ABA Research References and Summaries

The following research concerns EIBI (Early Intensive Behavioural Intervention) which is ABA as applied intensively to young children with autism.

Reference Type of research Key Aspects
Clinical Practice Guideline Report of the Guideline Recommendations, Autism / Pervasive Developmental Disorders, Assessment and Intervention for Young Children (Age 0-3 Years). Sponsored by New York State Department of Health Early Intervention Program. (1999) Appendix C, Summary of Evidence: Intensive Behavioral and Educational Intervention Programs Review of EIBI evidence ABA vs. standard/ eclectic education
New York State Guidelines
Cohen, H., et al., (2006) Early intensive behavioral treatment: Replication of the UCLA Model in a community setting. Developmental and Behavioral Paediatrics, 27, 145–155. Comparison controlled studies ABA vs. standard/ eclectic education
Eikeseth, S., (2009) Outcome of comprehensive psycho-educational interventions for young children with autism. Research Developmental Disabilities 30 (1): 158–78. Evaluates treatments for autism Shows advantages of ABA over TEACCH
Eikeseth, S., et al., (2002) Intensive behavioral treatment at school for 4–7-year-old children with autism: A 1-year comparison controlled study. Behavior Modification, 26, 49–68. Comparison controlled study Support for ABA for older children
Shows ABA successful in school setting
Eikeseth, S., et al., (2007) Outcome for children with autism who began intensive behavioral treatment between age four and seven: A comparison controlled study. Behavior Modification, 31, 264–278. Comparison controlled studies Older children
ABA vs. standard/ eclectic education
Eikeseth, S., et al., (2009) Intensity of supervision and outcome for preschool aged children receiving early and intensive behavioural interventions: A preliminary study. Research in Autism Spectrum Disorders 3 (2009) 67–73.
And
Hayward, D., et al., (2009) Assessing progress during treatment for young children with autism receiving intensive behavioural interventions Autism Vol 13(6) 613–633.
Comparison controlled studies UK based
Demonstrated factors affecting treatment outcomes
Eldevik, S., et al., (2009) Meta-analysis of Early Intensive Behavioral Intervention for children with autism. J Clin Child Adolesc Psychol 38 (3): 439–50. Systematic analysis of EIBI studies Rebuked an EIBI study by Speckley & Boyd asserting that EIBI was not better than eclectic
Grindle, C. F., et al., (2009) Parents’ Experiences of Home-Based Applied Behaviour Analysis Programmes for Young Children with Autism. J Autism Dev Disord (2009) 39:42–56 Looked at parent’s experiences of running EIBI Majority of parents felt ABA was the right decision
Howard, J. S., et al., (2005) A comparison of intensive behaviour analytic and eclectic treatment for young children with autism. Research in Developmental Disabilities, 26, 359–383. Comparison controlled studies ABA vs. standard/ eclectic education
Howlin, P., (1997) Prognosis in autism: do specialist treatments affect long-term outcome? European Child & Adolescent Psychiatry, 6, 55-72. Review of autism treatments Long term outcome
International Network of Agencies for Health Technology Assessment (2001) Behavioral Interventions for Preschool Children with Autism. Canadian Coordinating Office for Health Technology Assessment (CCOHTA) Technology Report, Issue 18, August 2001. Review of EIBI literature EIBI effective
Jacobson, J.W., et al., (1998) Cost-benefit estimates for early intensive behavioral intervention for young children with autism: General model and single state case. Behavioral Interventions, 13: 201-226. Cost benefit analyses of EIBI Demonstrates that EIBI is extremely cost effective
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.
Follow up study: –
McEachin, J. J., Smith, T., & Lovaas, O. I., (1993) Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal on Mental Retardation, 97 (4), 359-372.
Comparison controlled studies



Follow up study
Landmark research, first major EIBI study
EIBI vs. Eclectic education


