version date: January 20, 2022 TUW PsyD Oral Defense Template This template is provided for convenience and may not represent all requirements. There may be additional (or conflicting) requirements for certain methodologies. Please consult with your chair to ensure your presentation includes all appropriate and required elements. Each presentation section in the template is a single slide, but it may be appropriate to have multiple slides to cover some areas. INTRODUCTION Please note: No more than 30 minutes for proposal defense presentation. No more than 45 minutes for final defense presentation. Avoid reading from slides and seek to present material naturally. Some additional tips for presenting: https://www.ncsl.org/legislators-staff/legislative-staff/legislative-staff-coordinating-committee/tips-for-making-effectivepowerpoint-presentations.aspx https://www.themuse.com/advice/public-speaking-tips No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior written permission of TUW. © 2022 Touro University Worldwide (TUW). All rights reserved. 1 TITLE YOUR NAME DOCTOR OF PSYCHOLOGY IN HUMAN AND ORGANIZATIONAL PSYCHOLOGY ORGANIZATIONAL LEADERSHIP CONCENTRATION (IF APPLICABLE) PROPOSAL OR FINAL DEFENSE DATE CHAIR COMMITTEE MEMBER 1 COMMITTEE MEMBER 2 Introduction Very basic background / literature context (to be expanded in lit review) INTRODUCTION 3 Definitions / Key Terminology (optional, use if necessary) INTRODUCTION 4 Problem/Purpose Statement The problem statement should be exactly what you have in your document INTRODUCTION 5 Conceptual Framework If quantitative, this should be the image from your document. If qualitative, you may or may not have a CF. Describe variables and relationships between variables. INTRODUCTION 6 Research Questions / Hypotheses RQ1: H0: INTRODUCTION RQ2: H0: No more than 2 or 3 per slide. RQs should be used for both quantitative and qualitative research, but qualitative research may or may not include hypotheses. 7 Study Significance How does this study fit into the context of existing literature? INTRODUCTION 8 Literature Review Very brief summary of all sections of your literature review. INTRODUCTION 9 Participants and Recruitment Plan Who are the participants and how will you recruit them? Do you have permission? INTRODUCTION 10 Research Methods How will you measure your variables? What will participants do? Why is this methodology most appropriate? INTRODUCTION 11 Instrumentation What instruments will you use? Have you modified the instruments? How are those instruments scored? INTRODUCTION How do the instruments measure your variables? Do you have permission to use the instruments? Typically 1 instrument per slide. 12 Assumptions, Limitations, Delimitations INTRODUCTION 13 Ethical Concerns Are there risks? How will privacy be protected? How will data be stored? INTRODUCTION Are data anonymous? Are there any potential biases? 14 Results – Data Summary Descriptive statistics INTRODUCTION 15 Results – Analyses Data Analysis / inferential statistics For qualitative work, thematic analysis or other methodologically appropriate analysis INTRODUCTION 16 Results – Findings Findings in relation to hypotheses and research questions. INTRODUCTION 17 Implications What are the implications of the findings? INTRODUCTION 18 Future Work INTRODUCTION 19 Conclusion Optional INTRODUCTION 20 References INTRODUCTION 21 PARENTS PERSPECTIVE ON THE EFFECTIVENESS OF ABA THERAPY WHAT ARE PARENTS’ PERSPECTIVES ON THE EFFECTIVENESS OF ABA THERAPY? BY DISSERTATION PROPOSAL Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Psychology in Human and Organizational Psychology Touro University Worldwide, 2023 Doctoral Committee: Robert Lubin, Ph.D., Chair Michael Epstein, Ph.D., Committee Rachel Heater, Ph.D., Committee PARENTS PERSPECTIVE ON THE EFFECTIVENESS OF ABA THERAPY Signature page PARENTS PERSPECTIVE ON THE EFFECTIVENESS OF ABA THERAPY Yolanda Akwe Enanga © 2023 ALL RIGHTS RESERVED PARENTS PERSPECTIVE ON THE EFFECTIVENESS OF ABA THERAPY Acknowledgments Thank you to Dr. Lubin, Dr. Heater, and Dr Epstein for your guidance throughout the research work and for providing me with this template so I know where the optional acknowledgments page goes. Without this template, I may have placed it on a later page, or I may have incorrectly formatted it. iv PARENTS PERSPECTIVE ON THE EFFECTIVENESS OF ABA THERAPY I wish to dedicate this work to my entire family for their love and support throughout my entire degree journey. . v PARENTS PERSPECTIVE ON THE EFFECTIVENESS OF ABA THERAPY Abstract This qualitative research project is to inquire into how families affected by Autism Spectrum Disorder (ASD) see the success of ABA therapy. Applied behavior analysis (ABA) is a treatment strategy that teaches people with ASD new skills and rewards them for using them. Although ABA therapy has been demonstrated to improve a variety of skills in people with ASD, it is important to take into account the viewpoints of parents since they play such an important part in their children’s therapeutic journey. This study builds on the foundation of other qualitative investigations into comparable topics from the perspective of parents. The purpose of this study is to explore parents’ perceptions of ABA’s efficacy by interviewing them individually and in focus groups. The qualitative data collected from these discussions will be subjected to thematic analysis to reveal common threads in the parents’ perspectives. vi PARENTS PERSPECTIVE ON THE EFFECTIVENESS OF ABA THERAPY Table of Contents Acknowledgments………………………………………………………………………………………………………….. iv Abstract ………………………………………………………………………………………………………………………… vi List of Tables ………………………………………………………………………………………………………………… ix Glossary ………………………………………………………………………………………………………………………. xii List of Abbreviations ……………………………………………………………………………………………………. xiii Chapter 1: Introduction ……………………………………………………………………………………………………. 1 Statement of the Problem ……………………………………………………………………………………………… 2 Theoretical Model ……………………………………………………………………………………………………….. 2 Research Questions ……………………………………………………………………………………………………… 5 Significance of the Study ……………………………………………………………………………………………… 5 Assumptions ……………………………………………………………………………………………………………….. 5 Summary ……………………………………………………………………………………………………………………. 8 Chapter 2: Literature Review ………………………………………………………………………………………….. 10 ABA Therapy ……………………………………………………………………………………………………………. 10 Historical Background of ABA Therapy ……………………………………………………………………. 16 Core Principles and Techniques of ABA Therapy ………………………………………………………. 17 Perspectives of Parents on the Effectiveness of ABA Therapy …………………………………….. 18 Factors That Influence Parents’ Perceptions of ABA Therapy ………………………………………. 19 Ethical Considerations in the Use of ABA Therapy with Children ……………………………….. 20 Autism Spectrum as a Type of Disability ……………………………………………………………………… 22 Attitude and Perspective Towards Treatment for ASD……………………………………………………. 23 Objective Impact of Parents Participating in Their Child’s Treatment ………………………………. 24 ABA Therapy Treatment Recommendations …………………………………………………………………. 27 Relationship Between Therapist, Parents, and Treatment………………………………………………… 28 Summary ………………………………………………………………………………………………………………….. 29 Chapter 3: Methodology ………………………………………………………………………………………………… 31 Research Design ………………………………………………………………………………………………………… 32 The Rationale for Qualitative Research …………………………………………………………………….. 32 Research Paradigm …………………………………………………………………………………………………. 32 Researcher’s Role …………………………………………………………………………………………………… 32 Data Collection Methods …………………………………………………………………………………………….. 33 Sampling Strategy ………………………………………………………………………………………………….. 33 Ethical Considerations………………………………………………………………………………………………… 33 Participants ……………………………………………………………………………………………………………….. 34 Inclusion Criteria ……………………………………………………………………………………………………. 34 Recruitment Process ……………………………………………………………………………………………….. 34 Demographic Information ……………………………………………………………………………………….. 34 Sample Size Justification …………………………………………………………………………………………. 35 Data Collection ………………………………………………………………………………………………………….. 35 Interview Guide Development …………………………………………………………………………………. 35 Pilot Testing…………………………………………………………………………………………………………… 35 vii PARENTS PERSPECTIVE ON THE EFFECTIVENESS OF ABA THERAPY Interviews …………………………………………………………………………………………………………………. 36 Semi-Structured Interviews ……………………………………………………………………………………… 36 Interview Duration………………………………………………………………………………………………….. 36 Data Analysis ……………………………………………………………………………………………………………. 36 Transcription and Data Management ………………………………………………………………………… 36 Theme Development ………………………………………………………………………………………………. 36 Validity and Reliability …………………………………………………………………………………………… 37 References ……………………………………………………………………………………………………………………. 38 Appendix A ………………………………………………………………………………………………………………….. 43 Appendix B ………………………………………………………………………………………………………………….. 44 viii PARENTS PERSPECTIVE ON THE EFFECTIVENESS OF ABA THERAPY List of Tables ix PARENTS PERSPECTIVE ON THE EFFECTIVENESS OF ABA THERAPY No table of figures entries found. x PARENTS PERSPECTIVE ON THE EFFECTIVENESS OF ABA THERAPY List of Figures No table of figures entries found.Figure 1: Conceptual Framework …………………………………… 2 Figure 2: How an Increasingly Red Line Declines From 0 to 11 …………………………………………… 9 xi PARENTS PERSPECTIVE ON THE EFFECTIVENESS OF ABA THERAPY Glossary Behavior Analysis: This is a science that studies the behavior of human and non-human organisms. It focuses on understanding, explaining, describing and predicting behavior patterns. Autism Spectrum disorder: This is a developmental disorder caused by differences in the brain BCBA: This a graduate level certification provided to practitioners who provider behavior analytic service xii PARENTS PERSPECTIVE ON THE EFFECTIVENESS OF ABA THERAPY List of Abbreviations Abbreviation Explanation APA American Psychological Association TUW Touro University Worldwide ASD Autism Spectrum Disorder ABA Applied Behavior Analysis BCBA Board certified behavior analyst xiii PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Chapter 1: Introduction Autism Spectrum is a collection of neurodevelopmental differences that manifest as a variety of traits such as difficulty in communication and social interaction, sensory processing sensitivity, and repetitive behaviors. ASD can range from mild to severe and can include a variety of symptoms (Centers for Disease Control and Prevention, 2020). The Centers for Disease Control and Prevention (2018) report that in the United States, 1 out of every 59 children have been diagnosed with autism spectrum disorder. These children often face challenges in different areas of their life such as communication, social skills, and appropriate behaviors. While there is no single “cure” for ASD, various evidence-based treatments are available to help children with ASD boost their functioning and achieve their potential. One of the most common evidence-based treatments is Applied Behavioral Analysis (ABA). ABA is a scientific, data-driven approach to understanding behavior and helping individuals learn new skills (Autism Speaks, 2021). The approach focuses on teaching acceptable conduct, reducing problematic behaviors, and increasing language acquisition. It is used in children with ASD to increase their language, social, and communication skills. ABA is composed of four behavioral principles that guide its