Child-Focused Research Priorities

Therapies/Therapeutic Approaches: 

• Prompting, positive reinforcement, negative reinforcement: How do these strategies impact autonomy and a child’s comfort/ability to dissent or express negative emotions? 
• Environmental changes (caregiver/peer understanding and expectations) to support autistic children advocating for their wants and needs 

Questions: 

• What skills, characteristics, and environmental supports are important in early childhood to build autonomy and self-advocacy skills as children age? 
• How do we help autistic children advocate for their needs in ways that meet their preferences and developmental profiles (i.e., without enforcing a non-autistic developmental pathway or social norms not considerate of autistic people)? 
• How can we better support autistic children to express “negative emotions” (e.g., discomfort, anger)? 
• How do we balance the idea of autonomy with the need for compliance during some routines and emergency situations (e.g., in the event of a fire or immediate physical danger)? 
• How does supporting a child’s interoception abilities affect their capacity for self-advocacy? 
• How can we help children understand and work through distress/dysregulation in situations where their preferences cannot be fully met (e.g., safe spaces or strategies to help them process their emotions)?

Using Comparative Effectiveness Research:

• Compare the impact of traditional and neurodiversity-affirming therapies targeting developmental skills on autonomy and self-advocacy

Supporting Evidence: 

Many groups have agreed that autonomy, self-advocacy, and well-being are important goals for autistic people (Leadbitter et al., 2021; Pellicano et al., 2014). Some autistic adults have reported that their early childhood therapy experiences did not support them in achieving these goals or had a negative impact on these goals (Kupferstein, 2018). Specifically, there are concerns that strategies such as physical prompting and restriction of access encourage compliance and damage autonomy (Sandoval-Norton & Shkedy, 2019). These strategies are commonly used in early interventions for autistic toddlers (e.g., Naturalistic Developmental Behavioral Interventions [Schreibman et al., 2015]), and there is emerging evidence that these strategies are associated with increased rates of externalizing behaviors (Kushner, et al, 2023; Leadbitter et al., 2021). However, the effect of these types of strategies on child outcomes such as stress, comfort, and sense of autonomy with a long-term outlook has not yet been explored (Leadbitter et al., 2021). Furthermore, children’s sense of autonomy is thought to emerge even in toddlerhood, and studies have investigated ways that caregivers of toddlers promote these skills in toddlerhood (Andreadakis et al., 2019; Côté-Lecaldare et al., 2016), but little is known about ways to support these skills and self-concepts for autistic children.

 

These behaviors include self-injurious behaviors, aggressive behaviors, and other behaviors that may result in physical harm for the child and/or others in their environment. For example: eloping; running towards strangers; personal space violations; serious self-injurious behavior (e.g., headbanging, biting); hitting, punching, and physically harming others; behaviors with objects that may result in physical harm to self/others and/or destruction of property; behaviors that might impact ability to stay in childcare/daycare settings. 

Therapies/Therapeutic Approaches: 

• Supports for caregivers, EI providers, daycare/childcare providers, and others in a child’s environment to identify the root causes of these behaviors (e.g., sensory dysregulation, communicating an unmet need) 
• Supports that are tailored to the underlying cause of the potentially dangerous behavior or the child’s unmet need (e.g., sensory regulation, emotional regulation, communication). For example, if a child pushes someone’s body to indicate that they need space or do not want physical contact, expanding the acceptable communication options to replace “pushing” with another gesture that allows the child to communicate their needs without violating their desire to not be touched. 
• Proactively teaching skills to children and others in their environment that may address a child’s preferences or unmet needs, therefore reducing potentially dangerous behaviors (e.g., teaching consent to touch for both children and caregivers; expanding options for communicating and getting needs met) 
• Strategies/supports implemented by caregivers and EI/childcare-providers (e.g., de-escalation and coregulation strategies used by people in the child’s environment, as opposed to child-directed strategies only) 

Outcomes/Skills/Goals: 

