Skip to main content
SpringerLink
Log in

Advantages and Challenges of a Home- and Clinic-Based Model of Behavioral Intervention for Individuals Diagnosed with Autism Spectrum Disorder

  • Commentary
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

Researchers have demonstrated that comprehensive behavioral intervention can result in significant improvements in the lives of individuals diagnosed with autism spectrum disorder (ASD; e.g.; Lovaas, Journal of Consulting and Clinical Psychology 55(1):3–9, 1987; McEachin et al., American Journal of Mental Retardation 97(4):359–372, 1993). This intervention has occurred in a variety of settings (e.g., school, home, and clinic). Even though procedures based upon the principles of applied behavior analysis (ABA) can be implemented across a variety of settings, there is often confusion about the differences and relative advantages of home- versus clinic-based settings. The purpose of this paper is to provide a discussion of home- and clinic-based intervention within the context of a progressive approach to ABA and discus possible advantages of each type of setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Alai-Rosales, S. A., Thorisdottir, S., & Etzel, B. C. (2003). Behavioral teacher training programs. In Budd & Stokes (Eds.), A small matter of proof: The legacy of Donald M. Baer. Reno, NV: Context Press.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edn.). Washington, DC: Author.

    Book  Google Scholar 

  • Anderson, S. R., Avery, D. L., DiPietro, E. K., Edwards, G. L., & Christian, W. P. (1987). Intensive home-based early intervention with autistic children. Education and Treatment of Children, 10(4), 352–366.

    Google Scholar 

  • Ballaban-Gil, K., Rapin, I., Tuchman, R., & Shinnar, S. (1996). Longitudinal examination of the behavioral, language, and social changes in a population of adolescents and young adults with autistic disorder. Pediatric Neurology, 15(3), 217–223.

    Article  PubMed  Google Scholar 

  • Bearss, K., Johnson, C., Smith, T., Lecavalier, L., Swiezy, N., Aman, M., … Scahill, L. (2015). Effect of parent training vs. parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial. JAMA, 313(15), 1524–1533.

    Article  PubMed  Google Scholar 

  • Behavior Analyst Certification Board. (2014). Professional and ethical compliance code for behavior analysts. Littleton, CO: Behavior Analyst Certification Board.

    Google Scholar 

  • Bibby, P., Eikeseth, S., Martin, N. T., Mudford, O. C., & Reeves, D. (2001). Progress and outcomes for children with autism receiving parent-managed intensive interventions. Research in Developmental Disabilities, 22(6), 425–447.

    Article  PubMed  Google Scholar 

  • Cidav, Z., Munson, J., Estes, A., Dawson, G., Rogers, S., & Mandell, D. (2017). Cost offset associated with early start Denver model for children with autism. Journal of the American Academy of Child and Adolescent Psychiatry, 56(9), 777–783.

    Article  PubMed  Google Scholar 

  • Cohen, H., Amerine-Dickens, M., & Smith, T. (2006). Early intensive behavioral treatment: replication of the UCLA model in a community setting. Developmental and Behavioral Pediatrics, 27(2), S145–S155.

    Article  Google Scholar 

  • Constable, J. F., & Russell, D. W. (1986). The effect of social support and the work environment upon burnout among nurses. Journal of Human Stress, 11, 20–26.

    Article  Google Scholar 

  • DeMyer, M. K., & Ferster, C. B. (1962). Teaching new social behavior to schizophrenic children. Journal of the American Academy of Child Psychiatry, 1, 443–461.

    Article  Google Scholar 

  • Dotson, W. H., Leaf, J. B., Sheldon, J. B., & Sherman, J. A. (2010). Group teaching of conversational skills to adolescents on the autism spectrum. Research in Autism Spectrum Disorders, 4(2), 199–209.

    Article  Google Scholar 

  • Dworkin, L. K., McKee, L., & Nugent, M. (2015). Towards developing ABA soft skills: Opening the gate to more effective parent collaboration. San Antonio, TX: Panel discussion present at the meeting of Association for Behavior Analysis International.

    Google Scholar 

  • Elder, J. H., Valcante, G., Won, D., & Zylis, R. (2003). Effects of in-home training for culturally diverse fathers of children with autism. Issues in Mental Health Nursing, 24(3), 273–295.

    Article  PubMed  Google Scholar 

  • Fenske, E. C., Zalenski, S., Krantz, P. J., & McClannahan, L. E. (1985). Age at intervention and treatment outcome for autistic children in a comprehensive intervention program. Analysis and Intervention in Developmental Disabilities, 5(1–2), 49–58.

