Replicative Study of the Impacts of Applied Behavior Analysis on Target Behaviors in Individuals With Autism Using Repeated Measures

Background The effectiveness of interventions based on applied behavior analysis (ABA) for individuals with autism has been well documented in numerous meta-analyses, systematic reviews, and cost-benefit analyses. However, an observed ‘efficacy-effectiveness gap’ exists, which can be attributed to various factors. This third replication study, therefore, has significant implications for the field. By assessing the impact of ABA treatment, specifically involving discrete trial training and mass trials, within a naturalistic environment, the study provides valuable insights that can inform and improve the delivery of ABA treatments in real-world settings. Methods The study was conducted using a repeated measures research design. Retrospective chart review data were collected from 62 individuals with autism, age (M=8.65, SD=4.53), all of whom were level two autistic and required moderate support in communication, socialization, and daily life. These individuals received ABA treatment over five months. The study measured cumulative target behaviors using a repeated measures design, which allowed for the identification of statistically significant differences across 12 time points. This robust methodology ensures the validity and reliability of the study's findings. Results Mixed repeated measures analysis of variance (ANOVA) indicated statistical significance (sphericity assumed), F(11,495) = 55.432, p < 0.001 (time). Multiple comparisons using bootstrapped paired t-tests showed p < 0.05 on time points 1-8 and non-significance (p > 0.05) on time points 9-12. There was a significant interaction effect (sphericity assumed) with time x (age category), F(44,495) = 2.338, p < 0.001. Interaction contrasts indicated statistically significant differences over time, mainly within the one-year to four-year-old, five to eight-year-old, and most in the nine to 12-year-old age groups. There was some significance within the 13- to 16-year-old age group and no significance within the 17- to 26-year-old age group. Conclusions Over five months, individuals with autism who underwent ABA treatments demonstrated a statistically significant enhancement in general target behaviors. This finding is crucial as it underscores the effectiveness of ABA treatments in a naturalistic environment. Moreover, the study's discovery of a significant interaction between time and age in these behaviors provides valuable insights into the impact of age on treatment outcomes. Extensive large-N studies of general ABA broad effectiveness and repeated measures designs are lacking and can lead to further research to improve quality and outcomes. These findings contribute to the body of empirical evidence and emphasize the importance of replicative efficacy studies in ensuring the reliability of research findings.


Prevalence
Approximately one in 36 children has been identified with autism spectrum disorder (ASD), according to estimates on ASD prevalence from the Center for Disease Control's (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network.Autism spectrum disorder is reported to occur in all racial, ethnic, and socioeconomic groups and is nearly four times more common among boys than among girls [1].Overall, ASD prevalence was lower among non-Hispanic White children (24.3) and children of two or more races (22.9) than among non-Hispanic Black or African American, Hispanic, and non-Hispanic Asian or Pacific Islander children (29.3, 31.6, and 33.4, respectively).The prevalence of ASD among non-Hispanic American Indian or Alaska Native children (26.5) was like that of other racial and ethnic groups.About one in six (17%) children aged between three and 17 years were diagnosed with a developmental disability, as reported by parents, during a study period of 2009-2017.These included autism, attention-deficit/hyperactivity disorder, blindness, and cerebral palsy, among others [1].