• Reduction in “potentially dangerous behaviors” 
• Skills underlying potentially dangerous behaviors (e.g., communication, sensory regulation), when relevant 
• Stress, autonomy, and well-being 
• Peer, family, and provider (e.g., EI provider, daycare provider) relationships with the child 
• Caregiver, family, and EI/childcare-provider de-escalation and co-regulation skills 
• Child emotional regulation and use of self-soothing/self-regulating strategies 

Questions: 

• What are the primary causes/functions of potentially dangerous behaviors (e.g., sensory, communicative, dysregulation)? 
• How do supports for a child’s safety needs influence their sense of autonomy/control over their body and actions, and might this influence their potentially dangerous behaviors? (For example, a safety harness preventing eloping, but reducing a child’s feeling of control over their body, exacerbating the regulation needs contributing to eloping) 
• How can we help autistic children feel safe and in control over their bodies when using a potentially dangerous behavior? 
• How do we help people in the local community (e.g., first responders, law enforcement, neighbors) understand and de-escalate “potentially dangerous behaviors” to ensure that autistic people and their families of all racial and ethnic identities are safe, accepted, and supported in public settings and in their community? 
• What are practical steps that can be taken to ensure that children with higher safety concerns can participate in community events? 

Supporting Evidence:

Some autistic toddlers use “potentially dangerous behaviors” which may pose a threat to themselves or others in their environment (Soke et al., 2016). Evidence suggests that such “externalizing behaviors” are associated with parental stress for autistic and non-autistic parents (Olson et al., 2022), and a number of causes for these behaviors have been posited (All Audiences, n.d.; Dimian et al., 2023; Soke et al., 2017). In particular, underlying medical causes such as gastrointestinal symptoms are associated with increased self-injurious behaviors in autistic children (Restrepo et al., 2020). This highlights a need for collaboration between early intervention systems and healthcare systems. Caregivers have reported concerns with strategies that are not tailored to the underlying cause of their child’s behavior (Whittingham et al., 2006), making individualized supports an important area to focus on in the future. Furthermore, there is emerging evidence for caregiver skills like co-regulation as mitigating the frequency of these behaviors (Baker et al., 2018), but more research is needed on the topic.

Populations: 

• Autistic toddlers with co-occurring conditions affecting motor skills (e.g., hypermobility, connective tissue disorders, dyspraxia) 
• Autistic toddlers who may demonstrate signs of apraxia of speech 

Outcomes/Skills/Goals: 

• Participation in chores with caregivers and family members (e.g., cooking) 
• Using utensils 
• Getting dressed 
• Precursors to handwriting 
• Fine motor skills (buttons, snaps, etc.) 

Questions: 

• How does supporting a child’s motor skills influence other areas of development (e.g., adaptive functioning, use of AAC devices, play)? 

Supporting Evidence:

Many autistic children experience motor skills challenges, and there is evidence to suggest an association between autistic children’s fine and gross motor skills and their overall adaptive functioning and participation in important activities (MacDonald et al., 2013). Given the overall focus of EI on increasing toddlers’ participation in daily routines, motor skills are an important domain to address in EI therapy research. There is also emerging evidence for a relationship between autistic children’s motor skills and their later language skills (Mody et al., 2017; Wu et al., 2021), but the exact mechanism for this relationship is unclear. CommunicationFirst, an advocacy organization representing nonspeaking individuals who use AAC (including, but not limited to, autistic individuals), describes the need to disentangle the motor functions of speech from cognitive and language skills in assessing and supporting communication development (CommunicationFIRST, 2022). There have also been calls to explore the relationship between disorders affecting mobility and autism (Casanova et al., 2020), and even discussion of whether motor difficulties should be considered a core diagnostic feature of autism (Miller et al., 2024), but such work has not yet been initiated in a robust manner.