effectiveness. The first principle is that an individual’s behavior is affected by the environment (Slocum et al., 2014). It implies that the surroundings of an individual impact their behavior. For instance, if a child is bullied at school, the child is bound to either avoid going to school or escape from school. This habit will persist until a solution is found to the problem or they gain confidence in themselves; they will desist from attending school if a solution is not found. Parents’ perceptions of their child’s progress during ABA therapy may also be influenced by their level of involvement in the treatment. Researchers have found that parents who actively 1 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY participate in their child’s therapy have a more favorable outlook on the treatment’s success (Kurth et al., 2020). There is ongoing research on the efficacy of ABA therapy with new findings being published regularly; therefore, it’s important to have a firm grasp on what’s known currently and to seek advice from specialists (Wallisch et al., 2019). There is a need to perform more research on the parents’ perception of ABA therapy. Statement of the Problem As cases of autism spectrum disorder have become prevalent in the community, it has become more apparent that there is substantial variability of children affected with neurodevelopmental disorders, which causes many families to struggle to look for the best treatment option for their children diagnosed with autism. Many educational programs have been established to train applied behavior analysts to treat children with autism. Although early behavioral interventions, such as applied behavior analysis, have been applauded for addressing the issues of mental disorders, further studies need to be done to find parents’ perspectives on how effectively applied behavior analysis can be used in treating autism spectrum disorder. It will help realize a broader spectrum of the possible ways to treat the disease and give room for other parents, who are reluctant in deciding if aba if ABA is the right treatment option. Studies have shown that 1 in 44 families has applied for medical insurance coverage for evidence-based treatments for autism spectrum disorder, indicating an increased demand for treatment of the disease (Maenner et al., 2021). Theoretical Model This qualitative study’s theoretical approach suggests questioning ASD parents about ABA therapy’s success. The model assumes parents’ perceptions impact whether they continue ABA therapy for their children. The model incorporates several essential parental perception 2 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY components. The model also considers how motivating operations affect parental ABA compliance. Internal or external motivational processes alter reinforcement and punishment effectiveness. Understanding how reinforcement contingencies and contextual factors affect parental compliance might help explain the apparent effectiveness of ABA therapy. Demographic factors including parental education, money, and culture may indicate ABA misperceptions, according to the model. diverse populations have diverse views on autism and its treatment. Finally, the model considers changing parental views while opting to continue ABA therapy. It acknowledges that parents’ perspectives may alter as they experience their child’s progress and growth throughout therapy, prompting reevaluation of treatment goals and the need for continuous services. This theoretical framework will help researchers understand how ASD parents see and respond to ABA therapy. It shows how parental advice, driving factors, demographic movements, and worldviews change throughout time. By analyzing parents’ perspectives of ABA therapy’s success, therapists, educators, and lawmakers may increase ASD treatment quality and individualization. Conceptual Frame Work Diagram 3 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Fig 1: Theoretical Model The model shown in the figure is a theoretical framework for assessing the efficacy of Applied Behavior Analysis (ABA) therapy for children with Autism Spectrum Disorder (ASD). The diagram’s main idea is “Parental Perceptions of ABA Therapy’s Success in ASD Treatment.” Parental engagement and active involvement in ABA treatment are emphasized throughout the paradigm. It implies that parents’ evaluations of the therapy’s efficacy are considerably altered when participating actively in their child’s treatment. Parents involved in their child’s therapy are more likely to have optimistic hopes for their child’s progress and recovery. In addition to the model’s centrality, motivating operations are also crucial. These internal and external influences may affect the degree to which parents adhere to ABA treatment plans. Researchers may gain insight into ABA therapy’s apparent efficacy by learning how reinforcement variables and contextual factors impact parental compliance. 4 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Research Questions Research questions that guide the study of parents’ perception of the effectiveness of ABA therapy include: • How does parent training in ABA therapy influence parental compliance with treatment over a period of time? • How do motivating operations influence parental compliance with ABA therapy for children over a period of time? • Are there demographic variables that indicate parental misconception about ABA therapy over a period of time? Does parents’ perspective over a period of time determine if services are no longer necessary? Significance of the Study With the constantly increasing rate of diagnosis of autism spectrum disorder, parents are on the search for treatment options that would work or help in managing maladaptive behaviors displayed by kids with autism. Therefore, there is a need for research, i.e., evidence backed by data, to help parents facilitate their decision about treatment options. Assumptions Once the study is underway, it is based on a number of presumptions that inform its design and data collecting. First, it is presumed that the parents whose children have been diagnosed with autism spectrum disorder (ASD) are representative of the greater community. To provide a complete picture of parents’ views on ABA treatment, the researchers want to utilize a purposive sample approach to guarantee that the selected participants come from a wide variety of backgrounds, experiences, and viewpoints. 5 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Researchers secondly presume that participants have enough knowledge of ABA treatment and its relevance to their child’s ASD. Participants will be parents whose children have had or are receiving ABA therapy. The researchers hope that by having these parents take part in the study, they would be able to offer accurate information on how they feel the treatment has helped their kid. Finally, it is presumed that the participants’ replies to the interviews and focus groups would be honest and accurate representations of their actual experiences and viewpoints on ABA treatment. The researchers want to play the role of neutral facilitators, treating the participants with kindness and respect in order to foster an atmosphere conducive to honest and open communication. Researchers want participants to be as honest as possible about their experiences with ABA treatment, so they’ve taken steps to make them feel at ease. These presumptions form the basis of the study and will help the researchers collect reliable data on how beneficial ABA treatment is for children with ASD from the viewpoint of the children’s parents. Participants’ knowledge of ABA therapy, along with their candid responses, will help produce a solid qualitative analysis that can guide future ABA therapy developments and help families make educated decisions on their children’s behalf. Limitations There are a number of things to keep in mind as the study gets underway that will affect the research design and the limits of the results. The research has certain limitations. For one, it uses parents’ self-reported data, which may be prone to biases including memory bias and social desirability bias. Parents’ accounts of their interactions with ABA therapists may be skewed by the vividness of their memories or their desire to make a good impression. Researchers will take 6 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY steps to promote an atmosphere of trust and secrecy in order to encourage participants to provide open and honest feedback. Second, it is important to note that the results of this research may not be applicable to all parents of children with autism spectrum disorder. Researchers may have erred in thinking that the parents they interviewed would be representative of all parents of autistic children since they used a purposeful sample method. It’s also possible that the participants’ unique demographic features influenced their views on ABA treatment, so reducing the generalizability of the findings. Researchers will be forthright about the features of the sample and will use caution as they interpret results in light of the study’s breadth and the demographics of the participants. The size and length of the study’s sample are other crucial considerations. Qualitative research methods like in-depth interviews and focus groups are time-consuming and resource-intensive. Therefore, the research may not be able to fully investigate all aspects of how parents feel about ABA treatment. In addition, the size of the sample may affect how comprehensive and detailed the results are. The researchers want to collect enough data to draw valid conclusions, but they may not be able to account for all of the elements that might affect parents’ perspectives owing to time or manpower restrictions. Thus, the researchers recognize these possible constraints and will account for them when analyzing the results. Regardless of these caveats, the study’s primary goal is to provide light on parents’ perceptions of ABA therapy’s efficacy from the viewpoint of children with ASD. The project seeks to give useful information to the profession and to help the development of more individualized and successful therapies for children with autism and their families by openly addressing possible biases and sample limits. Delimitations 7 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY The purpose of this research is to understand how parents evaluate ABA therapy for their children who have autism spectrum condition. The scope of this study does not include an evaluation of other approaches to treating ASD. The research hopes to recruit parents from a wide range of cultural and ethnic backgrounds, but it doesn’t look at whether or not those variables affect how those parents see ABA. The study’s primary goal is to collect a heterogeneous sample of parental viewpoints without diving headfirst into cultural specifics. This research will only apply to a certain area. For this reason, although the results may be applicable in this specific scenario, they may not be transferable to another. Summary The importance of understanding parents’ perspectives on the effectiveness of ABA therapy in treating autism spectrum disorder. The studies suggest that parents play a critical role in their child’s treatment; their involvement can objectively impact the outcomes. However, the studies also highlight the need for therapists to establish strong and compassionate relationships, with both the child and parents, to facilitate effective treatment. The studies suggest that there are varying attitudes and perspectives, among parents, on treatment for ASD, which highlights the need for individualized treatment plans. Additionally, the literature highlights the importance of ABA therapy recommendations and the need for ongoing evaluation and development of treatment practices. Therefore, the reviewed literature emphasizes the importance of a collaborative approach, between therapists and parents, in treating ASD. This collaborative approach can lead to better outcomes for the child and a more positive experience for the parents. Further research is needed to better understand the dynamics of the therapist-parent-child 8 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY relationship and identify effective interventions that can improve treatment outcomes for individuals with ASD and their families. 