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

Montreal Gazette Speaks Up For Autistic Children

With few exceptions the mainstream media coverage of autism disorders has been abysmal. Even now many in the MSM can do little more than engage in a feeding frenzy over Oprah Winfrey's presentation of health issues including autism disorders. Seldom is concern for how to actually help autistic children or adults reflected in the popular press. Seldom are straightforward facts such as the long proven efficacy of ABA in helping autistic children overcome, in whole or in part, their autistic deficits been mentioned in the MSM. Yesterday the Montreal Gazette spoke up for autistic children and did it well.

In Autistic children deserve better the Gazette argued that the Quebec government of Liberal Premier Jean Charest should amend a piece of legislation, Bill 21, dealing with changes to various legislative rules in the field of mental health and human relations by permitting psychologists specially trained in autism to diagnose and treat persons with autism. Here in New Brunswick psychologists already diagnose and treat autism disorders. In making this argument the Gazette also pointed out that The American Academy of Pediatrics states that "the intensive treatment, known as Applied Behavioral Analysis, is now of "well-documented" effectiveness as a medical treatment" a point seldom made by the mainstream media.

The Montreal Gazette has spoken up, with wisdom and clarity, on behalf of autistic children in Quebec. Hopefully the learned autism journalists at Canada's CBC can take time out from their love affair with Michelle Dawson, Dr. Laurent Mottron and the anti-autism treatment Neurodiversity movement and do the same.

autism

Public Discussion of Vaccine Issues

I encourage parents and members of the public interested in autism and vaccine safety issues to visit Age of Autism and read The Vaccine Hard Sell at Pediatrics. That comment includes a letter by Michael Wagnitz, a chemist with 27 years experience, and self described father of a "vaccine injured child", in which Mr Wagnitz challenges Pediatrics and Dr. Paul Offit for alleged misinformation regarding the use of neurotoxic metals in vaccines.

Pediatrics, the journal of the American Academy of Pediatrics, apparently refused to publish Mr. Wagnitz letter, despite his chemistry background, and despite the sourcing for the points made in his letter. The Age of Autism, to its credit did publish the Wagnitz letter.

Vaccination programs are an important part of public health strategies and have been very successful in reducing or eliminating serious illnesses, some of which have taken the lives of many children. Claims regarding vaccine injuries should not be made lightly. But neither should democratic discussion, particularly well informed, rational discussion of possible vaccine induced injuries, including possibly autism, be shut down.

If the research which Dr. Bernardine Healy has called for into possible vaccine connections to autism is not done, if public discussion of such connection is shut down, if dissenting voices like Mr. Wagnitz with his chemistry background are not heard, then the public concerns about vaccines and autism or brain injuries will continue to grow.

It may also be the case that some of the claims about vaccine induced autism and other brain injuries are true. Without proper research and public discussion we may end up missing out on opportunities to prevent neurological damage to children.

Let us do the research, let us have the discussion. Let us hear from parents, doctors, chemists anyone with information and a perspective to offer. That is the ONLY way confidence in the vaccine programs will be strengthened. And we may learn of ways to prevent autism disorders and neurological damage.

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

Ottawa's Unfinished Autism Business

Autism should not be a partisan issue.

Here in New Brunswick progress has been made under the former Conservative government of Bernard Lord and the current Liberal government of Shawn Graham. It is more difficult to say the same of the situation in Ottawa where the separatist Bloc Québécois and the Conservative government of Stephen Harper combined to defeat Charlottetown Liberal MP Shawn Murphy's Private Members Bill C-304 which would have provided a real National Autism Treatment Strategy to ensure adequate financing and ABA/IEBI treatment for Canada's autistic children whether they had the good fortune to reside in a province sitting on large oil reserves or not.

The rationale for defeating Bill C-304 offered by the Harper Conservative party - that health care is a matter within provincial legislative jurisdiction - ignores the reality that we already have federal health care legislation - the very Canada Health Act that Bill C-304 would have amended. If the Canada Health Act itself can exist, whether by some constitutional basis for federal health care competency; or by the cooperation, compassion and common sense of Canadians then so too can an amendment to that Act.

