ABA in the Netherlands 31.01.2013 Dr. Jacqueline J. Schenk School of Pedagogical & Educational Sciences Erasmus University Rotterdam The Netherlands

Outline Diagnosis and prevalence Demand for behavioural interventions for people (of all ages) with autism in the NL Recent change in health care and education ABA-based services in the NL: study results ABA training and education in the NL Conclusions

Diagnosis of Autism

The Netherlands The two control regions were selected because they have similar size populations and a similar socioeconomic class. Schools in each region were asked to provide the number of children enrolled, the number having a clinical diagnosis of ASC and/or two control neurodevelopmental conditions (dyspraxia and ADHD). The participating schools in the three regions provided diagnostic information on a total of 62,505 children. The researchers found school-reported prevalence estimates of ASC in Eindhoven was 229 per 10,000, significantly higher than in Haarlem (84 per 10,000) and Utrecht (57 per 10,000), whilst the prevalence for the control conditions were similar in all regions. Diagnosed autism is more common in an IT-rich region, such as Eindhoven (Philips, ASML, IBM and ATOS Origin) Roelfsema et al. (2011) J Autism Dev Disord

Why this increase? Early diagnosis and screening More (scientific) knowledge of predictors and early warning signals Worldwide Boys: 1:54, girls: 1:252 The Netherlands: 1:100 on average..

After the diagnosis…..in NL ? ?

After the diagnosis (anecdotal) Bereavement groups Psycho-education Parent groups for support Random/inappropriate professional advice regarding effective behavioural interventions

Time to collect some data… 10 ABA (-ish) organisations Questionnaire (structural characteristics) Mission; claimed intervention characteristics staff:child ratio; educational background of staff; no. of hours per child (av/range); number of trainers per child; educational context; materials; admission & exclusion criteria, parent involvement etc. Behavioural observations on site To validate (or not) characteristics of interventions

Used in the NL (in theory) DTT (Discrete Trial Training) PRT (Pivotal Response Treatment) Sonrise Verbal Behavioural Intervention TEACCH (Treatment and Education of Autistic and Handicapped Children) CGT (Cognitive Behavioural Therapy) PECS (Picture Exchange Communication System) Bits and pieces from all of the above (Neidt & Schenk, Wetenschappelijk Tijdschrift voor Autisme, June 2012)

In reality? All had the same mission (i.e. optimal development) Similar in 1:1 training, all private, all working many hours, all working in isolation Huge differences in structural characteristics Educational background of staff Supervision and IRR procedures No of staff working with each child No of children attending the service (range 1-75, av. 20) Criteria for mastery Parental involvement (Neidt & Schenk, Wetenschappelijk Tijdschrift voor Autisme, June 2012)

Recent developments Parents increasingly demand ABA based interventions at all levels of (pre) education Increasing number of organisations offering “ABA” services of variable quality and cost (!) “ABA” services approach us to carry out effectiveness studies

WHY? Parents appear to read more than professionals Schools now responsible for EO “ABA “ services will not be paid by health care system if they don’t provide evidence for effectiveness Teachers working in inclusive schools lack knowledge and training on “behaviour”

Compared to many other countries in Europe, we are very behind

Education & training in NL 8 Dutch universities 8/8 offering Psychology, Pedagogical and/or Educational sciences at BA and MSc level 0/8 offering ABA training

Conclusions… Hardworking professionals and parents of children with autism, but… Eclectic use of early behavioural ABA-based interventions Lack of professional academic training and ABA consultancy opportunities Lack of funding despite the conclusion by Ministry of health (Gezondheidsraad, 2009) about its effectiveness and need for evidence-based practice

The STAMPPP Project Simple Steps in Dutch !-> Parental testimonies, animations, demonstrations, and textural material to teach ABA principles to Dutch parents, professionals, students etc. Maximises learning opportunities for children with autism Enables parents to become proficient in delivering home programs for their children Facilitates the coordination of child learning opportunities at home and school

THANK YOU! schenk@fsw.eur.nl