Ask an Autism Researcher – Home-based programs for adults
By Dr Mirko Uljarevic, OTARC – CRC Postdoctoral Research Fellow
Hi, I am running a home based 1:1 program for my 29 year old autistic son and hoping to combine this with a couple of carefully chosen group programs in the near future. We want to keep giving him more enriching activities than he has had in the past ten years in day services and I am especially interested to know if anyone anywhere (in the world!) has attempted to develop or modify ABA for use past early childhood, and if so, if such a program has been evaluated?
While there has been a lot of interest and investment on the part of researchers in understanding, diagnosing and treating Autism Spectrum Disorder (ASD) during early childhood, research on ASD during adolescence and adulthood remains relatively neglected. A good illustration is a recent review by Shattuck and colleagues (Shattuck et al., 2012) which showed that of all the studies published between 2000 and 2010, only 13 studies assessed the implementation or impact of an intervention or program intended to promote independent functioning, work skills or social participation for adults with ASD, and only eight of those studies evaluated behavioural interventions.
In general, behavioural interventions were found to be effective, but it is important to emphasize that all of the interventions reviewed by Shattuck and colleagues were focused on teaching particular skills rather than being more comprehensive behavioural intervention packages. The majority of studies concentrated on the training/development of necessary vocational skills. For example, Lattimore and Parsons (2008) taught adults with ASD work skills in a simulated setting (in a class room) before starting new duties at their place of work. They found that this training was effective in that less time was required to teach these skills on the job. Another study (Burke et al., 2010) showed that behavioural training, assisted by a “performance cue system” (i.e., an iPhone application adapted for the study) was successful in teaching six young adults targeted social-vocational skills.
Other studies have examined the efficacy of behavioural interventions on challenging behaviours in adults with ASD. For a detailed overview of these studies see the review by Matson and colleagues (2011), and for broader reviews on interventions for adolescents and young adults with ASD see Taylor et al (2012) and Bishop-Fitzpatrick et al (2013). In their systematic review Bishop-Fitzpatrick and colleagues found that the majority of studies were single case studies. Most of these studies focused on applied behaviour analysis or social cognition training.
A good example of a study evaluating a social cognition-training program is the one by Faja et al (2011). They showed that adults with high-functioning ASD who had difficulties recognizing faces improved after receiving instructions emphasizing paying attention to the face as a whole and to core features (eyes, mouth, etc.). An example of a study evaluating an ABA-based program is the one by Moore (2009). It describes training of an adolescent to use a self-training program in order to reduce stereotypical behavior (e.g., foot stomping, making a loud sound). The researchers found that the adolescent was able to teach himself to reduce the stereotypical behaviours (by increasing the latency or time for the behavior to occur).
In conclusion, the research in this area is sparse and there doesn’t seem to be any particular ABA program for adults that have been fully evaluated. However, the available literature seems to suggest that ABA strategies in general can be applied, and are effective in supporting adolescents and adults with ASD to continue learning new life skills in various settings throughout their lives.
- Bishop-Fitzpatrick et al. (2013). A systematic review of psychosocial interventions for adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43(3), 687-94.
- Burke et al. (2010). Evaluation of two instruction methods to increase employment options for young adults with autism spectrum disorders. Research in Developmental Disabilities, 31(6), 1223-33.
- Faja S, Webb SJ, Jones E, Merkle K, Kamara D, Bavaro J, et al. (2012). The effects of face expertise training on the behavioral performance and brain activity of adults with high functioning autism spectrum disorders. Journal of Autism & Developmental Disorders, 42(2), 278-93.
- Lattimore LP, Parsons M. (2008). Simulation training of community job skills for adults with autism: a further analysis. Behavior Analysis and Practice, 1(1):24–29.
- Matson, Sipe, Fodstadt, Fitzgerald. (2011). Issues in the management of challenging behaviours of adults with autism spectrum disorder. CNS Drugs, 25(7), 597-606. (Abstract)
- Moore, T. R. (2009). A brief report on the effects of a self-management treatment package on stereotypic behavior. Research in Autism Spectrum Disorders, 3(3), 695–701.
- Shattuck et al. (2012). Services for Adults with an Autism Spectrum Disorder. Canadian Journal of Psychiatry, 57(5), 284-291.
- Taylor et al (2012). Interventions for Adolescents and Young Adult with Autism Spectrum Disorders. Rockville: Agency for Healthcare Research and Quality.