topic #3 aba 553 - assessing autism interventions
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Applied Behavior Analysis & it's Effectiveness for Children with Autism. Topic #3 ABA 553 - Assessing Autism Interventions. How Can We Use Science to Study What & How a Child Learns?. We have a scientific branch of psychology that has been developing for SEVENTY years It’s called…. - PowerPoint PPT PresentationTRANSCRIPT
Topic #3ABA 553 - Assessing Autism Interventions
Applied Behavior Analysis & it's Effectiveness
for Children with Autism
How Can We Use Science to How Can We Use Science to Study What & How a Child Study What & How a Child
Learns?Learns?
We have a scientific branch of psychology that has been developing for SEVENTY years
It’s called….Applied Behavior Analysis (ABA)
What is Applied Behavior What is Applied Behavior Analysis? Analysis? (Cooper, Heron, & (Cooper, Heron, &
Heward, 1987)Heward, 1987)
Applied behavior analysis is the science in which
procedures derived from the principles of learning
are systematically applied to improve socially significant behavior
and to demonstrate experimentally that the procedures used were responsible for the improvement in behavior
Why?
Characteristics of ABACharacteristics of ABA(Baer, Wolf, & Risley, 1968, 1987)(Baer, Wolf, & Risley, 1968, 1987)
Applied – behavior is selected because it is
important to society– Specifically, how immediately
important is this behavior or these stimuli to these subjects.
– How does the therapist can describe & solve the subject’s problem?
E.g., society has technological illiteracy; how well can the media explain the problem to effectively generate a government solution?
Characteristics of ABACharacteristics of ABA(Baer, Wolf, & Risley, 1968, 1987)(Baer, Wolf, & Risley, 1968, 1987)Behavioral – treats actual, observable behavior rather
than verbal reports of behavior, feeling and/or attitudes
E.g., Why can’t he sit still, because he has ADHD.
E.g., Why can’t a child with autism talk, because they are not processing sounds correctly.
– Inter-observer agreement data to ensure data are accurate reflections of the subject’s behavior and not recording procedure.
Characteristics of ABACharacteristics of ABA(Baer, Wolf, & Risley, 1968, 1987)(Baer, Wolf, & Risley, 1968, 1987)
Analytic & Conceptual– functional relationship between the manipulated
events and the behavior of interest– Research design– relevance of techniques to principles from which
they were derived. This relates to a principle referred to as parsimony.
– attribute a child’s behavior to the laws of learning theory.
– Only use techniques that have been documented in the scientific literature to be effective.
– Seek the condition under which the intervention has maximal and minimal effectiveness
Characteristics of ABACharacteristics of ABA(Baer, Wolf, & Risley, 1968, 1987)(Baer, Wolf, & Risley, 1968, 1987)
Technological – procedures are identified, defined and
task analyzed Individualized programs
– dissemination
Characteristics of ABACharacteristics of ABA(Baer, Wolf, & Risley, 1968, 1987)(Baer, Wolf, & Risley, 1968, 1987)
Effective – altering behavior in a socially important
manner– How much of that behavior needed to be
changed and has that goal been accomplished?
– Social validity –the extent to which all consumers of an intervention lit it.
Characteristics of ABACharacteristics of ABA(Baer, Wolf, & Risley, 1968, 1987)(Baer, Wolf, & Risley, 1968, 1987)
Generality – behavior change is durable over time and
under a variety of conditions or spreads to a variety of related behaviors.
