Variation in Behavior Analysts' Treatment Intensity Recommendations for Patients with Autism Spectrum Disorder

Most outcome research on Applied Behavior Analysis (ABA) treatment suggests that high intensity yields the best outcomes for patients with autism spectrum disorder (ASD). However, little is known about what impacts the determinations behavior analysts make regarding individualized treatment intensity recommendations. We conducted a cross-sectional survey of behavior analysts with experience developing and overseeing behavior analytic treatment for individuals with ASD (N = 559). We asked participants to report how 36 patient, familial, and logistical factors impact their treatment intensity recommendations using a 7-point Likert scale (ranging from significantly decrease to significantly increase recommended treatment intensity). Results indicated variation in the factors that impact recommendations as well as the direction of impact, with the greatest agreement that patient diagnosis and skills deficits lead to increased treatment intensity recommendations. Although the data reveal patterns and areas of seemingly greater consensus, the significant variability in clinicians' approaches to individualizing treatment intensity recommendations indicates a need for future research on training and standards for clinicians to ensure appropriate treatment intensity recommendations are provided to all patients receiving ABA treatment.