Thinking in Pictures Educational Services (TIPES): A Preliminary Report of an Intensive Behavioral Intervention for Children with Moderate to Severe Autism Spectrum Disorder

Abstract

Introduction: Autism spectrum disorder (ASD) is a potentially severely disabling exceptionality, and there is evidence of increasing incidence. In extreme cases major challenges can develop early in childhood for those individuals, their families and educational services. Social isolation, language problems, sensory and behavioural problems can all become entrenched if effective support is not provided. Interventions capable of delivering a recovery trajectory with transition to public/private education for children with moderate to severe ASD have been infrequently reported in the literature. Intensive behavioural intervention (IBI) as delivered within the Thinking in Pictures Educational Services (TIPES) has, as yet, not been tested as an intervention for children with moderate to severe autism. Methodology: IBI was delivered over a minimum of 12 months with 25-40 hours of individual therapy per week. Following a baseline memory paradigm assessment, a participant-specific IBI intervention was delivered. A combination of discrete trial training and ESDM, verbal behavior approach followed by direct instruction programs were used to improve language and social functioning. Baseline and end of intervention Assessment of Basic Language and Learning Skills-Revised (ABLLS-R) scores were recorded and compared to standard age adjusted mean childhood scores for educational ability. Each participant was assessed Assessment of Autism Treatment Evaluation Checklist (ATEC) in order to evaluate the impact of the intervention on the 4 domains of ASD (speech, sociability, sensory, behaviour performance). The primary end point was taken as the last score on the ATEC and ABLLS-R. The primary outcome was attendance in public and privately funded classroom settings. Results: All results within this study were significant. In terms of the primary outcome 9 out of 14 children with moderate to severe childhood ASD treated with IBI, using the TIPES method attended public/private funded sector education during the second year. There was an effect size (number needed to treat) of 2 indicating a very effective intervention. Basic language and learning skills as scored on the ABLLS-R significantly improved (p<0.000). Core characteristics of ASD as measured on the ATEC total scores significantly improved at end of treatment (p<0.012). All ATEC subscale scores significantly improved. Baseline mean speech scores significantly improved (p<0.006) as did sociability (p<0.005), sensory (p<0.078) and behaviour scores (p<0.041). Conclusion: This preliminary study indicated that educational attendance was possible for the majority of children with moderate to severe ASD who were accepted by TIPES and treated with an individualised combined IBI approach based on memory and learning capacity. If these results can be replicated this would be a highly cost-effective intervention.