9 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Chapter 2: Literature Review This chapter will explore the literature available on ABA therapy to better understand it as an effective treatment option for children with autism. To relate a finer understanding of parents’ perspectives on the effectiveness of ABA, research about the perspectives of those parents whose kids are receiving ABA services at home and school will be examined. Previous studies highlighting parents’ perspectives on the effectiveness of ABA treatment would also be examined. Other literature has also depicted a mixture of opinions, from providers, about working with families of children on the spectrum where some voiced frustration related to treatment progress and system issues, and others felt the need for more training for better understanding. ABA Therapy Applied Behavioral Analysis (ABA) therapy is emerging as one of the most influential techniques in realizing some of the most interesting concepts that most parents embrace for their children. Therefore, according to Dennison et al. (2019), Applied Behavior Analysis (ABA) therapy is identified as a scientific and evidence-based approach to understanding and modifying behavior. Therapists define ABA as an interpersonal therapy, used on a child, by practitioners, to treat a spectrum disorder (Slocum et al., 2014). It is used to improve the social skills of the affected individual. ABA was first established, in the 1960s, by Dr. Ivar Lovaas, a behavioral psychologist. Since its establishment, his methods have evolved to identify children’s behavioral changes in a better way. Lovaas believed that autism is a behavioral symptom that could be modified. Back then, ABA punished those who declined to follow the established rules. For example, they were to be subjected to electrical shocks. However, as times have changed and 10 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY better methodologies have been established, the punishments have been replaced with rewards for any progress made. ABA is composed of four behavioral principles that guide its effectiveness. The first principle is that an individual’s behavior is affected by the environment (Slocum et al., 2014). It implies that the surrounding of an individual matters a lot when it comes to behavioral changes. It is rooted in the principles of behaviorism, which propose that environmental events, including antecedents and consequences, shape behavior. ABA therapy teaches new skills to individuals and decreases challenging behaviors by breaking down complex behaviors into smaller, manageable steps. It uses positive reinforcement to increase desired behaviors and punishment to decrease unwanted behaviors—although punishment is used sparingly and only after other interventions have proved unsuccessful (Dennison et al., 2019). ABA therapy is tailored to individual needs and involves ongoing data collection and analysis to measure progress and make necessary adjustments. It can be used with individuals of all ages and those with various disabilities and behavioral challenges including autism spectrum disorder, developmental disabilities, and mental health disorders. Therefore, ABA therapy aims to improve the quality of life of individuals and their families by teaching new skills, reducing challenging behaviors, and increasing independence and social functioning. It is a flexible and adaptable approach that can be customized to the cultural background of each individual, and their family, to meet their specific needs. Controversies Associated with ABA and Autism The controversy surrounding ABA and autism has been a topic of discussion and debate within the field. One point of contention is the use of punishment in ABA therapy. Critics claim 11 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY that using unpleasant measures, such as time-out or withholding reinforcement, can be damaging and create misery in autistic people(Vekatesan & Lyer, 2022) . Alternative measures, such as positive behavior support, some suggest, should be adopted in order to priorities positive reinforcement and establish a helpful workplace. Another point of contention is the intensity and duration of ABA therapy. Some say that the intense nature of ABA, which frequently requires many hours per week, can be exhausting for children and limit their opportunity for spontaneous social connections and play. Critics are also concerned about the long-term implications of extensive ABA therapy on the child’s wellbeing and quality of life. Another topic of dispute is the emphasis on behavior change. Some say that the ABA places too much focus on conformity and compliance, overlooking the significance of encouraging uniqueness and self-expression(Vekatesan & Lyer, 2022) . Critics argue that a more holistic approach should be taken, taking into account the unique strengths and challenges of people with autism. Daley et al., (2013) describes how cultural sensitivity and diversity also play a role in the debates over ABA therapy. Čolić et al. (2022) describe how culturally relevant ABA practices are required to meet the demands of varied communities. They stress the significance of incorporating cultural values and views into the therapy process in order to avoid potential harm and foster inclusivity. The ethical issues underlying ABA are fundamental to the debate. Daley et al. (2013) explore the ethical difficulties between children’s rights, parental rights, and service providers’ rights. Informed consent, the child’s autonomy, and the balance between the child’s best interests and parental decision-making are all raised as concerns. 12 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY It is crucial to remember that the issues surrounding ABA therapy are not universally accepted. Many experts, parents, and autistic people advocate for the benefits of ABA and highlight its evidence-based success in enhancing communication, social skills, and adaptive behaviors (Cooper et al., 2020). When performed responsibly and with care for individual needs and preferences, ABA therapy can be a beneficial intervention for people with autism (Cooper et al., 2020). . As a result, problems surrounding ABA and autism originate from concerns about the use of punishment, the intensity and duration of therapy, the emphasis on behavior change, cultural sensitivity, and ethical considerations. While these debates exist, there is a substantial body of evidence supporting the efficacy of ABA therapy (Vekatesan & Lyer, 2022).. Ongoing conversations and research strive to address these concerns, promote ethical practices, and ensure that individuals with autism receive quality treatment. Also, concerns concerning the ethical implications and possible harmful repercussions of Applied Behavior Analysis (ABA) and autism have spurred disputes within the profession. According to Cooper et al. (2020), ABA is widely accepted as an effective intervention for people with autism. However, some opponents say that using punishment in ABA treatment, such as time-outs or withholding rewards, may be harmful and cause suffering in autistic people. Some argue for alternate ways, such as positive behavior support, which emphasizes positive reinforcement and fosters a pleasant atmosphere. Another source of dispute is the length and severity of ABA treatment. Critics contend that the intensive nature of ABA, which sometimes requires several hours per week, might weary children and restrict their possibilities for spontaneous social connections and play(Vekatesan & Lyer, 2022) . Concerns have been raised concerning the long-term impact of intensive ABA treatment on a child’s well-being and general quality of life. 13 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY The focus on behavior modification within ABA is also debatable. Some critics claim that the ABA focuses too much on conformity and compliance, ignoring the value of encouraging originality and self-expression (Vekatesan & Lyer, 2022). Vekatesan and Lyer (2022), advocated for a more comprehensive strategy considering persons with autism’s unique strengths and problems. Furthermore, cultural sensitivity and diversity play a part in the debates over ABA treatment. Oli et al. (2022) emphasize the necessity for culturally appropriate ABA methods that embrace cultural values and viewpoints to minimize possible damage and promote inclusion. The ethical implications of ABA are central to the argument. Daley et al. (2013) investigate the ethical issues surrounding children’s, parental, and service providers’ rights. Concerns have been expressed concerning informed consent, child autonomy, and finding a balance between the kid’s best interests and parental decision-making. It is vital to remember that the ABA treatment controversy is not widely acknowledged. Many specialists, parents, and autistic people support ABA and emphasize its evidence-based effectiveness in improving communication, social skills, and adaptive behaviors (Cooper et al, 2020). When used responsibly and customized to the requirements and preferences of the person, ABA treatment may be an effective intervention for people with autism. As a result, criticisms about ABA and autism originate from worries about the use of punishment, the intensity, and length of treatment, the focus on behavior modification, cultural sensitivity, and ethical problems. Despite these continuing disagreements, a large amount of data exists to support the usefulness of ABA treatment. Continuous debates and research aim to address these problems, promote ethical methods, and ensure that people with autism get excellent care. 14 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY According to Autism Speaks (2021), ABA is largely accepted as a successful therapy for autistic people. It is based on behavior analysis concepts and focuses on teaching skills and eliminating undesirable behaviors. The method is customized and suited to the specific requirements of each autistic person. However, some issues have been expressed concerning the use of punishment in ABA treatment. According to critics, punishment measures such as timeouts or the withholding of rewards may be damaging and stressful for people with autism. They advocate for alternative ways that emphasize positive reinforcement and provide a loving atmosphere. Another