Acceptance and Commitment Therapy for Individuals with Disabilities: A Behavior Analytic Strategy for Addressing Private Events in Challenging Behavior
When hidden thoughts keep the behavior alive, ACT gives you a behavior-analytic way to reach them.
01Research in Context
What this study did
Hoffmann et al. (2016) wrote a how-to paper. They asked: what can we do when a client’s challenging behavior is driven by thoughts, feelings, or memories we cannot see?
They focused on people with intellectual or developmental disabilities. They mapped each step of Acceptance and Commitment Therapy onto familiar ABA terms.
What they found
The paper is not an experiment. It is a road map. The authors show that ACT can fit inside a behavior-analytic frame. They give sample goals, data sheets, and scripts.
How this fits with other research
Suarez et al. (2022) and Garcia et al. (2022) later rounded up every single-case ACT study for autism and DD. Both reviews say the evidence is still thin and many studies have bias. This looks like bad news, but it is not a contradiction. Hoffmann et al. never claimed ACT was proven; they only argued it should be tested.
Sandoz et al. (2022) tightened the rules. They warn that ACT must include an explicit functional assessment on each private event or it is not ABA. Their paper updates Hoffmann’s call: you can use ACT, but you still have to do an FA first.
Dixon et al. (2025) go further. They say adopting ACT will force the whole field to rethink how we define reinforcement. The 2016 paper opened the door; the 2025 paper says we may need to rebuild the house.
Why it matters
If your standard FBA keeps hitting a wall—escape maintained but no clear escape—this paper gives you a next step. Add ACT micro-skills like values or defusion to your plan. Track the private event as you would any operant. Start small: one client, one behavior, one ACT move.
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02At a glance
03Original abstract
Applied behavior analysts work with many populations including individuals with developmental and intellectual disabilities. Although behavior analysts have a variety of empirically supported treatments to implement when working with individuals with disabilities, sometimes, other variables may adversely impact treatment effectiveness. The degree to which problematic thoughts and feelings (private events) influence behavior may be a variable that contributes to treatment efficacy. Traditional behavior analytic services are not always equipped to successfully address the private events influencing client behavior. In such cases, it may be beneficial for behavior analysts to consider additional philosophically aligned treatments for private events. One such treatment, acceptance and commitment therapy, may be a useful tool for behavior analysts to incorporate into their toolbox in order to help clients. The purpose of this paper is to introduce behavior analysts to a potential solution to the problem of effectively addressing private events in behavior analytic services. We then propose a model for thinking about private events in relation to clients with disabilities and present a guide for taking steps to address private events in the clinical setting. We conclude this paper with a call for research and present a possible research agenda for behavior analysts.
Behavior Analysis in Practice, 2016 · doi:10.1007/s40617-016-0105-4