Behavior Analysis in Practice

https://doi.org/10.1007/s40617-023-00888-9

SI: COMPASSION IN APPLIED BEHAVIOR ANALYSIS

Compassion: The Eighth Dimension of Applied Behavior Analysis

Ashley M. Penney1 · Katherine J. Bateman2 · Yev Veverka2 · Adriana Luna2 · Ilene S. Schwartz2

Accepted: 6 November 2023

© Association for Behavior Analysis International 2023

Abstract
Applied behavior analysis (ABA) is rooted in the conviction that behavior change can lead to improved quality of life. The
goal of ABA has always been to help our consumers achieve outcomes and milestones that are important to them and improve
their lives in ways that they choose. For more than half a century, this approach has proven successful. But we are now hear-
ing increasing concerns about problematic application of behavioral principles, suggesting that as our field has grown, we
may have lost sight of client-centered interventions and outcomes. In this article, we propose a reconceptualization of the
practice of ABA, adding compassion to the current dimensions that have represented our field since 1968. Adding compas-
sion as a definitional dimension of ABA will help behavior analysts find their way back to implementing interventions in
a responsive, collaborative, and humble manner that includes working with our consumers and our critics, and listening to
perspectives that can help us improve our practice.

Keywords Autism · Applied behavior analysis · Compassion · Empathy · Beneficence

Applied behavior analysis (ABA) is “a self-examining, et al., 1985; Chhokar & Wallin, 1984) to education (e.g.,
self-evaluating, discovery-oriented procedure for studying Horner & Sugai, 2015; Ruggles & LeBlanc, 1982). As a
behavior” (Baer et al., 1968, p, 91). In the 50+ years since field, we have demonstrated that we can help people who
Baer et al. wrote their seminal article defining ABA, the field receive our services change their behavior in meaningful
has developed and grown in remarkable ways. The science ways, and these services can result in improvements in the
behind ABA has led to improvements in the quality of life quality of life of people who participate in them (Schwartz
for autistic people1 and people with intellectual and devel- & Kelly, 2021).
opmental disabilities (I/DD) (e.g., Estes et al., 2021; Lovaas, ABA has always been about compassion, values, and
1987; Reichow et al., 2012). It has enhanced treatment for optimism. It emerged as a response to clinical dilemmas
addiction (e.g., Silverman et al., 2011) and supported pro- that could not be answered through existing approaches in
gress in areas ranging from workplace safety (e.g., Balcazar the mid-20th century. In its earliest iterations, educators and
researchers collaborated to resolve clinical challenges they
1 could not address alone. For example, Wolf et al. (1963)
Language is a powerful and sometimes hurtful tool. Although many
of us have been taught to use person-first language, many autistic taught a young boy to wear his glasses so that he would
adults prefer identity-first language. Our practice is to begin interac- not lose his vision. Allen et al. (1964) taught students with
tions using the majority preferred identity-first language, but once a and without disabilities to play together during recess. After
person expresses a personal preference, we use the type of language
observing limited language skills of kindergarteners who
they prefer. We have tried to be intentional and respectful throughout
this article in our use of language. had attended Head Start, Hart and Risley (1968) developed
incidental teaching, a fundamental instructional strategy still
used by behavior analysts and early childhood educators
* Ashley M. Penney throughout the world, to improve the quantity and quality
aberger2@uw.edu of children’s verbal skills.
1
The University of Washington Autism Center, University
Not all outcomes have been good ones, however.
of Washington, Box 357920, 1701 NE Columbia Road, Although most practitioners and researchers implement
Seattle, WA, USA behavioral practices in an ethical and humane manner, there
2
The Haring Center for Inclusive Education, College are key examples where best practices in ABA have not been
of Education, University of Washington, Seattle, WA, USA

Vol.:(0123456789)
 Behavior Analysis in Practice

implemented (e.g., Sohn, 2020; Summers, 2022; Veverka, types of behaviorism that preceded it (e.g., experimental
2022). Some organizations providing ABA services have analysis of behavior). In 1968, Baer et al. provided that defi-
grown too quickly to maintain fidelity of implementation nition in their cornerstone article proposing seven principles
and training (Sohn, 2020). In other examples, individuali- or “some current dimensions” of ABA. In 1987, Baer et al.
zation of treatment has been lost during treatment planning revisited these seven dimensions, expanded upon our under-
(Veverka, 2022). For some providers, convenience seems to standing of them, and at that time, highlighted the impor-
have become more important than the applied nature of the tance of the need to revisit them again in 20 years. These
treatment, causing them to lose sight of the most important dimensions have served us well, and the time has come to
outcome, improving the quality of life of the client (Veverka, do as Baer et al. asked us to in 1987 and revisit how they fit
2022). In the most extreme cases, harm was done to many into the current practice of ABA.
clients (e.g., McAllister, 1972; McKim, 2019; Neumeier & In the half century since we first welcomed the seven
Brown, 2020; Summers, 2022). Although many of these current dimensions, our field has amassed a growing vol-
examples come from anecdotal reports or mainstream jour- ume of data demonstrating the fidelity of behavioral methods
nalism, and are not found in peer-reviewed journals, their and effectiveness of behavioral interventions. We are now
messages are important. Our critics are less likely to have a mature science with demonstrated efficacy. It is time to
access to publication in academic journals, but their voices build on our success and learn from the feedback of our cli-
and stories are valuable. Although publication in peer- ent consumers. As behavior analysts, we are committed to
reviewed journals is a gold standard for strong evidence to using evidence-based practices. As a field, it is also time to
support claims, anecdotal evidence can still be included as contextualize these practices in compassion and explore the
a source of social validity. These reports demonstrate the values that will result in improved quality of life for our cli-
social invalidity (Schwartz & Baer, 1991) of the services ents (Schwartz & Kelly, 2021). In 1968, Baer et al. implied
some consumers are receiving. They are not satisfied and compassion throughout their descriptions of the seven orig-
are angry enough to do something about it. inal dimensions. In 1987, they called more explicitly for
The purpose of this article is to build on the emerging defini- compassion through their descriptions of social validity and
tions of compassion in the behavior analytic literature, to pro- through examples included in the applied dimension. In this
pose compassion as a dimension of applied behavior analysis, article, we take it a step further and propose that compas-
and to provide examples for distinguishing compassionate ABA. sion be viewed as an eighth current and essential dimension
We gather to write this article as five women, four white and of ABA. This dimension builds on the descriptions of Baer
one Latina, all neurotypical board certified behavior analysts, et al., answering their call for continual examination of our
who are dedicated to working with autistic children and children science by incorporating 50 years of lessons learned through
with I/DD and other disabilities and their families. Although we practice and societal changes.
have followed different paths to get here, we all work at a major Taylor et al. (2019) described compassionate ABA as a
university. Some of us are parents, some of us are not, and one combination of empathy and action. Building on the definitions
of us is a parent of an autistic child. Some of us have research proposed by others in the field (Lown et al., 2014; Strauss et al.,
positions, some faculty, and some clinical. We are all dedicated 2016; Taylor et al., 2019), we define compassion as acting with
to promoting the quality of life of recipients of behavior-analytic empathy to improve the quality of life of the individuals we
services and concerned about preparing the next generation of serve and their families, as well as to prevent or alleviate current
behavior analysts. We acknowledge that not all behavior ana- or future suffering. Compassion elevates the voice of, and out-
lysts work with autistic individuals and individuals with devel- comes achieved by, the individual at the center of services, and
opmental disabilities. Given that this is our area of focus, most is action-oriented. Compassionate ABA is concerned with the
of the examples included in this article will be shared from this intersection of the procedures, outcomes, and goals, but extends
perspective. Future behavior analysts, as well as the clients that beyond social validity by incorporating humility into practice.
they will serve, and practitioners they will supervise, motivated Finally, compassionate ABA suggests that practitioners are not
us to write this article. the drivers of the program, but are partners, who like all partners
in the process are both learners and teachers.

