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Research

The Children’s Autism Project:  The research behind the results

 

More than 40 years of research have focused on autism intervention. The Children’s Autism Project is dedicated to using evidence-based procedures and recommendations to ensure best practices.  Research provides valuable recommendations about the components of autism intervention including:  1) autism intervention should use ABA, 2) individualized intervention, 3) systematic teaching and programming, 4) ongoing objective assessment, 5) intensive intervention, 6) involvement of families, 7) high level of staff training and 8) intervention should start at an early age (e.g., Myers & Johnson, 2007; National Research Council, 2001; National Standards Report, 2009; U.S. Department of Health and Human Services, 1999).  Each of these recommendations is discussed below.  The Homestead strives to include all of these components within the services of the Children’s Autism Project.

Applied Behavior Analysis (ABA)ABA is a science that is dedicated to understanding the principles of behavior and applying these to improve important behaviors (Cooper, Heron, and Heward, 2007), such as teaching a child to communicate, expanding play, and building meaningful social interactions.  One area in which ABA is recognized as making a substantial difference is within the treatment of individuals with autism.  The use of ABA is the recommended autism treatment approach by the U.S. Surgeon General and American Academy of Pediatrics (U.S. Department of Health and Human Services, 1999; Lilienfeld, 2005).  Research shows with an ABA intervention program, children with autism make significant gains in social interactions, communication, intellectual functioning, and adaptive behavior (e.g., Lovaas, 1987; Remington et al., 2007; Sheinkopf & Siegel, 1998; Smith, Eikeseth, Klevstrand, & Lovaas, 1997; Smith, Groen, & Wynn, 2000).  Comparison studies show that ABA is more effective when compared to a combination of other treatments (e.g., Howard, Sparkman, Cohen, Green, & Stanislaw, 2005; Eikeseth, Smith, Jahr, & Eldevik, 2007; Zachor, Ben-Itzchak, Rabinovich, & Lahat, 2007).  More specific details about these studies can be found in the Reference section below.

In addition to outcome studies, specific teaching strategies that use ABA have also been found to be effective in teaching individuals with autism.  The strategies found in the research include, but are not limited to:

  • Discrete Trial Teaching
  • Natural Environment Teaching
  • Verbal Behavior Approach
  • Incidental Teaching
  • Antecedent-Based Interventions
  • Generalization Training

Individualized:  Each child’s treatment should be individualized to meet his or her specific needs.  The Children’s Autism Project assesses each child before writing goals and procedures.  Individualized treatment plans focusing on each child’s needs are implemented.  Each child is provided one staff each session who focuses only on that child’s goals.

Systematic Teaching:  Systematic teaching involves identifying and manipulating variables to foster student success.  Variables include but are not limited to manipulating the level of distraction, difficulty of skill targets, and rate of reinforcement and feedback.  Research indicates systematic programming is often necessary for skills learned in structured settings to also occur in natural settings (Stokes and Baer, 1977).  The Children’s Autism Project makes this possible through a combination of structured teaching, group play activities, and parent training sessions to focus on skill generalization to the home, school, and community.

Objective ongoing assessment:  Ongoing assessment allows changes to be made to procedures, programs, and targets quickly.  The Children’s Autism Project takes data on each goal for data analysis.  Data analysis allows clinic supervisors to make data based decisions, changing procedures if needed and ensuring progress is made.

Intensive: Research indicates that for best outcomes, intervention needs to be provided intensively.  Intensive intervention includes keeping a child highly engaged throughout a session with a high number of learning opportunities.  In addition, research suggests providing intensive intervention for 12 months a year and up to 45 hours per week (National Research Council, 2001).  The Children’s Autism Project provides 2 ½ hours of intervention each day, five days per week, 12 months per year.  Within each session there is a high rate of learning opportunities and multiple skill areas focused on each day.  This effort is multiplied through family training to promote generalization and use of ABA strategies at home and through collaboration with schools and allied professionals.

Family involvement:  Research shows that family involvement is important in order to promote generalization of skills at home and collaboration of goals.  The Children’s Autism Project provides at least one hour of parent training each week.  The training is child specific, focusing on teaching strategies that will promote success.  The training is conducted in a variety of settings in order to provide the best potential for families to incorporate ABA strategies throughout daily life.