– How have we helped the child if there is no behavior change at home, at the dentist, at the doctor, in the mall, in the cafeteria, on the playground, in the supermarket
Scientifically Validated Scientifically Validated Intervention for Children with Intervention for Children with
AutismAutism
Applied behavior analysis (ABA) was specifically designed and researched for children with autism
empirically demonstrated to be most effective intervention for children with autism
Research findings have been replicated many times over span of many years (Lovass, 1960; Fenske, Zalenski, Krantz, & McClannahan,
1985; Smith, 1996; Anderson, Avery, DiPietro, Edwards, & Christian, 1987; Lovaas, 1987; Harris, Handleman, Gordon, Kristoff, & Fuentes, 1991; Birnbrauer & Leach, 1993; McEachin, Smith, & Lovaas, 1993; Perry, Cohen & DeCarlo, 1995; Sheinkopf & Siegel, 1998; Green, 1996, 1999; New York State Department of Health, 1999)
Scientifically Validated Scientifically Validated Intervention for Children with Intervention for Children with
AutismAutism ABA treats the entire child
Every aspect/dimension of the disorder Over 500 studies published in peer-reviewed
research journals about teaching many specific skills to children with autism using principles of ABA
General skill domains include: gross motor, fine motor, speech and language, reading, math, leisure, social, self-help and independence
Additional teaching procedures continue to be developed and refined
Applied Behavior AnalysisApplied Behavior Analysis(a/k/a Behavior Management; (a/k/a Behavior Management;
Intensive Behavioral Intervention)Intensive Behavioral Intervention)
“Intensive, behavioral intervention early in life can increase the ability of the child with autism to acquire language and ability to learn.”
“Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior.”
U.S. Surgeon General, David Satcher, M.D., Ph.D.
Applied Behavior AnalysisApplied Behavior Analysis
“All programs educating children with autism should include intensive behavioral interventions and year-round education”.
US Dept. of Education and the National Research Council's Report
'Educating Children with Autism‘ “Since intensive behavioral programs appear to be
effective in young children with autism, it is recommended that principles of applied behavior analysis be included as an important element of any intervention program”.
NYS Department of Health Early Intervention: Clinical Practice Guidelines:
Common Misconceptions of Common Misconceptions of Applied Behavior Analysis Applied Behavior Analysis
(ABA)(ABA)“Applied Behavior Analysis and discrete
trial instruction are synonymous terms and can be used interchangeably.”• Applied behavior analysis actually uses
dozens of teaching procedures; discrete-trial teaching is only one of these.
But…All Teaching Procedures But…All Teaching Procedures in ABA Do Have These in ABA Do Have These FeaturesFeatures (Lovitt, 1995)(Lovitt, 1995)
1. Precise definition and task analysis of new skill or behavior to be learned
2. Direct and frequent measurement of student’s performance of the skill
3. Frequent opportunities for active student response during instruction
4. Immediate and systematic feedback for student performance
4. Procedures for achieving transfer of stimulus control from instructional cues or prompts to naturally occurring stimuli
5. Strategies for promoting generalization and maintenance of newly learned skills to different, non-training situations and environments
Some Teaching Techniques Some Teaching Techniques Used in Applied Behavior Used in Applied Behavior
AnalysisAnalysis Schedule Following
Independent/Model building/Art script Audio/Video Modeling Script/Script Fading Procedures Small Group Instruction Imitation Incidental Teaching Discrete Trial Instruction Fluency Training Task analysis and chaining
More Misconceptions of ABAMore Misconceptions of ABA“You just need to attend a few workshops to ‘do’
applied behavior analysis.”– Actually need someone who has been specifically trained
in the techniques of applied behavior analysis implemented specifically with children with autism.
– Training consists of on-going, hands-on training and supervision ideally by a nationally Board Certified Behavior Analyst (BCBA), preferably at the doctoral level
– To become a Board Certified Behavior Analyst, one needs post-graduate coursework specifically in ABA, supervised or mentored experience by another BCBA, and pass a national exam in behavior analysis (www.bacb.com). These are merely minimal requirements that still do not guaranteed expert clinical skills.
More Misconceptions of ABAMore Misconceptions of ABA
“Behavior analysts spend too much time with their cumbersome data and not with the student.”• Data analysis allows the effectiveness of a specific
teaching strategy to be evaluated. If a child is not learning, we can modify a teaching strategy until the child does learn.
• Data do not need to be collected for every trial• Time sampling• Interval recording• Duration recording• Pre-test/post-test measures
More Misconceptions of ABAMore Misconceptions of ABA
“Applied Behavior Analysis is too structured for how the world actually works; we don’t always get rewards for what we do.”• Behavior analysts teach a child a variety of
functional/useful skills that often lead to engagement in productive activity, meaningful social exchanges, and additional learning opportunities (not necessarily M&Ms!) This may allow a child with autism to have a variety of choices that they previously didn’t have.
