by EV Larsson · Cited by 19 — Is Applied Behavior Analysis (ABA) and Early Intensive Behavioral aappolicy.aappublications/cgi/reprint/pediatrics;120/5/1162.pdf. Accessed.
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(2013) Eric V. Larsson, PhD, LP, BCBA -D Is Applied Behavior Analysis (ABA) and Early Intensive Behavioral Intervention ( EIBI) an Effective Treatment for Autism? A Cumulative History of Impartial Independent Reviews Eric V . Larsson, PhD, LP, BCBA -D (2013 ) Applied Behavior Analysis (ABA) and Early Intensive Behavioral Intervention (EIBI) for Autism are quite possibly the best examples of evidence -based behavioral health care. Impartial independent review panel s consistently agree that ABA and EIBI treatments for autism are effective, and that the extensive body of research meets high standards of scientific evidence. Th ese reviews also report that ABA and EIBI significantly improves the net health outcome in Autism in substantial and far -ranging ways. What is striking about the independent reviews of EIBI and ABA for autism is that the more careful the scrutiny, the mor e emphatic are the conclusions. For example, the New York, the Maine, and the US AHRQ commissions embarked upon yearlong independent reviews of the scientific support of ALL possible interventions for autism. Each panel stringently applied scientific sta ndards of proof to all interventions and found that ABA-based therapies alone, of all possible treatments for children with autism, had been proven effective. As a result, the practice of ABA and EIBI have become part of the mainstream community standard of care. The conclusions from many years of independent review are quoted below in chronological order . In 1987, researchers at the University of North Carolina reviewed the early intervention literature to identify the best practices at the time. They wrote: ÒLovaas’s (1980, 1982) experimental design included both an intensive treatment group that received 40 hours or more of treatment per week and a less intensive treatment group that received 10 hours of treatment per week. In other respects the natur e of intervention was the same for all children. As summarized in Table 4, the intensive application of this approach resulted in substantial improvement for about half the autistic children. They attained IQs, school placements, and social -emotional ratin gs not different from normal peers. Children receiving a less intensive version of this approach did not, in any of 19 cases, achieve such gains.Ó Simeonsson, R.J., Olley, J.G., & Rosenthal, S.L. (1987). Early intervention for children with autism. In M.J. Guralnick & F.C. Bennett (Eds.) The effectiveness of early intervention for at -risk and handicapped children. (pp. 275 -296). Orlando FL: Academic Press. In 1994, Bernard Rimland wrote in the Autism Research Review International concerning such results : Òwe are beginning to hear increasingly about recovery. The matter deserves our close attention. Reports of recovery, partial recovery, or near -recovery, come from several sources.Ó Rimland, B. (1994). Recovery from autism is possible. Autism Research Review International , 8, 3.
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Is EIBI and ABA Sufficiently Evidence -Based to be Medically N ecessary Treatment ? Page 2 (2013 ) Eric V. Larsson, PhD, LP, BCBA -D In the first Handbook of Autism and Pervasive Developmental Disorders , the researchers wrote: ÒDuring the past 10 years, behavioral interventions have become the predominant treatment approach for promoting the social, adaptive, and behavioral functioning of children and adults with autism. The sophistication of these strategies has increased substantially, reflecting advancements in technique and refinements in behavioral assessment.Ó Bregman, J.D. & Gerdtz, J. (1997). Behavioral In terventions. In D.J. Cohen & F.R. Volkmar, (Eds.), Handbook of Autism and Pervasive Developmental Disorders (pp. 606 -630). New York: Wiley. The Autism Society of America, in their informational paper on ABA approaches, stated: ÒProperly designed and execut ed ABA programs contain many if not all of the components of effective treatment approaches found to be most successful in treating children with autismÉ Research and anecdotal evidence indicate that ABA programs produce comprehensive and lasting improvem ents in many important skill areas.Ó Autism Society of America (1998) Intensive Behavioral Intervention. Informational handout downloaded from www.autism -society.org In 1998, Division 53 of the American Psychological Association (the Society for Clinical Child and Adolescent Psychology) conducted a Task Force on Empirically Supported Child Psychotherapy. For autism, they found: ÒThe literature on effective focal treatments in autism is plentiful and publ ished in a variety of journals, in the fields of developmental disabilities, applied behavior analysis, and discipline -specific journals. These studies generally consist of single -subject multiple -baseline designs or small sample treatment designs. Behav ioral treatment approaches are particularly well represented in this body of literature and have been amply demonstrated to be effective in reducing symptom frequency and severity as well as in increasing the development of adaptive skills.