May Institute National Autism Center Review: Applied Behavior Analysis The One Intervention Determined To Be Effective For Adults With Autism

National Autism Center Completes Most Comprehensive Review of Autism Interventions Identifies Established Interventions for Children, Adolescents, and Adults on the Autism Spectrum 

National Autism Center Press Release 0.1 

Randolph, Mass. – Researchers at the National Autism Center at May Institute today released the results of the largest systematic review to date of interventions for autism spectrum disorder (ASD). Their findings identify 14 “Established Interventions” for children and adolescents that have the most research support, produce beneficial outcomes, and are known to be effective, and one Established Intervention for adults on the autism spectrum.

“The National Standards Project is an ongoing effort designed to give educators, families, practitioners, and organizations the information and resources they need to make informed choices about effective interventions that will offer individuals with ASD the greatest hope for their futures,” said Hanna C. Rue, Ph.D., BCBA-D. Dr. Rue serves as Executive Director of the National Autism Center, May Institute’s Center for the Promotion of Evidence-based Practice.

Leading the way in the field of adult intervention, this latest iteration of the National Standards Project also included an analysis of intervention outcome studies for adults (ages 22 and older) that have never been systematically evaluated before now.

The one intervention determined to be effective for adults, and nearly all of those classified as effective for children and adolescents, are behaviorally based, meaning they are grounded in the methodologies of applied behavior analysis, behavioral psychology, and positive behavior support.

In spite of the burgeoning population of adults with ASD, there is little empirical research to guide intervention for this population. The overwhelming majority of research studies to date focus on interventions for children and adolescents.

“Because of the dearth of research on adult interventions, only 27 studies focused on adults with ASD met our inclusion criteria,” said Dr. Rue. “Although we are pleased to be able to identify one Established Intervention, these results draw attention to the dire need for further research in this area.

“Children with autism grow up to be adults with autism; they will require effective interventions throughout their lifetimes to ensure they reach and maintain their maximum potential,” Dr. Rue added.

The National Standards Project is the only systematic review of ASD interventions for individuals across the lifespan based on behavioral and educational studies. Through a rigorous process utilizing tools and strategies designed and vetted by a team of national experts, the Project’s goal was to analyze the research that was conducted and the impact on participants, and to determine the strength and scientific rigor of that research. The results will help to inform decisions about interventions, or treatments, for ASD.

The report released today, Findings and Conclusions: National Standards Project, Phase 2, updated the Center’s first summary of the ASD intervention literature for children and youth under age 22. Phase 1 of the project was published in 2009. The combined the results of Phases 1 and 2 have produced the largest compilation of studies ever reviewed.

Nationally recognized experts in autism, as well as other leaders representing diverse fields of study, were involved in both phases of the National Standards Project and guided the process of evaluation. Dozens of article reviewers analyzed 1,165 studies related to interventions for ASD throughout both phases of the project. The interventions were subsequently categorized as 1) Established, and producing beneficial outcomes known to be effective; 2) Emerging, with some evidence of effectiveness, but still requiring more research, and 3) Unestablished, and having little or no evidence of effectiveness.

This new report identifies three interventions for individuals under age 22 that were identified as Emerging in 2009 and have now garnered enough scientific evidence of effectiveness to be moved into the Established category.

During the past five years, the National Autism Center has disseminated the results of the first phase of the National Standards Project to hundreds of thousands of individuals throughout the country and around the world through the publication of the National Standards Report.

 The new free report download:  http://www.nationalautismcenter.org/category/press-release/.

About the National Autism Center

The National Autism Center is May Institute’s Center for the Promotion of Evidence-based Practice. It is a nonprofit organization dedicated to serving children and adolescents with autism spectrum disorder (ASD) by providing reliable information, promoting best practices, and offering comprehensive resources for families, practitioners, and communities. For more information about the National Autism Center, please visit www.nationalautismcenter.org.

About May Institute

May Institute is an award-winning nonprofit organization with 60 years of experience in serving children and adults with autism spectrum disorder and other developmental disabilities, brain injury, mental illness, and behavioral health needs. The organization provides educational, rehabilitative, and behavioral healthcare services to individuals, as well as training and consultation services to professionals, organizations, and public school systems. At more than 160 service locations across the country, highly trained staff work to create new and more effective ways to meet the special needs of individuals and families across the lifespan. Learn more at www.mayinstitute.org.