• The principles of applied behavior analysis are at work everyday in various situations, just like gravity!
Applied Behavior Analysis Applied Behavior Analysis and “Real Life”and “Real Life”
Functional Relationships: 3-Term Contingency
Antecedent Behavior ConsequenceWife’s birthday Husband makes dinner Wife says “MMM”
Baby’s hungry I feed baby peas Baby gets sick
Too many bills work more hours can pay bills
More Misconceptions of ABAMore Misconceptions of ABA
“Applied Behavior Analysis is just roteteaching and is not functional.”
• We teach on a very concrete level initially and then teach the generalization of behaviors to more natural environments
• This is accomplished by teaching a variety of skills using various different teaching procedures, across multiple settings under multiple conditions.
• Ultimately, these new skills allow children with autism to reciprocate, maintain, and enjoy social exchanges with peers/adults when initially they may have not.
More Misconceptions of ABAMore Misconceptions of ABA
“Behavior analysts say we should use individual treatment, but if all children get ABA, how individualized is that?” Principles of treatment are same in that most children
with autism initially need their skills task analyzed through discrete trial teaching for maximum learning to occur.
ABA, however, has many levels (as does autism) and levels are individualized accordingly for each child.
Each child has his or her own individualized program that uses principles of applied behavior analysis.
A child’s program is not scripted and will be constantly monitored and adjusted based on the data collected to assess effectiveness.
More Misconceptions of ABAMore Misconceptions of ABA
“Applied behavior analysis is only necessary for children with autism or those who are ‘severely disabled’.”• When a child is initially diagnosed with autism,
it is very challenging to predict how the disorder will manifest as the child ages.
• In Lovaas’s research, 47% of the children were mainstreamed into a regular education setting and were indistinguishable from their peers.
• Over the past three decades, applied behavior analysis has been shown to be successful in many, many situations (see next slides!)
Socially Important ProblemsSocially Important Problems(Martin & Pear, 1999)(Martin & Pear, 1999)
Parenting and Child Management – Increase walking skills, language skills, toilet
training, household chores, decrease frequent arguing, failure to comply with parents’ requests
Education: From Preschool to University– Oral reading, reading comprehension, spelling,
handwriting, mathematics, English composition, creativity, science concepts.
Clinical Behavior Therapy– Anxiety, obsessive compulsive disorders, stress-
related problems, depression, obesity, marital problems, sexual dysfunction and personality disorders
Socially Important ProblemsSocially Important Problems(Martin & Pear, 1999)(Martin & Pear, 1999)
Self Management of Personal Problems– Self control, self adjustment, self-modification
Medical & Health Care– Seizure disorders, chronic pain, addictive
disorders, and sleep disorders, improving motor skills, decreasing tremors characteristic of Parkinson’s disease, conducting brain injury rehabilitation, exercise, diet, stress management
Gerontology– Compensating for loss of skills, increase ability to
function independently
Socially Important ProblemsSocially Important Problems(Martin & Pear, 1999)(Martin & Pear, 1999)
Behavioral Community Psychology– Controlling littering, increasing recycling,
promoting energy conservation, encouraging welfare recipients to attend self-help meetings, helping college student live together, crime
Business, Industry, and Government– Performance management, improve productivity,
decrease tardiness and absenteeism, increase sales volume, create new business, improve worker safety, reduce theft by employees, reduce shoplifting, improve management-employee relations.
