By Brian M. Conners, Ph.D, BCBA, LLC and Seton Hall University
The Centers for Disease Control (2018) estimates the national rate of children identified with autism is 1 in 59 children. While the prevalence rates of comorbidity of psychiatric conditions amongst this population is unclear, various studies have consistently indicated that 70%-72% of participants with autism had at least one comorbid psychiatric disorder (Lugo-Marin et al., 2019; Collins & Siegel, 2019; Simonoff et al., 2008). Research has shown that anxiety, attention deficit hyperactivity disorder, mood disorders, eating disorders, psychosis and catatonia, as well as tic disorders are common amongst individuals with autism (Belardinelli, Raza, & Taneli, 2016; Simonoff et al., 2008). Given the complexities of treating individuals with autism who have comorbid psychiatric conditions, this increases the importance of behavior analysts being able to work effectively on an interdisciplinary team while simultaneously adhering to their professional and ethical responsibility.
TIPS FOR BEHAVIOR ANALYSTS
Working collaboratively on interdisciplinary team is essential in the treatment of complex cases. Here are some tips for behavior analyst to be able to collaborate effectively:
- Adhere to the Behavior Analyst Certification Board’s (2019) Professional and Ethical Compliance Code. It is important for behavior analyst to review the professional and ethical compliance code while working on interdisciplinary teams as there can be many areas for risk of potential violations. In particular, behavior analyst should look at Code 1.01: Reliance on Scientific Knowledge; Code 1.02: Boundaries of Competence; Code 2.04: Third Party Services; Code 2.09: Treatment/Intervention Efficacy; Code 3.04: Medical Consultation; Code 4.01: Conceptual Consistency; and Code 6.02: Disseminating Behavior Analysis. These codes are just a few to call attention to that are particularly important when working on interdisciplinary teams with various professionals including psychiatrists, neurologists, psychologists, speech therapists, occupational and physical therapists, and other medical or educational professionals that will be involved in working with a client with autism and comorbid psychiatric conditions. It is one where behavior analysts also need to be sure that while they are adhering to their professional and ethical compliance code that they are having an open and honest dialogue with the professionals on the team about potential conflicts of interest they may have with treatment. However, this information needs to be conveyed in a respectful way that does not hurt the interdisciplinary collaborative relationship you are trying to establish with the treatment team.
- Assess Non-Behavioral Treatments Using a Decision-Making Model. Brodhead (2015) published a very well designed decision-making model for examining non-behavioral treatments, which can be beneficial to utilize when working on interdisciplinary teams where non-behavior analytic treatments could be proposed. This model consists of various steps ranging from identification of non-behavior analytic treatments to determining whether the non-behavior analytic treatment can be translated into behavior principles to ultimately deciding if the impact on the client is sufficient to justify compromising the interprofessional relationship you are wishing to establish (Brodhead, 2015). I highly recommend any behavior analyst working on interdisciplinary teams to read this article (reference provided at the end of the blog) to better understand how to use this model to balance our ethical and professional obligations to clients while also being able to work collaboratively with professionals from other disciplines.
- Seek out supervision and training on collaboration. Minimal research to date has examine interdisciplinary collaboration between behavior analysts and other professions (Whiting & Muiread, 2019). Moreover, some researchers have highlighted that most behavior analysts do not have formalized training in how to collaborate with other disciplines (Kelly & Tincani, 2013). This is problematic because behavior analysts do work on treatment teams with various professionals and if behavior analysts are ineffective in establishing those interprofessional relationships then we can run into a situation where behavior analysts can be viewed negatively, which hurts the dissemination of our science. Therefore, I believe behavior analysts should be strongly encouraged that if they do not have formalized training in collaboration with other professionals that they should seek out continuing education workshops on such a topic and consult with other colleagues who do collaboration well and request for supervision in this area.
- Consult research literature from other disciplines. Since there are minimal research studies published at this point on interdisciplinary collaboration in behavior analysis with not many exemplar models for collaboration, it would be suggested that behavior analyst consult research literature on collaboration from related disciplines, such as psychology. This will at least provide behavior analysts with models that could perhaps be generalized to our profession until more models are published specifically for behavior analysis.
