1. Helping Parents Separate the Wheat from the Chaff: Putting Autism Treatments to the Test

2. Kay, S. & Vyse, S. ( 2005). Helping parents separate
the wheat from the chaff: Putting autism treatments to
the test. In J.W. Jacobson, R.M. Foxx, & J.A. Mulick (Eds.),
Controversial Therapies for Developmental Disabilities: Fad,
Fashion, and Science in Professional Practice. Mahwah, NJ:
Lawrence Erlbaum Associates.

3. Overview Rationale for this topic Helping parents evaluate treatments
Parent education
Presenting the idea of data-based decision-making
Designing and implementing the test
Case examples
References

4. Rationale Parents of children with developmental disabilities
often choose to utilize treatments which are not
scientifically validated.
Why?
Testimonials from other parents
News media
Information from internet or books
Recommendations from a professional

5. to alter the course of treatment.”
Rationale
“Even when working with qualified professionals, parents of children with developmental disabilities often exercise their considerable power
to alter the course of treatment.”
(p. 265)

6. __________________________________________
Rationale
Parent involvement
__________________________________________
Treatment of Treatment of
developmental disabilities medical problems
________________________________________________________
- Childrearing involves teaching Parents are not expected
skills to treat their child directly
Parents are heavily responsible for Choice of treatment is
their child’s educational & social typically left to the doctor
development For many common ailments,
- Parents of children w/ DD are rarely there is a single (scientifically
presented w/ a standard treatment validated) treatment which is
approach endorsed by all practitioners widely accepted

7. How do we help parents separate the wheat from the chaff?
Parent education
Presenting the idea of data-based decision-making
Designing and implementing a test

8. Parent Education Provide parents information on evaluating
treatment options, and the available empirical
evidence (or lack thereof) for “treatments” of
interest
Discussion
Reading material
*Use parent-friendly language!
*Create an atmosphere in which parents will feel comfortable talking with you re: alternative treatments!

9. Parent Education Helpful Resources for Parent Education:
“Evaluating Treatment Claims” chapter (Green,
1996)
ASAT website ( and newsletter
“The Road Less Traveled” (Celiberti, Buchanan,
Bleecker, Kreiss, & Rosenfeld, 2004)

10. Presenting the Idea of a Data-Based Decision
Discuss advantages of collecting data to help make
a decision about whether to continue the treatment:
See if the treatment is helping to solve the identified problem
See if the treatment is making things worse
If effective, can contribute to the research literature and help other families
See if this treatment is effective for this particular child

11. Designing and Implementing the Test
Identify the target behavior
2. Design the test
3. Develop decision rules
4. Collect the data
5. Evaluate the results and make a decision

12. Designing and Implementing the Test
Identify the target behavior
Which behaviors are the parents looking to change with the proposed therapy?
Work with parents to develop operational definition(s).
Decide how to measure the behavior(s).

13. Designing and Implementing the Test
2. Design the test
Develop a research design.
May use reversal (e.g., ABA, ABAB), multiple baseline, or alternating treatments design.
Kay & Vyse recommend alternating treatments design to compare the effects of two treatments—or of treatment vs. no treatment.

14. Designing and Implementing the Test
3. Develop decision rules
Determine (in advance) the level of behavior change that would indicate the treatment is working. (While not a necessary step, this may help make decisions about continuing or stopping the treatment.)

15. Designing and Implementing the Test
4. Collect the data
Collect data using the predetermined measurement system.
When possible, data collectors should be blind to the purpose of the experiment.
When possible, include measures for procedural integrity and IOA.

16. Designing and Implementing the Test
5. Evaluate the results and make a decision
Visually display data on a graph.
Meet with parents and discuss findings. (Carefully explain the measurement systems and the components of the graph in parent-friendly language! )
Assist the parents in making a data-based decision.