Socially Important ProblemsSocially Important Problems(Martin & Pear, 1999)(Martin & Pear, 1999)
Sports Psychology– Improving skills of athletes, motivating
practice and endurance training, changing the behavior of coaches, “ports psyching “ to prepare for competition
Behavioral Assessment– Functional analysis and functional
assessment for a variety of mental disorders Severe Problems
– Developmental disabilities, autism, and schizophrenia
More Misconceptions of ABAMore Misconceptions of ABA
“Verbal behavior is better than applied behavior analysis.”• B. F. Skinner is responsible for both verbal behavior and
behavior analysis.• Verbal behavior is a theoretical approach within ABA• Behavior analysts have been effectively teaching
language for 30 years and have developed a variety of behavioral techniques that have been shown to be effective for increasing and improving language and communication in children with autism (e.g., activity schedules, incidental teaching, audio modeling, video modeling, PECS)
• All behavior analytic language teaching procedures are influenced by Skinner’s theories on verbal behavior as well as traditional developmental and biological theories
More Misconceptions of ABAMore Misconceptions of ABA“Children with autism will not like their
behavior analysis sessions. They’re too long!”– A behavior analyst diligently establishes a positive
relationship with a child they are teaching and creates a very positive learning environment for that child.
– Maximum learning is the behavior analysts goal and maximum learning occurs in a positive learning environment.
– A skilled behavior analyst will make it difficult for a child to tell when learning is occurring and when they are just playing.
More Misconceptions of ABAMore Misconceptions of ABA“If a child with autism gets intensive early
intervention utilizing the techniques of applied behavior analysis, they will ‘recover’.”– Autism is a neurological disorder and no one can
predict the extent of the neurological damage in a child diagnosed with autism.
– The research indicates that 47%-67% of children with autism with intensive applied behavior analytic intervention will learn a sufficient number of skills to be indistinguishable from their peers. (Fenske, Zalenski, Krantz, & McClannahan, 1985; Lovaas, 1987 McEachin, Smith, & Lovaas, 1993)
– It takes several years for a child to make sufficient progress where they will be indistinguishable from their peers
More Misconceptions of ABAMore Misconceptions of ABA
“Behavior analysts ‘drill’ kids with hundreds of trials.”
– A behavior analyst will select a learning goal for each session for a specific child and will teach a particular skill until that goal is obtained. There is no set number of trials.
– Teaching is contingent on the child’s learning. – Challenging skills are interspersed with more
easily learned skills so the child has an opportunity for lots of reinforcement.
More Misconceptions of ABAMore Misconceptions of ABA
“Applied behavior analysts teach children to sound ‘robotic’.”• A behavior analyst will always model natural
sounding language, maximizing the extent to which the child’s language skills will generalize to other situations.
• A behavior analyst may speak to a child with few language skills in a manner that is concise, clear, and direct to increase the likelihood of the child’s comprehension. The inflection and volume of the behavior analyst’s voice, however, will still be natural.
• If a child’s inflection does not sound natural, the behavior analyst will develop an individualized program for that specific child to teach prosody.
Common Misconceptions of Common Misconceptions of Applied Behavior Analysis (ABA)Applied Behavior Analysis (ABA)
“Applied behavior analysis is too much structure; the individual needs to play and ‘get the stims out’.” • Behavior analysts teach a child to play
appropriately and break down play to concrete components when necessary.
• There is no research demonstrating that allowing a child to engage in stereotypic behavior will subsequently decrease the stereotypic behavior.
• The more a child engages in stereotypic behavior, the less likely he or she will engage in appropriate behavior. Also, a child is not available for learning when they are engaging in stereotypic behavior.
Common Misconceptions of Common Misconceptions of Applied Behavior Analysis (ABA)Applied Behavior Analysis (ABA)
“Applied Behavior Analysis is onlyeffective if you want to decrease a behavior.”
Behavior analysts will implement methods to decrease disruptive behavior and implement teaching strategies for teaching skills in all domains: academic, independent, self help, social, fine motor, gross motor, expressive language, receptive language, play, etc.
Common Misconceptions ABACommon Misconceptions ABA
“Applied behavior analysts work too much in isolation and alienate more traditional approaches such as those used by occupational and speech therapists. It is essential for behavior analysts to collaborate with all
professionals. Behavior analysts continually learn from various professionals. Consulting a speech and language pathologist, for example, can be extremely helpful in targeting new skills to teach a child. These skills can then be taught using the principles of applied behavior analysis.
