Andresa De Souza and her co-authors Carlos Henrique Santos da Silva and Guilherme Filgueiras recently published their research paper, “Applied Behavior Analysis Interventions for People With Autism in Brazil: A Systematic Literature Review,” in the Review Journal of Autism and Developmental Disorders. (Photo by Derik Holtmann)

After spending hours upon hours analyzing research studies on applied behavior analysis, Andresa De Souza is thrilled to finally be sharing her findings.

“It feels great to take it out of my in-process folder to my completed folder,” she said. “Conducting a literature review, it is a lot of work. People think it’s not – I don’t have to talk to people and just sit here in front of my computer and read articles – but it’s a lot of work. So, it’s great.”

De Souza, an assistant professor of special education at the University of Missouri–St. Louis, and her co-authors Carlos Henrique Santos da Silva and Guilherme Filgueiras recently published their research paper, “Applied Behavior Analysis Interventions for People With Autism in Brazil: A Systematic Literature Review,” in the Review Journal of Autism and Developmental Disorders.

The study explores the use of interventions based on applied behavior analysis for individuals with autism in Brazil. De Souza noted that there is much existing research on the subject, but it’s mostly conducted in places such as the United States and Western Europe. She said this research will contribute to a better understanding of the use of ABA in low- and middle-income countries such as Brazil.

“We don’t see a whole lot of research done with children or individuals with autism in other countries,” De Souza said. “So, we really lack that representativeness of different cultural backgrounds and people speaking different languages with different conditions. What are the effects or effectiveness of this intervention when it’s actually implemented with this other population? I think it’s good to bring awareness to that.”

Applied behavior analysis, typically abbreviated as ABA, is a long-established area of psychological science focused on understanding the variables that affect behavior and explaining why people act the way they do. ABA takes those insights and then utilizes them to manage behavior through individualized interventions guided by a mental health or education professional.

The goal is to increase positive behaviors and reduce negative behaviors, which ideally will make meaningful positive change in people’s lives. A common misconception is that ABA is only for individuals with developmental disabilities. In fact, the principles of ABA can be applied to improve any context where people are “behaving,” such as organizations, schools, higher education and the community in general.

De Souza explained that ABA has become particularly known for its effectiveness with autistic people and people with developmental disabilities in the past several decades. For the better part of the 20th century, people with intellectual and developmental disabilities often did not receive the care they needed and, in some cases, were institutionalized. But ABA interventions began to show promise with the group, teaching people new skills and helping them live more independent lives.

“That’s where it started,” De Souza said. “When people saw the result, it led to a lot of funding and research opportunities. That all led into a situation where we are today, where insurance typically approves intervention with ABA for so many hours.”

It’s also led to a situation where De Souza and her co-authors were able to secure funding for their study from Instituto Spectra, a Brazilian nonprofit dedicated to supporting autistic people through research, training and service. De Souza; Santos da Silva, who recently finished his master’s at Brock University in Canada; and Filgueiras, an associate professor at the Universidade Estadual de Londrina in Brazil, are all natives of Brazil, which led them to focus specifically on the country.

Ultimately, the aim of the project was to identify the overall scope of ABA research in Brazil and the demographics that have been served in that research. Additionally, the researchers evaluated the quality of the studies that have been published.

The primary takeaway from the study is that there is a distinct lack of quality research on ABA interventions in the country despite the presence of many practitioners. Through a systematic literature review, De Souza and her co-authors were only able to find 59 research articles that met their criteria for inclusion in the study. Of that total, 14 met the study standard for quality research, while 10 met the standard “with reservation.” The remaining 35 articles did not meet the standard.

“Most of the research did not meet the minimal quality criteria that’s established by organizations that we follow to evaluate research,” De Souza said. “I think there’s different reasons for that. One is resources, and not only financial resources, but human resources.”

Some of the major issues the researchers encountered included a minimal number of data points, experiments not designed to effectively demonstrate the effect of ABA interventions and a lack of interobserver agreement, which means that there are two people checking the same data to ensure it is reliable.

De Souza is optimistic that the study’s findings will help spur more high-quality research in Brazil. However, she stressed that studies on ABA in places like the United States have shown the effectiveness in addressing the needs of autistic individuals. There just needs to be more investigation into potential cultural adaptations in low- and middle-income countries like Brazil.