Efficacy Studies Delineating Applied Behavior Analysis (ABA) Efficacy
Applied behavior analysis therapy has been extensively recognized as the gold standard for the treatment of ASD.This acknowledgment comes from decades of research and a large body of supporting evidence.Yu et al. [2] reported via their meta-analyses containing 14 randomized control trials of 555 participants on the positive impacts of ABA with moderate to high effect sizes, bringing significant benefits for children with ASD.
Makrygianni et al. [3] meta-analyzed 29 studies and found that ABA programs are moderate to highly effective, bringing significant benefits to children with ASD.Dixon et al. [4], in their randomized controlled trial assessing 28 children with autism, found that the highest intelligence score changes were shown for participants in the comprehensive ABA group.
Rodgers et al. [5] evaluated 25 studies in a systematic review and meta-analysis of 20 studies to evaluate the clinical effectiveness of an early intensive applied behavior analysis-based intervention for autistic children.They found substantial heterogeneity, and effects varied considerably across studies.They commented that the impact of the intervention on autism symptom severity, language development, and school placement remains uncertain because of limited data.The long-term effects are unclear owing to a lack of follow-up data.
Further studies into the effectiveness of early intensive applied behavior analysis-based interventions may be warranted if they include well-defined, alternative interventions as comparators and collect relevant outcomes.Consideration should be given to future studies that not only address whether early intensive applied behavior analysis-based interventions are clinically effective but also aim to identify which components of early intensive applied behavior analysis-based interventions might drive effectiveness [5].
Eckes et al. assessed the effects of ABA on developmental outcomes in children with ASD and parental stress based on 11 studies with 632 participants.Compared to treatment as usual, minimal or no treatment, comprehensive ABA-based interventions showed medium effects for intellectual functioning and adaptive behavior.Language abilities, symptom severity, or parental stress did not improve beyond the improvement in control groups [6].
Gitimoghaddam et al. [7] searched seven online databases and identified systematic reviews for published peer-reviewed English-language studies examining the impact of ABA on health outcomes.They classified measured ABA outcomes into eight categories: cognitive, language, social/communication, problem behavior, adaptive behavior, emotional, autism symptoms, and quality of life.Anderson & Carr [8] highlighted numerous meta-analyses, systematic reviews, and cost-benefit analyses that testified to the effectiveness of interventions based on ABA with autistic individuals.However, there is a noted "efficacyeffectiveness gap" due to factors such as individuals' heterogeneity, reduced levels of compliance, presentation in general medical rather than specialist settings, less monitoring and standardizing of treatments, and cost pressures.
Despite strong supporting evidence, the uptake of evidence-based procedures remains poor.
Misunderstandings and misconceptions about ABA abound, and challenges regarding appropriate research methods to evaluate the effectiveness of individualized interventions contribute to disagreements about what counts as evidence [8].Applied behavior analysis has been extensively recognized as the gold standard for treating ASD.This acknowledgment comes from decades of research and a large body of supporting evidence [7].Applied behavior analysis is popular and widely preferred.The ranking or placement of therapies for ABA can vary based on several factors, such as the child's individual needs.Other treatments include speech, physical, occupational, nutritional, and cognitive behavioral therapy, play therapy, social skills training, and developmental approaches [9,10].

Original studies
Peterson et al. [11][12][13] analyzed and reported their initial and replicative results using large-N designs, with repeated measures analysis delineating the positive impacts of ABA with various samples (n=100, n=98, n=103).They affirmed the ongoing efficacy of ABA using discrete trial training and mass trials within a naturalistic environment with autistic individuals during a series of snapshot studies covering three months, one month, and one month.Since individual behavior and skill progress vary, measurements every two weeks were supported by our board-certified behavioral analysts (BCBAs) and behavioral technicians, who emphasized that gains in two weeks are typical and expected.Given this, upon inspection of the research dataset, we observed progress every two weeks for many individuals.Overall gains were achieved based on our results.All three studies observed statistically significant increases in mean measurements with multiple raters' composite general target behaviors acquired per session.Numerous comparisons between time points in the initial study [11] and the two replicative studies [12,13] indicated noteworthy upward trends of improvement and statistically significant differences between time points with medium to large

Replication objectives
This third replication's primary objective is to ascertain the impact of ABA treatment consisting of discrete trial training and mass trials within a naturalistic environment with a sample of 62 autistic individuals covering a five-month snapshot period from August 8, 2023, to January 8, 2024.It is hypothesized that the child cohorts treated with ABA in discrete trial training and mass trials in a naturalistic environment will demonstrate statistically significant progress toward target behavioral goals over the five-month snapshot period.It is also hypothesized that the time variable will significantly interact with age categories to produce significant improvement effects between time within age categories, as demonstrated by an increase in general cumulative target behaviors.The sample of autistic individuals exhibited a range of clinical characteristics with varying severity and manifestation.The sample individuals with autism avoid or do not maintain eye contact, may not respond to their names, and may not show typical facial expressions.They may have difficulty playing simple interactive games, using gestures, sharing interests with others, and pointing to show something interesting.They may not notice when others are hurt or upset and may not join other individuals in play.They may have delayed language skills and repeat words or phrases repeatedly.They may have difficulty following directions and identifying stimuli upon request.They may line up toys or objects and get upset when the order changes.They may be focused on parts of objects (for example, chair legs) and have obsessive interests.They may insist on following certain routines.The sample with autism may have unusual reactions to sound, smell, taste, look, or feel.They may have delayed movement skills, hyperactive, impulsive, and inattentive behavior, epilepsy or seizure disorder, unusual eating and sleeping habits, gastrointestinal issues (for example, constipation), distinctive mood or emotional reactions, anxiety, stress, or excessive worry.Note that not all our samples will exhibit all of these behaviors.

