The relationship between early learning rates and treatment outcome for children with autism receiving intensive home-based applied behavior analysis.

Abstract

The present study suggests that initial learning rates of young children with autism receiving early, intensive, home-based behavioral intervention are moderately correlated with outcome variables after four years of treatment. 20 children with autism who had Childhood Autism Rating Scale scores between 37.5 and 58 and Vineland Adaptive Behavior Scales scores between 38 and 63 at the beginning of treatment were re-evaluated after 4 years of treatment through the Rutgers Autism Program. School placement follow-up data were also available after 4 years. Treatment data reflecting rate of initial acquisition of skills was significantly correlated with school placement, severity of autism symptomatology, and adaptive behavior profiles four years into treatment, with those children having faster early skill acquisition showing greater gains in adaptive functioning, fewer or less severe symptoms of autism, and less restrictive educational placements after 4 years. The data are consistent with previous research showing the impact of intensive ABA intervention and variability in outcomes associated with such intervention, and also lend support to other published findings that early learning rates are correlated with outcome. Key Words: Early Behavioral Intervention, Home based Programs, Outcome, Learning Rates, Autism The demonstration of the benefits of intensive applied behavior analytic programming for preschoolers with autism has been compelling (e.g., Anderson, Avery, DiPietro, Edward & Christian, 1987; Fenske, Zalenski, Krantz & McClannahan, 1987; Harris, Handleman, Gordon, Kristoff & Fuentes, 1991; Lovaas, 1987). Approximately 50% of children with autism participating in such programs have been shown to have significant increases in IQ and/or be placed in regular educational classrooms with little or no support. A number of researchers have documented that intensive behavioral intervention (i.e., 30-40 hours per week) begun before age 4 and lasting at least 2 years sometimes produces these dramatic effects, although studies vary in degrees of experimental control and treatment fidelity. While some studies report that just under half of the children receiving 40 hours per week of 1:1 instruction achieved essentially normal educational and intellectual functioning (Lovaas, 1987; McEachin, Smith, & Lovaas, 1993; Perry, Cohen, & DeCarlo, 1995), slightly less dramatic improvements have been documented with less intensive (i.e., 20-25 hours per week) intervention (Birnbrauer & Leach, 1993, Andersen et al., 1987; Harris et al., 1991). It is important to note, however, that most of these children benefited from substantial gains in IQ scores, adaptive functioning, and language (Anderson et al., 1987; Harris et al., 1991). These early studies provide demonstrations of results achieved in both home programs (Lovaas, 1987, McEachin et al, 1993, Perry, Cohen & DeCarlo, 1995) and center-based programs (Birnbrauer & Leach, 1993, Andersen et al., 1987; Harris et al., 1991). Following the initial reports of the success of ABA intervention, another model of service delivery emerged in which intensive ABA was provided in home settings with programs coordinated by parents. Previous studies utilizing a home-based model were coordinated and supervised by ABA professionals who, in addition to directing programming, hired staff and managed data. However, in the alternate home-based model, parents played a much more central coordination role: hiring staff, managing data and assisting in programming decisions with consultation from ABA professionals. Smith, Buch and Evslin-Gamby (2000) reported on the effectiveness of parent directed, intensive early intervention programs in the home. While 5 of 6 children rapidly acquired skills at the start of treatment, only 2 improved on standardized tests at 2-3 year follow-up. These authors also noted that home instructors were less consistent than clinic employees in their implementation of teaching strategies. …