Friday, May 29, 2009

Autism Treatment of Choice

As pointed out on Nesrhtens… ABA and thoughts… Sigmund Eldevik, Richard P. Hastings, J. Carl Hughes, ErikJahr, Svein Eikeseth, and Scott Cross have published an article in Journal of Clinical Child & Adolescent Psychology, Volume 38, Issue 3 May 2009 , pages 439 - 450, Meta-Analysis of Early Intensive Behavioral Intervention for Children With Autism, which reports the results of an examination of 34 Early Intensive Behavioral Intervention studies "9 of which were controlled designs having either a comparison or a control group". The article authors found large full scale intelligence changes and moderate adaptive behavior changes.

The authors concluded that:

"at present, and in the absence of other interventions with established efficacy, Early Intensive Behavioral Intervention should be an intervention of choice for children with autism. "

It will be interesting to see if ABA critical researchers respond with anything positive, that is to say, with word of an evidence based effective alternative. My best is that the usual nonsensical rhetoric will flow from the usual anti-ABA activists who will offer absolutely no evidence based alternative. Or they will simply argue that autistic children, even the severely autistic, should unlike all other children, simply be left to develop on their own with no effective assistance.




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12 comments:

farmwifetwo said...

Did it prove intelligence only in the clinical setting or across all settings?? Since, ABA is not a "cross setting" model I suspect only within the clinical trials.

Also, how much work was done outside of ABA clinical settings by the parents?? Outside of the ABA settings were the children seeing OT and SLP's?? ABA therapists are not these professionals and as I was told they would not use sensory integration therapy, I had to do it outside of the program on my own time.

My children are doing amazing, but it's not b/c of ABA but b/c someone is taking the time to teach them.

Truth is Harold, until your son can handle going to Grandma's or spending time with the other children IMO ABA doesn't work. Your trip to Grandma's made me tear up, I couldn't imagine my children not running into either Grandparent's home. It's not addressing his other issues, like sensory. Yes he's learning, but he's still not enjoying life to it's fullest.

That is my #1 criteria at the end of the day. I don't care how far they come, but they must be able to enjoy life... go places, see things, laugh, play, interact as best they can will everyone... And sleep over at Grandma's.

Little boy got his ball chair yesterday at school. Since his regular EA (he's in a regular class - with modified work) is gone today and the OT is coming Mon, they will start using it then.... ABA does not do sensory... OT does.

S.

Marius Filip said...

There is one more way to prove the efficacy of ABA.

It is to gather the periodic evaluations of all the children who underwent ABA and show where they started from and how they progressed - month by month or trimester by trimester - compared with the children who experienced a different kind of treatment or no treatment at all.

Such study, which would be an epidemiological one indeed, would silence for good those folks who complain about lack of randomization in the Lovaas study (is randomization a valid criterion for a therapy that lasts 3 years and it is highly personalized? would any of the parents in the Lovaas study have permitted his child to be placed in the control group based on randomization?) and about aversives (largely no longer used) which, according to Michelle Dawson, is "the active ingredient of ABA" (totally nonsensical considering that aversives block generalization, hence the aversives could not have had a crucial role in the full recovery of the Lovaas kids who ended up generalizing like any normal kid).

Yet, in order for such epidemiological-like studies to be conducted, government agencies must design and endorse standard tests and uniform procedures for each kind of treatment under scrutiny, including ABA - otherwise any comparison would be comparing apples with pears.

That calls for national strategies regarding autism in the countries interested in such results.

THIS is one more reason to fight for a national policy on autism in Canada, that you have already advocated for for a long time.

Autism Reality NB said...

Farmwifetwo


I am glad your child is doing well. My son is doing much better than before he started ABA. Much better.

The article in question is an analysis based on review of 34 studies conducted on the efficacy of ABA as an autism intervention not how it has worked in the case of my son.

In terms of my son I think I am a whole lot better placed than you to evaluate the positive gains that he has made through ABA. You have NO idea where we started from pre-ABA.

I have commented in the past and shown pictures of him completing addition and reading from Dr. Seuss books. I have shown pictures of his handwriting on here as well. Reading, writin and 'rithmateric?

We are able to communicate with Conor on a very substantial level which we couldn't do before - at all.

Conor's self injurious behavior although still occurring occasionally is nowhere near where it was pre-ABA. AND we have used ABA, or his therapist did, to teach Conor not to wander across busy streets placing his life at risk as he did once before and as I have written about often.

The existence of further specific challenges is not a reason to reject ABA contrary to the professional evidence and contrary to the gains which I have seen in my son and which I have commented on previously on this site.

I would also remind you that Conor's ABA gains did not arise from Intensive Early Behavioral Intervention. Available ABA services were very scarce for kids in our province until a group of parents, of which I was one, lobbied hard for the provision of government funded properly trained pre-school autism support workers and clinical supervisors to work with our children. Then we had to fight for those services to be available in school from ABA trained teacher aides and resource teachers.

Most of Conor's ABA has been received in the school setting - not as part of an EIBI approach which just wasn't available to him.


As for Conor's grandmother that is really just a question of having time to desensitize him to being overstimulated. We have done that over the years with such unavoidable and difficult situations as getting a hair cut or using a public washroom with the hand dryers blowing.

Apart from school and a therapist we take the time to work with Conor every single day so please do not suggest the contrary.

You are simply WRONG about ABA not doing sensory. And since you asserted that to be the case please provide some information and authority to back it up.

Many OT's and SLP's by the way use ABA as part of their professional work with autistic children. OT and SLP's are occupational categories not specific interventions.


