Why ABA for Autism? Because Children with Autism Disorders Deserve Evidence-Based Intervention and ABA Meets That Standard

Autism Canada Foundation, a Canadian autism charity,  promotes itself as "The PREMIER Resource for Information on Autism Spectrum Disorders" but  typically downplays the importance of evidence support for ABA as the Premier autism intervention while promoting interventions with less substantial  evidence bases as determined by study and  credible authorities.

 Why criticize Autism Canada Foundation an autism charity? Why ABA for Autism? Why Evidence Based Intervention?  Because, as stated by Couper and Sampson in the Medical Journal of Australia 11 years ago,  ineffective therapies, while they may be immediately harmless, waste the child's valuable therapy time and parents' money.  Delay in implementing effective treatment may have a negative impact on the child's ultimate outcome.  ABA is the only intervention to date that meets the evidence based standard in every credible review, a fact downplayed by the Autism Canada Foundation.

ABA has for many years been confirmed by study and credible authorities as  the most substantially evidence based effective autism intervention.  If parents choose to try other methods they should in fact make informed choices. Autism Canada is a charitable organization which will be staging an autism conference this October called Changing the Course of Autism 2014.  The brochure highlights RDI and the Son-Rise program but makes no express mention of  Applied Behavior Analysis.  

As the following credible reviews indicate RDI and Son-Rise are not supported by the same level of evidence of their effectiveness as ABA ( I can't find any authoritative review mentioning any level of evidence  support for Son-Rise).   What the Autism Canada conference attendees are unlikely to be informed is that when it comes to autism therapies it  is not a close call - ABA was and remains the most substantiated, evidence based, effective autism intervention. 

The US Surgeon General, the MADSEC Maine Administrators of Services for Children with Disabilities (Maine Autism Task Force) Report (2000 revision),  American Academy of Pediatrics, Management of Children with Autism Spectrum Disorders, and a recent article in the Canadian Medical Association Journal all confirm ABA as the most effective autism intervention (specific treatment necessary for associated medical conditions - eg. seizures, gastro intestinal).  And as Couper and Sampson wrote ... Children with autism deserve evidence based intervention:

1. Couper and Sampson - Children with autism deserve evidence based intervention.

Children with autism deserve evidence-based intervention  

Jennifer J Couper and Amanda J Sampson

Med J Aust 2003; 178 (9): 424-425.

Jennifer J Couper and Amanda J Sampson, in the 2003 editorial in the MJA, reviewed some of the evidence in support of the effectiveness  of behavioral interventions for autism. The authors stressed the importance of an evidence based approach to autism interventions:

"While ineffective therapies may be harmless, they waste parents' money and the child's valuable therapy time. Furthermore, the delay in implementing effective treatment may compromise the child's outcome." 

- [Bold Highlighting Added - HLD]

Couper and Sampson reviewed the evidence at that time (2003) in relation to behavioral treatment for autism:

The early intervention that has been subjected to the most rigorous assessment is behavioural intervention. There is now definite evidence that behavioural intervention improves cognitive, communication, adaptive and social skills in young children with autism. In 1987, Lovaas showed apparent recovery, persisting into adolescence, in nine of 19 young children who received an intensive home-based intervention based on applied behavioural analysis, a scientific method of reinforcing adaptive and reducing maladaptive behaviours.5,6 Subsequent studies also showed that behavioural intervention caused significant, albeit somewhat lesser, gains.7-11 This has modified the orthodox view that autism is always a severe, lifelong disability. Criticisms of the adequacy of the design and power of these studies are being addressed by the multisite Lovaas replication Early Autism Project. The first US site has released data (Wisconsin Early Autism Project).12 Again, after three to four years of intensive applied behavioural analysis intervention, about half the preschool children with autism acquired near-normal functioning in language, performance IQ and adaptability. Ninety-two per cent of intervention children acquired some language. Control children who received special education showed no gains in IQ or adaptability.12

2. American Academy of Pediatrics - Management of Children with Autism Spectrum Disorders, (2007, reaffirmed 2010)

The American Academy of Pediatrics article Management of Children With Autism Spectrum Disorders, Scott M. Myers, MD, Chris Plauché Johnson, MD, MEd, the Council on Children with Disabilities (2007), reaffirmed (2010):

"Applied Behavior Analysis

Applied behavior analysis (ABA) is the process of applying interventions that are based on the principles of learning derived from experimental psychology research to systematically change behavior and to demonstrate that the interventions used are responsible for the observable improvement in behavior. ABA methods are used to increase and maintain desirable adaptive behaviors, reduce interfering maladaptive behaviors or narrow the conditions under which they occur, teach new skills, and generalize behaviors to new environments or situations. ABA focuses on the reliable measurement and objective evaluation of observable behavior within relevant settings including the home, school, and community. The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology21,25,27,28 and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings.29–40 Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.31–40"

 3. Australasian Society for Autism Research - A Review of the Research to Identify the MostEffective Models of Practice in Early Intervention for Children with AutismSpectrum Disorders - (2012)

As with every other major research review of the effectiveness of early autism interventions only ABA, applied behavior analysis, received the highest rating: E  - Established/Eligible based on evidence.

 4. Canadian Medical Association Journal, Autism spectrum disorder: advances in evidence-based practice (2014)

 An article in the January 13, 2014 issue of the Canadian Medical Association Journal, Autismspectrum disorder: advances in evidence-based practice, confirms what American authorities have told us for decades, from the US Surgeon General to MADSEC and the American Academy of Pediatrics, ABA still represents evidence based, effective best treatment practice while "Research on non-ABA–based treatments is sparse and shows limited efficacy.":

" Autism spectrum disorder: advances in evidence-based practice "What treatments and interventions are available, and are they effective?

 The goal of existing interventions is to facilitate the acquisition of skills, remove barriers to learning and improve functional skills and quality of life.

 Behavioural interventions

  Current best practices for preschool-aged children with ASD include a focus on improving language, cognitive and adaptive skills using applied behaviour analysis (ABA) techniques.58 Applied behaviour analysis refers to the application of empirically derived learning principles(i.e., the antecedent–behaviour–consequence contingency) to produce meaningful changes in behaviour.59 Such strategies are carefully engineered and implemented through a variety of approaches (e.g., discrete trial teaching to more naturalistic learning contexts) to teach skills and reduce problem behaviour. Applied behaviour analysis interventions can be provided in a variety of settings (e.g., home, specialized treatment centres, specialized or public schools) by a range of front-line therapists, ideally supervised by a psychologist or board-certified behaviour analyst who specializes in ASD.

