4 Separate Papers. Write a one-page review, single spaced of each of the assigned readings. Article responses should include a description of the article itself and a reaction to the article. I will a

4 Separate Papers. Write a one-page review, single spaced of each of the assigned readings. Article responses should include a description of the article itself and a reaction to the article. I will a
lASH1999, Vol. 24, No.3, 162-173copyright 1999 by The Association forPersons with Severe Handicaps EarlyIntervention forYoung Children with Autism: Continuum-Based Behavioral Models StephenR.Anderson Summit Educational Resources Raymond G.Romanczyk State University of NewYork-Binghamton Over the last three decades, instructionalmethodsde­ rived from applied behavior analysis (ABA) haveshown considerable promisefor many youngchildren with au­ tism. The ABA approach establishes a priorithat assess­ ment andintervention methodsmustbe based on gener­ ally accepted rules of scientific evidence. On one hand, the approach hasproduced a rich resource of conceptu­ ally consistent and scientifically validated techniquesthat can be applied in various combinations across many dif­ ferent contexts. On the other hand, this diversity has re­ sulted in someconfusion regarding the precise charac­ teristics of ABA. In this article, the authors first describe many of the common programmatic andmethodologic elements that formthefoundation of the approach. A summary of the scope of the behavioral research is pro­ vided including greater detail on six studies that demon­ strated large-scale interventions. Finally, the authorsde­ scribe components of program modelsthat share com­ mon elements of the ABA approach and use a broad continuum of traditional behavioral techniques. Some specific mythsabouttheapproach aresimultaneously addressed. DESCRIPTORS: applied behavior analysis,inter­ vention methods, programmodels,autism Autism is aserious developmental disabilitythatpro­ vides a complex challenge forparents, professionals, and all thosewho come in contactwith the child. Au­ tism is a syndrome, asopposed to a disease entity, that is characterized by specificbehavioralpatternsand characteristics. Acomplex disorder(BerkellZager, 1999; Cohen & Volkmar, 1997;Matson, 1994;Roman­ czyk, 1994; Schopler & Mesibov, 1988), autismspec­ trum disorder (ASD)hasbeen studied for 50 years, yet Address allcorrespondence andreprint requests for re­ prints toStephen R.Anderson, SummitEducational Re­ sources, 300 Fries Road,Tonawanda, NY 14150-8897. E-mail: [email protected] 162 stillresults incontroversy, misinformation, and is a source ofgreat confusion forparents attempting to make treatment andeducation decisions for theirchil­ dren. For the purposes of this article, we assume that the reader is familiar with the difficult and complex issues of obtaining anaccurate differential diagnosis for young children, as well as with the critical process of obtaining anassessment of thechild’s development (Harris & Handleman, 1994; NewYorkStateDepart­ ment ofHealth, 1999a; Powers & Handleman, 1984; Romanczyk, Lockshin, & Navalta,1994;Schopler & Mesibov, 1988). A general historical readingin the field of autism quickly results in the impressionthatautism is a severe disability for which little evidenceis found for long­ term positive outcome, thatit is difficult to diagnose, and that incidence andprevalence figures are contro­ versial (California Department ofDevelopmental Ser­ vices, 1999). Autismis also strongly associatedwith a great number of”fads” and”movements” thatover the last several decades havepromised much, but consis­ tently have failed to deliver when the harshlight of objective evaluation isfocused onsupposed break­ through procedures (Delmolino & Romanczyk, 1995; Green, 1996a; Olley & Gutentag, 1999; Smith, 1996). Often “models” arepromulgated with littleempirical support, but with a wealthof sincerity and enthusiasm. By studying this history, an appreciationisformed for the complexities ofgenerating aviable model that standsthe test of time and objectiveevaluation. It is in this contextthatwe first describe anapproach that establishes apriori thattheselection ofassessment and intervention approachesmust bebasedongener­ ally accepted rules of scientific evidencefor efficacy. It is a “bottom up”approach, inthat principles and pro­ cedures withdemonstrated efficacy areassembledinto a coherent modelthatis