In the 1970s, O. Ivar Lovaas embarked on research that would change the way we think about trajectories for young children with autism. He went on to publish a pivotal study entitled “Behavioral Treatment and Normal Education and Intellectual Functioning in Young Autistic Children,” which revealed how powerful early and intensive behavioral intervention could be in supporting skill development.1
Rachel Scott-Rosenbluth, MS, BCBA, LBA
Andrea Lavigne, PhD, BCBA, LBA, LABA
In his study, Lovaas compared two groups of autistic children. Members of both groups were under the age of 4 years, and all received the same individual behavioral intervention for 2 years or more. The only difference between the two groups was the intensity of the intervention received each week. One group received 10 or less hours while the other received 40 or more hours. Treatment goals included reducing challenging behaviors such as aggression and increasing adaptive behaviors such as language, imitation, interactive play, pre-academic skills, and observational learning. Although children across groups received the same intervention and all children were very young when participation began, findings showed drastically stronger gains for the children who received the intervention intensively. Gains in academic performance and IQ functioning were substantially greater and persisted as the children got older.
Since Lovaas’ study, researchers have replicated and extended his work. Findings consistently indicate Applied Behavior Analysis (ABA) significantly increases intelligence scores, expressive and receptive language skills, adaptive functioning (like social and independent living skills) and reduces maladaptive behavior like aggression to self and others. The gains made during treatment are substantially greater when treatment is delivered intensively (e.g., 30-40 hours per week) and initiated at an earlier age (e.g., under 7 years).234 As a result, early and intensive behavioral intervention (EIBI) is considered best practice for autism treatment by the Center for Disease Control, Surgeon General, and American Academy of Pediatrics.
With all the subsequent research and despite some considerable problems with Lovaas’ work (including use of physical aversives at times), his early study contributed significantly to our understanding of the impact of intensive intervention at an early age. I (Lavigne) continue to incorporate this study in the undergraduate and graduate courses I teach in psychology and behavior analysis. Much of our current conceptual understanding and clinical practice looks similar to how things were more than 30 years ago.
Today, early and intensive behavioral interventions (EIBI) continues to focus on pivotal skills, which are skills that lead to other, untaught skills. For example, teaching a child to how to initiate communication can lead to new skills like requesting and initiating greetings. In EIBI, providers also focus on what are called behavior cusps, which are skills that lead to new reinforcers and environments. Reading, for example, is a behavior cusp that opens a whole new world of opportunities for reinforcement and learning.
The first step in providing EIBI for a young child with autism is to determine their baseline level of functioning across a broad range of behaviors. The focus is on teaching behaviors that are socially significant, meaning the behaviors are meaningful for the child and promotes their independence. Skills that are the focus of teaching in EIBI often include:
- Eye contact and other nonverbal gestures to initiate or respond to social overtures.
- Imitation of oral, fine motor, and gross motor actions with or without objects. This allows children to learn from observing others engage in novel responses.
- Following single or multi-step directions. One might think that learning how to follow directions when you are under the age of three is a lofty goal, but that is the best time to start working on these abilities! Simple directions such as sitting, giving items, and cleaning up are appropriate at an early age, and following directions are building blocks for establishing routines that will ultimately not require explicit directions.
- Expressive and receptive identification of objects. This ranges from identifying letters and shapes to actions and people and builds vocabulary. It also increases attending, as they contact reinforcement for identifying what others ask of them.
- Matching and sorting objects to promote understanding of similarities and differences across objects and concept formation.
- Labeling what you see, hear, feel, taste, and smell. This aspect of our expressive language is called tacting and is essential to shared experiences and social communication.
- An additional critical aspect of expressive language and independence is the ability to request things we want or don’t want. In EIBI, this is called manding. The ability to express wants and needs can significantly reduce challenging behavior, because communicating your needs can replace problem behaviors.
- Activities of daily living. These includes skills like using utensils to feed oneself, getting dressed, washing hands, and using the bathroom independently.
In summary, research unequivocally supports the benefits of early and intensive intervention for children with autism spectrum disorder. The effectiveness of behavioral interventions on skill development increases substantially when the interventions are provided for 30 or more hours per week at a young age and is effective in promoting a broad range of socially significant behaviors.
Andrea Lavigne, PhD, BCBA, LBA, LABA, is Vice President at Autism Care Partners RI & MA. Rachel Scott-Rosenbluth, MS, BCBA, LBA, is Clinical Director at Autism Care Partners NY. For more information, visit www.autismcarepartners.com.
References
1. Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children.Journal of Consulting and Clinical Psychology,55(1), 3-9.
2. Granpeesheh, D., Tarbox, J., & Dixon, D. R. (2009). Applied behavior analytic interventions for children with autism: a description and review of treatment research. Annals of clinical psychiatry, 21(3), 162-173.
3. Howlin, P., Magiati, I., & Charman, T. (2009). Systematic review of early intensive behavioral interventions for children with autism. American journal on intellectual and developmental disabilities, 114(1), 23-41.
4. Peters-Scheffer, N., Didden, R., Korzilius, H., & Sturmey, P. (2011). A meta-analytic study on the effectiveness of comprehensive ABA-based early intervention programs for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 60-69.