I have tried to address your criticism of ABA ... please provide me with any reputable review of ANY other evidence based intervention. Just one. TEACCH, Floortime, RDI, DRI, etc etc etc do NOT have a solid evidence basis of support. Period. Again, OT and SLP are professional/occupational designations the members of which use various interventions ... including ABA with autistic children.

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Penny said...

Harold, with ABA we taught our child EVERYthing we intended. It worked. I stood firmly behind the science of it. I refused to look at other interventions because of the exact reasons you cite.

We were so pleased by the "progress" we saw!

But it wasn't meaningful.

And when our ABA fell apart, I fought the falling apart, tried to hold it together.

And (luckily) I failed.

RDI was available at that time and I thought I'd try it while I pulled ABA back together.

We never went back to ABA.

Just because the "science" is behind the "evidence" doesn't mean RDI doesn't work. It just means the science is behind.

The changes in us, in my daughter, have been far beyond anything ABA delivered.

I held onto the science behind ABA for too long. We created more autism in my daughter, not less, caused her to be more rigid and prompt dependent.

I feel a lot of guilt, now, looking back, and how rigidly (autistic-like?) I held on to the "science" behind ABA, when all the things we were teaching my daughter with it weren't adding up to meaningful relationships or an improved quality of life for her.

I *do* sense where you were pre-ABA, because when I read your words, I recognize a lot of it. We were there once.

ABA and the science behind it gave me a lot of hope. False hope.

The delay in getting the science to show that developmental approaches work, and work better in terms of relationships and quality of life, is not evidence enough to rule out those approaches.

Autism Reality NB said...

Thank you Penny.

I am glad that things finally worked out well for your child.

The fact remains though that RDI is not at present substantiated by professional study as evidence based in terms of its effectiveness.

Any time a study or report comes out confirming ABA effectiveness there will be people with individual stories that ABA didn't work for them or that something else did.

I am not sure what gains your child made with ABA that was not "meaningful"? My son despite not having Early Intensive Behavioral Intervention, has made substantial and meaningful gains from ABA. Enhanced communication, reduced self injury are all very meaningful gains apart from academic progress.

If RDI is effective then they should get the studies done to demonstrate that fact. There will be no problem getting parents willing to put their children in a comparative group to receive ABA.

Let's hope RDI advocates get the studies done soon to back up the claims. Otherwise they are unlikely to convince the public authorities to divert resources from the proven to the unproven.

Penny said...

PS: Me again. :)

I am not anti-ABA. My ABA days taught me when TO use ABA, and there is a time and a place for it (and there's science to prove it, too. lol)

If I need to break a task into smaller parts and teach it a certain way, I certainly know how to do that, and use it, appropriately.

I am still sometimes really amazed at how, by working on developmental foundations how higher level functions and skills emerge without directly working on them. For example, experience with non-verbal prototypes of communication via RDI, we see verbal and conversational development. Ignore the "talk", concentrate on interaction and reciprocity at non-verbal levels, and the "talk" will come!

WOW!

Marius Filip said...

Penny

The problem with RDI is that it's technique cannot be reliably verified until Mr. Gutstein releases the patent on it.

ABA is free domain. Parts of its power comes from this.

From your description, it seems the me that the generalization programs failed in the case of your child.

Have you tried ABA/VB?

It is ABA combined with Verbal Behavior. We are doing this with our son and we're seeing changes week by week - no kidding - and not only in what he knows, but in socialization as well, because he communicates much better than before.

What I have against RDI and Sensory Integration is that they seem to me to rely on too simplistic theories about the cause of autism.

According to what I've encountered in respect of autism research, autism seems way too pervasive, way too complex and way too heterogeneous to be explained by a single theory.

ABA makes no such assumptions. It applies behaviorism and that's all. It doesn't try to explain WHY it works in children with autism and not in children with the Rhett Syndrome or the ones with the Down Syndrome.

It works on autism, though.

Penny said...

Harold, did you ever read my man on the bicycle story?
Penny

Penny said...

Marius, our ABA program had a big VB component in it. Our problem was going for words and "talk" before my daughter had non-verbal reciprocity and interaction. The non-verbal prototypes need to be in place first, and then enhancements are added, with words and "talk" being the last enhancement to an already complex system of communication.

I would never go back to ABA/VB. EVER. We were on our 4th BCBA -- not one of them came in and corrected past mistakes.

Part of my journey is www.notnewtoautism.blogspot.com -- check out the label about autism intervention.

And, I am VERY HAPPY to hear that your child is making progress! I wish you ALL the very best!

I just don't want parents to make the same mistakes we made.

Anonymous said...

farmwifetwo-You clearly had VERY bad ABA providers. Good ABA providers specifically program for generalization and it must be written into each objective on the IEP that mastery will be across more than two therapists and parents across home, school and community settings. Some very outdated ABA providers (NECC in Masaschusetts) don't believe in sensory integration since there is no data to support it, but progressive ABA people will of course incorporate it and take advice from the OT.

Roger Kulp said...

As I have said before,I have no opinion one way or another about ABA. Clearly there is a lot of debate about the effectiveness of ABA,and you don't have to be a Michelle Dawson to bash it.

An interested observer would have to ask why there has not been a peer reviewed alternative to ABA to emerge in the last 40 years or so.I guess you could come up with all sorts of conspiracy theories about The Lovaas Institute suppressing any studies about alternatives to ABA.

Harold,I would be VERY interested if you could tell me,in detail,what methods the ABA therapist used to control Conor's eloping and self-injury.If you don't think this is the place for it,then send me a private email.