Research supporting ABA treatment
Autism ABA Study
A review of educational interventions for children with early autism (with a mean age of six years or less) found that ABA is well established and no other educational treatment is considered probably efficacious. Intensive ABA treatment that is carried out by trained therapists was found to be effective in enhancing general functioning in pre-school children.1 __Myers and Johnson, with the Council on Children with Disabilities, found that intensive, sustained special education programs and behavior therapy early in life can help children on the autism spectrum acquire self-care, social, and job skills.2__1 Eikeseth S (2009). "Outcome of comprehensive psycho-educational interventions for young children with autism". Res. Dev Disabilities 30 (1): 158â€“78._2 Myers SM, Johnson CP, Council on Children with Disabilities (2007). â€œManagement of children with autism spectrum disordersâ€. Pediatrics 120 (5): 1162â€“82.
Lovaas Young Autism Project
Before ABA, the prognosis for children diagnosed with autism was poor. Most parents were advised to place their children in institutional settings, and were given little or no hope for improvement. Children were kept in these institutions, and moved from wards with same-aged young children, to those for teenagers, young adults, then older adults, without much improvement over time. Common treatment at that time was to remove children from their mothers and place them in a psychiatric facility where psychiatrists, psychologists, and nursing staff would provide care and â€œunconditional loveâ€ with the intent of furthering the childrenâ€™s development. Such â€œloveâ€ treatments failed to document progress or support claims of improvement with any empirical data.
Dr. Lovaas began to develop appropriate treatment for children with autism, motivated by the lack of effectiveness from previous treatments and influenced by the current information available concerning how people learn (known in psychological terms as â€œoperant conditioningâ€).
The Lovaas 1973 Study
â€œSome Generalization and Follow-up Measures on Autistic Children in Behavior Therapyâ€
In an attempt to identify pivotal skills that may remediate autism, Dr. Lovaas attempted to teach language to young children with autism.
20 children with autism, ages 3 to 7 years old.
Discrete Trial Training in adherence with Applied Behavior Analysis principles and procedures.
Treatment was given in a hospital or home setting.
Discoveries were recorded 1-4 years after treatment:
Children learned with behavior intervention, which was a major discovery at the time. In the past, most children with autism were placed in hospitals where extreme behavior difficulties interfered with learning. Hence, it was previously thought that children with autism could not be taught language.
Although gains were made, there was no pivotal or critical behavior identified. Learning one skill did not mean a child would learn another skill.
Younger children, below 4 years of age, made more gains than older children.
The children of parents who were involved in the treatment received training in how to implement behavior therapy in the home environment made more gains. Parents were not only able to maintain the skills of the child but taught the child new skills.
As a result, this research demonstrated the need for:
As a result of discoveries from the 1973 study, Dr. Lovaas created a more rigorous and comprehensive study. He included the original treatments that contributed to the positive change in children from the 1973 study, including comprehension, early intervention, parental involvement, and home-based treatment.__Dr. Lovaas set up three different groups, each based on age, IQ, and diagnosis. At the onset of treatment, children were under 3.5 years of age. Most were in treatment for an average of 2 years.
Experimental Groupâ€”19_Avg. 35 to 40 hours of 1:1 behavioral intervention per week_Started before 3.5 years old (32 months)
Control Group 1â€”19_Received 10 hours of 1:1 behavioral intervention per week_Started before age 3.5 years old (35 months)
Control Group 2â€”21_No contact, referral group_Not significantly different from the other groups Assignment into Groupsâ€”Based on staff availability, varied independent of the client and made prior to contact with the client._Groups equivalent on 19 of 20 variables. They did vary in age (higher for control group, but age was not correlated with best outcome)
Experimental Group_IQ = gained up to 19 points, some gained up to 40 points, 9 out of 19 achieved typical IQ (avg. 107)_(9/19 = 107 IQ, 8/19 = 70IQ, and 2/19 = 30 IQ)_Classroom Placement = 9 out of 19 achieved typical classroom placement, 8 placed in language delay/aphasia classroom, 2 placed in classroom with children with autism_
Control Groups 1 and 2_IQ = on the avg. minimal gain (1/40 = 99 IQ, 18/40 = 70 IQ, and 21/41 = 40 IQ)
After 2.5 years of behavioral treatment, the children were subsequently evaluated on school placement and IQ change. School placement was separated into
(1) classroom with typically developing children and no additional school supports,
(2) classroom with children with a language delay,
(3) classroom with children with autism.
Children who received 40 hours of treatment were more likely to be placed in the typical classroom (9 out of 19) or a classroom with children with a language delay (8 out of 19).
Children who received 10 hours of treatment were more likely placed in a classroom with children who had a language delay (8 out of 19) or autism (11 out of 19). None of these children were placed in a typical classroom.
Children who received 10 hours of treatment were similar to the group of children who did not receive behavioral therapy.
Children who received 40 hours of treatment achieved normal IQ functioning. This mirrored their school placement. The average increase was about 30 points and those in the classroom with typical children gained up to 40 points.
Children who received 10 hours or no behavior treatment had IQ scores that remained basically the same.
As a result, the 1987 study demonstrated the following:
40 hours a week of intensive behavioral intervention is optimal.
Children who received 40 hours a week and placed in the classroom with typical children were designated â€œbest outcome.â€
1993 Study â€œLong-Term Outcome for Children with Autismâ€
This study investigated the children from the 1987 study, who were approximately 11 years old in 1993. Dr. Lovaas evaluated their progress to discover whether or not the children had maintained their gains. He also wanted to see if there were residual signs of autism among those children who received 40 hours of treatment and were placed in the typical classroom (designation of â€œbest outcomeâ€).
All children were evaluated on the following:
Additional adaptive behavior measures (behaviors such as communication, daily living skills, socialization, and motor skills)
Those children who received the â€œbest outcomeâ€ designation were given additional evaluations that assessed a broader range of skills including a personality test and clinical interview.
Skills were maintained over time when looking at school placement, IQ scores, and adaptive functioning No residual signs of autism were found in the children considered â€œbest outcomeâ€
8 out of the 9 â€œbest outcomeâ€ children maintained their gains
Replicating the Outcome of The Young Autism Project
Some people were skeptical of the findings from these research studies. Even today, some feel that â€œrecoveredâ€ and â€œbest outcomeâ€ are inconclusive. In an attempt to contribute to the external validity of these findings, the following research has been conducted:
Sallows, G. O., & Graupner, T. D. (2005). Intensive behavioral treatment for children with autism: Four year outcome and predictors, American Journal on Mental Retardation, 110, 417-438.
Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359-383