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Positive Behavior Support and Applied Behavior Analysis

March 2006
The Behavior analyst / MABA 29(1):51-74

DOI:10.1007/BF03392117

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PubMed

Authors:

Richard M Foxx

Penn State University Harrisburg

Gina Green

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This article reviews the origins and characteristics of the positive behavior support (PBS) movement and examines those features in the context of the field of applied behavior analysis (ABA). We raise a number of concerns about PBS as an approach to delivery of behavioral services and its impact on how ABA is viewed by those in human services. We also consider the features of PBS that have facilitated its broad dissemination and how ABA might benefit from emulating certain practices of the PBS movement.

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Positive Behavior Support and Applied

Behavior Analysis

J. M. Johnston

Auburn University

Richard M. Foxx

Penn State Harrisburg

John W. Jacobson and Gina Green

San Diego State University and University of North Texas

James A. Mulick

The Ohio State University

This article reviews the origins and characteristics of the positive behavior support (PBS)

movement and examines those features in the context of the field of applied behavior analysis

(ABA). We raise a number of concerns about PBS as an approach to delivery of behavioral

services and its impact on how ABA is viewed by those in human services. We also consider the

features of PBS that have facilitated its broad dissemination and how ABA might benefit from

emulating certain practices of the PBS movement.

Key words: applied behavior analysis, positive behavior support, developmental disabilities,

special education

Over the past dozen years or more,

an approach to delivery of behavioral

services known as positive behavior

support (PBS) has emerged as a high-

ly visible movement. Although PBS

has been substantially influenced by

applied behavior analysis (ABA),

other factors are also part of its

history. In response to an article by

Anderson and Freeman (2000) that

described PBS as consistent with

behavior analysis, J. Carr and Side-

ner (2002) noted growing evidence

that PBS is being represented as

a distinct ‘‘discipline’’ and concluded

that ‘‘now is the time to consider the

ramifications of separating PBS from

applied behavior analysis’’ (p. 251).

That suggestion raised fundamental

issues about the origins and features

of PBS, its relation to ABA, and the

implications of its development for

the ongoing development of ABA. As

well, the undeniable success of PBS in

the human services marketplace may

provide the ABA community with

some strategic examples of ways to

promote ABA interests more effec-

tively.

The purpose of this paper is to

examine the origins and characteris-

tics of PBS, particularly in relation to

ABA. Unlike some recent treatments

of PBS addressed to behavior ana-

lysts (e.g., Anderson & Freeman,

2000; Anderson & Kincaid, 2005),

this paper provides a general de-

scription of PBS as seen by outsiders

and considers some key differences

between PBS and ABA. Although the

origins of PBS in ABA are clear, we

view the differences as important and

problematic. Perhaps partly because

of those differences, efforts to estab-

lish PBS as a ‘‘brand name’’ and to

disseminate PBS as a service delivery

model have been enormously success-

This article is dedicated to the memory of

John W. Jacobson, whose invaluable contri-

butions to this paper reflect those he made to

behavior analysis throughout his remarkable

career.

Address correspondence to J. M. Johnston,

215 Thach, Psychology Department, Auburn

University, Auburn, Alabama (e-mail: johnsjm

@auburn.edu).

The Behavior Analyst 2006, 29, 51–74 No. 1 (Spring)

ful. Because PBS has largely been

marketed as an approach that is

distinct from, if not superior to,

ABA, however, its increasing accep-

tance in developmental disabilities

and education has not furthered the

acceptance of ABA.

On the other hand, the effective-

ness of PBS dissemination activities

might benefit ABA if it encourages

the ABA community to improve the

way it describes, promotes, and

delivers its service model. Our review

of the features of PBS that might

have contributed to its relatively

rapid adoption by many agencies

and individuals reveals both charac-

teristics that are worthy of emulation

by the field of behavior analysis

and characteristics that should be

avoided. In examining PBS, the

principal question that the behavior-

analytic community must answer is:

How can the field of behavior anal-

ysis improve communication of the

nature and benefits of ABA to di-

verse user communities and thereby

increase their support for ABA ser-

vices?

POSITIVE BEHAVIOR SUPPORT

Origins and Development

Positive behavior support (also

referred to as positive behavioral

support or positive behavioral inter-

ventions and supports) emerged from

the controversy surrounding the use

of aversive consequences with people

with developmental disabilities. A

seminal article by Horner et al.

(1990) began with the statement that

‘‘In recent years, a broad-based

movement has emerged in support

of nonaversive behavior manage-

ment’’ (p. 125). The authors cited

various articles to indicate that this

support emerged during the 1980s

(e.g., Berkman & Meyer, 1988; Don-

nellan, LaVigna, Negri-Shoultz, &

Fassbender, 1988; Donnellan, La-

Vigna, Zambito, & Thvedt, 1985;

Evans & Meyer, 1987; Horner, Dun-

lap, & Koegel, 1988; LaVigna &

Donnellan, 1986; McGee, Menolas-

cino, Hobbs, & Menousek, 1987).

Horner et al. (1990) asserted that

‘‘Nonaversive behavior management

… has developed … as an alternative

to the use of more extreme aversive

events’’ (p. 126) and coined the

phrase ‘‘positive behavior support’’

to refer to nonaversive behavior-

management procedures. They stated

that ‘‘many people … are being …

subjected to dehumanizing interven-

tions that are neither ethical nor

beneficial’’ (p. 125), citing sources

that contained strong statements of

opinion but little objective data to

support that assertion (e.g., Durand,

1988; Guess, Helmstetter, Turnbull,

& Knowlton, 1987).

Despite their assertions of a broad

popular and empirical foundation for

the nonaversive approach, Horner et

al. (1990) were tentative in their

depiction of PBS. They noted that

‘‘There is no specific technique or

procedure that distinguishes the ap-

proach. … Different proponents of-

fer varying procedural recommenda-

tions … [and] different theories of

behavior in its support’’ (p. 125).

Moreover, Horner et al. remarked,

The development of a well defined technology

of behavioral support will take time. There is

too little information available to assert that

positive approaches are capable of solving all

behavior problems or documenting that one

approach is superior to any other. Both well-

controlled empirical analyses and less con-

trolled clinical analyses are needed. (p. 128)

There are numerous definitions of

PBS. Although most are complemen-

tary to the original Horner et al.

(1990) definition and to each other,

Since that time, several empirical analyses

have suggested that the use of punishment

procedures involving aversive consequences

was, and remains, uncommon (e.g., Jacobson,

1992; Jacobson & Ackerman, 1993). Further-

more, research has shown that individuals

with moderate to severe behavior problems

are more likely to go without behavioral

intervention than they are to be treated with

contingencies involving aversive consequences

(e.g., Jacobson, 1998).

52 J. M. JOHNSTON et al.

there are some interesting differences.

For instance, E. Carr, Levin, et al.

(1999) stated that ‘‘From the stand-

point of the independent variable, the

PBS approach refers to those inter-

ventions that involve altering defi-

cient environmental conditions … or

deficient behavior repertoires’’ (p. 7).

‘‘The remediation of deficient con-

texts also helps to define the PBS

approach with respect to dependent

variables: (a) increased positive be-

havior, (b) improved lifestyle, and (c)

decreased problem behavior’’ (p. 8).

More recently, E. Carr et al. (2002)

described PBS as ‘‘an applied science

that uses educational methods to

expand an individual’s behavior rep-

ertoire and systems change methods

to redesign an individual’s living

environment to first enhance the

individual’s quality of life and, sec-

ond, to minimize his or her problem

behavior’’ (p. 4). Warren et al. (2003)

stated that ‘‘PBS is intended to

enhance quality of life and mini-

mize/prevent problem behavior

through the rational integration of

(a) valued outcomes, (b) behavioral

and biomedical science, (c) empirical-

ly supported procedures, and (d)

systems change’’ (pp. 80–81).

Horner (2000) has further typified

PBS as ‘‘an approach that blends

values about the rights of people with

disabilities with a practical science

about how learning and behavior

change occur’’ (p. 97). In an attempt

to specify the parameters of PBS,

Horner et al. (1990) asserted that it

encompassed many distinctive ele-

ments, including emphasis on lifestyle

change, functional analysis, multi-

component interventions, manipula-

tion of ecological and setting events,

antecedent manipulations, teaching

adaptive behavior, building environ-

ments with effective consequences,

minimizing the use of punishers,

distinguishing emergency procedures

from proactive programming, and

social validation, with a special role

for preserving the dignity of the

recipients of interventions. It should

be noted that most of those emphases

have long been accepted features of

mainstream ABA (APA Division 33,

1990; J. Carr & Sidener, 2002; Mulick

& Butter, 2005).

The development of PBS was

bolstered from 1987 to 1992 by

a U.S. Department of Education

National Institute on Disability and

Rehabilitation Research (NIDRR)

grant of $670,000 for a ‘‘Rehabilita-

tion Research and Training Center

on Community-Referenced Technol-

ogies for Nonaversive Behavior Man-

agement.’’ The grant was awarded

to a consortium of universities, in-

cluding the University of Oregon,

the University of California at Santa

Barbara, the State University of New

York at Stony Brook, the University

of Minnesota, and the University of

South Florida, among others. This

center later became the Rehabilita-

tion Research and Training Center

(RRTC) on Positive Behavior Sup-

port. At present, the RRTC-PBS is

funded through the University of

South Florida. Its purpose is ‘‘to

develop and disseminate effective,

practical and empirically validated

procedures for improving support

for individuals with disabilities’’ (see

http://rrtcpbs.fmhi.usf.edu/rrtcpbsweb/

rrtcpbsinfo.htm).