Our Roots and Looking Ahead

Rising Demand, Service Delivery Problems,
When ABA was in its embryonic stage of development dur- and Issues of Scope
ing the 1960s, behavior analysts worked to define the field,
to establish its methodological rigor, and to demonstrate its One of the challenges facing behavior analysts is to under-
most effective and useful outcomes. Our earliest colleagues stand how the science of ABA differs from the current prac-
needed to understand what differentiated ABA from the tice of ABA. The science of ABA is concerned with how
Behavior Analysis in Practice

we can change behavior to improve the quality of life for to respond. Unfortunately, responses defending a field with so
the people with whom we work. Unfortunately, the current much power and influence can come across as defensive and
practice of ABA is plagued with challenges that make ser- dissonant (e.g., Gorycki et al., 2020; Leaf et al., 2018), and they
vice delivery difficult and cause tension between providers drowned out opportunities for productive discussions, leaving
and clients. These include personnel shortages (Behavior two sides that refuse to compromise and a lot of people who
Analyst Certification Board [BACB], 2022) and criticism stand to lose. In this debate, many behavior analysts, parents,
of behavioral change procedures and outcomes. caregivers, and advocates occupy an uncomfortable middle
The personnel shortage is a serious problem. Rising ground.
demand means that some behavior analysts are taking lead When we hear from clients that our goals, outcomes, and
roles with families without adequate training or supervision procedures are not acceptable, we must remind ourselves
(Sohn, 2020), with some families reporting poor profession- that something about the behavior of behavior analysts led
alism and lack of compassionate care from their providers to these complaints. The behaviors of critiquing and com-
(Summers, 2022; Taylor et al., 2019). At the same time, plaining serve a function, and until we understand that func-
behavior analysts are still learning, along with the rest of tion we will not be able to address the underlying issues
our society, about how to work in allyship with the neurodi- motivating and maintaining the behavior. As a field, we
versity movement. Some autistics do not believe they should must be willing to own criticism and learn from it. Baer
be asked to change their behavior to the extent that most et al. (1968) described the dimension of “analytic” through
behavioral programs encourage. Many autistic advocates are the answer to the question: “How immediately important
concerned that the goal of ABA is to make autistic people is this behavior or these stimuli to this subject?” (p. 93).
appear neurotypical, to suppress the autism and make them The authors suggested that the relationship between the
“fit in” or mask their autism (Autistic Self-Advocacy Net- target behavior and the individual is the most important to
work [ASAN], 2019). We are experiencing growing friction determine the definition of “applied.” For example, the best
within the field and with consumers about what ABA is and person to make a choice about what is socially important
what the scope of intervention should be. As behavior ana- for a young child is often that child’s legal caregiver, and
lysts, our job is not to change behavior based on neurotypical when appropriate, the child. However, behavior analysts and
norms, or to target behaviors solely because they are associ- professionals from other disciplines need to work with the
ated with autism. Our job is to work in partnership with our caregiver to provide appropriate information so that caregiv-
clients, some of whom are autistic people and their families, ers can make informed choices. If we fail to recognize this,
to help them achieve goals that are important to them and our work is no longer “applied.”
learn behaviors that are valued by them.
ABA has always been a practice based on compassion,
values, and optimism. At present, researchers are exploring Rediscovering Our Values
these key characteristics (Kirby et al., 2022; Rohrer et al.,
2021; Taylor et al., 2019) and how they present in current As behavior analysts, we have the advantage of standing
practice. Our science has been built on the partnership of a on the shoulders of giants, the behavior analysts, mentors,
behavior analyst working with a client to solve a problem faculty, family members, people with disabilities, and others
of importance to that client. Individualization—including from whom we have learned our science. We can remain
understanding what clients thought of the importance of the committed to the original seven dimensions of ABA and the
target behavior, the appropriateness of the intervention, and science of behavior analysis while we respond to criticism to
significance of the outcomes—has been key to that process improve our field. We can use them to incorporate opinions
(Rosenberg & McConnachie, 2021; Schwartz & Baer, 1991; from behavior analysts, autistic adults, parents, teachers, other
Wolf, 1978). Encouraging behavior change without input consumers, colleagues from other fields, and implementation
from the client and their family is not, by definition, ABA scientists to build the next generation of behavior analysts.
(Baer et al., 1968, 1987; Wolf, 1978). Who but clients and We have seen the value of this form of adaptation in
their families can determine if the behaviors targeted for medicine (Mellado-Cairet et al., 2019; Zink et al., 2016), in
change are socially important? education (Horner & Sugai, 2015; Rubow et al., 2018), and in
Although these key characteristics are being outlined, many technology (Fedushko & Ustyianovych, 2022).
autistic advocates have simultaneously become vocal and vocif- Behaviorism is a natural science, not a therapy. In 1991,
erous critics of ABA as a practice (i.e., Devita-Raeburn, 2016; Neuringer discussed the value of humility in behavior anal-
Kupferstein, 2018; McGill & Robinson, 2021). Some of these ysis, specifically stating that it “is broadly used to imply
criticisms were made in journal articles, some in TED talks, tentativeness of theoretical and methodological positions,
and many elsewhere on the internet. Anti-ABA voices have willingness to consider alternative views, support for diver-
become loud and persuasive. Some behavior analysts attempted sity, openness to criticism—in brief, a scientific stance that
 Behavior Analysis in Practice

