Outcome for children with Autism who began intensive behavioral treatment between ages 4 and 7

Recent study results suggest ABA treatment is effective for older children

In recent years, several studies have built upon the landmark 1987 Lovaas study on the UCLA model of early intervention, replicating and extending research on the efficacy of ABA. In Lovaas' seminal study, it was reported that 47% of children with Autism who received approximately 40 hours per week of ABA initiated prior to the age of 4 achieved normal intellectual and education functioning, with normal-range IQ scores and successful first grade performance in public schools. Similar findings have been extended to children receiving services in a workshop model (Sallows & Graupner, 2005) and from private (non university-based) clinics (Cohen et al., 2006). Further, intensive ABA (25-40 hours per week) was shown to outperform similarly intensive levels of "eclectic" treatment across all developmental domains with the exception of motor skills (Howard et al., 2005). In sum, the body of evidence supporting the efficacy of ABA continues to grow.

One outstanding question with respect to early intensive ABA has been how "early" is necessary to achieve significant outcomes. As the children participating in the initial studies were very young (around 3 years old), it was not clear how effective this intervention would be when initiated at an older age. Fortunately, Svein Eikeseth and his associates have recently published a study describing the outcomes of children with Autism whose behavior intervention services were initiated between the ages of 4 and 7 (Eikeseth et al., 2007). In the study, children with a mean age of 5.5 years were assigned to one of two treatment groups: a) ABA treatment (13 children, 8 boys), and b) eclectic treatment (12 children, 11 boys). All treatment occurred at the children's schools, with sessions (either ABA or eclectic) occurring alone with instructors in separate rooms. Treatment occurred for an average of 2.6 years with varying levels of intensity. Both groups received an average of approximately 28 hours per week of services prior to the age of 6 (school age), at which time treatment was reduced to an average of approximately 17 hours per week. When not in ABA or eclectic sessions, the children were mainstreamed while being shadowed by their instructors.

The behavioral / ABA treatment was designed to progress gradually and systematically from relatively simple tasks, such as responding to basic requests made by an adult, verbal and nonverbal imitation, labeling objects, actions, and abstract concepts such as colors, size, and prepositions. The treatment progressed further to more advanced programs such as answering questions, conversation and making friends with peers. The program also emphasized play and social skills, progressing from simple toy play and parallel play, to more advanced skills such as symbolic play and cooperative play. Instruction was based on the principals of learning, initially took place in a one-to-one discrete trial format, and later shifted to more naturalistic teaching strategies to focus on generalization. The eclectic treatment was designed to reflect commonly used interventions often described as "best practices" for children with Autism, including using elements from a variety of different teaching procedures such as TEACCH, behavioral procedures, and sensory-motor therapies, as well as methods derived from personal experience. Discrete trial training was not utilized.

Outcomes for the two groups were assessed when the children were at an average age of 8 years, 2 months. As seen in the following graphs, the ABA treatment group showed growth both in IQ and all adaptive behavior measures (social, communication, and daily living). Further, those children receiving ABA treatment showed larger gains than the eclectic group (statistically significant).

These results are relevant in not only providing further evidence that ABA treatment is more effective than eclectic treatment provided at a similar intensity, but extend the findings to those children who begin treatment between the ages of 4 and 7. FirstSteps has copies of all of these studies available...let your Program Director know if you are interested in further reading!

Eikeseth, S., Smith, T., Jahr, E., & Eldevik, S. (2007). Outcome for children with autism who began intensive behavioral treatment between ages 4 and 7. Behavior Modification, 31, 264-278.

Cohen, H., Amerine-Dickens, M., Smith, T. (2006). Early intensive behavioral treatment: Replication of theUCLA model in a community setting. Developmental and Behavioral Pediatrics, 27, 145-155.

Howard, J., Sparkman, C., Cohen, H., Green, G, & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359-383.

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.

Sallows, G.O. & Graupner, T. D. (2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors. American Journal on Mental Retardation, 110, 417-438.