    Article  Google Scholar 

  • Garfinkle, A. N., & Schwartz, I. S. (2002). Peer imitation: Increasing social interactions in children with autism and other developmental disabilities in inclusive preschool classrooms. Topics in Early Childhood Special Education, 22(1), 26–38.

    Article  Google Scholar 

  • Green, G. (1996). Early behavioral intervention for autism: What does research tell us? In C. Maurice, G. Green & S. C. Luce (Eds.), Behavioral intervention for young children with autism (pp. 29–44). Austin, TX: Pro-Ed.

    Google Scholar 

  • Harchik, A. E., Sherman, J. A., Sheldon, J. B., & Strouse, M. C. (1992). Ongoing consultation as a method of improving performance of staff members in a group home. Journal of Applied Behavior Analysis, 25(3), 599–610.

    Article  PubMed  PubMed Central  Google Scholar 

  • Harris, S. L., & Handleman, J. S. (2000). Age and IQ at intake as predictors of placement for young children with autism: A four-to six-year follow-up. Journal of Autism and Developmental Disorders, 30(2), 137–142.

    Article  PubMed  Google Scholar 

  • Harris, S. L., Handleman, J. S., Gordon, R., Kristoff, B., & Fuentes, F. (1991). Changes in cognitive and language functioning of preschool children with autism. Journal of Autism and Developmental Disorders, 21(3), 281–290.

    Article  PubMed  Google Scholar 

  • Harris, S. L., & Weiss, M. J. (1998). Right from the start: Behavioral intervention for young children with autism. Bethesda, MD: Woodbine House.

    Google Scholar 

  • Harris, S. L., Wolchik, S. A., & Milch, R. E. (1983). Changing the speech of autistic children and their parents. Child and Family Behavior Therapy, 4(2–3), 151–173.

    Article  Google Scholar 

  • Horner, R. H., Dunlap, G., & Koegel, R. L. (Eds.). (1988). Generalization and maintenance: Life-style changes in applied settings. Baltimore: Paul H. Brookes.

    Google Scholar 

  • Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26(4), 359–383.

  • Howard, J. S., Stanislaw, H., Green, G., Sparkman, C. R., & Cohen, H. G. (2014). Comparison of behavior analytic and eclectic early interventions for young children with autism after three years. Research in Developmental Disabilities, 35(12), 3326–3344.

    Article  PubMed  Google Scholar 

  • Ingersoll, B., & Wainer, A. (2013). Initial efficacy of project ImPACT: A parent-mediated social communication intervention for young children with ASD. Journal of Autism and Developmental Disorders, 43(12), 2943–2952.

    Article  PubMed  Google Scholar 

  • Kamps, D. M., Leonard, B. R., Vernon, S., Dugan, E. P., Delquadri, J. C., Gershon, B., … Folk, L. (1992). Teaching social skills to students with autism to increase peer interactions in an integrated first-grade classroom. Journal of Applied Behavior Analysis, 25(2), 281–288.

    Article  PubMed  PubMed Central  Google Scholar 

  • Leaf, J. B., Cihon, J. H., Leaf, R., McEachin, J., & Taubman, M. (2016). A progressive approach to discrete trial teaching: Some current guidelines. International Electronic Journal of Elementary Education, 9(2), 361–372.

    Google Scholar 

  • Leaf, J. B., Leaf, J. A., Milne, C., Taubman, M., Oppenheim-Leaf, M., Torres, N., … Yoder, P. (2017a). An evaluation of a behaviorally based social skills group for individuals diagnosed with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(2), 243–259.

    Article  PubMed  Google Scholar 

  • Leaf, J. B., Leaf, R., McEachin, J., Taubman, M., Ala’i-Rosales, S., Ross, R. K., … Weiss, M. J. (2016). Applied behavior analysis is a science and, therefore, progressive. Journal of Autism and Developmental Disorders, 46(2), 720–731.

    Article  PubMed  Google Scholar 

  • Leaf, J. B., Leaf, R., McEachin, J., Taubman, M., Smith, T., Harris, S. L., … Waks, A. (2017b). Concerns about the registered behavior technician™ in relation to effective autism intervention. Behavior Analysis in Practice, 10(2), 154–163.

