Science in Autism Treatment, Spring 2015
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Science in Autism Treatment
Newsletter of the Association for Science in Autism Treatment
Vol. 12, No. 2

Spring 2015

S

pring is always a special issue of SIAT. April 2nd is World Autism Awareness Day and Autism
Awareness is celebrated the entire month. Although for ASAT every day is for autism awarenessand dissemination of evidence-based treatments, we enthusiastically join the community inmaking April blue for Autism.

This Spring issue is dedicated to our Partner Level Sponsor

We are thankful for their generous support and delighted to feature their program description (page 3)
and an interview with three members of BACA’s multidisciplinary team, Dr. Carl Sundberg, PhD,
BCBA-D, Hayleigh Kanzler, MA, CCC-SLP, and Angela Seal, MOT, OTR, conducted by our Executive
Director, Dr. David Celiberti, and newsletter contributor, Patrick O’Leary. BACA has also contributeda Clinical Corner, jointly written by Drs. Carl Sundberg and David Celiberti, answering a question
about Applied Behavior Analysis and sensory issues (pageInside this issue:11). See the next page for career opportunities at BACA.
Partner Level Sponsor Program Description
We are proud to feature our 2015 Professional Sponsors
3(page 16). These are organizations committed to evidence Related Services in an ABA Settings: An interview with
5
in autism treatment and to ASAT’s mission. With their
3 members of the BACA teamsupport and that of our 2014 Donors (page 32) we are
Clinical Corner: Sensory Issues
11
making reality the many goals we established for this year
2015 Professional Sponsors
16(please see the letter from our Executive Director in theWinter issue).
2015 Professional Sponsorship Initiative
17
Thank you for your continued support through direct
Clinical Corner: Explaining Applied Behavior Analysis
18
financial donations and dissemination of ASAT and our
newsletter SIAT. We enjoy preparing each issue and love to Ways to Support ASAT
24
receive your feedback by email to
From the Archives: What Autism Awareness Should be
25
newsletter@asatonline.org.
About
Have a wonderful Spring!
Donor Wall 201433
Warm wishes,
Article Summary: The Persistence of Fad Interventions 34

Daniela F. Fazzio, PhD, BCBA-D
SIAT Co-editor

Research Synopsis: EIBI in Community Settings

38

ASAT Coordinators, Externs & Committee Members

42

ASAT on Facebook

43

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Partner Level Sponsor
Program Description

ABOUT BACA
The Behavior Analysis Center for Autism (BACA) uses the principles and procedures of Applied Behavior Analysis (ABA) to teach language, social, self-help, academic, daily living, and life skills to individuals with autism and related disorders. BACA was established in 2009 by Carl T. Sundberg,
Ph.D., BCBA-D, and a group of highly trained Board Certified Behavior Analysts (BCBAs) who havebeen working with Dr. Sundberg for several years. BACA has four centers in Indiana: BACA 1 andBACA Prep in Fishers, BACA Z in Zionsville, and BACA Hart in Elkhart. Staff provide intervention toindividuals ages 2-22 who have been diagnosed with autism or a developmental disability. BACA
continuously educates and trains its staff through regular seminars and consultation by its esteemedclinical team.

OUR PROGRAMSBACA offers unique programs for families in the area, nationwide, and internationally.
BACA 1, Prep, Hart, and Z provide center-based programs with one-on-one and small group therapy
overseen by Ph.D. level behavior analysts. The centers are open year round. BACA has BCBA and
BCBA-D level consultants, as well as occupational and speech therapists, who are always available.
These facilities include areas designed for specific clientele to facilitate transition to the next appropriate living or learning environment. These areas include a typical-peer preschool for ages three-tofive, called the Sprouts program. For older clients, the Geof Mohs Achievement Center is designed toprepare adolescents for adult life by focusing on hygiene, employment, and independent living skills.

BACA Atlas is an intensive therapy clinic that provides families with access to renowned behavior
analysts and therapy services. Families that are seeking direction for their child have the opportunity
to engage in a clinic that creates programs to be implemented in the home setting. The staff assesses
client skills, provides behavioral therapy and trains the family, caregivers, and therapy team to implement the treatment program. The clinic sessions are based on the child’s needs and the family’sschedule and budget. In addition, staff receive ongoing supervision.
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BACA also offers Extended Services which are part-time services for students needing social, behavioral, and academic assistance. Clients receive up to 20 hours of ABA therapy per week under the direction of the program’s director, who is a BCBA, and a team of trained behavior technicians. Additionally, BACA offers flexible scheduling and services that are available in the evenings and on weekends.

ABOUT OUR CLINICAL TEAM
Dr. Carl Sundberg received his doctorate degree in ABA from Western Michigan University under
the direction of Dr. Jack Michael. While a graduate student, he taught behavior analysis at WMU forseven years. Dr. Sundberg has publications in The Analysis of Verbal Behavior and A Collection of Re-prints on Verbal Behavior. Dr. Sundberg has over thirty years of experience using behavioral interventions to teach individuals with autism and other developmental disabilities. He oversees the trainingof BACA staff and consistently spends time with the clients. Eighty percent of his time is spent contributing to the training of staff and addressing specific client programs.
BACA’s extensive clinical team also consists of Dr. Mark Sundberg, Dr. Barbara Esch, Dr. John Esch,Dr. Peter Gerhardt, Dr. Patrick McGreevy, Bob Ryan, Troy Fry and Dr. Genae Hall. Each possess expertise in the field of ABA and all are viewed as leaders in the field. Dr. Mark Sundberg is the authorof the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) which is a toolutilized widely including at BACA. Dr. Barb Esch is a behavior analyst and speech pathologist withover 30 years of experience in behavioral interventions for individuals with developmental disabilities. Dr. John Esch has over 30 years of experience as a psychologist, teacher, and consultant. He has
worked with individuals of all ages whose diagnoses include autism spectrum disorder, emotional
impairment, mental impairment, brain injury, hearing loss, learning disability, and ADHD/ADD.
Dr. Peter Gerhardt is the president of Peter Gerhardt Associates, LLC, in New York City. He has morethan 30 years of experience utilizing the principles of ABA in support of adolescents and adults with
autism spectrum disorder in educational, employment, residential, and community-based settings.
Dr. Patrick McGreevy has over 30 years of experience with individuals of all ages with developmental
disabilities. He is the first author of Essential for Living, a new assessment, curriculum, and teaching
manual for children and adults with moderate-to-severe disabilities. Bob Ryan acts as a consultant toschools and families, co-instructs for the Florida Institute of Technology’s ABA online program andworks with Dr. Carl Sundberg at BACA. Troy Fry has worked with children and adults with developmental disabilities for the past 25 years. He is also a co-author of Essential for Living. Dr. Genae Hallworks with BACA’s research department and clinic staff, to support the building of a research center
within the facility.
For more information about BACA or to schedule a tour, contact Colin Clayton at: 317-436-8961 or at:
cclayton@thebaca.com. You can also visit the website at: www.thebaca.com.

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Related Services in an ABA Setting:
Epiphanies, Opportunities, and Reflections from the Field
An Interview with Carl Sundberg, PhD, BCBA-D, Hayleigh Kanzler, MA, CCCSLP, & Angela Seal, MOT, OTR, Behavior Analysis Center for Autism
By David Celiberti, PhD, BCBA-D & Patrick O’Leary, MA, BCBAW

e want to thank you all for participating in this group interview.
Meaningful and effective multi-disciplinary collaboration is somethingthat may not come easily for many teams, particularly when there aredifferent views about the relevance of science in the treatment of autism. We are very
grateful for the opportunity to showcase the model used at the Behavior Analysis
Center for Autism.

Dr. Sundberg, please describe how BACA
came to include OTs and SLPs.

occupational therapist (OT) and eventually hired
an SLP and OT full time. BACA now employs
three SLPs and two OTs.

Carl Sundberg: In the years before BACA wasestablished, I consulted for families who were do- Our experiences have been similar with proing in-home ABA programs. In most cases, theviders working on similar targets but inchild was also receiving speech and/or OT serdifferent ways, and, in many cases, those divices through the school or another provider. It vergent methods were not necessarily comwas often difficult to coordinate services between patible or complementary. In many cases,
the various providers. In many cases where thethere may actually be an absence of commuchild was receiving speech services, the speechnication and coordination altogether. We canlanguage pathologist (SLP) involved would also
see how having providers onsite has the potarget general language acquisition. Sometimes
tential to promote consistency and synergy.
these recommendations/programs would differ
Was the hiring process challenging?
from the recommendations/programs made andestablished by the ABA provider. About 10 years Carl Sundberg: The hiring was a bit tricky. We
ago, when I was working for an ABA center, I had needed to find people who would fully embracesuggested that we begin contracting with an SLP ABA and especially Skinner’s analysis of verbal
behavior, commit to data-based decision making,so that we would all clearly be on the sameas well as agree to focus on more narrow objecpage. We would create the language programs
based on the principles of applied behavior analy- tives relating to the mechanics of speech, articulation, and feeding. For the OT, we needed tosis (ABA) and the SLP would focus on issues related to vocalization, articulation, feeding, swal- find someone who could help us with our OT
lowing, etc. We then started contracting with an(Continued on page 6)