Ó (p. 168). Rogers, S.J. (1998) Empirically supported comprehensive treatments for young children with autism. Journal of Clinical Child Psychology, 27, 168 -179. In 1999, the US Surgeon General issued a lengthy report on the Mental Health in America. In the section on a utism, he concluded: ÒThirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior.Ó ÒA well -designed study of a psychosocial intervention was carried out by Lovaas and colleagues. Nineteen children with autism were treated intensively with behavior therapy for 2 years and compared with two control groups. Followup of the experimental group in first grade, in late childhood, an d in adolescence found that nearly half the experimental group but almost none of the children in the matched control group were able to participate in regular schooling. Up to this point, a number of other research groups have provided at least a partial replication of the Lovaas modelÓ (p. 164). Satcher, D. (1999). Mental health: A report of the surgeon general. U.S. Public Health Service. Bethesda, MD. In 1999, the New York State Department of Health convened a panel of nationally regarded experts and consumers who were charged with evaluating the scientific evidence in support of all available treatments for autism. This panel produced a large monograph that exhaustively reviewed the evidence in sup port of each treatment. The New York State Department of Health then published a three -volume report based upon its extensive analysis of the available treatments. It also found that only ABA -based treatments had sufficient scientific support to merit end orsement. The three volumes include ÒThe Technical Report,Ó which contains the most complete information, including all the evidence tables from the articles reviewed, a full report of the research process, and the full text of all the recommendations. ÒThe Report of the RecommendationsÓ gives the background information, the full text of all the recommendations and a summary of the supporting evidence. ÒThe Quick Reference GuideÓ gives a summary of background information and a summary of the major recomm endations, and is also written in a less technical manner. Sample statements from the Quick Reference Guide follow. While this panel
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Is EIBI and ABA Sufficiently Evidence -Based to be Medically N ecessary Treatment ? Page 3 (2013 ) Eric V. Larsson, PhD, LP, BCBA -D found little support for most available treatments, their conclusion for ABA, after regarding the evidence of efficacy is : ÒIt is recommended that principles of applied behavior analysis (ABA) and behavior intervention strategies be included as important elements in any intervention program for young children with autism.Ó In contrast, their conclusions about a common treat ment for autism, sensory integration therapy, is characteristic of their conclusions about all other treatments, to wit: ÒNo adequate evidence has been found that supports the effectiveness of sensory integration therapy for treating autism. Therefore, se nsory integration therapy is not recommended as a primary intervention for young children with autism.Ó The New York Department of Health also concluded: Ò[Based upon strong scientific evidence] it is recommended that principles of applied behavior analysis and behavior intervention strategies be included as an important element of any intervention program for young children with autismÉ [Based upon strong scientific evidence] it is recommended that intensive behavioral programs include as a minimum approximately 20 hours per week of individualized behavioral intervention using applied behavioral analysis techniques (not including time spent by parents)É I t is recommended that all professional and paraprofessionals who function as therapistsÉreceive regular supervision from a qualified professional with specific expertise in applied behavioral approachesÉ [Based upon strong scientific evidence] it is import ant to include parents as active participants in the intervention team to the extent of their interests, resources, and abilitiesÉ [Based upon strong scientific evidence] it is recommended that training of parents in behavioral methods for interacting with their child be extensive and ongoing and include regular consultation with a qualified professionalÉÓ (pp. 138 -140). New York State Department of Health Early Intervention Program. (1999). Clinical Practice Guideline Report of the Recommendations for Auti sm/Pervasive Developmental Disorders . New York State Department of Health, Albany, NY. Also in 1999, a Practice Parameters Consensus Panel of the following Professional Organizations and Agencies was convened. (American Academy of Neurology American Acad emy of Family Physicians American Academy of Pediatrics American Occupational Therapy Association American Psychological Association American Speech -Language Hearing Association Society for Developmental and Behavioral Pediatrics Autism Society of America National Alliance for Autism Research National Institute of Child Health & Human Development National Institute of Mental Health): The practice parameters consensus panel on the diagnosis of autism stated that it was formed because: ÒThe press for early id entification comes from evidence gathered over the past 10 years that intensive early intervention in optimal educational settings results in improved outcomes in most young children with autism, including speech in 75% or more and significant increases in rates of developmental progress and intellectual performance.Ó While the focus of this report was on diagnosis, the panel made a number of significant statements about the need for early and intensive treatment. For example: ÒHowever, these kinds of outcomes have been documented only for children who receive 2 years or more of intensive intervention services during the preschool years. (page 440)Ó ÒAutism must be recognized as a medical disorder, and managed care policy must cease to deny appropriate medical or other therapeutic care under the rubric of Òdevelopmental delayÓ or Òmental health condition. (page 472)Ó
