Behavior analytic interventions for children with autism: Policy and practice in the United Kingdom and China

Abstract

This study explored the experiences of professionals and parents from the United Kingdom and China of autism-relevant policies, school involvement, and applied behavior analysis-based interventions. Semistructured interviews involving 36 parents and professionals and direct behavioral observations were carried out of five parents and three professionals. Results found: (1) a lack of autism support and applied behavior analysis-related services in both countries; (2) applied behavior analysis-based intervention was not as widely endorsed by healthcare or educational systems in the United Kingdom; Chinese parents faced challenges around inclusive education and accessing high-quality services and there was a social stigma attached to autism; (3) a limited awareness and application of early intensive behavior intervention in both regions; and (4) intervention fidelity with regards to the practice of one particular applied behavior analysis-based intervention, discrete trial teaching, was similar and increased with ongoing training. Professional and parental experiences were discussed in the context of policy and educational involvement. This study illustrates the need to support children with autism and to consider regional adaptations of evidence-based practice of behavior analysis for the affected population. Lay abstract The prevalence of autism is increasing, and the development of these children and the lived experience of their families have become a global concern. Applied behavioral analytic intervention is proved to be effective in improving their cognitive abilities, language skills, and social and emotional skills, but the service delivery between developed and developing countries is different. A qualitative study was conducted to explore personal experiences with actual practice fidelity of behavior analytic services for children with autism in a Western developed country (United Kingdom) and an Eastern developing country (China). The study found: (1) a lack of support for autism and behavioral analytic services in both countries; (2) applied behavioral analytic intervention was not as widely endorsed by healthcare or educational systems in the United Kingdom; Chinese parents faced challenges around inclusive education and accessing high-quality services and there was a social stigma attached to autism; (3) a limited awareness and application of early intensive behavior intervention in both regions; and (4) intervention fidelity with regards to the practice of one particular aspect of behavioral analytic interventions was similar and increased with ongoing training. This study emphasizes the need to support children with autism, and to consider regional adaptations of evidence-based practice of behavior analytic interventions for the affected population.

Assessing the Satisfaction and Acceptability of an Online Parent Coaching Intervention: A Mixed-Methods Approach

“…Despite the potential long-term contribution to lowering special education ( Chasson et al, 2007 ) or lifetime care costs ( Piccininni et al, 2017 ), EIBI has a high demand for trained specialists, and the cost of EIBI services for each family remains high ( Jacobson et al, 1998 ). Systematic barriers, such as a shortage of trained professionals ( Liao et al, 2021 ), disjointed care coordination ( Vohra et al, 2014 ), and high service cost ( Vohra et al, 2014 ; Sobotka et al, 2016 ), result in insufficient access to EIBI. To help overcome these barriers, the involvement of parents in implementing intervention strategies allows intervention to begin early and sustain ( Green et al, 2015 , 2017 ).…”

Controlled Trial of a Short-term Intensive Parent Training Program within the Context of Routine Services for Autistic Children in China

“…Short-term parent training is widely used to support families of autistic children in low-resource settings. Due to the increasing number of diagnoses of autism, limited local service provision, and substantial economic cost of the autism-associated consequences at both family-and state-levels, such programs have been increasingly advocated globally as a cost-effective alternative to more conventional intensive interventions delivered for consecutive years (such as the Early Intensive Behavioral Intervention; Anan et al, 2008;Bearss et al, 2015;De Vries, 2016;Liao et al, 2022;Morris et al, 2011).…”

“…Short-term parent training programs may be a more scalable approach in Chinese settings. As with some other countries, access to autism treatments in China is prohibited by the widening service gap, absence of educational opportunities, high cost of private therapies, and insufficient financial support (Chang & Zaroff, 2017;Liao et al, 2020;Liao et al, 2022;P. Liu & Liu, 2018;McCabe, 2012).…”