Autism and Learning - ABA Is Being Used To Help Autistic School Children

If you read only the writings of a few hard core anti-ABA activists like Dr. Laurent Mottron and his colleague Michelle Dawson, or their followers in the Neurodiversity movement, you would think that Applied Behavior Analysis, or ABA, is an oppressive violation of the rights of autistic children. You would not know that ABA is considered by thousands of autism experts, based on hundreds of studies over more than five decades of research to be an effective method of helping autistic children make continuing gains in learning, intellect, social and communication skills. Numerous responsible and respected agencies have reached the same conclusion, including the American Academy of Pediatrics, The US Surgeon General's Office, the Association for Science in Autism Treatment, and state and provincial agencies across Canada and the United States, including the best known in Maine, New York and California.

If you are a parent of a newly diagnosed autistic child I urge you to ignore the anti-ABA activists and read the material published by the responsible agencies I have listed above. And talk to parents who actually live with autistic children day in and day out and care for them who are helping their children with ABA. Finally consult with people like those at the May Institute who actually work with autistic children. And consult with people like those at the Half Hollows Hill school. There the teachers and other staff use the most effective known method of teaching students with autism Applied Behavior Analysis.

These people are not sitting in a Montreal research facility studying ways to prove that ABA is wrong. Nor are they working only with higher functioning autistic children. They work with autistic children from across the spectrum .... and they use ABA to help them learn .... because it works. The faculty and staff at Half Hollow Hills, like the professionals at the May Institute, know that autism works, not just because of the volumes of research telling them it works, but also from the daily experience of actually working with autistic children from across the autism spectrum and helping them learn by ABA methods. An experience not shared by anti-ABA activists Mottron and Dawson.

For a reality based view of ABA as actually used in helping autistic children read the Newsday article Half Hollow Hills teachers use reinforcement-and-reward strategies to teach their STUDENTS WITH AUTISM. Do not listen to the anti-ABA activists, get the input of people who know what they are talking about and who actually help autistic children day in and day out.

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Autism Challenges During The Holidays

Autism does not take a vacation during the Christmas, or any other, holiday season. Autistic children can face additional challenges. In Autistic children face holiday challenges Dr. Alan Harchik chief operating officer of the May Institute, a nonprofit organization that provides educational, rehabilitative, and behavioral health care services to individuals with autism and other developmental disabilities, brain injury, mental illness, and behavioral health care needs, offers some sound advice for helping your autistic child, and you, during the holiday season with its many additional stresses.

One of the many helpful points made by Dr. Harchik is one which I am emphasizing because I did not adhere to it last Saturday with Conor:

Shopping: If your child accompanies you to the mall, supermarket, or department store, try to go early in the day or during the mid-week when it is likely to be less crowded.

Last Saturday Conor and I went for a couple of outings early in the day to local establishments and things went extremely well. Then, a bit over confident, I tried again later in the afternoon with a visit to the Sears store in Fredericton's largest, busiest mall. Conor indicated his displeasure as we approached the store and continued as we entered. Realizing by Conor's reaction I was pushing the envelope I turned around and took him back to the car to wait there for his mother but it was too late and Conor suffered a serious meltdown.

Last week Conor paid the price because I was not careful enough about holiday shopping crowd activity. You should probably heed Dr. Harchik's advice about avoiding crowded shopping visits later in the day. I know I will.

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Autism, ABA and the Importance of Accurate Data

If parents seeking treatment for their autistic children are interested in getting past ideological rhetoric and ill informed opinions about ABA, applied behavior analysis, they would be wise to consider information available from sources like Alan Harchik chief operating officer of May Institute, a US national nonprofit organization that provides educational, rehabilitative, and behavioral healthcare services to individuals with autism and other developmental disabilities, brain injury, mental illness, and behavioral healthcare needs.

One of the great strengths and distinguishing features of ABA is the data keeping. In Autism studies need accurate flow of data Mr. Harchik stresses the importance of collecting accurate information about academic performance and problem behaviors; one of the distinguishing characteristics of using applied behavior analysis when working with children with autism and other developmental disabilities. This behavioral data provides an actual measure of a child's progress, can be shared with members of a child's interdisciplinary team, and allows for thoughtful, informed decisions about possible changes in procedures and treatments. In this article Mr. Harchik offers some practical suggestions on how to ensure the accuracy of this important information.