point of contention is the length and severity of ABA treatment. Some claim that the rigorous nature of ABA, which sometimes entails several hours of weekly treatment, may be exhausting and restrict a child’s opportunity for normal social connections and play. Critics are concerned about the long-term impact of intense ABA treatment on the general well-being and quality of life of autistic people. Furthermore, the focus on behavior modification within ABA has been a source of contention. Critics claim that the ABA focuses too much on uniformity and compliance, ignoring the value of encouraging originality and the ability to express oneself. They argue for a more comprehensive strategy that considers the specific strengths and problems of people with autism. Cultural sensitivity and diversity also play a part in the debates over ABA treatment. To deliver successful and inclusive therapies, it is important to understand the cultural values and views of people with autism and their families. Culturally appropriate ABA methods are required to prevent possible damage and guarantee that treatment is adapted to the individual requirements of varied populations. Ethical questions are crucial to the arguments over ABA and autism. Balancing the rights of the kid, parental rights, and service providers’ rights may be 15 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY difficult. Informed consent, child autonomy, and making choices in the child’s best interests are all essential ethical issues in the context of ABA treatment. While there are disagreements and disputes about ABA and autism, it is crucial to recognize that a substantial body of research supports the use of ABA treatment. Many specialists, parents, and autistic people argue for the advantages of autism in boosting communication, social skills, and adaptive behaviors. Individuals with autism may benefit from the responsible implementation of ABA treatment that considers their specific needs and preferences. Continuous dialogues, research, and attempts to address concerns and encourage ethical practices are required to guarantee that persons with autism get high-quality, inclusive care. Historical Background of ABA Therapy In their article, Morris and Peterson (2022) provide a detailed historical background of Applied Behavior Analysis (ABA) therapy and traces its roots to the works of B.F. Skinner and other behaviorists in the early 20th century. Skinner’s research in operant conditioning and his theories on reinforcement and punishment served as the foundation for ABA therapy (Morris & Peterson, 2022). The application of behaviorism, to the treatment of individuals with intellectual and developmental disabilities, began in the 1950s and 1960s with the work of Ole Ivar Lovaas and colleagues at the University of California, Los Angeles (UCLA) (Morris & Peterson, 2022). Lovaas developed the first intensive, individualized ABA-based treatment program for children with autism, which focused on increasing appropriate behavior and reducing problem behavior through positive reinforcement. 16 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY In the 1970s, ABA therapy gained further recognition through the establishment of the Journal of Applied Behavior Analysis and the creation of the Behavior Analyst Certification Board (BACB) to regulate the professional practice and provide certification for behavior analysts. In the 1980s and 1990s, ABA therapy continued to evolve with new techniques and strategies such as discrete trial and naturalistic teaching approaches (Morris & Peterson, 2022). The focus of ABA therapy also expanded beyond individuals with autism to include various developmental disabilities and behavior disorders. In recent years, ABA therapy has become a widely recognized and accepted treatment approach for individuals with autism and other developmental disabilities. It has also gained attention as a treatment approach for various behavioral and mental health disorders in children and adults (Morris & Peterson, 2022). Therefore, the historical background of ABA therapy is rooted in the principles of behaviorism and the work of pioneers such as B.F. Skinner and Ole Ivar Lovaas have continued to evolve and expand, over the decades, to become a widely recognized and effective treatment approach for individuals with various developmental and behavioral challenges. Core Principles and Techniques of ABA Therapy The core principles of Applied Behavior Analysis (ABA) therapy, as described by Sandoval-Norton et al. (2019), are based on the principles of behaviorism, which propose that environmental events shape behavior. ABA therapy aims to teach new skills and decrease problem behaviors by breaking down complex behaviors into smaller, manageable steps and utilizing positive reinforcement to increase desired behaviors. One of the core techniques of ABA therapy is discrete trial training, which involves breaking down skills into smaller, more manageable steps and using prompts and reinforcement 17 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY to teach each step. Another technique is naturalistic teaching, which focuses on teaching skills found in natural, everyday environments and utilizing natural rein forcers (Sandoval-Norton et al., 2019). Positive reinforcement is a key aspect of ABA therapy. It involves providing rewards or praise for desired behaviors to increase the likelihood of their reoccurrence. Negative reinforcement, which involves removing aversive stimuli in response to desired behaviors, is also used in ABA therapy. Punishment is sparingly used in ABA therapy; it is used only as a last resort when other interventions become unsuccessful. Punishment should be appropriately and ethically applied by focusing on preventing harm to the individual and avoiding long-term negative effects (Sandoval-Norton et al., 2019). Therefore, the core principles and techniques of ABA therapy focus on teaching new skills and decreasing problem behaviors and emphasize positive reinforcement and individualized, data-driven interventions. ABA therapy is a flexible and adaptable approach that can be tailored to meet the unique needs of each individual. It should be applied in a way that prioritizes the well-being and safety of the individual. Perspectives of Parents on the Effectiveness of ABA Therapy Other researchers, such as Cooper et al., (2020) note that there are wide variations in parents’ perspectives on the effectiveness of Applied Behavior Analysis (ABA) therapy. Some parents report significant improvements in their child’s behavior and functioning while others may not see as much progress or may have concerns about the ethical and practical aspects of ABA therapy. Research has shown that parents who participate in ABA therapy, and are actively involved in their child’s treatment, tend to report higher levels of satisfaction and improvement in their child’s behavior (Cooper et al., 2020). ABA therapy can be a long-term and intensive treatment approach, which requires significant time and commitment from the child and family. 18 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Some parents may have concerns about using reinforcement and punishment in ABA therapy. Behavior analysts and therapists need to address these concerns and work collaboratively with parents to develop a treatment plan that is ethical, effective, and tailored to their child’s unique needs (Cooper et al., 2020). Therefore, parents’ perspectives on the effectiveness of ABA therapy are diverse and can be influenced by various factors, including the child’s specific needs, the intensity and duration of treatment, and the ethical considerations of the therapy. Behavior analysts and therapists must communicate clearly and work collaboratively with parents to address any concerns or issues arising during treatment. Factors That Influence Parents’ Perceptions of ABA Therapy Mire et al. (2017) note that the perspectives of parents regarding Applied Behavior Analysis (ABA) therapy can be influenced by several factors including their understanding of autism spectrum disorder (ASD) and its treatment, their values and beliefs, their child’s individual needs and abilities, and their own experiences with ABA therapy or other treatments. For example, some parents may have limited knowledge or understanding of ASD and its treatment options, which can impact their willingness to consider ABA therapy. Other parents may have personal beliefs or values that conflict with behavioral interventions or reinforcement, which can lead them to choose alternative treatment options. In addition, parents may have different expectations and goals for their child’s treatment, which can influence their perspectives on the effectiveness of ABA therapy. For example, some parents may prioritize improving their child’s social skills, while others may prioritize reducing problem behaviors or improving academic performance (Mire et al., 2017). Parents’ experiences with ABA therapy, or other treatments, can also shape their perspectives on the effectiveness of ABA therapy. Positive experiences may lead them to be more supportive of ABA therapy, while 19 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY negative experiences may lead them to seek alternative treatments (Mire et al., 2017). Parents’ perspectives on ABA therapy are complex and can be influenced by various factors. Therefore, behavior analysts and therapists need to be aware of and sensitive to these factors and work collaboratively with parents to develop a treatment plan, tailored to their child’s unique needs, that aligns with their values and goals. Ethical Considerations in the Use of ABA Therapy with Children Daley et al. (2013) discuss several ethical considerations related to the use of Applied Behavior Analysis (ABA) therapy with children, particularly in low- and middle-income countries, on understanding the concept of ABA therapy and how parents perceive its effects on their children. These considerations include issues related to informed consent, cultural sensitivity, intervention fidelity, and the use of punishment and restrictive procedures (Daley et al., 2013). Informed consent is a critical aspect of ethical research and treatment with children, and behavior analysts and therapists must ensure that parents or legal guardians fully understand the nature of ABA therapy, the potential risks and benefits, and their right to withdraw from treatment at any time (Daley et al., 2013). This can be particularly challenging in low- and middle-income countries with low literacy rates and health literacy. Cultural norms may affect the understanding and response to information of parents or legal guardians. Cultural sensitivity is also important in using ABA therapy with children, as different cultural backgrounds may influence the views and responses of parents and children towards behavioral interventions. Behavior analysts and therapists should be aware of cultural differences and work collaboratively with families to ensure that treatment approaches are respectful, culturally sensitive, and aligned with the values and beliefs of the family (Daley et al., 2013). Intervention fidelity, or the extent to which treatment is delivered as intended, is another 20 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY important ethical consideration in using ABA