Recovery from Autism
Recovery from autism exists and has been a regular occurrence in top quality ABA programs for a few decades. Early intensive behavioral intervention (i.e., 30 or more hours per week of one-to-one ABA, starting before the age of 4, and continuing for 2 or more years) brings about recovery for some children with autism who receive it. However, a substantial portion (somewhere just over half) of children do not recover, even after having received the best possible treatment available. Many in the autism field are still afraid to acknowledge that recovery exists because it is still controversial and very little research has been conducted that has attempted to shed light on the variables that affect recovery. In 2009, CARD published the first study to document recovery in a relatively large sample of children with autism. In addition, CARD is engaged in several lines of research on recovery on an ongoing basis, in order to further document it, evaluate variables that contribute to it, as well as identifying early predictor variables.
Assessment and Treatment of Challenging Behaviors
Challenging behaviors such as aggression, disruption, and self-injury are common in individuals with autism. CARD continues to move on the forefront of innovative assessment and treatment techniques within this area and endeavors to identify the most effective and efficient methods of assessment, treatment, and caregiver training. Utilizing both indirect and direct measures, the underlying functions of challenging behaviors are ascertained. Treatment interventions are then tailored to fit the individual child. Our research publications in these areas have addressed rumination, bruxism, aggression, disruption, and self-injury, among others.
Independent Living and Adaptive Skills
Children with autism often exhibit deficits in adaptive behavior, such as delays in acquiring skills necessary for living independently and safely in their daily lives. Like any other behavior, these skills can be directly taught using ABA-based procedures. CARD research publications in this area have evaluated procedures for teaching pill-swallowing, liquid medication administration, and household safety, among others.
Pediatric Feeding Disorders
Feeding disorders are characterized by difficulties with eating or drinking that result in poor weight and/or nutrition. Common forms of feeding problems include partial or total food/liquid refusal and food/liquid selectivity by type and/or texture. Feeding problems are common in all populations. 25% of children of typical development and up to 80% of children with developmental disabilities present some sort of feeding disorder during childhood. CARD is actively pursuing several directions of research in the field of feeding disorders. For example, we are continually attempting to identify the least intrusive interventions necessary to effectively treat feeding disorders. Additionally, new methods to ease the transition from therapist to caregiver and from clinic to home are being researched. As each child comes to CARD as an individual, CARD works to learn which specific intervention(s) will be successful with each child. Caregivers are not only trained to implement working protocols, but are taught to understand why the protocols are effective. CARD research publications in feeding disorders have addressed caregiver-mediated treatment and stimulus fading, among others.
Language and Basic Verbal Operants
Autism is characterized by delays in language development and the remediation of these delays is a foundational component of ABA treatment for autism. Our language intervention research program at CARD focuses on establishing basic receptive and expressive language, including basic verbal operants, such as echoics, mands, tacts, and intraverbals. We are currently identifying novel intervention procedures which hold promise, as well as empirically evaluating commonly used but under-researched teaching procedures. In addition, special attention is paid to identifying which teaching procedure is likely to benefit which particular child, depending on each child's individual characteristics.
Higher-Order Cognitive, Verbal, and Social Skills
Applied behavior analysis is often criticized on the grounds that the treatment approach produces only simplistic, "rote," or "robotic" behavior. Criticisms such as these are typically espoused by individuals with little familiarity with good-quality ABA therapy. However, more research is needed in the area of higher-order skills and cognitive abilities, particularly in children with autism. A significant amount of behavior analytic research in the past 20 years, commonly referred to as Stimulus Equivalence and Relational Frame Theory research, has begun to isolate the basic behavioral processes behind complex language, cognition, and understanding. Our research in these areas focuses on extending basic research to the establishment and analysis of higher-order skills in children with autism. To that end, we are evaluating procedures for teaching skills in areas commonly referred to as "cognition" and "executive function." Published CARD research protocols in these areas of addressed perspective-taking, working memory, and rule-governed behavior.
Procedural and Methodological Innovations
Many behavioral procedures and methods are of known effectiveness but may be enhanced or made more efficient, thereby potentially saving time and money in the assessment and treatment process. We are engaged in ongoing research examining details of common assessment and treatment procedures, such as methods of data collection, data analysis, and duration of functional assessments, etc. Published CARD studies in these areas have addressed first-trial data collection and electronic data collection, among others.
The Role of Technology in Behavioral Intervention
CARD has been a leader in the development of innovative applications of information technology to the treatment of autism and for the dissemination of applied behavior analysis. The SKILLS online system is the most comprehensive assessment, curriculum, staff training, and treatment management system in existence for the treatment of autism spectrum disorders. Empirical research on several aspects of the system is ongoing and studies have already been published on components of the assessment and staff training systems. The goal of the SKILLS system is to bring evidence-based information on autism treatment to the maximum number of families affected by autism possible, around the world.