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Is EIBI and ABA Sufficiently Evidence -Based to be Medically N ecessary Treatment ? Page 4 (2013 ) Eric V. Larsson, PhD, LP, BCBA -D ÒExisting governmental agencies that provide services to individuals with developmental disabilities must also change their eligibility cri teria to include all individuals on the autistic spectrum, whether or not the relatively narrow criteria for Autistic Disorder are met, who nonetheless must also receive the same adequate assessments, appropriate diagnoses, and treatment options as do thos e with the formal diagnosis of Autistic Disorder. (page 472)Ó Filipek, P.A. et al. (1999). The screening and diagnosis of autistic spectrum disorders. Journal of Autism and Developmental Disorders . 29, 439 -484. A practice parameters panel of the American Academy of Child and Adolescent Psychiatry found: ÒAt the present time the best available evidence suggests the importance of appropriate and intensive educational interventions to foster acquisition of basic social, communicative, and cognitive skills re lated to ultimate outcomeÉ Early and sustained intervention appears to be particularly important, regardless of the philosophy of the program, so long as a high degree of structure is provided. Such programs have typically incorporated behavior modificat ion procedures and applied behavior analysisÉ These methods build upon a large body of research on the application of learning principles to the education of children with autism and related conditionsÉ It is clear that behavioral interventions can signif icantly facilitate acquisition of language, social, and other skills and that behavioral improvement is helpful in reducing levels of parental stress.Ó (p. 476). ÒConsiderable time (and money) is required for implementation of such programs, and older and more intellectually handicapped individuals are apparently less likely to respond.Ó (p. 515) Volkmar, F., Cook, E.H., Pomeroy, J., Realmuto, G. & Tanguay, P. (1999). Practice parameters for the assessment and treatment of children, adolescents, and adults with autism and other pervasive developmental disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 38 (Supplement), 32s -54s. In another year -long, exhaustive review, the Maine Administrators of Services for Children with Disabilit ies found: ÒEarly interventionists should leverage early autism diagnosis with the proven efficacy of intensive ABA for optimal outcome and long -term cost benefitÉ (p. 29). ÒThe importance of early, intensive intervention for children with autism cannot b e overstatedÉ Furthermore, early, intensive, effective intervention offers the hope of significant cost/benefit.Ó (p. 6). ÒOver 30 years of rigorous research and peer review of applied behavior analysisÕ effectiveness for individuals with autism demonstrate ABA has been objectively substantiated as effective based upon the scope and quality of science.Ó (p. 29). Maine Administrators of Services for Children with Disabilities (2000). Report of the MADSEC Autism Task Force. MADSEC, Manchester, ME. In an extensive report on the facts of litigation by parents who were seeking health -care funding in British Columbia, the Supreme Court made the following conclusions. In a subsequent ruling, the Court found that it was more appropriate for the executive to set policy than to have it imposed upon them by the courts, but its conclusions on the facts remain: ÒWhat children experience in their early years will shape the rest of their lives. We now know from research in a variety of sectors, that children’s e arly brain development has a profound effect on their ability to learn and on their behaviour, coping skills and health later in life.Ó ÒResearch also indicates that intensive early behavioural intervention with children with autism can make a significant difference in their ability to learn and keep pace with their peers. With the intervention many children with autism will make considerable gains by grade one.Ó Ò[1] These words embody the philosophy underlying the Ontario Government’s “Intensive Early Intervention Program For Children With Autism” commenced in 1999, and numerous programmes undertaken in other provinces, the United States and several countries.Ó Ò[156] The Crown discriminates against the petitioners contrary to s. 15(1) by failing to accommodate their disadvantaged position by providing effective treatment for autism. It is beyond debate that the appropriate treatment is ABA or early intensive behavioural intervention.Ó Auton et al. v. AGBC. (2000). British Columbia Supreme Court 1142.