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When you use an SLP in a program, whatneeds yet not be a major supporter of sensory in- does he or she typically address that a BCBA
tegration. Once hired our SLPs and OTs partici- cannot?
pate in the same trainings as our other clinicalstaff, beginning with the training required to be- Carl Sundberg: Before we worked closely
come a Registered Behavior Technician. They at- with SLPs, we already had an understanding oftend all in house training and are sent to behav- how to use the methods of ABA such as stimulusioral conferences and workshops as well. One of stimulus pairing, differential reinforcement, and
our SLPs has finished her BCBA coursework, sat shaping to attempt to produce new sounds, tofor and passed the exam while working at BACA. establish echoic responding, and to improve articulation. However, we were lacking a true meSounds like thechanical and develexpectations are
opmental underin place that prostanding that an
mote consistency
SLP can provide. An
across members
SLP can devise speof the team. Can
cific programs withyou tell our readspecific targets thaters a bit morecan greatly enhanceabout how OTs
success when it
are deployed atcomes to establishBACA? Do you use
ing and enhancing
OTs with every
vocalizations. In
child, or only theaddition, an SLP
ones who havecan give us a better
significant grossunderstanding ofor fine motor isthe child’s probabilsues?
ity of becoming a
Dr. Carl Sundberg, Hayleigh Kanzler and Angela Seal
functional speakCarl Sundberg: Not
er. This is a critical
every child is in need of OT services. Those who variable when deciding on a response form for ado receive services vary in need. Our OTs will
student, if continuing with vocalizations is feasiassess our clients’ gross and fine motor skills, and ble, when to fade out sign language, other forms
design, oversee, and train staff on programsof augmentative communication, etc. The input(exercises) to improve any weaknesses. Our OTs provided by our SLPs related to these areas has
also assess the need and make recommendations been invaluable to us.
for adaptive equipment (such as special scissors,
shoes or wrist guard to help with writing, etc.)
Thank you for sharing these experiences as I
and program equipment (such as swings, balance know that many programs for individuals
beams, large balls, etc.).
with autism have grappled with how to createsynergy through effective multi-disciplinary(Continued from page 5)(Continued on page 7)

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cises for line therapists to use, or do you docollaboration and coordination. We have the all the work directly with the children?
good fortune to have Hayleigh Kanzler availHayleigh Kanzler: To answer that question,
able to answer some questions. Hayleigh,how do you incorporate ABA into your thera- yes and yes! I do see children for direct therapy(one-to-one), but also have the flexibility to do
py sessions when focusing on communicasome consultations with children who are not ontion skills?
my caseload. Sometimes a consultation will inHayleigh Kanzler: My work is heavily guided clude helping to create vocal goals for children
who are just starting at BACA and sometimes it
by ABA principles and, in fact, I use reinforcecan be with a child on my caseload to help brainment strategies all the time in therapy! I havefound that the students I work with respond well storm with that child’s team. I see around 25 chiland will work harder if there is a tangible reward dren per week for direct services and then I leave
exercises to be practiced until I see them the next
at the end. I also use transfer trials for teaching
generalization. More specifically, we use ECTER: week. It’s a great model for daily practice anderror (child makes an error), correction (correct since I am often in the same building, I am there
to train and answer any questions the behavior
error with prompt), transfer (take away that
prompt for a correct response), expansion (have technicians may have.
the child do something else), and return (comeback to the target). That system of teaching really What are some underpinnings of ABA thatcan guide the practice of SLPs involved withallows the child to be successful, but also takethat skill beyond just knowing how to answer in a individuals with autism?
specific situation. It allows learners to transfer
Hayleigh Kanzler: Coming from a research
the skill beyond that one moment in time when background, I appreciate the data-driven nature
they know the answer- they have to do otherof ABA programming. I do think SLPs can implethings that distract them from the correct answer ment many ABA techniques to increase successand come back to it. Obviously, it would startin working with kids with autism. Many SLPs alwith one, small expansion, but the expansion
ready use reinforcement naturally but not necestime and number of expansion activities increas- sarily as intentionally or systematically as they
es! I think the greatest asset we have as SLPs at
could! Other behavior analytic teaching techan ABA center is having a behavior technicianniques- such as errorless learning, transfer trialswith us during therapy. I am constantly asking
are also great tools to have as an SLP when workquestions to promote consistency and also teach- ing with students with autism.
ing how to implement my speech goals within
their daily practice. The great thing is that theWhat advice do you have for BCBAs on school
behavior technicians follow through with pracbased teams who are trying to make inroads
tice, so I see faster progress than I typically would with OTs and SLPs?
if this carryover was not part of the culture.
Hayleigh Kanzler: The biggest thing with colDo you work in a consultative capacity or are laboration is to realize that we are all working for
you typically working one-on-one with chilthe same thing- for the good of the child. SLPs,
dren? In other words, do you provide exerOTs, and BCBAs may disagree with some things,(Continued from page 6)(Continued on page 8)

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discuss activities that will support the child’s probut these can often be worked through in a pro- gram. When a client is not on my caseload, one offessional and open manner. Every member of the our BCBAs can request a consult with an
OT. Usually during these consults, I give recomteam benefits when each person has an open
mind to the others’ specialties. Each professional mendations related to specific questions related
has knowledge and instead of getting frustrated, to fine or gross motor skills, daily living skills or
ask “why” something is being done a certain way feeding.
and, then, actually listen. These discussions areenhanced when research is incorporated and data What are some underpinnings of ABA thatcan guide the practice of OTs involved withare used to back up assertions being made.
individuals with autism?
Last, but not least,
Angela Seal: In my
we wanted to bring
opinion, the basic unAngela Seal into the
derpinning is theconversation in her
careful analysis of anrole as an OT at
tecedent and conseBACA. How do you
quences through theincorporate ABA incollection of ABC dato your therapy sesta. OTs should be ansions when focusing
alyzing what is hapon skills?
pening before and after a client’s behavAngela Seal: Primariors, specifically what
ily, I use reinforcea therapist’s response
ment procedures to
is to the behavior. The
strengthen the skills
OT must understandthat I am teaching our
how various modes ofclients. I also rely on
attention, such as eye
shaping and fading
contact, proximity toprocedures to teachclient, physical touch,skills. I utilized theseetc., can reinforce a
procedures before I
behavior (adaptive or maladaptive).
joined the Behavior Analysis Center for Autism;however, with guidance from our clinical staff, I
As you know, your skill building approach tohave been able to refine my skill level in impleOT is not universally shared. For many stumenting these procedures.
dents with autism, OT services are defined by
Do you work in a consultative capacity or are the delivery of sensory experiences. What are
you typically working one-on-one with chilyour views on sensory integration therapy?
dren?
Angela Seal: I would not consider myself an
Angela Seal: The majority of my time is spent expert in sensory integration theory as I don’t use
one-on-one with clients with brief consultations(Continued on page 9)
following with behavior therapists to teach and(Continued from page 7)

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it personally. I would be more inclined to utilize
sensory integration if there was a strong base of
research to support it. I have also observed fellow
OTs who are misapplying this theory. In manycases, utilizing sensory integration techniques
during behaviors has the potential to reinforce
that behavior. For example, placing a child on aswing to calm the child during a maladaptive behavior only teaches him or her that initiation of
the maladaptive behavior is one way in which heor she can access the swing. Therefore, instead ofutilizing a mand for the swing, a child will learn
to exhibit a maladaptive behavior to access theswing.

What can behavior analysts learn from
OTs? What can OTs learn from behavior analysts?

Angela Seal: OTs are able to teach behavior
analysts how to identify basic deficits for common tasks and then common activities or exercises to address those deficits. For example, clients
who have difficulty maintaining a grasp on atoothbrush most likely have strength deficits
within the hand. There are common activities
and exercises that would strengthen the hand,such as animal walks or playing with resistive materials. It would still be advantageous to request a
consult from an OT because there could be underlying issues but these activities could be utiWhat advice do you have for BCBAs on school lized until that consult could take place.
based teams who are trying to make inroads
Another example would include feeding in whichwith OTs and SLPs?
I would assess muscle tone; strength; oral motor
Angela Seal: As professionals, we all want re- skills; feeding skills (can the child use a fork orspect for the profession to which we chose to devote our lives. So, my number one piece of advice:respect the OT and SLP you work with in theschool system. Listen to them and let them describe what frames of references they are working
from when they are treating their clients - whether it be SIT, neuromuscular, cognitive,
etc. Discuss deficits and strengths of mutual clients. Ask how the OT and/or SLP focus on
strengthening the deficits, and then offer insighton how principles of applied behavior analysis
may impact or enhance that plan. Share information about ABA, how it can be utilized tostrengthen skills, and how data collection can beused to objectively measure progress. I would liketo think that most professionals in the school system are there for the good of the clients. The
strength of a client’s program often lies in thestrength of the relationships of those who are creating the program. Those relationships are built
on a mutual understanding and respect, as well as
collaboration.

(Continued on page 10)

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Science in Autism Treatment, Spring 2015
Page 10Behavior analysts are obviously skilled in the
spoon); tolerance to certain textures, temperaanalysis of behavior, more specifically the functures, tastes, feeding equipment; and/or position- tion of the behavior. I have learned valuable lesing (does the child require special support, is the sons from behavioral analysts when observing
child in a chair where he or she is stabilized with them complete a functional analysis of the behavfeet on the ground). I would also consider wheth- ior. After we have discussed the results and theyer the child or family have certain foods thathave given recommendations on behavior protoshould be avoided (for example, certain faiths do cols, I have been more successful in my treatment
not allow pork to be eaten). Once areas of conof the child.
cern have been identified, I can offer recommendations to the behavior analyst that may include Thank you all for a wonderful interview. We
positioning; types of utensils to utilize; methods are very grateful that you were able to sharein which to focus on desensitization to textures, your experiences and hope that the elementsof your model can be considered by others. It
temperatures and tastes; and oral motor
strengthening exercises (often times this is in col- takes a village to help a person with autism
realize their fullest potential and a strong
laboration with Speech Therapy). Together, thebehavior analyst and I can create a feeding proto- multi-disciplinary team that relies on sciencecol reflecting our respective areas of expertise. In and is grounded and guided by data is essensum, a behavior analyst can learn about underly- tial.
ing deficits preventing skill acquisition and basic
ways in which to address the deficits.

