A review of the research to identify the most effective models of practice in early intervention for children with autism spectrum disorders
Examples of behavioural interventions
(Including extracts from McGahan, 2001, pages 11-13)
Lovaas ProgramBased on principles of ABA, the Lovaas program, developed by the University of California Los Angeles Young Autism Project under the direction of Ivaar Lovaas, uses time-intensive (40 or greater hours per week) behavioural intervention techniques to treat children of two to three years of age, over a two to three year period. First stages of the program focus on teaching self-help and receptive language skills, nonverbal and verbal imitation, and the foundations of appropriate play through one-to-one DTT 40 hours per week. Parents are trained to apply the intervention during most of the child's waking hours (Dawson & Osterling, 1997). The second stage of the intervention emphasizes the teaching of expressive language and interactive play with peers. Advanced stages, taught at home and school, involve the learning of early academic tasks; socialization skills; cause-effect relationships; and learning by observation. Aggressive and self-stimulatory behaviours are managed by ignoring, time-out, shaping and the delivery of a loud "no" or slap on the thigh (Dawson & Osterling, 1997). The treatment strategy requires the presence of a therapist trained at the Lovaas Institute; thus dependence on the treatment provider may limit the generalization of treatment effects across community settings (Health Technology Assessment Information Service, 1999).
Douglas Developmental Disabilities Centre ProgramEstablished at Rutgers University, this program is based on principles of ABA and behaviour intervention approaches (Dawson & Osterling, 1997). Children progress through three preschool classrooms, from a segregated class to a highly structured group, to an integrated preschool classroom. The segregated class provides intensive one-to-one DTT, largely based on Lovaas's model. The highly structured group maintains a two educator teaching session per child and focuses on skills needed to function in an integrated classroom. The integrated class is partially based on the Learning Experiences-An Alternative Program for Preschoolers and Parents (LEAP). The program serves both children with autism and typically developing peers. Families are visited by a staff member twice a month and are offered parent and sibling support groups (Dawson & Osterling, 1997).
May InstituteThe May Institute offers a developmentally sequenced program based on the principles of ABA and behavioural intervention approaches. Intensive in–home training (15 hours per week) is provided to young children and their families for a period of six months. The in-home therapist and parents provide one-to-one intervention focusing on basic skills such as self care, language, and the reduction of problem behaviours. Following completion of home-based treatment, the children attend one of the Institute's two preschool programs, "Step 1" class or the integrated classroom. Children attending the Step 1 class, comprised only of children with autism, learn basic skills to follow instructions, develop imitation, and work in highly structured small groups for the duration of a year. The integrated class, in contrast, includes typically developing children as well as those with developmental disabilities. The curriculum focuses on teaching skills that children need in general kindergarten. A service coordinator visits families every month, during which time the child’s progress and the parent’s concerns are discussed. The program offers group support and respite care for families as well as outside referral information (Dawson & Osterling, 1997).
Autism Preschool ProgramThe Autism Preschool Program, based at the University of Manitoba, uses a variety of behavioural and language development methods similar to the Rutgers Autism Program. It is a collaborative program staffed by a multidisciplinary team and involves the university hospital, the provincial government, and local community resources. The intervention is directed by parents and day-care staff who are taught how to perform a functional analysis of behaviour and to plan and evaluate strategies for changing behaviour (Health Technology Assessment Information Service, 1999).
Princeton Child Development Institute Program (PCDI)The program for children with autism at the Princeton Child Development Institute is based on principles of ABA and behaviour intervention approaches. Children are first evaluated, to guide the design of individualised behaviour programs that target basic skills. Children in the day education and treatment program attend school 5.5 hours per day, five days per week, for 11 months of the year. Children participate in 30-minute classes with changes in activity and a change of classroom and teacher. Children are taught to use picture schedules to assist them with transitions throughout the day (Dawson & Osterling, 1997). It has been suggested that this arrangement of the school day assists in generalization (Health Technology Assessment Information Service, 1999). Picture schedules also help children to learn to initiate activities, make choices and encourage independence. Progress is periodically assessed and specific goals are revised. A home programmer may visit the family twice a month to help families implement behaviour programs that have been successfully achieved at school to maximize generalisation of these skills at home (Dawson & Osterling, 1997).
The IBI program in OntarioIn 1999 the Ontario provincial government in Canada began to provide support for early intensive behavioural intervention (IBI) which is the predominant form of early intervention in this province. A recent report on effectiveness of this large program using adaptive behaviour, cognitive, and symptom measures found that children had doubled the rate of their previous learning and that symptoms had significantly decreased. Outcomes were especially significant for children who began the intervention when they were less than 4 years of age and who were moderate or above in their level of development, with a significant proportion of these reaching average cognitive and diagnostic profiles. Other subgroups within the sample showed variable outcomes, but overall this evaluation of IBI demonstrated that the intervention can be effective in a community context (Freeman & Perry, 2006).
Additional ABA programs include the Eden Programs, The Childhood Learning Centre, Yale Child Development, Bancroft, Horizon, the ABA program in Prince Edward Island, the ABA pilot program in Newfoundland, the ABA pilot program in Nova Scotia, the pilot programs in Saskatchewan and the ABA programs in Alberta. Another ABA approach is the Comparative Applied Behavioural Analysis to Schooling Program (CABAS). There are a variety of ABA curriculum instructional and training materials available for use by families and health care professionals. Social Stories and social skill development are also behavioural interventions that are used to treat children with autism (Heflin & Simpson, 1998).