The RRTC’s activities are comple-

mented by the Office of Special

Education Programs (OSEP) Center

on Positive Behavioral Interventions

and Supports. Participants include

the Universities of Oregon, Kansas,

Kentucky, Missouri, Florida, North

Carolina, and South Florida, as well

as some nonacademic provider agen-

cies. Dissemination of the PBS

‘‘brand name’’ is augmented by the

OSEP Center, with its stated mission

‘‘to give schools capacity-building

information and technical assistance

for identifying, adapting, and sus-

taining school-wide disciplinary prac-

tices’’ (www.pbis.org/main.htm).

In addition, PBS is now represent-

ed at most special education and

developmental disabilities confer-

PBS AND ABA 53

ences, including regional and nation-

al meetings of the Council for Excep-

tional Children and the American

Association on Mental Retardation

(see www.pbis.org). In 2003, dissem-

ination activities were further diver-

sified by an international conference

on ‘‘The World of PBS: Science,

Values, & Vision’’ in Orlando, Flor-

ida. At that meeting, the Association

for Positive Behavior Support

(APBS) was founded as ‘‘an interna-

tional organization dedicated to the

advancement of positive behavior

support. APBS strives to expand

application of this approach with

children, adolescents, and adults with

problem behavior’’ (http://apbs.org/

main.htm). A second international

conference was held in Florida in

2005.

Dissemination efforts expanded

further with publication in 1999 of

the first issue of the Journal of

Positive Behavior Interventions, which

publishes descriptive and experimen-

tal studies. Dissemination of PBS was

also bolstered by its inclusion (as

positive behavioral interventions) in

the recodification of the federal

Individuals with Disabilities Educa-

tion Act (IDEA) in 1997. Some

authors have suggested that inclusion

of PBS in IDEA is consistent with

a policy of specifically discouraging

the use of punishment procedures as

an element of behavioral interven-

tion, with the possible specter of

liability associated with such proce-

dures (Turnbull, Wilcox, Stowe, Rap-

er, & Hedges, 2000; Turnbull, Wil-

cox, Stowe, & Turnbull, 2001).

PBS is now mandated by Kansas

law for children who are eligible for

medical health screening; the service

is funded by Medicaid (Freeman et

al., 2005). Although some recent

statements suggest that PBS focuses

mainly on disciplinary problems in

schools (e.g., Anderson & Kincaid,

2005; www.pbis.org), others assert

that PBS can be extended to serious

problem behaviors like ‘‘self-injury,

aggression, property destruction, pi-

ca, defiance, and disruption’’ (Hor-

ner, 2000, p. 97) and to a variety of

populations (Freeman et al., 2005).

These groups include children with

autism (e.g., Becker-Cottrill, McFar-

land, & Anderson, 2003; Dunlap &

Fox, 1999), abused or neglected

children (Buschbacher, 2002), fami-

lies (e.g., Boettcher, Koegel, McNer-

ney, & Koegel, 2003), children with

traumatic brain injury (Ylvisaker,

Jacobs, & Feeney, 2003), preschool

children (Fox, Dunlap, & Powell,

2002), at-risk and adjudicated youth

(Scott et al., 2002), and urban chil-

dren (Warren et al., 2003).

Emphasis on Selected Values

It is clear that PBS emphasizes

certain values in its approach to

services (see Anderson & Freeman,

2000). These values include commit-

ments to respect for the individual,

meaningful outcomes, social valida-

tion, dignity, normalization, inclu-

sion, person-centered planning, self-

determination, and stakeholder par-

ticipation, among others (e.g., E.

Carr et al., 2002; Horner et al.,

1990). These values are well known

in the field of developmental disabil-

ities and have long been accepted by

diverse professions serving this pop-

ulation, including ABA. Within the

PBS community, however, these val-

ues are part of the origin and

definition of its approach to behav-

ioral services (e.g., Anderson & Free-

man, 2000; E. Carr et al., 2002;

Horner, 1990). This priority seems

to risk allowing values to serve as

a filter through which research find-

ings and effective treatment alterna-

tives must pass. Such an emphasis

can encourage clinical decision mak-

ing to be guided more by cultural

values than by research findings.

The role given to cultural values in

PBS contrasts with how such values

are treated within ABA, where they

might be described as secondary

rather than primary. For the ABA

practitioner, the research literature

54 J. M. JOHNSTON et al.

on the efficacy of various procedures

is the primary source from which

clinical interventions are selected.

Cultural values serve more as a con-

text for clinical decision making than

an a priori criterion for evaluating

research findings. The well-trained

behavior analyst begins consideration

of an intervention with the full range

of empirically supported procedures

on the table.

There is no question, however, that

cultural values have substantially

influenced the evolution of ABA.

The development of much of the

ABA literature in the context of

developmental disabilities services

has exposed applied behavior ana-

lysts to all of the values-based social

movements that have arisen in this

service sector over the last few

decades. Those movements include

deinstitutionalization and institution-

al reform (Burg, Reid, & Lattimore,

1979; Scheerenberger, 1981), normal-

ization (Blatt & Kaplan, 1974; Wol-

fensberger, 1973), client rights and

protections (Stolz, 1977), educational

movements such as mainstreaming

(Alberto, Castricone, & Cohen, 1978;

MacMillan & Borthwick, 1980), per-

son-centered planning (Holburn,

1997; Osborne, 2005), and many

others.

Those values have had consider-

able influence on the field’s research

directions, the general focus of inter-

ventions, the selection of behavioral

targets, the form of intervention

procedures, standards for behavioral

outcomes, and underlying profession-

al values. The influence of cultural

values on ABA is particularly appar-

ent in the history of the aversives

controversy (Foxx, 2005a, 2005b;

Newsom & Kroeger, 2005). Although

the process was not always pretty,

concerns about the general approach

to treatment that was typical of the

field’s early years, as well as the form

of some intervention procedures,

gradually led to major changes in

ABA. Those changes were compre-

hensive and involved the rationale for

interventions, the interests of other

parties, the selection of behavior-

change procedures, and the research

literature underlying the technology.

Treatment Model

Antecedent control. One of the

prominent characteristics of PBS is

its emphasis on interventions that

involve manipulations of antecedent

stimuli (e.g., E. Carr et al., 2002;

Horner & Carr, 1997), including

substantial lifestyle adjustments in-

tended to achieve multiple outcomes

(see Becker-Cottrill et al., 2003). The

approach to antecedent control de-

scribed in PBS training materials is

relatively general, focusing on broad

changes in the environment and

typically lacking a technical rationale

for why such changes might be

expected to produce targeted out-

comes (for examples of this point, see

Dunlap et al., 2000; Kemp, 2000).

That is, antecedent changes tend to

be considered without comparable

attention to the role of consequences

(see Dunlap et al., 1994, for an

example). It should be noted, howev-

er, that this priority does not mean

that consequences are unimportant in

the PBS model.

Although ABA also shares consid-

erable interest in the antecedent side

of the three-term contingency, the

focus in ABA is appropriately bal-

anced in that antecedent influences

and procedures are characteristically

considered in the unavoidable con-

text of consequences (e.g., Cooper,

Heron, & Heward, 1987; Martin &

Pear, 2003; Miltenberger, 2004), in

keeping with the standard set forth

by Baer, Wolf, and Risley (1968) that

ABA must be conceptually systemat-

ic. Furthermore, well-trained behav-

ior analysts appreciate that mechan-

isms underlying the effects of general

changes in the environment involve

the full three-term contingency, are

quite complex, and require consider-

able expertise to anticipate and man-

age successfully.

PBS AND ABA 55

This difference in emphasis be-

tween PBS and ABA may lie in the

desire of PBS leaders to provide an

intervention model that appears to be

relatively nontechnical in nature.

Because PBS is marketed largely to

service providers who typically lack

formal training in ABA, it may be

important to avoid presenting a com-

plex body of procedures as the core

of its approach to services. ABA, on

the other hand, has a multitiered

approach to intervention in which

formally trained and certified profes-

sionals are, in principle, available to

provide guidance, assistance, and

monitoring to those who lack such

expertise.

Supports. Another key aspect of

the PBS treatment model is its

emphasis on behavioral supports.

Defined as adjustments to the envi-

ronment to provide accommodations

for disabilities, supports are an epon-

ymous feature of PBS. The concept

of supports was described and in-

corporated into service delivery in the

American Association on Mental

Retardation (AAMR) manual on

definition and classification of mental

retardation (Luckasson et al., 1992).

The supports model set forth by

AAMR in 1992 and in the sub-

sequent revision of its manual (Luck-

asson et al., 2002), which has been

embraced by PBS, might appear to

increase the range of an individual’s

activities, and implies that supports

can substitute for training or skill

development. Describing interven-

tions as supports thus enables the

PBS movement to market PBS to

agencies and providers that lack

expertise in ABA, because it mini-

mizes the technical requirements of

service delivery.

Although supports tend to be

effective in the short run, they often

do not require changes in competence

or performance by consumers or staff

(Foxx, 2005a; Kemp, 2000). The

emphasis on supports can create

tension between providing supports

and providing training, and by dis-

couraging skill development, can

perpetuate consumer dependency.

