With so many treatments out there claiming to be effective in helping children with autism, it can be difficult to know what to believe and what to try. When it comes to helping your child, it’s important to focus on evidence-based treatments, rooted in solid science. Behavior interventions using Applied Behavior Analysis (ABA) are supported by many years of research as highly effective forms of treatment for children with autism.
I’ve referenced several important research articles at the end. Since not everyone enjoys combing through scholarly research journals, I’ve summarized findings from some stand-outs here.
Lovaas (1987) looked at early (under the age of 4), intensive, behavioral treatment over a period of at least 2 years vs. less intensive behavioral treatment and other curriculum found in special education classrooms. The results showed that children receiving 40 hours per week of intensive, behavior intervention achieved greater gains than those receiving 10 hours per week. The greatest indicator was that 47% (9/19) of the children in the intensive behavior group achieved IQ scores in the normal range and passed a typical first grade. Of those receiving 10 hours per week, however, none achieved a normal IQ.
(McEachin, Smith, & Lovaas, 1993)
McEachin, Smith, and Lovaas (1993) published a study to follow up on the same children from the Lovaas (1987) study to determine if those children had maintained their gains several years later. The results showed that of those 9 children from Lovaas (1987) who had achieved normal IQ and passed 1st grade, 8 remained in typical classrooms 5-6 years later. In addition, 1 of the 19 students from that intensive group who hadn’t been enrolled in a typical first grade at the time of Lovaas (1987) outcomes, was now in a typical classroom. The mean IQ of the experimental group maintained a 30-point difference from that of the control group.
(Howard, Sparkman, Cohen, Green, & Stanislaw, 2005)
It seems like it would make sense that anyone receiving that much treatment of any kind would do better than someone receiving less. Howard, Sparkman, Cohen, Green, and Stanislaw (2005) set out to look at whether it was intensive ABA, or if a mixture of treatments at an intensive level would yield the same results. They compared groups of preschool-age (2.5-3 years old) children undergoing intensive ABA therapy with those receiving a combination of services fairly typical to a school setting. This class designed for children with autism, included methods such as, Discrete Trial Training, TEACCH, and Sensory Integration, with some students receiving additional services from a Speech and Language Pathologist. A third group received curriculum from a mixture of approaches reflecting a special day class at a public school, but with less intensity. Results showed that those receiving the intensive, behavior treatment outperformed the other groups, achieving higher scores in all domains than both the other groups combined. They achieved scores in the normal range on measures of cognitive, non-verbal, communication, and motor skills. This study, in particular, demonstrates that applying a variety of strategies isn’t necessarily better. Taking an eclectic approach can take away from valuable time for a more intensive, behavior program, which the data show to be more effective.
(Eikeseth, Smith, Jahr, & Eldevik, 2007)
While the focus of the previous studies was on early intervention (mostly under the age of 3), Eikeseth, Smith, Jahr, and Eldevik (2007), a continuation of Eikeseth, Smith, Jahr, and Eldevik (2002), set out to look at outcomes for children starting treatment after 4 years of age. Eikeseth et. al. (2002) reported results after 1 year of treatment. Eikeseth et. al. (2007) followed up on the same children after 2.5 years of treatment. The first group received 28 hours per week of behavioral treatment, while the comparison group received 29 hours per week of eclectic treatment. This eclectic group, like the group in Howard et. al. (2005), consisted of a mixture of ABA, TEACCH, and sensory integration, methods. The children in the behavioral treatment group showed an average increase in IQ of 25 points, as compared to the 7-point increase demonstrated by children in the other group. In addition to IQ measures, another notable difference was in scores from the Vineland Adaptive Behavior Scales (Sparrow, Balla, & Cicchetti, 1984), which measures communication, socialization, and daily living skills. The behavior treatment group increased scores on the Daily Living Skills domain by 9 points and 20 points on the communication domain. In contrast, the scores of the other group actually decreased by 6 points in daily living skills and 12 points in communication. This study, again, points to the benefits of ABA treatment and the potential detriments of taking a more eclectic approach. In addition, results suggest favorable outcomes can still be achieved for children beginning services at a slightly older age.
There is always more research to be done, and the field of Applied Behavior Analysis keeps it coming. Not only is there evidence for the effectiveness of ABA, but Behavior Analysts tirelessly research our methods, as well. There are several well-respected publications consistently churning out peer-reviewed research articles. Three big ones publish volumes on a quarterly basis: Behavioral Interventions, since 1986, The Journal of Applied Behavior Analysis, since 1968, and The Journal of the Experimental Analysis of Behavior, since 1958. Needless to say, that’s a lot of scientific research.
There are a lot of options out there, but if you’re researching for your child, I urge you to include scientific research. The following list of research is by no means exhaustive, but a good place to start in examining how well ABA works as a treatment for children with autism. Applied Behavior Analysis persists, because it’s effective. In addition to solid science telling me this, I have many years of experience, where I’ve seen the effects first-hand. I’ve seen it depicted in graphs of meticulously collected data; I’ve seen it in once non-vocal children now holding a conversation; I’ve seen it through years of parents reporting success for their children and grateful for the role ABA has played.
- Cohen, H., Amerine-Dickens, M., & Smith, T. (2006). Early intensive behavioral treatment: Replication of the UCLA model in a community setting. Developmental and Behavioral Pediatrics, 27, S145-S155.
- Eikeseth, S., Smith, T., Jahr, E., & Eldevik, S. (2002). Intensive behavioral treatment at school for 4- to 7-year-old children with autism: A 1-year comparison controlled study. Behavior Modification, 26, 49-68.
- Eikeseth, S., Smith, T., Jahr, E., & Eldevik, S. (2007). Outcome for children with autism who began Intensive behavioral treatment between ages 4 and 7: A comparison controlled study. Behavior Modification, 31, 264-278.
- Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatment for young children with autism. Research in Developmental Disabilities, 26, 359-383.
- Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.
- McEachin, J. J., Smith, T., & Lovaas, O. I. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal on Mental Retardation, 97, 359-372.
- Rogers, Sally J. and Vismara, Laurie A. (2008). Evidence-Based Comprehensive Treatments for Early Autism. Journal of Clinical Child & Adolescent Psychology, 37:1, 8-38.
- 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.
- Smith, T., Groen, A. D., & Wynn, J. W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal on Mental Retardation, 105, 269-285.
- Sparrow, S. S., Balla, D. A., & Cicchetti, D. V. (1984) Vineland Adaptive Behavior Scales. Circle Pines, MN: American Guidance Service.