Article Club: The Social Validity of Behavioral Interventions- Seeking Input from Autistic Adults

What Social Validity Is, and Why It Is Rare in ABA

Social validity (do the people involved accept it) is a plain test. It asks whether a plan is useful and fair to the client. The group opened the hour right there. The article treats social validity as a bar for evidence-based practice (methods backed by research). It is not a bonus step.

Two of the study authors are autistic: Zachary J. Williams and Patrick Dwyer. One has provided and supervised behavior analytic services. The other has worked with NDBIs (naturalistic teaching and intervention methods). The authors also cited posts from social media on purpose. They wanted the full range of what autistic adults say about services.

The first question of the hour was blunt. How can a plan work on paper and still fail this test? Data can move while daily life stays exactly the same. One member raised The Sound of Music. The father taught the children to line up to a whistle sound. It worked, and it meant nothing in their daily lives. Context still matters, as the group was quick to add. Kicking a soccer ball may be a strong goal for one child. For a child who cannot yet use the bathroom, that goal waits.

So why are social validity checks still rare in our research and our practice? The group named three reasons worth sitting with. Clinicians feel they already ask, since they talk with parents about quality of life. That focus on outcomes can crowd out the formal check. Much of the field's research is also old. It came before the push for compassionate care. Early studies were busy proving the methods worked at all.

I want to say that some of our research is older too.

From the talk — Pauli Catanese & Jasmine Abdel

Who Answered the Survey, and Who Could Not

The study surveyed 235 autistic adults who answered an online form. Of that group, 120 were female, 44 were male, and 51 were non-binary or genderqueer. Another 21 were unknown, and about 150 lived in the United States. Seventy said they had received behavioral intervention during childhood.

Only about three in four had a clinical diagnosis of autism. The rest identified as autistic without a formal diagnosis. Those 57 adults took a self-scored autism questionnaire online instead. The survey itself was a simple click-through form. Think of the extra-credit surveys you clicked through in college.

Demographics barely changed the ratings in this study. One exception stood out: non-binary adults were less likely to endorse either set of goals. Read the rest of the numbers with two limits in mind. Everyone in the sample chose to join a study on this topic. An online survey also needs a device, reading skills, and the drive to finish.

That last limit hit the room harder than the rest. Many of the clients these clinicians serve could not have taken this survey. Their views on goals and methods are still missing.

the people filling out this questionnaire are able to fill out this questionnaire

From the talk — Pauli Catanese & Jasmine Abdel

The Goals Autistic Adults Backed: Safety, Independence, Quality of Life

The article sorts goals into a hierarchy. Some came back uncontroversial, some controversial, and a third set covered social skills. Goals about safety, quality of life, and independence drew the strongest support.

Independence framed much of what these adults praised. Support went to goals that let a person function as themselves, with less help. Reducing danger scored well for the same reason. These are the goals most treatment plans already lead with. For that part of the work, the study reads as a green light.

Social goals did well too, which may surprise some readers. Adults in the study liked work on talking and on getting along with others. They also backed a focus on autistic children's inner thoughts and feelings. One member made the case plainly. Children learn to name feelings and to read other people. A diagnosis is no reason to skip that lesson.

uncontroversial goals were obviously very highly endorsed

From the talk — Pauli Catanese & Jasmine Abdel

Where They Pushed Back: Normalization, Stimming, Eye Contact

The controversial list had one clear theme. These were goals aimed at normalization (making a person seem more typical). Reducing stimming (self-soothing movement that calms the body) sat there. So did increasing eye contact. The complaint was never about effort or skill on our part. It was about whose standard the goal actually serves.

Eye contact drew the longest debate in the room, with no clean answer. Members admitted their own comfort with eye contact is a preference. Some cultures read it as rude, and others read it as respect. Several said they like eye contact and would still not target it. One offered a softer version: the child turns to look when you say their name. Another raised body orientation (turning your body toward someone) as an item worth studying.

The group landed on a different move: teach self-advocacy (speaking up for your own needs). A simple line from a client to a new adult can close the gap. A client can say: I do not make much eye contact, and I am still listening. That sentence costs nobody anything. It also shifts the work off the autistic person alone. One member asked why we so rarely teach other people how to meet autistic people halfway.

I don't need all my clients to like make eye contact when they say hello

From the talk — Pauli Catanese & Jasmine Abdel

Honor Every Form of a Request, Not Just Speech

Adults in the study were clear on communication: teach it in every form. Speech is welcome where it fits the learner. So are ASL (signs used as a full language), AAC (a device that speaks for you), and PECS (picture cards used to request). All of those forms should be taught, and all of them should be reinforced.

