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The professional practice of behavior analysis is the fourth domain of behavior analysis. The other three are behaviorism, experimental analysis of behavior, and applied behavior analysis.¹ The professional practice of behavior analysis is the delivery of interventions to consumers that are guided by the principles of behaviorism, and the research of both the experimental analysis of behavior and applied behavior analysis. Out of the four domains, professional practice seeks maximum precision to change behavior most effectively in specific instances.² The professional practice of behavior analysis ranges from treatment of autism, developmentally disabled individuals to behavioral coaching, and behavioral psychotherapy. In addition to treatment of mental health and corrections,³⁴⁵ the professional practice of behavior analysis also has areas including organizational behavioral management, behavioral safety, and even how to maintain the behavioral health of astronauts while within and beyond earth orbit.⁶. The professional practice of behavior analysis is a hybrid discipline with specific influences coming from counseling, psychology, education, special education, communication disorders, physical therapy, and criminal justice ⁷. As a discipline it has its own conference, organizations, certification process, and awards.

Defining the practice

The Behavior Analysis Certification Board (BACB) defines behavior analysis as:⁸

"The field of behavior analysis grew out of the scientific study of principles of learning and behavior. It has two main branches: experimental and applied behavior analysis. The experimental analysis of behavior (EAB) is the basic science of this field and has over many decades accumulated a substantial and well-respected research literature. This literature provides the scientific foundation for applied behavior analysis (ABA), which is both an applied science that develops methods of changing behavior and a profession that provides services to meet diverse behavioral needs. Briefly, professionals in applied behavior analysis engage in the specific and comprehensive use of principles of learning, including operant and respondent learning, in order to address behavioral needs of widely varying individuals in diverse settings. Examples of these applications include: building the skills and achievements of children in school settings; enhancing the development, abilities, and choices of children and adults with different kinds of disabilities; and augmenting the performance and satisfaction of employees in organizations and businesses"

As the above suggests, behavior analysis is based on the principles of operant and respondent conditioning. This places behavior analysis as one of the dominant models of behavior modification, behavior management, behavioral engineering, and behavior therapy. By behavior analysis's very nature of being an active, environmental based approach- behavior analytic procedures are considered highly restrictive (see Least Restrictive Environment). For example, these service may block access to preferred items and make the contingent on performance. This has led to abuses in the past in particular where punishment programs have been involved.⁹ In addition, failure to be an independent profession often leads behavior analysts and other behavior modifiers to have their ethical codes supplanted by other professions¹⁰ For example, a behavior analyst working in the hospital setting designs a token system, a form of contingency management. He may desire to meet his ethical obligation to make the program habilitative and in the clients best long term interest. The physicians and nurses in the hospital who supervise him may decide that the most important thing that the token system could do would be to create order in the nursing routines so that clients quickly and efficiently get their medication without hassling the hospital staff. Instead of the ethical code of the Behavior Analysis Certification board and the Association for Behavior Analysis International's position that those receiving treatment have a right to effective treatment¹¹ and a right to effective education.¹² In addition, failure on the part of a behavior analyst to adequately supervise his work could lead to abuse.¹³ Finally, misrepresentations of the field and historical problems between academics has led to frequent calls to professionalize behavior analysis¹⁴