 A recent overview of meta-analyses60 found significantly enhanced outcomes associated with early intensive ABA-based treatment (typically for 2–3 yr) in four of five included meta-analyses (effect sizes 0.30 to > 1); these findings have since been bolstered by a sixth meta-analysis.61 Gains appear to be greatest in verbal intelligence quotient (IQ) and language communication domains,62,63 for children with stronger pretreatment skills, if treatment is started earlier,64 and with greater intensity or duration of intervention. 60–62,64 These gains achieved in various domains have been summarized in a recent Cochrane review.63 Although the overall quality of evidence is low, it is the best evidence available. A recent study in Ontario reported predictors of outcome that account for some heterogeneity in treatment response.65

 A recent RCT supported the efficacy of ABA-based intervention in toddlers by showing improvements in IQ, adaptive skills and diagnostic classification.37 Models vary, notably by how ABA principles are implemented, but everyday contexts (e.g., free play v. “tabletop”) and activities based on the child’s interests (v. therapist’s agenda) have advantages, including greater generalization of learning.66 Questions remain about which forms and intensities of treatment are most effective for which children.

 Research on non-ABA–based treatments is sparse and shows limited efficacy.67 Translation of evidence-based intervention into community practice is being evaluated, including in Canada.68 A key question is whether effective high-quality programs can be less costly and more sustainable; the findings from Nova Scotia are promising.38 Studies of the effectiveness of treatment programs for older children, youth and adults with ASD are scarce. Benefits have been reported for structured teaching practices, including ABA based interventions, for a wide range of skill deficits and maladaptive behaviours.58" [Highlighting added - HLD]

Hopefully conferences such as the Autism Canada Foundation 2014 conference are not seeking to change the course of autism intervention away from evidence based interventions toward largely  anecdotal approaches.  Hopefully attendees and those who access the conference information will be informed of the importance of evidence based support for autism interventions and the level of credible evidence in support of ABA effectiveness, a level of evidence support which remains unmatched by ANY other behavioural, social or educational intervention.

Autism Research Progress To Date In Two Words: Lovaas, ABA

Research to date benefiting persons suffering from autism disorders can be summed up in two words: Lovaas, ABA. The work done by Dr. Ivar Lovaas has been applied successfully for decades as reported by the US Surgeon General's office (1999) and by the American Academy of Pediatrics (2007), reaffirmed (2010):

The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology21,25,27,28 and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings.29–40 Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.31–4

American Academy of Pediatrics, Management of Children with Autism Spectrum Disorders

Autism Pundit's Sound Advice for Autism Speaks

Autism Pundit is the new autism blog by Dr. Sabrina Freeman, a mother of an autistic daughter, who has been a powerful advocate for evidence based treatment for children with autism, and whose "about the blogger"  section states in more detail:

"Sabrina Freeman, Ph.D. (1958-) was born in Montreal, Quebec, and grew up in Vancouver, British Columbia. She graduated from Stanford University in 1995 with a Ph.D. in Sociology, specializing in small group research and the study of organizations. Upon her return to British Columbia, Freeman spent 14 years advocating for the rights of children with autism to be included in the government funded health care system for their core health need -- autism treatment. During this period, so many parents were desperate to access treatment programs that Freeman created a 35 minute VHS/DVD [Autism: Now What Do I Do?] to help guide parents through setting up science-based treatment programs for their children. In 2002, she was awarded Queen Elizabeth's 50th Golden Jubilee Medal for advocacy work done on behalf of children afflicted with autism. Freeman's advocacy culminated in the now famous Supreme Court of Canada ruling Auton (Guardian ad litem of) v. British Columbia in 2004.

During the last 15 years, Freeman wrote several books on autism, one of which [Teach Me Language] has been subsequently translated into French, Italian and Norwegian. The next book she wrote, [Science for Sale in the Autism Wars], chronicles the struggle children with autism face against a system that does not recognize their rights to treatment. Her most recent book [The Complete Guide to Autism Treatments (2011)] is an up-to-date evaluation on the various treatments offered for children with autism. Her hope is that through her scholarship, thousands of parents will not have to go through the uncertain journey of generations of parents of newly diagnosed children. Instead, she offers parents a way to quickly evaluate various treatments and make sure that their child receives science-based treatment rather than treatments based on testimonials and good wishes."

Dr. Freeman's blog promises to rapidly become one of the best autism blogs on the internet.  Her writing style is direct and does not cater to political correctness. A good example is a comment posted yesterday called "We're Aware Already!" in which she offers sound advice to Autism Speaks on two important points. 1. The need to educate ... sorry .... encourage ... many pediatricians to drop their opposition to routine early screening for autism. 2. Start publicizing the fact that ABA has been recognized as best autism practices since 1999 by the US Office of the Surgeon General and other key agencies:

"It is time for the Autism Speaks folk to publicize the fact that:

a) The U.S. Surgeon General has recognized Intensive Behavioral Treatment as best practices for autism treatment since 1999 (that was twelve years ago)!
b) New York State has also recognized Intensive Behavioral Treatment as best practices since 1999(that was twelve years ago)!
c) Over 50% of states in the U.S. have passed autism mandates forcing insurance companies to pay for treatment!

Once the mover’s and shakers i.e. the well funded charities, in the autism community recognize the above facts, only then will we be able to move beyond awareness into early intensive behavioral treatment for all the children who desperately need it!

What are we waiting for?"

I have already listed Autism Pundit on my sidebar as one of my favorite blogs to visit. If you are interested in helpful autism commentary I recommend Autism Pundit a blog which is serious about helping autistic children and adults written by someone who is extremely well informed, experienced in real autism advocacy, and who is a top notch writer. I encourage you to take a look at Autism Pundit and make it one of your regular blogs to visit.

Autism, ABA and Conor's Autism Medications (None)

The Internet criticism of ABA as an autism intervention comes largely from a rejection of evidence based medicine, ideological based rigidity and lack of any real experience with ABA. To the anti-behaviorists no ABA supportive studies are acceptable unless they are double blind controlled studies conducted over the life time of autistic persons. Obviously it would be unethical to provide a placebo intervention to an autistic child as an intervention over a lengthy period of time.

The various studies described by the American Academy of Pediatrics, the US Surgeon General, state agencies in New York, California and Maine, the Association for Science in Autism Treatment, the Center for Autism and Related Disorders, the May Institute and the thousands of health care and education professionals who actually work with and help autistic children will be ignored by the anti-ABA ideologues. There is no need to mention of course that the direct observations of autistic children by their own parents who live with their children, care for them, help them and observe them 24/7 are of no weight whatsoever to the ideologues for whom NO information supportive of ABA could ever be acceptable.

Some of the anti-ABA rhetoric originates with adult persons with various autism spectrum disorders who themselves have had no actual involvement with ABA. The further removed from the realities of ABA and the need for an effective intervention that helps autistic children the greater the chance that the irrational anti-ABA ideology will take root. The criticisms themselves are largely non-evidence based and ignore the many positive contributions that ABA has made to the lives of autistic children including my severely autistic son Conor.

Conor has learned various skills, reduced self injurious behavior, increased communication skills, attended a neighborhood school and functioned well. On the sidebar of this blog are pictures of Conor holding his perfect attendance certificate from grade 6 during which time he received ABA instruction at school. This year colds and a flu prevented him from perfect attendance but his desire to attend school did not diminish. He loves school ABA and all. Why would Conor jump up each day eager to attend school where he receives ABA intervention if it was so abusive?

I post many picture sets of Conor on this blog site over the past 3 years. These portray him as what he is -- a very happy, personable and lovable boy. ABA has not turned him "robotic" or robbed him of his personality. There is nothing at all abusive about ABA for autistic children, certainly not for Conor, despite the absurd rhetoric of the anti-behaviorists.

Conor is now 13 1/2 years old and stands 5' 11''. In the past year and a half he has undergone the adolescent "change of life" with rapid growth spurts and all the other changes that can be so disruptive of young personalities in the teen years. While there are some challenging behaviors at times there is nothing out of the ordinary. Despite his growing size, strength and disruptive adolescent changes he is still a very well behaved, gentle young man. We have not felt the need to provide Conor with ANY medications at any time to manage his behavior.

Although he used to bite himself with some frequency, and still does on occasion, such self harmful behavior is rare. He does not return home at the end of a day at school and engage in self injury as a way of coping psychologically as one prominent anti-ABA activist testified that she would do at the end of the work day. The ideologues can blame ABA intervention for Conor's near elimination of self injurious behavior or they can pretend that my direct observations about the impact of ABA in reducing such behavior are of no weight. No need to guess which way the anti-behaviorists would lean on that choice.

Conor has received NONE of the medications prescribed for many autistic children. The anti-ABA ideologues can also blame ABA for that result but they won't. They don't really want to look at the issue objectively. They do not want to look at the whole picture including the benefits ABA has brought to my son or other autistic children.

If you are the parent of a newly diagnosed autistic child consult your attending health care professionals about the best way to help your child. Make any treatment or intervention decisions with their input but do not be turned off of ABA as a possible intervention to help your child by the anti-ABA rhetoric that permeates some Internet autism hubs. Most of such rhetoric emanates from people with no direct involvement in helping autistic children. Most of such rhetoric emanates from people with no actual experience with ABA. Most of such rhetoric emanates from people, whether they fancy themselves researchers or not, who just don't know what they are talking about when they are talking about ABA. Do not be misled by the misbehavior of the anti-behaviorists.

In the meantime I am looking forward to another day with my wonderful son who has benefited greatly from his ABA intervention. Conor will probably also enjoy the day ... without the need to injure himself so that he can "cope psychologically" ... and without medication.

God damn that ABA!

autism

Michelle Dawson's False Claims Allegations? Where's the Evidence?

Jonathan Mitchell of Autism's Gadfly has run afoul, like so many others have, of Michelle Dawson.

On the discussion board Misbehaviour of Behaviourists Ms Dawson has accused Jonathan of making false statements about her. Apparently Jonathan made a statement about Ms Dawson's communications with the IACC, the Interagency Autism Coordinating Committee that might not have been correct; or at least not literally correct. Ms Dawson takes Jonathan to task over the issue at the Misbehaviour of Behaviourists. Then, out of left field, Ms Dawson also accuses me of making false claims about her as well:

Michelle Dawson	8995
03-06-2009 08:31 PM ET (US)

Edited by author 03-06-2009 08:32 PM

Still in the "pants-on-fire" dept., for what Mr Mitchell wrote on his blog, see /m8990. What Mr Mitchell has claimed on his blog is false. He made it up.

If Mr Mitchell did not make anything up, as he claims, then I'm sure he can provide sources to support his claim that I was "writing letters trying to influence the direction of NIMH autism research" and so was Mike S.

I suggest that as with Mr Doherty, no one should believe Mr Mitchell when he makes any claims about people he disagrees with, unless Mr Mitchell can provide sources (in this case, links to all the "letters" Mike S and I have written to the NIMH) to support his views.

Some day when I have a lot of spare time, I'll try to find and list all the false claims, misrepresentations, etc., made about me and my colleagues by Mr Mitchell and Mr Doherty.

As you can see Ms Dawson did not provide any specifics, particulars, examples, information or evidence of any kind whatsoever to substantiate her out of left field allegations against me. She just decreed that I have made false claims and informed her loyal subjects that some day, when she had the time, she would bother herself with substantiating her allegations. That my friends is the work of Michelle Dawson, autism researcher and anti-ABA activist.

To my knowledge the statements that I have consistently made about Ms Dawson are that:

1) She is an anti-ABA activist ( see the title of her forum (the Misbehaviour of Behaviourists), her appearances before the Supreme Court of Canada and the Canadian Senate in opposition to ABA for Canada's autistic children and her numerous media comments opposing ABA.)

2) That her anti-ABA views are inconsistent with the views of numerous credible authorities in the United States, like the US Surgeon General, the American Academy of Pediatrics, the MADSEC (Maine) Autism Task Force, the NY State Department of Health, and the Association for Science in Autism Treatment to name the most prominent.

I stand by these statements which are factually correct. And I caution anyone against putting too much weight on any of Michelle Dawson's allegations and statements that she has made against anyone, professional, reporter, parent or autistic person who dares to disagree with her views.

autism

Michelle Dawson, ABA and Autism in 2009

I read recently still more anti-ABA commentary from Ms Michelle Dawson, a long time crusader against government provision of Applied Behavioral Analysis for autistic children. Together with her colleague, Dr. Laurent Mottron, she has appeared as an "autistic" before the Supreme Court of Canada and before a Canadian Senate committee examining funding of autism treatment to oppose government funding of ABA treatments for autistic children.

Ms Dawson also comments frequently on the internet, and in the mainstream media, to speak on behalf of "autistics" and to advocate against ABA for autistic children in Canada. Ms Dawson takes great pleasure in explaining how the professionals who contribute to the American Academy of Pediatrics, the MADSEC (Maine) Autism Task Force, the New York State Department of Health, the Association for Science in Autism Treatment, and any of the professionals who actually work with autistic children, including heaven forbid, low functioning autistic children, are wrong about ABA and its effectiveness in helping autistic children make substantial, sustained gains as summarized in 2007 by the AAP:

Applied Behavior Analysis

Applied behavior analysis (ABA) is the process of applying interventions that are based on the principles of learning derived from experimental psychology research to systematically change behavior and to demonstrate that the interventions used are responsible for the observable improvement in behavior. ABA methods are used to increase and maintain desirable adaptive behaviors, reduce interfering maladaptive behaviors or narrow the conditions under which they occur, teach new skills, and generalize behaviors to new environments or situations.

ABA focuses on the reliable measurement and objective evaluation of observable behavior within relevant settings including the home, school, and community. The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology21,25,27,28 and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings.29–40 Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.31–40

Given the well documented record of sustained gains reported for autistic children using ABA, as reported by such credible agencies, it is difficult to understand the opposition by Michelle Dawson and her colleague and supporter Dr. Laurent Mottron. The writings of neither of these two staunch opponents of ABA disclose any first hand involvement with ABA.

Nor is it clear whether they have any direct contact with severely impaired autistic persons, you know, the ones who do NOT appear before legal, political and media entities on a regular basis, the people, like my son who require 24 hour supervision, the ones living in institutional care, THOSE "autistics", the ones whose existence Dr. Mottron and Ms Dawson rarely, if ever, mention. Dr. Mottron publishes several papers a year in learned publications about autistic savants and persons with Aspergers and High Functioning Autism. (With 2009 literally around the corner look for more papers from Dr. Mottron on autistic savants and the charcteristcs of superior autistic intelligence). Dr. Mottron is OK with Canadian tax dollars going to support his "research" into savant intelligence but opposes funding of ABA interventions for autistic children even those with limited communications, the "autistics" who do not appear in his frequently published papers.

Michelle Dawson, in addition to being a researcher working with Dr. Mottron, and assisting his investigations of high functioning autism, is also herself an "autistic". Affidavits filed by Dr. Mottron and Ms Dawson, then a postal worker, in support of her appearance as an intervenor before the Supreme Court of Canada describe her as an autistic person or autistic individual. She also states that she was diagnosed with "autism". Her specific autism spectrum disorder, or pervasive developmental disorder, is not expressly mentioned in either affidavit.

In her affidavit Ms Dawson, despite a slim affidavit record of her own "autism", challenged the legitimacy of the parents and professionals who appeared in the proceedings:


20.

In addition, no autistic individuals testified or participated in the process. Yet there are autistic individuals who could have coherently and cogently explained the realities of autism, with both its benefits and weaknesses to the courts.


21.

The courts were only left with the perspective of parents and the state in what became an argument over who was responsible to assume the costs of dealing with the disability;


22.

I believe that the perspective I could bring to this Court would be of assistance to the Court and allow it to have a fuller understanding of the issues before it;


23.

I know of no association or group seeking to intervene in these proceedings who could bring the true perspective of autistic individuals;


24.

While several groups and associations exist to promote the rights of autistic individuals, in my experience, they are usually dominated by parents and professionals, and very seldom have any input from autistic individuals, even when the autistics seek to participate in these organizations.


Ms Dawson intervened in Auton, according to her solemnly declared affidavit, because she offered the true perspective of autistic individuals. She made this solemn declaration without stating her specific autism spectrum disorder, elaborating on why she herself was not diagnosed until she was an adult in 1993-4, or discussing any differences that might exist between "autistics" who can appear before the Supreme Court and those who struggle with basic language. Nor did she explain in her affidavit how she could speak on behalf of those autistic children and adults who, unlike her, cannot speak at any significant level.

A few years ago I had the pleasure of two very brief telephone conversations with Ms Dawson. She contacted me because I was at that time the President of the Autism Society New Brunswick and she was interested in obtaining a copy of a document prepared for the ASNB by a Universite de Moncton law professor pertaining to autism and the Canadian constitution. I was surprised later, when learning of her intervention in the Auton case in the Supreme Court of Canada, that she purported to speak on behalf of so many other autistic persons; given her obvious abilities contrasted with the severe challenges faced by so many autistic persons, including my son.

On reflection I also remembered our brief conversations and the fact that despite taking on this self appointed representational role on behalf of "autistics", including my son, she had never asked me, during those conversations any questions about autistic people in New Brunswick or the health, education or living conditions of persons with autism spectrum disorders in New Brunswick. She disclosed no obvious interest in informing herself, while talking to the then President of ASNB about conditions faced by autistic persons in New Brunswick. (Nor did Ms Dawson ask whether we had any persons with an Autism Spectrum Disorder serving on our Board of Directors)

Of course Ms Dawson's failure to ask me any such questions now makes perfect sense having read her affidavit. As a mere parent of an autistic child I had no information that would be of any value to Ms Dawson who after all is an "autistic". Despite the responsibilities that nature, our society and our laws bestow upon parents to care for and nurture our children, we are not qualified to represent our autistic children's interests in Ms Dawson's view. Despite living with them, caring for them, loving them and sacrificing for our children, despite seeing their challenges and struggles up close and helping them overcome those challenges we can not possibly offer the perspective that Ms Dawson, a total stranger with no commitment to them or responsibility for their well being, can offer because she is after all an "autistic".

My son is severely "autistic". His diagnosis is autistic disorder, assessed with profound developmental delays. He can not speak for himself in ordinary daily interaction let alone before the Supreme Court of Canada. The information I just presented is supported by professional assessments and is more information than Michelle Dawson supplied in her leave to intervene affidavit in Auton. Michelle Dawson, whatever her diagnosis, has nothing in common with my son and does not, and never did, bring his "perspective" to courts, legislative bodies or in her media appearances.

Michelle Dawson will continue in 2009 to tell the world that the AAP, the US Surgeon General, the New York State Department of Health, the MADSEC (Maine) Autism Task Force, the Association for Science in Autism Treatment, Dr. Mickey Keenan of the University of Ulster, Dr. Doreen Granpeesheh of the Center for Autism and Related Disorders, Dr. Alan Harchik of the May Institute, Dr. Paul McDonnell, Professor Emeritus (Psychology), Dr. Ivar Lovaas, and literally thousands of other health care professionals and researchers are all wrong about the effectiveness of ABA in helping autistic children make sustained substantial gains in intellectual and social skills.

Meanwhile in 2009, Michelle Dawson and Dr. Mottron will undoubtedly continue to receive Canadian tax dollars for their research into, and publish papers about, autistic savants, Aspergers and high functioning autism. Curiously omitted from their scholarly works will be the severely autistic, those with cognitive deficits, those who injure themselves and others and live lives of dependency and solitude after the parents and others who actually care for them are gone.

If past is prologue Ms Dawson will still not ask about those "autistics" much less fortunate than her, like my son, or other autistic persons in New Brunswick, or elsewhere. Ms Dawson will continue in 2009 to ignore the existence of intellectually impaired, communication challenged, severely autistic persons on whose behalf she purports to speak. And she and Dr. Mottron will continue to oppose government funding of ABA for autistic children.

autism

This Christmas This Autism Dad Says Thank You

I started this blog as an extension of the autism advocacy in which I have been engaged for the past 10 years. Here in New Brunswick, Canada parents who were active autism advocates fought to secure pre-school government funded ABA intervention by University of New Brunswick trained Autism Support Workers and Clinical Supervisors. We also fought to extend that service model into the school system where UNB trained Teacher Aides and Resource Teachers provide ABA instruction to autistic students. While far from perfect, these efforts make New Brunswick one of the best jurisdictions in Canada or the United States in which to raise autistic children.

We had substantial assistance in our efforts from parents in British Columbia (Auton) and Ontario (Deskin-Wynberg) who fought court battles, ultimately unsuccessfully, but whose cases provided careful public examination, particularly in the trial level courts, of the existing scientific thought about autism and effective autism intervention - meaning Applied Behavioral Analysis. We had help from the United States where, unlike the Canadian health and research authorities, credible agencies like the US Surgeon General, the New York State Department of Health and the Maine (MADSEC) Autism Task Force reviewed decades of research and provided clear, coherent guidance and authority for use in our autism advocacy. God Bless America!