    Article  PubMed  Google Scholar 

  • Leaf, J. B., Oppenheim-Leaf, M. L., Call, N. A., Sheldon, J. B., Sherman, J. A., Taubman, M., … Leaf, R. (2012). Comparing the teaching interaction procedure to social stories for people with autism. Journal of Applied Behavior Analysis, 45(2), 281–298.

    Article  PubMed  PubMed Central  Google Scholar 

  • Leaf, R., & McEachin, J. (1999). A work in progress: Behavior management strategies and a curriculum for intensive behavioral treatment of autism. New York: DRL Books.

    Google Scholar 

  • Leaf, R., & McEachin, J. (2008). The UCLA young autism project. In R. Leaf, J. McEachin & M. Taubman (Eds.), Sense and nonsense in the behavioral treatment of autism: It has to be said (13–37). New York: DRL Books.

    Google Scholar 

  • Leaf, R., & McEachin, J. (2016). The Lovaas model: Love it or hate it, but first understand it. In R. G. Romanczyk & J. McEachin (Eds.), Comprehensive models of autism spectrum disorder treatment (pp. 7–43). New York: Springer.

    Chapter  Google Scholar 

  • Leaf, R. B., Taubman, M. T., McEachin, J. J., Leaf, J. B., & Tsuji, K. H. (2011). A program description of a community-based intensive behavioral intervention program for individuals with autism spectrum disorders. Education and Treatment of Children, 34(2), 259–285.

    Article  Google Scholar 

  • Ledford, J. R., Gast, D. L., Luscre, D., & Ayres, K. M. (2008). Observational and incidental learning by children with autism during small group instruction. Journal of Autism and Developmental Disorders, 38(1), 86–103.

    Article  PubMed  Google Scholar 

  • Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55(1), 3–9.

    Article  PubMed  Google Scholar 

  • Lovaas, O. I. (2003). Teaching individuals with developmental delays: Basic intervention techniques. Austin, TX: Pro-Ed.

    Google Scholar 

  • Lovaas, O. I., Koegel, R., Simmons, J. Q., & Long, J. S. (1973). Some generalization and follow-up measures on autistic children in behavior therapy. Journal of Applied Behavior Analysis, 6(1), 131–165.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lovaas, O. I., & Simmons, J. Q. (1969). Manipulation of self-destruction in three retarded children. Journal of Applied Behavior Analysis, 2(3), 143–157.

    Article  PubMed  PubMed Central  Google Scholar 

  • Maurice, C., Green, G., & Foxx, R. M. (Eds.), (2001). Making a difference: Behavioral intervention for autism. Austin, TX: Pro-Ed.

    Google Scholar 

  • Maurice, C., Green, G., & Luce, S. (Eds.), (1996). Behavioral intervention for young children with autism: A manual for parents and professionals. Austin, TX: Pro-Ed.

    Google Scholar 

  • McEachin, J. J., Smith, T., & Lovaas, O. I. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal of Mental Retardation, 97(4), 359–372.

  • Neidert, P. L., Dozier, C. L., Iwata, B. A., & Hafen, M. (2010). Behavior analysis in intellectual and developmental disabilities. Psychological Services, 7(2), 103–113.

    Article  Google Scholar 

  • Pierce, K. L., & Schreibman, L. (1994). Teaching daily living skills to children with autism in unsupervised settings through pictorial self-management. Journal of Applied Behavior Analysis, 27(3), 471–481.

    Article  PubMed  PubMed Central  Google Scholar 

  • Plavnick, J. B., Ferreri, S. J., & Maupin, A. N. (2010). The effects of self-monitoring on the procedural integrity of a behavioral intervention for young children with developmental disabilities. Journal of Applied Behavior Analysis, 43(2), 315–320.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rogers, S. J., & Dawson, G. (2010). Early start Denver model for young children with autism: Promoting language, learning, and engagement. New York: Guilford Press.

    Google Scholar 

  • Romanczyk, R. G., & McEachin, J. (Eds.), (2016). Comprehensive models of autism spectrum disorder treatment: Points of divergence and convergence. New York: Springer.

    Google Scholar 

  • Sallows, G. O., & Graupner, T. D. (2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors. American Journal of Mental Retardation, 110(6), 417–438.

    Article  PubMed  Google Scholar 

  • Schreibman, L. (1975). Effects of within-stimulus and extra-stimulus prompting on discrimination learning in autistic children. Journal of Applied Behavior Analysis, 8(1), 91–112.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sharpe, D. L., & Baker, D. L. (2007). Financial issues associated with having a child with autism. Journal of Family and Economic Issues, 28(2), 247–264.