The Behavior Analysis Certification Board offers a technical certificate in behavior analysis. This certification states the level of training and requires an exam to show a minimum level of competence (human resources) to call oneself a behavior analyst. Some have referred to this as a "national license" in behavior analysis- which clearly represents misinformation about the licensing process and a basic knowledge of U.S. civics, in which licensure is the prerogative of the state governments not the federal governments for matters of commerce in the state.¹⁵ Recently, a move has occurred to license behavior analysts.¹⁶¹⁷ The goal of licensing is to protect the public from those who claim to be behavior analysts but really lack training and experience. The lack to training and experience could lead to an overreliance on punishment procedures or aversives. To do so, the model licensing act states that a person is a behavior analyst by training and experience. The person seeking licensure must have mastered behavior analysis by achieving a masters degree in behavior analysis or related subject matter. Like all other master level licensed professions (see counseling) the model act sets the standard not just for a masters degree but twice this level of achievement (60 graduate master level credits instead of 30). This requirement states that the person certainly has achieved book knowledge of behavior analysis, which can be then tested through the exam offered by the Behavior Analysis Certification board to determine how much is retained. However, it does not stop there. It calls for an internship in which a behavior analysts works under another master or Ph.D. level behavior analyst for a period of one year (750 hours) with at least two hours/week of supervision. Finally, those 750 are considered tutelage time. After that the behavior analyst must engage in supervised practice under a behavior analyst for a period of another 2 years (2,000 hours). Once this process is complete the person applies to a state board, who ensures that he or she has indeed met the above conditions. If yes, the person is granted a license by the state. If no, the application is rejected. Once the person is licensed, public protection is still monitored by the licensing board, which makes sure that the person receives sufficient ongoing education and licensing board investigates ethical complaints. Thus, a licensed behavior analyst would have equal training, knowledge, skills, and abilities in his discipline as a mental health counselor or marriage and family therapist would have in his/her discipline. In February of 2008, Indiana, Arizona, Massachusetts, and other states currently have legislation pending to create state boards for behavior analysts. In October of 2008, Prairieville, Louisiana, was another place to offer such legislation.

Service delivery models

The two primary methods for delivering behavior analytic services are consultation and/or therapy; the former involves three parties - consultant, consultee, and a client whose behavior is changed.¹⁸ Consultation can involve working with the consultee (i.e. a parent or teacher) to build a plan around the behavior of a client (i.e. a child or student), or training the consultees themselves to modify the behavior of the client. Within the domain of parent-child consultation, standard intervention includes teaching parents skills such as basic reinforcement, time-out and how to manipulate different factors to modify behavior.¹⁹ Direct therapy involves the relationship of behavior analyst and client, usually one-on-one, in which the analyst is responsible for directly modifying the behavior of their client. Direct therapy is also used in schools, but can also be found in group homes, in a behavior modification facility and in behaviour therapy¹⁸ (where the focus may be on tasks such as quitting smoking, modifying behaviors for sex offenders or other types of offenders, or modifying behaviors related to mood disorders) or to encourage job seeking behavior in psychiatric patients.²⁰²¹

Two older less used models still exist for the delivery of behavior analytic services. These models worked mostly with normal/typically developing populations. The two models are the Behavioral Coaching and the Behavioral Counseling model. Both were very popular in the 1960-1980s but have recently seen a decline in popularity in spite of its success as proponents argued the merits of holding strictly to learning theory.^{22232425262728}

The behavioral coaching model is sometimes referred to as life coaching. However, like counselors and psychologists life coaches can have varied orientations/change theories (see Behavioural change theories); behavioral life coaches operate exclusively from a behavior analytic orientation. Unlike therapy, this model is applied to typically developing people, who desire to achieve a specific goal²⁹ such as increasing their assertiveness with others.³⁰³¹ This is a model is educative in behavioral principles and presented as an alternative to therapy. Coaches use behavioral techniques of goals and objective setting, self-control training, behavioral activation, and other techniques to help clients to achieve specific life goals [34]. Behavioral coaching sometimes was used with those with mental retardation or head injury to teach job skills. In this area, the model made extensive use of task analysis, direct instruction, role play, reinforcement, and error correction.³² Often this approach employs techniques of Direct instruction.