Even weaker is the argument, often advanced by the Harper government's offical autism dad, Mike Lake, that:

If this Bill were to pass, autism would be the one and only disorder or disease named in the Canada Health Act. Cancer is not named. Neither is diabetes or cardiovascular disease. Why autism and not these? Why not Down Syndrome? Why not Schizophrenia?

Under the Canada Health Act, the provinces are clearly responsible for decisions on which medical treatments they will fund. If we are to maintain the integrity of the Act, only the provinces can make those decisions.

To answer the first question the fact that autism would be the first to be named should be irrelevant. The need for a national effort to address Canada's autism crisis is clear. The Conservative government acknowledged that fact when it adopted Fredericton MP Andy Scott' s motion calling for a National Autism Strategy. While recognizing the need for such a strategy the Harper government has steadfastly refused to put any teeth in it. If the need for a National Strategy exists to address other disorders and diseases they can be looked at on case by case basis. There is no reason not to name autism now because other disorders and diseases may also have to be considered. Each can be examined on a case by case basis as required.

Provinces across Canada have begun financing, to the extent they are capable, the ABA that has been acknowledged, most recently (October 29, 2007) by the American Academy of Pediatrics, as the most evidence based effective treatment for autism:

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

Even Mr Lake has acknowledged the effectiveness of ABA in treating autism; he just doesn't seem to understand that not all provinces have the finances to properly fund ABA for all autistic children:

In my opinion, it is completely unacceptable for any province not to fund Applied Behavioural Analysis (ABA) for those who need it. If voters feel as strongly as I do about this, they must let their provincial governments know and then hold them accountable at election time.

As for the integrity of the Act what is that? An Act is established to give effect to the will of the people through their elected representatives on a given matter. They can change the scheme, structure, or "integrity" of the Act if that reflects the will of the people at that time. If Canadians want to provide financing for ABA treatment for autism, and judging by the number of provinces that provide some level of ABA treatment funding they do, then the only challenge for those provinces not as well off, is to find the money to adequately fund the treatment.

The last I checked the federal government has no qualms about taking money, in the form of taxes, from the pockets of Canadian families wherever they live. They should have no qualms about spending some of that money to help provide effective ABA treatment for persons with autism.

Mike Lake's autistic son deserves the opportunity to access the ABA treatment funded by oil rich Alberta. So too does Joe Smith's son in PEI, Jacques LeBlanc's son in Quebec and Joe Kowalchuck's son in Saskatchewan. It is long past time that the Harper government ceased making a mockery of its commitment to a National Autism Strategy and amended the Canada Health Act as set out in Shawn Murphy's Bill C-304. There is no good reason not to.

C-304

First Session, Thirty-ninth Parliament,
55 Elizabeth II, 2006

HOUSE OF COMMONS OF CANADA

BILL C-304

_____________________________________________

FIRST READING, MAY 17, 2006

_____________________________________________

MR. MURPHY (Charlottetown)

1st Session, 39th Parliament,
55 Elizabeth II, 2006

HOUSE OF COMMONS OF CANADA

BILL C-304

An Act to provide for the development of a
national strategy for the treatment of
autism and to amend the Canada Health
Act

Her Majesty, by and with the advice and
consent of the Senate and House of Commons
of Canada, enacts as follows:

SHORT TITLE

1. This Act may be cited as the National
Strategy for the Treatment of Autism Act.


NATIONAL CONFERENCE

2. The Minister of Health shall, before
December 31, 2006, convene a conference of
all provincial and territorial ministers responsible
for health for the purpose of working
together to develop a national strategy for the
treatment of autism. The Minister shall, before
December 31, 2007, table a report in both
Houses of Parliament specifying a plan of action
developed in collaboration with the provincial
and territorial ministers for the purpose of
implementing that strategy.

AMENDMENTS TO THE CANADA
HEALTH ACT

3. Section 2 of the Canada Health Act is
renumbered as subsection 2(1) and is
amended by adding the following:

(2) For the purposes of this Act, services
that are medically necessary or required under
this Act include Applied Behavioural Analysis
(ABA) and Intensive Behavioural Intervention
(IBI) for persons suffering from Autism Spectrum
Disorder.

autism

Autism Therapy: Autistic Man Benefited From ABA

If you listened to many of the anti-ABA ideologues in the Neurodiversity club you would not want ABA therapy for your child. If you are the parent of a newly diagnosed autistic child and you listened to thef promotoers of the Alleged Autism Rights Movement you would not seek ABA therapy for your child. If you listen to these ideologues you would pass on the only proven effective healt treatment AND education intervention for autistic children.