Long term maintenance  of outcome
Mudford, O., et al., (2009) Technical review of published research on applied behaviour analysis interventions for people with autism spectrum disorders: Auckland Uniservices Ltd. Wellington, New Zealand: Ministry of Education. Review of  ABA evidence Showed ABA 98% effective
National Autism Center, (2009) National Standards Report – Addressing the need for evidence-based practice guidelines for Autism Spectrum Disorders. National Autism Center Review of treatments for autism Reviewed 775 studies over 50 years and supported use of ABA
New Zealand Guidelines Group. The effectiveness of applied behaviour analysis interventions for people with autism spectrum disorder. Systematic Review. Wellington; 2008. Review of past EIBI research Extremely comprehensive
ABA vs. standard/ eclectic education
Reichow, B., et al., (2009) Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA Young Autism Project model. J Autism Dev Disord 31 (1): 23–41. Synthesis of EIBI studies Analysis of outcome data
Remington, B., et al., (2007) A field effectiveness study of early intensive behavioral intervention: Outcomes for children with autism and their parents after two years. American Journal of Mental Retardation, 112, 418–438. Comparison controlled studies UK Based
ABA vs. standard/ eclectic education
Parental stress observed
Roberts, J. M., (2003) A review of the research to identify the most effective models of best practice in the management of children with autism spectrum disorders. Sydney: Centre for Developmental Disability Studies. Review of research (autism treatments) ABA vs. many other autism treatments
Rogers, S. J., Vismara LA, (2008) Evidence-based comprehensive treatments for early autism. J Clin Child Adolesc Psychol 37 (1): 8–38. Looked at EIBI studies Showed ABA helps with core symptoms of autism
Sallows, G., et al., (2005) Intensive behavioral treatment for children with autism: four-year outcome and predictors. Am J Ment Retard 110 (6): 417–38. Followed 24 children receiving ABA 48% of children who received EIBI succeeded in regular classrooms
Outcome predictors
Smith, T., et al., (2000) Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal on Mental Retardation 105: 269-285. Comparison controlled studies ABA vs. Parent training

New York State Department of Health Early Intervention Program (1999)

Clinical Practice Guideline Report of the Guideline Recommendations, Autism / Pervasive Developmental Disorders, Assessment and Intervention for Young Children (Age 0-3 Years).
Appendix C, Summary of Evidence: Intensive Behavioral and Educational Intervention Programs

The four studies that met criteria for evidence about efficacy all compared groups of young children with autism who received either an intensive behavioural intervention, a comparison intervention, or no intervention. In all four of the studies reviewed, groups that received the intensive behavioural intervention showed significant functional improvements compared to the control groups. Since intensive behavioural programmes appear to be effective in young children with autism, it is recommended that principles of applied behaviour analysis and behavioural intervention strategies be included as an important element of any intervention programme. It stated that “Early Intervention Program provides consistent, high-quality, cost-effective, and appropriate services that result in measurable outcomes for eligible children and their families.” The report recommends a minimum of 20 hours per week of individualised behavioural interventions using ABA techniques, based on strong evidence in the research 2000 report from the Surgeon General which acknowledges the efficacy of applied behavioural methods in the treatment of children with autism and cites the “well-designed study carried out by Lovaas and colleagues”.

Cohen, H., et al., (2006)

Early intensive behavioral treatment: Replication of the UCLA Model in a community setting
Developmental and Behavioral Paediatrics, 27, 145–155.

This study compared effects of ABA treatment with special education provided at local public schools for children with autism or PDD-NOS. The follow-up assessment, conducted approximately 3 years after the treatment begun, showed that the ABA treatment group scored significantly higher as compared to the two comparison groups on IQ and adaptive functioning. Six of the 21 ABA treated children were fully included into regular education without assistance, and 11 others were included with support; in contrast, only 1 comparison child was placed primarily in regular education.

Eikeseth, S., (2009)

Outcome of comprehensive psycho-educational interventions for young children with autism.
Research Developmental Disabilities 30 (1): 158–78.

The report evaluates research on early intervention for children with autism. Interventions were included which addressed all three-core deficits in autism i.e. the interventions addressing social behaviours, communication and ritualistic/stereotyped behaviours. Twenty studies evaluated behavioural treatment, three studies evaluated TEACCH and two studies evaluated the Colorado Health Sciences Project.

ABA will be considered ‘Well Established’. TEACCH and Colorado Health Science model will be considered neither ‘Well Established’ nor ‘Probably efficacious’.

Eikeseth, S., et al., (2002)

Intensive behavioral treatment at school for 4–7-year-old children with autism: A 1-year comparison controlled study. Behavior Modification, 26, 49–68.

Results suggest that some 4- to 7-year-olds may make large gains with intensive behavioral treatment, that such treatment can be successfully implemented in school settings, and that specific aspects of behavioral treatment (not just its intensity) may account for favorable outcomes.”

Eikeseth, S., et al., (2007)

Outcome for children with autism who began intensive behavioral treatment between age four and seven: A comparison controlled study. Behavior Modification, 31, 264–278.

