Who here can actually provide appropriate research on the 40 hour recommended claim?

[u/wenchslapper]

For clarification, I am currently studying for my big exam. I’ve read lots of research and have been assigned lots. One of the biggest pain points I see between RBTs and BCBAs is “the kids are here too long.” BCBAs constantly quote how the “research supports it,” but I’ve failed to ever get any adequate examples that support this. I once got assigned a Linda Leblanc article that “supported this claim” by my CD and, upon actually analyzing the data, it didn’t actually support the claim and straight up stated that a “20% reduction in hours saw no reduction in efficiency of skill repertoire building.” Its lead me to strongly believe that some of these commonly quoted research statements are more of a result of capitalism mixing into research and people misquoting/understanding the data that’s out there in a way that supports padding their company’s bottom line. Also, so much research is done in settings that just don’t replicate real world environments that I find it difficult to look at my mentor and agree with them on the efficacy.

So here’s my question- can any BCBA/BCaBA/BCBA-D here provide me with research that can cover both a component and a parametric analysis on session longevity that actually supports the umbrella statement that “more hours of ABA shows better results,” because my experience has shown me that the sweet spot is 25-30, and my CD doesn’t like that but hasn’t given me the data I need to agree with them on a fundamental bases.

[u/msrosej]

The 40 hour model is based on Lovaas.. who has a whole slew of issues going on there that I won't get into.

Instead let me share a few articles that discuss how lower treatment hours can also have significant impact-

• A Multisite Randomized Controlled Trial Comparing the Effects of Intervention Intensity and Intervention Style on Outcomes for Young Children With Autism,” Rogers, Sally J. et al 2021.
• Data-driven, client-centric applied behavior analysis treatment-dose optimization improves functional outcomes,” Ostrovsky, A. et al 2023.
• Determining Associations Between Intervention Amount and Outcomes for Young Autistic Children: A Meta-Analysis," Sandbank M. et al 2024.

These are just three I've read in the last couple months, but I have a few colleagues who are going to send me more. At the end of the day, what really matters is quality over quantity, especially from practitioners who honor assent and work with learners and families rather than trying to force them into the same treatment model.

[u/wenchslapper → u/msrosej]

THANK YOU. You are the first BCBA I’ve spoken to willing to both take a position on this AND deliver research to support it.

[u/msrosej → u/wenchslapper]

That's me! I discuss a lot of these topics on IG and in various professional settings. Let me know if you want any more info!

[u/wenchslapper → u/msrosej]

I appreciate this starting point, I really do. I got the cold shoulder from my CD for a month because I straight up pointed out that the research article she had me read didn’t actually say what she claimed. My practicum BCBA just tried telling me she read it to, but disagreed with my assessment while not being able to actually give me a logical reason as to why.

I’m here because I love aba as a science, it’s the math behind what we do. I’m getting so sick of working under BCBAs who just spout the bullshit their CD claims as fact without actually reviewing the data, a core component of our duties. And I’m tired of reading through papers that were very obviously conducted by some grad student trying to pad their dissertation with good data so they contrive the most bullshit environments possible, OR vaguely describe behaviors with categorical statements like “severe problem behavior.”

Please, define “severe” for me in a behavior analytic way and I’ll be all ears, but that’s never the case and my BCBAs never want to admit that.

[u/msrosej → u/wenchslapper]

You are speaking to the larger discussion that the environment shapes the behavior. Everywhere. Everyone.

If it's punished to go against the CD, then people won't go against the CD. If constructive conversations are allowed, then significant conversations and change are allowed to flourish. (Also every research article is bias in one way or another, we are humans; humans are bias).

Additionally most research articles don't discuss the "bad data" that don't fit the narrative. There's one BCBA-D that is trying to put together a journal that is basically a collection of 'bad' or non-result research articles-- https://www.sixthandcenterpublishing.com/seven-dimensions Check out Dr. Shane Spiker, he's a got a lot of amazing things.