all knowledge is provisional and that one’s most deeply held who benefits from them?” It is time to reconceptualize the
positions must continually be reconsidered” (p. 1). This current dimensions of ABA.
important message was reiterated and built upon recently
by Kirby et al. (2022), suggesting that a lack of humility
continues to plague our field more than three decades later. Reconceptualizing The Dimensions
As with any science, a basic expectation of behavior analysis
is that it changes and improves over time as we learn more. Baer et al. (1968) proposed their original seven dimen-
It is time to codify compassion within ABA. Compassion sions to define a new science of ABA and to evaluate the
requires behavior analysts to show concern for our clients results of research that was applied rather than basic in its
and their families. Behavior analysis has always been dedi- nature. These dimensions provided a bedrock for our sci-
cated to addressing and solving problems that are socially ence and helped consumers, researchers, practitioners, and
important, but compassion requires our field to take a large family members achieve meaningful and lasting behavioral
step forward and consider how the professional behavior of change. Building from this foundation, ABA has grown into
behavior analysts impacts our clients and partners. Unfor- a thriving field of practice that cannot meet all the requests
tunately, our practice recently seems to be contextualized for intervention. Demands for services resulted in unprec-
in profit (Bannow, 2022), rather than compassion. In the edented growth in our field, with now more than half of
field of autism intervention, where private equity firms are certified behavior analysts receiving their training within
taking over many behavioral health agencies, behavior ana- the last 5 years (BACB, 2022). In this attempt to address an
lysts might make recommendations that are motivated by increasing demand for behavioral services, it is possible that
the concerns of their private equity partners rather than the important elements of the applied and analytic nature of our
quality of life of their clients. We may end up prioritizing science may have taken a back seat to easier-to-implement
acquisition of skills in decontextualized clinical settings standardized and prescriptive approaches (Bannow, 2022).
over learning skills in settings where behaviors naturally Although the seven original dimensions remain critical,
occur (e.g., Dixon et al., 2017). We may focus on goals that they are no longer sufficient to define the current practice
are easy to teach, rather than those that address socially of high-quality ABA today. The 1968 article by Baer et al.
important behaviors. Although adaptations to implementa- was titled, “some” current dimensions, not “all.” Codify-
tion may have seemed necessary for financial reasons or ing these dimensions helped define our field. If a study
efficiency, they may have also detracted from an emphasis didn’t meet these dimensions, for example, it did not qual-
on compassion, opening the potential for harm to the quality ify as being ABA. Figure 1 demonstrates the evolution of
of life of people receiving services. Codifying compassion compassion from the original 1968 article by Baer et al.
as a dimension elevates it from an accessory to a neces- through today. In 1968, compassion was implied many
sity in the practice of behavior analysis. It is time for that times in the examples laid out by Baer et al., but the pri-
change. mary purpose of the article was to define and differentiate
In 1978, Mont Wolf described measures of social valid- ABA from the experimental analysis of behavior. In their
ity as integral to our moral compass, as a field, as a way original description of the dimension “applied,” Baer et al.
to measure “complex reinforcers in socially acceptable and discussed how the “behavior, stimuli, and/or organism
practical ways” (p. 213). When we ask ourselves, why we under study are chosen because of their importance to man
are here, behavior analysts respond in similar ways to doc- and society, rather than their importance to theory” (p. 92).
tors, educators, and social workers, we are here to help. We “Effective” was discussed as having practical importance
are here to improve the quality of life of our clients and and altering a behavior enough to be socially important. In
consumers. We are here to make the world a place where 1987, Baer et al. revisited these seven dimensions, extend-
everyone belongs. ing their examples and descriptions from the original 1968
As behavior analysts we have spent much time focusing article, suggesting more focus on compassionate ABA.
on “how” and “what” we do. We use an ever-improving col- They carefully detailed through the description of “effec-
lection of strategies and interventions to change socially tive” the need for measures of social validity. They called
important behaviors and teach new skills. We have lost our out practitioners for focusing on “attractive programs that
way when it comes to “why” we do what we do. Despite don’t solve problems” in their description of “applied” (p.
Wolf’s efforts to restore the heart of behavior analysis in 314). Further, they described the need for modification of
1978, the goalposts of social validity most often continue procedures to fit local and cultural contexts (p. 321). When
to focus on the what and the how of our work (Snodgrass discussing “technological,” Baer et al. stated the need for
et al., 2018, 2022). Therefore, behavior analysts should ask flexibility in application so others can modify programs
the question; “Why am I making these choices about out- to “suit their situation and their contingencies.” When
comes and behavior change procedures for this client, and describing the dimension “effective,” Baer et al. (1987)
Behavior Analysis in Practice

Fig. 1  Progression of compassion within the dimensions of ABA in 1968, 1987, and 2023