Trained Staff: It has been recommended that a Board Certified Behavior Analyst supervise programs and staff (Association for Behavior Analysis International Autism Special Interest Group Consumer Guidelines, 2007; Williams and Williams, 2011).  The Children’s Autism Project requires all supervisors to be a Board Certified Behavior Analyst (BCBA) or a Board Certified Assistant Behavior Analyst (BCaBA).  Research also suggests that children make more gains when staff are trained and implement procedures correctly (Sarakoff and Sturmey, 2008).  Direct staff members are trained by the clinic supervisor on the child specific procedures and goals.  Training is done for each staff at a high frequency, providing a minimum of bi-weekly supervision for each staff member every month.

Early Intervention: Research recommends intervention should start as early as possible (Myers & Johnson, 2007; National Research Council, 2001).  The Children’s Autism Project is focused on providing services to children eight and under.

References

Autism Special Interest Group of the Association of Behavior Analysis (2007). Consumer guidelines for identifying, selecting, and evaluating behavior analysts working with individuals with autism spectrum disorders. Retrieved from http://www.abainternational.org/Special_Interests/AutGuidelines.pdf.

Cooper, J.O., Heron, T.E., & Heward, W.L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, NJ: Pearson.

Eikeseth, S., Smith, T., Jahr, E., & Eldevik. S. (2007). Outcome for children with autism who began intensive behavioral treatment between the ages of 4 and 7: A comparison controlled study. Behavior Modification, 31, 264-278.

Howard, J.S., Sparkman, C.R., Cohen, H.G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359-383.

Lilienfeld, S.O. (2005). Scientifically unsupported and supported interventions for childhood psychopathology: A summary. Pediatrics, 115, 761-764.

Lord, C., & McGee, J.P. (Eds.) (2001). Educating Children with Autism, National Research Council. Washington D.C.: National Academy Press.

Lovaas, O.I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.

Myers, S.M., & Johnson, C.P. (2007). Management of children with autism spectrum disorders. Pediatrics, 120, 1162-1182.

National Autism Center (2009). National Standards Report: The national standards project: addressing the need for evidence-based practice guidelines for autism spectrum disorders. Retrieved from http://www.nationalautismcenter.org/nsp/.

Remington, B., et al. (2007). Early intensive behavioral intervention: Outcomes for children with autism and their parents after two years. American Journal on Mental Retardation, 112, 418-438.

Sarakoff, R.A., & Sturmey, P. (2008). The effects of instructions, rehearsal modeling, and feedback on acquisition and generalization of staff use of discrete trial teaching and child correct responses. Research in Autism Spectrum Disorders, 2, 125-136.

Sheinkopf, S.J., & Siegel, B. (1998). Home based behavioral treatment of young children with autism. Journal of Autism and Developmental Disorders, 28, 15-23.

Smith, T., Eikeseth, S., Klevstrand, M., & Lovaas, O.I. (1997). Intensive behavioral treatment for preschoolers with severe mental retardation and pervasive developmental disorder. American Journal on Mental Retardation, 102, 238-249.

Smith, T., Groen, A.D., & Wynn, J.W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal on Mental Retardation, 105, 269-285.

Stokes, T.F., & Baer, D.M. (1977). An implicit technology of generalization. Journal of Applied Behavior Analysis, 10, 349-367.

U.S. Department of Health and Human Services. (1999). Mental health: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.

Williams, B.F., & Williams, R.L. (2011). Effective programs for treating autism spectrum disorder: Applied behavioral analysis models. New York, NY: Routledge.

Zachor, D.A., Ben-Itzchak, E., Rabinovich, A., & Lahat, E. (2007). Change in autism core symptoms with intervention. Research in Autism Spectrum Disorders, 1, 304-317.

 

Research Studies

 

Outcomes of research studies offer important information about best practices and treatments of autism intervention.  Here are some studies related specifically to research supporting the interventions used in the Children’s Autism Project at The Homestead. We hope you will find this information helpful. 

 

ReferenceDetails

Lovaas, O.I. (1987).

Behavioral treatment and normal educational and intellectual functioning in young autistic children.

Journal of Consulting and Clinical Psychology, 55, 3-9.

Participants

38 children (19 in experimental, 19 in control)

  1. ASD diagnosis
  2. Less than 40 months if non-vocal or 46 months if vocal

Intervention

ABA: 40 hours per week for 2 years in home, school, community; 1:1 instruction; focused on application of behavior principles such as reinforcement and discrimination training.

Control 1: 10 hours or less per week for 2 years; 1:1 instruction.

Effectiveness & Outcome

IQ Increase:

  • ABA: 47% achieved IQ within normal limits; 40% children mild MR and 10% children severe MR.
  • Control: 2% achieved IQ in normal limits; 45% mild MR; 53% severe MR

Mainstream School:

ABA: 9 children were in public mainstream classroom

Smith, T., Eikeseth, S., Klevstrand, M., & Lovaas, O.I. (1997).

