Tuesday, December 16, 2008

Couldn't Sleep Last Night

The Airtalk (KPCC 89.3 FM) panel on Autism Treatment hosted by Larry Mantle was recorded last night and I had a hard time sleeping afterward. Larry was a very gracious host and certainly knowledgeable about the subject. He seemed quite interested in letting the audience know about ABA and how it works and how it is different from other treatments.

I must say it was upsetting to hear some of the information being presented by panelists. It was unfortunate that the first speaker who discussed ABA presented it in such a narrow way (e.g., done primarily at a table, not involving parents, working on limited skills, etc.). As I said, it is unfortunate that rigid and poor quality ABA does exist but good ABA can be both systematic and implemented in a natural and child-friendly way.

I was even more disturbed regarding the panelists’ continual discounting of solid research and the promoting of interventions that have limited to no data and in some cases has even been shown to be ineffective or harmful. For example, there is only one study on Floor Time. This study is riddled with fatal methodological flaws (e.g., published in Dr. Greenspan’s own journal, no experimental design--simply case reviews, no independent evaluations--the reviews were conducted by his own graduate student, no identification of the outcome criteria, etc.). The discussion regarding Gluten/Casein free diets could have sent parents on the wrong track. There is actually no research showing that children with Autism have a higher rate of gastro-intestinal problems. The only quasi research study shows actually that the rate of this problem is actually less than the general population. Additionally, the only experimental study conducted shows that the diet was no more effective than a placebo. Furthermore, there is a total lack of understanding that perhaps those children that do have such problems perhaps it is a result of their very unusual eating patterns. In other words the G.I. difficulties might be the result of autism rather than the cause of it.

A pediatrician on the panel asserted that one does not need to rely on research because one can be guided by one’s personal clinical experience. I find this an extremely dangerous position. As I commented, this is why parents have all too often subjected their children to an array of intervention, some benign and some dangerous, but almost all wasting the precious time children have. Some of these interventions (e.g., music and dance therapy) may not be “dangerous” but they can take away time from the intervention that is effective. Others are even more problematic (e.g., Sensory Integration) because they undermine the effectiveness of proven intervention.

I fear parents who listened will be swayed by the charisma and passion of the panel members, will not recognize the misinformation, and ultimately their children will suffer. The bottom line is that children can make amazing progress as long as they receive the correct intervention. We are gratified that yearly we can graduate children from our program because they have become indistinguishable from their peers and most importantly are fully on the road to enjoying a high quality of life!

All that being said, we think people should listen to the podcast from the show which aired on Dec. 18, but we urge listeners to carefully and critically evaluate what is being said. Interventions can be appealing but lack substance and without being scientifically minded it is easy to be fooled into thinking that something makes a difference, when it is mostly an illusion. You can find the podcast (Real Player format) at KPCC’s website, but it is divided into three parts and the first hour has about 20 mins. on a different topic. We converted the podcast into a single MP3 file which contains only the Autism discussion. Both downloads are available at: autismpartnership.com/ap_media.html


Sunday, November 23, 2008

A debate about ABA in the UK

We recently were asked to assist in rebutting the arguments of a Local Education Authority (LEA) against the use of Applied Behavior Analysis (ABA) in the education of children with autism. An LEA is the U.K. equivalent of a U.S. school district. The original critique of ABA appears in the left column below and our response to each section appears in the right column. As you will see, the arguments made are based on misunderstanding of ABA and behavioral theory. According to the theories they cite, ABA should not work. But numerous controlled studies with autistic children clearly show that ABA does work. If one follows the scientific method, the only possible conclusion is that their theories are incorrect. After all, theories are just hypotheses that must be tested before they can be considered valid and when the evidence contradicts a theory, it should be revised or discarded. -JM

LEA Critique of ABAResponse from AP

Here are the full references for citations listed above:

Anderson, S.R., Avery, D.L., DiPietro, E.K., Edwards, G.L., & Christian, W.P. (1987). Intensive home-based intervention with autistic children. Education and Treatment of Children, 10, 352-366.

Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1(1), 91-97

Birnbrauer, J.S., & Leach, D.J. (1993). The Murdoch early intervention program after two years. Behaviour Change, 10, 63-74.