Therapies/Therapeutic Approaches: 

• Augmentative and Alternative Communication (see General Therapies below for more information) 
• Gestalt Language Processing 
• Communication-support strategies rooted in theories of multilingual development for multilingual children and families 

Outcomes/Skills/Goals: 

• Comprehension/receptive language: comprehension of words, grammatical structures, following directions, and other functions 
• Comprehension and expression of functions: commenting, requesting, asking questions, answering questions, giving directions, protesting, dissenting 
• Communication modalities: spoken language, Alternative and Augmentative communication (high-tech device, picture cards, etc.), sign language (e.g., American Sign Language, especially for children who are Deaf/Hard of Hearing) 
• Foundational skills for literacy, writing/spelling, AAC use, storytelling, and other communication-related functions that emerge as children age 
• Joint engagement and co-regulated interactions 

Questions: 

• How do current therapies/strategies:
  • support forms of communication other than spoken language in short- and long-term ways? 
  • influence the language input required to learn a variety of language-related skills? 
  • support children who use delayed echolalia/scripting to communicate? 
• How do we assess language comprehension in autistic children using methods that do not rely on expressive language skills or compliance with directions/demands? 
• How do current measures of communication skills reinforce non-autistic norms, or norms of White, monolingual, English-speaking children, as ideal outcomes of therapy (e.g., eye contact embedded in measures of joint engagement)? 
• How might we more accurately assess language skills and set goals for autistic toddlers from multilingual families 
• How might we more accurately assess language skills and set goals for autistic toddlers with motor planning and executive functioning challenges influencing speech and execution of tasks? 
• How do we support language development for autistic children in families that are bilingual or speak languages other than English, such that caregivers do not feel pressured to make a language choice they would not make for their child if they were not autistic? 
• How do we better identify idiosyncratic (unique) communication attempts or signals, and incorporate such idiosyncrasies in outcome measures in research and clinical settings? 
• Do children who used delayed echolalia/scripting develop language in a categorically distinct way (e.g., “gestalt language processors” vs “analytic language processors”)? 
• What do satisfying, engaged, regulated social interactions look like for autistic toddlers?

Using Comparative Effectiveness Research:

• Compare the effectiveness of current approaches with those tailored to gestalt language processing
• Compare the effectiveness of AAC and spoken language-focused approaches on language, participation in routines, and self-regulation, for short- and long-term outcomes
• Compare the effectiveness of approaches on standard and neurodiversity-informed social communication outcome measures

Supporting Evidence:

Children require different language input to learn different language-related skills (Rowe & Snow, 2020). Priorities for child communication development and caregiving practices used to support skill-development may be influenced by factors such as culture (Bernstein et al., 2005; Guiberson & Ferris, 2019). Given that autism research has primarily included white, monolingual, middle- and upper-class boys and their families, it is likely that current therapies do not meet the priorities and preferences of many autistic toddlers’ families. Furthermore, many autistic children use delayed echolalia or “scripting” to communicate (Prizant & Rydell, 1984), but current research that takes this communication method into account primarily focus on eliminating it (Ryan et al., 2022; Stiegler, 2015). Autistic adults and caregivers report that scripting is valuable for communication and regulatory purposes (Sullivan, 2020; Walton et al., 2023), and theories of distinct forms of language development amongst those who use these scripts (i.e., gestalt language processing [Blanc et al., 2023]) have risen in popularity in clinical spaces. Many older autistic children and autistic adults also use spelling- and symbol-based AAC to communicate. Providing the building blocks for these forms of communication from early ages may facilitate functional communication earlier, rather than waiting until adulthood when “traditional methods” of supporting spoken language have not been successful. Measurement of receptive language that does not solely rely on compliance, speech, or performance of tasks may also be more sensitive for autistic people with such challenges (Plesa Skwerer et al., 2016). Emerging evidence about different trajectories of language development in autistic children (Talbott et al., 2020) and communication styles in adulthood (Crompton et al., 2020) should be taken into account to develop social communication and language supports that are more efficient and appropriate for autistic children.

Therapies/Therapeutic Approaches: 

• Sensory garments 
• Stimming and “stim toys/tools” 
• Individualized sensory diets that are tailored to meet a child’s unique sensory input needs and support their regulation when needed, rather than a rigid schedule of activities a child is forced to do at certain times 
• Social sensory routines 
• Breathing and stretching exercises 

Outcomes/skills/goals: 

• Attention 
• Engagement 
• Self-regulation 
• Well-being 
• Participation in daily routines 
• Arousal regulation 
• Emotional regulation 
• Co-regulation 

Questions: 

• How do we better support co-regulation between autistic toddlers and others in their environment? 
• How do we encourage safe sensory exploration for autistic toddlers who may demonstrate some unsafe sensory-seeking behaviors (e.g., mouthing non-food objects that are hazardous)? 
• What is the impact of supporting sensory regulation on outcomes in other domains (communication, ADLs, emotional regulation, etc.)? 

