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 Research Community's Failing Grades: Vocational Interventions Research

"In the end, the researchers found only five studies that focused on vocational interventions. While this handful of studies looked at certain on-the-job programs designed to support young adults with autism and suggest these "interventions" can improve quality of life and reduce symptoms of autism, the study authors concluded, "all studies were of poor quality." They say these studies had serious flaws including the randomization or comparison groups, which makes it difficult to draw any conclusions. Lack of follow-up and the fact that most studies were small also contributed to the researchers' deeming the quality of the research as poor. The study was published Monday in the medical journal Pediatrics. 

Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, says she finds it remarkable that only five studies that address vocation skills were published in the last three decades and all were of poor quality. "There is a tremendous knowledge gap regarding how to help young people with autism be successful in the work environment," Dawson says."

Evidence weak that vocational programs help young adults with autism, CNN, August 28, 2012

This information does not indicate that vocational interventions are not effective. What it indicates is that the autism research community has not bothered to conduct any serious research to evaluate those interventions. The autism research community has its obsessions and it pursues them doggedly even when the results don't support their particular obsessions. But those obsessions do not necessarily result in quality autism research. 

We all know that within the next couple of years the "Mottron group" will publish more studies telling us how autism is just a different, in some ways superior, type of intelligence, one that can not, and should not, be cured. There will be more studies about the genetic bases of autism without ever pinpointing specific genes or genetic groupings that explain the diverse types of autism disorders as they manifest in so many individuals. The environmental side of the autism equation will be ignored. No new treatments or cures will be explored. 

The autism research community has done little to advance our understanding of what autism disorders are, how they are caused, how to treat or cure autism disorders or even, since Lovaas, how to assess or evalute interventions. The review of vocational autism research is just one more failing grade for the autism community that puts up lots of posters and makes grand speeches at IMFAR conventions in hotels around the world but really does little to help the lives of those who actually suffer from autism disorders. 

I realize how pessimistic this comment is. My son was diagnosed 14 years ago at age 2. I have seen many hopes raised and false starts made but I have seen little lasting progress in the past 14 years. Instead of progress we have a new definition of autism disorders scheduled to arrive in the DSM5 that will do nothing to improve the lives of those with autism and will not advance diagnosis, treatment or cure for autism disorders. The world autism research community has been talking in circles since my son was diagnosed studiously avoiding the tough research issues but achieving nothing. 

Yes my comment is pessimistic. I would love to be wrong about this. I would love to see some substantial breakthrough in understanding autism, how it is caused, how to ameliorate its challenges for my son and others, breakthroughs in treatments and cures. I do believe that progress must be achieved through research but as my son grows older I do not see the qualitative results, beyond the work of Lovaas and those who followed his lead, of any such research to date. Perhaps a review like this will help those at the IACC and other autism research leaders face some autism reality and improve the direction and quality of autism research.

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.

Neurodiversity's Ten Autism Commandments

1. Thou shall not call autism disorder a disorder.
2. Thou shall not seek to treat or cure thy autistic child for if you do you shall forever be known in the records as a "curebie".
3. Thou shall not conduct research into environmental causes of autism.
4. Thou shall not conduct research into the genetic nature of autism.
5. Thou shall not abuse thy autistic child by exposure to Applied Behavior Analysis or any other such evidence based effective autism interventions with which Satan, or Lovaas, may tempt ye.
6. Thou shall speak no evil, make negative comments or say bad stuff of autism.
7. Thou shall have no researchers before Mottron and Gernsbacher unless they conduct experiments in such a way as to prove that autism intelligence is really superior intelligence.
8. Thou shall make no mention of autistic youths and adults living in institutional care.
9. Thou shall not lay down with evil or watch the "Autism Every Day" video.
10. Thou shall repent for all thy NT sins.

Autism Quotes # 1

"If a child cannot learn in the way we teach ... we must teach in a way the child can learn."

Dr. O. Ivar Lovaas

"When Jack was diagnosed we were devastated at that thought of what life might be like for him. Now he can talk. ABA is hard work, but it has opened up a whole range of opportunities for him. Life just keeps getting better."

Charmaine Fraser, Mother of Autistic Son, Australia

So we're choosing to tell our daughter's story now, after being quiet about it for the last 16 months: to emphasize how important it is that this bill pass in its original form. If it seems opportunistic or self-serving, well...there's not much I can say about that, except that things like ABA and other therapy programs would seem to be the point of insurance: to insure the well-being of these kids who otherwise would be without hope for a future.

Finally, the only thing that really gave me pause about posting this was something that was said to me about the possibility SWSNBN might read this later on in her life and be mortified. My only response to that is this: I'm not a religious person, so prayer is out of the question, but I hope beyond anything I have ever hoped in my miserable life that my daughter, at some point in the future, is able to read this blog and yell at her father about it. I want that so badly it physically hurts."

Pete, A Perfectly Cromulent Blog, Father of Autistic Daughter, Texas

Myths and Misrepresentations about ABA and Lovaas (1)

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

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

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

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

Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.
Smith, T., Groen, A. D., Wynn, J. W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal of Mental Retardation, 105, 269-85.
Sallows, Glen O. & Graupner, Tamlynn D. (2005). Intensive Behavioral Treatment for Children with Autism: Four-Year Outcome and Predictors. American Journal on Mental Retardation,110 (6), 417-438.

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

Conor, Autism and ABA from Apple to Seuss

Conor was 2 1/2 years old and had NO effective speech; as in NO words at all with which to communicate. When he wanted something he would simply scream until we figured out what he wanted and provided it. An apple, one of his favorite foods, was always a good guess. Then I attended a lecture by Paul McDonnell, a clinical psychologist working with autistic children and professor emeritus (psychology). Paul described ABA and showed data charts and strategies for extinguishing problem behavior, teaching positive behaviors and elements of speech. That evening at home I tried ABA with Conor for the first time. When he screamed I showed him an apple but did not give it to him right away. I held the apple and kept repeating the first syllable until Conor, some 45 minutes later, finally said "ap". After an hour and a half Conor was able to say apple.

Since then Conor has received ABA intervention from a number of therapists, but not the 40 hours a week, between the ages of 2 and 5. Nonetheless his vocabulary and understanding of language today while still limited compared to others his age is light years ahead of where it was when we first worked with that apple. Above is a picture of Conor, with his mother, at the edge of the picture listening, while Conor reads aloud from the Cat in the Hat Comes Back by Dr. Seuss. (Dr. Seuss is his favorite writer by far).

Conor's diagnosis is Autism Disorder. His pediatrician's commentary describes him as profoundly autistic which he is. But ABA has helped him,and me, immeasurably. It has opened the world for him as language and reading does for all once acquired to any extent. And it has allowed me to communicate with my buddy. Both are priceless gifts. I thank Paul McDonnell for his many efforts on educating parents of autistic children in New Brunswick, the therapists that have worked with Conor and Dr. O. Ivar Lovaas for his incredible gift to autistic children and their parents.