again subjected toempirical validation. This is quite differentfrom the process of developing aconceptual modelandthen seeking to find confirmatory evidence. at FLORIDA INTERNATIONAL UNIV on June 17, 2015 rps.sagepub.com Downloaded from Continuum-BasedBehavioralModels 163 To date, only one nonmedicalapproachmeets the boundary conditions of this model as applied to autism. This approach hasconsistently producedoutcomes that are reproducible, describablein precise terms, are tied to a conceptualization thathas strong and extensive experimental support,and uses, as a necessary compo­ nent, continuing objectiveevaluation. Thisapproach, known as applied behavioranalysis(ABA)in the con­ text of autism, but more generically as behaviortherapy or the behavioral approach,was firstappliedin the treatment of autism more than threedecades ago. Its roots are strongly within a research/academicframe­ work, and it has beenapplied with empirically evalu­ ated success to a wide array of humanproblems (Bar­ low, 1988; Barlow, Hayes, & Nelson, 1984; Spiegler & Guevremont, 1993).Interestingly, perhapsbecause of its focus on objective evaluationratherthanon consen­ sus of opinion, it has not becomepopularized and has often beengrossly misunderstood (cf. Maurice, 1993). Over the past threedecades, systematic researchin­ vestigations have demonstratedthe utility of specific components ofABA. More recently, larger scale out­ come studies again have consistentlydemonstrated that significant impactcan be made for childrenwith autism (New York State Health Department, 1999a). For those who are influencedbyresearch versusanecdotal reports, thereexists a growing and diverse behavioral technology thatcan be applied. One unexpectedout­ come of this extensiveness hasbeen a clustering of be­ havior analysts into several schools with strongly held positions. In ouropinion, theseare divisions based largely on emphasison oneparticular instructional technique oranother, agrouping oftechniques in a certain clustering, or differences in the strategyof ser­ vice delivery. However,all fall within the rubricof ABA. It is our opinionthatno single technique nor collection oftechniques can becorrect (or effective) for every person in every situation. Thus, the databased feedback loop in ABA isinherently aself-correcting mechanism if applied in the contextof clinical decision making. It is our goal in this article to first outlinethe common programmatic andmethodologic elementsof the ABA approach. We discuss some of the features that seemtodefine typical behavioral modelsand within this contextrespond to the many myths that have arisen regardingABA. Programmatic CommonElements It isprobably accuratetostate thatmany models, behavioral analytic and nonbehavioral analytic,share some common programmatic elements.Dawsonand Osterling (1997) reviewed a numberofprograms for children with autism thatmet the boundary condition of having published detaileddescriptions of the pro­ grams and providedintakeandoutcome data(many are reviewed in this special issue of JASH). They pre- sent a series of commonelements thatwere observed that areconsidered triedand true. Moreprecisely, by examining commonelements thatexist across programs that differ significantly in approach,theauthors state that these programmatic commonelements are “un­ likely to reflectanidiosyncratic viewpointor one inves­ tigator’s philosophical attitude”(p. 314).Thesepro­ grammatic commonelements are specific curriculum content, highlysupportive teachingenvironments and generalization strategies,predictable routine,func­ tional approach toproblem behaviors, plannedtransi­ tion, and family involvement. These programmatic commonelements perhapsre­ flect the minimum startingpointforprogram develop­ ment, along with appropriatelytrainedand caring staff, adequate resources, andsupervisory and review mecha­ nisms. Given these as “basics,” thenthe task is to utilize a methodology thatallows each of these elementsto be addressed in anindividualized manner,for children, family, and staff. It is at the pointof selecting specific methodology forinstruction that behavioral and non­ behavioral modelssometimes begin to diverge. Methodologic Common Elements There aremethodologic commonelements within the behavioral approach.First, theapproach views be­ havior as functional andpurposeful, even when func­ tion and purposeare notimmediately discernibleby an