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Is EIBI and ABA Sufficiently Evidence -Based to be Medically N ecessary Treatment ? Page 5 (2013 ) Eric V. Larsson, PhD, LP, BCBA -D In 2001, t he American Academy Of Pediatrics issued a policy statement entitled, ÒThe Pediatrician’s Role in the Diagnosis and Management of Autistic Spectrum Disorder in Children. Ó The AAP regularly issues policy statements to guide and define the child health care system. The more recent AAP Clinical Report is also cited below . This policy statement from 2001 is included to help illustrate that the general professional consensus on the evidence for intensive early intervention had begun to turn by this earlier date. This policy stateme nt is accompanied by a lengthy technical report. In both papers, the AAP clearly defines accepted treatments as behavioral interventions, and draws heavily on the ABA literature to support their findings. For example, in the introduction to the treatment section, the AAP makes two central statements, as follows: ÒThere is a growing body of evidence that intensive early intervention services for children in whom autism is diagnosed before 5 years of age may lead to better overall outcomesÉ Behavioral training, including teaching appropriate communication behaviors, has been shown to be effective in decreasing behavior problems and improving adaptation.Ó (pp. 8 -10). ÒCurrently accepted strategies are to improve the overall functional status of the child by enrolling the child in an appropriate and intensive early intervention program that promotes development of communication, social, adaptive, behavioral, and academic skills; decrease maladaptive and repetitive behaviors through use of behavioral and someti mes pharmacologic strategiesÉ Early diagnosis resulting in early, appropriate, and consistent intervention has also been shown to be associated with improved long -term outcomesÉ Behavioral training, including communication development, has been shown to b e effective in reducing problem behavio rs and improving adaptation.Ó (p.1223). American Academy of Pediatrics (2001). Policy Statement: The Pediatrician’s Role in the Diagnosis and Management of Autistic Spectrum Disorder in Children (RE060018) Pediatrics , 107, 1221 -1226. In the more detailed accompanying technical report, the AAP states: ÒThere is a growing body of evidence that intensive early intervention services for children in whom autism is diagnosed before 5 years of age may lead to better overall outcomes. (pa ge 8)Ò The most heavily emphasized treatment strategy in the technical report is Òbehavioral management,Ó about which the AAP states: ÒOne of the mainstays of the management of ASD in children at any age is the implementation of behavioral training and ma nagement protocols at home and at school. Behavioral management must go hand -in-hand with structured teaching of skills to prevent undesirable behavior from developing. Behavioral training, including teaching appropriate communication behaviors, has been s hown to be effective in decreasing behavior problems and improving adaptation. (page 10)Ó Committee on Children With Disabilities (2001). Technical Report: The Pediatrician’s Role in the Diagnosis and Management of Autistic Spectrum Disorder in Children. Pediatrics , 107, e85. The National Research Council convened a panel of perhaps the most well recognized national experts in the treatment of autism. The United States Department of Education commissioned the National Research Council to provide input into the controversy circling around the press for scho ol funding for behavior therapy and early intervention. In turn the National Research Council engaged the services of a large number of respected researchers in the field of autism. This panel was also charged with integrating the scientific literature an d creating a framework for evaluating the scientific evidence concerning the effects and distinguishing features of the various treatments for autism. The resulting report clearly focused on ABA -based interventions. For example, the chapter on Òcomprehen sive programsÓ identifies ten Òwell -known model approaches,Ó all of which are ABA -based. A sample of the many statements, upon which it can be fairly said that the primary focus of the book is on ABA -based treatment, are offered here: ÒThere is general ag reement across comprehensive intervention programs about a number of features of effective programsÉ The consensus across programs is generally strong concerning the need for: early entry into an intervention programÉ Overall, effective programs are more similar than different in terms of levels of organization, staffing, ongoing monitoring, and the use of certain techniques, such as discrete trials, incidental learning, and structured teaching