We had the intellectual leadership of Professor Emeritus (Psychology) and Clinical Psychologist Paul McDonnell and the organizational savvy and drive of Ann Higgins of the University of New Brunswick College of Extended Learning. They provided us with a clear focus on evidence based approaches to autism interventions and the means by which to obtain such interventions for our autistic children.

We had the considerable abilities and inspirational support of a very smart gentleman with Aspergers named Jason Oldford who demonstrated his own determination in addressing his challenges with every meeting and with his public speaking efforts. And we had a core group of very, very tenacious parents of autistic children who put a lot on the line with their family time and careers in the nursing, military, financial services, and a variety of other occupations.

To the autism support workers, clinical supervisors, teacher aides, resource teachers, educators and civil servants, to all these people and to our New Brunswick politicians who listened and did the right thing I say thank you. Much more remains to be done, particularly in youth and adult residential care, but for what we have today I say again thank you.

I also thank Autism Speaks, an organization which has done great work in creating Autism Awareness and raising funds for research. Autism Speaks did not exist during most or our local autism advocacy and has made no direct contribution to autism efforts in this area. It is an organization under attack from all quarters these days from those who assert that vaccines cause autism to "neurodiversity" advocates and persons with Aspergers and High Functioning Autism who oppose the very concept of curing and treating autism. Even some internet blogging parents who want immediate help in their efforts to help their children now attack Autism Speaks.

Personally I believe Autism Speaks should be criticized like any organization BUT I also believe that it has done unbelievably great work in publicizing and raising awareness of the realities of autism disorders from the various walks, entertainment industry events, and stock car racing events to the United Nations' World Autism Awareness Day.

Autism Speaks has been very active in raising funds for research and research is what has provided the foundation for gains made by autistic persons everywhere. CNN and CBC will continue to interview a few high profile, gifted autistic persons who will explain why THEY do not want to be cured of their autism. But for the millions of people around the world, and their families, who actually struggle with autism challenges, research is the only direction that offers hope for the future and hope that more effective treatments and cures will be found for the neurological disorders now referred to as autism spectrum disorders and Autism Speaks is a driving force behind much of that research. Hopefully the research sponsored by Autism Speaks will not be limited by any specific ideological perspective except that of actually helping autistic persons. Hopefully Autism Speaks will sponsor both genetic and environmental research into autism cause and cure.

For now though this "autism dad" says thank you to everyone who has helped us with our present achievements here in New Brunswick and thank you to Autism Speaks for your tremendous efforts to date and for offering hope for the future.

autism

Autism and ABA Abuse of Autistic Children - A Case Study, Part 3

Conor had a long weekend again, because of teacher interviews/teacher association council days at the end of last week. Such extended breaks from school are difficult for Conor who apparently has been deceived by nefarious ABA trickery into thinking that he actually enjoys the ABA based instruction he receives in school. Hence, the perfect attendance he achieved last year as Middle School.

Conor has, with ABA instruction, developed some reading skills but they are not yet on a level where he can understand the writings of Michelle Dawson (admittedly as a lawyer with 24 years experience I also have trouble reading, understanding and finding the evidentiary basis of Ms Dawson's essays and opinions).

Without her objective input, (Ms Dawson's own opinions do not appear to be contaminated by any direct involvement with, or first hand knowledge, of ABA, or respect for the opinions of the hundreds of medical and education professionals and researchers who endorse ABA as an effective intervention for children with autistic disorders), Conor does not understand that his human rights, as an autistic person, are being violated by exposure to ABA abuse.

Although Ms Dawson, diagnosed as "autistic", by someone, as an adult, does not indicate that she herself was ever abused by exposure to ABA that does not, in itself, mean that she does not know what she is talking about does it? Does it?

Surely her lack of respect for the opinions of health care professionals who actually work with autistic children, including severely affected autistic children, providing ABA treatment to help reduce self injurious behavior and increase cognitive, communication and social skills (AAP, MADSEC, US Surgeon General) does not mean that Ms Dawson does not know what she is talking about does it?

Michelle Dawson has said that the human rights of autistic persons like my son Conor are denied by exposure to ABA. His autistic essence as she would define it is being trampled and he is effectively being abused. After all Michelle Dawson says so.

Conor's perfect attendance record at middle school where he receives daily ABA instruction must be proof that he is abused, his autistic essence trampled, his human rights as an autistic person trampled right? Well if you are still not convinced that ABA advocates, especially parents, are violating our children's human rights, as pronounced by Michelle Dawson, then please see also:

Autism and ABA Abuse of Autistic Children - A Case Study, Part 1

Autism and ABA Abuse of Autistic Children - A Case Study, Part 2

autism

Time To Resume The Struggle, Canada Still Needs A Real National Autism Strategy

The general election in Canada has come and gone. And Canada's National Autism Crisis remains.

Prime Minister Stephen Harper had no qualms about spending hundreds of millions of dollars on an unnecessary election. But still he can not even spend five cents on actually helping autistic children and adults in Canada. Prime Minister Stephen Harper has done nothing to help autistic children receive evidence based treatment in Canada. Nothing of substance will be done to help autistic children in Canada while Stephen Harper is Prime Minister.

There were many people who fought hard to raise the profile of autism and Canada's autism crisis during this election. I am not offering any names because I do not want to offend anyone by accidental omission. From BC to Nova Scotia the fight was waged for a real National Autism Strategy. The ultimate objective was not achieved .... this time. But the fight will continue for a real National Autism Strategy.

We know that autistic children across Canada deserve the opportunity for a better life. They deserve to receive Applied Behavioral Analysis and any other evidence based treatment that might be developed in future. They need treatment now. They do not need sham National Autism Symposiums which exclude parent advocates and provide watered down versions of what more credible American agencies like the American Academy of Pediatrics, the New York State Department of Health, the MADSEC Autism Task Force and the Office of the US Surgeon General have been telling us for many years.

We have to continue the fight for a National Autism Strategy. We have to reboot, recalibrate, recharge and resume the struggle and we have to start right now!

autism

Wesley Romey Says It Is Time for Medicare for Autism

If you listened to anti-ABA advocates like Michelle Dawson and Dr. Laurent Mottron you might erroneously think that ABA oppresses autistic children. These staunch opponents of ABA for autistic children, with little or no direct experience themselves with ABA as an autism treatment, have made representations to the Supreme Court of Canada and the Canadian Senate in a continuing campaign to prevent government funding of ABA treatment for autism in Canada.

Ms. Dawson and Dr. Mottron conduct this anti-ABA campaign despite reviews by responsible, credible agencies like the American Academy of Pediatrics, the US Surgeon General, the MADSEC (Maine) Autism Task Force, and the New York State Department of Health, all of which have confirmed that ABA, based on hundreds of studies over several decades of research, is effective at realizing persistent gains in intellect, communication and socialization skills and improved positive behavior.

Michelle Dawson is an adult diagnosed autistic who often offers her perspectives on behalf of all autistic people, including her anti-ABA biases. Unlike Ms Dawson, Wesley Romey is a 13 year old autistic boy, diagnosed as a child, who has actually received ABA treatment and advocates for Medicare coverage of autism treatment, specifically ABA, as he did compellingly at a rally Saturday in Surrey, British Columbia. As reported by Surrey Now Wesley enthralled the audience with his comments:

"We want medicare for autism and we want it now!" he cried to the crowd, and was met with a standing ovation.

