Newsletter
Volume 30 | 2007 | Number 3
What Has Behavior Analysis Contributed to the Understanding and Treatment of Autism Spectrum Disorders
By Dr. Tristram Smith, University of Rochester Medical Center
“I’m done studying kids with autism,” Ivar Lovaas announced to his research team when he learned that his soon-to-be-famous study on intensive applied behavior analysis (ABA) for preschool children with autism was accepted for publication (Lovaas, 1987). He explained that he had made his point, showing the power of ABA research to identify highly effective interventions for children with autism. Now, he felt it was time for him to help identify effective interventions for other children.
As it turned out, Lovaas was half right, which, of course, is half more than most of the rest of us. Building on many previous ABA studies, his 1987 report indeed transformed the autism community. However, rather than moving on, he continues to study and treat children with autism, as do I and others who had the privilege of working with him at that time. I suspect we all realize that a great deal has been accomplished, but much work remains.
What Have We Learned?
The contributions of ABA can be traced to its applied, behavioral, and analytic components:
Applied
For behavior analysts, applied means a focus on socially important outcomes (Baer et al., 1968). In the 1960s, behavior analysts sought to discharge individuals with autism from institutions such as state hospitals, where most lived, back into their family homes or communities (Lovaas et al., 1973). These investigators demonstrated that even nonverbal individuals with autism could learn to communicate, and even severely aggressive individuals could lessen their problem behavior. Their successes helped fuel an international movement to deinstitutionalize individuals with autism and other developmental disabilities. They also contributed to legislation entitling children with autism to specialized instruction in public schools. Later investigators broadened the focus to promote inclusion in community settings such as general education classes and to enhance interactions with peers and caregivers (Koegel & Koegel, 2006).
In early, intensive ABA (25-40 hours per week of individual instruction during the toddler and preschool years), some children with autism make dramatic gains, achieving age-appropriate skill levels in many areas (Lovaas, 1987). This discovery, subsequently replicated numerous times, raised awareness of the need for early identification and intervention (Filipek et al., 1999). Popular accounts of early, intensive ABA, notably Catherine Maurice’s Let Me Hear Your Voice, sparked unprecedented enthusiasm for ABA among families and service providers.
Behavioral
The term behavioral indicates that ABA emphasizes measurable outcomes. Early behavior analysts introduced precise measures of the frequency of behavior. This advance enabled careful evaluations of the effects of systematically altering environmental antecedents and consequences (Lovaas et al., 1965; Wolf et al., 1964). Such studies were the forerunners of what is now called functional analysis.
Behavior analysts also pioneered objective measures of communication and conducted the first data-based studies on teaching communication to children with autism (Lovaas et al., 1966). These studies addressed the centuries-old question of whether nonverbal children could be taught to speak. Subsequently, behavior analysts developed some of the first objective measures of other complex skills such as peer interaction (Strain et al., 1977).
ABA observations revealed that individuals with autism often focused on only one feature of a complex stimulus. This phenomenon, called stimulus overselectivity, led to refinements in ABA teaching methods (Lovaas et al., 1979). It also contributed to a prominent neuropsychological theory in autism, Weak Central Coherence, which is a tendency to attend to individual details rather than the Gestalt or “big picture” (Noens & van Berckelaer-Onnes, 2005).
Mostly, however, behavior analysts found that individuals with autism were similar to others in their response to environmental events. This finding suggested that autism is on a continuum with typical development rather than a distinct disease. Many non-behavior analysts independently reached a similar conclusion. The popular term autism spectrum disorders reflects the idea that the social and communication problems seen in autism and related disorders reflect different degrees of impaired social understanding, with the mildest impairments “shad[ing] into the eccentric end of the wide range of normal behavior” (Wing, 1992, p. 138).
Analytic
Analytic refers to the use of a rigorous experimental design to document whether and why an intervention works. Behavior analysts published the first experimental study documenting successful, non-medical intervention for individuals with autism (Wolf et al., 1964) and now conduct a majority of such studies. The most common methodologies are single subject research designs. These designs have become widely accepted (Smith et al., 2007) and are occasionally used by investigators outside ABA (Rogers et al., 2006).
Where Are We Now and What’s Next?