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Is EIBI and ABA Sufficiently Evidence -Based to be Medically N ecessary Treatment ? Page 6 (2013 ) Eric V. Larsson, PhD, LP, BCBA -D periodsÉ there is substantial research supporting the effect iveness of many specific therapeutic techniques and of comprehensive programs in contrast to less intense, nonspecific interventions.Ó ÒThere is now a large body of empirical support for more contemporary behavioral approaches using naturalistic teaching m ethods that demonstrate efficacy for teaching not only speech and language, but also communicationÉ Some advantages of the behavioral research on teaching social skills have been the measurement of generalization and maintenance, attention to antecedents and consequences, and use of systematic strategies to teach complex skills by breaking them down into smaller, teachable parts.Ó (p. 53). ÒOutcomes of discrete trial approaches have included improvements in IQ scores, which are correlated with language ski lls, and improvements in communication domains of broader measuresÉ Behavioral interventions use the powerful tools of operant learning to treat symptoms of autism spectrum disorders. (p. 53). ÒEarly research on the benefits of applied behavior analysis b y Lovaas and his colleagues (1973) showed that children with autism who returned to a home prepared to support their learning maintained their treatment gains better than children who went to institutional settings that failed to carry over the treatment m ethods. (page 35)Ó ÒThere is now a large body of empirical support for more contemporary behavioral approaches using naturalistic teaching methods that demonstrate efficacy for teaching not only speech and language, but also communication. (page 53)Ó ÒBeha vioral interventions use the powerful tools of operant learning to treat symptoms of autism spectrum disorders. (page 68)Ó ÒSome advantages of the behavioral research on teaching social skills have been the measurement of generalization and maintenance, at tention to antecedents and consequences, and use of systematic strategies to teach complex skills by breaking them down into smaller, teachable parts. Some drawbacks of traditional behavioral approaches are the complex data systems that often accompany th em and that may impede their use in more typical settings, as well as the lack of training in their use that most staff members on early childhood teams receive. (page 72)Ó The conclusions and recommendations of the report revolve around how to set up easi ly accessible funding and training for more teachers. While the report clearly endorses school department funding for intensive early intervention with behavior therapy, it also suggests that health -care based funding, such as the U.S. Medicaid program wo uld also be appropriate: ÒA state fund for intensive intervention, or more systematic use of Medicaid waivers or other patterns of funding currently in place in some states, should be considered. (page 224)Ó National Research Council (2001). Educating Chi ldren with Autism, Committee on Educational Interventions for Children with Autism , Division of Behavioral and Social Sciences and Education, Washington, D.C.: National Academy Press. A review by Mayo Clinic and Harvard pediatricians found: ÒThe weight of currently available scientific evidence, however, indicates that ABA should be viewed as the optimal, comprehensive treatment approach in young children with ASD.Ó Barbaresi, W.J., Katusic, S.K., & Voigt, R.G. (2006). Autism: A review of the state of the science for pediatric primary health care clinicians. Archives of Pediatric and Adolescent Medicine , 160. 1167 -1175. The Department of Health Policy, Management and Evaluation of the University of Toronto , ON found: ÒUnder our model parameters, expansion of IBI to all eligible children represents a cost -saving policy whereby total costs of care for autistic individuals are lower and gains in dependency -free life years are higher.Ó (page 136). Motiw ala, S.S., Gupta, S., Lilly, M.D., Ungar, W.J., & Coyte, P.C. (2006). The cost -effectiveness of expanding intensive behavioural intervention to all autistic children in Ontario. Healthcare Policy, 1, 135 -151. The Hawaii Department of Health Empirical Basi s to Services Task Force found: ÒThese results are quite promising in terms of effect size, although it should be noted that the outcome variables for these studies mainly involved reductions in the frequency of autistic behaviors or increases in social communication or other forms of so cial exchange (e.g., turn