Real Autism Advice from Alan Harchik - Generalization

Alan Harchik, Ph.D., Chief Operating Officer of the May Institute, offers sound advice on how to accomplish one of the most frustrating goals in educating your autistic child - encourage generalization of skills once they are acquired by an autistic child. Harchik presents five practices found to be effective by researchers and practitioners:

Modify rewards: Once the child has mastered the skill, we can try to modify the rewards to make them similar to those that may be found in other settings.

For example, after a child learns to participate in a simple conversation, we might begin using rewards after every five or six responses instead of after every response. Similarly, certain toys or food items used as rewards to initially establish the skill might not be available at home or in the community, but other rewards could be identified. We can bring these items into the teaching sessions.

Finally, structured opportunities to practice the skills with typical peers can be helpful in promoting generalization.

Use lots of examples: Most skills we teach should require the child to learn to respond to many variations of those skills.

For example, if we are teaching imitation, we will teach the child to imitate 20 or 30 different movements. If we are teaching a child to identify something, such as clothing, animals or colors, we will work with the child until he or she can correctly identify many examples.

For some children, generalization occurs after as few as four or five examples. For other children, it may take dozens of examples.

Present common features: The materials used while teaching should incorporate all of the relevant features and characteristics of the materials to be found in other situations.

For example, if we are teaching a child to put on a shirt, we should ensure that we use shirts that have long and short sleeves, are pull-over and button-down, have different types of material, etc. If teaching how to prepare a microwave meal, we should use microwave ovens of different sizes and with different dials and buttons, as well as meals that involve a variety of times, sizes and foods.

Teach loosely: Although teaching sessions often begin with very structured and set procedures to help the child acquire the skill, over time the sessions should be conducted more "loosely." This means that specific instructions may vary in wording, the exact style of prompting may not be as rigid and the pace of the session may fluctuate.

Further, the child should work with a number of different instructors throughout the day and week. This prepares the student to be less "locked in" to specific wording and interactions from the instructor.

Use intermediaries: Some skills for some children can be transferred by a "carrier" or "intermediary." For example, if a child has learned to follow a picture schedule, that same (or similar) picture schedule can be used in the generalization setting.

We teach children with good memorization skills to memorize and verbally state a sequence of steps at school, such as for washing hands (turn on water, wet hands, press soap dispenser, rub hands together, etc.), and then have them repeat the steps out loud at home while engaging in the skill or task.

http://www.masslive.com/news/republican/

Applied Autism Research & Education - ABA Most Effective for Teaching Autistic Individuals

There is a real explosion in research taking place today; an Autism Knowledge Revolution is happening as we type our blogs and read our daily news. Much of the research is directed towards causes and cures and some of the promising recent developments offer hope for treatments and cures for autism. In the meantime though autistic children need interventions that work, that will help them learn and grow. Applied research is the term used by Alan Harchik to describe research into effective autism interventions. Alan Harchik Ph.D., is senior vice president of the May Institute, which operates schools for children and adolescents with autism and other developmental disabilities in Arlington, Braintree, Chatham and West Springfield. Mr. Harchik comments on the current state of applied autism research in an article in The Republican.

We already know that the principles and procedures of applied behavior analysis provide us with the most effective and most evidence-based methods for teaching individuals with autism. However, there is still much for us to learn about behavior analysis, and a great deal of research is being conducted in this area that looks at the intricacies of an instructional session. It is the type of research that has caught the attention of U.S. senators Hillary Clinton and Wayne Allard. Their "Expanding the Promise for Individuals with Autism Act" focuses on treatment provision and determining the most effective interventions.

Similarly, the Organization for Autism Research www.researchautism.org is a group that provides funding solely for the conduct of "applied" research that examines, in a scientific manner, effective interventions for children with autism. Applied research means that the procedures and findings are directly applied to real-world situations. Typically, the research is conducted in natural settings and includes children who directly benefit from their participation in the research.

One line of applied research has examined the details of discrete-trial, one-to-one teaching during which the instructor works on simple tasks, such as imitation of movements or verbal sounds, matching pictures, identifying common everyday objects, making requests, or following simple instructions. In these interactions, the instructor establishes attention and eye contact with the child, gives the instruction, and provides praise and a reward for a correct answer. If an incorrect answer occurs, the instructor provides some sort of assistance. This assistance is called a "prompt."

Applied research is being conducted all over the country to explore the best ways to provide a prompt when a child needs assistance. For example, my colleagues at the May Center in West Springfield and in Kansas, Texas, and Wisconsin are examining the differences that occur when we provide a prompt (a) immediately as compared to waiting a few seconds; (b) before as compared to after a child answers; and (c) paired with saying "no."