Behavioral counseling was very popular throughout the 1970s and at least into the early 1980s³³³⁴ Behavioral counseling is an active action oriented approach that works with the typically developing population also but also assists people with specific/discrete problems such as drinking, smoking, or rehabilitation after injury.³⁵³⁶

Behavioral counseling was largely seen as a growth model, that tried to increase the individuals sense of "freedom" be helping the client reduce punishment or coercion in their lives, build skills, and increase access to reinforcement.³⁷ Even B.F. Skinner himself created a video discussing the processes involved and the importance of reinforcement to increase the sense of "freedom". [35] . Behavioral counseling attempts to (1) use in-session reinforcement to improve decision making,³⁸³⁹ functional assessment of the clients problem⁴⁰ and (3) use behavioral interventions to reduce problem behaviors.⁴¹ Some behavioral counselors approach therapy from a social learning perspective⁴² but many held a position based on the use of behavioral psychology with a focus on the use of operant, respondent conditioning procedures.⁴³ Some who did adopt a position on modeling held closer to the behavioral view of modeling as generalized imitation developed through learning processes.⁴⁴ The behavioral counseling approach became very popular in weight reduction⁴⁵⁴⁶⁴⁷ and is on APA's list of evidenced based practices for weight loss. Behavioral counseling for weight loss by Richard B. Stuart led to the commercial program called Weight Watchers.⁴⁸ Recently, efforts have been made to resurge interest in behavioral counseling as a method to effectively deliver services to normal problemed populations⁴⁹⁵⁰

Summary

Behavior analytic services can be and often are delivered through various treatment modalities. These include:

Consultation - an indirect model in which the consultant works with the consultee to change the behavior of the client.

Therapy - (individual, group, or family) in which the therapist works directly with a person with some form of pathology to lessen the pathology.

Counseling - where the counselor works directly with a person who has problems but no pathology.

Coaching - in which the coach works with a person to achieve a life goal.

Treatment of autism

Among the available approaches to treating autism, ABA therapies have demonstrated efficacy in promoting social and language development and in reducing behaviors that interfere with learning and cognitive functioning.^5152535455 The ABA approach teaches play,⁵⁶⁵⁷social, motor, and verbal behaviors as well as reasoning skills.⁵⁸ ABA therapy is used to teach behaviors to individuals with autism who may not otherwise "pick up" these behaviors spontaneously through imitation. Imitation can also be directly trained.⁵⁹ ABA therapies teach these skills through use of behavioral observation and reinforcement or prompting to teach each step of a behavior.⁶⁰ ABA therapy often employs principles of overlearning to help acquire mastery and fluency of skills.

Generally treatment based from ABA involves intensive training of the therapists, extensive time spent in ABA therapy (20–40 hours per week) and weekly supervision by experienced clinical supervisors known as a board certified behavior analyst.⁶¹

Extensive research exists to show the behavior analysis is an effective treatment for autism with literally hundreds of studies showing its effeciveness with persons of all ages in enhancing functioning, building skills and independence, as well as improving life quality.⁶² What remains controversial are claims of behavior analysis "curing autism".⁶³ While several small studies exist showing that behavior analysis holds promise in this area, the number of well controlled studies do not rise to the level required by APA to hold the treatment as empirically supported in this area.⁶⁴

An increasing amount of research in the field of ABA is concerned with autism; and it is a common misconception that Behavior Analysts work almost exclusively with individuals with autism and that ABA is synonymous with discrete trials teaching. ABA principles can also be used with a range of typical or atypical individuals whose issues vary from developmental delays, significant behavioral problems or undesirable habits.

ABA is often confused as a table-only therapy. Properly performed, ABA should be done in both table and natural environments depending on the student's progress and needs. Once a student has mastered a skill at the table, the ABA team should move the student into a natural environment for further training and generalization of the skill.

Frequently, the Assessment of Basic Language and Learning Skills (ABLLS) is used to create a baseline of the learner's functional skill set. The ABLLS breaks down the learner's strengths and weaknesses to best tailor the ABA curriculum to them. By focusing on the exact skills that need help, the teacher does not teach a skill the student knows. This can also prevent student frustration at attempting a skill for which he or she is not ready. Bridget Taylor is one of the first popularized autism therapists as a major proponent in Catherine Maurice's book: Let Me Hear Your Voice.

