversees the therapy that is being given to clients.
• Special Education – In the special education system, someone can use ABA skills to modify a child's behavior that is disruptive or may cause harm to children or peers around them.
• Addictions – ABA skills can be used to treat and reduce addictions that may be destructive to someone.
• Animal Behavior Analyst – By using the same skills taught in how to help people using ABA, they can also help animals. This is used by finding effective reinforcers in order to modify animal behavior. This can benefit both the animal and the owner.
• Correction Treatment Specialist (rehabilitation for criminal) – criminal rehabilitation is seen both inside and outside of prisons. By using ABA, someone will be able to reduce or eliminate incorrect behaviors that are detrimental to clients.
• FBI/Criminal Profiler – Criminal profilers can use the skills of ABA to catch criminals, create profiles of people, and train other agents on how to recognize dangerous warning signs in people.

Major journals

Applied behavior analysts publish in many journals. Some examples of "core" behavior analytic journals are:

1. Applied Animal Behaviour Science
2. Behavioral Health and Medicine
3. Behavior Analysis: Research and Practice
4. Behavior and Philosophy
5. Behavior and Social Issues
6. Behavior Modification
7. Behavior Therapy
8. Journal of Applied Behavior Analysis
9. Journal of Behavior Analysis of Offender and Victim: Treatment and Prevention
10. Journal of Behavior Analysis of Sports, Health, Fitness, and Behavioral Medicine
11. Journal of Contextual Behavioral Science
12. Journal of Early and Intensive Behavior Interventions
13. Journal of Organizational Behavior Management
14. Journal of Positive Behavior Interventions
15. Journal of the Experimental Analysis of Behavior
16. Perspectives on Behavior Science (formerly The Behavior Analyst until 2018)
17. The Behavioral Development Bulletin
18. The Behavior Analyst Today
19. The International Journal of Behavioral Consultation and Therapy
20. The Journal of Behavioral Assessment and Intervention in Children
21. The Journal of Speech-Language Pathology and Applied Behavior Analysis
22. The Psychological Record

Other species

ABA has also been successfully used in other species. Morris uses ABA to reduce feather-plucking in the black vulture (Coragyps atratus).