Inclusion Criteria
Male and female participants were included in the study.Any autistic individual between the ages of one and 73 who was medically cleared for treatment and had an official diagnosis of autism spectrum disorder by a psychiatrist, psychologist, or primary care physician was included.

Exclusion Criteria
The study excluded individuals without a diagnosis of ASD, those with a medical condition or disability that makes ABA therapy unsafe, and individuals with a history of abuse, neglect, or trauma that may interfere with their ability to benefit from ABA therapy.Individuals who received another intervention were incompatible with ABA therapy, and those with families and providers who could not resolve important issues related to the treatment plan were excluded.

Method of data collection
Behavioral measurements with autistic individuals were gathered by behavioral technicians daily and recorded in the Catalyst behavioral software.The duration of the data collection period was 22 weeks minus one day from August 8, 2023, to January 8, 2024.The authors decided that measurements every two weeks appeared practical regarding the dataset build, considering individual behavior and skill development variability.Our BCBAs and behavioral technicians consistently observed typical and expected gains within this biweekly timeframe.Upon analyzing the research dataset, we noted progress occurring every two weeks for numerous individuals.These consistent positive trends contributed to overall gains, as evidenced by our results.

Dependent variable
The dependent (outcome) variable was the number of cumulative target mastery behaviors achieved per session, measured at 12 time points, which were as follows: time The composite scores (target behaviors achieved) from multiple behavioral raters (the behavior technicians) represented the count of mastered general target behaviors.These scores were recorded at 12 intervals, each two weeks apart, over five months.These "general aggregate target behaviors," as defined by BCBAs and behavioral technicians at The Oxford Center, encompassed a range of daily living skills [11][12][13].These included routines for organization, time management, eating, toileting, and hygiene.Participants were taught expressive communication skills, which involved using words and phrases, expanding their vocalizations to include more complex vocabulary, enhancing conversational skills, greeting others, responding to greetings, asking for help, and making requests [11][12][13].Emphasis was also placed on receptive language skills, such as following instructions and identifying requested stimuli.Social skills training was provided, including taking turns, sharing, being assertive, interacting with peers, and responding appropriately to new acquaintances.Community skills were practiced in real-world settings and included interactions with cashiers, making purchases, managing money, grocery shopping, ordering food at restaurants, interacting with law enforcement, walking safely on sidewalks, playing safely in parks, and learning how to interact safely with strangers [11][12][13].

Experimental design: repeated measures over time
Repeated measures designs allow researchers to measure how the treatment affects each child on an ongoing basis to assess the empirical effectiveness of treatments more precisely through observation and analysis.Repeated measures designs look at response outcomes measured on the same experimental unit at various times or under different conditions.In repeated measures designs, each subject serves as their own control [14].

Applied behavior analysis interventions
Discrete trial training (DTT), an applied behavior analytic approach, simplifies complexity by breaking down large tasks into small, individualized steps.It employs straightforward and systematic methods for teaching these tasks.Within DTT, mass trials involve repeatedly presenting the same stimulus until the learner responds correctly.Naturalistic environment training (NET), another form of ABA, teaches behavioral skills within a natural learning environment.It leverages the learner's preferences and interests as motivation [11][12][13].A blend of DTT, mass trials, and NET can significantly benefit autistic children by enhancing cognitive, language, social, and adaptive skill development.Discrete trial training helps autistic children learn appropriate responses to various situations, improving communication and relationships with family, classmates, and peers.Skills like matching, discrimination, and imitation, taught through DTT, enhance learning that might be challenging to acquire in naturalistic settings [11][12][13].Mass trials expedite the acquisition of new behaviors by exposing autistic children to the same or similar stimuli repeatedly.This method strengthens memory and recall abilities, aiding in retaining learned behaviors over time.Naturalistic environment training facilitates the transfer of generalization skills from discrete trial training to different contexts (people, materials, and settings).Using naturally occurring reinforcements, NET enhances motivation, spontaneity, and engagement [11][12][13].