(Continued from page 9)

ASAT Advisory Board
Jane Asher

Richard Foxx, PhD, BCBA-D

Catherine Maurice, PhD

F. J. Barrera, PhD, BCBA-D

Gina Green, PhD, BCBA-D

Bobby Newman, PhD, BCBA-D

Stephen Barrett, MD

William Heward, EdD, BCBA-D John Pomeroy, MD

Martha Bridge Denckla, MD

Ronald Kallen, MD

Stephen Porges, PhD

Curtis Deutsch, PhD

Alan Leslie, PhD

Sharon Reeve, PhD, BCBA-D

William V. Dube, PhD

Bennett Leventhal, MD

Joyce Rosenfeld, MD, FACEP

Deborah Fein, PhD

Johnny L. Matson, PhD

Arthur Toga, PhD

Eric Fombonne, MD

Joyce E. Mauk, MD

Paul Touchette, PhD

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Clinical Corner
Sensory Issues: Is a BCBA the Right Person?
By Carl Sundberg, PhD, BCBA-D & David Celiberti PhD, BCBA-D

In this Clinical Corner, Dr. Carl Sundberg and Dr. David Celiberti tackle a common
question among parents of children with autism regarding sensory issues and BCBAs.
By discussing motivation and its many faces, these authors explain how, from abehavior analytic point of view, identifying sensory issues as the cause of problem
behavior, may not lead to an effective intervention. Instead, a comprehensive
assessment of problem behaviors can identify all the underlying motivation and leadto a more individualized treatment.
Amanda Fisher, PhD, BCBA-D
Clinical Corner Coordinator

I am the mother of a young boy who was justrecently diagnosed with autism. I was ree are really glad this question was
ferred to a board certified behavior analyst
asked, as it comes up often. Some peo(BCBA) by my pediatrician for a behavioral
ple believe behavior analysts are "antiassessment to help with some problem behaviors my son is having at home, such as bit- sensory" — opposed to offering sensory diets,
massages, deep pressure, jumping on a trampoing. I have heard from others that BCBAs
line, etc., for individuals with autism spectrum
don't “believe in sensory issues,” and these
problems are central to autism. Is a BCBA the disorders. However, this is not necessarily true,
right professional to help me since he or she and we would like to take this opportunity toclarify how behavior analysts tend to approach
won't even believe my son has a problem?
sensory issues. In fact, the term “issues,” in and of
itself, can be problematic and ambiguous because
Answered by:
it does not specify whether an individual is showCarl Sundberg, PhD, BCBA-D
ing sensory preferences or sensory aversion, nor
Behavior Analysis Center for Autism
whether the sensory experience is a “like” or a“need.” These distinctions are significant in develDavid Celiberti, PhD, BCBA-D
Association for Science in Autism Treatment

W(Continued on page 12)

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oping a treatment plan, as we will highlight below.



Tommy bites his teacher when she attempts
to help him put on boots.

Gunner bites his teacher as soon as she put
his sight word cards on his tabletop.

First and foremost, it would be beneficial to discuss the many faces of motivation. Each of us,and children in particular, may be highly motivated by sensory experiences that vary in modality, variation, movement and pressure. Ever catchyourself tapping your pencil, twiddling your
thumbs, biting your nails, or popping bubble
wrap (a personal favorite of the first author)? If
so, would you say you have "sensory needs" or“sensory issues?”

Lisa bites her father as soon as he stops playing with her and attempts to leave the room
to take a call.
Sudhir may bite his older brother when theolder brother is accessing the iPad.
Sudhir also bites his babysitter when she asks
him to put away his iPad.

It is important to keep in mind that we are all Antonio bites a classmate who sits too close tohighly motivated by other experiences as well.
him during circle time.
Sometimes we are motivated by attention such asa smile, a knowing look, or laughter. Other times,  Melanie bites classmates when the fire alarmsounds or her older sister plays music loudly.
it is something tangible and specific which motivates us, such as a new pair of sneakers or a piece  Jennica bites her father’s arm when he wears
of artwork. We all engage in a wide array of belong sleeve dress shirts.
haviors to access these experiences. On the flipside, sometimes we are motivated to avoid or get  Mitchell’s teeth are coming in and he hasaway from certain forms of attention (e.g., closing
been seen biting a plastic hanger.
our office door or ignoring the incoming call of a
As you can see in each of the examples above, thetelemarketer) or other specific things (e.g., asame behavior (biting) occurs in very different
traffic ticket or non-preferred vegetables).
contexts and likely serves very different funcWhy is this important? First, assessment of chal- tions. In some instances, the motivation may belenging behavior must carefully investigate theto get or keep a preferred item or activity, wheremotivation of that behavior (i.e., the “function” of as in other instances, the child is trying to avoid
the behavior) in order to have the greatest likeli- or escape something they do not like. We hope
hood of leading to effective intervention. It isyou can appreciate that a “sensory” explanation
through recognition of the function of the chalbased on the fact that they are biting would misslenging behavior that effective behavioral interthe mark in most or all of the examples illustratvention is developed. A “knee-jerk” or “cookie
ed above.
cutter” approach would do a disservice to yourson or to anyone else who may be attempting to So the first takeaway message is that not evenegotiate their environment in less than desirable ry behavior problem should be assumed tohave a sensory basis; in other words, sensory
ways. Let’s explore a few scenarios using somestimulation may not be the relevant motivafictitious children. We intentionally referenced
tion. So if we mislabel certain behaviors as
the same behavior (biting) in each example.
(Continued on page 13)

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Science in Autism Treatment, Spring 2015
Page 13(Continued from page 12)“sensory,” the recommended sensory intervention will not address it properly.

ence they would choose (children experiencing
pain relief from taking aspirin may also benefit
from it but not necessarily choose it).

Secondly, we should differentiate between a sen- So the second takeaway message is that notsory need and a sensory preference. A hand wash- every sensory-seeking behavior reflects a
ing example may illustrate this distinction. Both “need.”
April and Alice engage in high rates of handLet’s examine the misuse of the term “sensory
washing.
need.” It is not unusual to see a person with au April washes her hands every time she touches tism engage in unwanted behaviors such as biting
which cease when a vest is applied or a tantrum
a doorknob, wet surface, or uses the officethat stops after a cookie is delivered. In both casphone. She reports that she is worried about
es, something was missing from the person's imgerms and will often appear agitated if handwashing is delayed (e.g., she is in a meeting or mediate situation. In both cases, the behavior isthere is a line to use the restroom). From a be- likely to decrease once the vest or cookie is delivered. This is evidence that these items may behavior analytic standpoint, hand washing inthis instance may serve as a negative reinforcer, functioning as reinforcers and the function of the
because the behavior terminates the discomfort behavior is to access them. Why is it that in thefirst case (engaging in biting to get the vest), it'sthat April associates with unwashed hands.
often concluded that the child’s behavior is due
April might say, “I really need to wash myto "sensory needs," however, in the second casehands and feel so relieved after I do so.”(engaging in a tantrum to access a cookie), it is Alice, on the other hand (no pun intended), al- rarely said that the child has "food needs?"
so washes her hands a few times per day. She isa huge fan of a “high-end” salted caramel hand Activities stimulating the senses can serve multiple behavioral functions, depending on the motisoap that is in the restroom two floors above
her office. She will happily wait in line to access vation. Jumping on a trampoline is likely to be
this restroom. From a behavior analytic stand- repeated because of its reinforcing vestibular
effects — it is fun. This leads to the question, "Do
point, hand washing here serves as a positive
reinforcer because of the resultant access to an I jump on the trampoline because I need to jumpon the trampoline, or because it's fun?" Either
item that she enjoys. Alice might say, “I reallylike to wash my hands with this particular prod- way, I am going to do whatever I can to get theopportunity to jump on the trampoline (thus, atuct. I hope I get this for my birthday.”testing to the reinforcing value). Again, the reAs you can see, April has a “need” and Alice has a sponses one engages in depend on the history of“like.” To make this distinction more relevant to reinforcement and punishment, verbal repertoire,
autism, we could substitute the use of swings
social contingencies and perhaps the level ofhere. Like many children, some children with au- deprivation or strength of the motivation. That is,tism often appear to enjoy swinging, may be will- if I had been jumping on the trampoline for exing to work hard to earn it and demonstratetended periods of time, I may be less motivatedpleasure while swinging, whereas other children to continue jumping, and less likely to engage inmay start off agitated and appear calmer follow- behaviors that will allow me to jump.
ing swinging, but it is not necessarily an experi(Continued on page 14)

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possible, we may have to tolerate the situation.
We have learned that behaviors such as biting
will result in undesired social consequences. But
what if:

