Behavioural interventions

This is a brief overview of information about behavioural interventions, taken from the Autism CRC report, Interventions for children on the autism spectrum: A synthesis of research evidence (Autism Interventions Evidence Report).

There are seven other category overviews available to help people learn about different interventions and their research evidence. To understand the information in its full context, we encourage you to access the full report.

Why are behavioural interventions supposed to support children's development?

Behaviourism proposes that children’s behaviour, which includes the development of skills, is governed by their interactions with their environment. Central to this theory is the role of operant conditioning, which refers to the way intentional behaviours are shaped by one’s environment, thus increasing or decreasing the likelihood of the same or a similar behaviour occurring again in the future¹.

From a behaviourism perspective, complex tasks (e.g., a child joining in a group activity at preschool) can be broken down into a set of specific behaviours, and systematically taught and supported through the application of teaching strategies.

These include creating an environment in which the behaviour is likely to occur; cueing the behaviour; prompting, modelling, and shaping the behaviour; and reinforcing attempts toward successful use of the behaviour.

How are these interventions used in clinical practice?

Behavioural interventions for children on the autism spectrum have arisen primarily from Applied Behaviour Analysis (ABA). ABA is the scientific application of behavioural principles to, first, identify variables that are responsible for behavioural change, and second, to use these variables to improve ‘socially significant’ behaviours².

ABA can involve the use of intervention techniques (e.g., modelling, prompting, reinforcement, shaping) and/or the combination of these in an intervention practice (e.g., Discrete Trial Training, Early Intensive Behavioural Intervention).

ABA became a widely used intervention for children on the autism spectrum following the 1987 publication of a clinical trial that suggested positive developmental outcomes for children on the autism spectrum who received intensive ABA, compared to a control group³. Although methodological limitations mean that the findings should be interpreted with caution, the publication of the study was followed by the development of a range of intervention practices that were based on behaviour theory.

Behavioural techniques and practices may be used (a) in the delivery of ABA intervention (e.g., by people trained as Board Certified Behavior Analysts), and (b) as part of other interventions, within and across intervention categories, and delivered by a range of professionals.

To illustrate, behavioural principles have formed part of the evolution of a new category of intervention – Naturalistic Development Behavioural Interventions (NDBIs). These principles are also foundational to Positive Behaviour Support, which aims to address challenging behaviour through broadening an individual’s skills and experiences, enhancing their environments, and improving quality of life⁴. While the extent to which these different approaches reflect fundamentally different interventions has been debated⁵, at a practical level, behavioural principles and practices continue to be relevant to new and evolving interventions.

What are the principles that underpin the use of behavioural interventions?

When behavioural interventions are used in the context of ABA, they reflect seven ‘dimensions’⁶:

• Applied - targeting socially significant behaviours.
• Behavioural - specifically addressing a measurable behaviour.
• Analytic - demonstrating a functional relation between the delivery of an intervention and change in the behaviour.
• Technological - including a clear and replicable explanation of procedures.
• Conceptually systematic - using strategies that are clearly linked to the underlying theory.
• Effective – ensuring that the magnitude of behaviour change is clinically and socially significant.
• Generality – ensuring the change in skills/behaviour generalises across interactions and contexts, and is maintained over time.

Who delivers these interventions?

Children on the autism spectrum often have needs across multiple domains of learning, and physical and mental health. Accordingly, children and families may benefit from the expertise of a range of clinical practitioners spanning health, education and medical disciplines.

For all intervention categories, it is essential that clinical practitioners have acquired appropriate qualifications, are regulated (e.g., by a professional or government body), and deliver interventions that are within their scope of practice. A detailed explanation is provided in the full report.

What is the evidence for the effect of behavioural interventions on child and family outcomes?

Below is a summary of the evidence for the effect of behavioural interventions on child and family outcomes, taken from systematic reviews published since 2010. This means that a range of relevant individual studies have been considered, and thus reflects the best available evidence at this point in time.

Listed first are findings from systematic reviews that considered a mixture of behavioural interventions. Following that are findings relating to specific behavioural intervention practices.

Evidence table for behavioural interventions

		Core autism characteristics				Related skills and development									Education and participation				Family wellbeing
Interventions	No. of systematic reviews	Overall autistic characteristics	Social-communication	Restricted and repetitive interests and behaviours	Sensory behaviours	Communication	Expressive language	Receptive language	Cognition	Motor	Social-emotional/ challenging behaviour	Play	Adaptive behaviour	General outcomes	School/ learning readiness	Academic skills	Quality of life	Community participation	Caregiver communication and interaction strategies	Caregiver social emotional wellbeing	Caregiver satisfaction	Caregiver financial wellbeing	Child satisfaction
Systematic reviews of assorted behavioural practices*	3	M	M	L	L	M			M	M	M	L	M		L	L
Discrete Trial Training	1		L			L			L		L	L	L		L	L
Early intensive behavioural intervention	4	M	M			M	M	M	M	L	M		L		L M	L				M
Functional Communication training	2		L			L					L	L	L	L	L
Language Training (production)	1					L
Language Training (production and understanding)	1													L
Picture Exchange Communication System (PECS)	2		L				L							L

View the full evidence table for all intervention categories

Intervention category overviews

• Behavioural interventions
• Developmental interventions
• Naturalistic developmental behavioural interventions
• Sensory-based interventions
• Technology-based interventions
• Animal-assisted interventions
• Cognitive behaviour therapy
• Treatment and Education of Autistic and related Communication-handicapped Children (TEACCH) interventions

References

1. Skinner, B. F. (1953). Science and Human Behaviour. New York: Macmillan.
2. Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied Behaviour Analysis (Vol. 3rd Ed). United Kingdom: Pearson.
3. 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. doi:10.1037//0022-006x.55.1.3
4. Carr, E. G., Dunlop, G., Horner, R. H., Koegel, R. L., Turnbull, A. P., Sailor, W., . . . Foz, L. (2002). Positive behaviour support: evolution of an applied science. Journal of Positive Behavior Interventions, 4(1), 4-20.
5. Johnston, J. M., Foxx, R. M., Jacobson, J. W., Green, G., & Mulick, J. A. (2006). Positive behaviour support and applied behavior analysis. The Behavior Analyst, 29(1), 51-74. doi:10.1007/BF03392117
6. Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of Applied Behavior Analysis. Journal of Applied Behavior Analysis, 1(1), 91-97. doi:10.1901/jaba.1968.1-91