Inter-observer reliability
A two-way random effects model was computed, where people's effects and impact measures are also arbitrary.We used the interclass correlation coefficient (ICC) (2), which is used when multiple measurements are made from each averaged rater.The ICC (2) value was 0.980 (95% CI: 0.972-0.987),indicating excellent agreement between the raters.This value was more significant than the average Pearson r (0.856), suggesting that the ICC (2) was more sensitive to the variability among raters and measurements.Cronbach's alpha for the 12 time point variables was r = 0.980, indicating a high internal consistency reliability [15,16].

Power analysis: study size
A posteriori power analysis was conducted using GPower 3*1 (Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany) [17].The study indicated that a total sample size of n = 27 participants was required to produce a high effect size (.80) for a repeated measures design with (α) = 0.05 using a mixed repeated measures analysis of variance (ANOVA), with a power equal to 0.987.These parameters indicated a high likelihood that this current study, with 62 participants, possessed an acceptable sample size.A mixed repeated measures ANOVA was run to determine the overall statistical significance between the 12 (time 1 to time 12) levels of the independent variable, as well as any interaction effects between the fixed factor (age categories) and the 12 repeated measures time points assessing target behaviors [18].If an overall significant omnibus F statistic was detected (p < 0.05) within the mixed repeated measures ANOVA, a step-down analysis was performed using resampling multiple comparison procedures in the form of bootstrapped paired t-tests (1000 replications).Using bootstrapping with paired t-tests, resampling methods mitigate potential multiplicity, thereby reducing familywise error rate (FEW) likelihoods [19,20].

Statistical methods
Suppose an overall significant omnibus interaction F statistic is detected (p < 0.05) within the mixed repeated measures ANOVA, a step-down analysis will be performed using interaction contrasts, comparing each between-subject's factors (age category) with the within-subjects' factors (time) to determine precisely where the significant differences (effects) came about.

Institutional review board approval
The Oxford Center was issued approval number 1-1703366-1 from the Western Institutional Review Board (WIRB)-Copernicus Group.

Demographics
For the sample of 62 autistic individuals, the age was M=8.65, SD=4.53, the median was eight years, the minimum was two years, and the maximum was 26 years.Results for descriptive statistics for time 1 through time 12 measurements are illustrated in Table 1.The data have been represented by N, mean, standard deviation, and median.

Inferential statistics
A mixed repeated measures ANOVA was performed with post hoc tests in the form of paired t-tests with bootstrapping (1,000 replications) and interaction contrasts, beginning with an analysis of the underlying .Because of the nature of the learning progress of the population of autistic individuals and this repeated measures analysis, the outliers will be retained as they are natural to the study's research question.
The time point variables demonstrated a non-normal configuration.The skewness scores for eight time points were outside the typically accepted range of -1 to +1.Mixed repeated measures ANOVA is quite "robust" for violations of normality, meaning that the assumption can be somewhat violated and still provide valid results [21].
Homogeneity of variances for each combination of the within-subjects factor and the between-subjects factor in significance tests is required."Sphericity" relates to the variances of the differences between the related groups of the within-subject factor for all groups of the between-subjects factor (the within-subjects factor and between-subjects factor) must be approximately equal.
Therefore, Greenhouse-Geyser Epsilon will be used to adjust the degrees of freedom for the averaged tests of significance.Greenhouse-Geyser Epsilon correction is a common correction statistic used when "sphericity," i.e., homogeneity of variance with every combination of repeated measures timepoints, is not achieved, thus increasing the likelihood of a type I error.It adjusts the degrees of freedom (df), which produces a higher Fcritical value, which makes it more difficult to reject the null hypothesis, thus reducing the likelihood of a Type I error.[18].Greenhouse-Geyser Epsilon-corrected F-values are reported in the Results section.
Several investigations [18,21] and others using Monte Carlo simulations into the robustness of generalized linear models (GLMs), of which mixed (between x within) ANOVA is a member, have been reported, suggesting robustness (the likelihoods of Type I error are reduced).