observer. Behavioris viewed as the result of a complex blend of variables thatinclude theindividual’s strengths and limitations, physical status, history, and the current social-en vironmen talcircumstances (Romanczyk & Matthews,1998). As with many complex approaches, there areoften subtle differences betweenspecific methodologies andtheories thatareassociated with the approach. Withrespect to autism, ABA is a specific form of the more generalbehavioral model. AnalysisandMeasurement ABA places stress on understandingthebehavior in question, whetherit is theacquisition of a skillthatis currently absentin aperson’s repertoire or the amelio­ ration of aproblem behavior. If emphasis is placed on the analysis level, thenit follows thatthere need to be certain prerequisite steps. The first of these prerequisitesis the objective mea­ surement ofbehavior. Mostmeasurement systems have technical pros and cons, as well as practicalcost effec­ tiveness parameters. Thereis a large body of literature within the field of science in generaland psychology specifically thatindicates humanobservers areprone to a number of very specific errorsinconducting obser­ vations. We are all subject to influences and biases that limit our objectivity. One credible reasonfor this diffi- at FLORIDA INTERNATIONAL UNIV on June 17, 2015 rps.sagepub.com Downloaded from 164 AndersonandRomanczyk culty inobjective measurement is that one of our strengths withrespect toinformation processingis the ability todetectpatterns. However, as with all systems, our ability todetectpatterns is not perfect.We are able to perceive specificpatterns where,in fact, none exists. We can be differentially influencedbyinformation, context, andexperience that have emotional as well as informational content. Often in clinical and educationalservicedelivery, we violate this basic principleofobjectivity so that the in­ dividuals performing assessment, deliveringservices, and evaluating outcomeare one and the same. It is important to stress that the influences that limit our ability to make objectiveobservations are not primarily based on such factorsassophistication, education,fal­ sification, intentional bias, anddeception. Rather,they are based on aninformation processinglimitation that allhumans share.Byunderstanding theseprocesses, we can guard against potentially inaccurateobservations and conclusions. Thus, the sine qua non of theapplied behavior analyticapproach is that objectivemeasures are taken of the individual’s behaviorand that these measures must meet theboundary conditions ofbeing operationally defined,reliable, and valid. Operational definitionssimplytranslate thenormal colloquial reference that we give to certainbehaviors into more objectively definedobservational terms. A good example would be attempting to assess a child who is “anxious.” This is a term that mostindividuals would recognize andbelieve that they have an under­ standing ofwhat itmeans. Difficulty arises with respect to precision and theapplication of suchtermsto spe­ cific individuals. For example, withanxiety, one could view it as a construct,thesummation of a number of different factors that areassumed to becoherent. We can divide the impreciseconstructofanxiety into a number ofcomponents: cognition,self-report, overtbe­ havior, performance, and physiologic. Although anxietyis a useful term for thepurpose of communication concerningaproblem theindividual is experiencing, from abehavioral perspective it would be further defined within the abovecategories. This allows highly individualized assessmentfor a given personas to how specifically anxietyismanifested for the indi­ vidual. ABA emphasizes addressing the specific, unique expression ofbehavior by theindividual. Reliable observations referto the degree to which the various specific behavioral observations conducted by different observers are inagreement. This is typi­ cally done by having two independentobserversper­ form observations and then compareveryprecisely the degree to which they agreeanddisagree on the specific temporal pattern of the behaviors observed.To be in­ dependent, individualsshould not be given specific ex­ pectations such as”medication is beingconsidered,” or “we are seeingproblems with rising anxiety,”or”it’s clear he’s anxious and we need todocument that.”Op- erationalized, unbiased,andreliable observation serves as the basis for hypothesistestingas to factors that may