Many families have fought school districts for such programs. Donald Baer, a behavior analyst who often testified as an expert witness has provided several letters to lawyers before he passed. Ohio state has archived a reading of those letters at [36]

Discrete trials

Discrete trials were originally used by people studying classical conditioning to demonstrate stimulus - stimulus pairing. Discrete trails are often contrasted with free operant procedures like one ones used by B.F. Skinner in learning experiments with rats and pigeons how learning was influenced by rates of reinforcement. . The discrete trials method was adapted as a therapy for developmentally delayed children and individuals with autism. For example, Ole Ivar Lovaas used discrete trials to teach autistic children skills including making eye contact and following simple instructions and advanced language and social skills. These discrete trials involved breaking a behavior into its most basic functional unit and presenting the units in a series.

A discrete trial usually consists of the following: The antecedent, possibly combined with a prompt (a non-essential element used to assist learning or correct responding), the behavior of the student, and a consequence. If the student's behavior is what is desired, the consequence is something positive: food, candy, a game, praise, etc. If the behavior was not correct, the teacher offers the correct answer, then repeats the trial, possibly with more prompting if needed.

There is usually an inter-trial interval that allows for a few seconds to separate each trial, to allow the student to process the information, teaches the student to wait, and makes the onset of the next trial more discrete. Discrete trials can be used to develop most skills, which includes cognitive, verbal communication, play, social and self-help skills. There is a carefully laid out procedure for error correction and a problem solving model to use if the program gets stuck.⁶⁵ Discrete trial is sometimes referred to as Lovaas technique.

Free operant procedures

In language training, many free operant procedures emerged in the late 1960s and early 1970s (e.g.,⁶⁶ ). These procedures did not try to train discrimination first and then passively wait for generalization but instead worked from the start on actively promoting generalization.⁶⁷ Initially, the model was referred to as incidental teaching but later was called milieu language teaching and finally natural languaged teaching. Peterson (2007) completed a comprehensive review of 57 studies on these training procedures.⁶⁸ This review found that 84% of the studies of the natural language procedures looked at maintenance and 94% looked at generalization and were able to provide direct support of its occurrence as part of the training.

Application

Clinical

Dougher's edited volume tilted Clinical Behavior Analysis on Context Press highlights the application of behavior analysis to adult outpatients. He identifies four comprehensive behavior analytic programs: Stephen Hayes, et al's Acceptance and Commitment Therapy (ACT), Behavioral activation (BA), Kohlenberg & Tsai's Functional Analytic Psychotherapy and community reinforcement approach for treating addictions. In addition, the book highlights several recent areas of functional analysis research for common clinical problems. Many of these areas are specified in the section on behavior therapy.

Community reinforcement approach has considerable research supporting it as efficacious.⁶⁹ Started in the 1970s, community reinforcement approach is a comprehensive operant program built on a functional assessment of a clients drinking behavior and the use of positive reinforcement & contingency management for nondrinking.⁷⁰ When combined with disulfiram (an Aversives procedure or see Aversion therapy), community reinforcement showed remarkable effects.⁷¹ One component of the program that appears to be particularly strong is the non-drinking club.⁷² Applications of community reinforcement to public policy has become the recent focus of this approach⁷³

An off-shoot of the community reinforcement approach is the community reinforcement and family training approach.⁷⁴ This program is designed to help family members of substance abusers feel empowered and get drinker or drug users to engage in treatment. The rates of success have varied somewhat by study but seem to cluster around 70%.^75767778 The program uses a variety of interventions based on functional assessment including a module to prevent domestic violence. Partners are trained to use positive reinforcement, various communication skills, and natural consequences.

With children, applied behavior analysis provides the core of the positive behavior support movement ,⁷⁹⁸⁰ and creates the basis of teaching family homes. Teaching family homes have been found to reduce recidivism for delinquent youth both while they are in the homes and after they leave.⁸¹ Finally, operant procedures form the basis of behavioral parent training developed from social learning theorists. The etiological models for antisocial behavior show considerable correlation with negative reinforcement and response matching see matching law.⁸²⁸³⁸⁴ Behavioral parent training (see Parenting) has been very successful in the treatment of conduct disorders in children and adolescents with recent research focusing on making it more culturally sensitive.⁸⁵ In addition, behavioral parent training has been shown to reduce corperal or abusive child discipline tactics.⁸⁶ Behavior analysts typically adhere to a behavioral model of child development in their practice (see child development)