Mixed Repeated Measures ANOVA: Main Effects
There was a significant main effect (sphericity assumed) on the dependent variable (targets mastered) across time, F(11,495) = 55.432,p < 0.001, ES = 0.552, indicating an overall statistically significant effect (increase in targets mastered) detected across the 12 timepoints of the independent variable (time) over five months, with a large effect size as represented by partial eta squared (Table 3).The data are represented as sources of variation, assumption violation corrections, sums of squares, degrees of freedom (df), mean square, F-statistic, pvalue, and effect size estimates (partial eta squared).

Mixed Repeated Measures ANOVA: Interaction Effects (Time x Age Category)
There was a significant interaction effect (sphericity assumed) on the dependent variable (targets mastered) across time and age categories (F(44,495) = 2.338, p < 0.001, ES=0.172, indicating a statistically significant interaction effect detected across the 12 timepoints of the independent variable (time) with the age category (Table 3).

Post Hoc Analyses: Multiple Comparisons
Multiple comparisons using bootstrapped paired t-tests indicated significance (p < 0.05) on time points 1-9 and non-significance (p > 0.05) on time points 9-12 (Table 4).Health outcomes include improvements observed across outcome measures with the impact of ABA on children and youth with ASD.It's crucial to note that while ABA is beneficial, it's also an intensive process that typically demands many hours per week of patient participation.Furthermore, the effectiveness of ABA can vary among individuals, making it essential to customize the therapy to the individual's needs.

Bootstrap
Previous replications highlighting the effect of ABA on ASD Replications relative to the impacts of ABA on individuals with ASD are heterogeneous in scope.Hillman et al. [22] replicated and extended prior research by examining the acquisition, maintenance, and generalization of DTT performance of adults with ASD who were interested in careers as behavior technicians.
Nicolosi & Dillenburger [23] reported a systematic literature review of replication studies over 30 years.Their data showed that the high-intensity, ABA-based University of California at Los Angeles-Young Autism Project (UCLA-YAP) model can benefit children on the autism spectrum, particularly regarding their cognitive functioning and adaptive behavior.Their review concluded that, while more research is always welcome, the impact of the UCLA-YAP model on autism interventions is justified by more than 30 years of outcome evidence.
Nottingham et al. [24] replicated and extended the study by Griffen and Griffen [25] by comparing a condition in which secondary targets were presented during each trial of a session, a condition in which secondary targets were proposed every other trial and a condition in which secondary targets were proposed about every four trials.Within-subject replications were included for both participants.One of the intermittent presentation schedules was associated with the most optimal outcomes in all four comparisons.
Barbosa et al.'s [26] replication aimed to evaluate, with strict experimental control, the efficiency of instructional video modeling while training parents of children with ASD to implement discrete trial instruction.Three mother-child dyads participated.Their results showed an increase in the performance accuracy of all mothers in the application of discrete trials, with an average duration of four hours.This instructional tool may affect motivation and broadly promote access to training contingencies, unlike the limitations of face-to-face training.However, it is essential to emphasize that this tool only reaches its full function if it is inserted within a broader training program.
Ferguson et al. [27] replicated and extended previous research on practical, functional assessment with a different group of researchers and in a different setting (i.e., an early intensive behavioral intervention clinic).This study sought to extend previous literature by including additional social validity measures on the open-ended interview, contingency analysis, treatment, and pre-post measures on parental stress.The results were similar to those of previous studies, with an overall reduction in problem behavior and increased functional communicative responses and compliance with demands.
Conine et al. [28] replicated and extended a study with three school-aged children with ASD using a multiple baseline design across stories.For some participants and some stories, story recall was mastered under less intensive intervention conditions than in the previous study.When it was necessary to implement the complete intervention package, the effects primarily replicated previous research.Improvements in recall were correlated with increases in the correct answers to comprehension questions.These data have important implications for clinicians and educators providing reading and recall interventions to children with ASD.Results also theoretically impact verbal behavior accounts of memory and recall, suggesting several possible avenues for future research.
Grow et al.'s [29] replication compared two approaches using progressive prompting with two boys with autism.The results showed that the conditional-only method was a more efficient and reliable teaching procedure than the simple conditional method.The results further called into question the practice of teaching simple discriminations to facilitate the acquisition of conditional discriminations.
Vladescu et al. [30] replicated a study and evaluated tact acquisition in three, six, and 12 stimulus set sizes.The set sizes of three and six stimuli were associated with the most efficient acquisition, whereas the fixed size of 12 stimuli was not.
Dhadwal et al. [31] replicated and extended research by teaching three children diagnosed with autism spectrum disorder and other developmental disabilities to respond appropriately to false-belief tasks using behavioral intervention strategies conducted in the natural environment with people in their environment.They used a nonconcurrent multiple-baseline across-participants design to evaluate multiple-exemplary training, prompting, and reinforcement for training correct responses with two false-belief tasks: the hideand-seek task and the M&M task.They also conducted a pretest/posttest of an untrained false-belief task, the Sally-Anne task.All participants learned to pass the hide-and-seek task and the M&M task and improved their performance on the Sally-Anne task during the post-test.

