Behavior Analysts’ Use of Autism Treatments: Key Findings from a 2023 Survey
In 2023, a group of researchers conducted a large-scale survey to better understand how behavior analysts are selecting and using treatments for individuals with autism. The results, published in Behavior Analysis in Practice by Marshall et al. (2023), shed light on important shifts—and ongoing concerns—in the field.
This survey matters because it highlights how our field is evolving, which practices remain strong, and where we may be drifting from evidence-based care. Let’s break down the findings in a way that every behavior analyst—whether a Registered Behavior Technician (RBT), Board Certified Behavior Analyst (BCBA), or supervisor—can understand and apply.
📄 Full study citation: Marshall, K. B., Bowman, K. S., Tereshko, L., Suarez, V. D., Schreck, K. A., Zane, T., & Leaf, J. B. (2023). Behavior Analysts’ Use of Treatments for Individuals with Autism. Behavior Analysis in Practice, 16, 1061–1084. https://doi.org/10.1007/s40617-023-00776-2
Who Took the Survey?
A total of 921 behavior analysts responded to the 2023 survey. The breakdown was:
- 51.6% BCBAs
- 41.9% RBTs
- 4.1% BCBA-Ds
- 2.4% BCaBAs
Most participants:
- Identified as female (89%)
- Were between ages 26–30 (20%)
- Were actively treating individuals with autism (95%+)
This demographic represents a diverse and active sample of professionals contributing day-to-day to autism support.
What Treatments Were Evaluated?
The survey covered 31 autism interventions, divided into four levels of scientific support:
1. Established Treatments
(Evidence-based)
- Applied Behavior Analysis (ABA)
- PECS
- Social Stories
- Pivotal Response Training
2. Emerging Treatments
(Some research support)
- Music Therapy
- TEACCH
- Relationship Development Intervention (RDI)
3. Unestablished Treatments
(Insufficient evidence)
- DIR/Floortime
- Gluten-Free Casein-Free Diet
- SCERTS
- Social Thinking
- ACT (Acceptance and Commitment Therapy—outside of scope)
- Early Start Denver Model
4. Ineffective or Harmful Treatments
(Demonstrated harm or danger)
- Facilitated Communication
- Chelation Therapy
- Bleach Therapy
What Are Analysts Actually Using?
Here are the top 10 most used treatments, according to BCBAs:
- ABA – 95.1%
- PECS – 64.4%
- Social Stories – 50.9%
- Pivotal Response Training – 34.1%
- Social Thinking – 15.7%
- ACT – 15.3%
- Early Start Denver Model – 13.2%
- TEACCH – 11.3%
- Sensory Integration Therapy – 11.3%
- DIR/Floortime – 10.5%
The good news: Established treatments top the list. However, several treatments with weak or no scientific support are still being used by a significant number of professionals.
10 Key Trends in the Field
- ABA use has slightly declined from prior surveys (2016 and 2008).
- Over 10% of respondents reported using unestablished methods like DIR/Floortime and Social Thinking.
- Some respondents still mistakenly believe Facilitated Communication is effective.
- RBTs often implement treatment without truly understanding its effectiveness.
- Employer/supervisor suggestions strongly determine treatment use.
- Academic training equals stronger reliance on evidence-based treatments.
- Analyst understanding of terms like “ABA” and “Evidence-Based” varies significantly.
- Some pseudoscientific treatments linger due to client or family demand.
- Analysts mistakenly believe supplements like CBD are scientifically supported.
- Quality supervision directly impacts treatment ethics and implementation.
Problem Areas: Commonly Used Unestablished or Harmful Treatments
Too many behavior analysts reported using these questionable therapies:
- DIR/Floortime
- Social Thinking
- SCERTS
- ACT (outside its validated scope)
- Sensory Integration Therapy
- Gluten-Free Casein-Free Diet
- Early Start Denver Model
- Complementary/Alternative Medicine (CBD, essential oils, vitamins)
- Rapid Prompting Method
- Facilitated Communication (harmful)
- Chelation Therapy (harmful)
- Bleach Therapy (dangerous)
These treatments either lack evidence, are based on pseudoscience, or are outright harmful.
What Influences Treatment Decisions?
The study found that these top variables shaped treatment selection:
- Employer/supervisor pressure
- Colleague or peer use
- Family requests
- Past workplace or internship exposure
- Conference or workshop presentations
For ongoing use, analysts cited:
- Perceived success
- Positive family feedback
- Ease of implementation
- Insurance coverage
- Supervisor support
Surprisingly, direct engagement with scientific journals was not a leading influence, especially among RBTs.
Supervision and Training: A Weak Link?
The report raised red flags around supervision:
- Some RBTs said they never talked to clients’ families about treatment plans.
- Over 95% of direct services are delivered by RBTs, yet often without close oversight.
- Supervisory training and guidance play a big role in ethical decision-making.
- Many supervisors aren't actively correcting misuse of NESTs.
This calls for tighter supervision requirements and competency checks for those in leadership roles.
Ethical Standards Are at Risk
Using unproven or dangerous treatments violates key sections of the BACB Ethics Code, including:
- Section 2.01: Relying on scientifically supported interventions
- Section 2.14: Avoiding treatments with unknown risks
- Section 2.15: Upholding high standards of care
Failure to follow these codes:
- Puts clients at risk
- Damages the reputation of ABA
- Reduces trust from families and communities
Recommendations: Building a More Ethical, Science-Driven ABA Landscape
Improve Training
- Add evidence-based practice modules to university ABA programs
- Use credible resources like the Association for Science in Autism Treatment (ASAT)
- Teach future analysts how to spot pseudoscientific claims
Fix Supervision
- Require skill and competency checklists for supervisors
- Increase case-monitoring for RBT-led sessions
- Hold supervisors accountable for treatment decisions
Engage Families Wisely
- Train analysts on how to discuss NESTs with compassion
- Equip behavior analysts to explain evidence—or lack thereof—clearly and respectfully
- Include families in decision-making, without compromising scientific standards
Final Thoughts
This survey confirms that most behavior analysts still rely on safe, science-backed practices. However, the continued use of questionable or harmful treatments is a serious concern. It’s our responsibility—as a field—to protect the people we serve and ensure every treatment meets the highest standard of evidence and ethics.
📖 Read the full study: Marshall et al., 2023 | Behavior Analysis in Practice
🔎 Want to improve your treatment skills or supervision practices? Start with trusted resources like:
- ASAT
- Behavior Analyst Certification Board Ethics Code
- Slocum et al. (2014) on Evidence-Based Practice in ABA
🚀 Let’s aim for a future where every intervention is thoughtful, ethical, and backed by science.
Got thoughts or questions? Drop them in the comments below!