The clinical case here is easy to picture. Some learners may top out at one or two spoken words. Give those same learners sign, and they tell you what they need in full sentences. The study faults our field for ranking one form of requesting above the rest.

The hard part is caregiver buy-in, and the room knew it. One member described parents who refused a device for a child with few clear words. The family waited for failure first, which costs the child time. The room believed research shows a device does not slow speech. Nobody had a citation ready for it. What they really wanted was plain material written for families. Journal articles sit behind paywalls, and the prose is not built for parents.

It says the push for vocal speech is just one example of how neurotypical standards of what is normal, take precedent over autistic needs.

From the talk — Pauli Catanese & Jasmine Abdel

Broad Survey Items Hid the Real Question

Go easy on any single number from this study. The authors built their own tool and called it the Autism Intervention Attitudes Test. Adults rated 19 interventions on a six-point agree scale. The paper reports a percent who endorsed each item and also a mean rating. One table covers goals and another covers practices. The tool has not been used in another study since, so nothing replicates it yet.

Broad wording explains some of the odd results. Improving sensory tolerance landed in the controversial group, which surprised the room. They read that as a wording problem more than a values problem. Tolerating toothpaste protects teeth. Tolerating a disliked fabric may serve nobody. One clinician described a client who dislikes clothing tags, with no formal goal written for it. The team removes the tag when asked instead of targeting tolerance. Increasing school readiness drew the same complaint. It sounds normative until you name the actual skills. Learn in a group, stay safe around peers, follow group instructions.

The rewards item is the one to sit with longest. Only about 35% backed using rewards like candy or stickers to teach new skills. The group picked that wording apart in a hurry. The item said plans should use candy or stickers, not that they can. It also paired stickers with food, which are not the same thing to a family. Our field is sloppy here too. Treats get used without a reinforcer assessment (a check of what motivates someone). Adults in the study favored natural rewards that fit the setting.

I think improving sensory tolerance would be a good thing but they rated it controversial

From the talk — Pauli Catanese & Jasmine Abdel

When a Caregiver Asks for a Normalization Goal

The talk turned to ethics on its own, as these talks do. Say a parent asks you to stop their child from stimming in public. The reason is public judgment, not safety and not health. If social validity means the people involved are satisfied, that parent may be satisfied. The group saw the trap at once. The client is the person who lives in that body.

Autism as a culture framed the rest of the discussion. A child can be born into a culture the parents do not share. Education is the first tool, and it works better than argument. Share what stimming does: it calms the body and lowers anxiety. Short videos from autistic advocates land better than a journal article. One member keeps that kind of clip ready for parent meetings. Hearing it from an autistic adult carries weight a clinician cannot borrow.

Buy-in may still fail, and then professional boundaries do the work. You can name what your practice does and what it does not do. It helps to label each goal out loud for families: quality of life or normalization. Then explain what a normalization goal looks like, in plain words. Eye contact and motor stimming make the clearest examples.

i can work on quality of life goals and prioritize those but normalization goals fall outside of our practice

From the talk — Pauli Catanese & Jasmine Abdel

What These Clinicians Changed in Their Own Sessions

Feelings work came up as a direct answer to the study. Our methods need behavior you can see, so target feelings through behavior you can see. You notice screaming and kicking, then ask the child if they feel mad. Several in the room use zones of regulation (color-coded names for feelings). Name the feeling, name the zone, then pick an option. Speech and occupational therapists use the same frame. The child hears one language across providers.

The sharpest change in the room was about play. One member follows autistic adults who had ABA as children. A common report: they learned to talk at people who are busy. That tracks a habit many of us carry into sessions. We stack blocks with a child and fire questions through the whole game. The fix the group tried is descriptive play (narrate what you are doing). Say what the blocks are, then hand over a red one. Children often drift toward you and ask to join in.

A second play habit came up near the end. One clinician answers every bid for attention right away, every time. Real life will never do that for the child. At some skill levels, a small delay is part of the lesson. The group also wants follow-up research on all of this. Survey caregivers, survey practitioners, and write items that name the context. The last question of the hour was the useful one. Before you write a goal, ask yourself why you are targeting it.

how can you regulate yourself if you don't even know what you're feeling

From the talk — Pauli Catanese & Jasmine Abdel