The Promise of ABA: Creating Meaningful Lives Throughout Adolescence and Adulthood

The past decade has seen dramatic reports citing the increase in the prevalence of autism and related disorders. From an earlier prevalence estimate of approximately 2-5 cases per 10,000 individuals (2.5 per 1,000), according to the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994), the figure most often cited today is approximately 4-7 cases per 1,000 individuals, with the higher estimate resulting in the 1 case per 150 individuals most recently identified by the Centers for Disease Control in 2007. While the reasons behind this increase remain unclear (e.g., Gernsbacher, Dawson & Goldsmith, 2005; Shattuck, 2006), and at times controversial (e.g., Kirby, 2005; Williams, Mellis, & Peat, 2005), what is generally accepted is that there are greater numbers of learners being diagnosed with autism spectrum disorder (ASD) in general and, subsequently, of adolescent and young adult learners in particular who are in need of appropriate, evidence-based interventions and services than ever before.

With this increase in prevalence has come an increased demand for appropriate and effective services for adolescents and young adults with ASD. Unfortunately, the need in both areas continues to far exceed the available resources, leaving a generation of learners with ASD and their families in programmatic, financial and personal limbo (e.g., Howlin, et al., 2004). The reasons behind this disparity between needs and services are myriad and include, but are not limited to:

• poorly implemented transition services required under IDEA; 
• a continued misunderstanding as to the potential of individuals with ASD to be employed, contributing and active members of their community when the appropriate interventions and supports are provided; 
• a lack of coordination among the educational, behavioral, mental health, vocational rehabilitation and MR/DD systems intended to support individuals into adult life and, most relevant to this discussion; 
• a pervasive and inaccurate belief that interventions based upon principles of Applied Behavior Analysis (ABA) are no longer applicable to adolescent and adult learner.

Given this list of challenges, it seems reasonable to argue that the potential of adults with ASD to become employed and engaged is limited more by the inadequacies of the system charged with supporting them than by the challenges presented by their disability. And the economic cost of these systemic inadequacies is not inconsequential and, in fact, is rather far reaching. As Ganz (2007) notes, “Autism is a very expensive disorder, costing our society upwards of $35 billion in direct (both medical and nonmedical) and indirect costs to care for all individuals diagnosed each year over their lifetimes” (p. 343). Absent a concerted effort on behalf of all stakeholders (i.e., parents, professionals, employers, society at large) to correct these inadequacies, these costs can only be expected to grow in the coming years.

Research Supports ABA for Adult Learners

There are, however, things that can be done. Among the many interventions currently available to educate individuals with autism, those based upon the principles of ABA are the most well documented and empirically validated (Rosenwasser & Axelrod, 2001), with over 35 years of research support. Unfortunately, behavior analytic research specifically addressing the instructional needs of older learners is less available, which can present a major challenge to those interested in supporting adolescents and adults on the spectrum. And while much of the research targeting younger learners can be generalized, with some modification, for use with older individuals, this, in practice, would appear to be more the exception than the rule. For those who know how to look for it, there is a broader research base supporting the use of behavior analytic interventions with adults on the spectrum. Take, for example, a study by Hagner & Cooney (2005). In this study the authors interviewed the supervisors of 14 successfully employed individuals on the spectrum to determine effective supervisory practices. A qualitative analysis found that a specific set of supervisory strategies were associated with employment success. Their results, presented below, are not necessarily surprising. But what may be remarkable is that despite being discussed by the authors in less than behavior analytic terms, all of the identified strategies are well-documented behavior analytic interventions. For example: