EIBI as Intervention of Choice for Young Children with Autism

".... the results of our meta-analysis supports the implication that early intensive behavioral intervention (EIBI) should be the intervention of choice for young children with autism."

Sigmund Eldevik, Richard Hastings, and Carl Hughes, Bangor College, UK

Erik Jahr, Akershus University Hospital, Norway

Svein Eikeseth, Akershus University College, Norway

Scott Cross, Lovaas Institute for Early Intervention, USA

The recent meta-analysis by Eldevik and others must be very disheartening to anti-ABA crusaders in their efforts to disparage ABA intervention for children with autism. Parents seeking to actually help their autistic children though can take heart that yet another study supports their struggle to obtain ABA intervention for their children. Hopefully public decision makers will be guided by this and previous studies and reviews in determining how best to help autistic children.

The meta-analysis was summarized in Meta-analyses of research findings can help guide practice and policy in Issue # 9, of the newsletter of the Association of Professional Behavior Analysts. In conducting their meta-analysis the authors identified 34 studies through a systematic literature search and included 9 studies that had either a comparison or a control group. The authors found statistically significant improvements in IQ and adaptive behavior. They also reviewed a recent meta-analysis published in 2009 (Spreckley & Boyd) that purported to show that EIBI produced no better effects than what was described as standard care. The Eldevik team identified several serious errors in the Spreckley & Boyd meta-analysis though one of which I found particularly interesting, a misunderstanding by the authors of the Spreckly & Boyd meta-analyis of how EIBI and ABA are delivered:

"That analysis had a number of serious limitations, however. First, only 4 studies were included, so the full range of evidence for EIBI was not reviewed. Second, it was not clear from the report how EIBI was defined, so the studies may not reflect genuine EIBI as it is understood in our field. Third, and perhaps most problematic, the authors (Australian physical therapists) seemed to misunderstand how genuine EIBI is delivered, and what a study by Sallows and Graupner (2005) showed. In that study, one group of children with autism received EIBI directed by professional behavior analysts, and the other group received EIBI managed by their parents, who received training and frequent consultation from the behavior analysts. Both groups had comparably large gains on several measures after 4 years of EIBI. Spreckley and Boyd (2009) incorrectly characterized the parent-managed EIBI as “standard care,” i.e., non-ABA intervention. Because there were few differences between the groups after treatment, those authors concluded that EIBI was no more effective than what they erroneously treated as “standard care.”"

The misunderstanding of how EIBI and ABA are actually delivered is an impression that seems to permeate much of the online criticisms of ABA, particularly those by people who have absolutely no experience with ABA. Eldevik, Jahr, Eikeseth and Cross have performed a valuable service by helping to replace anti-ABA ideology with still more demonstrated evidence of ABA effectiveness.

autism

Myths and Misrepresentations about ABA and Lovaas (1)

The Lovaas, and related ABA, studies are amongst the most frequently discussed of autism topics. They attract criticism both rational and irrational, amateur, professional, and pseudo-professional, informed and ill informed. One of the knocks against the Lovaas studies is that they purportedly were based on study groups which did not represent lower functioning autistic persons. Lisa Jo Rudy of the About Autism Spectrum Disorders site has attempted to dispel this myth:

http://autism.about.com/od/alllaboutaba/f/toohiforaba.htm

"Ironically, one of the myths about the 1987 study is that children did well because a high-functioning sample group was used. However, in his study, Lovaas reported that 17 out of 19 patients scored in the mentally retarded range on IQ tests.

In the 2005 replication study, 10/23 children were nonverbal prior to treatment. In the 2006 replication study, all subjects had “developmental delays comparable to other children with autism”. Thus, in early intensive behavioral treatment studies, every effort is made to create a representative sample of children diagnosed with autism rather than one skewed with learners who have a normal IQ or are already verbal."

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.
Smith, T., Groen, A. D., Wynn, J. W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal of Mental Retardation, 105, 269-85.
Sallows, Glen O. & Graupner, Tamlynn D. (2005). Intensive Behavioral Treatment for Children with Autism: Four-Year Outcome and Predictors. American Journal on Mental Retardation,110 (6), 417-438.

ABA, and Lovaas, deserve the critical examination they receive. The Lovaas initiated ABA revolution in autism treatment is successful in part because it is data based and can withhold such critical examination. Any claim for efficacy must be based on evidence not philosophy. So too criticism should be based on the evidence, facts and careful, rational, analysis. Ill informed, predisposed hostility to ABA, and the Lovaas studies, can only cause harm to autistic children in need of effective treatment and educational assistance.