Further, reconceptualizing clinical

services as supports risks minimizing

the need for expertise in ABA and

otherwise encouraging the deprofes-

sionalization of developmental dis-

abilities services (Baumeister, 2004).

In contrast, although the design

and implementation of prosthetic

environments to provide accommo-

dations and adaptations for people

with disabilities has been a longstand-

ing component of ABA interventions

(e.g., Lindsley, 1964), for behavior

analysts that concept has not sup-

planted or replaced professionally de-

signed procedures for teaching new

skills or addressing specific problem

behaviors.

Practitioner Competencies

and Training

Given the disciplines and proce-

dures PBS is said to encompass, it

seems to follow that competent prac-

tice of PBS requires substantial ex-

pertise in multiple areas. That is, it

might be argued that preparation of

PBS practitioners should involve

training in aspects of systems analy-

sis, ecological psychology, environ-

mental psychology, community psy-

chology, biomedical science, human

development, and education, as well

as the ‘‘values’’ embedded in various

social movements such as normaliza-

tion, full inclusion, person- and family-

centered planning, wraparound mod-

els, and self-determination (E. Carr

et al., 2002; Horner, 2000; Horner et

al., 1990; Knoster, Anderson, Carr,

Dunlap, & Horner, 2003; Warren

et al., 2003).

Furthermore, if PBS is equivalent

to or derived principally from ABA,

as some proponents suggest, then

PBS practitioners should also master

the full array of basic competencies in

ABA. In particular, because PBS

emphasizes manipulating broad an-

tecedent variables, it follows that

PBS practitioners need to be espe-

56 J. M. JOHNSTON et al.

cially competent in designing and

implementing such interventions ef-

fectively. In fact, research suggests

that there are substantial challenges

to implementing and sustaining com-

plex antecedent-based interventions

in educational and developmental

disabilities service settings in the

absence of adequate competence in

behavioral assessment and behavior-

change technologies (e.g., Huberman

& O’Brien, 1999; Peterson & Mar-

tens, 1995). Basic competencies in

ABA and the training required to

develop them have been well defined

by the behavior-analytic community

and are enumerated in the require-

ments of the Behavior Analyst Certi-

fication Board, Inc. (BACB; see

Johnston & Shook, 2001; Shook,

Hartsfield, & Hemingway, 1995;

Shook, Johnston, & Mellichamp,

2004; www.bacb.com). Those re-

quirements specify that ABA practi-

tioners must exhibit both a sophisti-

cated approach to functional

assessment and a firm grounding in

operant conditioning principles and

behavior-change methods as they

apply to the complexities of daily life.

Despite the apparent need for

comprehensive skills on the part of

PBS practitioners, the PBS service

model is based on providing training

directly to ‘‘end users’’—individuals

who provide direct services to con-

sumers and those who supervise these

individuals. There is no general

mechanism for academic training of

professionals, as in the ABA model.

Although at least one model for

master’s degree training in PBS has

been proposed (O’Neill, Johnson,

Kiefer-O’Donnell, & McDonnell,

2001), periodic in-service training is

the primary format for preparing

PBS practitioners. Because PBS

training is usually offered in non-

academic settings to individuals with

varied backgrounds, the curricula are

necessarily constrained in breadth

and depth (see Dunlap et al., 2000;

Freeman, Smith, & Tieghi-Benet,

2003; Freeman et al., 2005; Reid et

al., 2003; Scott, Nelson, & Zabala,

2003; Shannon, Daly, Malatchi,

Kvarfordt, & Yoder, 2001). For

instance, the California Department

of Developmental Services requires

all direct support professionals to

receive training in PBS as part of

a 70-hr training program (spread

over 2 years) that also covers many

other topics (California Department

of Education, 2004; www.dds.ca.gov/

DSPT/DSPT_trpr.cfm).

Training provided by behavior

analysts to direct providers under

such conditions is often similarly

limited. However, the BACB, guided

by extensive input from practitioners

and academics, has held that the

competencies required for practicing

behavior analysis cannot be acquired

through nonacademic training experi-

ences because those experiences tend

to lack many important features, such

as prerequisites for admission, inten-

sive supervised involvement with

course material and recipients of

behavior-analytic services over a

period of months, and systematic

measurement of performance.

The availability of numerous aca-

demic ABA training programs that

focus on systematically developed and

consensually validated baccalaureate

and graduate curricula, along with an

established program for certifying

individuals by examination, makes it

at least possible for ABA services to

be designed and supervised by profes-

sionals who have meaningful training

in the basic principles of operant

conditioning and their application. It

should be noted that availability of

this cadre of professionals does not by

itself resolve the question of how their

expertise might lead to effective ser-

vices by the much larger community

of direct service providers who do not

have this background. The PBS ap-

proach to dissemination provides

some interesting ideas for behavior

analysts to consider in this regard.

Nonetheless, the differences in how

PBS and ABA approach practitioner

training are significant. The risk

PBS AND ABA 57

inherent in the PBS approach is that

services may not adequately incorpo-

rate the findings of decades of re-

search in behavior analysis because

its practitioners lack the necessary

training in ABA. This risk is exacer-

bated by the failure of many propo-

nents of PBS to acknowledge the

foundation of PBS in ABA. Al-

though the PBS approach to practi-

tioner training presumably makes it

easier to sell PBS to federal, state,

and local service agencies, it is likely

that interventions implemented by

such practitioners will not be as

effective as the research literature

shows they can be. If the PBS

community openly acknowledged ex-

pertise in ABA as the foundation for

PBS services and encouraged practi-

tioners to obtain such expertise, their

strategy of disseminating directly to

end users would be less problematic.

Finally, it should not be expected

that training in PBS will motivate

recipients to pursue formal training

in ABA. It is not surprising, there-

fore, that a recent job analysis survey

of BACB certificants and many

members of the Association for

Behavior Analysis revealed that only

7% of board-certified behavior ana-

lysts described their work as PBS

(Shook et al., 2004). Interestingly,

PBS seemed to appeal more to those

with less training in ABA: 13% of

board-certified associate behavior

analysts identified their primary fo-

cus as PBS, whereas only 3% of the

surveyed members of the Association

for Behavior Analysis (93% of whom

held the doctorate) listed PBS as

a primary focus.

As of this writing,

only one of the 10 authors of a recent

description of PBS (E. Carr et al.,

2002) holds BACB certification.

Evaluation of PBS Efficacy

If PBS is a new applied science or

discipline, as some have argued (e.g.,

Bambara, Mitchell-Kvacky, & Iaco-

belli, 1994; E. Carr, 1997; E. Carr et

al., 2002; Sisson, 1992), it would be

reasonable to expect it to have pro-

duced new research questions, meth-

ods, findings, and applications that

can be evaluated. Such an evaluation

is complicated by the difficulty of

identifying research that is clearly

and uniquely PBS in character. For

example, J. Carr and Sidener (2002)

and Mulick and Butter (2005) noted

that the majority of the studies

included in what were represented

as meta-analyses of the PBS literature

(E. Carr et al., 1999; Marquis et al.,

2000) were actually published in the

ABA literature. Moreover, many

studies published in the Journal of

Positive Behavior Interventions are

also indistinguishable in focus and

style from typical ABA studies.

An additional complication in

evaluating PBS is that it has been

described by Sailor and Paul (2004)

as ‘‘flexible in its engagement of

scientific procedures’’ (p. 10). Ac-

cording to those authors, in addition

to ‘‘positivistic experiments and di-

rect observation … other methodol-

ogies, including subjectivist methods

of science, have found legitimacy [in

PBS]. These include correlational

analyses, naturalistic observation,

and case studies’’ (p. 10). Sailor and

Paul also stated that ‘‘PBS thus

departs from the traditional modern

perspective on research in order to (a)

inform professional practice by sub-

jugating methods of science applica-

tions in natural social contexts and

(b) address problems from the stand-

point of the individual affected’’

(p. 10). They further stated that

‘‘Where ABA has historically been

almost wholly focused on interven-

tions that can be evaluated with

positivist methods (i.e., single-subject

designs), PBS increasingly is relying

on multi-method investigations that

It is interesting to note that most academic

centers of PBS activity are located in colleges

of education, typically in departments of

special education. In contrast, most ABA

training programs are located in departments

of psychology.

58 J. M. JOHNSTON et al.

sometimes include subjectivist meth-

odologies’’ (p. 10).

The difficulty with the methodolo-

gies described by Sailor and Paul

(2004) is that they produce informa-

tion that is especially likely to reflect

personal opinions, impressions, and

beliefs, which are problematic be-

cause they are prone to influence by

many variables that may have little or

nothing to do with the actual effects

of the intervention under study. Thus

they may not yield credible, reliable

evidence about changes in behavior

or what is responsible for any docu-

mented changes (Favell, 2005; Green,

1996; Newsom & Hovanitz, 2005;

Schick & Vaughn, 1999).

Among the relatively few pub-

lished studies that appear to be

explicit evaluations of PBS, there is

considerable variability in methods.