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Is EIBI and ABA Sufficiently Evidence -Based to be Medically N ecessary Treatment ? Page 8 (2013 ) Eric V. Larsson, PhD, LP, BCBA -D supports throughout their lifetimes. In addition, parent education is recommended so that intervention may be ongoing throughout the childÕs waking hours. (pages 39 -40)Ó The California Legislative Blue Ribbon Commission on Autism (2007). Report: An Opportunity to Achieve Real Change for Californians with Autism Spectrum Disorders . Sacramento, CA: The Legislative Office Building (HTTP://senweb03.sen.ca.gov/autism). In a se cond Clinical Report of the American Academy Of Pediatrics Council on Children With Disabilities: Management of children with autism spectrum disorders, the overall impact is inescapable: Children with autism are best treated by continuous, integrated beha vior therapy throughout their daily lives, and can make great gains when treated so. The definitive research cited is for the ABA research. By contrast this report also clearly cites the nonbehavioral interventions that have insufficient evidence to supp ort them, or may even be harmful. The report also clearly reviews the critical variables of effective intensive early intervention. For example, the AAP makes the following central statement about Applied Behavior Analysis (ABA): ÒThe effectiveness of AB A-based intervention in ASDs has been well documented through 5 decades of research by using single -subject methodology and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings. Childr en who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly be tter than those of children in control groups. (pg. 1164)Ó Then, regarding specific behavioral interventions, the AAP makes the following statements: ÒDTT methods are useful in establishing learning readiness by teaching foundation skills such as attention , compliance, imitation, and discrimination learning, as well as a variety of other skills. (pg. 1164)Ó ÒNaturalistic behavioral interventions, such as incidental teaching and natural language paradigm/ pivotal response training, may enhance generalization of skills. (pg. 1164)Ó ÒFunctional assessment is a rigorous, empirically based method of gathering information that can be used to maximize the effectiveness and efficiency of behavioral support interventions. (pg. 1164)Ó ÒA variety of approaches have bee n reported to be effective in producing gains in communication skills in children with ASDs. Didactic and naturalistic behavioral methodologies ( e.g. , DTT, verbal behavior, natural language paradigm, pivotal response training, milieu teaching) have been studied most thoroughly. (pg. 1165)Ó ÒTraditional, low -intensity pull -out service delivery models often are ineffective, and speech -language pathologists are likely to be most effective when they train and work in close collaboration with teachers, support p ersonnel, families, and the childÕs peers to promote functional communication in natural settings throughout the day. (pg. 1165)Ó ÒThere is some objective evidence to support traditional and newer naturalistic behavioral strategies and other approaches to teaching social skills. (pg. 1165)Ó ÒProponents of behavior analytic approaches have been the most active in using scientific methods to evaluate their work, and most studies of comprehensive treatment programs that meet minimal scientific standards involv e treatment of preschoolers using behavioral approaches. (pg. 1166)Ó ÒThree studies that compared intensive ABA programs (25 Ð40 hours/week) to equally intensive eclectic approaches have suggested that ABA programs were significantly more effective. (pg. 1166)Ó ÒIt is now recognized that parents play a key role in effective treatment. Physicians and other health care professionals can provide support to parents by educating them about ASDs; providing anticipatory guidance; training and involving them as coth erapists; (pg 1174)Ó Myers, S.M., Johnson, C.P. & the American Academy of Pediatrics Council on Children With Disabilities, (2007). Management of children with autism spectrum disorders. Pediatrics . 120, 1162 Ð1182. Available online at http://aappolicy.aappublications.org/cgi/reprint/pediatrics;120/5/1162.pdf. Accessed November 27, 2007.