be of importance andinfluence theindividual, and thus leads to the processofconducting afunctional analysis (a point to bediscussed next). Assessing the Child Assessment is a crucialcomponentof any clinical/ educational model.Because thereare as many differ­ ences between youngchildren withautism as similari­ ties among them,assessment must be aconstantfocus point when developing andimplementing acompre­ hensive intervention program.Traditional assessment methods such as the administration ofstandardized psychological, speech,andachievement tests,”survey” assessments such asratingscales, and behavioralassess­ ment all haverelativestrengths andweaknesses. Within thepractice of ABA, therearevarious sub­ components ofassessment. First,assessment of an in­ dividual with autism, particularlya young child, can be a very difficult task. While assessmentisoften some­ what arbitrarily dividedintostandardized psychometric evaluation, socialhistory/family statusassessment, in­ formal observation, and much more rarely,functional assessment, ABA focuses strongly onfunctional assess­ ment (functional analysis). It is not andshould not be seen asincompatible with the assessment methods mentionedabove. For example,standardized assess­ ment, iffeasible andproperly conducted, providesim­ portant information. Suchassessment allows theestab­ lishment of a “marker” as to the currentrepertoire of the child with respecttovarious developmental do­ mains and allows a comparisontoother individuals, as well as relative strengths andweaknesses within the individual. It also serves as a standardizedformatto assess the ability to interactin a social manner with respect to thevarious directions anddemands and in­ terchanges that occur during standardized assessment. Standardized assessment,however,is not necessarily directly useful in the selectionof specific, immediate, short-term goals. Nor is it typically useful in determin­ ing the specific intervention methodology that will be utilized. It is beyondthe scope of this articletoexamine in detail thevarious aspects of the assessmentprocess. We focus on that aspect most specific to the behavioral model, that of functional analysis. Functional analysis is an oftenmisunderstood term, partly because different disciplines have varying defini­ tions. Within ABA, functional analysis is the processof ascertaining empiricallythecontrolling variables that enhanceorinhibit theexpression of abehavior. It is not done byobservation, filling out abehaviorchecklistor scale, nor by consensus amonginvolved parties.Rather, these sources ofinformation are used to form hypoth­ eses as to what factorsmay be involved, and then to test these hypotheses (Iwata,Vollmer, Zarcone, & Rod­ gers, 1993; Miltenberger, 1998). It is aprocessof ob- at FLORIDA INTERNATIONAL UNIV on June 17, 2015 rps.sagepub.com Downloaded from Continuum-BasedBehavioralModels 165 serving, hypothesizing, testing,evaluating, refininghy­ potheses, andrepeating. The essential aspect of functional analysis is the ex­ plicit testing of factors presumedto beimportant, and to conduct the testing in a mannerthathas the potential to clearly disprovethehypothesis. There are many uses for this very powerfulmethodology beyondunder­ standing problem behaviors, and it isparticularly useful for assessment ofchildren withoutverballanguage. While it is oftentechnically difficult and time consum­ ing to perform, the accuracy of the informationob­ tained through functionalanalysis and its directappli­ cability to intervention makeit a most important com­ ponent of ABA. Developing anIndividualized Curriculum The word curriculum has various connotations and meanings for various professionals. In thecontext of this article, curriculummeansasequence of goals: (1) organized fromboththelong-term andshort-term per­ spective’ (2)resulting from focused assessment,(3) re­ flecting the collective prioritiesof involved adults, and (4) tempered by thecurrent developmental level of child. Because thisshould be aninteractive process, and typically involves individualsat various levels of exper­ tise, it is useful to have an outlineordocument that serves as a map (Romanczyk,1996).However, caution must be expressed inthat acurriculum shouldnot be seen as a specific sequenceoflearning and skill activi­ ties that allchildren willprogress throughin asequen­ tial manner. One of the important characteristics ofchildren with autism