Many of the anti-ABA ideologues have no actual experience with ABA themselves and yet they dismiss the conclusions of responsible agencies such as the American Academy of Pediatrics, the Maine (MADSEC) Autism Task Force, the New York State Department of Health, the US Surgeon Generals Office, the Association for Science in Autism Treatment, the May Institute, and five decades of research pointing to the effectiveness of ABA in helping autistic children. Of course the ideologues who believe that autism is not truly a disorder, because their mild version of autism poses few restriction on their enjoyment of life, also dismiss, the views and efforts of hundreds of thousands of parents across North America who are seeking to treat, educate or otherwise help their autistic children with ABA intervention.

If you are the parent of a newly diagnosed autistic child seeking therapy for your child read the responsible authorities referenced above, the latest being the 2007 report of the American Academy of Pediatrcs, Management of Children with Autism Spectrum Disorders. ABA is not a "cure" for autism. But it is have been proven effective at helping autistic children as stated by the American Academy of Pediatrics:

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

You may also want to read the NBC10 feature Autism Therapy Proves Effective For Bucks County Teen which tells the story of A.J. Corless diagnosed with low-functioning autism whose family sought ABA intervention for their son, now a thriving adult:

"I learned how to do current events, English, spelling, proofreading. I'm learning how to cook, take inventory, put pictures on scrapbook and upload pictures," Corless said.

But his life wasn't always that way.A short time after his second birthday, Corless was diagnosed with low-functioning autism."I was told to go home, worry about my other children. He wouldn't amount to anything," Joanne Corless, A.J.'s mother, said.The Corless family chose to ignore the bleak diagnosis from doctors and were determined to help A.J. reach his full potential.That's when they turned to an intense, one-on-one therapy, called applied behavioral analysis or ABA.

"The ABA is just constantly keeping them on task, constantly reinforcing them, making them learn," Joanne Corless said.The Corless family saw change instantly."He's come a lot further than we've ever dreamed he's come," Joanne Corless said.Joanne said shortly after beginning ABA therapy, A.J. began to speak and follow directions.Now at 18, he plays classical piano, volunteers at a library and excels in many sports."I have a red belt in karate. I like going to the special Olympic games," A.J. Corless said.

He also can get you anywhere you need to go."I like to get my mom directions to places so she doesn't get lost," A.J. Corless said. Everyday, he works to overcome the obstacles of autism and his family said specialized therapy makes it possible."I look at A.J. and I think that he is a child that has learned to live with his disability. He has a great life. He really does," Joanne Corless said.




autism

Autism Treatment Quotes 2007-2008

"If we had done what so many people told us to do years ago, we wouldn't have the child we have today. We would have written her off. Then what would she be today?

We never would have seen she could write these things. Can you imagine? We would have never have gotten out of her how articulate she is how intelligent she is. Now, she tells us stories, she teases her brother. She just does it in a different way, she does it with her computer."

Arthur Fleishmann, Carly's Dad, discussing his, and his wife Tammy's, decision to provide Carly with early intensive ABA treatment, CTV, February 17, 2008

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

American Academy of Pediatrics, Management of Children With Autism Spectrum Disorders, October 29, 2007

JAMA Article Highlights AAP Autism Reports

The current edition, of the Journal of the American Medical Association , includes an article by Tracy Hampton, PhD JAMA. 2007; 298(22):2610 highlighting the recent American Academy of Pediatrics autism reports. In Reports Help Identify and Manage Autism Doctor Hampton highlights the recommendation for early, 18 and 24 month, universal screening and the early intervention, particularly early behavioral intervention.

The most significant recommendation is to screen all children at age 18 months and 24 months. "This is the first time that the Academy has recommended universal screening rather than just when a parent is concerned," said co-author Chris Plauche Johnson, MD, MEd, clinical professor of pediatrics at the University of Texas Health Science Center at San Antonio.