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Is EIBI and ABA Sufficiently Evidence -Based to be Medically N ecessary Treatment ? Page 9 (2013 ) Eric V. Larsson, PhD, LP, BCBA -D In a second review, the Division 53 of the American Psychological Association Task Force on Empirically Supported Child Psychotherapy again found: ÒRandomized controlled trials have demonstrated positive effects in both short -term and longer term studies. The evidence suggests that early intervention programs are indeed beneficial for children with autism, often improving developmental functioning and decreasing maladaptive behaviors and symptom severity at the level of group analysisÉ LovaasÕs treatment meet Chambless and colleagueÕs criteria for Ôwell -establishedÕÓ (p. 8). ÒAcros s all the studies we cited, improvements in language, communication, and IQ, and reduction in severity of autism symptoms indicate that the core symptoms of autism appear malleable in early childhood.Ó (p. 30). Report for Division 53 of the American Psycho logical Association (the Society for Clinical Child and Adolescent Psychology): Rogers, S.J., & Vismara, L.A. (2008). Evidence -based comprehensive treatments for early autism. Journal of Clinical Child and Adolescent Psychology . 37, 8 -38. While the common finding is that one third to one half of the children dramatically outperform controls, there is also evidence that a subset even reach typical levels of functioning. These results are important to note, because the results of these studies are not that the children are scoring barely higher than the controls. Instead, the results are clinically significant in that a substantial number of the children are reaching socially important levels of functioning. For example in a review of children referred to a number of leading comprehensive medical evaluation clinics throughout the Northeastern US, a review by pediatricians and psychologists compared a group of such Òoptimal outcomeÓ (OO) children with a group of typical children, and with a group of Òhigh fu nctioning autismÓ (HFA) children, at least three years after treatment had concluded. They found: ÒThe pattern of test results was consistent across all measures: On all measures, the typically -developing children had the highest average scores, followed by the optimal -outcome group, and the HFA group showed the lowest level of functioning on all tasks. Additionally, the optimal outcome group, as a whole, scored within the normal range on all tasks and only the high -functioning ASD group scored in the impa ired range on some of the standardized tests. The OO group also scored lower than the typically developing group (but well within the average range) on parent ratings of attention problems, atypical behavior, and depression. On the numerous other tasks tha t we used to assess these groups, the children in the optimal -outcome group were statistically indistinguishable from their typically developing peers. In sum, we appear to have found a group that, with the possible exception of some very subtle pragmatic deficits, is currently functioning at the same level as their typically developing peers, and we are continuing to follow this group.Ó Helt, M., Kelley, E., Kinsbourne, M., Pandey, J., Boorstein, H., Herbert, M., & Fein, D. (2008). Can children with autism recover? If so, how? Neuropsychology Review . 18, 339 -366. The NIMH ( National Institute of Mental Health ) states: ÒAmong the many methods available for treatment and education of people with autism, applied behavior analysis (ABA) has become widely accept ed as an effective treatment. ÉThe basic research done by Ivar Lovaas and his colleagues at the University of California, Los Angeles, calling for an intensive, one -on-one child -teacher interaction for 40 hours a week, laid a foundation for other educators and researchers in the search for further effective early interventions to help those with ASD attain their potential.Ó National Institute of Mental Health (2008). Autism Spectrum Disorders: Pervasive Developmental Disorders. NIH Publication no. 08 -5511. A review by US and British pediatricians in the Lancet found: ÒThe most well researched treatment programmes are based on principles of applied behaviour analysis. Treatments based on such principles represent a wide range of early intervention strategies for children with autism Ñfrom highly structured programmes run in one -on-one settings to behaviourally based inclusion programmes that include children with typical development. The first types of behavioural treatment programmes developed and examined we re very structured, intensive, one -on-one programmes called discrete trial training, which were
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