Exploring Providers’ Perspectives and Experiences in Creating Treatment Plans to Treat Children Diagnosed with Autism Restricted; Files Only

Abstract

Objective: Although there are many early intervention methods for children with autism spectrum disorder, there has been little research exploring clinician experiences and perspectives in their decision-making process. This study aims to characterize clinicians’ beliefs and priorities about making intervention decisions for children on the autism spectrum and evaluate whether there is consensus among important factors that inform their decisions.

Methods: The study recruited certified Board-Certified Behavior Analysts or Clinical Psychologists (n= 41) with experience treating children with autism spectrum disorder to complete a Qualtrics survey. The survey characterized clinicians’ intervention and clinical experience and queried the contextual and client factors they consider when making treatment plan decisions. Analysis consisted of descriptive statistics, frequencies, and weighted ranking analysis calculated for Likert scale ratings. Consensus was quantified as any response shared by ≥80% of clinicians for the most important consideration for clinical decision-making. Responses to open-ended prompts were summarized by theme.

Results: Most (95%) providers have expertise in Discrete Trial Training, Social Skills Training, and Functional Communication Training, with Discrete Trial Training being the most used therapy (100%). Almost all (98%) clinicians reported experience with individual intervention, some (54%) clinicians reported experience with group intervention, and many (61%) clinicians reported experience with a combination of both individual and group intervention. Client characteristics considered most important for decision-making process were presence of complex behaviors (n=35), deficits in social communication and social interaction (n=36) and interaction with peers of similar age ranges (n=29). For case factors, empirical evidence (n=36) and social validity (n=35) were reported as the most important for clinical decision-making. Out of the 20 identified case factors, no factors met criteria for consensus as being regarded as the top three most important consideration for clinicians.

Conclusion and Relevance: No consensus was found among clinicians, indicating that clinicians consider and weigh the factors of a case with a lot of variability. Common considerations were identified, including complex behaviors, deficits of social communication, empirical evidence and social validity. The findings reinforce the need for further research exploring clinician perspectives on barriers of different intervention methods and outcomes within ASD.

Table of Contents

Introduction ..................................................................................................................................... 1

Background ...................................................................................................................................... 4

Neuroscience behind Autism Spectrum Disorder ................................................................................. 4

Applied Behavioral Analysis (ABA) ..................................................................................................... 8

Efficacy of ABA ................................................................................................................................ 11

Varieties of Interventions ..................................................................................................................12

Group versus Individual Intervention................................................................................................. 15

Intervention Decision-Making Process ............................................................................................... 18

Methods........................................................................................................................................... 19

Overview ......................................................................................................................................... 19

Participants Recruitment .................................................................................................................. 19

Survey Questionnaire ....................................................................................................................... 20

Analysis ........................................................................................................................................... 23

Results ............................................................................................................................................. 24

Discussion ........................................................................................................................................ 28

Figures and Graphs ............................................................................................................................ 39

Table 1. Participant Demographics including Training and Experience................................................... 39

Table 2. Clinician Experience with Different Identified Interventions .................................................... 39

Figure 1. Clinician experience with Different Identified Interventions. .................................................. 40

Table 3. Clinician Experience with Different Co-occurring Profiles for Clients ........................................ 40

Table 4. Clinician Experience with Different Client Ages ....................................................................... 41

Figure 2. Professional Locations of Study Respondents ......................................................................... 41

Figure 3. Clinician Ranking of Different Client Factors on Importance. .................................................. 42

Figure 4. Mean Ranking of Different Factors in a Client’s Case on Importance......................................... 43

Figure 5. Clinician Identified Most Important Client Information. ......................................................... 44

Figure 6. Influence of Contextual Factors in Case that Impact Decision-Making. .................................... 45

Figure 7. Clinician Identified Most Important Case Factors. .................................................................. 46

Figure 8. Clinician Agreement for Statements on Decision-Making Process ........................................... 47

Appendices ...................................................................................................................................... 48

Works Cited ..................................................................................................................................... 55

About this Honors Thesis

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School	Emory College
Department	Neuroscience and Behavioral Biology
Degree	B.S.
Submission	Honors Thesis
Language	English
Research Field	Psychology, General Psychology, Developmental Psychology, Clinical
Keyword	Autism Spectrum Disorder Intervention Decisions Applied Behavior Analysis
Committee Chair / Thesis Advisor	Jennifer Mascaro, Emory University
Committee Members	Summer Bottini, Emory University J. Alex Grizzell, Emory University Deanna Kaplan, Emory University

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