Data-driven, client-centric applied behavior analysis treatment-dose optimization improves functional outcomes

BACKGROUND: With increasing numbers of individuals diagnosed with autism spectrum disorder (ASD) and with affirmation of applied behavior analysis (ABA) as an evidence-based standard of care for ASD, there has been a proliferation of agencies offering ABA services over the last several decades. Disagreement exists among ABA providers and health plans that reimburse those providers on the optimal number of hours of ABA services that should be reimbursed. This study aims to understand whether children who receive more hours of ABA therapy achieve better outcomes and to evaluate the impact of the COVID-19-induced shift to telehealth clinical supervision on outcomes. METHODS: A retrospective cohort analysis was performed using data from the Vineland 3 Comprehensive Interview Form to assess function throughout ABA treatment. Paired sample t tests, independent sample t tests, Cohen’s D, and Pearson correlations were used to determine relationships between Vineland scores and input variables including hours of service and modality of supervision (in-person vs. telehealth). RESULTS: While statistically and clinically significant improvements in function were observed, children appear to have improved outcomes independent of the number of hours of service received. There were also no significant associations between modality of supervision and Vineland standard scores. CONCLUSIONS: These findings challenge prior research that demonstrated a linear dose–response relationship. By tailoring treatment dosage to the individual client’s needs, providers may be able to better maximize functional progress of the client, to preserve family time, and to utilize health plan dollars more efficiently. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12519-022-00643-0.