Common Misconceptions of Common Misconceptions of Applied Behavior Analysis Applied Behavior Analysis
(ABA(ABA))“Applied behavior analysts need to work
alone and do not work with other professionals.” Various professionals can work with one child as long as
every person on that child’s intervention team is held accountable for the child’s progress. For example, the speech therapist must collect data as behavior analysts do to ensure that what they are doing is effective.
Furthermore, there must be one person coordinating a child’s treatment to ensure that all treatments are working together and not contradicting each other (which can be harmful to a child’s skill acquisition).
Common Misconceptions of Common Misconceptions of Applied Behavior Analysis Applied Behavior Analysis
(ABA)(ABA)“Behavior analysts always use food
to reinforce behavior.”
• Behavior analysts use whatever the child prefers.
• Primary reinforcers are often used to teach new or difficult skills but these are always paired with a conditioned reinforcer such as verbal praise.
• The goal is to fade from primary reinforcers, to conditioned reinforcers, to natural reinforcers.
Why Is ABA Effective For Why Is ABA Effective For
Children with Autism?Children with Autism?
Techniques specifically designed and researched for children with autism (Lovass, 1960; 1987; Fenske, Zalenski, Krantz, &
McClannahan, 1985; Harris, Handleman, Gordon, Kristoff, & Fuentes, 1991; Lovaas, 1987; McEachin, Smith, & Lovaas, 1993)
Represents a teaching method with tremendous versatility
Breaks complex material into smaller, more teachable units
Why Is ABA Effective ForWhy Is ABA Effective ForChildren with Autism?Children with Autism?
Provides numerous structured opportunities for a child to learn a new skill before advancing to the next skill
Highlights relevant stimuli Highlights relevant stimuli while
simultaneously minimizing extraneous stimuli
Utilizes reinforcement Contingent reinforcement Differential reinforcement
Why Is ABA Effective For Why Is ABA Effective For Children with Autism?Children with Autism?
• Utilizes systematic prompting and prompt fading
• Promotes consistency across teachers
• Provides data based decision making
Research-Based Research-Based Effectiveness of ABAEffectiveness of ABA
Lovaas (1987) Lovaas (1987)
Purpose:– Behavioral-intervention project that sought to
maximize behavioral treatment gains by treating children with autism most of their waking hours for multiple years
Research-Based Effectiveness of Research-Based Effectiveness of ABA: Lovaas (1987) ABA: Lovaas (1987)
Method: Subjects:
– diagnosis of autism, less than 40 months if mute and less than 46 months if echolalic
Treatment condition– Intensive-Treatment Experimental Group (n=19)
Received minimum of 40 hours of 1:1 treatment per week
– Minimal Treatment Control Group (n=19) Received 10 hours or less of 1:1 treatment/wk
– Both groups received treatment for 2 or more years– Subjects were assigned to groups using functional random
procedures due to ethical constraints
Research-Based Effectiveness of Research-Based Effectiveness of ABA: Lovaas (1987) ABA: Lovaas (1987)
Assessment: – Standardized tests
Bayley, Stanford-Binet, Vineland
– Behavioral observations Stereotypy, play, recognizable words
– Parent interview Recognizable words, toy play, emotional attachment, apparent
deficit, peer play, stereotypy, tantrums,toilet training, abnormal speech, age of walking, number of siblings, socioeconomic status, sex, neurological finding
Research-Based Effectiveness of Research-Based Effectiveness of ABA: Lovaas (1987) ABA: Lovaas (1987)
– Experimental group IQ
– 2 had normal IQ, 7 mod retarded range, 10 severely retarded range
Play– No subject had pretend play, 2 had complex play, rest had
simple play
Speech– 1 subject had minimal speech, 7 echolalic, 11 mute.