therapy on children. Behavior analysts and therapists should monitor and evaluate treatment fidelity, to ensure that interventions are being implemented consistently and effectively, and make necessary adjustments. Finally, the use of punishment and restrictive procedures, in ABA therapy for children, can raise ethical concerns related to the potential for physical harm, psychological distress, and loss of autonomy. Behavior analysts, therapists, and family members should carefully weigh the potential risks and benefits of these procedures and use them only when necessary and under ethical guidelines (Daley et al., 2013). Therefore, the ethical considerations involved in using ABA therapy with children are complex and multifaceted and require ongoing attention and reflection by behavior analysts, therapists, and researchers. Generally, Applied Behavior Analysis (ABA) therapy is considered an evidence-based treatment approach that effectively addresses the behavioral and communication challenges associated with autism spectrum disorder (ASD). ABA therapy is based on the principles of behaviorism and uses positive reinforcement to increase desired behaviors and decrease problem behaviors. However, using ABA therapy with children requires careful consideration of ethical issues related to informed consent, cultural sensitivity, intervention fidelity, punishment, and restrictive procedures. Behavior analysts, therapists, and researchers must work collaboratively with parents or legal guardians to ensure that treatment approaches are respectful, culturally sensitive, and aligned with the values and beliefs of the family and that interventions are implemented consistently and effectively while taking into account the potential risks and benefits of each procedure. Therefore, understanding the parents’ perspectives and the factors influencing their views on ABA therapy is also crucial, as it can impact treatment choices and 21 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY outcomes. By taking a collaborative and ethical approach to ABA therapy, behavior analysts and therapists can help children with ASD to reach their full potential and lead fulfilling lives. Autism Spectrum as a Type of Disability Autism Spectrum Disorder (ASD) is a type of disability that impacts individuals throughout their lifespan. It is mainly characterized by interaction and social communication including repetitive, and sometimes restricted, behavior patterns, activities, and interests. For instance, according to McLeod et al., (2019), ASD is considered a neurodevelopmental condition that impacts an average of 1 out of 59 children according to the United States statistics. People suffering from ASD occasionally have complications with their interactions and social communication including challenges in responding and understanding social cues, and maintaining or initiating a conversation or a relationship with others (McLeod et al., 2019). They may also engage in various repetitive behaviors such as hand flapping, rocking, or having a highly focused interest in specific objects or topics. The experiences of individuals with ASD can vary widely depending on their strengths, challenges, and support needs. McLeod et al. (2019) conducted a study comparing the experiences of college students with ASD to their neurotypical peers. They found that college students with ASD reported higher social anxiety levels and lower social support levels than their neurotypical peers. They also reported higher stress levels related to academic and social challenges and difficulty with executive functioning such as planning and organizing tasks. Individuals with ASD are also at an increased risk for other health conditions and comorbidities. For instance, according to Ptomey et al. (2020), individuals with ASD have higher rates of overweight and obesity than the general population and higher rates of associated comorbidities such as type 2 diabetes, hypertension, and sleep apnea. These health conditions 22 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY can significantly impact the quality of life of individuals with ASD, and their families, and increase healthcare costs and the burden on healthcare systems. Effective supports and interventions, for individuals suffering from ASD, are essential for improving their quality of life and promoting their well-being. These interventions include speech and language therapy, behavioral therapies like ABA, and social skill training. Pharmacological interventions can also be included to treat comorbidities such as anxiety or ADHD (Ptomey et al., 2020). Thus, ASD is a complicated neurodevelopmental disorder that impacts individuals despite their lifespan. Individuals suffering from ASD, thus, often experience interaction and social communication challenges and repetitive and restricted behavioral patterns. Effective support and interventions are thus critical for improving their quality of life and promoting their well-being and addressing associated commodities and health conditions. However, further research is required to better understand the support needed and experiences for individuals with ASD to develop more support and effective interventions. Attitude and Perspective Towards Treatment for ASD Attitudes and perspectives on treatment for autism spectrum disorder (ASD) can widely vary among families of children with ASD and healthcare providers. Kalankesh et al. (2020) conducted a qualitative study to identify the needs of families of children with ASD, in Iran, from the perspective of specialists and parents. They found that parents and specialists had different priorities and views on treatment for ASD. For instance, according to the study, parents of children with ASD prioritized the need for early diagnosis and intervention, access to highquality, specialized services, and support for their mental and emotional well-being. They also wanted greater involvement in their child’s treatment planning and decision-making (Kalankesh et al., 2020). On the other hand, specialists prioritized the need for increased public awareness 23 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY and education about ASD, improved training and resources for healthcare providers, and advanced research on effective interventions for ASD. Similarly, Viljoen et al. (2021) conducted a global scoping review of parental perspectives on functioning in children with ASD. They found that parents’ views on their child’s functioning were influenced by various factors including their child’s strengths and challenges, their child’s access to effective interventions and supports, and their own personal and social context. Parents often emphasized the importance of individualized interventions and supports, tailored to their child’s unique needs, and the need for greater access to services and resources. Therefore, attitudes and perspectives, on treatment for ASD, are complex and can be influenced by various factors, including individual, social, and cultural factors. Parents of children with ASD often prioritize early diagnosis and intervention, access to high-quality, specialized services, and greater involvement in their child’s treatment planning and decision-making (Viljoen et al., 2021). Specialists often prioritize increased public awareness and education, improved training and resources for healthcare providers, and advanced research on effective interventions. Healthcare providers and policymakers need to consider the perspectives and needs of parents and specialists while developing and implementing effective interventions and support for individuals with ASD. Collaborative and individualized treatment planning and decision-making approaches may be particularly effective in meeting the complex and diverse needs of individuals with ASD and their families. Objective Impact of Parents Participating in Their Child’s Treatment Parents play a significant role in caring and treating for children with ASD. The impact of their participation in the child’s treatment can be experienced in various areas. For instance, Kurzrok et al., (2021) examined the relationship between the involvement of parent-reported 24 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY interventions, caregiver burden, and satisfaction with the intervention-related training. These also include the issues of parenting self-efficacy and caregiving burden. The research also found that parents who actively engaged in their children’s treatment reported higher satisfaction with the intervention-related training; it also reported a high level of parenting self-efficacy, which is an important predictor of positive results in children with ASD (Kurzrok et al., 2021). Conversely, high levels of caregiver burden were associated with lower levels of parenting self-efficacy. Similarly, Ruble et al. (2019) conducted a preliminary study of parent activation, parentteacher alliance, transition planning quality, individualized education program (IEP), and postsecondary goal attainment of students with ASD. They found that the children of parents who were more involved in the transition planning process and reported higher levels of the parentteacher alliance were more likely to achieve their IEP and postsecondary goals. These studies suggest that parent participation in their child’s treatment can objectively impact outcomes for children with ASD. When parents are involved in their child’s treatment and feel confident in their ability to support their child, they may be better equipped to advocate for their child’s needs and facilitate positive outcomes. Additionally, involving parents in the treatment process can lead to better alignment between home and therapy settings and enhance the effectiveness of the interventions. This is particularly important in ASD treatment where interventions often involve ongoing support and strategies that must be implemented across different locations (Ruble et al., 2019). Thus, the objective impact of parent participation in their child’s treatment can be seen in a range of outcomes from improved parenting self-efficacy to better alignment between home and therapy settings and positive results for children with ASD. Healthcare providers and therapists must 25 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY involve parents in the treatment process and provide them with the training and support they need to effectively support their child’s development and well-being. Subjective Impact of Parents Participating in Their Childs Treatment While the objective impact of parent participation in their child’s treatment has been welldocumented, the emotional impact is equally important to consider. Two studies, by Sheppard and Monden (2019) and Yaden and Griffiths (2020), offer insights into the emotional impact of participation in different contexts. For instance, Sheppard and Monden (2019) investigated the subjective well-being of first-time grandparents, which they defined as “a multi-dimensional construct encompassing positive affect, life satisfaction, and a sense of purpose and meaning in life” (p. 1017). They found that grand parenting was associated with a significant increase in subjective well-being, particularly regarding a sense of purpose and meaning in life. They argued that this increase was due to the social and emotional support that grandparents received