is unevenlearning ability and skill levels. Thus, individualization ofintervention cannotbeoverstated. While generally anexcellent startingpoint,it is not necessarily most effective to teachall skills in a “typi­ cally developing” sequence.Use of acurriculum must occur within a very tight feedbackloop that assesses not only the logic and priorityof a goal and its subcompo­ nents, but also its interactionwithassessment informa­ tion which includes a child’s currentrepertoire, moti­ vation, andpreferences. A goodcurriculum should have a conceptual structure(we suggest a developmen­ tal sequence), offergreat detail (operalization), and be used in a child specific manner(nonlinear branching). Selecting andSystematically UsingReinforcers It is a truism concerning humanbehavior thatmoti­ vation is animportant component oflearning and main­ taining skills.Motivation can come from a numberof sources. For most individuals,this diversity providesa rich context foracquiring andmaintaining skills. It is also the case thatsome individuals, such aschildren with autism, have impairmentinmotivation. At times, motivation may be quite idiosyncraticandlimited in its extensiveness. Anexample would be childrenwho are not motivated by socialattention andpraise, physical contact, and the sense of accomplishmentforcomplet­ ing a task or solving a problem.Rather,theseindividu­ als might find theirownrepetitive andstereotyped be­ havior moreinteresting andenjoyable, and thusengage in it disproportionately comparedtoprosocial behav­ ior. The termreinforcer describesafunctional relation­ ship thatisempirical innature, not speculative. This is a critical aspectof thebehavioral model:procedural or technique components are not to be used in isolation, detached from the critical processofongoing assess­ ment. The stereotyped andincorrect reinforcement procedure “forchildren withautism who fail to make eye contact, each time they look at you, reinforcethem with a fruit loop,”iscompletely erroneousand misses the point entirely. Alsoerroneous would be the con­ clusion that”eye contact is not getting better even though wekeep reinforcing them with fruit loops.” Even at its most basic level, ABA isintimately tied to continuous assessmentof theindividual and not simply the application ofmisperceived standardtechniques. Promoting Generalization Generalization is a keyconcept. It isoften viewed as the degree to which a behavioror skilllearned under particular conditions andsettings will beexpressed in other conditions and settings. An examplemight be taking pianolessons and being able to performa par­ ticular musical piece quiteadequately athome with the piano teacher, andthen being asked topresent that same piece duringarecital whereperformance may be observed to be significantly impaired. From theinception of ABA, generalization hasbeen a focal concept thatisbound directly to goal selection, teaching, andevaluation ofbehavior. Intheir classic article thatappeared in the first issue of the Journal of Applied BehaviorAnalysis, Baer,Wolf, &Risley (1968) stated thatgeneralization is acentral component of ABA and that “… generalization should be pro­ grammed,ratherthanexpected orlamented” (p. 97). That is, animportant characteristic of ABA isthat the intervention process must explicitly addressstrategies and procedures toteach andpromote generalization across time, setting,people, and tasks. There is anextensive generalization methodologyto be found in thepublished literature. It involves knowl­ edge of stimulus control,stimulus generalization, rein­ forcement schedules,prompthierarchies and fading, setting events, antecedent conditions,responsevariabil­ ity, contingency criteria,use ofmultiple exemplars, set­ tings, people, andcontexts, as well as task analysis and response repertoire assembly.Becausegeneralization can be problematic forcertain individuals, and given the complex factorsthatinfluence generalization, a spe­ cific and detailedplan for generalization shouldbe a part of allintervention programs. at FLORIDA INTERNATIONAL UNIV on June 17, 2015 rps.sagepub.com Downloaded from 166 AndersonandRomanczyk Selecting Intervention Techniques With Documented Effectiveness Froma clinical perspective, selectionofintervention techniques has twocomponents. The first is to ascertain controlled researchevidence concerning specific skills, behaviors, orconditions forindividuals with a similar diagnosis/characteristics