Research-Based Effectiveness of Research-Based Effectiveness of ABA: Lovaas (1987) ABA: Lovaas (1987)
Treatment Experimental group: – 40 hrs/wk for 2 years by trained therapists and parents
in home school & community– 1st year: reducing stereotypy & aggression, building
compliance, imitation, toy play, extended treatment to family
– 2nd year: expressive & early abstract language, interactive play with peers, extended treatment to community and preschool
– 3rd year: emotions, preacademics, observational learned, extended treatment to preschool
Research-Based Effectiveness of Research-Based Effectiveness of ABA: Lovaas (1987) ABA: Lovaas (1987)
Treatment Control Group: – Same as experimental group but less than 10
hours of 1:1 treatment– Also received a variety of other treatment
provided by small special ed classes
Research-Based Effectiveness of Research-Based Effectiveness of ABA: Lovaas (1987) ABA: Lovaas (1987)
Control Group 2:– 21 subjects– 42 mo or younger– IQ above 40 at intake– Assessed as control group 1 but not treated
Research-Based Effectiveness of Research-Based Effectiveness of ABA: Lovaas (1987) ABA: Lovaas (1987)
Results Pre-Treatment Comparison
– No significant differences between groups except for chronological age at onset (42 mo vs 46 mo)
– Statistical analyses were used to see if CA was related to outcome –it was not.
Related to outcome was: prorated mental age and abnormal speech
– Prorated mental age: 18.8 mo in experimental group and 17.1 mo in control group
Research-Based Effectiveness of Research-Based Effectiveness of ABA: Lovaas (1987) ABA: Lovaas (1987)
Results data– Experimental group
18.8 MA (mental age); 83.3 IQ 9 passed general ed 1st grade and normal IQ (47%) 8 passed 1st grade in aphasia classes and IQ was mildly retarded
(42%) 2 placed in classes for autistic children and IQ was profoundly
retarded (10%)
– Control groups 1 & 2 17.1 MA, 52.2 IQ 1 subject passed 1st grade and had an IQ of 99 (2%) 18 were in aphasia classes average IQ was 70 (45%) 21 subjects were autism class mean I!Q 40 (53%)
Research-Based Effectiveness of Research-Based Effectiveness of ABA: Lovaas (1987) ABA: Lovaas (1987)
Discussion– “Results were consistent with a very large body of prior
research on the application of learning theory to the treatment and education of developmentally disabled persons and with the very extensive 100 year old history of psychology laboratory work on learning processes in man and animals”
– Unlikely treatment effects could be replicated without highly trained individuals administering the behavioral treatment
Research-Based Effectiveness of ABA: Research-Based Effectiveness of ABA: McEachin, Smith, & Lovaas (1993) McEachin, Smith, & Lovaas (1993)
Purpose:– To see if behavioral treatment can produce
long-lasting gains
Research-Based Effectiveness of ABA: Research-Based Effectiveness of ABA: McEachin, Smith, & Lovaas (1993) McEachin, Smith, & Lovaas (1993)
Method– 1. Assessed students from Lovaas 1987 study at a mean age of
11.5 years to see if they maintained treatment gains– 2. Assessed the best outcome students to see if they could be
considered free of autistic symptomology, compared them to children with no clinically significant behavioral disturbance: (blind evaluators)
Assessed for deficits in:– idiosyncratic thought patters, mannerisms, and interest; – lack of close relationships with family and friends; – difficulty in getting along with people; – relative weaknesses in cognitive functioning such as abstract reasoning; – not working up to ability in school; – flatness of affect, – absence or peculiarity in sense of humor
Research-Based Effectiveness of ABA: Research-Based Effectiveness of ABA: McEachin, Smith, & Lovaas (1993) McEachin, Smith, & Lovaas (1993)
Results: Experimental vs. Control Group– Experimental group children preserved their
gains over the control groups Out of the 9 experimental best outcome subjects, 8
were still indistinguishable from their peers. Out of the 10 in special ed, one went to a regular ed class
For children from the Lovaas 1987 control group, none had made it to regular ed class
Research-Based Effectiveness of ABA: Research-Based Effectiveness of ABA: McEachin, Smith, & Lovaas (1993) McEachin, Smith, & Lovaas (1993)
Results: Best Outcome vs. Nonclinical Comparison Group– No significant difference in age between the best
outcome group and the comparison group of “typical” children
– All best outcome students scored within normal ranges in all areas:
– IQ: 99-136– Adaptive: 80-108– Maladaptive: 2-16– Personality: similar to nonclinical comparison group
Research-Based Effectiveness of ABA: Research-Based Effectiveness of ABA: McEachin, Smith, & Lovaas (1993) McEachin, Smith, & Lovaas (1993)
Discussion:– Subjects in the experimental group had maintained their level of
intellectual functioning between their previous assessment at age 7 and the present evaluation at a mean age of 13, (IQs 30 pts higher than control group).
