Jon Bailey, PhD, BCBA
Mary Burch, PhD, BCBA
Note: This is the first in a series of articles on ethics where we attempt to answer ethics questions from behavior analysts. This question came from a BCBA in California. Numbers in parentheses denote specific citations of the BACB Guidelines for Responsible Conduct.
QUESTION: “Many BCBAs promote interventions for autism and related disorders that have proved ineffective or harmful in sound research (such as Facilitated Communication, auditory integration training, sensory integration therapy, secretin, and megavitamins) or have not yet been evaluated in scientific studies (e.g., elimination diets, chelation therapy). Those interventions and the theories on which they are based clearly contradict behavior analytic principles and methods.”
ANSWER: Many of us never thought we would see the day that behavior analysis would become a commodity in our culture, but this particular question certainly makes it clear that commercial interests are beginning to erode on our traditionally “pure” values as scientists-practitioners. We understand there are pressures from consumers, primarily parents of children with a diagnosis of autism, to “try anything” rather than putting all their eggs in one behavioral basket so to speak. We know parents are under extreme duress when the autism diagnosis is made. It is highly unlikely most parents will have a background in science and a scientist’s respect for the importance of solid evidence for effectiveness. Unfortunately we seem to be living in a time where there is a culture of skepticism about science and many people would rather make their own judgments rather than rely on unknown researchers who are promoting (possibly bogus) treatments. As behavior analysts, we trust our science, but this doesn’t mean parents who are learning about a diagnosis of autism for the first time and hearing that there are evidence-based treatments available will be willing to place their full trust in this information. It is quite a gamble for consumer if you think about it; if there was any chance one of these unproven treatment approaches, diet regimens or drug therapies might work, many parents will want to spend at least some time and money on it.
The enormous pressures to find something
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that works may result in comments and questions to their BCBA about alternatives to behavioral treatment, which leads us back to the question of commerce. If the BCBA thinks she is about to lose a customer by saying, “If you don’t use behavior analysis exclusively I’m afraid I will have to drop you as a client” she may think twice about the consequences of lost revenue. The acceptable statement, “My ethical guidelines require me to inform you that these alternatives you are considering have no empirical base; there is no legitimate, well-controlled research to support them.” is preferred. Informing consumers that these alternatives are ineffective is the minimum required of the ethical behavior analyst; promoting alternatives to improve the bottom line is of course is an entirely different matter.
So, what do the BACB Guidelines for Responsible Conduct say the ethical behavior analyst should do when confronted with pressures from parents to offer or at least endorse other unproven methods? To start, it is clear from the Guidelines (2.09) “The behavior analyst always has the responsibility to recommend scientifically supported most effective treatment procedures” (i.e. those that have been “validated as having both long-term and short-term benefits”). Note that recommending does not mean insist on, which means it is not unethical to work with clients who are at the same time trying other, unproven, methods of treatment. But, we do have an ethical obligation to inform them and educate consumers. Next, the Guidelines clearly state (4.0) behavior analysts do what they are trained to do which is “design programs based on behavior analytic principles.” This means it is absolutely unethical for a behavior analyst to be trafficking in unproven approaches such as Facilitated Communication, auditory integration training, sensory integration therapy, secretin, megavitamins, elimination diets, and chelation therapy. If you know of a Board Certified Behavior Analyst engaging in these practices you have an obligation to inform them (9.01) by bringing the ethical lapse to their attention. You could show a Behavior Analyst who is using unproven methods the Guidelines and you have permission to use this article to make your point.
Finally, rather than supporting these unproven, dangerous and controversial procedures, the ethical behavior analyst should be promoting the “application of |
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