Recent studies showing that behavior modification based on behavior analysis can reduce recidivism has led to a resurgence in behavior modification facility.⁸⁷ In addition, behaviorally based early intervention programs have shown effectiveness⁸⁸

Methods of counter conditioning and respondent extinction—called Exposure Therapy—are often employed by many behavior therapists in the treatment of phobias, anxiety disorders such as post-traumatic stress disorder, and addictions (cue exposure). Prolonged exposure therapy has been particularly helpful with post traumatic stress disorder⁸⁹Several procedures to block respondent conditioning such as blocking and overshadowing are sometimes used in behavioral medicine to prevent conditioned taste aversion for patients with chemotherapy treatments. Exposure with Response Prevention (ERP is a respondent extinction procedure often used to treat obsessive compulsive behavior. Escape response blocking is critical for this procedure. For post traumatic stress disorders, exposure therapy is one of the few evidenced based techniques.⁹⁰ Recent research suggests exposure therapy is an excellent means of alleviating both the anxiety and cognitive symptoms specific to PTSD, with no additive effect for additional cognitive components (see review by⁹¹). Several authors have argued that exposure by itself is necessary and sufficient to produce behavior change in reducing fear in social phobics and helping them engage more effectively with others⁹² The Washington Post ran a story that only exposure therapy is proven for PTSD and that cognitive therapy or even drug therapy are not shown at this time to be effective (see [37] )

There are multiple journals, which produce articles on the clinical applications of applied behavior analysis. These include- The Behavior Analyst Today, The International Journal of Behavioral Consultation and Therapy and three new journals scheduled for release in 2008- Behavior Analysis in Sports, Health, Fitness and Behavioral Medicine, the Journal of Behavior Analysis in Crime and Victim: Treatment and Prevention (see BAO), as well as, a new journal to be released from the Association for Behavior Analysis International titled Behavior Analytic Practice.

Organizational

Behavior Analysis with organizations combined with systems theory (an approach called organizational behavior management) has shown some success particularly in the area of Behavior-based safety. Behavior safety research has lately become focused on factors that lead programs to being retained in institutions long after the designer leaves.⁹³ For other areas see behavioral engineering

Educational

Direct instruction and Direct Instruction with the former representing the process and the latter a specific curriculum that highlights that process remain both current and controversial in behavior analysis.⁹⁴ The essential features are a carefully structured fast paced-program based on teacher directed small group instruction.⁹⁵ One controversy that remains is that teacher creativity is admonished in the program.⁹⁶ Even with such issues to be worked out, positive gains in reading for the approach have been reported in the literature since 1968.⁹⁷⁹⁸ An example of the positive gains reported Meyer(1984) found that 34% of children in the DISTAR group were accepted to college as compared to only 17% of the control school.⁹⁹ Current research is focused on peer delivery of program¹⁰⁰

School wide positive behavioral support¹⁰¹ is based on the use of behavior analytic procedures delivered in an organizational behavior management approach. School wide behavioral support has been increasingly accepted by administrators, lawmakers, and teachers as away to improve safety in classrooms¹⁰²¹⁰³

Curriculum based measurement and curriculum matching is another active area of application.¹⁰⁴ Curriculum based measurement uses rate and reading performance as the primary variable in determining reading levels. The goal is to better match children to the appropriate curriculum level to remove frustration, as well as to track reading performance over time to see if it is improving with intervention.

Functional behavioral assessment was mandated in the United states for children who meet criteria under the individuals with disabilities education act.¹⁰⁵ This approach has precluded many procedures for modifying and maintaining children in not just the school system but in many cases the regular education setting.¹⁰⁶¹⁰⁷ Even children with severe behavior problems appear to be helped^108109110

Teaching children to recruit attention¹¹¹ has become a very important area in education. In many cases one function of children's disruptive behavior is to get attention¹¹²

Hospital settings

Discrete trials have been helpful in the treatment of pediatric feeding problems.¹¹³ They have also been helpful in the prevention of feeding problems¹¹⁴

Another area of growing interest in hospitals is the blocking effect especially for conditioned taste aversion. This area of interest is considered important in the prevention of weigh loss during chemotherapy for cancer patients.

