Abstract
Early intensive behavioral intervention (EIBI) and its recent variant, naturalist developmental behavioral intervention (NDBI) aim to increase socialization and communication, and to decrease repetitive and challenging behaviors in preschool age autistic children. These behaviorist techniques are based on the precocity and intensity of the intervention, face-to-face interaction, errorless learning, and information fragmentation. Once considered to be “scientifically proven”, the efficacy of these approaches has been called into question in the last decade due to poor-quality data, small effects, low cost-efficiency, and the evolution of ethical and societal standards. Grounded on a reappraisal of the genetic and cognitive neuroscience of autism, we question three aspects of EIBI/NDBI: their focus on prerequisites for typical socio-communicative behaviors, their lack of consideration of autistic language development and learning modes, and their negative view of repetitive behaviors and restricted interests. We propose alternative predictions for empirical validation, based on the strengths of prototypical autistic children: (a) their non-verbal intelligence should be normally distributed and within the normal range; (b) improving access to non-communicative verbal and written auditory language material should favor their subsequent speech development and (c) decrease their problematic behavior; (d) lateral tutorship should increase the well-being of children and parents to a greater extent than personalized, face-to-face interventions by professionals; (e) admission to regular, but supervised daycare centers, combined with parental support and on-site crisis solving, represents a more cost-effective educational intervention than EIBI/NDBI.
Highlights
Reconsideration of our attitude towards early repetitive behaviorsIn addition to its socio-communicative aspects, autism is characterized by “restricted interest and repetitive behaviors” (RIRBs)
Autism can be diagnosed at approximately 2 years of age, making it possible to intervene before the child starts school
The interventions employed worldwide are grouped under the umbrella term “early, intensive behavioral intervention” (EIBI) in meta-analyses and practice guidelines for psychosocial interventions targeting the “core autism feature of impaired reciprocal social communication and interaction” [47]
Summary
In addition to its socio-communicative aspects, autism is characterized by “restricted interest and repetitive behaviors” (RIRBs). Several types of RIRBs have been distinguished Some, such as echolalic or hyperlexical behaviors, as well as intense interests in general, are related to information processing and seeking and are highly specific to autism. The “captivity” subgroup of RIRBs (including rocking, or wandering in circles) is not specific to autism Such behaviors are observed even in animals and are caused by information deprivation. Autistic interests should be included within an educational framework, consistent with safety and educational requirements This does not modify our position: RIRBs that reflect the search for and processing of information relevant to the child’s interest should be encouraged. They represent the motivational foundation on which the education of the autistic child should be based. This is a drastic departure from using them as a pretext for social routine, such as in NDBI
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