Summary of this replication's findings
The primary objective of this study was to replicate new data on 12 time points between August 8, 2023, and January 8, 2024, to show the impact of ABA treatments in a retrospective chart review of 62 individuals with ASD treated with ABA over 12 time points covering five months.The statistical results suggested that ABA intervention over 12 time point measurements significantly increased target behaviors.Expressly, the multiple comparisons between each time point indicated an upward trend of improvement and statistically significant differences between time points in time points 1-8 (p < 0.05), with moderate to high effect sizes (-0.545 to -1.06).There were non-significant mean differences in time points 9-12 (p > 0.05) with minor to moderate effect sizes (-0.128 to -0.361).
The secondary objective was to determine whether an association existed between the 12 time points and age categories.We hypothesized that the children receiving ABA therapy would significantly progress toward targeted general behavioral goals.The secondary hypothesis was that time would significantly interact with age categories, thus yielding significant effects between time and age categories, namely improvement in target behaviors as indicated by time point mean differences.This hypothesis was confirmed within the one-to four-year, five-to-eight-year, and most of the nine-to 12-year categories.This hypothesis was partially confirmed as there was some significance within the 13-16 year age group and not established as there was no significance within the 17-26 year age group.

Comparison with original studies
This study's results resembled those of Peterson et al. [11][12][13], with statistically significant findings on the impact of ABA treatments in a five-month snapshot of 62 autistic individuals.Like the first three studies, functional analysis, which consisted of discrete trial training and mass trials within a naturalistic environment, was utilized within a natural environment.Unlike the second study [12], we found a statistically significant interaction (time x age) within many age groups, as mentioned above.

Implications
Our current research presents evidence that may increase confidence in the results of the first three studies [11][12][13].The multimodality of discrete trial training and mass trials within a naturalistic environment with autistic children enhances the development of cognitive, language, social, and adaptive skills.The steady increase in this replication study with general target mastery behaviors over the designated 12 time points, covering five months, is noteworthy.Ongoing studies of general ABA broad effectiveness, with large-N studies, can lead to studies to further improve quality and service and support evidence-based practices and improvement [35].