– Experimental subjects displayed significantly higher levels of functioning than did control subjects on measure of adaptive behavior and personality
– Out of the 9 subjects who had been classified as normal functioning they still exhibited average intelligence and average levels of adaptive functioning
– Some deviance from average was found on the personality test and clinical ratings but seemed to be the result of extreme scores from one subject who was placed in special ed from regular ed.
Research-Based Effectiveness of ABA: Research-Based Effectiveness of ABA: McEachin, Smith, & Lovaas (1993) McEachin, Smith, & Lovaas (1993)
Safeguards taken to ensure that favorable outcome of experimental subjects can be attributed to treatment and not extraneous factors– Equivalent assessment– All subject remained in assigned groups– Independent diagnoses– All subjects had comparable diagnoses and intake data– Control group 1 an 2 did not differ in outcome – Consistent socioeconomic status– Treatment has been experimentally demonstrated for 30 yrs and is replicable– Treatment gains maintained– Wide range of measures were used– Blind & quantifiable assessment of effectiveness
Research-Based Effectiveness of ABA: Research-Based Effectiveness of ABA: McEachin, Smith, & Lovaas (1993) McEachin, Smith, & Lovaas (1993)
Addressing validity of results of Lovaas (1987):– Assignment to experimental or control group not
random, but unlikely assignment was biased
Future research:– Replication by independent investigator– Use younger children to see if age affects outcome– Determine the extent to which early intervention alters
neurological structures
Criticisms of Lovaas: British Columbia Office of Criticisms of Lovaas: British Columbia Office of Health Technology Assessment (BCOHTA) Health Technology Assessment (BCOHTA)
Freeman, 2003Freeman, 2003
Lovaas didn’t compare different therapies!– But only institutionalization & special ed
existed at the time
Criticisms of Lovaas: British Columbia Office of Criticisms of Lovaas: British Columbia Office of Health Technology Assessment (BCOHTA) Health Technology Assessment (BCOHTA)
Freeman, 2003Freeman, 2003
Lovaas used quasi (or functional), not pure random assignment!– Lovaas used 8 different psychological measures to ensure close
matching of groups– Pure random assignment is unethical.
According to the New York Early Intervention Report “Use of an intervention method is a type of indirect harm if its use supplants an effective intervention method that the child might have otherwise received”
– US National Institute of Mental Health (the granting agency supporting the study) approved functional random assignment.
– Subjects were assigned on the basis of therapist availability
Criticisms of Lovaas: British Columbia Office of Criticisms of Lovaas: British Columbia Office of Health Technology Assessment (BCOHTA) Health Technology Assessment (BCOHTA)
Freeman, 2003Freeman, 2003 Lovaas included children with echolalia, a characteristic with a
better prognosis!– Out of the 4 children in the experimental group with echolalia, only 1
transitioned– None of the 4 children in the control group transitioned
Lovaas did not describe the application of method!– Lovaas treatment protocols are published in “The Me Book” and “A
Work in Progress”– Detailed data were collected for every child on all aspects of method
implementation The evaluators were biased!
– Evaluators were independent of the study– Educational system was outcome measure (passing K)
Criticisms of Lovaas: British Columbia Office of Criticisms of Lovaas: British Columbia Office of Health Technology Assessment (BCOHTA) Health Technology Assessment (BCOHTA)
Freeman, 2003Freeman, 2003 The treatment was effective because of some of
the therapist’s characteristics (warmth, rapport) and not the treatment!– Warmth and rapport are probably necessary
components of treatment, but they are not sufficient to help children with autism.