from their family and the importance of generativity and continuity that grand parenting provides. In contrast, Yaden and Griffiths (2020) investigated the subjective effects of psychedelics and their relationship to enduring therapeutic effects. They argued that the personal effects of psychedelics, such as altered states of consciousness, mystical experiences, and increased emotional openness, are necessary for their therapeutic benefits. They found that the degree to which individuals experience these subjective effects predicts the therapeutic benefits they receive such as increased well-being, decreased anxiety and depression, and improved social and emotional functioning. These studies suggest that subjective experiences are important in understanding the impact of parent participation in their child’s treatment. For example, parents who feel supported and engaged in their child’s treatment may experience increased subjective well-being similar to 26 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY how grandparents experience a sense of purpose and meaning through their involvement with their grandchildren. On the other hand, parents who feel disconnected or disengaged from their child’s treatment may experience negative subjective effects such as increased stress and anxiety. Generally, the subjective impact of parent participation in their child’s treatment is an important aspect to consider alongside objective outcomes. Studies such as Sheppard and Monden (2019) and Yaden and Griffiths (2020) highlight the importance of subjective experiences and their relationship to well-being and therapeutic benefits. Future research should continue to explore the subjective experiences of parents, in the context of ASD treatment, to better understand the full impact of their involvement. ABA Therapy Treatment Recommendations Applied Behavior Analysis (ABA) therapy has been one of the most widely used evidence-based interventions for children with autism spectrum disorder (ASD) for several decades. However, concerns have been raised about some of the methods used in ABA therapy and their potential negative impact on children with ASD. Leaf et al. (2022) identify several potential concerns about ABA-based interventions including using aversive techniques such as punishment and the restriction of freedom of movement, lack of respect for the child’s preferences, lack of individualization in treatment plans, and insufficient training and supervision of therapists. They argue that these issues can lead to negative outcomes such as increased anxiety and aggression, decreased motivation to learn, and reduced quality of life for the child and family. To address these concerns, Leaf et al. (2022) recommend that ABA-based interventions should prioritize positive reinforcement and avoid the use of aversive techniques. They suggest that treatment plans should be tailored to each child’s individual needs and preferences and that 27 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY therapists should receive comprehensive and ongoing training and supervision. Additionally, they recommend involving parents and caregivers in the treatment process to ensure that the child’s needs are met and that the family is well-informed and supported throughout the intervention. Leaf et al. (2022) also argue that ABA-based interventions can be effective for children with ASD. Still, they must be implemented in a way that prioritizes the child’s well-being and individual needs. They emphasize the importance of ongoing evaluation and adaptation of treatment plans to ensure that they are effective and appropriate for each child. Additionally, they stress the need for increased collaboration between parents, therapists, and researchers to improve the effectiveness and ethicality of ABA-based interventions continually (Leaf et al., 2022). Therefore, ABA therapy is a widely used and effective intervention for children with ASD. However, addressing concerns and potential negative impacts associated with ABA-based interventions is essential. Leaf et al.’s (2022) recommendations offer valuable insights into how ABA-based interventions can be improved to provide better outcomes for children with ASD and their families. Relationship Between Therapist, Parents, and Treatment Lastly, the relationship between the therapist and the treatment and the relationship between the parents and the treatment are crucial elements in providing effective therapy for children with autism spectrum disorder (ASD). For instance, Byrne et al. (2021) conducted a systematic review of studies that explored the use of acceptance and commitment therapy (ACT) in supporting parents of children with ASD. They found that ACT improved the parents’ psychological flexibility, reduced stress, and improved their relationships with their children. 28 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY This suggests that a strong and positive relationship between the therapist and the parents is essential for the effective treatment of ASD. In another study, Mössler et al. (2019) investigated the therapeutic relationship as a predictor of change, in music therapy, for young children with ASD. They found that a strong therapeutic relationship between the therapist and the child was positively associated with improved social communication skills and interaction behaviors. This highlights the importance of the therapist-child relationship in facilitating positive treatment outcomes. Taylor et al. (2019) focused on the importance of compassionate care in behavioranalytic treatment for children with ASD. They found that using compassion-focused language and attending to the caregivers’ emotions and perspectives was associated with better treatment outcomes. The authors concluded that compassionate care is essential in developing a strong relationship between the therapist and the caregivers, which will lead to better treatment outcomes. In short, the relationship between the therapist and treatment and parents and treatment are critical components in providing effective therapy for children with ASD. Positive therapeutic relationships between the therapist, the child, and caregivers can improve the effectiveness of treatment and lead to positive outcomes. Therefore, therapists need to cultivate a positive and supportive relationship with the child and pay attention to their emotional wellbeing to provide the best possible care. Summary The reviewed literature highlights the importance of understanding parents’ perspectives on the effectiveness of ABA therapy in treating autism spectrum disorder. The studies suggest that parents play a critical role in their child’s treatment and that their involvement can 29 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY objectively impact the outcomes. However, the studies also highlight the need for therapists to establish strong and compassionate relationships with both the child and their parents to facilitate effective treatment. The studies suggest that there are varying attitudes and perspectives on treatment for ASD among parents, which highlights the need for individualized treatment plans that consider the needs of each family. Additionally, the literature highlights the importance of ABA therapy treatment recommendations and the need for ongoing evaluation and development of treatment practices. Therefore, the reviewed literature emphasizes the importance of a collaborative approach between therapists and parents in treating ASD. This collaborative approach can lead to better outcomes for the child and a more positive experience for the parents. Further research is needed to better understand the dynamics of the therapist-parent-child relationship and identify effective interventions that can improve treatment outcomes for individuals with ASD and their families. 30 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Chapter 3: Methodology This qualitative interview driven study, aims to give insight into how parents of children with ASD rate the efficacy of their child’s ABA treatment. Applied behavior analysis (ABA) is a popular treatment that aims to improve patient’s quality of life by teaching them new skills and providing positive reinforcement. Although ABA treatment has been effective in helping persons with ASD improve various abilities, it is essential to consider parents’ perspectives, which play a big part in their children’s therapeutic journey. Several parent-focused qualitative research projects influence this approach in similar domains. Kalmbach et al., (2020) studied parents’ impressions of equine-based occupational therapy for children with autism spectrum disorders. The views of parents of potential college students with ASD were investigated by Hillier et al. (2021). Parental experiences with a telemedicine occupational therapy program were explored by Wallisch et al. (2019). Čolić, et al., (2022) looked into the experiences of Black caregivers regarding racism in ASD services to further support the need for culturally sensitive ABA therapy. This research aims to acquire insight into parents’ experiences, thoughts, and perspectives on the efficacy of ABA treatment for their children with ASD by conducting in-depth interviews or focus group discussions with them. The obtained qualitative data will be thematically evaluated to reveal recurring themes and patterns in the parents’ points of view. The results of this research will add to the body of literature on parents’ opinions of ABA therapy by illuminating the intervention’s benefits and drawbacks from the perspective of those closest to the children receiving treatment. This study has the potential to pave the way for improved ABA therapies tailored to the unique requirements of children with ASD and their families. 31 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Research Design This study investigates, uses interviews to evaluate how parents perceive the success of ABA treatment. Understanding and interpreting people’s experiences, meanings, and views, within a given situation, is at the heart of qualitative research. The researcher’s goal in using this method is to better understand the perspectives of parents whose children have received ABA treatment. The Rationale for Qualitative Research Studying parents’ impressions of ABA treatment is a complicated and nuanced issue well suited to qualitative research methods. Beyond quantitative measures, it permits an in-depth comprehension of parents’ experiences, beliefs, and attitudes and yields invaluable insights into the efficacy of ABA treatment. This study employs open-ended questionnaires to capture the full range of parental perspectives on ABA treatment. Research Paradigm The interpretive research paradigm, which recognizes the social construction and subjectivity of knowledge, serves as the theoretical foundation for this investigation. It acknowledges the value of many viewpoints and attempts to comprehend the significance parents attribute to their ABA treatment experiences. The researcher’s goal in adopting this paradigm is to learn more about how ABA treatment is interpreted and appreciated by parents. Researcher’s Role The researcher becomes a vital cog in the research machine. As objective facilitators, researchers should treat parents with respect and empathy to earn their trust and encourage them to share their experiences. The researcher recognizes and maintains reflexivity on their biases 32 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY throughout the study and promotes openness and reduces the likelihood of bias in data collection and analysis. Data Collection Methods This research will use interviews to gather information. The parents’ perceptions of ABA treatment and its effect are gathered through one-on-one interviews. Sampling Strategy Participants will be selected using a purposive sampling technique. Cooperation with local ABA treatment facilities and support organizations will be used to identify parents whose children have been diagnosed with developmental problems and have participated in ABA therapy. To guarantee a balanced sample, participants will be chosen based on factors including their child’s age in ABA treatment, socioeconomic status, and geography. Ethical Considerations The rights and safety of all participants will be protected by following established ethical standards. All participants will voluntarily give their permission and be made aware of their ability to discontinue participation at any time. Participants will be given pseudonyms, during data processing and reporting, to protect their privacy and identity. Potential dangers, such as mental anguish, will be mitigated by preparing ahead and giving participants access to help when needed. The permission of the institutional review board will be acquired before any data is collected, and the study will be performed in conformity with all applicable ethical standards. 