Evaluations of PBS interventions are

often more descriptive than experi-

mental. Not infrequently, they in-

volve subjective personal impressions

(e.g., naturalistic observations, ‘‘field

notes,’’ anecdotal reports) and in-

direct measures of behavior (e.g.,

interviews, surveys, checklists, and

rating scales) rather than data pro-

duced by direct, objective measure-

ment methods. Some research on

PBS is also marked by incomplete

or ambiguous descriptions of inde-

pendent variables (e.g., Dunlap &

Fox, 1999; Kincaid, Knoster, Har-

rower, Shannon, & Bustamante,

2002), failure to measure key vari-

ables (see E. Carr, McLaughlin,

Giacobbe-Greico, & Smith, 2003;

Jensen, McConnachie, & Pierson,

2001), and omission of data on

successful and unsuccessful cases.

These methodological issues make it

difficult to determine the critical

features and effects of interventions

offered under the rubric of PBS.

This general assessment should not

be interpreted as indicating that there

are no sound studies in the PBS

literature. Some evaluations of

school-wide interventions have uti-

lized reasonable designs and proper

longitudinal methods (e.g., McCurdy,

Mannella, & Eldridge, 2003). Never-

theless, many studies of school-wide

interventions have relied heavily on

quasiexperimental designs (e.g., AB

comparisons) and indirect and sub-

jective measures of behavior, such as

discipline referrals by teachers (see

Anderson & Kincaid, 2005).

A meta-analysis of PBS research

by proponents found little evidence

that the approach has produced

positive lifestyle change for people

with disabilities—one of the hall-

marks of PBS. The authors acknowl-

edged that lifestyle change was a stat-

ed intervention goal for only 10% of

all participants (24 of 230) across

studies, was targeted with formal

intervention procedures for only 8

participants, was measured for only 6

participants, and was documented by

data showing improvement over

baseline for only 2 participants (E.

Carr, Horner, et al., 1999).

Relationship to ABA

Identification and description. It is

clear that PBS evolved from and

remains similar to ABA in certain

ways. Several of its leaders were

trained in behavior analysis, and its

literature has notable similarities to

the ABA literature. Nevertheless, it is

also clear that this relationship is

infrequently acknowledged in PBS

literature; indeed, it often seems to

be systematically ignored or even

hidden. Mulick and Butter (2005)

pointed out that in contrast to a few

early statements about the depen-

dence of PBS on ABA, there is

a notable absence of recognition of

this relationship in more recent pub-

lications. It is difficult to find any

mention of behavior analysis in some

highly visible representations of PBS,

such as the website of the OSEP

Center for Positive Behavioral Inter-

ventions and Supports (www.pbis.

org).

It might be expected that the

relationship to ABA would be clearly

PBS AND ABA 59

identified in PBS training materials.

Our review of a variety of such

materials, however, shows that ABA

is mentioned infrequently. Further-

more, PBS practitioner training

focuses less on competencies for de-

signing and delivering effective be-

havioral intervention than on the role

of values in service delivery (e.g.,

Anderson & Freeman, 2000; Autism

Training Center, undated; California

Department of Education, 2004). As

we noted previously, no formal train-

ing or competencies in ABA are

required to enter or exit from PBS

training, and the coverage of basic

operant principles and behavior-

change techniques based on them

tends to be highly superficial, cer-

tainly well short of the breadth and

depth necessary for basic competence

in ABA (e.g., Autism Training Cen-

ter; California Department of Edu-

cation; Vermont Division of Devel-

opmental Services, 2004).

Some PBS training materials even

contrast PBS with ABA in a manner

that denigrates ABA. For example, in

materials used in PBS workshops

conducted by the Autism Training

Center at Marshall University (Au-

tism Training Center, undated), ‘‘tra-

ditional behavior management’’ is

described as narrow in emphasis,

short term, concerned only with the

topography or form of behavior,

implementing behavior ‘‘programs,’’

using restrictive procedures, involv-

ing simple interventions, relying on

consequences, focusing on decreasing

target behaviors, aversive (punitive),

and reactive. In contrast, PBS is

depicted as broad in emphasis, taking

a long-term perspective, focusing on

function rather than form, conduct-

ing functional analyses of behaviors,

selecting methods based on individu-

ality and effectiveness, being multi-

component in nature, emphasizing

antecedents, teaching functional (re-

placement) skills, positive and rein-

forcing, and proactive.

A PBS training document devel-

oped by the California Department

of Education Positive Environments,

Network of Trainers compares ‘‘cur-

rent thinking’’ with ‘‘past practice’’ in

the conceptualization of behavior.

‘‘Past practice’’ is portrayed as ‘‘be-

havior management’’ with a focus on

consequences (including aversives to

stop behavior) and a philosophy that

‘‘Problem behavior needs to be con-

trolled or eliminated. Positive behav-

iors are to be expected regardless of

environment.’’ In contrast, ‘‘current

thinking’’ is characterized as ‘‘behav-

ior support,’’ focusing on under-

standing why problem behavior oc-

curs and teaching alternative

‘‘positive’’ behavior in a ‘‘conducive

environment’’ (Wright, 2002). Behav-

ior support guidelines promulgated

by the Vermont Division of Devel-

opmental Services, although not

mentioning behavior analysis, include

a statement that ‘‘Positive behavior

supports represent a basic change

from older methods of changing

behavior through external controls,

such as rewards and punishments and

are based on a commitment to end

coercion’’ (Vermont Division of De-

velopmental Services, 2004, p. 5).

Similar rhetoric can be found in

a recent article by E. Carr et al.

(2002), which characterized ABA re-

search as involving applications of

single interventions resulting in ‘‘in-

effective practice,’’ whereas PBS is

depicted as ‘‘comprehensive’’ and

‘‘multicomponent.’’ PBS is also de-

scribed repeatedly as ‘‘proactive,’’

and contrasted with ‘‘traditional ap-

proaches, which have emphasized the

use of aversive procedures that ad-

dress problem behaviors with reac-

tive, crisis-driven strategies.’’ Behav-

ior-analytic research methods are

labeled ‘‘rigid’’ and ‘‘imped[ing] ap-

plication,’’ while PBS methods are

said to be ‘‘flexible’’ and ‘‘pragmatic’’

(pp. 9–10). Indeed, the label ‘‘positive

behavior support’’ subtly implies

that what it replaces (e.g., ABA) is

neither positive nor supportive of

people who exhibit problem behav-

ior.

60 J. M. JOHNSTON et al.

These contrasting descriptors are

characteristic of a ‘‘straw man’’ style

of persuasion, in which the alterna-

tive position is often characterized in

ways that are not only negative but at

least partly untrue. In this case, the

characteristics ascribed to ABA fail

to reflect the considerable changes

over the past three to four decades of

research and practice in ABA, result-

ing in a depiction of contemporary

ABA practice that is highly mislead-

ing. It should not be surprising if

individuals who lack expertise in

ABA—like the majority of education

and human service personnel who are

targeted for PBS training—conclude

from such presentations that ABA is

an inferior approach.

A new science? Perhaps there is

a tendency to draw pejorative con-

trasts between PBS and ABA in

order to bolster claims about the

status of PBS as a new and distinct

science or discipline (e.g., Bambara et

al., 1994; E. Carr, 1997; E. Carr et al.,

2002; Knoster et al., 2003; Sisson,

1992). There may be disagreement

among PBS leaders on this point. On

the one hand, for example, Horner

(2000) stated that ‘‘Positive behavior

support is not a new approach. … [It

is] the application of behavior anal-

ysis to the social problems created by

such behaviors as self-injury’’ (p. 97).

He further stated, ‘‘There is no

difference in theory or science be-

tween positive behavior support and

behavior modification. These are the

same approach with different names.

If any difference exists, it is in the

acceptance [by PBS] of much larger

outcomes and the need to deliver the

global technology that will deliver

these outcomes’’ (p. 99). Other wri-

ters have referred to PBS as an

‘‘extension’’ of applied behavior anal-

ysis (e.g., Turnbull et al., 2002,

p. 377).

In contrast, E. Carr (1997) de-

clared that ABA had ‘‘evolved into’’

PBS, implying that PBS was not only

newer than, but also superior to,

ABA. He further articulated this

position in E. Carr et al. (2002), and

others in the PBS community have

taken a similar stand (e.g., Bambara,

2002: Bambara et al., 1994; Sisson,

1992). More recently, Horner joined

E. Carr et al. in stating that PBS has

‘‘evolved beyond the parent discipline

[ABA] to assume its own identity’’

(p. 5), and Knoster et al. (2003)

described PBS as a unique approach

(ABA is not mentioned in the latter

article).

In our view, there is no basis for

asserting that PBS is a new science. It

addresses no new phenomena or

subject matter. Neither has PBS de-

veloped any new methods for study-

ing or changing behavior. Although

proponents of PBS differ on the

degree to which PBS methods are

derived from or are identical to

sound ABA research and practice

methods, J. Carr and Sidener (2000)

and Mulick and Butter (2005) point-

ed out that it is easy to document

that the behavior-change methods

claimed by PBS were documented in

the ABA literature long ago. There is

no evidence that PBS has produced

scientific knowledge that significantly

extends what is already well estab-

lished. Its research literature cannot

be clearly distinguished in general

ways from the ABA literature. Nor

are its values new or unique; improv-

ing the lives of people with disabilities

It may be interesting to speculate about the

factors that led some PBS leaders to move so

distinctively outside the field of behavior

analysis. Aside from the influences associated

with advocacy interests, funding opportuni-

ties, and marketing priorities discussed in this

paper, it may be that some were dissatisfied

with the requirements for publishing in the

Journal of Applied Behavior Analysis (JABA).