Another area of growing interest in the hospital setting is the use of operant based biofeedback with those suffering from cerbral palsey^115116117 or minor spinal injuries. Brucker's group at the University of Maimi has had some success with specific operant conditioning based biofeedback procedures to enhance functioning.¹¹⁸¹¹⁹ While such methods are not a cure and gains tend to be in the moderate range, they do show ability to help remaining central nervous system cells to regain some control over lost areas of functioning.¹²⁰

Space program

Probably one of the most interesting applications of behavior analysis in the 1960s was its contribution to the space program.¹²¹ Research in this area is used to train astronauts including the chimpanzees sent into space. Continued work in this area focuses on ensuring that astronauts who live in confined areas and space do not develop mental health problems.¹²²

Consumer and professional relationships

Open communication and a supportive relationship between educational systems and families allow the student to receive a beneficial education. This pertains to typical learners as well as to individuals who need additional services. It was not until the 1960s that researchers began exploring Behavior Analysis as a method to educate those children who fall somewhere on the autism spectrum. Behavior analysts agree that consistency in and out of the school classroom is key in order for children with autism to maintain proper standing in school and continue to develop to their greatest potential.

Applied behavior analysts sometimes work with a team to address a person's educational or behavioral needs. Other professionals such as speech therapists, physician and the primary caregivers are treated as key to the implementation of successful therapy in the ABA model. The ABA method relies on behavior principles to develop treatments appropriate for the individual. As such, regular meetings with professionals to discuss programming are one way to establish a successful working relationship between a family and their school. It is beneficial when a caregiver can conduct generalization procedures outside of school. In the ABA framework, developing and maintaining a structured working relationship between parents or guardians and professionals is essential to ensure consistent treatment.

Intervention goals

When working directly with clients, behavior analysts engage in a process of collaborative goal setting. ¹²³Goal setting ensures that the client is already under stimulus control of the goal and thus is more likely to engage in behavior to achieve it.¹²⁴ Behavior analytic programs are ultimately skill building¹²⁵ enhance functioning, lead to higher quality of life, and build self-control.^{126127128129130131132133134} Indeed, one of the most distinguishing features of behavior analysis has been its core belief that all individuals have a right ot the most effective treatment for their condition[38] and a right to the most effective educational strategy available [39]

History

Applied behavior analysis is the applied side of the experimental analysis of behavior. It is based on the principles of operant and respondent conditioning and represents a major approach to behavior modification and behavior management. Its origin can be traced back to Teodoro Ayllon and Jack Michael's 1959 article "The psychiatric nurse as a behavioral engineer"¹³⁵ as well as to initial efforts to implement teaching machines.¹³⁶

The research basis of ABA can be found in the theoretical work of behaviorism and radical behaviorism originating with the work of B. F. Skinner. In 1968, Baer, Wolf, and Risley wrote an article¹³⁷ that was the source of contemporary applied behavior analysis, providing the criteria to judge the adequacy of research and practice in applied behavior analysis. It became the core and center piece of behavior modification and behavioral engineering.

Work in respondent conditioning (what some would term classical conditioning) began with the work of Joseph Wolpe in the 1960s. It was improved by the work of Edna B Foa who did extensive research on exposure and response prevention for obsessive compulsive disorder. In addition, she worked on exposure therapy for post traumatic stress disorder.