Lastly, any discussion on “sensory issues” would
be remiss without some mention of sensory hypersensitivity. We have also observed individuals
with autism who have extreme reactions to sen-  We did not have the language to ask for themusic to be turned down?
sory input (e.g., loud noises, bright lights) andthere are those who are extra sensitive to textures  We did not know that leaving was an option,or certain clothing (e.g., the tag in the back of aor did not know how to ask, or were forced toshirt or particular food). These children/adults
stay?
learn to engage in behaviors that reduce the aversive nature of such stimulation. But this isn’t ex-  We didn’t value the social consequences as
clusive to autism – there are also people without
most people? That is, we don't care how othautism who are sensitive to certain stimuli as
ers perceive us or if we get invited back.
well.
If all that were true, we might engage in biting to
There are some who experience extreme discom- get the music turned off or get removed from thefort when exposed to situations which would be room.
considered typical to most of us (e.g., loud music). Some people with the requisite skill-set will Now, suppose we do have those skills, and we canengage in behaviors that relieve the anxiety, such always find a way to get out of situations thatas escape behaviors (leaving the situation), avoid- cause stress or sensory overload; or we tough it
ance behaviors (skipping the situation entirely), out because of the social contingencies that havebeen shaped up over our lifetime. Chances are,or engaging in some incompatible behaviors(practicing relaxation techniques). In these cases, no one would suggest we had sensory issues andput us on a sensory diet or prescribe sensory intesophisticated repertoires of skills are in place.
gration therapy. However, a person with autism
Rarely will an adult (who does not have autism)
who may have the same level of discomfort andrun and scream from a room or become aggressive when confronted with an uncomfortable sit- escapes the situation in the only way he or sheknows how, is often said to have “sensory issues”
uation. Most of us have a sophisticated verbal
when perhaps it would better to say they had skill
repertoire allowing us to compensate or better
deficits.
negotiate the situation in a more sociallyaccepted way.
So a final takeaway message is that “sensory”
Unfortunately, many people with autism do not concerns have profound implications for theteaching of new skills, skills that can be tarhave the repertoires to engage in the sociallyaccepted methods that relieve the anxiety or dis- geted through behavior analytic strategies.

comfort. However, many other non-socially acIn summary, we are not suggesting that yourcepted behaviors have been shaped over the years
son’s biting behavior lacks a sensory basis. Our
and have proven to be effective in removing thepoint is that perhaps there may be other explanaaversive stimulation. If we were in a room wheretions that would emerge during a functional asthe music is too loud, we would leave or ask for it
sessment, and that these alternative explanations
to be turned down. If those behaviors are not(Continued on page 15)

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need to be carefully considered. In order to develop the most appropriate, and individuallytargeted treatment for your son, one must analyze the function of the behavior, evaluate
whether the behavior has a sensory basis (andwhether it reflects a “need” or a “like”), and identify skill deficits (e.g., manding) that may either
compete with and potentially replace the biting
behavior or provide him with coping skills tobetter negotiate his environment.
We would like to thank Different Roads to Learning www.difflearn.com for permission to reprint
this adapted response from an article written by
the first author that appears here
www.difflearn.com/category/expert-articles.
Please visit the DRL website often to peruse
their incredible array of books and supplies, aswell as their rich library of guidance and strategies from experts in the field of autism.

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These sponsorships not only
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We believe that it should not
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IMPORTANT DISCLAIMER: ASAT has no formal relationship with any of the sponsor organizations. Furthermore, their stated endorsement of the above
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ASAT does not assume responsibility for ensuring that sponsoring organizations engage in behavior that is consistently congruent with the statements
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Science in Autism Treatment, Spring 2015
Page 18

Clinical Corner
Explaining Applied Behavior Analysis
to Parents and Colleagues
By Patrick O’Leary, MA, BCBA

Despite Applied Behavior Analysis (ABA) being at the forefront of scientificallyvalidated treatment options for individuals with autism for more than 30 years, there
remains a need to help parents and consumers at large better understand theprinciples that underlie this science. Doing so not only alleviates misconceptions
about ABA but also makes it more approachable when people realize the are using
these principles in their everyday lives! In this Clinical Corner, Patrick O'Leary does
exactly that by sharing consumer-friendly explanations and examples of several basic
ABA principles that providers can use to demystify and promote ABA among thosewith whom they work and live.

Nicole Pearson, PsyD, BCBA-D
Clinical Corner CoordinatorI’m a newly-minted BCBA, working in a
public school. I really love my job andthe students with whom I work. A concern I have is how to help parents and others
understand what it is that I do, especially as
it relates to some of the more fundamental
principles that underlie our work, such as reinforcement and punishment. How can I best
explain some of the basics of applied behavior analysis (ABA) to others?
Answered by Patrick O’Leary, MA, BCBA

T

his is a great question, and somethingwith which the field of behavior analysis
has historically struggled (Bailey, 1991).

Consumers can indeed be intimidated by our useof terminology. We have a powerful science inour hands, and we need to make it approachable
and understandable to those with whom wework. The principles of ABA are evident in how
the environment – including the social setting –impacts our behaviors. Parents and colleagues
may hold the false belief that these principles only apply to their classroom instruction. They may
not appreciate that these same principles of behavior are at play, regardless of the individual,
the setting, or the behavior of interest. Let’s takea brief look at some well-known, though often
misunderstood, principles of behavior.

(Continued on page 19)

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Positive Reinforcement
A hallmark of ABA, positive reinforcement is aprinciple of behavior stating: “a behavior occurs
and is followed by the introduction of something
to the environment, which subsequently increases the likelihood that the behavior will occur
again in the future” (Cooper, Heron, & Heward,2007). A typical example in teaching situations
involves the delivery of praise (e.g., “Great job
saying blue!”) following a student correctly labeling a blue ball. Assuming social praise is positively reinforcing, correct responding will likely increase in the future.
But when we look at the definition, we see that
this doesn’t necessarily only relate to classroom
instruction. Take for example, a 30-somethingyear-old male who is hungry for breakfast. He
walks into the kitchen and opens a cabinet that
contains a variety of cereals. The next morning,
he finds himself hungry again and wanting cereal. He opens the same cabinet and is rewarded
with cereal. What has happened? We see thesame behavior in both scenarios, opening thecabinet. Opening the cabinet changes the environment in a way that cereal is introduced. We
see in the second part of the scenario that
“opening the cabinet” was reinforced – the behavior occurred more often in the future as a result of the positive reinforcement, the introduction of cereal.

Negative Reinforcement
Negative reinforcement is often considered synonymous with punishment; however, like positive reinforcement, negative reinforcement also
increases the frequency with which a behavior
occurs (Iwata, 1987). The difference can be subtle, but it is quite important. Negative reinforce-

ment is also unique in that there are two aspects:
escape and avoidance.
In the typical negative reinforcement example, anunpleasant situation is present. A behavior occurs and the unpleasant situation is removed.
The behavior is likely to occur again in the future. It was reinforced by the removal of the unpleasant situation. We refer to this as “escape”
because the unpleasant situation is removed as aconsequence of the behavior. Contrast this with“avoidance.” If we use the same example, the behavior occurs prior to the unpleasant situation
occurring. Thus, the behavior results in an avoidance of the unpleasant situation altogether.
In a typical teaching example, a student with an
autism spectrum disorder (ASD) is assigned awork to complete at her desk. The worksheet isdifficult for the student, and she doesn’t wish tocontinue work. Self-injury occurs, after which theteacher removes the task and presents a break.
Self-injury is thus reinforced by the removal of
the unpleasant task. In the future, self-injury may
re-occur during similar, unpleasant tasks. The
task is presented, self-injury occurs, and the task
is removed.
Now, take the following example as an instanceof avoidance responding. In this example, theteacher enters the classroom while carrying a boxof teaching materials. As the teacher approaches
the student, the student begins to engage in selfinjury. The teacher hasn’t even begun teachingyet! Following the start of this self-injury, theteacher pivots away and directs her attention toanother student. What happened? The teacher’s
presence (paired with the box of materials) signaled to the student that work was about tobegin. The student engages in self-injury, to(Continued on page 20)

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which the teacher removes the opportunity to dowork. The student has avoided work. The unpleasant situation (work) is avoided following an
instance of self-injury. Assuming self-injury increases in the future in similar scenarios, we see
negative reinforcement (in the form of avoidance
responding) at work.

Again, we can see this principle play out in our
day-to-day activities as well. For example, ayoung woman is hiking in the woods. Though repeatedly told by her husband to stop shufflingher feet when she walks, she continues to ignore
his request (a failed attempt at positive punishment). The environment will take care of that!
While hiking on a rocky trail, she painfully stubs
her toe. Pain was introduced after the behavior of“feet shuffling.” In the future, she no longer
shuffles her feet. The introduction of pain reduced how frequently she shuffled her feet in the
future.

Again, these principles are in play throughout
our daily lives. For example, I recently purchased
a new car. In the past, I rarely wore a seatbelt.
This new car took care of that. Not only is there a
red seatbelt icon on the dashboard, but a repetiNegative Punishment
tive, loud beeping noise that occurs until theseatbelt is put on. Oh, it was so unpleasant! To
escape from this unpleasant situation, over sever- In negative punishment (think negative = subal days, I found that I put my seatbelt on shortly tract = removal), a behavior occurs and is folafter starting my car, in order to “escape” the in- lowed by the removal of a pleasant situation(Cooper et al., 2007). As a result, the behavior occessant beeping. Shortly after that, I began putcurs less often in the future. A common example
ting on the seatbelt prior to starting the car, incan be found in the use of time-out. In time-out,order to avoid the beeping in the first place.
a behavior occurs and the student is removed
from an enjoyable activity. For example, a stuPositive Punishment
dent playing a soccer game swears at a peer. As a
Positive punishment is described as an introduc- consequence, the teacher removes the student
tion of something into the environment (thinkfrom the game and he sits on the bench for a pepositive = addition = introduction), following a
riod of time to watch. In this instance, time-out
behavior, which is followed by a future decrease has the desired effect in that the student swears
in how often that behavior occurs (Cooper et al., less often in the future.
2007). An example, used in most schools, is a repA great example of this concept in daily life is therimand. “Don’t do that!” or “Stop talking!” It iseasy to imagine the behaviors that are occurring use of fines, particularly for breaking the law
prior to these statements: a classmate pulling an- while driving. An individual is driving a car at 75
other’s hair, high school students texting during a mph, where the speed limit is 55 mph. A police
lecture, etc. The reprimand, following the behav- officer pulls the individual over, and provides aior, often immediately stops the behavior. In the $75 ticket. The individual loses a portion of apleasant stimulus (money) following a behavior
future, the behaviors are less likely to occur because they have been followed by the reprimand (speeding). The individual is thus less likely to(assuming the reprimand functions as a punish- speed in the future.
er).