Typically, we present a child with the different types of prompts during instruction on different skills and then make comparisons. We are finding that all of these methods are usually effective, but that some children learn better with one type of prompt compared to another.

A next task for us is to determine which method is most effective for each child. This example of intervention research shows the importance of examining even the smallest aspects of instruction. It is research that builds our knowledge over time and can be used today by parents and teachers who work with children and adults with autism.


http://www.masslive.com/metroeastplus/republican/index.ssf?/base/news-3/1183447612315370.xml&coll=1

Mr. Harchik's expertise and authority to speak about autism, aba and applied autism research is not based on an ideological perspective or on obsessive deconstruction of one or two leading ABA studies. His knowledge and opinions are solidly rooted in an impressive clinical and professional background as set out in his profile on the May Institute web site:

Clinical Leadership

Alan Harchik, Ph.D., BCBA
Chief Operating Officer

Alan Harchik, Ph.D., BCBA, is Chief Operating Officer of May Institute. He is responsible for the operation of the Institute’s service programs in autism, mental retardation, brain injury, and mental health. Dr. Harchik is a licensed psychologist, a board certified behavior analyst, and a certified teacher of children with moderate and severe special needs.

Dr. Harchik’s experience at the May Institute began in 1983 when he was a live-in group home parent and residential direct-care staff member. As May’s Senior Vice-President for Autism and Developmental Disabilities Services in Western Massachusetts and Connecticut, he later developed and managed programs for children and adults with disabilities, including a specialized day school, home-based early intervention services, outreach consultation to public schools, community group homes and apartments, and employment services.

Dr. Harchik has expertise in the areas of autism and developmental disabilities, applied behavior analysis, organizational behavior management, staff training and supervision, severe challenging behavior, choice making, self-management, and skill development.

Dr. Harchik earned his Ph.D. in psychology from the University of Kansas after graduating magna cum laude from Boston University with a degree in special education. He holds active teaching appointments at the University of Massachusetts at Amherst and Westfield State College, and is an adjunct faculty member at the University of Kansas, Northeastern University, and Fitchburg State College.

He has published in a variety of professional journals and presented at numerous conferences across the United States. He writes a monthly column on autism and disabilities for the Springfield Republican newspaper and serves as an expert consultant for the Civil Rights Division of the United States Department of Justice.

http://www.mayinstitute.org/about_may/leadership/bio_alan_harchik.asp

Evidence Based Autism Interventions

The expression "evidence based" is often encountered in discussion of autism treatments or interventions. Parents, government officials, professionals and researchers will use the expression when discussing the effectiveness of various interventions in treating or curing autism. A well known article in the Journal of the Australian Medical Association, linked on the sidebar of this blog site, is entitled "Autistic Children Deserve Evidence Based Intervention". But what does the expression "evidence based" mean and which autism interventions, if any, meet the evidence based standard?

It is important for parents and political decision makers trying to determine what interventions to provide autistic persons to understand the concept of "evidence based" interventions. There have been many quack autism interventions offered both by self promoters and wishful thinkers. Such interventions waste valuable development time of autistic children, waste family and government funds, and in some cases, actually cause direct harm. Unfortunately there have also been those who are opposed to curing or treating autistic persons, those who wish to promote alternative interventions, or who wish to avoid expending public resources to provide treatment, who attack Applied Behavior Analysis (ABA) despite the quality and quantity of research supporting the efficacy of ABA as a health and education intervention for autistic children.

CAIRN, the Canadian Autism Intervention Network, defines "evidence based":

By evidence-based, we mean the best available information based on scientifically rigorous research that produces consistent findings no matter how many times the study is repeated.

CAIRN also notes that there are substantial differences in the quality of evidence. It lists on its web site the characteristics of studies that provide high quality evidence.


Systematic reviews
A systematic review uses a clear and systematic method of finding and appraising relevant, high quality research studies whose combined results are used to answer a pre-determined question about treatment.

The strength of the systematic review is in its ability to combine data from studies of different populations in different settings to show if a treatment is widely applicable. By pooling data from patients in a number of studies, thus increasing the sample size, a systematic review can increase the reliability of the findings, showing whether a treatment actually works or may be useless or even harmful.