Cohen, H., Amerine-Dickens, M., & Smith, T. (2006). Early Intensive Behavioral Treatment: Replication of the UCLA Model in a Community Setting. Journal of Developmental & Behavioral Pediatrics, 27 (2), 145-155.

Eikeseth, S., Smith, T., & Eldevik, S. (2002). Intensive behavioral treatment at school for 4- to 7- year old children with autism. Behavior Modification, 26, 49-68.

Fenske, E.C., Zalenski, S., Krantz, P.J., McClannahan, L.E. (1985). Age at intervention and treatment outcome for autistic children in a comprehensive intervention program. Analysis and Intervention in Developmental Disabilities, 5, 49-58.

Handleman, J.S., Harris, S.L., Cebiberti, D., Lilleht, E., & Tomcheck, L. (1991). Developmental changes of preschool children with autism and normally developing peers. Infant-Toddler Intervention, 1, 137-143.

Handleman, J.S., Harris, S.L., Kristoff, B., Fuentes, F., & Alessandri, M. (1991). A specialized program for preschool children with autism. Language, Speech and Hearing Services in Schools, 22, 107-110.

Harris, S.L., & Handleman, J.S., (1994). Preschool education programs for children with autism. Austin, TX: Pro-Ed.

Harris, S.L., Handleman, J.S., Gordon, R, Kristoff, B., Fuentes, F. (1991). Changes in cognitive and language functioning of preschool children with autism. Journal of Autism and Developmental Disabilities, 21, 181-290.

Harris, S., Handleman, J.S., Kristoff, B., Bass, L., & Gordon, R. (1990). Changes in language development among autistic and peer children in segregated and integrated preschool settings. Journal of Autism and Developmental Disabilities, 20, 23-31.

Howard, J.S., Sparkman, C.R., Cohen, H.G., 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.

Leaf, R, & McEachin, J. (1999). A Work in Progress: Behavior Management Strategies & A Curriculum for Intensive Behavioral Treatment of Autism. NY: DRL Books

Leaf, R.B., Taubman, M, & McEachin, J.J. (2008) It’s Time For School: Building Quality ABA Educational Programs. New York, NY: DRL Books.

Leaf, R.B., McEachin, J.J., & Taubman, M. (2008). Sense and Nonsense in the Behavioral Treatment of Autism: It Has to be Said. New York, NY: DRL Books.

Lovaas, O.I. (1987). Behavioral Treatment and normal educational and intellectual functioning in young autistic children. Journal of Clinical and Consulting Psychology, 55(1), 3-9.

Lovaas, O.I., Koegel, R. L., Simmons, J. Q., & Long, J. (1973). Some Generalization and Follow-up Measures on Autistic Children in Behavior Therapy. Journal of Applied Behavior Analysis, 6. 131-166.

Matson, J., Benavidez, D., Compton, L., Paclawskyj, T., & Baglio, C., 1996. Behavioral Treatment of Autistic Persons: A Review of Research From 1980 to the Present. Research in Developmental Disabilities, 17-6, 433-465

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.

Mental Health: A Report of the Surgeon General. (2000). Chapter 3.

National Research Council. (2001). Educating Children with Autism. National Academy Press: Washington, DC.

New York State Department of Health. (1999). Clinical practice guideline: Report of the recommendations autism/pervasive developmental disorders. Assessment and intervention for young children (ages 0-3). Albany: Author.

Perry, R., Cohen, I., & DeCarlo R. (1995). Case study: Deterioration, autism, and recovery in two siblings. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 232-237.

Sallows, G.O, and Graupner, T. D. (2005). Intensive Behavioral Treatment for Children With Autism: Four-Year Outcome and Predictors. American Journal on Mental Retardation, 110, 417-438.

Sheinkopf, S. J. & Siegel, B. (1998). Home-based behavioral treatment of young children with autism. Journal of Autism and Developmental Disorders, 28 (1), 15-23.

Smith, T., Groen., A., & Wynn, J.W. (2000). Randomized Trial of Intensive Early Intervention for Children with Pervasive Developmental Disorder. American Journal on Mental Retardation, 105, 269-285.

Weiss, M. J. (1999). Differential Rates of Skill Acquisition and Outcomes of Early Intensive Behavioral Intervention for Autism. Behavior Interventions, 14 (1), 3-22.

For more references on behavioral treatment and education of children with autism click here