Intensive behavioral treatment for preschoolers with severe mental retardation and pervasive developmental disorder.

American Journal on Mental Retardation, 102, 238-249.

Participants

21 children (average age 3.08 years); 11 children in intensive treatment; 10 in minimal treatment.

Intervention

Behavior analytic procedures based on Lovaas et al., 1981.

Intensive: 30+ hours/week 1:1 instruction for 2 or more years in home and community.

Minimal: 10 hours or less/week 1:1 instruction for 2 or more years.

Effectiveness & Outcome

Average IQ:

Intensive: Pre: 28; Post: 36

Minimal: Pre: 27; Post: 24

Spoken Words:

Intensive: Pre: 0 children; Post: 10/11

Minimal: Pre: 0; Post: 2/10

Sheinkopf, S.J., & Siegel, B. (1998).

Home based behavioral treatment of young children with autism.

Journal of Autism and Developmental Disorders, 28, 15-23.

Participants

22 children

  • average age 34.65 (23-47 months)
  • IQ range: severe to normal

Intervention

Intensive home treatment: DTT based treatment based on principles of applied behavior analysis (ABA) averaging 20/week in home; special education at school average 6 hours/week.

Control:  0 hours experimental therapy; special education at school average 10 hours/week.

Effectiveness & Outcome

Intensive intervention: Higher increases in IQ approximately 25 point difference between the groups.

Experimental Group:

Subject 2, 23 months, increased IQ from 22 (severe) to 102 (normal limits).

Subject 3, 27 months, increased IQ from 27 (severe) to 65 (mild).

Subject 4, 34 months, increased IQ from 47 (moderate) to 69 (mild).

Subject 7, 31 months, increased IQ from 68 (mild) to 96 (normal limits).

Smith, T., Groen, A.D., & Wynn, J.W. (2000). 

Randomized trial of intensive early intervention for children with pervasive developmental disorder.

American Journal on Mental Retardation, 105, 269-285.

Participants

28 children diagnosed with ASD and PDD-NOS

  • Ages 18-42 months
  • IQ range 35-75
  • ASD or PDD-NOS diagnosis
  • No other major medical problems

Intervention

Intensive: 30 hours per week for 2-3 years utilizing discrete trial and other behavior analytic methods.

Control: 5 hours of parent training for 3-9 months; parents required to complete 5 other hours per week.

Effectiveness & Outcome

IQ change:

  • Intensive treatment:  16 point increase
  • Control:  1 point decrease

Children with PDD-NOS on average made more gains than children diagnosed with autism.

Intensive group made more gains in communication, IQ, language, and academic skills, compared to control.

Eikeseth, S., Smith, T., Jahr, E., & Eldevik, S. (2002).

Intensive behavioral treatment at school for 4-7 year old children with autism: A 1 year comparison controlled study.

Behavior Modification, 26, 49-68.

Participants

23 participants (17 boys, 6 girls)

  1. ASD diagnosis
  2. Between ages of 4-7
  3. IQ of 50 or above

Intervention

Behavioral treatment

Average of 28-29 hours per week in public school.

Teaching:  methods in applied behavior analysis (ABA) focusing on communication, play, and social skills.

Parent participation: 4 hours per week for first 3 months in the classroom then focus on community and generalization.

 

Eclectic treatment in public school

Average of 28-29 hours per week.

Included components of Project TEACCH, sensory-motor therapies, and applied behavior analysis.  Intervention was selected based on school recommendations.

Effectiveness & Outcome

Average IQ increase:

  • Behavioral treatment: 17.15 points
  • Eclectic:  4.33 points

Average language functioning increase:

  • Behavior treatment:  27 points
  • Eclectic: 1.08 points

Vineland Adaptive Behavior Scale increase:

  • Behavior treatment: 11 points
  • Eclectic: .17 points

Howard, J.S., Sparkman, C.R., Cohen, H.G., Green, G., & Stanislaw, H. (2005).

A comparison of intensive behavior analytic and eclectic treatments for young children with autism.

Research in Developmental Disabilities, 26, 359-383.

Participants

61 children

  1. ASD or PDD-NOS diagnosis
  2. Began intervention before 48 months of age
  3. No prior treatment longer than 100 hours

Intervention

Intensive behavior treatment in home, school, and community:

25-40 hours per week children; 50-100 learning opportunities per hour with behavior analytic procedures;  no other services such as speech or OT were provided.

 

Autism educational programming in public classroom:

25-30 hours per week; variety of methods used including behavior analytic methods, Picture Exchange Communication Systems (PECS), sensory integration, and components of TEACCH, speech therapy services, and group activities.