[u/RonaldWeedsley → u/msrosej]

Great summary!

It infuriates me that you hear from our ABA leadership organizations constantly putting out press releases refuting the articles that you cited in your post. That is the reality of the science that we are dealing with; ABA leaders who would rather see their profits go up rather than the quality of our services going up.

[u/msrosej → u/RonaldWeedsley]

In general, very true, especially when PE gets involved! However there's a good section of practitioners who are aligned with what I said above. Practitioners and small ABA business owners who actually look at each learner as a whole human and what they need to be successful. I'm holding out hope that this will become more commonplace, as long as we keep fighting for this. I could have thrown in the towel when I was only a technician, but found a great group of people and now I'm shouting these lessons from the rooftops 🗣

[u/RonaldWeedsley → u/msrosej]

Totally and 100% with you! There’s a strong group of like minded thinkers that know we need to do better. We just have to make sure our voices are heard.

Keep up the great work!

[u/msrosej → u/RonaldWeedsley]

I'm about the say something that I understand comes from privilege and financial security that not everyone has, so if this doesn't resonate with the reader, feel free to ignore or chime in, but BCBAs are in demand. They need us. It's really hard to ignore practitioners when you need them. If a company isn't going to act right, there's 10+ other companies looking to hire. Also it's really hard to ignore practitioners that families trust and believe in. Keep doing the right thing, and (in the most non behavior analytic way) the universe will provide.

[u/Rainy_devil666 → u/msrosej]

Nice I’m going to read these thank you!

[u/DD_equals_doodoo]

>result of capitalism

Insurance companies aren't exactly known for running to meet you with a check.

According to this article:

Reichow, B., Barton, E. E., Boyd, B. A., & Hume, K. (2014). Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD): A systematic review. Campbell Systematic Reviews, 10(1), 1-116.

It cites this book:

Smith T. Early and intensive behavioral intervention in autism. In: Weisz JR, Kazdin AE editor(s). Evidence-Based Psychotherapies for Children and Adolescents. 2nd Edition. New York: Guilford, 2010:312–26.

And this article:

Eldevik, S., Hastings, R. P., Hughes, J. C., Jahr, E., Eikeseth, S., & Cross, S. (2009). Meta-analysis of early intensive behavioral intervention for children with autism. Journal of Clinical Child & Adolescent Psychology, 38(3), 439-450.

I quickly scanned (not thoroughly so correct me if I'm wrong here), but a number of studies cited in Table 1 show best treatments between 25-40 hours and worst are under 25.

They seem to be building off of this Reichow, B., & Wolery, M. (2009). Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA young autism project model. Journal of autism and developmental disorders, 39, 23-41.

This article shows more hours + more time (days) in intensive ABA is associated with the most progress.

[u/wenchslapper → u/DD_equals_doodoo]

Thank you! I appreciate that you’re able to give me the research, I’ll save this and read these as well!

I want it to be known that I am 100% open to scientific proof showing me the data. My problem lies in just how lazy my BCBAs have been in actually producing it, on top of grad school barely even acknowledging it. For as common as it is to hear “more is best,” it’s embarrassingly uncommon to hear “and here’s the actual research that supports it.” Instead I’m often given an article that directly implies the opposite when you analyze the data, while avoiding to admit it. And that is not the kind of article anyone in a clinical position should base an objective opinion on.

[u/BeardedBehaviorist]

@msrosaj gives all the research I would, but I would like to add this:

Lovaas' assumptions about autism heavily drove his research practices. He subscribed to the medical model of disability, which viewed disability as being something to be cured. His own words on this are telling: "You see you start pretty much from scratch when you work with an autistic child. You have a person in the physical sense – they have hair, a nose and a mouth – but they are not people in the psychological sense. One way to look at the job of helping autistic kids is to see it as a matter of constructing a person. You have the raw materials, but you have to build a person."