(Continued on page 21)

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Extinction

tention, he may simply try this new behavior,
since he learned that it is more successful. It’s
easy to see how this can escalate quickly to inappropriate classroom behaviors.

This one is easy, right? We just have to mention
dinosaurs, and it’ll clear everything up. Just kid- A daily life example that explains this phenomeding! Extinction ties in with the principle of rein- non well is when an individual is trying to get elforcement. The phenomenon of extinction occurs evator doors to close. In the past, there is a histowhen reinforcement of a behavior is withheld
ry of reinforcement for pressing the “door close”
and, as a result, the rate of the behavior decreases button; the button is pressed, and the door is(Lerman & Iwata, 1996). Let’s look at our typical closed. Now, suppose the “door close” button isteaching scenario. A student in our classroom has broken, or on the verge of breaking. A simple
learned that talking out in class will result inpress no longer is successful; reinforcement isteacher attention. The student talks out during a withheld. Pressing the button once no longer
lecture (imagine a “class clown”) and the teacher leads to the door closing. Here comes the extincprovides a light-hearted reprimand. Talking out tion burst! Now, because pressing the button
is thus reinforced. Our teacher, after learning of once doesn’t work, the individual rapidly, andthe principle of extinction, decides to withhold
forcefully presses the button 3, 4, or 5 times. On
her attention the next time the student talks out. the 5th time, it works! Pressing the button once
Notice that she did not remove her attention;
was not successful, the “ante was upped”, and thethat would indicate that she was giving him atdoor closed only after the 5th forceful push. In
tention in the moment and then stopped. She
the future, in similar elevator circumstances, thewithheld her attention; she ignored his talking
individual is more likely to press the button moreout.
than once, and forcefully.
Before moving on to our daily life example, it is
Motivating Operations
important to touch on another aspect of extinction: the “extinction burst.” An extinction burst is In behavior analysis, motivation is an essential
basically an increase in some aspect of the behav- component that is often overlooked. The comior, which occurs soon after the behavior under- mon definition of motivating operations includes
goes extinction (Lerman & Iwata, 1996). Basically, two operations and two effects: the establishing/abolishing operation and the evocative/abative
the student has learned that the behavior noeffect (Cooper, et al., 2007). In terms of the establonger works, and they “up the ante.” Let’s golishing/abolishing operation, we are talking
back to our class clown. He has learned that, inthe past, talking out results in teacher attention. about an increase/decrease, respectively, in the
But this time it didn’t. What does the student do? effectiveness of some stimulus as a reinforcer. In
Likely, some aspect of the behavior will increase. terms of the evocative/abative effect, we are talking about the increase/decrease, respectively, in
In our example, the student may talk louder,the class of responses that has resulted in the
wave his hands in addition to talking, jump on
his desk, or throw a pencil at the teacher. If theteacher attends to any one of these behaviors, we(Continued on page 22)
see that the new behavior is thus reinforced; thenext time the student is looking for teacher at-

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Science in Autism Treatment, Spring 2015
Page 22that will help. Several of the guidelines discuss
the importance of talking to consumers in lanaforementioned reinforcer. What does thisguage that is easily understandable (Behavior Anmean?
alyst Certification Board Guidelines for ResponsiWe can analyze this in a simple, hypothetical sce- ble Conduct 1.04a; 1.05b; 1.05d; 2.04b; 3.03).
nario. Let’s use sleep as our example. Last night, I That’s great! But why does the BACB see this as
slept a total of 2 hours. We can say that I am
an important part of our job? It can all go back to“sleep deprived.” This state of deprivation has
what behavior analysis fundamentally is: a scidone something interesting. It has establishedence.
sleep as an effective reinforcer. It’s very easy tothink of a night that you did not get much sleep. Applied behavior analysis has 7 dimensions, outThe stimulus that may be most reinforcing thelined by Baer, Wolf, and Risley in 1968. These dinext morning is an opportunity to sleep. Now
mensions outline what ABA is and does. Howevthat sleep has been established as a powerful re- er, there are some additional characteristics that
inforcer, what will I do about it? We will see anare overlooked and yet of great importance. ABA
evocative effect, in that I am now likely to engage should be public and doable (Cooper et al., 2007).
in behavior that has led to sleep in the past (e.g., What do these mean? When we say that behavior
staying in bed, taking a nap as soon as it’s availa- analysis is public, it essentially means that ourble, etc.). Note that these behaviors may or may methods are out there for the public to analyze.
not be socially appropriate.
We don’t sit in dark offices, manipulating theworld to do what we want. Our methods are out
Let’s now turn to our second operation/effect:
there for the general public to see, analyze, andabolishing and abative. Let’s use food as our exunderstand. Think about physics. The principles
ample. I’ve just had a wonderful dinner. Steak,of physics are always acting on us. Though we
potatoes, Brussel’s sprouts, bread, wine, and so
may not fully understand all the details
on. I am stuffed! This feeling of being “full” has(physicists spend immense time learning thosean interesting effect on food. Because I’ve justdetails, as do BCBAs for behavior analysis), theeaten all this food, the effectiveness of food as abasic concepts are available for the general public
reinforcer has been abolished. How likely is it
to learn and understand. This takes some of thethat I will accept food at this point? We will also mystique of the science away. While sciences
see an abative effect, in that the likelihood that I have made their mistakes in the past, they arewill engage in “food-seeking” behavior is reduced. ultimately available for the public to observe, anFor example, I am unlikely to drive to McDonalyze, and understand.
ald’s, make a sandwich, or order chicken Alfredofrom my local delivery restaurant.
This feeds into our next concept: doable. We sawthat physicists spend long hours learning the speWhy Should We Care?
cifics and details of their science. BCBAs andBCaBAs do the same for behavior analysis. But
As a newly minted BCBA, problems such as these this doesn’t mean that the methods are mystical,
should prompt a look at our ethical guidelines.
beyond the understanding of any others. In fact,
Let’s do just that. While a full review of thethis Clinical Corner shows just the opposite! Of
guidelines is beyond the scope of this Clinicalcourse, to fully understand and ethically engage
Corner, we can pull out some important specifics(Continued from page 21)(Continued on page 23)

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in behavior analytic science, the proper training
is required. However, the general principles arereadily available for anyone to learn about. To
fully “do” ABA requires extensive training andprecise implementation, but an appreciation of
key ABA principles is available to virtually everyone.
Conclusion

some fancy procedure that no one understands.
While it takes highly competent and trained individuals to ethically and appropriately apply thesetechniques in therapy, it can help show consumers that we have nothing to hide.
References
Baer, D. M., Wolf, M. M., & Risley, T. R. (1968).
Some current dimensions of applied behavior
analysis. Journal of Applied Behavior Analysis,
1, (1), 95-97.

Since behavior analysis is the most widelyaccepted and scientifically-based treatment for
Bailey, J. S. (1991). Marketing behavior analysis
individuals with ASD, it is important that consumers know what they are getting. The only way requires different talk. Journal of Applied Behavior Analysis, 24 (3), 445-448.
to truly garner informed consent for the workthat is done is to inform. The best way to informis to explain, in simple and non-technical terms, Cooper, J. O., Heron, T. E., & Heward, W. K.
(2007). Applied Behavior Analysis (2nd ed.).
just what is actually being done. Think of a time
Upper Saddle River, NJ: Pearson.
that you spoke with someone who worked in afield that was completely alien to you. Listening
Iwata, B. A. (1987). Negative reinforcement in apto that person talk about their job may be interplied behavior analysis: An emerging technoloesting, but you likely will stop attending once you
gy. Journal of Applied Behavior Analysis , 20 (4),
don’t understand what’s being said. We have a361-378.
responsibility to disseminate behavior analysis to
the general public and to the parents with whom Lerman, D. C., & Iwata, B. A. (1996). Developing a
we work. We should teach parents that the contechnology for the use of operant extinction in
cepts we are using in therapy are actually occurclinical settings: An examination of basic andring all around us. This will help show consumers applied research. Journal of Applied Behavior
that we are not trying to hide anything, or use
Analysis, 29 (3), 345-385.
1

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Page 24

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From the Archives
What Autism Awareness Should be About
By David Celiberti, PhD, BCBA-D

The following article about autism awarenessappeared in the Spring 2013 issue of Science in Autism
Treatment. April is autism awareness month, andthis installment of "From the Archives" outlines adifferent type of awareness, one that is multidimensional and nuanced. Although consumers,
professionals, and the media are aware of the current
prevalence of autism, this article proposesthat deeper appreciation of science and broader
application of scientifically-backed treatments for
autism is needed to assure that individuals with
autism receive the quality services that they deserve.
Patrick O’Leary, MA, BCBASIAT From the Archives CoordinatorApril is Autism Awareness Month. The Clearly, autism spectrum disorder (ASD) is noblue puzzle pieces will appear on thou- longer the rare diagnosis that it once was. With
sands of Facebook pages and billboards, the incidence of one in 68 children and one in 42
and the media will give greater attention to, and boys, our own families, neighbors, and coinformation about, autism. Further awareness is a workers are all touched by autism. In fact, thesheer numbers have heightened awareness of auwonderful thing, as detection and diagnosis arenecessary first steps to accessing help in the form tism in and of themselves. This awareness is essential: it promotes early detection, and with earof treatment, information, and support. Withly detection, we hope for a relatively clearer
over 400 treatments from which to choose, parents of children with autism need guidance, tools, course toward effective treatment and better outand accurate information to make the best possi- comes. Sadly, however, the early detection of autism alone does not always mean a seamless pathble choices for their children; choices that will
to intervention. Furthermore, families whose
undoubtedly have a profound impact on bothchildren are diagnosed with autism are still nottheir current quality of life and their children’s(Continued on page 26)
future.