Randomized controlled trials (RCTs)
In RCTs, research subjects are randomly placed in one of two groups. One group receives the intervention that the study has been designed to measure; the other group (known as the control group) does not. The control group may receive a placebo, no treatment, or another therapy. Study participants (and ideally, the researchers) do not know to which group they have been assigned.

RCTs are considered the second strongest level of evidence for the effectiveness of a treatment. The strength of the RCT is that it helps ensure that the two groups under study do not have any important differences between them that could influence whether or not the treatment they receive works.

Controlled clinical trials (CCTs)
In a controlled clinical trial, one group receives a therapy and the other (control group) does not. As in RCTs, the control group may receive a placebo, no treatment, or another therapy. Unlike RCTs, however, the participants are not randomly assigned to each group.

With some populations, or in some situations, it is not possible to randomly assign participants to one group or another. CCTs still use a comparison group and efforts are made to ensure that the two groups do not have serious differences between them that could influence the results of the study.

Multiple and single case studies
In multiple and single case studies, subjects are tested to establish a baseline. They are then given an intervention, after which they are re-tested to determine what change, if any, has occurred.

Sometimes, especially when there is great variability in a condition, or small numbers of people with a condition, it is not possible to conduct research with two groups. In multiple and single case studies, the participants are used as their own comparison when they are given alternating treatments, or a treatment and then no treatment. Although not providing the same strength of evidence as an RCT or CCT, when done rigorously, these studies can yield valuable information about treatments.

In its February 2000 (Rev.) Autism Task Force Report the Maine Administrators of Services for Children with Disabilities (MADSEC) reported the results of its thorough review of the professional literature on educational interventions for autism. The MADSEC Task Force also interviewed leading practicioners of various autism interventions. It concluded that only one intervention met the standard of being an evidence based effective autism intervention - ABA.

• 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.


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

• 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.

Since the publication of the MADSEC Autism Task Force Report there have been more studies confirming ABA as the most effective autism intervention. In "A comparison of intensive behavior analytic and eclectic treatments for young children with autism" published in Research in Developmental Disabilities, 26, (2005), pp. 359-383, the authors, Jane S. Howard, Coleen R. Sparkman, Howard G. Cohen, Gina Green, Harold Stanislaw reported the results of a non randomized comparison trial with three intervention groups of children with autism spectrum disorders. 29 children received one-on-one intensive behavioral therapy for 25 to 40 hours per week (IBT group); 16 received eclectic therapy (multiple treatment methods) with a teacher to student ratio of 1:1 or 1:2 for 30 hours per week (AP group); and 16 received a non-intensive, eclectic, small group, public early intervention program for 15 hours per week (GP group.) The study's authors reported that 14 months after initiation of the interventions, the intensive behavioral therapy group scored significantly higher on all measures, with the exception of motor skills, where there was no difference among groups.

Alan Harchik, senior Vice President with the May Institute, has written an excellent article on the topic of evidence based interventions. Mr. Harchik describes evidence based standards and cautions against the use of the many treatments and interventions for autism that do not meet that standard including sensory integration, facilitated communication, auditory integration, chelation and hyperbaric oxygen treatments.

The term evidence-based practice is frequently used in the fields of science and medicine. It refers to procedures that have been tested using scientific research methods and shown to be most likely to produce positive results. This means that objective studies have been conducted using reliable data collection methods, consistent implementation of the treatments and the careful control of the research conditions.

The research findings are then published in professional journals after review by a panel of experts in the field.

Mr. Harchik, like the MADSEC Autism Task Force Report, concludes that ABA is the intervention with the most evidence supporting its effectiveness.

"For children with autism, the procedures that have the most evidence supporting their effectiveness are those that use applied behavior analysis. .... applied behavior analysis methods include an assessment of the factors that are impeding learning or maintaining behavior problems, using positive rewards, teaching in small steps, using prompts and guidance, and collecting data to monitor progress. "

The studies and expertise which provide evidence of the efficacy of ABA in autism intervention have not persuaded some who oppose the use of ABA interventions with autistic persons. Some will continue to insist on an unattainable standard being met before they will acknowledge the efficacy of ABA. For others though, for parents, professionals and government decision makers seeking to help autistic children now ABA, their only agenda is to find out what works, what really works, based on the best available evidence. To date, ABA is the only intervention for which claims of efficacy meet the high quality evidence based standard. That is why parents and sincere autism advocates try to obtain passage of legislation in Canada and the United States to ensure the availability of ABA treatment for autistic children.