This study compared the effects of ABA and eclectic treatment for children with autism. Participants in the ABA treatment group received 28 hours per week of one-to-one ABA treatment during the first year of intervention with a gradual reduction of treatment hours over the next 2 years. Participants in the eclectic group received 29 hours per week of one-to-one eclectic treatment with a gradual reduction of treatment hours over the next 2 years. Measures included IQ, language functioning, adaptive functioning, maladaptive behaviour and socio-emotional functioning. The follow-up assessment, conducted approximately 3 years after the treatment begun, showed that the ABA treatment group scored significantly higher as compared to the eclectic treatment group on intelligence, language, adaptive functioning, maladaptive functioning and on two of the subscales on the socio-emotional assessment (social and aggression).

Eikeseth, S., et al., (2009)

Intensity of supervision and outcome for preschool aged children receiving early and intensive behavioural interventions: A preliminary study. Research in Autism Spectrum Disorders 3 (2009) 67–73.

And

Hayward, D., et al., (2009)

Assessing progress during treatment for young children with autism receiving intensive behavioural interventions Autism Vol 13(6) 613–633.

 

These research papers were both based on data from a study where 44 children were provided with ABA programmes. All programmes had an ABA consultant provided and some also had a team of tutors and senior tutors provided.  After one year, results showed that both groups improved significantly on IQ, visual-spatial IQ, language comprehension, expressive language, social skills, motor skills, and adaptive behaviour. The children in the study increased their IQ by an average of 16 points in one year.

It was also investigated whether the frequency of workshop consultation affected a child’s progress. Results showed that an increased amount of consultancy was related to increases that the children make in their IQ.

Successful intervention was characterised by: treatment in the child’s natural environment, intensive intervention, treatment based on ABA principles, staff training and management, parental involvement, evaluation of progress, and research-based provision.

Eldevik, S., et al., (2009)

Meta-analysis of Early Intensive Behavioral Intervention for children with autism. J Clin Child Adolesc Psychol 38 (3): 439–50.

A systematic literature search for studies reporting effects of Early Intensive Behavioural Intervention. ‘These results support the clinical implication that EIBI at present should be an intervention of choice for children with ASD. However, randomised controlled trials comparing EIBI to other interventions are still needed’. (Page 449)

The authors found statistically significant improvements in IQ and adaptive behaviour. They also reviewed a recent meta-analysis published in 2009 (Spreckley & Boyd) that purported to show that EIBI produced no better effects than what was described as standard care. The Eldevik team identified several serious errors in the Spreckley & Boyd meta-analysis.

Grindle, C. F., et al., (2009)

Parents’ Experiences of Home-Based Applied Behaviour Analysis Programmes for Young Children with Autism. J Autism Dev Disord (2009) 39:42–56

The study interviewed both mothers and fathers of children with autism receiving EIBI (early intensive behavioural intervention) to document their perspective on the impact of programmes on their personal and family life. Fifty-three parents (32 mothers and 21 fathers) of children with autism were interviewed. Parents were asked to identify practical benefits and difficulties of running the EIBI programme for all family members. The data revealed many benefits for family members, for example:

  • All parents regarded their child’s progress in language and communication skills as a positive feature of the programme.
  • All parents remarked that their relationship with the child with autism had improved, particularly because of improved communication skills or increases in manifest affection.
  • The vast majority of parents reported that their child’s social skills had improved.
  • Approximately two thirds of parents said that EIBI teaching released their time for other activities such as complete household chores and recreation.
  • Approximately one quarter of parents reported they had acquired a much wider social network, members of which understood their problems.
  • In those families with at least one typically developing child over three quarters of parents reported at least one practical benefit for the sibling.
  • Over three quarters of parents reported that, despite the difficulties, EIBI was unequivocally the right choice for all the family, particularly because of the child’s progress and its subsequent positive impact on the family.

NB: Earlier studies have also shown that parents whose children received intensive behaviour analytic intervention showed high satisfaction and reduced stress over the course of treatment in comparison to parents whose children did not receive intensive behaviour analytic intervention (Anderson et al., 1987; Birnbrauer & Leach, 1993; Smith et al., 2000).

Howard, J. S., et al., (2005)

A comparison of intensive behaviour analytic and eclectic treatment for young children with autism. Research in Developmental Disabilities, 26, 359–383.