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For most other medical conditions, a provider
able to expeditiously access the most effective sci- who disregards proven intervention in favor ofence-based treatments available. Instead, families using a “fringe” treatment could then be sued foroften have to sort through over 400 pseudomalpractice! Such safeguards do not exist for auscientific treatments until they arrive at the most tism treatment. We do no favors for children witheffective and research-proven intervention in ad- autism, their families, and those charged withdressing the complex disorder of autism. We
providing effective services when we ignore themust do better!
quackery and do not counter baseless claims.
Families deserve better. Visit our website to learn"Autism awareness" should be about more thanmore about the scientific support behind various
just detection and diagnosis. It has always been
autism treatments well as the pitfalls of testimoASAT’s hope that the conversation around autism nials.
awareness would be broadened to focus upon the
obstacles that separate individuals with autism#2 of 10 ideas about Autism Awareness:from effective, science-based intervention and"Autism Awareness" must recognize the redistract their families, caregivers, and teachers
sponsibility to make sound choices.
from accurate information about effective autism
Decision-making power comes with tremendousintervention. Below are 10 ideas about what Autism Awareness should be about, along with ways responsibility. There are myriad stakeholders
whose decisions have profound implications forthat ASAT can assist families and providers innavigating the complex maze of autism treatment children and adults with autism - not just parents, but siblings, teachers, treatment providers,
options.
administrators, program coordinators, and taxpayers.
#1 of 10 ideas about Autism Awareness:"Autism Awareness" must differentiate effective treatments that are scientifically validat-  Scientists need to take responsibility in making
their findings about an intervention’s effectiveed from the plethora of "therapies" andness clear, unambiguous, and unexaggerated.
"cures" lacking scientific support. Such a distinction is critical.
 Administrators and program leaders need totake responsibility in identifying internal andAutism treatment is a multi-million dollar indusexternal training opportunities that further
try with 400+ alleged therapies and interventions. their staff’s competence with evidence-based
For the majority of these methods, science ispractice. Additionally, they should make sureoverlooked in favor of pseudoscience, and they
their staff receives the support needed to susare marketed with heart-wrenching testimonials
tain these efforts and to continually engage inor poorly crafted surveys, anecdotes, slow-motion data-based decision making when both selectvideo montages, and inaccurate and even outraing and monitoring interventions. They must be
geous claims that are touted as evidence of effecsavvy and selective in their selections of traintiveness. Aggressive marketing of these so-called
ings for their staff and not fall prey to gim"therapies" and "cures" is absolutely overwhelmmicks, splashy sales pitches or fads.
ing and it drowns out accurate information forparents who are desperate to help their children.  Providers need to select procedures which are
based on published research, adhere to their(Continued from page 25)(Continued on page 27)

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discipline’s ethical guidelines about evidencebased practices, and maintain a commitment toensuring that parents have truly been given theopportunity to provide informed consent. For
example, if there is no scientific evidence tosupport an intervention that one is using, thenit is ethical obligation of the professional to inform parents of this. Please see Principle 1 F of
the Ethical code for occupational therapists,
section 2.04 of the Ethical Principles of Psychologists and Code of Conduct, and section 2of the Guidelines for Responsible Conduct for
Behavior Analysts.

Phase III: Monitoring the implementation of
the treatment and evaluating effectiveness.

#3 of 10 ideas about Autism Awareness:"Autism Awareness" must alert and remindthe community that available information on
the Internet (and actual information fromproviders) varies greatly in accuracy, and, infact, can be completely wrong. This cannot be
overstated.

As we know, not all information on the Internet
is reliable and accurate. You have probably heard
the term, caveat emptor (“Let the buyer beware”).
Consumers must also practice caveat lector (“Letthe reader beware”).

Parents must continue to exercise caution insorting through autism treatment options tomake the best possible choice for their children, Often Internet information is deemed equivalent
particularly since many providers do not make in relevance, importance, and validity to research
the path to effective treatment clear and simple. published in peer-reviewed scientific journals,
but it is not. Testimonials and uncontrolled studThere are far too many individuals with autism
who do not have access to effective treatment, are ies from so-called researchers can lead parents
astray and be a tremendous source of distraction.
receiving ineffective treatment, or are subjected
to treatments which are, in fact, dangerous. Every Parents of newly-diagnosed children may be parminute of ineffective intervention is one less mi- ticularly vulnerable. Know the red flags to avoid
nute spent accessing effective intervention. Every and learn how to evaluate research by visiting our
website. Our library of articles highlights sciendollar spent on an intervention which does nottific concepts and methods as they relate to powork depletes resources available for interventions that do work. For questions to ask to make tential autism interventions, with the goal ofsure that the individual with autism in your life is providing families, educators and clinicians with
the information they need in order to be savvy
receiving science-based treatment, read more
about the following three phases of inquiry about consumers of marketed treatment products andtherapies.
particular interventions and their associated

questions and considerations in The Road Less
Traveled: Charting a Clear Course for Autism
Treatment:#4 of 10 ideas about Autism Awareness:“Autism Awareness" must include responsible reporting by journalists who fully embrace
their role as "public educators" and who are Phase I: Exploring the viability and appropriatecommitted to spreading accurate inforness of a particular treatment approach.
mation.
 Phase II: Assessing the appropriateness of anintervention under the supervision of a specific There are scores of "miracle cures" andservice provider for a specific individual with"breakthroughs" for autism which receive wide(Continued on page 28)
autism.

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5. What position statements have respected professional organizations generated which supspread media attention (e.g., print and online
port, or do not support, this intervention methnews outlets, radio and television programs),
od? Are there science-based interventions (sucheven if they have not been shown to be beneficial
through published research. Unfortunately, effec- as applied behavior analysis) which are recommended by these organizations?
tive treatments typically receive less press because their providers are often focusing more on
6. Have I consulted with an unbiased entity foroutcomes than on garnering media attention.
their input?
Things are not likely to improve in terms of access to effective treatment for the autism commu7. Have I taken necessary steps to avoid putting
nity without more accurate representations ofcaregivers and treatment recipients at risk?
autism treatment in the media.

(Continued from page 27)

The media have a responsibility to scrutinize sensational claims related to a proposed treatment,
and to be knowledgeable enough to report on
those treatments with the most scientific approach. Such scrutiny can be accomplished byasking important questions such as:

To support accuracy in the media, ASAT has developed resources for journalists. For examples ofaccurate and inaccurate reporting, please visit
our Media page and learn more about our Media
Watch efforts.

#5 of 10 ideas about Autism Awareness:"Autism Awareness" must recognize the criti1. Are there any published research articles inpeer-reviewed journals documenting the effica- cal need for newly-diagnosed children to accy of the intervention method? If not, why not? cess effective treatment ASAP. We know that
If so, are the studies well designed? Have they early intervention makes a huge difference.
been replicated by others?
For many conditions, such as Lyme disease and
2. Who am I interviewing for this story and what breast cancer, awareness is essential because
awareness promotes detection, and with detecare his/her qualifications? Is he/she making
claims of efficacy/effectiveness that are not sup- tion comes a well established set of treatment opported by scientific data? What does he or she tions. Furthermore, optimal prognoses are often
stand to gain by this interview? Who may bene- associated with early detection. Within a few
short weeks of proper diagnosis, individuals have
fit financially from my article?
opportunity to receive the best treatment thatscience has to offer. If their conditions are not
3. How much does the intervention cost? Are
these costs reasonable? How is it paid? Is there detected early, then access to such treatments is
any evidence of harm imposed by this interven- delayed and their conditions will likely worsen.
tion? What are the risks?
With autism, the story is too often different. Unfortunately, at the time of diagnosis, many chil4. What kinds of training and supervision dodren with autism are not accessing the best thattreatment agents need to have before implementing the intervention? If none or very little, science has to offer, and their families are bomhave I explored the ethics surrounding this and barded with solicitations to partake in any numif there is adequate protection for consumers,(Continued on page 30)
particularly for those with autism?