suggested that “perhaps the most important remedy of all, compassion as equally fundamental to ABA as the original
however, will be to establish the proper context in which seven dimensions.
to respond to failures” (p. 324). And yet, today our field
is at a crossroads, firmly established in our original seven
dimensions, but still struggling to learn from our mistakes Five Guiding Principles
and improve.
The seven original dimensions differentiated applied A set of five guiding principles that predates the updated
research from basic research. The addition of compassion as BACB’s (2022) core principles has been suggested for
the eighth dimension will help us better serve clients in our behavior analysts to use in making clinical and ethical deci-
current contexts of practice that include clinics, schools, and sions (Kelly et al., 2021). Conversations about the current
other community settings. We need to learn what socially issues in our field are complex and nuanced. Therefore, we
important behaviors are valued and what quality of life looks use the five guiding principles proposed by Kelly et al. to
like to each unique individual, family, and community we support our ability as practitioners to contextualize deci-
serve. And, we need guidance that will help us walk the sion making around compassionate behavior analysis. Ethi-
tightrope between increased demand for services and losing cal principles are important to our practice. They serve as
the individualization that has always made ABA a person- a north star, or overall propositions to describe why we do
alized and unique service. In addition to ensuring that the the work we do and make the decisions we make as behav-
practices are scientifically rigorous and evidence-based, as ior analysts. The following section will explore the defini-
behavior analysts we must ensure that our practices prior- tion of compassion as the eighth dimension of ABA and
itize consumers’ interests. We believe that the new dimen- the associated behaviors and outcomes through the guiding
sion we propose will help us do that. principles of (1) beneficence; (2) inclusion; (3) professional
We are clearly not alone in these concerns (BACB, 2022; excellence; (4) self-determination; and (5) social justice. For
Kirby et al., 2022; Taylor et al., 2019). The 2022 BACB ethi- each guiding principle we will provide an overview of the
cal code was updated to include core principles intended to guiding principle and implications for practice associated
serve as the foundation and framework for the ethical code. with compassionate ABA.
These core principles are (1) benefit others; (2) treat oth-
ers with compassion, dignity, and respect; (3) behave with Beneficence
integrity; and (4) ensure their competence. These additions
are meaningful and have further stressed the importance of Kelly et al. (2021) defined beneficence as engaging “in
compassion as a core value of the field of behavior analysis. practices that maximize their clients’ well-being and avoid
Although most of these core principles focus on the profes- those that cause harm. We understand that behavior-analytic
sional behavior of behavior analysts, the inclusion of com- services are most likely to benefit our clients when they are
passion centers the consumer. The original seven dimen- provided in the context of a trusting and compassionate rela-
sions of behavior analysis have served as a constant and tionship. Where conflicts of interest arise between consum-
consistent foundation for our field. As we learn and grow ers of behavior analysis, we prioritize outcomes for the most
as a field, we update and improve upon our ethical code. vulnerable clients” (p. 494). Behavior analysts, like profes-
Likewise, it is time to update our dimensions and codify sionals in other fields, must first do no harm. This means that
 Behavior Analysis in Practice

the ultimate goal of everything behavior analysts do should we as a field should incorporate into practice as we move
be guided by the well-being of our clients. It can be easy to forward:
believe that our work is accomplishing this goal, especially
when our graphs may demonstrate immediate or significant 1. Social significance requires practitioners to put aside
behavior change. Unfortunately, a beautiful graph does not their personal biases, beliefs, and standardized interven-
sufficiently answer the question about the client’s well-being tion formats when developing goals for clients. Behavior
or the acceptability, sustainability, and cultural relevance of analysts need to consider the contexts in which consum-
behavior change, all of which are important measurements ers exist and focus on goals the consumer and their fam-
for compassionate ABA. A compelling graph also does not ily want and believe to be important for the person. We
identify harm. After all, what is more important: a better propose extending the social significance of the goals
graph or a meaningful outcome? targeted in intervention by considering who we are con-
sulting when making these decisions. What perspectives
Implications for Practice Behavior analysts are accustomed or identities might we need to include in our consid-
to improving practices based on feedback from consumers eration of social significance for this client? Are we
or the emergence of unexpected outcomes. In 1968, Baer considering social significance from the perspective of
et al. said, “If the application of behavioral techniques does neurodivergent individuals, culturally diverse individu-
not produce large enough effects for practical value, then als, society at large, or predominately neurotypical indi-
application has failed” (p. 96). That admonition stands today, viduals? Also, who would benefit from these goals—the
as we hear from consumers that our behavioral techniques individual, the family, or society?
have not “done enough,” have not led to the improvements 2. Social appropriateness requires behavior analysts to
the family hoped to see, or in some cases, have also caused attend to the fit of intervention to the client and their
harm (e.g., McAllister, 1972; McKim, 2019; Neumeier & caregivers. Wolf (1978) discussed the importance of
Brown, 2020). asking whether the procedures are acceptable to the
Another question posed by the founders of our field was, consumer. If a client has questions about a procedure,
“How much did that behavior need to be changed?” (Baer those should be addressed. If a procedure feels objec-
et al., 1968, p. 96). We should couple that advice with the tionable to an individual, it should not be used. As prac-
idea of, “is this behavior interfering with a person's ability titioners, it is not our role to convince consumers of our
to participate in a manner that is meaningful to them?” This application or procedures but rather to find strategies
is important as we learn from autistic advocates about the and supports that are acceptable to consumers and their
impact of intervening on noninjurious self-stimulatory behav- families. This does not mean that we are taking effec-
iors, eye contact, or other neurotypical-normative skills. tiveness and rigor out of our analysis, but it does mean
The most important goal of our work as behavior analysts the addition of compassion. If a consumer or family
will always be the well-being of our clients, research par- member says no to an intervention, behavior analysts
ticipants, students, and consumers. Consumer satisfaction, need to listen and rethink the procedures and interven-
or social validity, is our way of seeking feedback about con- tion plan with family members as active participants.
sumer well-being and measuring the effects of high-quality For example, if a family says no to escape extinction,
intervention. But a review of studies published between behavior analysts need to hear that no means no and
1999 and 2016 found that only 12% of studies in The Journal work to find an alternative way to achieve the desired
of Applied Behavior Analysis included measures of social outcomes.
validity (Ferguson et al., 2019). This finding is consistent 3. Social importance of the effects can be defined as the
with those of other studies, including any measurement impact that the intervention has on the quality of life
of social validity (Snodgrass et al., 2018, 2022). Over the for the consumer and their family. Did the intervention
past few decades, researchers have identified shortcomings solve a problem? Does it provide the consumer with
related to the rigor of measuring social validity, including more opportunities to participate in an authentic manner
reliability and validity (Anderson et al., 2022) as well as in their community? This question bears considerable
psychometric rigor (Fuqua & Schwade, 1986; Schwartz weight as our field grapples with criticisms and unin-
& Baer, 1991). These problems persist and contribute to a tended outcomes of intervention for consumers. Some
lack of understanding of the value of intervention (Ferguson autistic advocates and autistic people are expressing
et al., 2019). trauma because of ABA-based intervention (Anderson,
Interventions should be evaluated based on the social 2023; Kupferstein, 2018; McGill & Robinson, 2021).
importance of behavior change. In particular, Wolf (1978) We must routinely ask not only whether we helped but
identifies the following three areas for evaluation, which also whether we did any harm.
Behavior Analysis in Practice

