Respecting Autonomy and Dignity in Adults with Disabilities: A Review of Preference Assessments and Social Validity
Faculty Mentor Name
Fernanda Oda
Research or Creativity Area
Natural Sciences
Abstract
Behavior analysts have been discussing ways to ensure that respect for autonomy, dignity, and compassion are present when working with adults with disabilities. A focus on dignity within human and legal rights, specifically for this population, could inform an essential need for understanding the social validity of procedures used by behavior analysts. A foundational part of behavior-analytic practice is identifying preferences of the individuals we serve. A preference assessment is an essential tool used by behavior analysts to predict stimuli that may function as reinforcers. To understand acceptability of these procedures by individuals whose preference is assessed, collecting social validity data of preference assessment procedures can inform practices that respect individuals’ choice and dignity. This study reviews and summarizes the literature on preference assessment and its social validity in adults with disabilities from 2013 to 2023 in the Journal of Applied Behavior Analysis. We reviewed 11 studies, of which only one reported social validity data. We discuss implications and future direction.
Purpose
The purpose of this literature review study was to identify and summarize the literature on preference assessments and their social validity in adults with disabilities from 2013 to 2023 in the Journal of Applied Behavior Analysis.
Results
We identified 11 articles (N = 11) that described preference assessments with adults with disabilities during the 2013-2023 period in the Journal of Applied Behavior Analysis. Across the 11 studies, there were 24 adult participants whose ages were specified. Four articles did not specify the ages of participants but instead gave an age range. Of the participants whose gender identity was reported, there were 17 male and six female participants. Three articles did not disclose information about participants’ gender identity. No other demographic data, such as race or ethnicity, was provided in any study. Eight PAs were paired stimuli, two were multiple stimulus without replacement, and one was a concurrent-chain preference assessment. PA locations were schools (N = 5), an adult day center (N = 1), a padded session room (N = 1), a day program (N = 2), an inpatient unit (N = 1), and a therapy room (N = 1). PA materials were edibles alone (N = 3), tangibles alone (N = 1), edibles and tangibles (N = 2), pictures (N = 2), edibles, leisure items, and social attention (N = 1), praise (N = 1) and activities (N = 1).
Researchers collected social validity via a questionnaire in only one of the 11 included studies. Krentz et al. (2016) used a token economy to increase walking in adults. They administered a questionnaire to assess social validity to both the participants and staff prior to the study and after the study. The questionnaires asked questions about both the acceptability of the program and if walking increased due to the program.
Significance
Behavior analysts focus on social validity by ensuring that consumers and the community value treatment goals, procedures, and outcomes (Wolf, 1978). Researchers gather social validity using direct (e.g., evaluating affect and providing choices) or indirect methods (e.g., conducting surveys) (Bahry, 2024). Identifying potential reinforcers for individuals is a necessary part of treatment. Providing treatment choices and preference assessments is a way to respect the autonomy of those we serve (Hanley, 2010). Honoring individual preferences allows practitioners to facilitate the independence and welfare of those we serve (Contreras et al., 2021).
The behavior-analytic literature generally focuses on children or adolescents (Jones et al., 2020). Only 11 out of 57 articles in our search had any number of adult participants. In recent years, however, individuals within neurodivergent communities have expressed concerns about behavior-analytic procedures and interventions (Allen et al., 2024; Veneziano & Shea, 2022). Behavior analysts ensure that interventions are acceptable to individuals by taking social validity data. However, only one of the 11 included studies included any measure of social validity. Future studies should focus on the growing population of adults with disabilities and include social validity data in any form and direct social validity when possible. This would allow behavior analysts to assess the acceptability of the treatment goals, procedures, and outcomes (Wolf, 1978).
Start Date
26-4-2025 10:00 AM
End Date
26-4-2025 1:00 PM
Respecting Autonomy and Dignity in Adults with Disabilities: A Review of Preference Assessments and Social Validity
Behavior analysts have been discussing ways to ensure that respect for autonomy, dignity, and compassion are present when working with adults with disabilities. A focus on dignity within human and legal rights, specifically for this population, could inform an essential need for understanding the social validity of procedures used by behavior analysts. A foundational part of behavior-analytic practice is identifying preferences of the individuals we serve. A preference assessment is an essential tool used by behavior analysts to predict stimuli that may function as reinforcers. To understand acceptability of these procedures by individuals whose preference is assessed, collecting social validity data of preference assessment procedures can inform practices that respect individuals’ choice and dignity. This study reviews and summarizes the literature on preference assessment and its social validity in adults with disabilities from 2013 to 2023 in the Journal of Applied Behavior Analysis. We reviewed 11 studies, of which only one reported social validity data. We discuss implications and future direction.