that appear inpeer reviewed journals andthat meet generally acceptedcriteriafor well controlled clinical studies. Anecdotes,casestudies, “expert opinions,” theoretical arguments, andappeals to “clinical experience” are not acceptablesubstitutes. Such sources canprovide potentially usefulinformation in order to test hypotheses abouteffectiveness compari­ son of different approaches andprocedures in a re­ searchcontext, butshould not be used as a substitute for controlled researchevidence for clinical practice. Second, the selected intervention must meet the boundaryconditions of theoriginal research param­ eters. Sadly, interventions areoften implemented in name only,thatis,terms are used to label what is being offered, but the specifics of the interventionas actually applied are not consistent with the specifics of the origi­ nal intervention research.Procedural integrityis mea­ sured andevaluated as is theobjective evaluation of the child’s progress. Specifically, anevaluative process known as single subjectmethodology isemployed (Bar­ low et aI., 1984; Hersen & Barlow1981;Sidman, 1988). There are many very powerfultoolscurrently avail­ able to parents, educators, and clinicians who wish to avail themselves of theempirical literature. One cau­ tion that should beraised isthat it isessential in this process toread and review researchreportsintheir original form, rather thanassummaries. Inparticular, the explosion ofinformation on theinternet has suf­ fered greatly bymisrepresentation andinaccuracy. In­ formation isoften “packaged” toprovide noncritical support for aparticular pointof view. In readingthe original research report,one is able to ascertainthe specific characteristics of thechildren whoparticipated, the specifics of the proceduresutilized, the adequacyof the research design, and the degreeandmagnitude of the outcomes. Certainly,it ispossible to have a research study thatdemonstrates a significantstatisticaldiffer­ ence between intervention procedures, but thatdoes not necessarily mean that thissignificant difference rises to the level of clinical significance. We require both statistical significance and substantialchangein the child’s cognitive, social, and family and community life. The task of reviewing suchresearch can seem daunt­ ing. Because ABA isbased on basic principles of hu­ manbehavior, thereis awealth ofresearch available. The published literatureofprofessional journalswas searched forresearch studiesconcerning applied be­ havior analysis and autism(Palmieri, Valluripalli, Arn­ stein, & Romanczyk, 1998). Given the varying termi­ nology, thereareabout 19,000 published articles if one uses applied behavior analysis and its synonyms. While not all this literatureis directly relevantto ABA as an intervention for autism, it underscoresthe vast base of research thatserves as the foundationfor the ABA approachand itsbroadapplicability to a wide range of populations, skills, andbehaviors. Five hundred articles specific to both ABA and au­ tism were found. If we narrowthe focus to research with young childrenwith autism, conductedafter1980, and employ a single subjectresearch methodology, ap­ proximately 90published researchstudies were identi­ fied. These provide supportfor abroad continuum of behavioral techniques thatfocus on the development of skills in social, cognitive, self-help, independence,emo­ tion, language, self-control, attachment,recreation,and academic areas. In short, thereis a large base of researchliterature that addresses specificpopulations, ages,characteris­ tics, and specific educational,clinical, social, and physi­ cal emphases, as well as a substantialbase ofresearch specific to ABA and young childrenwith autism. A full review of thesearticles is not possible here(for exten­ sive reviews, see Matson,Benavidez, Compton,Paclaw­ skyj, & Baglio, 1996; New YorkState Department of Health, 1999b).However, thereareseveral large-scale studies thatbase their conceptualization andproce­ dures on the large researchbase, which we will briefly review. Theyrepresent theimportant endeavorof con­ ducting controlled clinical trials. Six studies havebeen published thatevaluated the benefits ofintensive homebased intervention for chil­ dren with autism. Each of these studies involved at least 1 year of intervention, includedabroad rangeof be­ havioral techniques, andevaluated its effects of a vari­ ety of developmental