Review of Recent Treatment Acceptability Research

With recent increases in the use of positive approaches to treatment for individuals with developmental disabilities, it seems appropriate to review the variables that have been found to influence the acceptability of various treatments. Programmatic treatments for problematic behaviors that incorporate primarily positive (reinforcement) components rather than negative (punishment) components may still be susceptible to variables found to influence the acceptability of treatments. Although more positive reinforcement based approaches are certainly preferred, the need to consider the right to effective treatment is also an important component of any intervention for problematic behavior. To continually assure the right to effective treatment, the examination of variables affecting the acceptance of treatments continues to be an important area of research. This paper reviews the instruments that have been used to evaluate the acceptability of treatments as well as the variables that have shown demonstrated influence on the acceptability of treatments for problematic behavior. Research in the area of treatment acceptability is relatively new to the area of education and psychology with a noticeable increase in treatment acceptability studies occurring during the 1980’s (Elliott, 1988). Recognition of the need for research in the area of social validity became more evident with an elaboration of the topic in an article by Baer, Wolf, and Risley (1968). Prior to this publication, the primary emphasis with regard to educational and behavioral treatments had been treatment efficacy (Witt, 1986). Wolf (1978) stated that social validity refers to decisions based on the social importance of interventions on three related levels. First, objectives of the treatment must be socially significant in which the desired outcome is both important and pertinent. Second, treatment procedures must be deemed as socially appropriate in that they are generally considered acceptable by society. Third, effects of the treatment should have clinical significance. Kazdin (1980) noted that social validity research has mainly focused on the appropriateness of treatment procedures, an area of research also known as treatment acceptability. The term treatment acceptability, a component of social validity, was defined by Kazdin as judgments of treatments by actual or potential consumers of the treatments, such as nonprofessionals, clients, laypersons, and others. For the purposes of this review, treatment acceptability will be defined according to the definition proposed by Kazdin and the terms treatment and intervention will be used interchangeably. Treatment Acceptability Measurement Instruments Two of the most frequently used instruments for measuring treatment acceptability are the Treatment Evaluation Inventory (TEI; Kazdin, 1980) and the Intervention Rating Profile (IRP; Witt & Elliott, 1985). Both of these instruments have been modified and revised in multiple ways by researchers in attempts to address target raters more effectively or to reduce the administration time of the instruments. Because modifications to these instruments have been implemented in various acceptability studies, a review of these two instruments and their subsequent modifications is provided (refer to Table 1). Treatment Evaluation Inventory. The TEI was originally designed to assess treatments recommended for children with behavior disorders (Kazdin, 1980). It consists of 15 items that ask direct questions regarding specific treatment procedures. Ratings are made on a seven point Likert-type scale, with descriptive anchor points that vary depending on the Correspondence concerning this article should be addressed to Stacy L. Carter, 4518 20 St., Lubbock, TX 79407. Education and Training in Developmental Disabilities, 2007, 42(3), 301–316 © Division on Developmental Disabilities Treatment Acceptability / 301