Using Comparative Effectiveness Research…

• Compare the effect of sensory diets/routines/accommodations to desensitization approaches on sensory regulation, stress, and emotional regulation in short-term and long-term capacities

Supporting Evidence:

Differences in sensory processing and sensitivities is one of the key features of autism. Many autistic people report feeling uncomfortable or dysregulated in response to certain sensory input, and sensory processing challenges in toddlers are associated with higher child anxiety (Green et al., 2012), higher parental stress and limited participation in meaningful activities for families (Ben-Sasson et al., 2013). Despite the importance of these needs to autistic people and families, there is a dearth of rigorous research investigating sensory supports for young autistic children (Sandbank et al., 2023).  Additionally, autistic people report a close connection between their sensory and emotional regulation such that stimming and other efforts to meet their sensory needs also help them regulate their emotions, but that they face pressure from the social environment to suppress these regulating behaviors (Charlton et al., 2021; Kapp et al., 2019). The positive and negative effects of therapies to support sensory regulation should also be explored in toddlerhood to promote healthy coping and overall well-being of autistic children and their families.

Outcomes/skills/goals: 

• Attention span 
• Impulse control 
• Transitioning between tasks 
• Understanding expectations/sequences 
• Maintaining regulation during changes to routines or expectations 
• Problem-solving 

Supporting Evidence:

Autistic children may experience increased challenges in executive functioning as they age (Yerys et al., 2007), and early executive functioning skills are related to sensory regulation and autism characteristics (Stephens 2018). One study found that parent-reported executive functioning skills were related to behavior regulation and activities of daily living for school-aged autistic children, which they posit could have a downstream impact on autistic children’s mental health and well-being (Gardiner 2018). Thus, providing a foundation for development of these skills can impact a wide range of outcomes as autistic toddlers age. Autistic toddlers and their families may benefit from ways to scaffold these emerging skills and mitigate potential challenges in the future.

Populations: 

• Children showing signs of Avoidant/Restrictive Food Intake Disorder (ARFID) 

Therapies/Therapeutic Approaches: 

• Sensory approaches to feeding 
• Culturally-sensitive feeding therapies (e.g., respecting the types of foods and mealtime preferences of each family) 
• Supports that consider how other factors (e.g., stress, preference for routines) impact safe food options 
• Advocacy and support for caregivers facing stigma or shame for their child’s food preferences from providers, doctors, or others in their environment 
• Maintaining comfort around safe food options while introducing new food options 

Outcomes/goals/skills to support: 

• Protecting safe foods 
• Comfort with new food options, when helpful for the child 
• Meeting nutritional needs 
• Use of food and drink containers/utensils for accessible feeding 

Questions: 

• How do we support autistic children with food-related sensitivities in expanding their repertoire of foods while respecting their sensory needs and preferences? 
• How do we support feeding- and nutrition-related needs for autistic children for families with limited access to different types of foods or nutritional supplements? 

Using Comparative Effectiveness Research:

• Compare the effect of sensory-informed approaches to behavioral-informed approaches to feeding on food repertoire and stress during mealtimes

Supporting Evidence:

Many autistic toddlers experience difficulties with feeding such as food refusal, stuffing, and selectivity (Seiverling et al., 2018), with one study finding that up to 90% of autistic children have some form of feeding difficulty (Kodak & Piazza, 2008). There is also evidence to suggest that many people with Avoidant/Restrictive Food Intake Disorder (ARFID) may be autistic (Farag et al., 2022). There is evidence to suggest that these feeding difficulties are associated with sensory sensitivities or processing differences, but mechanisms like oral-motor skills have been investigated less frequently (Pinto-Silva et al., 2023). Parents of older autistic children report difficulties with feeding and mealtime, but mealtime-specific concerns are often unaddressed (Bonsall et al., 2021). There is also a high co-occurrence of gastrointestinal difficulties in autistic children (Restrepo et al., 2020), and evidence suggests that some feeding concerns are associated with gastrointestinal symptoms (Leader et al., 2020).  Therefore, addressing feeding concerns may support challenges in these domains as well.