Such features as single target behaviors, brief

sessions, contrived settings, and limited re-

search interests have been criticized by E. Carr

(1997, 2002), for example. Those concerns,

however, fail to distinguish between method-

ological requirements for sound research and

the characteristics of ABA service delivery.

Although some of the features of JABA

research may certainly be found in routine

practice, the pages of that journal do not

represent the full range of practices in ABA.

PBS AND ABA 61

and valuing them as individuals have

been longstanding and well-docu-

mented concerns of behavior analysts

and other professionals.

Wacker and Berg (2002) drew the

same conclusion. They noted that the

proponents of PBS ‘‘have attempted

to merge philosophies, findings, and

practices from several related disci-

plines, but this does not necessarily

constitute the evolution of an (ap-

plied) science. Instead it appears to

constitute the evolution of a service

delivery system’’ (p. 25). ‘‘The blend-

ing of science and philosophy is

perhaps a necessary step for most

applied researchers, but it is not

a sufficient step for describing the

practice as constituting a new sci-

ence’’ (p. 27).

We also find no evidence that PBS

constitutes a new behavioral technol-

ogy. It is not supported by a new area

of basic or applied science and has

not generated new or distinctive

treatment methods. The actual op-

erations represented in PBS interven-

tions are well established in the

literature of behavior analysis and

related fields, such as behavior ther-

apy and scientific psychology. As

Mulick and Butter (2005) noted,

instead of acknowledging this, PBS

proponents often use ABA technolo-

gy without appropriate attribution,

or rename it, or selectively avoid its

straightforward application.

It follows from these considera-

tions that PBS is not a new pro-

fessional field or discipline. To dis-

tinguish itself, a new field must be

based on a new science, technology,

or academic discipline with a litera-

ture or research base that is sub-

stantively different from that of other

disciplines. PBS is not sufficiently

different from existing fields such as

behavior analysis and clinical psy-

chology to warrant this status. In-

deed, PBS is theoretically character-

ized by amalgamation of knowledge

and methods from behavior analysis

as well as systems analysis, ecological

psychology, environmental psycholo-

gy, and community psychology

(E. Carr et al., 2002). PBS further

incorporates a wide range of ideolog-

ically driven, politically correct views

that mirror and subsume, but do not

amplify, the policies of most state

and national special education and

developmental disabilities agencies,

as well as advocacy organizations

such as the Association for Persons

with Severe Handicaps.

In their brief review of PBS, J. Carr

and Sidener (2002) argued that be-

cause each of the characteristics of

PBS were historically important and

central features of ABA, ‘‘conceptu-

alizing PBS apart from applied be-

havior analysis is unsupported by the

evidence’’ (p. 249). Mulick and But-

ter (2005) suggested that PBS seems

more accurately described as a social

movement or a marketing strategy

than a professional discipline.

Similar but different. Given that

PBS emerged from ABA and offers

interventions that are at least partly

based on ABA, it seems easy to argue

that PBS is fundamentally much like

ABA. Although some of the proce-

dures offered in the name of PBS are

more or less consistent with the ABA

literature, it may also be argued that

as a general model of how to deliver

behavioral services, PBS is funda-

mentally different from ABA. The

most important distinction may be

that by not clearly and consistently

It might be suggested that PBS should be

viewed as doing no more than what organiza-

tional behavior management (OBM) does in

its approach to providing services in business

and industrial settings. As J. Carr and Sidener

(2002) noted, however, the OBM community

has remained fully within the field of behavior

analysis and employs individuals with ABA

training to provide services to client organiza-

tions. To our knowledge, OBM practitioners

have not proclaimed OBM a new discipline or

science that is superior to ABA. Instead, the

OBM leadership clearly recognizes that the

successful application, adoption, and advance-

ment of their specialty requires that it remain

true to its scientific roots and that lasting

acceptance by the business community will

result only from effective services (Norman,

Bucklin, & Austin, 1999).

62 J. M. JOHNSTON et al.

acknowledging the role of ABA in

PBS interventions, it is possible to

avoid stipulating that expertise in

ABA is a prerequisite for adopting

the PBS model. Therefore, it is

difficult to argue that PBS offers

ABA technology as part of its model

because the means for producing that

outcome are not included in the

model. Instead, PBS represents an

approach in which expertise in ABA

is neither required nor trained at

a meaningful level.

GENERAL ISSUES FOR ABA

The Success of PBS and the Threat

to ABA

The PBS movement has clearly

been effective in a number of ways.

For example, PBS leaders have been

very successful in garnering the sup-

port of federal agencies. That has

resulted in political support for PBS

within the federal government as well

as substantial funding for develop-

ment of organizational infrastruc-

ture, extensive dissemination activi-

ties, and research efforts. With this

support, the PBS movement has been

very effective in marketing its treat-

ment model to the human services

community, particularly in the area

of developmental disabilities and

within educational settings. PBS is

now a default model in many state

service systems and provider agen-

cies, including school systems. Those

successes are particularly impressive

because they have occurred in a span

of only 15 years.

The effectiveness of the PBS move-

ment in political and marketing

arenas has important implications

for ABA. Support for any technology

depends on demand, and ABA has

always faced the special challenge of

selling its services to buyers who

might best be described as unin-

formed, if not sometimes reluctant.

In spite of ABA’s strong scientific

foundation and well-documented ef-

fectiveness, if administrators and pro-

fessional staff in service settings are

not inclined to pay for ABA services,

the field of behavior analysis will lose

important users. If federal and state

statutes and regulations identify PBS

as the approach of choice in de-

velopmental disabilities or in services

to children with emotional and be-

havioral disorders, even administra-

tors sympathetic to ABA will find it

difficult to support ABA services.

It has been our experience that in

settings in which PBS is accepted as

a service delivery model, ABA is

likely to be viewed as either incom-

patible with PBS or simply unneces-

sary. Worse, ABA may be viewed

negatively and rejected as a service

model. The threat to ABA is not

merely speculative. In discussing

the evolution of PBS as an applied

science, E. Carr et al. (2002) de-

scribed applied behavior analysts as

having ‘‘prided themselves on the

publication of many successful re-

search demonstrations that involve

the application of single interventions.

These demonstrations may have

made for great science but ineffective

practice’’ (p. 9). The authors went on

to say that functional analysis has

‘‘most often been used by atypical

intervention agents (e.g., researchers)

operating in atypical settings (e.g.,

institutions) in highly circumscribed

venues over short periods of time’’

(p. 10). Behavior analysts are de-

scribed as controlling all aspects of

treatment (e.g., selecting and design-

ing interventions, defining the issues)

in their role as experts, whereas ‘‘the

PBS approach, in contrast, has

emphasized that consumers are not

helpers but, rather, function as

active participants and collaborators

… to build the vision, methods, and

success criteria pertinent to defining

quality of life for everyone con-

cerned’’ (p. 8).

The negative views of ABA artic-

ulated by E. Carr et al. (2002) and

other PBS proponents cited earlier,

coupled with the likely adoption of

such views by individuals with little

or no background in ABA as a result

PBS AND ABA 63

of participating in PBS workshops,

constitute a serious problem for the

entire field of behavior analysis.

Behavior analysis cannot afford to

write off government agencies, ser-

vice providers, and school systems

that are attracted to or have formally

adopted PBS. Not only has PBS been

too pervasive in its influence to allow

such an option, but with the aid of

continued federal funding it con-

tinues to market its model to re-

ceptive communities and to extend its

reach. ABA, and the larger commu-

nity of behavior analysis, must there-

fore consider how the challenges

presented by the PBS movement can

be effectively addressed.

If the PBS movement prominently

acknowledged ABA literature and

technology as the basis for effective

behavioral services, its marketing

successes might be reflected in vari-

ous benefits to ABA. As we have

noted, however, such acknowledg-

ment is minimal and inconsistent at

best. The result is that acceptance of

PBS seems to be inversely related to

acceptance of ABA, particularly

among PBS adherents who are not

well trained in ABA and among

users. This suggests that the field of

behavior analysis must determine

how to prevent the deleterious effects

ofPBSonABA.Tothatend,itmay

be valuable to examine why PBS has

been so successful in order to de-

termine how behavior analysis might

address the threat PBS poses while

attaining some of the goals long held

by behavior analysts.

Reasons PBS Has Been Successful

Politically involved leadership. The

leaders of the PBS movement have

developed close ties to federal agen-

cies (notably the U.S. Department of

Education and various subordinate

entities), and those relationships have

been useful in garnering agency

support for developing and promot-

ing PBS. Such a practical approach

involves determining the interests and

needs of an agency and finding ways

that the interests of a profession or

service model can address them. In

the present case, agency interests

included a need for an approach to

providing behavioral services that

was consistent with agency philoso-

phy and that appeared to provide

assistance to educational and devel-

opmental disabilities service systems.

The PBS leaders were able to see the

benefits of this relationship early on

and were willing to focus their pro-

fessional efforts on fulfilling the

agencies’ needs. That approach af-

fords opportunities to help agency

officials define their interests and

determine how funds are used. Pro-

fessionals with this kind of access are

invited to sit on panels, meet with

staff, and shape funding initiatives.

Pursuit of federal funding. Natural-

ly, professionals who cultivate agen-

cies in this manner have an inside

track to win grant funding, which

allows them to further promote their

interests. PBS leaders have clearly

done well in this regard. Federal

funding in support of PBS has

allowed development of the organi-

zational structure of the PBS move-

ment and widespread dissemination

efforts, ranging from Web sites to

state-level initiatives. Success in ob-

taining agency funding has also

opened doors to service settings in

which funded projects are conducted.

