In New Brunswick an interdepartmental committee was struck (Health, Education and Family Services) to study services available for autistic persons in New Brunswick and make recommendations. It sat from 1999 to 2001 and issued its report in November 2001. Its report then went unread by the lead Minister of the day, Health Minister Elvy Robichaud, for a further year. The committee studiously avoided making any recommendations about the effectiveness of any particular intervention.
The criteria for "Community" Autism Centres seeking funding from the government has required that these centres not promote any specific intervention and instead provide information on various interventions. Meanwhile our good neighbors in the State of Maine took a different approach. There the stakeholders group involved in education of autistic children examined the professional literature concerning efficacy of autism interventions and concluded in the MADSEC Autism Task Force Report 1999, revised Feb. 2000, that ONLY Applied Behavior Analysis (ABA) could be said to be evidence based effective intervention for educating autistic children. Since then specific studies have confirmed the superiority of ABA in educating autistic children. The Lovaas site has an excellent summary of the most significant of the hundreds of studies which substantiate ABA as the intervention of choice in educating autistic children:
Between 1985 and 2005, there were over 500 articles published concerning Applied Behavior Analysis and autism. Here is some of the key information from those sources.
1987 study by Dr. Lovaas
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.
Original research in peer-reviewed journals indicating that 90% of children substantially improved when utilizing the Lovaas Model of Applied Behavior Analysis, compared to the control group. Close to half attained a normal IQ and tested within the normal range on adaptive and social skills.
1993 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 in early adolescence showed that children in the 1987 study maintained their skills and could succeed in life without costly special education and residential services.
1998 cost-benefit analysis of intensive, early behavioral intervention. Jacobson, John W., Mulick, James A., & Green, Gina. (1998 ). "Cost-Benefit Estimates for Early Intensive Behavioral Intervention for Young Children with AutismÑGeneral Model and Single State Case." Behavioral Interventions, 13, 201-226.
Demonstrates that providing behavioral treatment to all children with autism for three years, delivered between the ages of 2 to 6 years, 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. The savings per child even takes into account that some children will not benefit at all from behavioral treatment and some will only make modest gains.
1999 report from the New York State health department http://www.health.state.ny.us/community/infants_children/early_intervention/auti Recommends a minimum of 20 hours per week of individualized behavioral interventions using ABA techniques, based on strong evidence in the research 2000 report from the Surgeon General
http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec6.html Acknowledges the efficacy of applied behavioral methods in the treatment of children with autism and cites the "well-designed study carried out by Lovaas and colleagues" 2002 study by Dr. Eikeseth directly comparing two treatments
Eikeseth, Svein, Smith, Tristram, & Eldevik, Erik Jahr Sigmund. (2002). Intensive Behavioral Treatment at School for 4- to 7-Year-Old Children with Autism. Behavior Modification, 26, 49-68.
Demonstrates that a focused behavioral treatment program is far superior than an eclectic special education approach that uses a variety of treatments. (Children in both groups received the same number of hours of treatment by qualified personnel.)
2005 replication study by Dr. Jane Howard directly comparing two treatments
Howard, Jane S. , Sparkman, Coleen R., Cohen, Howard G., Green, Gina, & Stanislaw, Harold. (2005). A Comparison of Intensive Behavior Analytic and Eclectic Treatments for Young Children with Autism. Research in Developmental Disabilities, 26 (4), 359-383.
Again demonstrates that a focused behavioral treatment program is far superior than an eclectic special education approach that uses a variety of treatments. (Children in both groups received the same number of hours of treatment by qualified personnel.)
2005 study by Dr. Sallows, replicating the 1987 Lovaas study results
Sallows, Glen O. & Graupner, Tamlynn D. (2005). Intensive Behavioral Treatment for Children with Autism: Four-Year Outcome and Predictors. American Journal on Mental Retardation, 110 (6), 417-438.
Replication study of the Lovaas Model of Applied Behavior Analysis by an independent author. Dr. Sallows states, "We found that 48% of all children showed rapid learning, achieved average posttreatment scores, and at age 7, were succeeding in regular education classrooms. These results are consistent with those reported by Lovaas and colleagues (Lovaas, 1987; McEachin, Smith, & Lovaas, 1993)."
2006 study by Dr. Cohen Howard, again replicating the 1987 Lovaas study results
Cohen, Howard, Amerine-Dickens, Mila, Smith, Tristram. (2006). Early Intensive Behavioral Treatment: Replication of the UCLA Model in a Community Setting. Journal of Developmental & Behavioral Pediatrics, 27 (2), 145-155.
Another replication study of the Lovaas Model of Applied Behavior Analysis by an independent author. Children in behavioral treatment scored significantly higher in IQ and adaptive behavior scores than the comparison group. Further, 29% (6 of 21) children were fully included in regular education without assistance and another 52% (11 of 21) were included with support. This compares to only 5% (1 of 21) children in the control group who were placed in regular education.
Despite this wealth of literature supporting the efficacy of ABA as an educational intervention for autistic children there remains opposition to its use for that purpose. There are many ulterior motives some cost based others emotion based. Arguments are also advanced on the basis that studies generally are not based on a random assignment to control groups. What these criticisms ignore are that as the trial judge in the Auton case concluded after reviewing the expert evidence in that case, whether done by design or not the assignments did not indicate any bias in group assignment - the assignments were not substantially different than they would have been under pure random assignment. Such criticisms also gloss over the ethical problems posed by random assignment to groups in which children would receive educational interventions which are generally believed not to be effective in educating autistic children.
The criticisms also ignore the reality that children have to be educated now. Parents will not accept waiting another generation for academics and anti-ABA die-hards to be convinced. Our children need to be educated now. Hundreds of studies support the efficacy of ABA in educating autistic children. It is long past time to give our children the opportunity of a real education and development to the best of their potential.