- Consider how you are modeling collaboration to supervisees. Many behavior analysts provide supervision to behavior technicians and candidates studying to become behavior analysts. It is extremely important to be mindful when supervising future generations of behavior analytic professionals that we are modeling how to collaborate with other disciplines effectively in order to produce quality outcomes with clients, such as those with autism and comorbid psychiatric conditions. Failure to model appropriate collaboration behaviors to supervisees will create a perpetual cycle of producing behavior analytic professionals that are viewed negatively in the interdisciplinary collaboration process. Therefore, supervisors need to model and reinforce appropriate collaborative behaviors to shape future generations of professionals in the field.
In closing, behavior analysts are a vital part of the treatment team for individuals with autism and comorbid psychiatric conditions. Therefore, it is important for behavior analysts to balance their professional and ethical standards while maintaining the integrity of the interprofessional collaborative relationship to ultimately benefit the client.
Brian M. Conners, Ph.D., BCBA is a New Jersey Department of Education certified school psychologist and a Board Certified Behavior Analyst. He is the Chief Executive Officer of Brian Conners, BCBA, LLC, which is his private practice in behavior analysis where he provides consultation, public speaking, and mentorship to ABA business owners. He originally developed the graduate program in Applied Behavior Analysis at Seton Hall University, where he currently serves on their faculty. He has worked within various sectors as a behavior analyst and consultant including public and private schools, psychiatric hospitals, and community agencies. He also was the former owner and Chief Executive Officer of a nationally recognized Behavioral Health Center of Excellence for four years in private practice. He specializes in providing behavioral treatment to clients with severe developmental disabilities, emotional and behavioral disorders, and psychiatric conditions. His clinical areas of expertise include crisis intervention, behavioral assessment, and providing treatment and interventions for clients with the severe problem behaviors of physical aggression and self-injury. He has presented at state and national conferences and has published articles and book chapters in multicultural and diversity issues in behavior analysis, crisis intervention, and restraint and seclusion practices in schools.
Behavior Analyst Certification Board. (2019). Professional and ethical compliance code for behavior analysts. Retrieved from https://www.bacb.com/wp-content/uploads/2017/09/170706-compliance-code-english.pdf
Belardinelli, C., Raza, M., & Taneli, T. (2016). Comorbid behavioral problems and psychiatric disorders in Autism Spectrum Disorders. Journal of Childhood & Developmental Disorders, 2(11). doi: 10.4172/2472-1786.100019
Brodhead, M. T. (2015). Maintaining professional relationships in an interdisciplinary setting: Strategies for navigating nonbehavioral treatment recommendations for individuals with autism. Behavior Analysis in Practice, 8(1), 70-78. doi: 10.1007/s40617-015-0042-7
Center for Disease Control. (2018). Prevalence of Autism Spectrum Disorder among children aged 8 years – Autism and developmental disabilities monitoring network, 11 sites, United States, 2014. Retrieved from https://www.cdc.gov/mmwr/volumes/67/ss/ss6706a1.htm
Collins, H. C., & Siegel, M. S. (2019). Recognizing and treating comorbid psychiatric disorders in people with autism. Retrieved from https://www.psychiatrictimes.com/special-reports/recognizing-and-treating-comorbid-psychiatric-disorders-people-autism
Kelly, A. & Tincani, M. (2013). Collaborative training and practice among applied behavior analysts who support individuals with Autism Spectrum Disorder. Education and Training in Autism and Developmental Disabilities, 48(1), 120-131.
Lugo-Marin, J. et al., (2019). Prevalence of psychiatric disorders in adults with Autism Spectrum Disorder: A systematic review and meta-analysis. Research in Autism Spectrum Disorders, 59(2), 22-33. https://doi.org/10.1016/j.rasd.2018.12.004
Simonoff E., Pickles A., Charman T., Chandler S., Loucas T., & Baird G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 921–929. doi: 10.1097/CHI.0b013e318179964f
Whiting, C. C., & Muirhead, K. (2019) Interprofessional collaborative practice between occupational therapists and behavior analysts for children with autism. Journal of Occupational Therapy, Schools, & Early Intervention, 12(4), 466-475, DOI: 10.1080/19411243.2019.1672603