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ber of the 400+ autism treatments, most of whichlack even an iota of scientific support.
While individuals with autism learn and progress
across their life span, it is widely understood thatthe earlier intervention begins, the greater the
potential for an optimal outcome. It is also important to remember the limited window of time
there is to prepare children for the “least restrictive setting” once they enter the public school
system. Investment in effective early intervention
saves a tremendous amount of resources over anindividual’s lifespan. These cost savings should
become an integral part of conversation about
intensive early intervention. Children’s futures
hang in the balance, which is clearly a function of
their early intervention experiences. Please see
the following articles on the ASAT’s website:

Early Detection and Intervention

applied behavior analysis (ABA), individuals with
autism learn to work in the community, accessfaith communities, enjoy a range of recreational
pursuits, become independent in their self-careneeds, have meaningful relationships and are active, contributing members of their communities.
The importance of such gains for individuals with
autism must be recognized as a significant benefit
of effective treatment. Autism awareness should
definitively include a celebration of a broad arrayof outcomes!
Please visit our website for more information onteaching procedures using the principles of applied behavior analysis. You may also consider
reviewing our library of responses in the ClinicalCorner section of the website.
#7 of 10 ideas about Autism Awareness:"Autism Awareness" must mandate accountability from all treatment providers.

Accountability involves a shared commitment toclearly-defined targets, participation in data col
Summary of research on early intensive belection, respect for the scientific method, andhavioral intervention
proper solicitation of informed consent. It shouldbe every treatment provider’s obligation to objec#6 of 10: "Autism Awareness" should also in- tively measure outcomes. No one should be perstill hope for a better tomorrow for those in- mitted to boast claims which are unsupported by
dividuals who are not part of the "best outdata. No one should get a pass on accountability,
come" group.
transparency, and objectivity just because theycome from a particular discipline which has not
With the right treatment, all individuals with auproven their methods through research.
tism demonstrate improvement, and many go on
to lead happy, productive and fulfilling lives.
Providers using interventions which lack scienMuch of the conversation about treatment, how- tific support have an ethical obligation to share
ever, focuses on “best outcome” and this is often this fact with consumers, and to exercise caution
defined as entering “mainstreamed” educationin making claims about outcomes. Far too often
settings or losing the diagnosis of autism altoapplications of interventions which lack any scigether. This may delegitimize the significant pro- entific support are carried out in a manner devoid
gress made by most individuals with autism,of transparency and objective measures to subwhose outcome may be different, but nonetheless stantiate claims of the treatment’s success. This
important and meaningful. We know, for exam(Continued on page 31)
ple, with intensive intervention which is based onTeaching an 18-month-old

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must not be tolerated. They must make sound,scientifically-validated decisions and recommendations. Please encourage all members of yourteam to subscribe to our free newsletter, Sciencein Autism Treatment. We also have more information on Ethics and Evidence-based Practice.

read research synopses and our vast library oftreatment summaries.
#9 of 10 ideas about Autism Awareness:"Autism Awareness" should help us identify
and overcome the barriers that families andchildren face even within their own communities.

#8 of 10 ideas about Autism Awareness:"Autism Awareness" must involve recognition Not every child with autism is invited to birthday
parties. Not every faith community welcomesthat an abundance of clinical research alfamilies of children with autism. Not every school
ready exists, and this body of research matprovides meaningful contact between students
ters.
with autism and their typically-developing peers.
Not every community provides recreational andIn the world of autism intervention, peerreviewed research which should guide and inform other important opportunities for individuals
treatment efforts is too often disregarded or igwith autism.
nored. Imagine a world in which it was deemed
Like all families, those with children with autism
acceptable for mainstream cancer providers totreat childhood leukemia with methods they pre- want to be able to live comfortably and fully
ferred without consideration of existing research. within their community. That may mean simply
going to the park, attending religious services,
Sadly, that is the reality of autism treatment, asgoing to the movies, or eating at a restaurant. Unmany providers use their unresearched but perfortunately, many families are not able to accesssonally-preferred methods, often divorced fromscientific support and carried out without any ob- these activities because the social community is
not sufficiently informed or prepared to include
jective means to assess benefit.
individuals with autism within these settings,
There are thousands of published research artiand, in some cases, the children are not taught
cles which can guide autism treatment. Published how to manage these situations well due to inresearch exists which documents effective inter- effective treatments. As a result, families of chilventions to address a broad range of issues relat- dren with autism are often isolated. This lack of
ed to autism such as improving conversation
opportunity is both a function of misinformation
skills, promoting academic skills, reducing chal- about autism and the lack of awareness about thelenging behavior, and developing tolerance forsuccessful efforts of those who have overcome
health care procedures. These peer-reviewed
such barriers. With 1 in 68 children being diagstudies are often not accessed by treatment pro- nosed with autism, every facet of society needs toviders and caregivers. Thousands of researchers, be informed of the supports necessary for indiexperts in their fields, have published their find- viduals with autism to succeed within their comings in peer-reviewed journals, yet their findings munities. Our website contains information on
are often overshadowed by a media which emhow to successfully include children with autism
phasizes sensationalism about the "next big
in the classroom and including people with authing" in autism treatment over objective scien- tism in the workforce.
tific research. Please visit our website often to(Continued on page 32)

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Science in Autism Treatment, Spring 2015
Page 32(Continued from page 31)#10 of 10: "Autism Awareness" should be
about the reality that the hundreds of thousands of children with autism will soon become hundreds of thousands of young adults
with autism.

this extensively within Media Watch. Please see
the following examples:

ASAT responds to MSNBC’s “1 in 3 autistic
young adults lack jobs education”

ASAT responds to Triblive.com’s “Pa. Autism
When children with autism turn twenty-one,
Services Hope to make inroads in workplace”
funding for services drastically changes. As a result, there are very few quality programs forASAT responds to Portland Press-Herald’s
adults with autism. We are facing a crisis in the“Graduating to an Uncertain Fate”
field, with a scarcity of services for adults with
ASAT responds to News.com.au’s “Cost of auautism and the absence of a clear strategy forclosing the gap between the ever-increasing need,tistic children cripples parents up to $50,000 a
and an unprepared supply of resources. Quality
year”
science-based services for individuals with autism
must continue into the adult years. Research in-  ASAT responds to FoxPhilly.com’s “Parents Of
dicates that interventions such as applied behavAutistic Children Worry What Life Will Bringior analysis (ABA) can effectively help adolesWhen They’re Adults”
cents and adults with autism realize their fullest
potential. The conversation about "cure" often

ASAT responds to TheStar.com’sdelegitimizes and derails important conversa“Groundbreaking adult autism survey reveals
tions about how we can help individuals with aumountain of unmet needs”
tism to live and work independently, develop
meaningful relationships, reduce challenging be- We hope these ideas have furthered your apprecihaviors which may limit opportunities, accessation of the complexities and nuances surroundfaith communities, and enjoy the array of recrea- ing autism awareness. We all play a role in bettertional pursuits which are available within theiring the lives of individuals with autism and helpcommunities. Those are important conversations ing their families and supporters becoming
to have.
skilled and savvy consumers. Embrace that rolewith an eye toward identifying what additional
ASAT is committed to broadening our scope so
steps you can take to become a contributor to imthat we can be a part of this important dialogue; portant conversations and an even bigger part ofan essential dialogue to be had. In response to
the solution for there is much more important
this need, we are developing a webpage to adwork to be done.
dress lifespan topics. Learn about maximizing
employment opportunities, strategies to support For more information on how to join ASAT inolder learners, and a guide for transition to adult- being part of the solution, please visit ourhood.
website. On this page you will learn more
about how to become a sponsor, volunteer,
We are expanding our collection of synopses ofor extern. Or you can make a donation. Join
research including adolescent and adult partici- us in making a difference in the autism compants with autism. Finally, we have written about munity!

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DONOR WALL 2014

In addition to our entire Board of Directors, we acknowledge the following 2014 donors. Without
their support our important work could not be carried out.

SUSTAINING | $20,000

The Leah and Alain Lebec Foundation, Inc.
BENEFACTOR | $1,000—$1,999

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ALLIANCE | $500—$999
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PATRON | $100—$499
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Ferrando3
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Richard Foxx

Phyllis Freidt
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Nea Hanscomb2
David Hinds1
Gale and Lynn
Hoksberger
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Richard Malott
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Tom and Carol Sloan
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In honor of:
1.Peggy Halliday
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3.Daniela Fazzio

FRIEND | $1—$99
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Science in Autism Treatment, Spring 2015
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Article Summary
The Persistence of Fad Interventions in the Face of Negative
Scientific Evidence: Facilitated Communication for Autism as aCase Example1
By Alice Bravo, MEd.
1

Lilienfeld, S., Marshall, J., Todd, J., & Shane, facilitated communication (FC), a practice targetH. (2015). The persistence of fad interventions ing expressive communication among nonin the face of negative scientific evidence: Fa- speaking individuals, as a case example.
cilitated communication for autism as a caseexample. Evidence-Based Communication As- Facilitated Communication
sessment and Intervention, 66–101. DOI:
Facilitated communication is a practice involving
10.1080/17489539.2014.976332. Available free
two people: the non-speaking individual and a
for a limited time: http://goo.gl/o7DqGn“facilitator” – an individual who supports thehand and/or arm of the non-speaking person as
he or she uses a keyboard or similar device totype a message. The goal is that this supported
Introductionuse of a keyboard will allow the non-speaking inith the multitude of marketed interdividual to communicate. This approach to exventions for autism spectrum disorder pressive communication intervention gained(ASD), identifying which to pursue
popularity in the early 1990’s, but by the mid- to
and which to avoid is a common struggle for fam- late-1990’s it had been discredited by researchilies of children with ASD, as well as the provid- and was thus rejected by the scientific communiers who serve them. Researchers have subjected ty. This was largely due to the replicated finding
many of these interventions to scientific scrutiny. that facilitators tended to have control over the
Unfortunately, even after being found to be inactual communication. While facilitators wereeffective by scientific research, some intervenoften convinced that they were simply supporting
tions continue to be marketed and implemented. an individual’s hand, rigorous studies tested thisIn a significant article published in the journal
by asking questions to FC users in two condiEvidence-Based Communication Assessment and tions; in one, the facilitators did not know the anIntervention, Lilienfeld, Marshall, Todd and Shane swers to the questions, and in the other, they did.
(2015) – researchers from Emory University, East- The studies demonstrated that FC only “worked”
ern Michigan University and Boston Children’s
when the facilitators knew the answers to the
Hospital – discussed reasons why interventions
questions posed. Additionally, numerous abuse
that have been deemed ineffective by scientificallegations against FC users’ caregivers emerged
research continue to be utilized. In tackling this through communication supported by facilitaimportant and relevant topic, the authors used