This study compared effects of three treatment approaches on children with autism or PDD-NOS. The approaches were EIBI, 1:1 or 2:1 eclectic intervention in public special education classrooms, public early intervention in small groups. Measures included IQ, language functioning, and adaptive functioning. The follow-up assessment, approximately 14 months after the treatment begun, showed that the ABA treatment group scored significantly higher scores as compared to the two comparison groups on all measures. Learning rates at follow-up were also substantially higher for children in the ABA group than for participants in either of the other two comparison groups.

Howlin, P., (1997)

Prognosis in autism: do specialist treatments affect long-term outcome? European Child & Adolescent Psychiatry, 6, 55-72.

‘There is little doubt that the use of behavioural procedures has resulted in major improvements in the education, management and treatment of children with autism in the last three decades. The benefits are particularly striking when parents are involved in therapy and such techniques are now widely accepted as playing a crucial role in intervention’. (Page 9)

International Network of Agencies for Health Technology Assessment. (2001).

Behavioral Interventions for Preschool Children with Autism. Canadian Coordinating Office for Health Technology Assessment (CCOHTA) Technology Report, Issue 18, August 2001.

Evidence suggests that preschool children with autism show cognitive and functional improvement when they receive behavioural intervention with applied behavioural analysis for about 20 hours per week or more.

Jacobson, J.W., et al., (1998)

Cost-benefit estimates for early intensive behavioral intervention for young children with autism: General model and single state case. Behavioral Interventions, 13: 201-226.

This study looked at the potential savings of providing EIBI to all children with autism for three years (starting before the age of 6 years). They estimated that it would save approximately $200,000 per child for ages 3-22 years and up to $1,000,000 per child for ages 3-55 years. These are even conservative estimates which assume that some children will not benefit at all.

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.

This was a landmark study that highlighted how useful ABA could be as a treatment for children with autism. The research showed that 90% of children receiving ABA substantially improved compared to the control group who received eclectic treatment. Close to half 47% attained a normal IQ and passed first grade (compared to only 1 child in the control group).

tested within the normal range on adaptive and social skills.

Follow up study: –

McEachin, J. J., Smith, T., & Lovaas, O. I., (1993)

Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal on Mental Retardation, 97 (4), 359-372.

Follow-up research showed that the ‘best outcome’ children in the 1987 study maintained their skills and could succeed in life without costly special education and residential services.

Mudford, O., et al., (2009)

Technical review of published research on applied behaviour analysis interventions for people with autism spectrum disorders: Auckland Uniservices Ltd. Wellington, New Zealand: Ministry of Education.

The report consists of a comprehensive review of the evidence concerning the effectiveness of ABA intervention methods for people with autism. Overall, there is strong evidence that behavioural interventions result in beneficial outcomes for individuals with autism. Only 2% of the 508 items studied were ineffective in a particular case. However, no behavioural interventions were rated overall as ineffective. In no case was harm reported as a result of behavioural intervention. Specifically, the overall evidence for beneficial outcomes was rated as ‘strong’ in the areas of social development, cognitive development, communication, play/vocational engagement, development of organisational skills, and prevention and replacement of challenging behaviours.

National Autism Center (2009)

National Standards Report – Addressing the need for evidence-based practice guidelines for Autism Spectrum Disorders. National Autism Center

The report published in 2009 by The National Autism Center in the US provides comprehensive information about the level of scientific evidence that exists in support of the many educational and behavioural treatments currently available for individuals with autism.

The project reviewed 775 studies published between 1957 and 2007.

Interestingly approx 66% of those treatments categorised as established were developed exclusively from behavioural literature i.e. applied behaviour analysis and positive behavioural support. Twenty-two other treatments were classified as emerging, such as massage/touch therapy, music therapy and sign instruction. Five treatments were highlighted as un-established academic interventions, auditory integration training, facilitated communication, gluten and casein free diet and sensory integration. These were considered un-established either due to the quality, quantity or the consistency of the research findings being poor or not applying to individuals with ASC.

These key points regarding the research evidence for behavioural interventions were evident in the report:

1. [The] ‘pattern of findings suggests that treatments from the behavioural literature have the strongest research support at this time’. (Page 52)

2. Behavioural interventions have demonstrated favourable outcomes for many treatment targets.  (Page 51)

‘Behavioural Package has demonstrated favourable outcomes with three-quarters of the behaviours that are often targeted to decrease.’ (Page 51)

3. Behavioural Package is the only treatment with favourable outcomes for all age groups. (Page 53)

New Zealand Guidelines Group

The effectiveness of applied behaviour analysis interventions for people with autism spectrum disorder. Systematic Review. Wellington; 2008.