Limitations
There are limitations to this replication.A convenience sample was used and could not be generalized to any larger population.With non-random (convenience) samples such as the one analyzed in this study, there is no ability to generalize results to more extensive circumstances (the population).With random samples, however, whereby every member of the population has an equal likelihood of being selected for the research, this type of sample is as representative of the population (theoretically, anyway) as it can be.Why?Because every member of the population had an equal likelihood of being selected, the likelihood of numerous confounding variables biasing our results is reduced, and we can generalize our sample results back to the population from which the sample was selected.Such is not the case with this sample.Furthermore, given the nature of this multimodal approach, it was impossible to determine statistically significant differences between the groups relative to discrete trial training, mass trials, and naturalistic environment training.
Peterson et al. [11][12][13] emphasized limitations regarding the seven threats to internal validity, which are always potential sources of bias in repeated measures analyses.Regarding the impact of history, extraneous variables may not be part of the study, or any external events that may have affected outcomes.Maturation involves age-related bodily changes and includes age-related physical changes that can occur with time, such as hunger, tiredness, fatigue, wound healing, surgery recovery, disease progression, etc. Testing relates to the notion that the test may affect the individuals' responses when tested again.These are less of an issue when the tests are routine.Instrumentation refers to any change in measurement ability, including that of any judge, rater, etc. Statistical regression is the tendency for individuals who score extremely high or low on a measure to score closer to the mean of that variable the next time they are measured on it.Selection refers to the potential bias in selecting participants who will serve in the experimental and control groups.Mortality refers to the differential loss of study participants, drop-out rate, or attrition [36].
This is a mixed repeated measures analysis using a within-subjects design.The subjects served as their own control.No "control group" was used as ethical issues precluded the withdrawal of treatment intervention for the research subjects.There is a need in the literature to analyze discrete trial and naturalistic environment training with repeated measures using large-N designs that call for future studies [11][12][13]35].

Conclusions
This replicative study puts forth further evidence for the ongoing impact of ABA using discrete trial training and mass trials within a naturalistic environment with autistic individuals during a five-month snapshot.Statistically significant mean differences in target behaviors were determined across the 12 time points, and there were statistically significant associations between many time and age categories.Replicative efficacy studies are common and vital for reporting empirical evidence gathered, helping to confirm the reliability of findings.The results indicate a requirement for further research to explore the intricate impacts of ABA on different developmental benchmarks.This could offer insights for tailoring intervention approaches for individuals with autism.We recommend further replicative studies on ABA and ASD to enhance scientific plausibility.

2024
Peterson et al.Cureus 16(3): e56226.DOI 10.7759/cureus.56226 Retrospective chart review data were collected from a cohort of 62 autistic individuals using the Catalyst tracking software (Catalyst Software Corp., New York City, NY) who were administered ABA treatment over a five-month snapshot period from August 8, 2023, to January 8, 2024, measuring cumulative target behaviors.Data collection was conducted at The Oxford Center in Brighton, MI.Reporting and manuscript preparation adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

TABLE 1 : Descriptive statistics for repeated measures
Data have been represented by n, mean, standard deviation, and median.Descriptive statistics for repeated measurements by age groups are presented in Table2.2024 Peterson et al.Cureus 16(3): e56226.DOI 10.7759/cureus.562265 of 29

TABLE 4 : Multiple comparisons using bootstrapped paired samples test Results
Interaction contrasts indicated statistically significant differences (p<.05) over time, mostly within the age categories of one to four years, five to eight years, and most of the nine to 12-year age group.There was some significance (p<.05) within the 13-to 16-year-old age group and no significance (p>.05) within the 17to 26-year-old age groups.Time x age interaction contrasts are presented in Table5.

TABLE 5 : Time x age interaction contrasts
[34]nd & Eldevik[32]conducted a systematic replication with the same synthesized treatments as the original study with a young child with ASD enrolled in a home-based Early Intensive Behavior Intervention program (EIBI).Outcomes were similar, with a marked reduction in problem behaviors and increased appropriate requests.Their findings suggested that it is possible to conduct this intervention in a home setting, with weekly consultations with parents.Their study shows the utility of the synthesized treatment in an EIBI program in a home setting and how this can contribute to client time and costs.Dowdy et al.[34]conducted a systematic replication to evaluate an intervention that did not require escape extinction for increasing compliance with nail cutting.With two adolescents diagnosed with ASD who resisted nail cutting, they assessed the effects of delivering a preferred edible item contingent on compliance with nail cutting.Results indicated that the treatment reduced participants' escape responses and increased their compliance with nail cutting.
[33]r et al.[33]replicated procedures involving learners with ASD in that responding in both full-session and spaced-responding differential reinforcement of low rates of behavior (DRL) schedules were low but not eliminated.Their results provided preliminary evidence to suggest that children with ASD are responsive to signals in DRL arrangements, which may set the stage for evaluating signaled DRL arrangements for socially significant response forms.2024 Peterson et al.Cureus 16(3): e56226.DOI 10.7759/cureus.56226