...

Wesley, though, was the speaker who particularly touched the crowd. Wesley shared with the audience his success with Applied Behavioral Analysis (ABA) therapy. He urged listeners to demand the government fund autism treatment, because he is proof that it works.

"I want to say this to every Canadian out there. It's not fair that every child with autism doesn't get the same chance that I did. If you don't stand up for your children, who will?"

It is time to break the self perpetuated myth that Michelle Dawson speaks for all autistic persons in her opposition to ABA treatment for autistic children. She does not have the experience, the expertise, or any legitimate moral basis, to oppose effective, evidence based, ABA treatment for autism.

It is time the federal government stopped holding sham "national autism symposiums", with keynote speakers like anti-ABA advocate Dr. Laurent Mottron, and started acknolwedging the credible agencies like the AAP, the MADSEC Autism Task Force, the New York State Department of Health and the US Surgeon General that, based on objective reviews of hundreds of studies, confirm ABA as an effective autism treatment.

It is time the federal government read the Senate report "Pay Now or Pay Later" and started taking Canada's autism crisis seriously with1 in 150 children being diagnosed with autism.

It is time that the federal government started listening to the thousands of parents of autistic children across Canada who are fighting tooth and nail to obtain ABA treatment for their autistic children while such treatment will be most effective.

It is time, it is long past time, that the federal government stop ingoring the plight of so many autistic children and their families.

It is time, it is long past time, that all autistic children in Canada in need of ABA treatment receive such treatment in timely fashion regardless of which province their parents live in.

Take it from Wesley Romey, it is time for Medicare for Autism NOW!

autism

Tony Clement's Autism Whopper

"Canada's Government has already begun to address the issues that individuals with ASD and their families are facing."

- Alleged Health Minister Tony Clement, The Tyee, September 1, 2008

Alleged Health Minister Tony Clement has given us quite a whopper with that one. To the extent that individuals with autism spectrum disorders have had their issues addressed in Canada it has been provincial governments, acting in response to parent advocates, that have been responsible. The federal government has done absolutely nothing of substance to help autistic individuals in Canada and Tony Clement should be ashamed of himself for pretending otherwise.

In fact the Canadian government has been counter productive, staging a sham autism conference, in an attempt to marginalize parent autism advocates, and to obscure the clear and compelling autism treatment information provided by responsible, credible American agencies like the American Academy of Pediatrics, the New York State Department of Health, the MADSEC (Maine) Autism Task Force and the US Surgeon General. And to add insult to injury the Canadian government has provided a mediocre autism web page.

Contrary to Tony Clement's claim, the truth, the honest truth, is that the Canadian government has done nothing to address the issues that individuals with autism spectrum disorders and their families are facing.

autism

Autism Society Canada Rejects Evidence Based Approach To Autism Treatment And Fails Autistic Children

Recent statements by current Autism Society Canada President Kathleen Provost to a Montreal Gazette reporter have me asking again what the ASC actually does to help autistic Canadians? When the ASC can not even tell the Canadian public in a forthright manner what numerous American state and professional agencies have told us for years about the evidence basis supporting the effectiveness of Applied Behavior Analysis in treating autism it becomes difficult to understand the ASC's raison d'être.

For parents of autistic children there are few things more important than trying to help their autistic children overcome, to the fullest extent possible, the deficits and challenges that accompany their autistic disorders - self injurious behavior, dangerous behavior such as wandering into traffic or getting lost, lack of communication and language abilities and intellectual deficits. These are all serious challenges facing many autistic Canadians. But they do not receive accurate information about the state of autism treatment from the ASC.

Autism Society Canada Statements on Autism Treatment

The Autism Society Canada has made incomplete, inaccurate and even misleading statements about the effectiveness of autism treatments. It does so by rejecting an evidence based approach to treating autism. It states that there are many approaches to treating autism without informing the public forthrightly that only Applied Behavior Analysis is supported by a large body of evidence supporting its effectiveness.

In More than one approach to autism the Autism Society Canada has failed, once again, to help Canadians evaluate the evidence supporting ABA as an autism intervention and, as the article title illustrates, helps mislead Canadians into thinking that all autism interventions are created equal. That no single autism intervention is better than any other. Nothing could be further from the truth. In that article Kathleen Provost, ASC President, is reported and quoted as follows:

Kathleen Provost of Autism Society Canada noted a lack of consensus among experts about the best ways of dealing with the condition.

"What we have the most researcher and information on is behaviour therapy," Provost said.

The society does not endorse any method.

"Some of it is new and we don't have enough information," Provost said. "We leave it up to the parents to make decisions."

There is no unanimity amongst "experts" about the best ways of dealing with autism, or any other issue, in any other field, for that matter. Most noticeable in opposing ABA as an autism intervention is the Montreal neuroscience community which dominates the Canadian Institutes for Health Research. (Anti-ABA advocate, Dr Laurent Mottron, of the Psychiatry Department of the Hopital Riviere-Des-Prairies was a key note speaker at the CIHR's November 2007 Autism Symposium which itself had to be rescheduled to ensure that known ABA advocates would be excluded from representing any of the provincial autism "communities"). There is, however, a clear consensus amongst experts about the best ways of dealing with autism and that consensus clearly points to ABA as the most effective evidence based intervention for dealing with autism.

Evidence Based-Medicine

To properly understand that consensus it is important to understand a point not often mentioned by the Autism Society Canada, or the CIHR for that matter, the concept of evidence based-medicine:

"Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgement that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisi ons about their care. By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centred clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens. External clinical evidence both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer.

Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicabl e to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients."

Center for Evidence-Based Medicine (CEBM) and the British Medical Journal, 13th January 1996 (BMJ 1996; 312: 71-2)

The CEBM also refers readers to the Wikipedia entry on Evidence Based-Medicine:

Evidence-based medicine (EBM) aims to apply evidence gained from the scientific method to certain parts of medical practice. It seeks to assess the quality of evidence[1] relevant to the risks and benefits of treatments (including lack of treatment). According to the Centre for Evidence-Based Medicine, "Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients."[2]

EBM recognizes that many aspects of medical care depend on individual factors such as quality and value-of-life judgments, which are only partially subject to scientific methods. EBM, however, seeks to clarify those parts of medical practice that are in principle subject to scientific methods and to apply these methods to ensure the best prediction of outcomes in medical treatment, even as debate about which outcomes are desirable continues.

Practicing evidence-based medicine requires clinical expertise, but also expertise in retrieving, interpreting, and applying the results of scientific studies and in communicating the risks and benefits of different courses of action to patients.

....