Therapies/Therapeutic Approaches: 

• Child-led, play-based therapy (e.g., not teaching specific play sequences) 

Questions: 

• How do autistic children enjoy playing with toys/objects? 
• How do autistic children enjoy playing with other children? 
• How does supporting autistic children to play in ways that are natural to them support their skill development in other areas? 
• Are there any negative consequences on teaching play skills according to non-autistic norms (e.g., not encouraging an interest in letters for children who may be hyperlexic)? 
• What characteristics of joint play interactions are satisfying, regulating, and beneficial for skill-building for autistic toddlers?

Supporting Evidence:

Play is a common setting for EI therapies (Nwokah et al., 2013), and provides a context in which children can explore their environment and learn new skills. Research has demonstrated that autistic children demonstrate lower symbolic play skills than non-autistic children on a variety of standard assessments (González-Sala et al., 2021), and most current therapies aim to teach autistic toddlers to play in ‘expected’ ways. However, the unique ways in which autistic toddlers like to play (e.g., lining up objects, identifying patterns) may be satisfying and useful for developing other types of skills. Researchers have yet to explore these advantages, but autistic people and some clinicians have shifted towards more child-led styles of play (Burch, 2022).

• Sleep quality and quantity (and how supports for sleep impact the emotional regulation and well-being of autistic toddlers and their caregivers)
• Toileting: What factors (sensory sensitivities, interoception, communication challenges) underlie difficulties with toileting? How do we create supports for toileting that are tailored to these challenges?

Using Comparative Effectiveness Research:

• Compare the effect of behavioral and sensory-informed toileting approaches on independent toileting, regulation, and autonomy, in short-term and long-term capacities

Supporting Evidence:

Many caregivers report their autistic child has problems with sleep, and that these difficulties pose challenges for their child’s well-being as well as that of other family members (Cotton & Richdale, 2006). Some supports and therapies exist for sleep problems, but many caregivers report this is still a concern. Future research should not only measure the effects of various supports on sleep-related difficulties for autistic children, but also on their families (Tilford et al., 2015). Additionally, autistic toddlers frequently experience challenges with toileting (Matson & LoVullo, 2009), and autistic adults report that toileting is an important avenue for autism therapy research (Baiden et al., 2024).

Questions:

• How might common strategies and goals based on norms and practices for white, monolingual, English-speaking families impact the cultural identity and sense of cultural belonging for autistic children and caregivers, including within the context of the caregiver-child relationship?
• How might families feel pressure to make changes to their caregiving preferences to follow through with “best practices” for supporting autistic toddlers?
• How can caregiving practices and priorities of families who have been excluded from autism research be used to support autistic children’s development?
• How might EI therapies and/or goals encourage autistic toddlers to act in ‘non-autistic’ ways, intentionally or unintentionally?

Using Comparative Effectiveness Research:

• Compare the effect of current approaches and culturally-informed approaches to therapy (for wide-ranging skills) on child skills and child/family feelings of belonging in their community

 

Supporting Evidence:

A robust body of cross-cultural research suggests that desired childhood competencies and child-rearing practices vary across cultures. Given that autism research primarily includes white boys (Sandbank et al., 2023; Steinbrenner et al., 2022), it is possible that current strategies to support autistic toddlers do not reflect the diverse goals and practices for all families. In fact, one study found that many commonly-used strategies are not compatible with the interdependent interactional styles used by some Latine caregivers (Guiberson & Ferris, 2019). Further exploration about the appropriateness of current practices for diverse families and the impact of encouraging “ideal” practices that are not compatible with families’ unique preferences is therefore a vital next step to ensuring effective and equitable EI for all autistic children and families.