33 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Participants Inclusion Criteria The following are the requirements for inclusion in this study: 1. Individuals whose children have been diagnosed with autism spectrum 2. Parents whose children have completed or are enrolled in an ABA treatment program. 3. Parents who are fluent in the study language. Recruitment Process Participants will be gathered by teaming up with community ABA treatment clinics and advocacy organizations. Participants who fit the inclusion criteria will be identified via outreach to the organizations. The researchers will brief them about the study’s goals and the importance of informed consent. Parents who express interest will be issued permission forms and can participate in interviews or focus groups when convenient. Demographic Information Choosing participant from different age range and cultural backgrounds, gives the study the opportunity to learn from parents’ experiences from various educational backgrounds. Participants will come from different socioeconomic backgrounds including those with varying levels of education and career stability. This variant will shed light on how parental attitudes about ABA treatment may vary according to the parent’s socioeconomic status. The children of the participants should be officially diagnosed with a developmental problem such as autism spectrum disorder (ASD) . This requirement ensures that participants have seen their children benefit from ABA treatment. 34 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Sample Size Justification Data saturation, the point at which no more insights or themes can be drawn from the data, will be used to establish the sample size for this research. The team believes that they will have collected enough information with twenty-five individuals. If new insights continue to emerge, however, the sample size may be revised while the data is collected. This sample size will allow researchers to hear from a broad spectrum of parents with individual opinions on the efficacy of ABA treatment. The goal is to collect enough data to get a deep insight into parents’ experiences while keeping the scope of the research within reasonable bounds. Data Collection Interview Guide Development A semi-structured interview guide will be established to maintain consistency and allow for flexibility in researching parents’ perceptions of the efficacy of ABA treatment. The interview schedule will include free-form questions on topics including parents’ reactions to ABA treatment, their views on its strengths and weaknesses, and their level of satisfaction with it. The manual will be written to motivate respondents to submit rich, in-depth answers that will facilitate a full grasp of their perspectives. Pilot Testing A subset of parents who are eligible for participation will be interviewed as a pilot test before the whole sample is interviewed. Using the results of this pilot study, we may update the interview guide or clarify any confusing parts. The pilot’s responses will shape the final version of the interview guide, which will be improved to more accurately gather the necessary data from participants while ensuring that it is easy to read and follow. 35 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Interviews Semi-Structured Interviews Participants will be interviewed, one-on-one, using semi-structured questions to get their thoughts on ABA treatment. Participants can speak freely about their thoughts, feelings, and observations in these interviews. The semi-structured style allows the researcher to ask follow-up questions, go more deeply into areas of interest, and investigate developing themes without sacrificing the ability to capture subtleties. Interview Duration The average duration of an interview is 45–60 minutes. This duration will allow for an indepth examination of the participants’ experiences, viewpoints, and any other data they may choose to provide. The interview size will depend on the number of questions asked and the amount of time that participants take to answer them. Data Analysis Transcription and Data Management Conversations, in both individual interviews and group discussions, will be videotaped and transcribed word for word. An editor will proofread all transcriptions before being saved, in an encrypted digital archive, for safekeeping. Participants will be given a unique identification to protect their privacy during data analysis. Theme Development Related codes will be grouped, and overarching patterns and ideas will be extracted from the data to form the themes. To ensure the analysis is thorough and accurate, the researcher will compare codes and articles inside and between interviews. 36 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Validity and Reliability Multiple methods will be used to ensure the reliability of the results. The first step is “member checking” in which all involved parties go through the previously established topics and provide their input to ensure that the analysis is correct. A recognized metrics would be used to evaluate inter-rater agreement, such as Cohen’s kappa coefficient, to guarantee consistency and reliability in coding judgments. The data analysis approach will be rigorous, systematic, and iterative to ensure a thorough investigation of the data and the creation of relevant and credible conclusions. 37 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY References Autism Speaks. (2021). Applied behavior analysis (ABA). Retrieved from https://www.autismspeaks.org/applied-behavior-analysis-aba-0 Bagaiolo, L. F., Mari, J. D. J., Bordini, D., Ribeiro, T. C., Martone, M. C. C., Caetano, S. C., … & Paula, C. S. (2017). Procedures and compliance of a video modeling applied behavior analysis intervention for Brazilian parents of children with autism spectrum disorders. Autism, 21(5), 603-610. https://doi.org/10.1177/1362361316677718 Byrne, G., Ghráda, Á. N., O’Mahony, T., & Brennan, E. (2021). A systematic review of the use of acceptance and commitment therapy in supporting parents. Psychology and Psychotherapy: Theory, Research, and Practice, 94, 378–407. Centers for Disease Control and Prevention. (2018). Prevalence of autism spectrum disorder among children aged 8 years – Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. MMWR Surveillance Summaries, 67(6), 1-23 Centers for Disease Control and Prevention. (2020). Autism Spectrum Disorder (ASD): Data and statistics. Retrieved from https://www.cdc.gov/ncbddd/autism/data.html Čolić, M., Araiba, S., Lovelace, T. S., & Dababnah, S. (2022). Black caregivers’ perspectives on racism in ASD services: Toward culturally responsive ABA practice. Behaviour Analysis in Practice, 15(4), 1032–1041. Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied Behavior Analysis. Pearson. Daley, T., Singhal, N., & Singhal, N. (2013). Ethical considerations in autism intervention research: A brief review of the literature. Journal of Autism and Developmental Disorders, 43(7), 1662-1674. 38 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Daley, T., Weisner, T. S., Singhal, N., & Himle, M. B. (2013). Ethical considerations in the use of applied behavior analysis with children: The rights of the child versus the rights of the parents and service providers. Journal of Applied Behavior Analysis, 46(1), 81-89. Dennison, A., Lund, E. M., Brodhead, M. T., Mejia, L., Armenta, A., & Leal, J. (2019). Delivering home-supported applied behavior analysis therapies to culturally and linguistically diverse families. Behavior Analysis in Practice, 12, 887-898. Gundumogula, M. (2020). Importance of focus groups in qualitative research. International Journal of Humanities and Social Science (IJHSS), 8(11), 299–302. http://dx.doi.org/10.24940/theijhss/2020/v8/i11/HS2011-082 Hillier, A., Ryan, J., Buckingham, A., Schena, D., Queenan, A., Dottolo, A., & Abreu, M. (2021). Prospective college students with autism spectrum disorder: Parent perspectives. Psychological Reports, 124(1), 88–107. Kalankesh, L. R., Shahrokhi, H., Dastgiri, S., Gholipour, K., & Feizi-Derakhshi, M. R. (2020). Identifying the needs of families of children with Autism Spectrum Disorder from specialists and parents’ perspectives: A qualitative study. Iranian Journal of Psychiatry and Behavioral Sciences, 14(4). Kalmbach, D., Wood, W., & Peters, B. C. (2020). Parental perspectives of occupational therapy in an equine environment for children with autism spectrum disorder. Occupational Therapy in Health Care, 34(3), 230–252. Kurth, J. A., Feeley, K. M., & Scheurich, R. (2020). Investigating predictors of parent participation in early intervention services for children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 50(11), 3964-3979. 39 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Kurzrok, J., McBride, E., & Grossman, R. B. (2021). Autism-specific parenting self-efficacy: An examination of the role of parent-reported intervention involvement, satisfaction with intervention-related training, and caregiver burden. Autism, 25(5), 1395–1408. Leaf, J. B., Cihon, J. H., Leaf, R., McEachin, J., Liu, N., Russell, N., … Khosrowshahi, D. (2022). Concerns about ABA-based intervention: An evaluation and recommendations. Journal of Autism and Developmental Disorders, 52(6), 2838–2853. Maenner, M. J., Shaw, K. A., Baio, J., Washington, A., Patrick, M., DiRienzo, M., … & Dowling, N. F. (2021). Prevalence of autism spectrum disorder among children aged 8 years – Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2016. MMWR Surveillance Summaries, 70(4), 1-19. McLeod, J. D., Meanwell, E., & Hawbaker, A. (2019). The experiences of college students on the autism spectrum: A comparison to their neurotypical peers. Journal of Autism and Developmental Disorders, 49, 2320–2336. McPhilemy, C., & Dillenburger, K. (2023). Parents’ experiences of applied behavior analysis (ABA)‐based interventions for children diagnosed with an autistic spectrum disorder. British Journal of Special Education, 40(4), 154-161. https://doi.org/10.1111/14678578.12038 Mire, S. S., Gealy, W., Kubiszyn, T., Burridge, A. B., & Goin-Kochel, R. P. (2017). Parent perceptions about autism spectrum disorder influence treatment choices. Focus on Autism and Other Developmental Disabilities, 32(4), 305-318. Morris, C., & Peterson, S. M. (2022). Teaching the History of Applied Behavior Analysis. Perspectives on Behavior Science, 1-18. 