Qualification of evidence

Evidence-based medicine categorizes different types of clinical evidence and ranks them according to the strength of their freedom from the various biases that beset medical research. For example, the strongest evidence for therapeutic interventions is provided by systematic review of randomized, double-blind, placebo-controlled trials involving a homogeneous patient population and medical condition. In contrast, patient testimonials, case reports, and even expert opinion have little value as proof because of the placebo effect, the biases inherent in observation and reporting of cases, difficulties in ascertaining who is an expert, and more.

Systems to stratify evidence by quality have been developed, such as this one by the U.S. Preventive Services Task Force for ranking evidence about the effectiveness of treatments or screening:

* Level I: Evidence obtained from at least one properly designed randomized controlled trial.
* Level II-1: Evidence obtained from well-designed controlled trials without randomization.
* Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
* Level II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
* Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

The UK National Health Service uses a similar system with categories labeled A, B, C, and D. The above Levels are only appropriate for treatment or interventions; different types of research are required for assessing diagnostic accuracy or natural history and prognosis, and hence different "levels" are required. For example, the Oxford Centre for Evidence-based Medicine suggests levels of evidence (LOE) according to the study designs and critical appraisal of prevention, diagnosis, prognosis, therapy, and harm studies:[9]

* Level A: Consistent Randomised Controlled Clinical Trial, cohort study, all or none (see note below),clinical decision rule validated in different populations.
* Level B: Consistent Retrospective Cohort, Exploratory Cohort, Ecological Study, Outcomes Research, case-control study; or extrapolations from level A studies.
* Level C: Case-series study or extrapolations from level B studies.
* Level D: Expert opinion without explicit critical appraisal, or based on physiology, bench research or first principles.

Evidence Based-Medicine and Autism Interventions

Autism has been plagued by a host of "alternative" treatments and interventions including some as whacky as "swimming with dolphins"; the notion that somehow swimming in close proximity to these intelligent but still wild and powerful sea creatures somehow has therapeutic value for autistic children. Facilitated communication in which a therapist aids non-verbal autistic children in communicating through a variety of assisted communication technologies has caused actual harm as seen very recently in Oakland County Michigan where a family was torn apart when the parents of autistic children were wrongully charged with abuse based on a therapists Facilitated Communication interpretations of the autistic daughter's responses. The interpretations were exposed as nonsense at trial when the same process elicited answers such as these to questions posed to the daughter:

Q: What color is your sweater?

A: JIBHJIH

Q: What are you holding in your hand right now?

A: I AM 14


In Children with autism deserve evidence-based intervention, The evidence for behavioural therapy, MJA 2003; 178 (9): 424-425, Jennifer J Couper and Amanda J Sampson, reviewed some of the evidence in support of the efficacy of behavioral interventions for autism. The authors stressed the importance of an evidence based approach to autism interventions:

While ineffective therapies may be harmless, they waste parents' money and the child's valuable therapy time. Furthermore, the delay in implementing effective treatment may compromise the child's outcome.

Couper and Sampson reviewed the evidence at that time (2003) in relation to behavioral treatment for autism:

the early intervention that has been subjected to the most rigorous assessment is behavioural intervention. There is now definite evidence that behavioural intervention improves cognitive, communication, adaptive and social skills in young children with autism. In 1987, Lovaas showed apparent recovery, persisting into adolescence, in nine of 19 young children who received an intensive home-based intervention based on applied behavioural analysis, a scientific method of reinforcing adaptive and reducing maladaptive behaviours.5,6 Subsequent studies also showed that behavioural intervention caused significant, albeit somewhat lesser, gains.7-11 This has modified the orthodox view that autism is always a severe, lifelong disability. Criticisms of the adequacy of the design and power of these studies are being addressed by the multisite Lovaas replication Early Autism Project. The first US site has released data (Wisconsin Early Autism Project).12 Again, after three to four years of intensive applied behavioural analysis intervention, about half the preschool children with autism acquired near-normal functioning in language, performance IQ and adaptability. Ninety-two per cent of intervention children acquired some language. Control children who received special education showed no gains in IQ or adaptability.12

Why is intensive applied behavioural analysis intervention more effective than special education for children with autism? This can not be simply explained by the intensity of these programs (30–40 hours per week). Children in a school-based Scandinavian study who received behavioural intervention gained an average of 25 language IQ points in the first year of the intervention, with improvements in performance IQ, communication and adaptability. On all scores, they surpassed control children who received special education according to best practice for autism, and the same intensity, duration and supervision of therapy.13

Autism Treatment Consensus - God Bless America

Contrary to Kathleen Provost's, and the ASC's, statements, there IS a consensus on the best way to "deal with" autism. That consensus has been clearly articulated in a number of reviews of autism treatment effectiveness by responsible, respected American authorities. Thankfully the internet ensures that Canadian parents are not dependent on a sham Autism Symposium, the self interested dictates of some members of the Montreal neuroscience community, or the misleading statements of timid ASC representatives. We can read for ourselves what more credible authorities have concluded.

The American Academy of Pediatrics - Management of Children with Autism Spectrum Disorders 2007

The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology21,25,27,28 and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings.29–40 Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have
been significantly better than those of children in control groups.31–40

No other intervention reviewed by the AAP approached ABA in the quantity or the quality of evidence in support of its effectiveness as an ABA intervention.

New York State Department of Health - Clinical Practice Guidelines - Report of the Recommendations Autism/Pervasive Developmental Disorders 2005 (rev ed)

Intervention Methods

Intensive Behavioral and Educational Intervention Programs

Summary Conclusions

Intensive behavioral and educational intervention programs involve systematic use of behavioral teaching techniques and intervention procedures, intensive direct instruction by the therapist, and extensive parent training and support.

* Articles screened for this topic: The literature search found 232 articles that reported using behavioral and educational approaches in children with autism as well as 68 articles from a comprehensive review article on single-subject design studies.

* Articles meeting criteria for evidence: 5

Several studies done by independent groups of researchers have evaluated the use of intensive behavioral intervention programs for young children with autism. The four studies that met criteria for evidence about efficacy all compared groups of young children with autism who received either an intensive behavioral intervention, a comparison intervention, or no intervention. In all four of the studies reviewed, groups that received the intensive behavioral intervention showed significant functional improvements compared to the control groups.

While none of the four studies used random assignment of subjects to groups, there did not appear to be any evidence of important bias in group assignment. Within each study, the groups receiving different interventions had equivalent subject characteristics. Furthermore, all studies showed similar and consistent results.

Since intensive behavioral programs appear to be effective in young children with autism, it is recommended that principles of applied behavior analysis and behavioral intervention strategies be included as an important element of any intervention program.

It is recommended that intensive behavioral programs include a minimum of 20 hours per week of direct instruction by the therapist. The precise number of hours of behavioral intervention may vary depending on a variety of child and family characteristics. Considerations include age, severity of autistic symptoms, rate of progress, other health considerations, tolerance of the child for the intervention, and family participation. It is recommended that the number of hours be periodically reviewed and revised when necessary. Monitoring of progress may lead to a conclusion that hours need to be increased or decreased.

It is recommended that all professionals and paraprofessionals providing therapy to the child as part of an intensive behavioral program receive regular supervision from a qualified professional.