Outcomes:

• Overall autism characteristics
• Eye contact
• Compliance, including when serving as a proxy for skill development in other domains like communication

Supporting Evidence:

Many community members report that the goal of early supports and therapies should not be to make a child act less autistic, and that they prefer supports for specific challenges. Thus, “overall autism characteristics” is an unhelpful outcome measure despite its common use in research studies (Sandbank et al., 2023). Furthermore, some autistic adults have reported that eye contact is an unhelpful social cue or uncomfortable for them (Trevisan et al., 2017). A recent survey of autistic adults found that increasing eye contact and reducing noncompliance are “controversial” goals of behavioral-based interventions (Baiden et al., 2024). These goals should not be prioritized as outcomes of EI therapy research, and intentional consideration of the ways in which other measures may actually include these constructs must be considered when planning EI autism research studies.

Questions:

• What is the comparative effectiveness of educational apps versus traditional methods in promoting language and pre-literacy skills in autistic toddlers?
• What are the potential benefits and limitations of incorporating apps/technology into traditional interventions to promote engagement, regulation, and to meet individual learning styles for autistic toddlers and caregivers?
• How can educational apps be used by the child independently or collaboratively between the child and their caregivers to support child skill development and caregiver-child relationships?

Supporting Evidence:

There are hundreds of smartphone apps that have been created for autistic individuals’ learning, yet only 5% of them offer any clinical evidence supporting their efficacy, particularly in real-world settings (Kim et al., 2018). There is some preliminary evidence demonstrating effectiveness of educational apps for promoting language and academic skills in school-age autistic children (Hussain et al., 2021). However, studies comparing the effectiveness of these apps to traditional methods have not yet been conducted, in addition to minimal research regarding using educational apps with very young autistic children. Using technology to support autistic individuals’ learning is a topic of increasing interest among researchers (Cramer et al., 2023; Odom et al., 2015; Shic & Goodwin, 2015), yet little has addressed how to do so effectively with caregivers of autistic toddlers.

Questions:

• How does participation in common activities of early childhood (e.g., playing in the park or joining a music class) support children’s skill development and social inclusion?
• What is the impact of “high dosage” therapies on children’s social inclusion in their natural environment?
• Does unstructured time (e.g., time not in therapeutic or structured activities) help autistic children regulate so that they’re more readily available to learn from their environment and interactions?

Using Comparative Effectiveness Research:

• Compare the effect of autism-specific, one-on-one therapies to community-based therapies on child skills, participation in daily routines, and inclusion in their community

Supporting Evidence:

There is inconclusive evidence of the impact of “high dosage” therapies on outcomes such as social communication and behavior regulation,(Pellecchia et al., 2020) with little focus on other important outcomes such as social inclusion in children’s natural environments. Furthermore, parents have reported that “breaks” are important for their autistic child’s self-regulation and management of the social environment Walton et al., 2023) but this strategy and its impact on a variety of outcomes has not been investigated in a formal way.

AAC here refers to: speech-generating devices, spelling- and text-based communication, symbol-based communication

• What are best practices for supporting AAC use for autistic children?
• How do we best develop AAC methods tailored towards children who: a) use (or learn from) delayed echolalia/scripts (e.g., machine learning, AI, or other methods); b) are from multilingual families; c) have motor challenges impacting their use of traditional AAC devices/methods?
• How do we support early motor and literacy/language necessary for future communication using various AAC methods (e.g., spelling-based AAC)?
• How do we support the early motor and literacy-related skills that will allow autistic children to access spelling- and text-based communication as they age?
• What can we learn from autistic adults who use symbol- and text-based communication methods (e.g., Spelling 2 Communicate, Rapid Prompting Method) about the strengths and appropriateness of these methods, and how this can be applied to support access to meaningful communication for toddlers?