There are several additional questions, guided by benefi- the caregivers in their life, to help us understand what mean-
cence, for behavior analysts to ask when evaluating compas- ingful inclusion and participation is on an individual level.
sion in their work. For example, how is the client’s life better
after the intervention? Whose life is being improved by the Implications for Practice As behavior analysts, we must
client acquiring this skill? How is the behavior analyst seek- remember that children exist within systems (Bronfenbren-
ing feedback from clients? Who is providing the feedback? ner, 1996). Instead of fitting a child into ABA, we should
Answers to these questions should inform the behavior ana- be thinking about where ABA belongs within their existing
lyst as to whether or not meaningful goals and outcomes. systems, or communities. Take, for example, a family that
Take, for example, a family whose primary concern is their loves to go to the beach, but the young child does not yet
young child eloping from home. This behavior is danger- have the capacity to distinguish dangerous from not danger-
ous, leaving caregivers constantly on edge and worried about ous. The caregiver shares with the therapist that the family
their child’s safety. Following a functional assessment, the loves the beach, but she does not bring her daughter to the
behavior analyst created a comprehensive program to reduce beach often because she will run through the busy park-
eloping, including environmental modifications such as ing lot, straight into the water, or engage in other high-risk
adding locks on doors and windows. The BCBA shares a behaviors. Teaching the child other things to do while at the
graph with caregivers to show that eloping has significantly beach (e.g., collecting shells, burying toes in the sand) while
reduced, thus is no longer a behavior of concern and they practicing responding to simple safety directions of “stop”
are going to close out the program. However, locks remain or “come back” would allow this family and child to access
on doors and windows, and the parents feel their child is an activity that would likely improve their daughter’s quality
still unsafe in different environments. Elopement remains a of life. Contextualizing instruction changes an instructional
primary concern for the family and should not be closed out program from something that sounds arbitrary to something
until the family is no longer concerned about their child’s that may be life changing for a consumer.
safety in this area. In this instance, behavioral change has not It is important to consider the locations where individuals
occurred to the extent that it actually improves the quality access ABA services. As a field, we often ask families to
of life of the family, nor has this led to a reduction in harm commit their young children to hours of intensive services
for the child or family, indicating that the work of this ABA without requiring practitioners to demonstrate generality to
team is not yet done. We must seek feedback from our cli- meaningful daily activities and events that matter to the child
ents about the outcomes that matter to them, with the focus and family. Unfortunately, when the outcomes do not match
remaining on the most vulnerable individual. our projections, some practitioners recommend increased
intensity rather than engaging the child and family to con-
sider the fit and relevance of goals and services (Summers,
2022). It is time to innovate our practice, moving towards
Inclusion collaborative integration of behavioral principles within
extracurricular activities such as Little League or soccer
Kelly et al. (2021) defined inclusion as, “authentic partici- practice.
pation in meaningful activities that promote relationships, Pulling children out of school early to go to ABA is a
a sense of community, and an improved quality of life” (p. commonly discussed practice (Raches, 2018). Under the
494). Unfortunately, many families and individuals access- Individuals with Disabilities Education Act (IDEA, 2004),
ing behavior analytic services are faced with decisions all students have the right to a free and appropriate public
between participating in extracurricular activities and fam- education (“Free appropriate public education for students
ily time or receiving ABA services, because there are only with disabilities,” 1996). All children are entitled to educa-
so many hours in a day. These services are presented as a tional services and for some, this may be the only opportu-
therapy to improve quality of life, so it is not surprising that nity they have to participate in their community, so removing
families are missing after school activities, family events, children from free educational services to attend services in
and other extracurricular activities when they are told that a clinic is problematic. Any time someone is profiting finan-
they must participate in a high number of hours to ensure cially from pulling a child out of their community activities
best outcomes. However, as a field we should consider the and participation, we should be required to provide a com-
places where recipients of our services want to spend their pelling answer as to why and how this is in the best interest
time, where they would choose to spend their time if they of the child and family.
were not receiving behavior analytic services. The empha- It is essential that ABA practice aligns with the best inter-
sis on inclusion as a guiding principle for compassionate ests of the child and family. Rather than pulling children
behavior analysis means that we may need to program for out of school, we should as a field be advocating for inclu-
clients outside of clinical settings and allow our clients, and sive education practices, where children can benefit from
 Behavior Analysis in Practice