This is an extremely comprehensive and rigorous review of past research. Of the 1517 articles originally identified, only 43 publications were identified as eligible for appraisal and inclusion in the review.

The key findings and conclusions were that there is consistent evidence across a range of studies that interventions based on the principles of ABA can produce beneficial outcomes in young children with autism, and appear to hold more promise when compared to eclectic/standard care approaches.

Reichow, B., et al., (2009)

Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA Young Autism Project model. J Autism Dev Disord 31 (1): 23–41.

The purpose of this paper is to provide a comprehensive synthesis of the studies on Early Intensive Behavioural Intervention (EIBI). This synthesis includes an examination of the characteristics of the experimental methods, participants, and intervention programme (i.e., EIBI), as well an analysis of the effects of EIBI on participants (e.g., outcome data).

Findings from the review suggest that “EIBI is an effective treatment, on average, for children with autism.” (Page 23)

Remington, B., et al., (2007)

A field effectiveness study of early intensive behavioral intervention: Outcomes for children with autism and their parents after two years. American Journal of Mental Retardation, 112, 418–438.

This study compared effects of ABA with ‘treatment as usual’ for children with autism within the UK. The follow-up assessment showed that the ABA treatment group scored significantly higher as compared to the comparison group on intelligence, language, daily living skills, positive social behavior, and a statistical measure of best outcome for individual children. Measures of parental well-being, obtained at the same three time points, produced no evidence that behavioral intervention created increased problems for either mothers or fathers of children receiving it. The ABA group showed significantly better score on responding to joint attention as compared to the comparison group, but not in initiating joint attention.

Roberts, J. M., (2003)

A review of the research to identify the most effective models of best practice in the management of children with autism spectrum disorders. Sydney: Centre for Developmental Disability Studies.

This review of research literature relating to the management and treatment of children with autism is to identify the most effective models of best practice. The review concluded that “There is universal agreement that behavioural interventions have produced positive outcomes for children with autism that are well supported by research”.

Rogers, S.J., Vismara LA (2008)

Evidence-based comprehensive treatments for early autism. J Clin Child Adolesc Psychol 37 (1): 8–38.

The evidence from this study suggests that early intervention programmes are beneficial for children with autism, often improving developmental functioning and decreasing symptom severity. Significant increases in language and communication abilities in the treated group occurred in most studies and interventions with many targeted hours per week resulted in increases in IQ.

Across all the studies cited, improvements in language, communication, and IQ, and reduction in severity of autism symptoms indicate that the core symptoms of autism appear malleable in early childhood.

This letter in the Lancet provides a positive reference for the research and ABA as an intervention.

http://www.thelancet.com/journals/lancet/article/PIIS0140673610603005/fulltext?rss=yes

 

Sallows, G., et al., (2005)

Intensive behavioral treatment for children with autism: four-year outcome and predictors. Am J Ment Retard 110 (6): 417–38.

Twenty-four children with autism were randomly assigned to a clinic-directed group, replicating the parameters of the early intensive behavioural treatment developed at UCLA, or to a parent-directed group that received intensive hours but less supervision by equally well-trained supervisors. Outcome after 4 years of treatment, including cognitive, language, adaptive, social, and academic measures, was similar for both groups. After combining groups, we found that 48% of all children showed rapid learning, achieved average posttreatment scores, and at age 7, were succeeding in regular education classrooms. Treatment outcome was best predicted by pre-treatment imitation, language, and social responsiveness. These results are consistent with those reported by Lovaas and colleagues

Smith, T., et al., (2000)

Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal on Mental Retardation 105: 269-285.

Smith, Groen, & Wynne examined the effects of ABA treatment for children with autism and children with PDD-NOS. The EIBI group received a mean of 24.5 hours per week of one-to-one ABA treatment during the first year of intervention with a gradual reduction of treatment hours over the next 2 years. Participants in the control group received 3 – 9 months of parent training for several hours per week. Measures included IQ, visual-spatial IQ, language functioning, adaptive functioning, socio-emotional functioning, academic achievement, class placement progress in treatment, and parent evaluation. At follow-up the ABA treatment group scored significantly higher as compared to the parent training group on IQ, visual-spatial skills, language (assessed the by score combining comprehension and expression), school placement and academics. The ABA treatment group gained an average of sixteen IQ points. By comparison, the parent training group lost one IQ point. Children with PDD-NOS gained more than those with autism. Twenty-seven percent of the children in the ABA group achieved average post-treatment scores and were succeeding in regular education classrooms.