Supporting Evidence:

AAC is a way to provide access to meaningful and functional communication for individuals who do not use spoken language, but caregivers have reported difficulty in understanding how to best support their child to use AAC (Walton et al., 2023). Early challenges with communication have been reported by caregivers to influence children’s emotional regulation and well-being (Walton et al., 2023), and therefore access to communication through AAC may also impact outcomes not directly related to communication. Some autistic adults who use spoken language also report that AAC access allows them to communicate more easily, especially when experiencing regulation challenges, and that AAC access provides autistic children and adults with autonomy over their communication and increased ability to self-regulate (Donaldson et al., 2021). Thus, research about AAC use must not only be restricted to non-speaking autistic people, but viewed as a tool to allow for meaningful communication, self-regulation, autonomy, and well-being from a holistic perspective. Furthermore, many autistic people may have motor challenges that impact their use of AAC modalities, but the accessibility of other AAC systems has not been robustly studied (Sowers & Wilkinson, 2023). As with other communication-facilitation strategies, research about best practices in supporting AAC should consider multilingualism and alternate ways of language processing. Finally, many autistic people use spelling-based AAC methods to communicate; supporting the foundational skills for reading and writing may facilitate use of these communication methods earlier in life, rather than waiting until autistic children are older to first begin teaching literacy skills.

Supporting Evidence:

Art and music-based therapies can be used to target a variety of skills, and many children and families may find these therapies enjoyable. Although some music-based therapies have been found to be effective (Hume et al., 2021), there is less evidence of effectiveness for other arts-based therapies. More work is needed to understand the effect of these therapies and how arts-based activities may be used to support autistic children’s development early in life.

Questions:

• How might the strategies and principles of ABA and behaviorism be used in ways that are more acceptable to proponents of the neurodiversity movement?
• What do caregivers, clinicians, and autistic people who participated in ABA perceive as strengths of ABA (e.g., data collection methods, concrete strategies and sequences), and how may these be applied to other therapeutic approaches?
• What are the impacts of different ABA and behavioral approaches on children’s stress, well-being, confidence, and emotional regulation in short-term and long-term capacities? (see questions about prompting and reinforcement)

Supporting Evidence:

An ethical guidance brief created by the Autistic Self Advocacy Network and based on a thorough review of the literature, among other autistic advocates’ voices, outlines guiding principles for early interventions for autism to ensure these interventions align with the neurodiversity movement and lead to positive short and long-term outcomes (Autistic Self-Advocacy Network, 2021; “Red Flags of Early Intervention for Autism,” 2019). These suggest that ethical and effective autism interventions will value autistic people’s identities, focus on improving quality of life as defined by autistic individuals, and involve shared decision-making for developing therapeutic goals. While behavioral-based therapies are frequently used to support autistic children, research has demonstrated that many autistic individuals experienced harmful long-term effects related to receiving ABA therapy as a child (Kupferstein, 2018). There is evidence supporting some positive outcomes of ABA and behavioral based approaches on some skills such expressive and receptive language, adaptive skills, and cognitive skills (Peters-Scheffer et al., 2011). But existing research on the effects of ABA strategies predominantly focuses on outcomes that are not prioritized by autistic individuals (Anderson, 2023; Rodgers et al., 2021).

• How might desensitization therapies for children’s sensory regulation impact their autonomy, overall well-being, and self-regulation long-term?

Supporting Evidence:

Systematic desensitization and exposure therapies have been researched as a way to build autistic people’s tolerance to bothersome sensory input. However, research suggests that autistic children may have similar neurological responses to sensory stimuli after exposure, even if they do not display observable behaviors or challenges related to sensory exposure (Green et al., 2019). In other words, they may still experience overwhelm or stress in response to some sensory input even if they have learned not to respond to it outwardly. This calls into question the effectiveness of these therapies, the validity of measures of anxiety or comfort related to observable behaviors, and the need for research and therapy approaches that use a wider range of data sources to measure progress.

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All audiences. (n.d.). Retrieved April 3, 2024, from https://www.autism.org.uk/advice-and-guidance/topics/behaviour/self-injurious-behaviour/all-audiences

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Ben-Sasson, A., Soto, T. W., Martínez-Pedraza, F., & Carter, A. S. (2013). Early sensory over-responsivity in toddlers with autism spectrum disorders as a predictor of family impairment and parenting stress. Journal of Child Psychology and Psychiatry, 54(8), 846–853. https://doi.org/10.1111/jcpp.12035

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