Three years of intensive applied behavior analysis: A case study.

Abstract

For more than thirty years empirical studies have been conducted and published in numerous peer-reviewed journals showing the efficacy of applied behaviour analysis (ABA) in the treatment of autism spectrum disorders. It is not surprising given the years of dedication by many well respected researchers that ABA has more empirical support than any other treatment or therapy for children diagnosed with autism. It incorporates numerous teaching strategies, each of which have an empirical basis demonstrating their effectiveness. (Matson, Benavidez, Compton, Paclawskyj, & Baglio, 1996). Applied Behaviour Analysis is a science-based approach to education. Numerous governmental and private agencies in the U.S.A. have endorsed it as the preferred therapy for children with autism (e.g., Surgeon-General, 1999; Maine Administrators of Service for Children With Disabilities, 2000; New York State Department of Health, 1999). There are hundreds of objective research studies that have shown applied behavior analysis to be an effective method for teaching language and communication, social and leisure skills, and independent functioning, as well as reducing, replacing and eliminating challenging behaviours (Matson et al., 1996.) There are a number of comparison studies that have 'tested' the outcomes of treatment models for children with autism. The first large-scale and most well documented outcome study of ABA as a treatment for autism was published by Lovaas (1987). Out of 19 children given 40 hours of one-on-one treatment for two years, almost half were able to complete a typical first grade class without special supports or accommodations. These nine children achieved IQ scores in the normal range (94-120). They had achieved typical or average functioning both developmentally and educationally. In a follow-up study aimed at investigating the long-term outcomes of these same children, McEachin, Smith, and Lovaas (1993) found that IQ and behavioral gains were maintained over about a ten-year period. Using double blind clinical assessments, eight of the nine children with the best outcomes were indistinguishable from normal controls based both on clinical evaluation as well as standard clinical assessment measures. Results indicated that these children continued to function normally into adolescence (McEachin et. al., 1993). A study conducted by Anderson, Avery, DiPietro, Edwards, and Christian (1987) produced results similar to Lovaas', but did not include a control group. Three additional studies have in part replicated Lovaas' original findings and demonstrated results in significant gains intellectually or in precise skills for participants (Birnbrauer & Leach, 1993; Sheinkopf & Siegel, 1998; Smith, Eikseth, Klevstrand, and Lovaas, 1997). All three of these studies demonstrated IQ improvements and other gains in children receiving ABA, although not to the same degree demonstrated by Lovaas (1987). However, the intensity of treatment differed somewhat from that in the Lovaas study with fewer hours of ABA intervention per week, so it is difficult to draw comparisons. Like Lovaas (1987), Sallows & Graupner (2001) demonstrated that 45% of those receiving ABA treatment in their study (these children were considered to show the best outcomes) achieved average levels of intellectual functioning. While earlier research investigated the different effects of varying the intensity of treatment, more recently, research has focused on comparison of treatment types. For example, recent studies have indicated important outcomes by providing a comparison between the use of an applied behavior analysis approach and 'eclectic' mixtures of procedures. Such studies presented one group of children with an applied behavior analysis program that emphasized the use of empirically supported techniques, such as reinforcement strategies, shaping, prompting, functional communication training etc. …