a free and appropriate public education while getting their than demonstrating proficiency on a task list. Our colleagues
behavioral needs met in that setting. Our goals as behavior have identified humility in particular as vital to our success
analysts should be integrated into individualized education (Neuringer, 1991; Kirby et al., 2022). To be humble prac-
plans (IEPs) rather than separate from school goals, where titioners, we must understand that we have just as much to
children spend most of their time. learn (but likely more) from our clients and their families as
In a system where ABA is funded through insurance they do from us. A colleague once shared with us her motto
companies, access to ABA is indicated by what is deemed for collaboration: “Make friends before you make changes.”
“medically necessary.” Medical necessity means that treat-
ment from a health-care provider is indicated for a specific Implications for Practice Behavior analysts are accustomed
condition or diagnosis, and is not cosmetic, experimental, or to families accessing different types of services for their
purely for convenience (National Association of Insurance child(ren). Yet, although we know coordination across ser-
Commissioners, n.d.). These services should supplement, vices is a facilitator of high-quality intervention and treat-
not supplant publicly funded educational programs to which ment (Schwartz et al., 2017), implementation of our services
children are entitled. Sometimes authentic participation in often occurs in isolation. Through intentional coordination
communities and activities that result in good quality of life and consistency among all team members, outcomes of
may extend beyond what is funded by health insurance. In intervention can be maximized.
this case, it makes sense for practitioners to rethink how Neuringer (1991) pointed out our need to collaborate
these services may be accessed in community services, when referencing research outside of the field of ABA:
schools, and other relevant settings. When considering the “We hinder our contributions to a science by not taking
lifespan of supports that some individuals may require, link- that research seriously” (p. 10). For those unable to secure
ing services solely to schools is problematic, in that services employment in interdisciplinary organizations, service deliv-
end at the age of 21. The problem with insurance as the sole ery models such as Project ECHO (Extension of Commu-
funder for services is that coverage only pertains to issues nity Healthcare Outcomes; Arora et al., 2007) hold promise
deemed “medically necessary.” The real issue facing prac- for supporting resource-efficient ways to conduct such col-
titioners of our field is, how do we support individuals who laboration. Project ECHO is a state-of-the-art approach to
need services in a holistic way? Compassionate care may facilitating virtual, high-quality support, professional devel-
extend beyond our current funding sources, suggesting the opment, and collaboration. Project ECHO teams consist of
need for a funding model that supports this. Although this interdisciplinary university-based experts (hub) and rural
funding implication may extend beyond what is immedi- and/or community-based professionals (spokes) connecting
ately possible for most behavior analysts, there are simple, virtually, via Zoom, to engage in didactic instruction and an
actionable things professional behavior analysts can do in opportunity for telementoring through interdisciplinary case-
the meantime. Behavior analysts can begin asking clients, based support. Common in medicine (Arora et al., 2007;
“where would your family choose to spend time if your child Bennett et al., 2018; Katzman et al., 2016) and increasingly
wasn’t busy with ABA?” “Is there something you wish your popular in education (e.g., Bateman et al., 2023; Hardesty
family could do together or that your child would like to et al., 2020; Root-Elledge et al., 2018; Sussman et al., 2021),
participate in, but barriers are preventing this right now?” the ECHO model and similar case-based learning formats
For now, the onus should be on practitioners to demonstrate could lead to meaningful interdisciplinary collaboration and
that their goals and programs are closely tied and directly professional development for behavior analysts.
relevant to the lives and goals of their clients. Working with other professionals involves myriad com-
plexities that cannot be fully accomplished within one field.
Collaboration is crucial to our work, and behavior analysts
Professional Excellence should collaborate with, among others, educators, speech
pathologists, and occupational and physical therapists. When
Kelly et al. (2021) defined professional excellence as being a behavior analyst sees a client in a school setting, at home,
honest and transparent about one’s skills and scope of com- or in a clinic, there may be more than one professional on
petence and engaging in ongoing professional develop- the team who is present. In both public and private agen-
ment, including analyzing our own practices. Professional cies, multidisciplinary professionals are often not housed in
excellence requires respectful and effective collaboration the same building, which can lead to disconnects, miscom-
with individuals from other disciplines, while maintaining munication, and misunderstandings across disciplines. To
a commitment to data-based decision making. Analyzing provide continuity of care, BCBAs should ensure that they
evidence from different methodologies is encouraged as a are effectively reaching out to all relevant stakeholders in
way of collaborating with others and improving practice” (p. ways that highlight each discipline. Examples of this would
494). Professional excellence for behavior analysts is more include working collaboratively with a speech pathologist,
Behavior Analysis in Practice

together with the family, on communication goals to ensure autonomy. We assist clients in setting and achieving their
that important language development expertise is included in own goals, developing their own agency, and making their
the planning and implementation of communication goals, as own decisions about their own lives” (p. 494). Self-determi-
well as relevance and fit of the goals for the child and family. nation relates to people’s ability to set goals for themselves
The language used by behavior analysts can be adapted to and take action to achieve them. Unfortunately, it is common
facilitate collaboration across disciplines. ABA profession- that the clients we serve are not present in these important
als are often criticized for using ABA-specific terminology conversations, sharing their own wants and needs in their
during times of collaboration, where they should instead intervention programming (Summers, 2022). We hear this
employ more simple terminology because it is established from the disability community itself (e.g., Lynch, 2019),
in research that the use of technical language creates hurdles and it is at the heart of what social validity means for ABA.
for consumers (Becirevic et al., 2016). For example, why But self-determination can be complicated by many factors.
use words like “mands,” and “tacts,” when “request,” and We often find professional and moral gray areas
“label,” may be more effective when communicating with related to informed consent and assent. When safety is
parents and other professionals? Other examples include concerned, for example, there may be times when the
negative connotations that some of our terminology car- ability to follow rules or directions may override client
ries in the common vernacular, such as “consequence” and assent or choice. For example, wearing a seatbelt in an
“negative reinforcement.” When working collaboratively airplane during take-off is not a choice. In some cases,
with parents and providers from other disciplines, language decision-making rights can also extend to parents or to
that is specific and descriptive would be better. nonparental adults via the principle of “in loco parentis”
ABA agencies have the ability to influence a workplace (“in place of a parent”), which allows an adult who is not
culture that values collaboration. In our Zoom-friendly, the child’s parent to make decisions on behalf of a child
post-2020 world, it is now easier to find time for a brief in their best interest. This issue of assent, especially when
meeting with other providers in our schedules. Positive expe- addressing dangerous or potentially isolating behaviors is
riences with collaboration can strengthen beliefs about its complex. Decisions about consent, assent, and treatment
value and increase provider desire to collaborate more in the should always be made with the safety and best interest of
course of practice. BCBAs often operate in an overworked, the individual as the priority (see Breaux & Smith, 2023;
overburdened culture that prevents them from having the Flowers & Dawes, 2023, for more thorough discussion of
bandwidth to collaborate with others. For example, a BCBA assent and consent).
working 60-hr weeks with too many clients on their case- Self-determination means understanding client and family
load will understandably not prioritize additional time to priorities. Although self-determination is a lifespan issue,
talk with other providers. This, however, may lead to dimin- how it is realized changes with age. As behavior analysts,
ishing quality of services. When our field has consistently our job is to help clients and their families achieve outcomes
overworked practitioners, we can begin to lose sight of our that they believe are socially important. We can advise and
“why” and instead only focus on “what” we need to do. provide choices, but we can never determine the social
As individual practitioners within a field, we must be importance, cultural relevance, or acceptability of interven-
willing to enter into what social researcher Brené Brown, tion targets or behavioral interventions.
calls “the wilderness” (Brown, 2017). This means learn-
ing about our shortcomings as practitioners and working Implications for Practice Autistic individuals and individu-
together to solve them. We should meet our consumers and als with IDD should be included in as many decisions about
their families on their turf, where we have left them alone their lives as possible, in chronologically age-appropriate
for too long. We must be prepared to participate in uncom- ways from the beginning of intervention. They should be
fortable discussions with an openness to being wrong and given as many opportunities to make decisions about their
a commitment to working together until we can get it right. lives as neurotypical people are given. For very young chil-
This process may begin with small conversations with other dren this could mean allowing them to make choices about
providers working with our clients or by listening to a parent what to wear or how to play. For older children this could
express concern about our treatment procedures and being mean deciding which activities they want to participate in
willing to make changes based on this feedback. after school. In circumstances when an individual is una-
ble to make decisions for themselves (e.g. young children,
individuals in crisis, individuals with significant support
Self‑Determination needs), a group of people with the person’s best interests in
mind might come together to make decisions based on what
Kelly et al. (2021) defined self-determination as, respecting they believe the individual wants and needs (Rosenberg &
“clients’ rights and promoting client dignity, privacy, and McConnachie, 2021).
 Behavior Analysis in Practice

