Wednesday, May 13, 2009

Misleading Autism Treatment Statements at Autism

Lisa Jo Rudy at Autism, for reasons unknown to me has made misleading statements about the evidence in support of the efficacy of various autism treatments. Coming on the heels of the recent Deborah Fein study showing that 10-20% of subject children with autism recovered from their autism with Intensive Early Behavioral Intervention ... ABA ... it is surprising to see Autism apparently react to that study with the assertion that all autism therapies are created equal. Ms Rudy and Autism appear to have turned their backs on evidence based assessments of autism treatments.

Ms Rudy stated in Can All Positive, Intensive Therapies Help Kids with Autism?:

As a result, there's no good way to know whether a child who received Floortime would have done better with RDI or ABA. Certainly, evidence shows that most children with autism improve to varying degrees with intensive therapy, no matter what its name.

Apart from the recent Fein study demonstrating full recovery as set out above other studies and reviews of those studies have unequivocally indicated that only ABA enjoys a solid evidence basis in support of its effectiveness:

The MADSEC (Maine) Autism Task Force assessed the evidence basis in support of various autism interventions as of 2000 and found that only one, ABA, met the highest standard:

"Based upon a thorough examination of numerous methodologies considered as interventions for children with autism, the MADSEC Autism Task Force has characterized the interventions reviewed as follows:

• Substantiated as effective based upon the scope and quality of research:
Applied behavior analysis.

In addition, applied behavior analysis’ evaluative procedures are
effective not only with behaviorally-based interventions, but also for the systematic evaluation of the efficacy of any intervention intended to affect individual learning and behavior. ABA’s emphasis on functional assessment and positive behavioral support will help meet heightened standards of IDEA ‘97. Its emphasis on measurable goals and reliable data collection will substantiate the child’s progress in the event of due process.

In describing the evidence backed benefits of ABA the MADSEC Report noted that:

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.

Other major contributions of ABA to the education and treatment of individuals with autism

• a large number of empirically-based systematic instruction methods that lead to the
acquisition of skills, and to the decrease/elimination of aberrant behaviors;

• a technology for systematically evaluating the efficacy of interventions intended to affect individual learning and behavior; and

• substantial cost/benefit.

Over 30 years of rigorous research and peer review of applied behavior analysis’ effectiveness for individuals with autism demonstrate ABA has been objectively substantiated as effective based upon the scope and quality of science. Professionals considering applied behavior analysis should portray the method as objectively substantiated as effective. Methods of applied behavior analysis should be considered to evaluate the effectiveness of any intervention used to help individuals with autism. Researchers should continue to vigorously investigate behavioral intervention as the most promising area of research and treatment benefiting individuals with autism known today. Early interventionists should leverage early autism diagnosis with

The American Academy of Pediatrics Management of Children with Autism Spectrum Disorders (2007) report described the level of evidence of ABA effectiveness in a manner that no other treatment mentioned in the report even remotely approximated:

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

To these reviews of studies supporting ABA effectiveness in treating autism can be added the US Surgeon General and the NY State Department of Health. Now the Fein study on autism recovery would add to the information basis of such reports.

We are decades past the point where Autism can claim that all autism interventions are created equal as long as they are positive and done early and intensively. There is no evidence to support the position. The Autism position is in essence a rejection of an evidence based approach to assessing autism interventions.

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Lisa Jo Rudy said...

Hey, Harold.

I stand by my statement: we have no way to compare either/or outcomes. So far as I'm aware, no one has conducted such a study on a cohort of similar kiddos to see which therapies are more likely to support which outcomes.

In addition, while ABA is obviously well-documented, research studies are increasingly supporting the efficacy of developmental therapies.

Bottom line: I would never discourage anyone from going the ABA route. But by the same token, I believe there is a great deal to be said for several of the developmental therapies (Floortime, RDI, Play Project).

As I said in a response to your comment on my own blog, the question of what "success" looks like is very real. That is: is "success" a child who is able to manage in a typical classroom? Or is there more to being fully human?

Lisa (

Unknown said...

I am sorry Lisa Jo but I can't reconcile your position, stand by it or not, with the various and numerous studies and reviews that have found ABA, and to date only ABA, as effective in making the kinds of gains detailed in the MADSEC and AAP reports.

BigAutism said...

"Coming on the heels of the recent Deborah Fein study showing that 10-20% of subject children with autism recovered from their autism with Intensive Early Behavioral Intervention ... ABA ."

I assume it's an ever windingly lower standard. We started with 47% (Lovaas 87') and now we are down to 10-20%. At some point, perhaps in another 20 years, we'll be down again to perhaps 1-5% and another generation of parents will feel as though they were "suckered" out of thousands of dollars better spent on special needs trusts etc. The Big Autism industry will continue to churn.

Unknown said...

Hello "BigAutism"

Lovaas results referenced 47% being indistinguishable from peers by the time they finished their 40 hours a week, ages 2-5.

It said nothing about recovery, long term. 10=20% is a very substantial rate of FULL recovery. And If you read the rest of my comment you will also read what the MADSEC and AAP reports said about the hundreds of studies confirming specific gains ... improvements short of recovery.

I am sure you are happy for the 10-20% who are recovered from their autism disorders and the others who have reduced problem behaviors such as self injury and who acquired specific intellectual, communciation and social skills short of recovery.

As for your Big Autism Industry what are you talking about? Do you have anything to explain that "concept" and back it up?