Veneziano & Shea wrote an amazing article on this topic titled They have a Voice; are we Listening? (see citation below). Essentially, they demonstrate how Lovaas' work is founded on a very shaky foundation.

Now, to add to this, in a somewhat hilarious twist, Ron Leaf, in an interview by Justin Leaf (Ron's son) and Joe Cihon on their podcast It Has To Be Said (formerly Rants with Justin & Joe) admitted that the 40 hours recommendation was pulled out of their asses. Ron was one of Lovaas' research assistants. It's one of the first 3 podcasts of the show. And if they removed it, no problem, I have friends who have backups. But to summarize, they forgot to track the hours, so when they were finalizing the article someone said it felt like a full time job, and that's where the 40 hours came from.

Add in those other studies that @msrosaj shared and it paints a pretty clear picture of confirmation bias and justification in order to gain and maintain access to reinforcement (money, power, influence) at the expense of a vulnerable population.

Source: Veneziano J, Shea S. They have a Voice; are we Listening? Behav Anal Pract. 2022 Apr 6;16(1):127-144. doi: 10.1007/s40617-022-00690-z. PMID: 37006422; PMCID: PMC10050513.

[u/corkum]

It's interesting to me that this rift has formed in our field between "intensive hours are most effective" and "intensive hours aren't necessary." It's a weird false dichotomy in debate and is HIGHLY perpetuated in this sub.

The reality is that both are true and the route that's the best recommendation for any given client is highly dependent on several variables.

I can include a non-exhaustive list of each.

Some studies that show high-intensity is effective:

• 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. <i>Research in Developmental Disabilities, 26(4) 359-383.

• The same group followed up on the same journal in 2014 and and affirmed results.

• Reichow, B., Barton, E. E., Boyd, B. A., & Hume, K. (2014). Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD): A systematic review. Campbell Systematic Reviews, 10(1), 1-116. 

• Lotfizadeh AD, Kazemi E, Pompa-Craven P, Eldevik S. Moderate Effects of Low-Intensity Behavioral Intervention. Behav Modif. 2020 Jan;44(1):92-113. doi: 10.1177/0145445518796204. Epub 2018 Aug 23. PMID: 30136599.

Some studies that show less intense hours are effective:

• Peters-Scheffer, N.; Didden, R.; Mulders, M.; Korzilius, H (2013)  Effectiveness of low intensity behavioral treatment for children with autism spectrum disorder and intellectual disability. Research in Autism Spectrum Disorders, 7(9), 1012-1025.

• Casarini, F.; Du, L.; Galanti, E. Low-Intensity ABA Intervention for young children with ASD in Italy (2024). European Journal of Behavior Analysis, 1-18.

This is not a totally exhaustive list, just a few I have available on hand while responding on my phone. But there are plenty of studies, new and old, that provide support for all kinds of intensity of treatment.

What's really important in these studies is the quality and the kind of therapy provided, and the types of skills being targeted, as well as the specific demographics of the individuals involved.

ABA is not a monolith, and it takes a trained professional to implement objective assessment tools and weigh these results against the literature available to recommend the most appropriate intensity of treatment on an individual basis.

We need to stop looking at this as an either/or dynamic. Plenty of studies in the last 5-10 years show either model is effective. None of these studies necessarily contradict each other because the variables in each study are so dynamic.

These all add to the body of research and tools available, and provide more resources and procedures available to provide more comprehensive and individualized treatment. It's not a battle between one or the other and we need to push back on those who are proponents of either/or and instead embrace a spectrum of available recommendations.

Autism is, after all, a spectrum disorder. We should recognize a spectrum of available treatment recommendations to provide individualzied, targeted treatment to those on that spectrum.

[u/fencer_327 → u/corkum]

Absolutely! It's also important to take the rest of your clients schedule into account. I've had to write too many letters about this to my students practitioners, with parents in tears because they were told anything less than 40 hours wouldn't make a difference anyways.