W

(Continued on page 35)

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tors, the majority of which were never substantiated. Yet despite all of the evidence against FC
and a previous decline in its use, FC use has persisted and even appears to be making a comeback, sometimes under a new name (e.g.,“supported typing”).

tific community fails to speak out against its continued use.
Rationale for the Persistence of Fad Treatments

What causes an intervention to take this thirdroute? One reason such treatments seem to attain a strong footing is due to “naïve realism” –“Fad” Treatments
the belief that our subjective experiences regardLilienfeld et al. (2015) analyzed what could lead to ing treatment effectiveness outweighs that of dathe persistence of “fad” treatments such as FC; a ta gathered through controlled studies (Ross &fad treatment being one that has “short-lived en- Ward, 1996). Consequently, when an individual
hears about or sees what appears to be successful
thusiasm” and a “rapid loss of popularity” (Best,
implementation of FC, he or she may believe that
2006). Two typical routes that fad interventions
tend to take were described: 1. They are demon- this single experience negates the findings of scientific research.
strated as ineffective by scientific studies andsubsequently abandoned, or 2. They are validated
by research and thus adopted by clinical profes- An additional factor is “confirmation bias,” whichleads us to pursue evidence that confirms our exsionals (Overholser, 2014). In their analysis, Lilienfeld et al. (2015) identified a third route of fad isting beliefs and to disregard or explain away evinterventions: once deemed unsuccessful by sci- idence that does not (Nickerson, 1998). Confirmation bias may lead individuals to focus on theentific research, the fad treatment “goes underground” and remains utilized within various pro- few studies that demonstrate success of FC, while
fessional communities, where it acquires enough ignoring the considerably larger number of studies demonstrating otherwise. In FC’s case, not onrespectability to be sustained. In this situation,
there are too few researchers concerned with the ly are there more studies disproving its effectivetreatment’s credibility and, as a result, the scien- ness, but also the better-controlled studies havereported the least cases of support for FC(Mostert, 2010).
A third element potentially contributing to thepersistence of fad treatments is the “familiarity
backfire effect.” This is a phenomenon in which
an individual believes something to be true and/or effective simply due to hearing about it multiple times – that is, being “familiar” with the treatment. For this reason, Lilienfeld et al. (2015) argued that one of the important aspects of combatting a scientifically debunked and yet persisting fad treatment is to provide a replacement
treatment. In the case of FC, this involves thepromotion of scientifically supported augmenta-(Continued on page 36)

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References

tive and alternative communication (AAC) methods and applied behavior analysis (ABA). Both of Best, J. (2006). Flavor of the month: Why smart
these treatment methods are supported by scien- people fall for fads. Berkeley, CA: University oftific research and can be used to target expressive California Press.
communication, as FC was originally meant to
Mostert, M. P. (2010). Facilitated communicationdo.
and its legitimacy—twenty-first century developments.
Exceptionality, 18, 31–41.
Conclusion
Nickerson, R. S. (1998). Confirmation bias: A
The widespread promotion of evidence-based
interventions for ASD and related disabilities can ubiquitous phenomenon in many guises. Reprovide parents with a genuine hope for support- view of General Psychology, 2, 175–220.
ing their loved ones. Lilienfeld et al. (2015) encourage researchers in the fields of communica- Overholser, J. C. (2014). Chasing the latest fad:
Confronting recent and historical innovations
tion disorders, psychology and education to bein mental illness. Journal of Contemporary Psycome more involved in speaking out against fad
chotherapy, 44, 53–61.
interventions that have been discredited, andsimultaneously to actively promote scientificallyRoss, L., & Ward, A. (1996). Naive realism: Implisupported interventions. In addition to conductcations for social conflict and misunderstanding research, scientists play an important role ining. In T. Brown, E. Reed, & E. Turiel (Eds.),
disseminating their findings in order to ensure
Values and knowledge (pp. 547–135). Hillsdale,that unsupported interventions are permanently
NJ: Erlbaum.
put aside in favor of ones that are backed by science.

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Research Synopsis
Evaluation of Early Intensive Behavioral Intervention in
Community Settings: Public Preschool and Kindergarten

This study compared Early Intensive Behavioral Intervention (EIBI) based on the UCLA model
developed by Lovaas and colleagues with an eclectic treatment.
We hope you will find it informative!
Sharon A. Reeve, PhD, BCBA-D
Research Synopses Coordinator
Eikeseth, S., Klintwall, L., Jahr, E., & Karlsson, P. (2012). Outcomes for children with autism
receiving early and intensive behavioral intervention in mainstream preschool and kindergarten settings. Research in Autism Spectrum Disorders, 2, 829-835. doi: 10.1016/
j.rasd.2011.09.002
Reviewed by: Casey L. Nottingham, Caldwell University
Why research this topic?
Early and intensive behavioral intervention (EIBI) is widely implemented with individuals with autism spectrum disorder (ASD) as in-home or center-based specialized settings. Several studies support the use of EIBI for improving academic and adaptive behaviors. However, limited research exists
on the effectiveness of EIBI implemented in community settings such as preschools and kindergarten classrooms. This may be because EIBI is intensive and comprehensive and trained instructors
and supervisors are necessary. Additionally, caregiver involvement is typically required. To add tothe evidence of the effectiveness of community-based EIBI, the authors compared EIBI in public preschools or kindergarten classrooms to treatment as usual in these settings.
What did the researcher do?
Participants included 59 children who were diagnosed with autism and had not previously received
EIBI services. Thirty-five participants received EIBI services in mainstream classrooms. Twenty-four(Continued on page 39)

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received treatment as usual. All children received services in their local, publically funded preschoolsor kindergartens. Children in the EIBI group also received services at their homes.
Most of the EIBI therapists had no prior training or experience. Their supervisors had a minimum ofa bachelor’s degree, some had master’s degrees, and one was a Board Certified Behavior Analyst. EIBI
was based on the UCLA model developed by Ivar Lovaas and colleagues. This model begins withhighly structured, one-to-one teaching such as discrete trial training and gradually moves toward
more child-led interactions and inclusion in group settings. Although the curriculum is standardized
in a manual, the intervention goals are individualized for each child. Treatment intensity ranged
from 15 to 37 hours per week of intervention for the EIBI group (average = 23 hours per week), andweekly supervision meetings were held that included the child, primary therapist, caregiver, and supervisor.

In the treatment as usual group, the primary therapists were special education teachers who had aminimum of a bachelor’s degree; teacher assistants sometimes also provided intervention. Treatmentin this group was eclectic including alternative communication (e.g., signs, symbols), sensory-motor
therapies, behavioral analytic techniques, and procedures that the special education teachers createdbased on personal experience.

The authors measured adaptive and interfering behavior with the Vineland Adaptive Behavior Scales(VABS) and the Childhood Autism Rating Scale (CARS). These assessments were given at the start ofthe study, after one year of treatment, and (for the EIBI group only) after two years of treatment.
What did the researchers find?
The researchers found that the EIBI group and treatment as usual group did not differ in the adaptive and interfering behavior measurements at the start of the study. After one year of treatment, the(Continued on page 40)

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Science in Autism Treatment, Spring 2015
Page 40(Continued from page 39)

children receiving EIBI showed larger gains in adaptive behaviors and greater reductions in interfering behaviors and behaviors characteristic of ASD than did the children receiving treatment as usual.
The EIBI group continued to improve from Year 1 to Year 2, although the improvements were smaller
than those seen from Intake to Year 1.
What were the strengths and limitations of the study? What do the results mean?
Several limitations exist in the current study. First, the individuals who completed the assessments
for children in EIBI were the therapists providing services. Because the therapists were responsible
for the outcome of the children, they may have been inclined to assign lower scores on the intake
assessments and higher scores on the later assessments. Second, the participants in the study were
not randomly assigned to either the EIBI or treatment as usual group. This is a problem because although the two groups did not differ with regard to their adaptive and interfering behavior scores atthe beginning of the study, they might have differed on other variables; random assignment togroups would allow for greater confidence that the groups were comparable. Nevertheless, the study
does add to the limited evidence of the effectiveness of community-based EIBI and suggests thatpublic school educators can deliver EIBI effectively.

Patrick O’Leary, MA, BCBAASAT
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Science in Autism Treatment, Spring 2015
Page 41

ASAT
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Science in Autism Treatment, Spring 2015
Page 42ASAT Coordinators, Externs & Committee Members
In addition to our Advisory Board, a number of Coordinators, Externs, and other
Volunteers lend their time and talents to support ASAT's mission and initiatives. These
are our helping hands.
Biomedical Advances Coordinator
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Subscriptions Coordinator
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ASAT’s Newsletter, Science in Autism Treatment
Caroline Simard-Nicolas, MS, BCBA
Externs
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Social Media Coordinator
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