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Abstract

Practitioners and caregivers face the important question of what treatment will be most effective for a particular person’s presenting problem (Sturmey, 2009a). Information from randomized controlled trials (RCTs) may be helpful in general terms; however, the relevant question is not whether this treatment works for the average person, but whether it works for this specific person here and now. Group experimental designs arose in the field of agriculture where the average weight of the average corn cob was indeed important to the farmer; however, the outcomes for the hypothetical average person are of little use to specific people if these outcomes do not apply to the person of interest. For example, within a RCT with clinically significant results will be participants whose problem changed to a clinically significant degree, participants whose problem changed to a moderate, but unimportant extent, participants who did not change at all, and participants who become significantly worse because of the treatment. Thus, even if a RCT based on diagnostic categories produced significant results, these results may be of little help in guiding treatment for individual people. Additionally, RCTs tend to focus on symptom reduction, rather than positive changes in the person’s behavior; thus, RCTs may sometimes identify treatments that effectively reduce problematic behavior, but leave the person with few relevant skills and a poor quality of life. Thus, predicting the most effective treatment for an individual’s specific problem is an applied question of paramount importance, but RCTs provide imperfect answers to this question.

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Ward-Horner, J., Seiverling, L.J., Sturmey, P. (2011). Functional Behavioral Assessment and Analysis. In: Matson, J., Sturmey, P. (eds) International Handbook of Autism and Pervasive Developmental Disorders. Autism and Child Psychopathology Series. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-8065-6_16

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