Our clients and their families have a right to be involved participate in their preferred activities. Practitioners in the
in decision making about their treatment. In recent years, field can lean into opportunities to engage clients and key
the field has noted the importance of client assent in addi- stakeholders in self-determination outcomes by asking ques-
tion to informed consent. Self-determination requires that tions such as, “Where do you want to spend your time?” and
we have informed consent or assent prior to initiating treat- “How can I help you do that?”
ment. In the United States, consent typically can only be
given by an individual who is 18 years of age or older.
For children under the age of 18, consent is often achieved Social Justice
through written agreement from a parent or legal guard-
ian. Assent for services should also be sought from clients Although beneficence, inclusion, professional excellence,
younger than 18 or those who cannot provide informed and self-determination are all crucial guiding principles,
consent. This is not only best practice, but is now required we end on social justice because it is central to determin-
by our ethical code (BACB, 2022; Code 2.11 and 6.04). ing compassionate ABA. Kelly et al. (2021) defined social
Assent-based intervention means asking recipients if they justice as attending “to injustice where they see it, avoid
agree to take part in services and only continuing on with perpetuating inequitable systems, and advocate for change
programming when individuals participate willingly. This to produce equitable systems. We are uniquely qualified to
also means honoring, adapting, and problem-solving when identify controlling and contextual variables that contrib-
assent is withdrawn. Assent-withdrawal might be verbal ute to inequitable educational and service-delivery systems
(e.g. saying “no”) or nonverbal (e.g. pushing a task away, and develop solutions to supplant them” (p. 494). Social
or leaving the room). Continued research and clinical appli- justice concerns itself with the concepts of fairness and
cation of assent-based intervention is needed until this is equity. Although this concept can be applied to a variety of
the norm in ABA. disciplines, we must consider how social justice intersects
Of critical importance to self-determination are factors of with the field of ABA by first highlighting the populations
culture and family values. We must keep families in the driv- of people that have historically been oppressed and suffer
er’s seat for their young children. It is our duty as profession- injustice—namely, people of color and individuals with dis-
als in the field to support parents and work in partnership abilities. The field has been experiencing a movement from
while not overriding their ultimate authority in their child’s autistic advocates banding together to create space and cel-
development. Let us consider the examples of interdepend- ebrate neurodiversity. They have encouraged fellow autistics
ence versus independence in a family’s life. One family may to take pride in who they are. In the United States, we have
place high importance on their child’s independence and fos- also been experiencing a new wave of racial reckoning while
ter skills such as self-advocacy, self-help skills, making deci- our field has been learning how critical it is to acknowledge
sions, and playing on their own. Another family may place family culture and hold it at the very center of our work
high importance on the interdependence of their family unit (Mathur & Rodriguez, 2021).
and foster skills such as helping others, community-building, Despite the many challenges outlined in this article, our
and being a part of the larger group (e.g., family, classroom). field has been growing exponentially in recent years, with
In another example, many families consider deference to be more practitioners entering every year. From 2012 to 2022,
a form of respect, especially when in the presence of elders the number of board certified behavior analysts (BCBAs) in
(Calzada et al., 2010). Other families may value individual- the United States increased by 449%, or 46,585 certificants
ism. Practitioners must work within each family to meet their (BACB, 2022). As the U.S. population continues to grow,
goals, while remembering that many of the research studies so do the ranges of individuals and families from a multi-
that inform our work are based on a white-centered “norm” tude of racial and ethnic backgrounds. Data from the 2020
that often excludes people of color. Census reveal that the white population in the United States
Children without disabilities get to choose, to an extent, decreased from 63.7% to 57.8% since the year 2010 (Jones
what they participate in. We ask them, for example, if they et al., 2020). Our increasingly racially diverse population
want to try soccer or karate. By contrast, children with dis- requires our field to become more culturally inclusive. In a
abilities are often put into hours of ABA without being asked survey conducted by Conners et al., (2019), BCBAs indi-
or without being given a way to explore their interests. As cated feeling that their graduate coursework was lacking in
behavior analysts, we should seek the most effective way cultural responsivity. These behavior analysts call for more
to integrate ABA support with activities and participation robust certification requirements to create a field that sup-
that the child wants to do. This could involve attending soc- ports intersectional ties of disability, race, religion, etc. Cen-
cer practice, gymnastics, or guitar lessons with the child, tering each individual child and family’s values, customs,
or implementing behavior-analytic strategies throughout and beliefs will allow us to humbly and effectively achieve
the child’s day to ensure that the child is able to choose to our goals of improved well-being and quality of life.
Behavior Analysis in Practice