Although federal funding supports

research on PBS, it may be that its

more valuable function has been in

fostering dissemination of PBS.

Focus on dissemination. The prima-

ry dimension underlying the success

of the PBS movement is its wide-

spread visibility and relatively broad

acceptance in human services and

special education. Those successes

reflect the collective impact of the

factors described in this section. Note

that this visibility and acceptance do

not require that PBS be generally

effective relative to other treatment

models. The appeal of PBS seems to

lie more in its focus on certain

64 J. M. JOHNSTON et al.

cultural values and its relatively non-

technical approach to interventions

than on experimental evidence of

treatment efficacy. Those character-

istics, together with a systematic ef-

fort to brand and market the PBS

model, have led to impressive adop-

tion of the model by agencies and by

individuals with varied educational

backgrounds.

The means by which PBS leaders

accomplished this result warrant

thoughtful study. The key elements

include not only defining PBS in

ways described in this section but

also in explicitly allocating consider-

able resources to marketing the PBS

brand and service model. The PBS

approach to working with some state

service agencies is particularly nota-

ble. States contract with PBS centers

for workshop training, which entails

the formation of state implementa-

tion teams that provide training and

technical assistance in PBS. Through

this mechanism, the PBS model is

promulgated with the aid of state

bureaucratic processes. This strategy

seems to have contributed substan-

tially to the promotion of PBS

interests.

Service model adapted to market

interests. Another critical feature of

the success of the PBS movement

seems to be that PBS has been

defined and described in ways that

appeal to potential users. One impor-

tant feature of this fit, whether as

cause or effect, is that the social

policy values and interests of the

principal funding agencies are re-

flected in the values and interests of

the PBS service model. As previously

noted, those values have long been

broadly accepted in the field of

developmental disabilities, but PBS

leaders took political advantage of

those shared values by making them

the primary or defining feature of

PBS, rather than a general context

for the delivery of a science-based

technology (see Anderson & Free-

man, 2000). In other words, leaders

of federal agencies (notably the De-

partment of Education), who are

presumably inclined to take a values-

oriented approach to services (He-

ward & Silvestri, 2005; Kozloff, 2005;

Zane, 2005), were likely to find

a service model that emphasizes

values especially appealing. Similarly,

state agency officials, professionals

trained in other fields, and parapro-

fessionals are likely to find such an

approach appealing because it does

not confront them with the challenge

of acquiring expertise in a technically

complex field (e.g., ABA).

Operational features adapted to

agency limitations. In a similar vein,

and as we noted previously, the PBS

service delivery model is based on

providing nonacademic training to

individuals who lack any specific

educational or training history. This

training deemphasizes the technical

formalities of behavior-analytic treat-

ment procedures in favor of a treat-

ment model that involves relatively

broad and technically unstructured

changes in the environment. In other

words, PBS is described in a way that

implies that it does not require

advanced training in the science-

based methods of ABA and adher-

ence to complex procedures.

Service agencies in developmental

disabilities and special education may

not have access to expertise in ABA,

and acquiring such access is often

difficult due to the limited supply of

professionals with this expertise. This

constraint is a substantial barrier to

acceptance of a treatment model that

is predicated on such expertise. By

describing PBS as a relatively non-

technical approach to intervention

that does not require expertise in

ABA, PBS leaders are able to attract

the interest of a broad array of

individuals who lack such expertise

but are charged with delivering be-

havioral services.

Minimize technical vocabulary. The

language of PBS is another important

basis for its broad appeal. The

vocabulary is relatively colloquial

and is replete with familiar values-

PBS AND ABA 65

based phrases (e.g., positive, person

centered, personal dignity, self-deter-

mination, stakeholder participation,

quality of life, lifestyle change). Un-

like the more technical vocabulary of

ABA, PBS language is not off-put-

ting to users, particularly individuals

who lack training in ABA.

Organizational focus on service de-

livery. Although it might seem obvi-

ous, it is worth noting that PBS has

succeeded in part because it has

largely been described as a treatment

model rather than as a research

enterprise. Aside from the character-

izations of PBS by some leaders as

a new science or discipline, PBS has

primarily been offered as a way for

agencies and individuals who are

responsible for providing services to

meet their obligations. This practical

focus is more likely to generate

political and financial support among

targeted agencies (e.g., departments

of education and developmental dis-

abilities services) than is a research

agenda. In addition, characterizing

PBS as a service delivery model does

not require the development of a re-

search foundation before building

a dissemination system and promis-

ing to resolve behavior problems.

What Can ABA Learn from PBS

The success of PBS leaders in

marketing this service model to di-

verse interests in human services

provides an opportunity for ABA to

consider whether the means by which

dissemination and acceptance of PBS

has been accomplished has relevance

for ABA. The evaluation that follows

focuses specifically on marketing

activities of the PBS movement. In

light of the problematic features of

the PBS approach that we have

identified, we do not propose that

PBS is a model for delivering effective

behavioral services.

Developing a consensus on priorities.

From the beginning, PBS leaders

seemed to develop a clear focus on

establishing the PBS brand and

broadly disseminating it as a service

model. It might be argued that the

ABA community has never devel-

oped clear priorities in this regard,

which would seem to be necessary for

organizing concerted action. At issue

is the mechanism for identifying

priorities and developing the means

for pursuing them. In the case of the

nascent PBS movement, a relatively

small group of individuals took

leadership roles early on. In the large

and diverse ABA community, no

such coterie exists, so it seems neces-

sary to turn to the Association for

Behavior Analysis (referred to here-

after as ABA International) as a pos-

sible organizational mechanism.

ABA International has generally

not served broad leadership and

organizational functions for the field.

It has evolved primarily as a means of

sponsoring an annual meeting, al-

though this is not to gainsay the

variety of auxiliary functions served

by its boards and committees. The

collective activities of the association

to date, however, do not reveal the

organizational capabilities, interests,

and resources necessary to develop

and promote the field’s growing

applied interests. Addressing the

needs revealed by PBS, for example,

would require ABA International to

resolve longstanding issues regarding

the fundamental nature of the orga-

nization and its service to scholarly

versus professional constituents.

Cultivating federal agencies. There

are sound reasons to attempt to

emulate the effectiveness with which

PBS leaders have cultivated the favor

of federal agencies. Identifying agen-

cies whose interests are consonant

with those of ABA is a prerequisite to

improving the dissemination of ABA.

The issue here may be how closely

agency and professional interests

must match. Winning the support of

federal agencies will require under-

standing and accommodating their

goals, but we would caution that

there are limits to the degree of

accommodation to agency goals that

66 J. M. JOHNSTON et al.

ABA International and the field

should be willing to make.

Although individuals who play

leadership roles must be at the heart

of relationships with federal agencies,

organizational support for such re-

lationships is essential. Again, how-

ever, ABA International is not struc-

tured in a way that fosters the kind of

communication with federal and state

agencies that is required to address

issues such as research, treatment

models, and dissemination. For in-

stance, ABA International has no

physical presence in Washington, DC

and no full-time staff who are as-

signed to develop and maintain

relationships with federal or state

agencies. The organization is admin-

istered primarily by a part-time exec-

utive director and a small full-time

staff. Although elected members of

the Executive Council determine or-

ganizational policy, they do not play

a strong role in transforming policy

into specific initiatives and daily

activities.

Focusing on dissemination. Dissem-

ination of ABA has largely relied on

the initiatives of individuals who

work within situations available to

them. Although this has sometimes

led to large-scale outcomes (e.g.,

Johnston & Shook, 1988), more often

any effects (aside from publications)

have tended to be relatively local or,

at the most, statewide. Emulating the

tactics used by PBS to disseminate its

brand and service model will require

a large-scale organized effort. Cer-

tainly it will require careful consider-

ation of what exactly should be

disseminated. How might the ABA

service model be depicted so that

federal and state agencies will be

receptive? The fairly widespread ac-

ceptance of ABA for individuals with

autism may provide one exemplar.

Large numbers of consumers, and to

some extent federal and state agen-

cies, have become more receptive to

ABA largely as the result of publica-

tion of a trade book written by

a parent (Maurice, 1993). That book

chronicled in compelling, nontechni-

cal language the same outcomes in

two children with autism who re-

ceived early intensive ABA interven-

tion that had been reported for some

children who participated in a study

conducted by Lovaas (1987). It cre-

ated a sufficient groundswell of de-

mand from parents to cause some

state agencies (e.g., New York State

Department of Health, 1999) and

some federal entities (e.g., U.S. Public

Health Service, 1999) to evaluate

various treatment options and en-

dorse early intensive ABA for autism

as efficacious.

An effort to disseminate ABA

more broadly will also require focus-

ing on state and local systems, given

that services in the United States tend

to be organized and funded at those

levels. It will be insufficient to merely

describe the ABA treatment model in

appealing terms. The model will have

to be integrated with how state and

local agencies work, which will re-

quire answering some difficult ques-

tions. For example, given that ABA

requires certain levels of professional

expertise for competent delivery of

services, how will agencies obtain

such expertise? How will individuals

with such expertise be employed, and

how will they relate to staff who lack

such expertise? How will these other

staff acquire intermediate levels of

expertise? The field will have to

address these issues in an organized

manner if it is to appeal to service

agencies.