IQ scores improved because of compliance rather than increased cognitive functioning– Outdated notion refuted by research whereby other
studies with less intensive protocols fail to obtain IQ increases with treatment
Criticisms of Lovaas: British Columbia Office of Criticisms of Lovaas: British Columbia Office of Health Technology Assessment (BCOHTA) Health Technology Assessment (BCOHTA)
Freeman, 2003Freeman, 2003 Lovaas’s study only worked because of use of
Aversives– Until Sallows and Graupner 2005 study, we didn’t
know for sure whether aversives WERE one of the factors behind effectiveness
– Since the time the study began in the 1970s research has advanced so significantly it has rendered such procedures unnecessary
– None of the replication studies have used aversives and the results for the treatment groups were still significant and impressive
SummarySummaryFreeman, 2003Freeman, 2003
US Surgeon General and the NYS Dept of Health consider Lovaas’s study high quality and a landmark achievement in the field of autism treatment
Replicated Success of Lovaas’s StudyReplicated Success of Lovaas’s Study Sheinkopf and Siegal (1998)
– 11 children in experimental group all under 3– 11 matched children in control group– 10-39 hrs per week for 7-24 mos– 7 out of 11 pairs showed sig improvement– Problems:
No measure in specific skill domains Not enough description abut the nature of the intervention Not enough about number of hrs per week (although later said
that those receiving 30 had higher IQ than 20)
Smith et al., (1997) – IQs of 11 children with severely autistic mentally
retarded subjects increased by 12 points and demonstrated more expressive speech than did the minimally treated children
Replicated Success of Lovaas’s StudyReplicated Success of Lovaas’s Study Anderson (1987) The May Institute Study
– 14 children (average age 43 mos) – Assessed by “blind” professionals on standardized
assessment measures– Ongoing skill acquisition was recorded daily– The children only received 15-25 hours of intervention
and none were mainstreamed in a regular kindergarten.– Increases in language, self-care, social and academia– For 12-13 children tested the range of social age scores
increased 2-23 months.– Differences from Lovaas?
Children were about a year older Less number of hours per week (20 instead of 40) Shorter treatment duration (1-2- years vs 2-6 yrs) Within subj design –typical education and then ABA
Replicated Success of Lovaas’s StudyReplicated Success of Lovaas’s Study
Murdoch early Intervention Program (Birnbrauer & Leach, 1993)– 9 children (average age 39 mos) in experimental group– 5 children in control group– Assessed by “blind” professionals on standardized tests– Ongoing skill acquisition was video taped & recorded – 19 hours of intervention per week for 2 years– 4 out of the 9 children made substantial gains (IQ 80)– 4 made moderate gain and 1 mild gain– Increases in communication, play, social,m self help,
productive behavior– Differences from Lovaas?
Less number of hours per week (19 vs 40) Therapists received on the job training (Lovaas trained before)
Replicated Success of Lovaas’s StudyReplicated Success of Lovaas’s Study
PCDI (Fenske, Krantz & McClannahan, 1985) – 9 children (enrolled before age 5) in experimental
group– 9 children (enrolled after age 5) in control group– Assessed by “blind” professionals on standardized tests– Ongoing skill acquisition was recorded – 27.5 hours of intervention per week for 2 years– 6 out of the 9 experimental group children transitioned
to regular ed– 1 out of the 9 transitioned to regular ed in control group– Differences from Lovaas?
No research design PCDI approximate these rates of transition every year!
Implications of StudiesImplications of Studies
Effectiveness– ABA produces large, lasting improvement– Larger gains than other treatments to date
Age for optimal effectiveness– Optimal between 2-3 (good under 5)
Nature of Intervention– Components of treatment: variety of ABA based
teaching procedures– Intensity: at least 30 hrs per week– Duration: at least 2 years– Quality: doctoral level behavior analyst– Setting: teach in all settings child interacts in
Other Studies Published in Other Studies Published in Peer-Reviewed JournalsPeer-Reviewed Journals
Over 500 studies have shown that behavioral intervention can produce large improvements in specific and important areas such as– Peer interaction & classroom behavior– Imitation– Self care– Language skills– Social skills– Academic skills– Reduction in non-adaptive behavior