Currently, ABA is often considered the intervention of choice for individuals with autism (New York State Department of Health, 2001). With a big boost from advocacy groups, it has become the standard of care in many areas (Jacobson, 2000), though its availability remains quite spotty.
The far-reaching influence of ABA is exciting but poses challenges. To evaluate large-scale implementation of ABA, single-case designs, which have been behavior analysts’ stock-in-trade, are no longer sufficient. These designs are excellent tools for testing whether an intervention technique reliably changes a behavior and for monitoring effects closely in order to refine the technique. However, the designs involve few participants and usually center on a particular intervention for a circumscribed target behavior. Therefore, they supply little information on what happens when techniques are combined into a comprehensive package and evaluated across many individuals on measures of long-term, global outcomes such as quality of life. They also are ill-suited for evaluating outcomes routinely achieved by non-specialists in community settings (Smith et al., 2007).
Some ABA studies address these issues (NYSDOH, 2001). While such studies have yielded highly encouraging outcomes, they still require replication in large studies with random assignment to groups.
Another challenge is that, recently, investigators outside ABA have begun to enter the field of intervention research for individuals with autism. Their additional expertise may enhance outcomes (Kasari et al., 2006) but also may divert attention from ABA. To remain at the vanguard, behavior analysts will need to form interdisciplinary collaborations rather than continuing to work in isolation.
Finally, despite all the advances that have occurred, ABA interventions do not always work, and many individuals with autism still require a high level of support throughout their lives. Thus, ABA for individuals with autism has been a long-running success story, but we await the concluding chapter.
References
Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, 91-97.
Filipek, P. A., Accardo, P. J., Baranek, et al. (1999). The screening and diagnosis of autistic spectrum disorders. Journal of Autism and Developmental Disorders, 29, 439-484.
Jacobson, J. W. (2000). Early intensive behavioral intervention: Emergence of a consumer-driven service model. The Behavior Analyst, 23, 149-171.
Kasari, C., Freeman, S., & Paparella, T. (2006). Joint attention and symbolic play in young children with autism: A randomized controlled intervention study. Journal of Child Psychology and Psychiatry, 47, 611-620.
Koegel, R. L., & Koegel, L. K. (2006). Pivotal response treatments for autism. Baltimore: Paul H. Brookes. vLovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.
Lovaas, O. I., Freitag, G., Gold, V. J., et al. (1965). Recording apparatus and procedure for observation of behaviors of children in free play settings. Journal of Experimental Child Psychology, 2, 108-120.
Lovaas, O. I., Berberich, J. P., Perloff, B. F., et al. (1966). Acquisition of imitative speech in schizophrenic children. Science, 151, 705-707.
Lovaas, O., Koegel, R., & Schreibman, L. (1979). Stimulus overselectivity in autism: A review of research. Psychological Bulletin, 86, 1236-1254.
Lovaas, O. I., Koegel, R., Simmons, J. Q., et al. (1973). Some generalization and follow-up measures on autistic children in behavior therapy. Journal of Applied Behavior Analysis, 6, 131-166.
New York State Department of Health (2001). Clinical Practice Guidelines: Report of the Recommendations. Albany, NY: Author.
Noens, I. L. J., & van Berckelaer-Onnes, I. A. (2005). Captured by details: Sense-making, language and communication in autism. Journal of Communication Disorders, 38, 123-141.
Rogers, S., Hayden, D., Hepburn, S., et al. (2006). Teaching young nonverbal children with autism useful speech: A pilot study of the Denver Model and PROMPT interventions. Journal of Autism and Developmental Disorders, 36, 1007-1024.
Smith, T., Scahill, L., Dawson, G., et al. (2007). Designing research studies on psychosocial interventions in autism. Journal of Autism & Developmental Disorders, 37, 354-366.
Strain, S., Shores, R. E., & Timm, M. A. (1977). Effects of peer social initiations on the behavior of withdrawn preschool children. Journal of Applied Behavior Analysis, 10, 289-298.
Wing, L. (1992). Manifestations of social problems in high-functioning autistic people. In E. Schopler & G. B. Mesibov (Eds.), High-functioning individuals with autism (pp. 129-142). New York: Plenum.
Wolf, M. M., Risley, T. R., & Mees, H. (1964). Application of operant conditioning procedures to the behaviour problems of an autistic child. Behavioural Research and Therapy, 1, 305-312.