 

General education programming:

15 hours per week; 1:6 ratio; focus on language, play and sensory experiences, speech services.

Effectiveness & Outcome

Standard score increase:

  • Intensive behavior treatment: 11 point increase
  • Autism education: no change
  • General education: 3 point decrease

 

Learning rate:

  • At intake children in all 3 groups had learning rates lower than average.
  • At follow-up, after intervention the intensive behavior group had the most children acquiring skills at a typical learning rate.

 

Sallows, G.O. & Graupner., T.D. (2005).

Intensive behavioral treatment for children with autism:  Four-year outcome and predictors.

American Journal on Mental Retardation, 110, 417-438.

Participants

23 children

  • ASD diagnosis

Intervention

Clinic directed group and parent directed group employed methods using principles of applied behavior analysis (ABA).

Effectiveness & Outcome

IQ change:

  • Rapid learners: 55 to 104.
  • Moderate learners: only change in performance IQ.

 

Change in diagnosis/school placement:

  • Rapid learner: 8/11 scored in non-autistic range and were in regular education classrooms.
  • Moderate learner: 4/12 in regular education classroom; 6/12 in special and general education; 2/12 in full time special education.

Strongest pretreatment predictors of outcome were imitation, language, daily living skills, and socialization.

Eldevik, S., Eikeseth, S., Jahr, E. & Smith, T. (2006).

Effects of low-intensity behavioral treatment of children with autism and mental retardation.

Journal of Autism and Developmental Disorders, 36, 211-224.

Participants

28 children; average age; all children started treatment at 6 years or younger.

Intervention

Behavioral:  All children received interventions based on principles of applied behavior analysis (ABA) in home, school, and community; average 12.5 hours/week in treatment room and 8.3 hours in inclusive setting for an average of 20 months.

 

Eclectic: At least two of the following: alternative communication, applied behavior analysis, total communication sensory motor, TEACCH; average 12 hours/week in treatment room and 12 hours/week in inclusive setting for 21.4 months.

Effectiveness & Outcome

Behavioral group significantly made more progress than eclectic group on intellectual functioning, language comprehension, expressive language, and VABS (Vineland) Communication.
Behavioral: 38% children reduced degree of mental retardation; 1 moved from profound to severe; 3 moving from moderate to mild; 1 moving from mild to normal level IQ. 0% received more severe MR diagnosis after intervention.

Eclectic: 7% reduced MR; 1/15 children moved from moderate to mild. 40% were more severe MR after intervention.

Remington, B., et al. (2007). 

Early intensive behavioral intervention:  Outcomes for children with autism and their parents after two years.

American Journal on Mental Retardation, 112, 418-438.   

Participants

44 children

  • ASD diagnosis
  • Average age 34.7 months

Intervention

Intervention:  Early intensive behavioral intervention in home; 2 years; average 25.6 hours/week 1:1 teaching; DTT, generalization procedures, natural environment training, and verbal behavior.

Comparison:  Eclectic treatments including speech therapy, TEACCH principles, school programs, communication systems.

Effectiveness & Outcome

In mainstream school: Intervention: Pre: 0%, 1 year: 57%, 2 year: 74%.Comparison: Pre: 0%, 1 year: 48%, 2 year: 48%. 

IQ:

Intervention:  Pre: 61.4; 1 year:  68.8; 2 year: 73.4.
Comparison:  Pre: 62.3; 1 year: 58.9; 2 year: 44.4.

Zachor, D.A., Ben-Itzchak, E., Rabinovich, A., & Lahat, E. (2007).

Change in autism core symptoms with intervention.

Research in Autism Spectrum Disorders, 1, 304-317.

Participants

39 children

  • ASD or PDD-NOS diagnosis
  • Ages 22-34 months

Intervention

ABA:  Program based on applied behavior analysis, 1:1 treatment by behavior therapists, 35 hours/week, play dates, regular preschool activities, focus on imitation, communication, joint attention, non-verbal communication, pre-academic skills, play, fine motor, adaptive.  Speech and occupational therapists consulted with the team.

 

Eclectic:  Small group activities supervised by special education teachers; speech therapy, occupational therapy, music therapy, parent group meeting.

Effectiveness & Outcome

ADOS scores:

ABA:  Statistically significant improvements in language and communication, and reciprocal social interaction.

Eclectic: Statistically significant improvement in reciprocal social interaction; however, less treatment effects than ABA group.

 

Changes in autism diagnosis:

ABA:  Autism to off spectrum:  4/20.

ED:  Autism to off spectrum:  0/19.