....

The second AAP clinical report, Management of Children With Autism Spectrum Disorders, highlights early interventions that are important for effective treatment. The report advises intervention as soon as a diagnosis is seriously considered, for at least 25 hours per week in settings with a low student-to-teacher ratio. Parents should also be included in therapy sessions.

For controlling problems such as tantrums, aggressive behaviors, and self-injury, the report recommends behavior management strategies and, in some cases, medications.

autism

Dear Health Minister Clement: Re Autism Gold Standard Intervention

October 31, 2007

Honourable Tony Clement
Minister of Health (Canada)

Dear Honourable Minister

Recently your government filed its response to the Senate's "Pay Now Or Pay Later" report on autism services and funding in Canada. As the parent of a profoundly autistic 11 1/2 year old boy I have been active in autism advocacy in my province for the past 9 years. I was disappointed, extremely disappointed, with your government's weak response to an issue which now is estimated to directly affect 1 in 150 Canadians and their families.

In particular I found objectionable your government's stated position that there is no consensus on a gold standard of treatment for autism. That position is simply inconsistent with the professional literature as I understand it, admittedly from the perspective of a mere parent. State and federal agencies in the United States over the past decade from Maine to New York to California have routinely described ABA, Applied Behavior Analysis, as an evidence based effective intervention for autistic children; the only intervention to be accorded that level of recognition of its efficacy.

This week the American Academy of Pediatrics released two autism reports one dealing with, and setting out recommendations concerning the need for very early diagnosis of autism disorders in children. The other report included a review of the professional literature on autism interventions. In Management of Children With Autism Spectrum Disorders the AAP stated with respect to Applied Behavior Analysis (ABA) :

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

With all respect Honourable Minister, the position that there is no Gold Standard treatment or intervention for autism, is not in the language of the legal profession of which I am a member, "credible". I ask you to reconsider this stand by your government. I also ask you to look past the strict interpretation of Canadian constitutional jurisdiction over health matters on which your government and Mr. Duceppe's Bloc Quebecois relies in opposing federally funded ABA treatment for autism. Cooperative federalism has worked well in many instances in this country and to my knowledge is not inconsistent with the ultimate separatist aims of Mr. Duceppe's party. Before his party achieves full sovereignty autistic children will be growing older and needing ABA services in Quebec where autistic children despite claims of "we do it differently" are also badly in need of funded ABA services.

I ask you to put aside petty politics and help autistic children wherever they reside in Canada. Put the ideology and rhetoric in a drawer for safe keeping and help autistic children with some of the multi billion dollar federal surplus. Help autistic children now. Tomorrow is too late.

Harold L Doherty
Fredericton NB

Autism's Gold Standard Intervention - A Note to Dr. Rémi Quirion

Dr. Rémi Quirion
Scientific Director
Institute of Neurosciences, Mental Health and Addiction (INMHA)
Canadian Institutes for Health Research

Dear Dr. Quirion

Re: Autism's Gold Standard Intervention and the National Autism Symposium

I am a parent of an 11 1/2 year old boy with Autism Disorder. He is profoundly autistic. By profoundly I mean that he has limited communication skills and understanding of language and does not appreciate many of the dangers presented by everyday life. He also engages, from time to time, in self injurious behavior. As a distinguished professional in Montreal neuro-research circles you may not place much weight on my assessment of my son's realities even after living with, caring for, and loving him, for 11 1/2 years. To that end let me assure you that my assessment of my son is confirmed by a Pediatric Doctor's (two in fact) and a Psychologist's assessments.

As an outspoken parent advocate on autism issues my name was rejected by your organisation as a New Brunswick community representative at the National Autism Symposium to be held on November 8 and 9. Despite that fact, I ask you to consider, and anyone of the chosen delegates to consider during this symposium, the question of whether there is a Gold Standard for autism interventions at this time. You may not understand that for parents this is a critical question. Parents of autistic children will not be spending a lot of time worrying about the next development in Montreal neuro-research circles over the next few years. We tend to focus on the well being and best interests of our children; on the best ways to enhance their development and life prospects, to make their life better for them. Parents of newly diagnosed autistic children may not understand that there is in fact a Gold Standard intervention for autism, and that time is important in obtaining that intervention for their children.