Part of dissemination is about

publicity. Behavior analysis has never

engaged in a systematic and sustained

effort to inform decision makers in

state and local agencies, as well as

individuals who provide services di-

rectly, about the field and its tech-

nology. Such an effort requires not

only tailoring the message to different

audiences but also a plan by which

communication with these groups

might be most usefully achieved.

Again, an effective dissemination

program requires a central mecha-

PBS AND ABA 67

nism for organizing and planning,

and ABA International is the prima-

ry organization available for this role.

Although ABA International has

made some efforts at dissemination

associated with its annual conven-

tion, the effects have been modest,

which supports the argument that

this mission must involve profes-

sionals in public relations.

Addressing values interests. In

adapting the depiction of ABA to

the interests of federal, state, and local

agencies, as well as individuals pro-

viding direct services, the current

zeitgeist clearly mandates attention

to the role of cultural values in ABA

services. We have already noted that

ABA has accommodated emerging

cultural values in developmental dis-

abilities services over the last 30 years.

Although individuals who are well-

trained in ABA are aware of this

accommodation, it is apparently less

obvious to others. The ‘‘values first’’

characterization of PBS has undoubt-

edly aided its widespread acceptance

in human services. The challenge for

ABA is to show how particular

cultural values have been effectively

integrated into the ABA treatment

model without compromising the

science-based foundation of its effec-

tiveness. Given that cultural values

are indeed a respected part of ABA, it

would seem that the effort needs to

focus on how ABA is described.

Using effective vocabulary. It is old

news to most behavior analysts that

the field’s technical vocabulary is at

best unappealing and at worst in-

effective for communicating with

individuals who are not trained in

the field. Foxx (1996) addressed this

issue thoroughly, arguing that we

should adapt our verbal repertoire

to different audiences. Judging the

requirements for effective communi-

cation is a skill that many practi-

tioners master only after a sufficient

punishment history. It is especially

difficult for new graduates to aban-

don the technical verbal repertoire

that they have labored to master in

favor of a colloquial and politically

correct dialect when talking with

coworkers, families, and others.

It may be even more challenging to

reconsider how we present the field in

written form. The varied interests

within developmental disabilities of-

ten seem to be more concerned with

cultural values than outcomes. De-

scriptions of ABA in documents and

Web sites must accommodate that

priority in order to develop relation-

ships that can then provide behavior

analysts with opportunities to focus

on the outcomes that ABA can pro-

duce. Presentations to agencies and

interest groups must be similarly

framed in the context of broadly

accepted values and colloquial lan-

guage. This accommodation need not

compromise the scientific foundation

of ABA.

What not to do. Although the PBS

movement may provide valuable

guidance to ABA in some areas, it

provides negative examples in others.

In our view, the successes of PBS in

reaching out to governmental agen-

cies, providers, and individuals not

trained in behavior analysis have

come at too dear a price. In seeking

to appeal to diverse interests in

developmental disabilities services

and special education, leaders of the

PBS movement have described its

focus and service model in several

ways that we find problematic.

First, although PBS has accommo-

dated cultural values in its descrip-

tion and service model, they have

been given too pervasive and domi-

nant a role relative to ABA technol-

ogy and its scientific foundation.

PBS literature and Web sites describe

an approach in which values seem

to constitute not merely a context for

practice but the highest priority for

clinical decision making. Balancing

cultural values and clinical decision

making always requires thoughtful

consideration, but ABA should be

particularly cautious about compro-

mising its technology in the process

(Meinhold & Mulick, 1992).

68 J. M. JOHNSTON et al.

Second, descriptions of PBS fail to

adequately acknowledge the founda-

tion of its intervention procedures in

ABA and the resulting requirements

for expertise in ABA. Although this

omission undoubtedly facilitates the

marketing of PBS, it fails to foster the

delivery of effective interventions.

Provision of training in PBS via

workshops and online courses cannot

avoid the consequences of inadequate

training and experience in ABA when

services are delivered—especially to

people who exhibit severe and chron-

ic learning and behavioral difficulties.

ABA must find a way to meet the

needs of potential users without

compromising its service model and

the minimum requirements for de-

livering effective services. The growth

of the behavior analyst certification

program holds promise for resolving

this issue.

Third, the PBS treatment model

focuses on making relatively general

and nontechnical changes in the

antecedent environment and deem-

phasizes the formal complexities of

consequence-based procedures. Al-

though this shift away from conse-

quence-based interventions and the

associated research literature is likely

to be appealing to those who lack

training in ABA, it is at odds with

both basic and applied research find-

ings. The role of consequences in

operant behavior and the essential

contribution of consequences to what

might appear to be primarily ante-

cedent manipulations are well docu-

mented. Any effort to market ABA

must accommodate all aspects of the

technology that are supported by

sound research. The depiction of the

general treatment model to users

need not detail all of the considerable

complexity of the technology, but all

of its required elements must be

included.

Although the foregoing three fea-

tures have almost certainly contrib-

uted to the successful dissemination

and acceptance of the PBS brand and

service model, we propose that they

cannot help but constrain the effec-

tiveness of PBS as it is typically

practiced in service settings, especial-

ly those that serve people who exhibit

severe problem behaviors. Again, we

would caution that efforts to broaden

the awareness and acceptance of

ABA must avoid the temptation to

compromise the features that are the

foundation for its effectiveness.

Conclusions

In trying to understand the PBS

movement, we have found it useful to

consider not merely the statements of

its leaders (particularly those ad-

dressed to ABA and other profes-

sional audiences) but also how PBS is

presented to (and by) governmental

agencies, service providers, and indi-

viduals who are not trained in ABA.

We have learned that it is difficult to

characterize PBS in ways that will not

invite disagreement. Leaders of the

PBS movement have published nu-

merous articles and chapters over the

years, and some of their descriptions

of PBS vary in significant ways.

Descriptions of PBS on Web sites

and in materials used in training and

service delivery settings, which ad-

dress more varied audiences than do

journal articles and chapters, must

also be fully considered. The large

PBS literature aimed at those audi-

ences makes it possible to describe

PBS in different ways depending on

one’s interests, or to refute any

characterization of PBS with con-

trary citations. In the final analysis,

PBS is defined by the perceptions of

those who are attracted to the ap-

proach, particularly how they per-

ceive PBS in relation to ABA, and by

what PBS looks like in practice.

We believe that the PBS movement

represents a well-intended attempt to

disseminate a more or less behavior-

ally based treatment model. That

effort, however, has been driven more

by ideological and marketing inter-

ests than by research findings and

professional considerations. Those

PBS AND ABA 69

priorities have resulted in undeniable

success in the marketplace but have

raised serious concerns for ABA as

well as for those who require effective

behavioral services. It is important

that the issues raised in this paper be

addressed by both proponents of PBS

and the ABA community.

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Family-Centered Positive Behavior Support on Children with ADHD: A Literature Review

Article

Full-text available

Jan 2023

Yinuo Lyu

Advocacy and Open Science in the UK: Case Studies in the Autism Wars

Article

Full-text available

Nov 2023

Individuals on the autism spectrum experience a wide range of support needs and it comes as no surprise that opinions differ as to the best way to provide necessary supports. Some articulate self-advocates argue that societal acceptance of neurodiversity is the key issue. These views have clashed with those of parents and professionals who advocate for access to evidence-based interventions for profoundly autistic children and adults. The consequences of these kinds of differing opinions are so far-reaching that the term “autism wars” was coined. In this article, we argue that although acceptance of diversity is obviously important, this should include an openness to diverse scientific traditions, especially if lack of such openness limits public policy and adversely affects individuals and families. “Open Science” holds much promise in many fields, but its influence cannot be taken for granted when it comes to evidence-based support practices that are grounded in the science of behavior analysis. Benefiting from open science in autism research requires well-developed advocacy skills. To illustrate, we use case studies from the UK, where advocates of open science have met with intractable obstacles.

Impact of real-time stress monitoring in people with an intellectual disability

Conference Paper

Full-text available

Jan 2023

People with an intellectual disability are vulnerable to stress, which can result in challenging behaviour, such as apathy, self-harm, or aggression. By monitoring stress in real-time, professional caregivers can timely intervene to prevent escalations and improve the quality of life for both the client and themselves. The aim of this study was to investigate the impact of real-time stress monitoring using the stress-detection system HUME on the quality of life of people with a severe intellectual disability and their professional caregivers. The study comprised two parts. A case series study (n=12) was conducted with long-term care clients with intellectual disabilities to validate the HUME. HUME stress measurements, based on physiological data and trained artificial intelligence models, were collected, and compared with labelled video observations of professional caregivers. A second study was conducted to measure the impact of HUME and the induced interventions on quality of life. Physiology data and quality of life scores were collected. The HUME stress prediction was used 1) for early warning to deploy interventions based on what the professional caregiver deemed best, and 2) as an assessment tool to understand the effectiveness of care interventions. The quality of life for both the client (n=41) and professional caregiver (n=31) was evaluated via a questionnaire. Results showed that the HUME was able to detect stress in all cases, and stressful events detected by the HUME were consistent with the behavioural observations. The real-time stress monitoring using HUME, along with subsequent interventions, was effective. Clients with intellectual disabilities experienced reduced stress and an improvement in their perceived quality of life. Also, professional caregivers perceived an increase in the quality of life during the period the HUME was used. In most of the cases, HUME-based interventions led to a reduction in escalations, fixations, and self-harming behaviour. Further randomized controlled studies are needed to substantiate these results.