40 hours of aba a week can be great for some children. 40 hours of aba plus 35 hours of school is a 75 hour work week, that would exhaust anyone. We have pullout therapy services, all practitioners are invited to come to iep and BIP meetings or write a letter/have parents relay their current goals. My current class has a 1:2 staff ratio for most students, 1:1 for some, we can totally work on the same goals with other therapists if they are based on good reasoning.

[u/hollowlegs111]

it’s was an average of the hours each client got. some clients got it morning to night (60 hrs) some as low as 25 i believe. there was another smaller group without effect and a control group. they were also slapped on the knees for getting questions wrong so…

[u/wenchslapper → u/hollowlegs111]

Can I get a link to this article? I’m honestly getting really peeved about the number of BCBAs that can “quote research” but can’t supply the actual paper.

[u/msrosej → u/wenchslapper]

Check out - "Screams, Slaps, and Love: The Strange Birth of Applied Behavior Analysis"

[u/hollowlegs111 → u/msrosej]

I also think it’s is described as a ‘swift tap’ in the video recordings of the original therapy sessions in the 70s.

[u/wenchslapper → u/msrosej]

I appreciate the response, will do! Looks like I have a lot of stuff to go over thus weekend before sitting down with my CD….

Ugh it sucks being a confrontational person by nature when you’re this close to having your 4 magic letters. I’m in that grey zone of “idk how much to push before I’ve pushed too far and my future gets pitched in the bin” lmao

[u/msrosej → u/wenchslapper]

Honestly as someone who also struggles with "I need to speak out because I see an injustice and you're wrong," there will be times that you don't have to speak up. It's going to feel weird, and you might even feel guilty. Unless a learner is in danger or being harmed, if it's just a theoretical discussion, you can hold it. At this point in my life and career I've collected enough privilege that now I must speak up. However when you are a tech or student analyst, it's scary AF. Do what you need to do! Does that make sense?

[u/sweetpotatoezz]

I don’t have any research to give you but as a BCBA I completely agree! 40 hours is too much! Especially for a child. I feel like most of my kiddos thrive at 30 hours or even less. Obviously it depends on the kid. My company gets on my ass for recommending less than 35-40 hours but I strongly advocate for my recommendations. It’s just sucks cause companies want more money and that money trumps what’s ethical. When your a BCBA strongly advocate for what best for clients and RBTs!

[u/Ivegotthatboomboom]

40 hours is disgusting. Stealing children’s childhoods for money! Unstructured free play is a fundamental RIGHT of children. Even autistic children. That’s what childhood should be. And it’s much better for them to be playing with other children and not adults for obvious reasons. Straight up setting up these children to be heavily susceptible to grooming, not even joking as repeatedly “pairing” with adults who use that bond as a way to get a child to do things they don’t want to has been a totally normal childhood experience for hours and hours a day for years. Instead of yk, a normal childhood spent playing and interacting with other children without an adult overseeing and guiding the play. It’s unnatural. One BT and BCBA staying with the child throughout the therapy and for up to 10 hours a week is much better.

No, there is no research that backs up that claim, in fact the largest study showed the opposite. They actually lost gains.

And yes, it’s greedy ABA companies. It’s a giant fucking money grab because it’s literally the ONLY “therapy” that employs the people doing the bulk of the work with no education requirements, meaning they can pay them shit wages. Which means they make a HUGE profit. Unlike with a SLP or an OT, where they are compensated for their education and there is no profit.

This is why SLPs and OTs are speaking out, because these children need THEIR services as they are actually educated in neurodevelopmental disorders, but insurance will only cover for 1-2 days a week for 30 mins because their services cost a lot of money and there’s no profit even though THEY are the professionals these children need.

So we have a situation where untrained and unqualified people are treating neurological language disorders, neurological disorders in general, etc. all so companies can make a profit and it’s dangerous and disgusting.

Those companies are billing so much for money and no other reason at harm to these children. ABA makes billions a year. That’s the TRUTH. I had to leave ABA, I just couldn’t anymore, I couldn’t be a part of it.