You may or may not know that several reviewing agencies over the past decade have essentially reached the conclusion that there is, despite the superficial conclusions to the contrary of some otherwise earnest professionals, a gold standard for autism intervention. From Maine to New York to California, to the office of the US Surgeon General to the advisory board of the Association for Science in Autism Treatment to a recent United Kingdom review, all such reviews consistently point to Applied Behavior Analysis as the only effective evidence based autism intervention - to date.

This past week saw two further developments. Most well known are the two reports of the American Academy of Pediatrics. One report recommended early screening for autism. The other report reviewed some interventions. This quote is taken directly from one of those AAP Reports Management of Children With Autism Spectrum Disorders

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


It will not receive the attention of the AAP Reports but the Province of New Scotia also release a report, Autism Treatment Program Getting Positive Results, this week on its ABA based EIBI program :

The interim results of an independent program evaluation conducted by IWK Health Centre Research Services and Dalhousie University indicates that after one year of Early Intensive Behavioural Intervention (EIBI)treatment, virtually all 27 children in the first phase of the program had significantly improved communication skills. According to tests and parental feedback, they also had improved problem-solving skills and reduced behavioural problems.

...

Many of the children were about a year and a half behind in language-development skills when they began EIBI treatment. On average, children gained more than a year's worth of language skills in the first 12 months of treatment.

The National Autism Symposium is designed to be conducted by professional "facilitators" which usually means that open, frank discussion will not take place, that the issues discussed and conclusions reached will be essentially determined in advance of the symposium. On the assumption though that there is still some room for actual candid discussion of research issues of real import to autistic children and their families I ask you to encourage your professional colleagues, and others in attendance, to consider these two recent reports, the numerous other credible reviews of autism intervention research and the hundreds of studies over 5 decades which clearly establish Applied Behavior Analysis as the Gold Standard intervention for autistic children.

Respectfully,

Harold L Doherty
Fredericton NB

cc. Dr. Barbara Beckett
Assistant Director, Ottawa

AAP's "Other Report" Endorses ABA as Autism Treatment

Most of the autism news and blog coverage dealt with the American Academy of Pediatrics report calling for early autism screening for all children, including two screenings before age 2. Good advice. The AAP also issues a second report. However, the AAP's other report went virtually unmentioned amongst news sources, autism bloggers and neurodiversity bloggers. The second AAP report, Management of Children With Autism Spectrum Disorders, reviewed autism interventions and had this to say about ABA treatment for autism (Bold Text Highlighting added for emphasis - HLD) :

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 methodology^21,25,27,28 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

Highly structured comprehensive early intervention programs for children with ASDs, such as the Young Autism Project developed by Lovaas^35,41 at the University of California Los Angeles, rely heavily on discrete trial training (DTT) methodology, but this is only one of many techniques used within the realm of ABA. DTT methods are useful in establishing learning readiness by teaching foundation skills such as attention, compliance, imitation, and discrimination learning, as well as a variety of other skills. However, DTT has been criticized because of problems with generalization of learned behaviors to spontaneous use in natural environments and because the highly structured teaching environment is not representative of natural adult-child interactions. Traditional ABA techniques have been modified to address these issues. Naturalistic behavioral interventions, such as incidental teaching and natural language paradigm/pivotal response training, may enhance generalization of skills.¹³

Functional behavior analysis, or functional assessment, is an important aspect of behaviorally based treatment of unwanted behaviors. Most problem behaviors serve an adaptive function of some type and are reinforced by their consequences, such as attainment of (1) adult attention, (2) a desired object, activity, or sensation, or (3) escape from an undesired situation or demand. Functional assessment is a rigorous, empirically based method of gathering information that can be used to maximize the effectiveness and efficiency of behavioral support interventions.⁴² It includes formulating a clear description of the problem behavior (including frequency and intensity); identifying the antecedents, consequences, and other environmental factors that maintain the behavior; developing hypotheses that specify the motivating function of the behavior; and collecting direct observational data to test the hypothesis. Functional analysis also is useful in identifying antecedents and consequences that are associated with increased frequency of desirable behaviors so that they can be used to evoke new adaptive behaviors.