Over the years most behavior analysts have existed and conducted research in many areas and University departments including behavior analysis departments, psychology, special education, regular education, speech-language pathology and communication disorders departments, school psychology, criminal justice, and family life. They have belonged to many organizations including the American Psychological Association. They have most often found a core intellectual home in the Association for Behavior Analysis International.^{citation needed}

With a core focus on enhanced functioning and skill development, behavior analytic interventions under the heading behavior therapy have come to form the core of evidenced based practices in speech-language pathology, organizational behavior management, education, and mental health & addictions treatments. In the area of mental health & addictions a recent article looked at APA's list for well established and promising practices and found a considerable number of them based on the principles of operant and respondent conditioning.¹³⁸ A 1985 meta-analysis of social skills training methods found operant conditioning procedures had the largest effect size, the greatest generalization, and the shortest training time; modeling, coaching, and social cognitive techniques, respectively, had smaller and smaller effect sizes.¹³⁹

Behavior analysis remains one of the most active research areas in all of psychology, counseling, special education, developmental disability, mental health and other studies of human behavior. Current research in behavior analysis focuses on expanding the tradition by looking at setting events, behavioral activation, the Matching law, relational frame theory, stimulus equivalences, Verbal Behavior (book), Skinner's model of rule-governed behavior¹⁴⁰¹⁴¹ and covert conditioning. Behavior analysis has moved past just basic interventions for problems and into more comprehensive analyses behavior analysis of child development.

Historical controversies

Initially, ABA used aversives such as shouting and slaps to reduce unwanted behaviors.¹⁴² Ethical opposition to such aversive practices caused them to fall out of favor and has stimulated development of less aversive methods. In general, aversion therapy and punishment are now less frequently used as ABA treatments, due to legal restrictions.¹⁴³ However, procedures such as odor aversion, covert sensitization and other covert conditioning procedures based on punishment or aversion strategies are still used effectively in the treatment of pedophiles.¹⁴⁴ In addition with some populations such as conduct disorder children considerable evidence has developed to show that all positive programs can produce change but children will not enter into the normal range without punishment procedures ¹⁴⁵¹⁴⁶. These programs have shifted to using child time-out and response cost procedures to ensure that clients rights to effective interventins are met.

In 1973 the American Psychiatric Association removed homosexuality from its Diagnostic and Statistical Manual, yet it kept "ego dystonic" homosexuality as a condition until the DSM III-R (circa 1985). In 1974 Ole Ivar Lovaas, pioneer of the use of ABA to treat autism, was second author on an journal article describing the use of ABA to reduce 'feminine' behaviors and increase 'masculine' behaviors of a male child in an effort to prevent adult transsexualism.¹⁴⁷ Treatments designed to uphold traditional sex-role behaviors were opposed by some behavior analysts who argued that the intervention was not justified.¹⁴⁸ In the late 1960s, Wolpe refused to treat homosexual behavior, arguing that it was easier and more productive to treat the religious guilt than the homosexuality. He instead provided assertiveness training to a homosexual client.¹⁴⁹ Most behavior analysts and behavior therapists have not worked in sexual reorientation therapy since Davison argued that the issue was not one of effectiveness but of ethics.¹⁵⁰ When he wrote the paper presenting this position, Davison was president of the Association for the Advancement of Behavior Therapy, and thus his views carried much weight. Davison argued that homosexuality is not pathological, and is only a problem if it is regarded as one by society and the therapist.

Ethical practice

The use of Punishment (psychology) and Aversion therapy procedures are a constant ethical challenge for behavior analysts. Indeed, one of the original reasons for the development of the Behavior Analysis Certification board was case of abuse from behavior analysts and behavior modifiers.¹⁵¹ Both continue to draw proponents and opposition; however, in some of the more controversial cases some middle ground has been found through legislation (see Judge Rotenberg Educational Center.¹⁵²¹⁵³).

In areas such as sex offender treatment covert sensitization has been shown to have some effects on reducing recividism when it is part of a behavior modification treatment package;¹⁵⁴ however, Gene Able who has done extensive research in this area suggests that it is not as effective outside of the package, which contains odor aversion, satiation therapy (mastubatory reconditioning)¹⁵⁵, and various social skills training programs including empathy training.[40] Current behavior analytic programs offer this type of comprehensive treatment approach [41].¹⁵⁶ In addition, they use a combination of functional assessement and behavior chain analysis to create relapse prevention strategies and to help the offender to develop better self-control.

References