It is important that parents be included as integral members of the intervention team. It is recommended that parents be trained in behavioral techniques and be encouraged to provide additional hours of instruction to the child. It is also recommended that training of parents in behavioral methods for interacting with their child be extensive and ongoing, and that it include regular consultation with the primary therapist.

Although some of the intensive behavioral intervention programs that were effective included use of physical aversives (such as a slap on the thigh), other programs reported good outcomes without the use of any physical aversives. The panel does not recommend the use of physical aversives, especially given the small physical size and vulnerability of young children in the age group from birth to age three years.

None of the other interventions reviewed by the NYSDOH approached ABA as an evidence based effective intervention for autism.

Report of the MADSEC (Maine Administrators of Services for Children with Disabilities) Task Force Report 2000 (rev ed)



Over the past 30 years, several thousand published research studies have documented the effectiveness of ABA across a wide range of:


• populations (children and adults with mental illness, developmental disabilities and learning disorders)
• interventionists (parents, teachers and staff)
• settings (schools, homes, institutions, group homes, hospitals and business offices), and
• behaviors (language; social, academic, leisure and functional life skills; aggression, selfinjury,
oppositional and stereotyped behaviors)

…

The effectiveness of ABA-based interventions with persons with autism is well documented, with current research replicating already-proven methods and further developing the field.

Documentation of the efficacy of ABA-based interventions with persons with autism emerged in the 1960s, with comprehensive evaluations beginning in the early 1970s. Hingtgen & Bryson (1972) reviewed over 400 research articles pertinent to the field of autism that were published between 1964 and 1970. They concluded that behaviorally-based interventions demonstrated the most consistent results. In a follow-up study, DeMeyer, Hingtgen & Jackson (1981) reviewed over 1,100 additional studies that appeared in the 1970s. They examined studies that included behaviorally-based interventions as well as interventions based upon a wide range of theoretical foundations. Following a comprehensive review of these studies, DeMeyer, Hingtgen & Jackson (1982) concluded “. . .the overwhelming evidence strongly suggest that the treatment of choice for maximal expansion of the autistic child’s behavioral repertoire is a systematic behavioral education program, involving as many child contact hours as possible, and using therapists (including parents) who have been trained in the behavioral techniques” (p.435).

Support of the consistent effectiveness and broad-based application of ABA methods with persons with autism is found in hundreds of additional published reports.


Baglio, Benavidiz, Compton, et al (1996) reviewed 251 studies from 1980 to 1995 that reported on the efficacy of behaviorally-based interventions with persons with autism. Baglio, et al (1996) concluded that since 1980, research on behavioral treatment of autistic children has become increasingly sophisticated and encompassing, and that interventions based upon ABA have consistentlyresulted in positive behavioral outcomes. In their review, categories of target behaviors included aberrant behaviors (ie self injury, aggression), language (ie receptive and expressive skills, augmentative communication), daily living skills (self-care, domestic skills), community living skills (vocational, public transportation and shopping skills), academics (reading, math, spelling, written language), and social skills (reciprocal social interactions, age-appropriate social skills).

In 1987, Lovaas published his report of research conducted with 38 autistic children using methods of applied behavior analysis 40 hours per week. Treatment occurred in the home and school setting. After the first two years, some of the children in the treatment group were able to enter kindergarten with assistance of only 10 hours of discrete trial training per week, and required only minimal assistance while completing first grade. Others, those who did not progress to independent school functioning early in treatment, continued in 40 hours per week of treatment for up to 6 years. All of the children in the study were re-evaluated between the ages of six and seven by independent evaluators who were blind as to whether the child had been in the treatment or control groups. There were several significant findings:

1) In the treatment group, 47% passed “normal” first grade and scored average or above on IQ tests. Of the control groups, only one child had a normal first grade placement and average IQ.

2) Eight of the remaining children in the treatment group were successful in a language disordered classroom and scored a mean IQ of 70 (range = 56-95). Of the control groups, 18 students were in a language disordered class (mean IQ = 70).

3) Two students in the treatment group were in a class for autistic or retarded children and scored in the profound MR range. By comparison, 21 of the control students were in autistic/MR classes, with a mean IQ of 40.

4) In contrast to the treatment group which showed significant gains in tested IQ, the control groups’ mean IQ did not improve. The mean post-treatment IQ was 83.3 for the treatment group, while only 53.3 for the control groups.

In 1993, McEachin, et al investigated the nine students who achieved the best
outcomes in the 1987 Lovaas study. After a thorough evaluation of adaptive functioning, IQ and personality conducted by professionals blind as to the child’s treatment status, evaluators could not distinguish treatment subjects from those who were not. Subsequent to the work of Lovaas and his associates, a number of investigators have addressed outcomes from intensive intervention programs for children with autism.

For example, the May Institute reported outcomes on 14 children with autism who received 15 - 20 hours of discrete trial training (Anderson, et al, 1987). While results were not as striking as those reported by Lovaas, significant gains were reported which exceeded those obtained in more traditional treatment paradigms. Similarly, Sheinkopf and Siegel (1998) have recently reported on interventions based upon discrete trial training which resulted in significant gains in the treated children’s’ IQ, as well as a reduction in the symptoms of autism. It should be noted that subjects in the May and Sheinkopf and Siegel studies were given a far less intense program than those of the Lovaas study, which may have implications regarding the impact of intensity on the effectiveness of treatment.

...

Conclusions

There is a wealth of validated and peer-reviewed studies supporting the efficacy of ABA methods to improve and sustain socially significant behaviors in every domain, in individuals with autism. Importantly, results reported include “meaningful” outcomes such as increased social skills, communication skills academic performance, and overall cognitive functioning.

These reflect clinically-significant quality of life improvements. While studies varied as to the magnitude of gains, all have demonstrated long term retention of gains made.


Mental Health: A Report of the US Surgeon General 1999

Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior. A well-designed study of a psychosocial intervention was carried out by Lovaas and colleagues (Lovaas, 1987; McEachin et al., 1993). Nineteen children with autism were treated intensively with behavior therapy for 2 years and compared with two control groups. Followup of the experimental group in first grade, in late childhood, and in adolescence found that nearly half the experimental group but almost none of the children in the matched control group were able to participate in regular schooling. Up to this point, a number of other research groups have provided at least a partial replication of the Lovaas model (see Rogers, 1998).

Consensus and Fully Informed Choices

The above are some of the leading statements by credible agencies that have reviewed the evidence bases in support of various autism interventions. No other intervention has anywhere near the same evidence in support of its efficacy as documented by these credible American agencies. Contrary to the unsubstantiated statement by Kathleen Provost there is in fact a clear consensus that ABA is the treatment of choice for autism.

If Kathleen Provost, and the Autism Society Canada, wish to exercise their information role responsibly they should make this clear to the public. Parents of newly diagnosed autistic children should be told that they might be gambling their child's precious development time, and their future development potential by forgoing ABA in favor of "feel good" unproven alternatives. In failing to do so they are failing autistic children in Canada.

autism