40 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Mössler, K., Gold, C., Aßmus, J., Schumacher, K., Calvet, C., Reimer, S., … Schmid, W. (2019). The therapeutic relationship as predictor of change in music therapy with young children with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 49, 2795–2809. Oli, N., Johnson, C. P., Smith, C. J., Utley, M., & Taylor, R. (2022). Advocating for cultural sensitivity and diversity in applied behavior analysis. Journal of Autism and Developmental Disorders, 52(1), 1-14. Ptomey, L. T., Walpitage, D. L., Mohseni, M., Dreyer Gillette, M. L., Davis, A. M., Forseth, B., aitman, L. R. (2020). Weight status and associated comorbidities in children and adults with Down syndrome, Autism Spectrum Disorder, and intellectual and developmental disabilities. Journal of Intellectual Disability Research, 64(9), 725–737. Ruble, L., McGrew, J. H., Wong, V., Adams, M., & Yu, Y. (2019). A preliminary study of parent activation, parent-teacher alliance, transition planning quality, and IEP and postsecondary goal attainment of students with ASD. Journal of Autism and Developmental Disorders, 49, 3231–3243. Sandoval-Norton, A. H., Shkedy, G., & Shkedy, D. (2019). How much compliance is too much compliance: Is long-term ABA therapy abuse? Cogent Psychology, 6(1), 1641258. Sheppard, P., & Monden, C. (2019). Becoming a first‐time grandparent and subjective well‐ being: a fixed effects approach. Journal of Marriage and Family, 81(4), 1016–1026. Slocum, T. A., Detrich, R., Wilczynski, S. M., Spencer, T. D., Lewis, T., & Wolfe, K. (2014). The evidence-based practice of applied behavior analysis. The Behavior Analyst, 37(1), 41-56. 41 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Taylor, B. A., LeBlanc, L. A., & Nosik, M. R. (2019). Compassionate care in behavior analytic treatment: Can outcomes be enhanced by attending to relationships with caregivers. Behavior Analysis in Practice, 12(3), 654–666. Tritter, J. Q., & Landstad, B. J. (2020). Focus groups. Qualitative research in health care, 57-66. https://doi.org/10.1002/9781119410867.ch5 Viljoen, M., Mahdi, S., Shelly, J., & de Vries, P. J. (2021). Parental perspectives of functioning in their children with autism spectrum disorder: A global scoping review. Autism, 25(1), 176–198. Wallisch, A., Little, L., Pope, E., & Dunn, W. (2019). Parent perspectives of an occupational therapy telehealth intervention. International Journal of Telerehabilitation, 11(1), 15. Yaden, D. B., & Griffiths, R. R. (2020). The subjective effects of psychedelics are necessary for their enduring therapeutic effects. ACS Pharmacology & Translational Science, 4(2), 568–572. 42 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Appendix A Letter of Confidentiality or Privacy Dear Sir or Madam, We invite you to participate in our study on parental perceptions of the effectiveness of Applied Behavioral Analysis (ABA) therapy for children with special needs. Before we proceed, we would like to inform you of our commitment to ensure your privacy and confidentiality. Participation in this study is voluntary, and all information you provide will be kept anonymous and confidential. Your responses will be used only for research purposes and will not be shared with any third party without your consent. Additionally, all data will be stored securely, and it will only be accessible to the research team. We understand that the information you provide may be sensitive and personal, and we want to assure you that your privacy is paramount to us. Therefore, we will take all necessary steps to ensure your data is protected, and your identity remains anonymous. If you agree to participate in the study, we will provide you with a link to an online survey or a paper copy depending on your preference. We will also provide further details on the study including the purpose, procedures, and potential risks and benefits. If you have any concerns or questions about the study, please do not hesitate to contact us. Your participation in this study is greatly appreciated and will contribute to our understanding of parental perceptions of ABA therapy. Thank you for considering our invitation to participate in this study. Sincerely, Yolanda Akwe Enanga 43 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Appendix B Interview Questions 1. How long have you known about ABA treatment? 2. How did you feel when you decided to enroll your child in ABA therapy? 3. In what ways do you think your child’s ABA therapy has been beneficial, if any? 4. In what ways do you think your child’s ABA therapy has been harmful, if any? 5. How do you see yourself playing a role in your child’s ABA therapy? When it comes to your child’s care, how hands-on should you be? 6. How successfully do you and the specialists help your child get the most out of their ABA therapy sessions? 7. Tell us about how ABA treatment has impacted your child’s day-to-day existence and overall quality of life. 8. To what extent do you believe ABA treatment will benefit your child? 9. Is your kid benefiting from any specific ABA strategies in their development and education? 10. How has your child’s ABA therapy affected their behavior, friendships, and language development? 11. If your child is receiving ABA therapy, please describe how well you think the program is tailoring its services to your child’s specific needs. 12. Is there anything about your family’s background or upbringing that can help us tailor your child’s ABA therapy to his or her specific needs? 13. Have you encountered any cultural insensitivity or prejudice during your child’s ABA therapy sessions? How were these issues fixed, if at all? 44 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY 14. Do you feel that ABA therapy has helped you better understand your autistic kid and help them? 15. What are your overall impressions of your child’s progress following ABA therapy? 16. Is there anything about your child’s development that you believe ABA therapy may improve? 17. To other parents who are considering or who are already engaging in ABA therapy for their child with ASD, what insights or advice would you offer? Explanation The chosen interview questions aim to get parents’ insights about the efficacy of ABA treatment for children with ASD. Based on the available literature, we’ve carefully constructed each question to help us learn more about the many facets of ABA therapy and their effects on the child’s growth, the family’s dynamic, and the child’s and the family’s general quality of life. For instance, the first two questions probe parents’ prior knowledge and emotions before engaging in ABA treatment. According to studies conducted by Autism Speaks (2021), knowing how long a parent has been exposed to ABA treatment and how it affects their perspective is crucial. The advantages and disadvantages of ABA therapy are explored in Questions 3, 4, and 10. Both Bagaiolo et al. (2017) and Byrne et al. (2021) highlight the need to assess ABA’s efficacy in improving abilities and reducing problematic behaviors while also recognizing its limitations. Questions 5, 6, and 11 all center on how ABA therapists and parents may work together for the best results. Cooper et al. (2020) stress the need for open lines of communication and cooperation between parents and professionals as essential components of ABA therapy. The effects of ABA treatment on the child’s life and development are the focus of Questions 7, 8, 15, 45 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY and 16. Both Daley et al. (2013) and Bagaiolo et al. (2017) stress the need to measure the child’s growth and development due to ABA therapy. Inquiries 9, 12, and 13 probe specific ABA techniques’ usefulness, applicability, and possible cultural insensitivity. Both the CDC study from 2018 and the study by Oli et al. (2022) stress the need for culturally sensitive techniques and methods within ABA. To help other parents, questions 14 and 17 ask for in-depth responses from parents. Olivier et al. (2022) emphasize the value of learning how parents feel about their knowledge and abilities to help their autistic kid and their helpful suggestions for other parents. Thus, the interviews have been designed to elicit thorough and insightful replies from parents, expanding our knowledge of how ABA treatment helps children with ASD and their families. 46 PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY Interview Questions 1. How long have you known about ABA treatment? 2. How did you feel when you decided to enroll your child in ABA therapy? 3. In what ways do you think your child’s ABA therapy has been beneficial, if any? 4. In what ways do you think your child’s ABA therapy has been harmful, if any? 5. How do you see yourself playing a role in your child’s ABA therapy? 6. When it comes to your child’s care, how hands-on should you be? 7. How successfully do you and the specialists help your child get the most out of their ABA therapy sessions? 8. Tell us about how ABA treatment has impacted your child’s day-to-day existence and overall quality of life. 9. Is your kid benefiting from any specific ABA strategies in their development and education? 10. How has your child’s ABA therapy affected their behavior, friendships, and language development? 11. If your child is receiving ABA therapy, please describe how well you think the program is tailoring its services to your child’s specific needs. 12. Is there anything about your family’s background or upbringing that can help us tailor your child’s ABA therapy to his or her specific needs? 13. Have you encountered any cultural insensitivity or prejudice during your child’s ABA therapy sessions? How were these issues fixed, if at all? 14. Do you feel that ABA therapy has helped you better understand your autistic kid and help them? PARENT PESPECTIVE ON THE EFFECTIVNESS OF ABA THERAPY 15. What are your overall impressions of your child’s progress following ABA therapy? 16. Is there anything about your child’s development that you believe ABA therapy may improve? 17. To other parents who are considering or who are already engaging in ABA therapy for their child with ASD, what insights or advice would you offer? Research Questions Research questions that guide the study of parents’ perception of the effectiveness of ABA therapy include: • How does parent training in ABA therapy influence parental compliance with treatment over a period of time? • How do motivating operations influence parental compliance with ABA therapy for children over a period of time? • Are there demographic variables that indicate parental misconception about ABA therapy over a period of time? Does parents’ perspective over a period of time determine if services are no longer necessary?
Purchase answer to see full attachment