Making it fit: A provocative look at models of early intensive behavioral intervention for children with autism.

Abstract

Abstract Recommendations for ABA for children with Autism have exponentially increased, creating a shortage of qualified ABA consultants. The increase in demand, lack of financial support for in-home programs and difficulty of maintaining in-home staff create a need for alternative delivery models for Early Intensive Behavioral Intervention (EIBI). We present a preliminary analysis of learning rates and psychometric outcomes for children in 3 different delivery models--Home based EIBI, only; and Home and School EIBI; Home Based EIBI with alternative school methods. ********** An impressive body of research exists that supports the effectiveness of early intensive behavioral intervention (EIBI) programs based on principles of applied behavior analysis (ABA) implemented with preschool age children diagnosed with autism and PDD-NOS (see New York State Department of Health Early Intervention Program, 1999a, 1999b, 1999c). Traditionally, these programs have included 40+ hours per week of programming conducted by trained therapists in home settings over a period of 2-3 years. Given the daunting financial and logistical demands inherent in organizing and implementing programs of this type, it is often necessary to implement different service delivery models. Some of these models have included school-based programs (often housed in special needs schools), combined home/school programs, and partial home programs - among others. Relatively little research has been done comparing the outcomes and relative effectiveness of these program variants. Effective EIBI programs can significantly increase the quality of life of children and families, and can significantly reduce costs to society (Jacobson, Mulick, & Green, 1998). Increased knowledge of the comparative efficacy of EIBI program variants can be of benefit to school districts and parents of autistic children attempting to balance limited resources with effective intervention. This study is viewed as a pilot project. Data are presented for children in 3 different service delivery models: Home based EIBI, only; Home based and School EIBI; and Home based EIBI and alternative school program. The intent of the study is to obtain initial data to be used in formulating follow-up studies of the efficacy of alternative EIBI service delivery models. Method Participants This study was conducted with children of preschool age (N = 5) initially diagnosed with autism or PDD-NOS currently in EIBI programs followed by the psychology department of Columbus Children's Hospital. Participants were between 3 and 6 years of age, who received a comprehensive psychological evaluation at least twice by the Psychology Department, have received at least 10 hours per week of EIBI intervention over the past 18 months (or more), and have tutors other than parents. Exclusionary criteria included diagnoses of Asperger's, Rett's, Fragile X without Mental Retardation, Mental Retardation without Autism, and Tuberous Sclerosis. See Table 1 for a brief description of each participant. Materials Because of age and skill differences, children received a variety of standardized cognitive and language measures. These measures included: Cognitive measures: 1. Bayley Scales of Infant Development Second Edition (Bayley; Bayley, 1993) The Bayley was designed to assist professionals in early identification of developmental delays. Standardized scores for cognitive, motor, and behavioral development are available. Correlations with measures of cognitive ability (e. g. IQ tests) are adequate for estimates of developmental delay (correlation with WPPSI-R Full Scale IQ = .73). Test-retest reliability for the mental scale was also adequate (.87). 2. Mullen Scales of Early Learning Manual (Mullen; Mullen, 1995) The Mullen was designed to provide estimates of cognitive development for young children. …