    Article  Google Scholar 

  • Sheinkopf, S. J., & Siegel, B. (1998). Home-based behavioral treatment of young children with autism. Journal of Autism and Developmental Disorders, 28(1), 15–23.

    Article  PubMed  Google Scholar 

  • Slaton, J. D., Hanley, G. P., & Raftery, K. J. (2017). Interview-informed functional analyses: A comparison of synthesized and isolated components. Journal of Applied Behavior Analysis, 50(2), 252–277.

    Article  PubMed  Google Scholar 

  • Smith, L. E., Maenner, M. J., & Seltzer, M. M. (2012). Developmental trajectories in adolescents and adults with autism: The case of daily living skills. Journal of the American Academy of Child and Adolescent Psychiatry, 51(6), 622–631.

    Article  PubMed  PubMed Central  Google Scholar 

  • Smith, T., Groen, A. D., & Wynn, J. W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal on Mental Retardation, 105(4), 269–285.

    Article  PubMed  Google Scholar 

  • Soluaga, D., Leaf, J. B., Taubman, M., McEachin, J., & Leaf, R. (2008). A comparison of flexible prompt fading and constant time delay for five children with autism. Research in Autism Spectrum Disorders, 2(4), 753–765.

    Article  Google Scholar 

  • Stokes, T., & Baer, D. (1977). An implicit technology of generalization. Journal of Applied Behavior Analysis, 10(2), 349–367.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stuecher, U. (1972). Tommy: A treatment study of an autistic child. Arlington: Council for Exceptional Children.

    Google Scholar 

  • Taubman, M., Brierley, S., Wishner, J., Baker, D., McEachin, J., & Leaf, R. B. (2001). The effectiveness of a group discrete trial instructional approach for preschoolers with developmental disabilities. Research in Developmental Disabilities, 22(3), 205–219.

    Article  PubMed  Google Scholar 

  • Weiss, M. J. (2002). Hardiness and social support as predictors of stress in mothers of typical children, children with autism, and children with mental retardation. Autism, 6(1), 115–130.

    Article  PubMed  Google Scholar 

  • Wenger, E., McDermott, R. A., & Snyder, W. (2002). Cultivating communities of practice: A guide to managing knowledge. Boston: Harvard Business Press.

    Google Scholar 

  • Wolf, M., Risley, T., & Mees, H. (1963). Application of operant conditioning procedures to the behavior problems of an autistic child. Behaviour Research and Therapy, 1(2), 305–312.

    Article  Google Scholar 

Download references

Acknowledgments

We wish to thank Steve Woolf for his help on a previous version of this manuscript.

Author Contributions

JL conceived of the manuscript, and participated in the drafting and editing of the manuscript; RL conceived of the manuscript, and participated in the editing of the manuscript; JM participated in the editing of the manuscript; JC provided substantial contributions to the drafting and editing of the manuscript; JF participated in the editing of the manuscript.

Author information

Authors and Affiliations

  1. Autism Partnership Foundation, 200 Marina Drive, Seal Beach, CA, 90740, USA

    Justin B. Leaf, Ronald Leaf, John McEachin, Joseph H. Cihon & Julia L. Ferguson

  2. Endicott College, 376 Hale Street, Beverly, MA, 01915, USA

    Justin B. Leaf & Joseph H. Cihon

Authors
  1. Justin B. Leaf
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ronald Leaf
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John McEachin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joseph H. Cihon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Julia L. Ferguson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Justin B. Leaf.

Ethics declarations

Conflict of interest

All five authors work for an agency which provides behavioral intervention to individuals with ASD in primary a clinic based model and occasionally in a home-based model. Thus, all five authors receive a salary from this agency. The first author speaks at various conferences on this topic, for which he occasionally gets an honorarium to present. The second and third author have curriculum and training materials available for purchase for which they receive royalties. The fourth and fifth author have no further conflict of interests.

Ethical Standards

This article does not contain any studies with human or animal participants performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leaf, J.B., Leaf, R., McEachin, J. et al. Advantages and Challenges of a Home- and Clinic-Based Model of Behavioral Intervention for Individuals Diagnosed with Autism Spectrum Disorder. J Autism Dev Disord 48, 2258–2266 (2018). https://doi.org/10.1007/s10803-017-3443-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-017-3443-3

Keywords

Search

Navigation