As behavior analysts, we are in a position to work in ally- and therefore should work within the family unit to ensure
ship against oppressive systems and move towards a more that the goals chosen are indeed representative of what they
equitable practice. ABA is grounded in social validity (Wolf, want for their child. For example, Fong et al. (2016) discuss
1978) and in today’s practice we must therefore embed this an example of a behavior analyst who fails to prioritize a
in a way that honors social justice (Pritchett et al., 2021). family’s goals that would increase their child’s participa-
Mathur and Rodriguez (2021) explain that racism, implicit tion in church, a highly valued activity for this family. The
bias, and white supremacy are deeply entrenched in the U.S. adverse outcome in this situation could be a lack of partici-
health-care system and in society, which continue to margin- pation in a meaningful community because the behavior ana-
alize Black, Indigenous, and People of Color (BIPOC). For lyst centered their values and beliefs over those of the family.
behavior analysts, it takes an active, culturally responsive Behavior analysts can and should take action towards cre-
approach to work against this. For example, we can be con- ating a field that centers social justice. For example, practi-
tinuously asking our consumers (e.g., families, or our clients tioners can support organizations that elevate and empower
themselves) if our interventions are providing meaningful practitioners of historically marginalized communities (e.g.,
change, rather than assuming that they are. Behavior analytic Black applied behavior analysts [BABAs], https://​babai​nfo.​
practices are based on decades of research. However, there org/; Latino Association for Behavior Analysis [LABA],
are documented racial disparities in this body of research, https://​www.​laba-​aba.​com/; Asian and Pacific Islander
with white families being much more likely to participate in Association for Behavior Analysts [APIABA], https://​www.​
ABA research than families of color (West et al., 2016). This apiaba.​org/) within the field of ABA in a variety of ways,
is a social injustice. Returning to the definition provided including by becoming members and supporting and elevat-
by Kelly et al. (2021), we are in a position to take action ing the work of our colleagues. ABA graduate programs
on this and ask ourselves, “what are the behaviors that are can also train new practitioners in ways that center social
maintaining the systems that result in disproportionate racial justice, such as reading articles by BIPOC behavior ana-
representation in research?” We can’t assume that the strate- lysts, particularly those that aim to work against oppressive
gies and practices that have been effective in the research of systems (e.g., Pritchett et al., 2021). Behavior analysts make
white children and families are also effective and a good fit decisions every day that lead their clients either closer to or
for BIPOC families if we don’t include them in the process. further from social justice. For example, when training new
The concept of cultural humility aims to reduce the power behavior analysts to work with families on goal selection for
imbalances that inherently exist between a professional (e.g., behavior analytic services, practitioners should be taught to
a behavior analyst) and the client or patient (Fisher-Borne select behaviors that are culturally sustaining and relevant to
et al., 2015). It is critical to remember that behavior analysts the family. In addition, as mentioned previously in this arti-
are already in an inherent position of power. This power cle, behavior analysts should consider the context in which
imbalance is heightened if a white practitioner is working the behaviors will occur and if there are reinforcers in those
with a family of color (Miller et al., 2019). A family of color environments to maintain those new behaviors (Čolić et al.,
may not feel like they can speak up regarding their child’s 2021; Mathur & Rodriguez, 2021). Using social justice as
ABA services for fear that they may lose services (Mathur a guiding principle for compassionate ABA will support
& Rodriguez, 2021). As behavior analysts, we must work behavior analysts in truly centering their clients.
towards undoing assumptions that white, middle class, and
able-bodied American culture is the norm, and all families
or individuals who do not fit this mold are “outside of it.”
Why Does Compassion Need to be the Eighth
Implications for Practice Researchers such as Fong et al. Dimension?
(2016) propose ways to combat a lack of cultural humility
by becoming more aware of our assessment methods in ways Baer et al. (1987) suggested that “codification will evoke
that highlight each family and individual’s unique makeup. more of the necessary professional behavior” (p. 321). It
Not only can we move towards more equitable assessment is for this reason that we are proposing compassion as the
standards, but we can also remember that some assessment eighth dimension. Naming and defining compassion as a
methods may not work for all families such as assessment dimension makes it clear that if our practice is not com-
questions and practices that default to white, middle-class passionate, it no longer meets the standards associated with
norms around mealtimes. Although our field awaits innova- applied behavior analysis. Elevating compassion to a dimen-
tive research to formulate new assessments that more accu- sion of the field allows us to evaluate whether or not our
rately capture a variety of cultures, there are strategies that procedures are compassionate, just as we evaluate whether
we can put into place today. Behavior analysts working with or not they are applied, behavioral, analytic, technological,
families can remember that these assessments may be biased conceptually systematic, effective, or have generality.
 Behavior Analysis in Practice

The original seven dimensions on their own do not ensure work in compassion while identifying what can give way
compassion. Take, for example, a physical prompting pro- or change to meet the needs of autistic and I/DD popula-
cedure for teaching a child to tie their shoe. A case can be tions more effectively. Borrowing a sentiment from Wolf,
made that the goal and procedures fit the original seven we encourage practitioners in the ABA field to reflect on
dimensions. We can say that the goal of shoe tying is applied our own work with a critical eye, to learn our missteps and
and behavioral. Shoe tying is a measurable behavior that struggles, and adapt to meet the needs of individuals we
could be deemed to be socially significant to the individual. work with to the best of our ability. Are we humble enough
A shoe-tying program could be based on behavior change to change our practices? If not, we risk too much. What
principles such as prompt fading, chaining, or shaping and do our years of research demonstrating the effectiveness
written in a way that all those who work with the child could of ABA mean if consumers do not want to access it? The
implement, making it conceptually systematic and techno- reevaluation we propose in this article is needed to ensure
logical. The learned skill would be said to have generality that compassionate, high-quality intervention is provided
when it’s used in various environments. The behavior analyst with a focus on continuous improvement.
implementing the shoe tying program would certainly ana-
lyze data to determine whether the intervention is working
Funding This article was supported in part through funding from the
to consider it effective, regardless of if the child is crying Seattle Foundation.
throughout physical prompting.
Adding compassion as a dimension forces us to pause and Data Availability Data sharing not applicable to this article as no data-
ask different questions about our goals and procedures. Are sets were generated or analyzed during the current study.
we practicing beneficence by maximizing well-being and
avoiding harm? If the child is in distress due to the proce-
Declarations
dures we use, then the answer is “no.” Does shoe-tying lead Conflict of Interest The authors declare that they have no conflict of
to inclusion? Forcing one to learn to tie shoes when there interest.
are other options for footwear (e.g., slip-ons, Velcro shoes)
Ethical Approval This article does not contain any studies with human
doesn’t increase access to environments of their choosing. Are or animal participants performed by any of the authors.
we practicing professional excellence by considering evidence
from different methodologies, or are we just pulling from our Informed Consent This article does not contain any studies with par-
“bag of tricks” because that’s always how we’ve taught shoe- ticipants requiring informed consent.
tying? Are we building self-determination if we don’t allow
our client to withdraw assent from an intervention that feels
aversive or from learning skills that they believe to be a waste
of their time? Finally, and this is an important question, is this References
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