Barriers and facilitators to practitioners’ implementation of positive behavior support practice in social care organizations in Ireland

Article

May 2023

In Ireland, the provision of behavior support services has developed following the introduction of Health Information and Quality Authority (2013) standards and the regulation of Positive Behavior Support (PBS) under the Health Act (2007). The purpose of this study was to explore what factors facilitate and act as barriers to implementation of behavioral recommendations in Intellectual Disability organizations from the practitioner’s perspective. Twelve interviews were carried out, audio recorded, transcribed and analysed using Braun and Clarke’s (2006) Thematic Analysis. One superordinate theme (administrator support), four themes (values, resources, relationships and implementation of consequences) and five sub-themes (staff turnover and burnout, training and knowledge, time and physical contact, relationships between practitioners and staff and staff and service users) were identified, all interconnected in the implementation process. A common thread reflected throughout the themes, was the practitioner’s acknowledgment of barriers overpowering facilitation which resulted in a less than optimum implementation of PBS.

Eating Disorders and Neurodivergence: A Stepped Care Approach

Technical Report

Full-text available

Mar 2023

While eating disorders have been estimated to affect at least 4% of the Australian population, research demonstrates that feeding difficulties and eating disorders are overrepresented in neurodivergent people, including in autism, ADHD, intellectual disability, giftedness, and Tourette’s disorder. However, despite there being a substantial body of literature spanning decades evidencing links between neurodivergence and eating disorders, awareness among clinicians and researchers of this existing knowledge base is only emerging in Australia. NEDC commissioned Eating Disorders Neurodiversity Australia (EDNA) to write a report, Eating Disorders and Neurodivergence: A Stepped Care Approach, that synthesizes research and lived experience evidence regarding the prevention, early identification and treatment of eating disorders and disordered eating for neurodivergent people. This report aims to encourage collaboration among stakeholders to co-produce and co-design appropriate, effective, culturally valid, and safe neurodiversity-affirming support systems and care pathways. It is designed for the use of a wide range of stakeholders, especially health care professionals (e.g., psychiatrists, psychologists, dietitians, general practitioners, paediatricians, occupational therapists), researchers, academics, educators (e.g., teachers), service managers, and lived experience experts. This report draws on fundamental constructs relating to human rights, bioethics, humanistic psychology, phenomenology, and social justice. It challenges traditional understandings of neurodivergence as pathological. It seeks to destigamtise neurodivergent body awareness and image, feeding, and eating experiences and behaviours. It is a call to action for all eating disorder stakeholders to engage in a radical rethink of how neuronormative feeding and eating practices, which influence research and clinical practice across all levels of eating disorder care, may prove harmful for neurodivergent people.

Putting the power of behavior analysis in the hands of nonbehavioral professionals: Toward a blueprint for dissemination†

Article

Nov 2023
J APPL BEHAV ANAL

Dorothea C Lerman

Behavior analysts have much to offer nonbehavioral professionals who work with the communities that we serve. Successful dissemination of behavior‐analytic technologies to these professionals could potentially improve their practice. Although the literature contains some exemplary examples of successful dissemination, our discipline would benefit from a blueprint for conducting this important work. In this article, I share our experiences disseminating behavioral technologies to educators, law enforcement officers, and health care providers who engage with neurodiverse individuals. These experiences form the basis of a recommended blueprint for dissemination, which awaits empirical support. After describing this tentative blueprint, I provide suggestions for future research on how best to disseminate our technologies to nonbehavioral professionals, the ideal content of those dissemination activities, and the conditions under which professionals may be more likely to embed our technologies into their best practices.

Latent Class Analysis on Types of Challenging Behavior in Persons with Developmental Disabilities: Focusing on Factors Affecting the Types of Challenging Behavior

Article

Full-text available

Oct 2023

Daeyong Kim

This study sought to analyze the latent classes of challenging behaviors among persons with developmental disabilities and examine the effects of related variables. To this end, the Korea Employment Agency for Persons with Disabilities collected data from the Survey on the Work and Life of Persons with Developmental Disabilities from 3000 households that included at least one family member with a developmental disability aged ≥15 years, surveying the persons themselves as well as their caregivers. As a result of the analysis, four latent classes were derived based on the types of challenging behavior and named as follows: overall challenging behavior, aggressive behavior, socially inappropriate behavior, and no challenging behavior. The main disability, disability grade, presence of multiple disabilities, disability status, activities of daily living, reading skills, writing skills, and situational awareness were significant factors affecting each latent class in the type of challenging behavior. Significant factors differed among the groups. This study identified the types of challenging behaviors and their influencing factors in a large sample of individuals with developmental disabilities and analyzed the correlation between their challenging behaviors and activities of daily living.

Parental Punishment: Don’t Throw Out the Baby with the Bathwater

Chapter

Sep 2023

Over the past several decades, the use of punishment as a strategy to discipline children has fallen into disfavor in popular books and among many parenting researchers. Other well-respected researchers point out important instances where punishment can be beneficial if implemented appropriately together with positive reinforcement. In this chapter, we summarize the research on punishment, ranging from parental use of timeout to the clinical use of mild electric shocks to treat severe self-destructive behaviors that are otherwise resistant to change. We find that the bifurcation of research into causally informative studies of clinical child cases and correlational studies of more representative samples have prevented progress on how consistent mild punishment can enhance positive parenting techniques such as reasoning and negotiation, especially in children with oppositional defiance. We need better punishment research to help parents, because most of them will use some kind of punishment sometimes.

Future Directions for What Works for Offenders with Intellectual and Developmental Disabilities

Chapter

Oct 2019

People with Intellectual and Developmental Disabilities

Chapter

Apr 2023

Behavior analysis has long been used to improve the quality of life of people with intellectual disabilities (IDD); some of the first examples of applied behavior analysis were conducted with people with IDD. As there has been a shift from custodial care to meaningful quality of life and from institutionalization to community integration, the goals of behavior change programs and the methods used have been adapted to be kinder and more focused on well-being. We discuss how the current behavioral literature allows clinicians and researchers to conduct work that aligns with the 2006 UN Convention on the Rights of Persons with Disabilities. Despite significant improvements in behavior-analytic programs for people with IDD, there remains room for improvement with regard to ensuring people with IDD have access to the full range of life experiences.KeywordsIntellectual disabilityDevelopmental disabilityRightsQuality of lifeAdults

Some Current Dimensions of Applied Behavior Analysis

Article

Full-text available

Feb 1968
J APPL BEHAV ANAL

Translated and published article

Training human service supervisors in aspects of PBS: Evaluation of a statewide, performance-based program

Article

Full-text available

Jan 2003
J POSIT BEHAV INTERV

Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children

Article

Full-text available

Feb 1987

O. Ivar Lovaas

Autism is a serious psychological disorder with onset in early childhood. Autistic children show minimal emotional attachment, absent or abnormal speech, retarded IQ, ritualistic behaviors, aggression, and self-injury. The prognosis is very poor, and medical therapies have not proven effective. This article reports the results of behavior modification treatment for two groups of similarly constituted, young autistic children. Follow-up data from an intensive, long-term experimental treatment group (n = 19) showed that 47% achieved normal intellectual and educational functioning, with normal-range IQ scores and successful first grade performance in public schools. Another 40% were mildly retarded and assigned to special classes for the language delayed, and only 10% were profoundly retarded and assigned to classes for the autistic/retarded. In contrast, only 2% of the control-group children (n = 40) achieved normal educational and intellectual functioning; 45% were mildly retarded and placed in language-delayed classes, and 53% were severely retarded and placed in autistic/retarded classes.

Positive Behavioral Support for Students with Severe Disabilities: An Emerging Multicomponent Approach for Addressing Challenging Behaviors

Article

Jun 1994

Students with severe disabilities who exhibit severe problem behaviors present difficult challenges for teachers and other school personnel. As school psychologists assume the role of educational consultant, they may be called upon to design effective behavioral interventions to meet the needs of these students. In this article, an emerging conceptual framework for developing positive, nonaversive behavioral support plans for students with severe disabilities is introduced. Comprised of multiple components such as alternative skill training, antecedent interventions, and lifestyle planning, positive support plans offer a comprehensive, proactive approach to the reduction and prevention of difficult problem behaviors. The research bases and rationale for this framework are highlighted. Two case examples taken from practice illustrate the use of multicomponent support plans in classroom settings. Implications for school psychologists are discussed.

Positive behavior support: Evolution of an applied science

Article

Jan 2002

Positive behavior support in urban schools: Can we prevent the escalation of antisocial behavior?

Article

Jan 2003

Geriatric Behavioral Prosthetics

Chapter

Dec 1974

Ogden R. Lindsley

Human behavior is a functional relationship between a person and a specific social or mechanical environment. If the behavior is deficient, we can alter either the individual or the environment in order to produce effective behavior. Most previous attempts to restore behavioral efficiency by retraining, punishment, or physiological treatment have focused on only one side of this relation, the deficient individual. This approach implies that normal individuals can function in all currently existing social environments, that deficient individuals can be normalized, and that there are ordinarily no deficient environments. Scientists have only recently directly focused on the environmental side of deficient behavior functions and on the design of specialized or prosthetic environments to restore competent performance.

The evolution of applied behavior analysis into positive behavior support

Article