outcomes(intellectual function­ ing, language, socialinteractions, adaptivefunctioning). The most comprehensive study of homebasedinter­ vention forchildren withautism waspublished by Lovaas (1987). Lovaas assigned preschoolaged chil­ dren to one of two groups: an intensivetreatment group that received anaverage of 40hours ofone-on-one treatment per week or a minimaltreatment control group thatreceived 10 hours or less per week.Each child in the experimental groupwas assigned several well trained therapists whoworked with the child and the parents in thehomefor 2 or moreyears. Pretreat­ ment measures revealedno significant differencesbe­ tween the treatment and control groups. However, posttreatment dataindicated that9 of 19 (47%) chil­ dren in the experimental grouprecovered. Thesechil­ dren were reported to haveachieved normalintellec­ tual and educational functioningin the first grade. In contrast, only 20/0 of thechildren in thecontrol group met this criterion. A follow-up study was conducted when thesechildren reachedamean of age 13 years (McEachin, Smith, & Lovaas, 1993). Evaluationwas done by clinicians blind to the children’spriorhistory at FLORIDA INTERNATIONAL UNIV on June 17, 2015 rps.sagepub.com Downloaded from Continuum-BasedBehavioralModels 167 and intermixed withchildren who had no history of developmental orpsychological disturbance. At this point, 8 of the 9 recovered childrenwere still indistin­ guishable from thecomparison group. Several other investigators (Birnbrauer & Leach, 1993; Sheinkopf & Siegel, 1998;Smith, Eikeseth, Klevstrand, & Lovaas, 1997) have partiallyreplicated the intensive behavioral intervention modeldescribed by Lovaas. In each case, therewereimportant devia­ tions from the modelincluding the fact thatall of these studies provided fewerhours per week (18 to 30 hours rather thanthe 40 hours providedbyLovaas). In each of these studies, children whoreceived thebehavioral interventions showedgreaterimprovement thanchil­ dren in the control groupswhoreceived eitherless in­ tervention oranother type ofintervention. A sixth study byAnderson, Avery,DiPietro, Edwards, and Christian (1987)appears tosupport thesefindings as well, but did not includeacontrol group of comparable children receiving an alternativeapproach. The results of these group studies when mergedwith the results of single subjectresearch methods offer con­ siderable supportfor the positive effects of intensive behavioral interventions for youngchildrenwith au­ tism. Nevertheless, manyquestions remain.AsGreen (1996b) pointed out, it is still unclearwhatvariables are critical tointervention intensity (number ofhours, length of theintervention, proportionofone-to-one to group instruction) and what are the expectedoutcomes when intervention intensityvaries. It is also unclear what particular behavioral techniques (discretetrials, incidental teaching,pivotalresponse training)are most likely to be successful for a given child and in what proportions particulartechniques shouldbe used. The current research islimited inthat it does not allow us to draw comparisons across studies. At thispoint, we can conclude thatthe best outcomes haveoccurred when the children received at least 30 hours of behavioral intervention. Continuum-Based BehavioralModels Since thepublication of Let Me HearYourVoice by Catherine Maurice(1993),requests for ABA services has grown rapidly. Parents,armedwithempirical stud­ ies, often approach localgatekeepers of special educa­ tion services by strongly advocatingfor ABA. The re­ quests have challengedlocal capacity to providequali­ fied personnel and tomeettheextraordinary demand for the number of hours recommended. Theseissues are exacerbated byresistance from some key officials, sometimes basedoninaccurate, butstrongly held be­ liefs about behavioral interventions. Contrary to the beliefs of some, ABA isnot a stag­ nate, single continuum ofprescribed methods.It em­ phasizes the use of methodsthatchange behavior in systematic andmeasurable ways. Theuniquecontribu- tion of this approachis itsinsistence on analysis, repli­ cation, socialimportance, andaccountability (Baeret al., 1968; Sulzar-Azaroff &Mayer, 1991). Arguably,any intervention strategycould be studiedandembraced by behavior analysts,if it can be describedinprecise terms, reproduced, anddemonstrated to be effective. At this point, ABA is ane

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