17. Case Example: Prism Glasses
8 year old boy
difficulty walking appropriately (rarely alternated feet,
frequently toe-walked and galloped)
optometrist told child’s parents wearing prism glasses
would improve visual processing—which would increase
appropriate gait and decrease toe-walking
appropriate walking defined as taking two steps with
alternating feet, using heel-toe motion
alternating treatments design examined % of appropriate
walking while wearing prism glasses vs. wearing pretend
glasses

19. Case Example: Sensory Integration
5 year old boy
frequently engaged in frequent falling to the floor when tasks
were presented
OT told child’s parents the behavior resulted from an
inadequate sensory diet—and if his vestibular system were
balanced, he would not fall out of his chair
falling out of chair was defined as buttocks or stomach in
contact with the floor
alternating treatments design examined frequency of falling
out of chair on days when SI was administered before the
data collection period vs. days when a DRL procedure was
implemented

21. Case Example: GFCF Diet
Bechner, L., Mozingo, D., & Adams, S. An Evaluation of the Effects
of an Elimination Diet on Target Behaviors in a Child with Autistic
Disorder. Presented as part of the symposium “Data-Based
Examination of the Effects of Alternative Treatments for Autism”
at the 27th Annual Meeting of the Association for Behavior
Analysis, New Orleans, LA, May 2001.

22. Dennis Mozingo, PhD, BCBA
An Evaluation of the Effects of an Elimination Diet on Target Behaviors in a Child with Autistic Disorder
Lori Bechner, MA, BCBA
Dennis Mozingo, PhD, BCBA
Stacy Adams, BS .

23. Rationale Elimination diets have been proposed for treatment of autism
Proponents of these diets suggest that autism is
related to allergies to specific foods, and eliminating
these foods from the diet can result in improvement
in symptoms of autism
No scientifically sound studies have evaluated
whether children with autism actually have
trouble tolerating these foods,
or whether elimination diets are
helpful for them .

24. Participant male 5 years old diagnosis of autism
student at ABA school program .

25. Target Behavior to be increased:
Eye Contact: Eye to eye gaze, sustained for 5
seconds, in response to the child’s name being
called. .

26. Target Behaviors to be decreased:
Clapping: Any instance of clapping hand(s) or
fist(s) together or against another object (e.g.,
wall or floor) more than once.
Shaking Objects: Shaking and/or waving objects
not intended to be shaken.
Noncontextual Giggling: Giggling/laughing in
the absence of an apparently funny stimulus.
Running: Running back and forth
or in circles. .

27. Eye Contact
Measurement: per opportunity measure (5 probes throughout school day) .

28. .

29. Clapping
Measurement: 30-second momentary time sample (two 30-minute sessions per day) .

30. .

31. Shaking Objects
Measurement: frequency recording .

32. .

33. Noncontextual Giggling
Measurement: frequency recording .

34. .

35. Running
Measurement: frequency recording .

36. .

37. Results Eye Contact: Diet had no apparent effect; behavioral
intervention had positive effect.
Clapping: Diet had no apparent effect; behavioral
Shaking Objects: Diet had no apparent effect;
behavioral intervention had positive effect.
Noncontextual Giggling: Diet had no
apparent effect.
Running: Diet had no apparent effect. .

38. Conclusion The elimination diet did not lead to the desired
changes in “autistic” behavior.
Side Effects of the diet:
Elimination of several edible reinforcers
Decreased food consumption and variety of
foods consumed
Weight loss
Problem behavior at snack/lunch time at school .

39. Conclusion
When parents are unable or unwilling to evaluate evidence regarding treatment options for their child, Behavior Analysts can help them make informed treatment decisions.

40. References
Bechner, L., Mozingo, D., & Adams, S. An Evaluation of the Effects of an Elimination Diet on
Target Behaviors in a Child with Autistic Disorder. Presented as part of the symposium “Data-
Based Examination of the Effects of Alternative Treatments for Autism” at the 27th Annual
Meeting of the Association for Behavior Analysis, New Orleans, LA, May 2001.
Celiberti, D. A., Buchanan, S. M., Bleeker, F., Kreiss, D., & Rosenfeld, D. (2004). The road less
traveled: Charting a clear course for autism treatment. In Autism New Jersey’s Autism: Basic
Information (5th ed.).
Green, G. (1996). Evaluating claims about treatments for autism. In C. Maurice , G. Green,
& S. C. Luce (Eds.), Behavioral intervention for young children with autism: A manual for
parents and professionals. Austin, TX: PRO-ED.
Kay, S. & Vyse, S. ( 2005). Helping parents separate the wheat from the chaff: Putting autism
treatments to the test. In J.W. Jacobson, R.M. Foxx, & J.A. Mulick (Eds.), Controversial
Therapies for Developmental Disabilities: Fad, Fashion, and Science in Professional Practice.
Mahwah, NJ: Lawrence Erlbaum Associates.