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One Box Does Not Fit All in ABA & Autism


Media reports abound with regard to mandating ABA (Applied Behavioral Analysis), in some way shape or form, for intensive earliest intervention in autism. Most recently, a teacher in Michigan is bringing action against an insurance company and a school in order to mandate ABA. However, when one reads that ABA is effective, what hasn't been mentioned is the fact that there is no set program that defines ABA; just a sea of programs that claim they apply the ABA type of approach. 

The reporting on the teacher's action in Michigan didn't define the types of intervention that are currently transpiring at the school that is being litigated against, and instead presented the often read story line; ABA is validated in the scientific community. 

From Fox News: ABA therapy is known to be extremely effective in treating children with autism if given at an early stage of development. It is scientifically validated and includes positive reinforcements and individual goal setting, to achieve dramatic behavior modification. ABA therapy allows children with autism the opportunity to reach maximum potential and the hope of becoming independent in their adult lives.

As example, here is some information with regard autism programming that has received recent public attention and validation in the scientific community - as having possibility or proven plausibility of being efficacious:

  • Pivotal Response
  • Combined Programming
  • Early Start Denver Model
  • DIR

Pivotal Response Study (Source) "...This study confirms what we have been seeing at our clinic since we began providing Pivotal Response Treatment in 2007," Dr. Robert Daniels, executive director of the Chicago Children's Clinic, said in a statement. "Parents can be trained to be the best clinicians for their children."

Combined Programming (Source): ...In the January issue of the Journal of Positive Behavior Interventions, Ingersoll contends that advocates of the behavioral and developmental approaches should set aside their differences and use the best practices from each to meet the needs of the student and the strengths of the parent or teacher. 

Early Start Denver Model: It appears that JAAPA sees promise in Early Start Denver Model findings but a little more follow up needs to be done to determine overall implications of earliest intervention's lifelong benefits...What is clear, is that communication skills are the biggest benefit derived from earliest intervention strategies - with autistic features remaining.

From JAAPA:...Intensive intervention, using the Early Start Denver Model, in children with autistic disorder or pervasive developmental disorder may improve early learning, especially language development, and adaptive behavior after 2 years of treatment. This study did not find a benefit of treatment on behavior and did not report on the long-term benefits, if any, of the intervention.

Developmental Individual Difference, Relationship Based  (Source): ...More than 2,200 families received notice this week of a preliminary settlement in a class-action lawsuit that, if approved by a judge, would force the Eastern Los Angeles County Regional Center to continue to provide the treatment, known as the DIR model (for "developmental, individual difference, relationship-based")...DIR is the basis for Floortime, a popular method in which a therapist follows a child's lead during play activities to develop communication and social skills.

Barbara Dowling,  (MAT Special Education, MS Speech Language Pathology, MA Education Technology, 2005 Teacher of the Year (Sioux Falls), 2006 Teacher of the Year (SD), 2008 National Head Start Fellow), describes an in-home program she facilitated in the late 1990's. Upon review, it looks very much like the combined programming that has recently begun to illicit interest as the best cast scenario for autism intervention.

In-home report: The behavioral intervention home program that Sarah was involved in was one of behavior modification based on operant conditioning theory. This type of programming is also known as ABA (Applied Behavior Analysis) or discrete trial training. When behavior modification is used with children with autism, the child’s behaviors are divided into deficits and excesses. Skills which are deficient are taught and behaviors that are excessive are decreased. Each skill to be taught is broken down into its most simple individual components. The child is then prompted to exhibit the desired simple skills and rewarded for success. Prompts may be used initially to elicit the behavior then are gradually removed so that the child is able to demonstrate independent performance of the behavior. As a result, the behavior is strengthened and gradually acquired. Once individual components of the behavior have been acquired, each component is chained together to produce behaviors which are more complex and functional. As new behaviors are learned, inappropriate behaviors are not rewarded. As a result, these inappropriate behaviors decrease in strength and gradually extinguish. This results in inappropriate behaviors being replaced by more functional and desirable behaviors which enable the child to more successfully communicate and learn.

The above program included: discrete-trials, hour-intensive massed trials, naturalistic behavioral strategies, incidental teaching, preschool and pivotal response. During the sessions, the therapist would present discrete/massed trials (drills), but they also engaged young Sarah in a predetermined fun activity between drills. The fun activity involved the therapist utilizing a more naturalistic, incidental teaching strategy. Pivotal response was represented in the process, as elimination of some stimulatory behaviors appeared to coincide with Sarah's acquisition of new skills. The first year had Sarah involved in 8 hour per day programming, and the second year 4 to 6 hours per day. (The overall outcome for Sarah is in Hello, Dr. Wells)

Most agree that it is essential to do all that we can for those within the autism spectrum. Since the spectrum covers such a wide and diverse range of ability, what needs to be emphasized is the fact that one box does not fit all. Additionally, ABA cannot be built and should not be described as an one box fits all program. Each individual child will need a program that is very specific to their deficits, excesses and intellectual ability.

What educational professionals are really looking for is prolonged purposeful and meaningful interactions with a very young child, who doesn't perceive the world typically - hours' intensive meaningful interaction that might be beneficial. ABA is not the cure all for autism - especially not for those on the severe end of the spectrum who have intellectual disability that does not prove to normalize with programming. Many who have been in the field of autism have already seen that at some point intense early intervention needs to be able to morph into something that fits with a child's ability to respond, and their ability to continue to have a meaningful learning experience.

IQ is an attention grabber as it relates to how it is represented in the autism spectrum. IQ measures upon initial diagnoses provide an indication of what to expect later on. According to Dr. James Copeland, if two children present with the same degree of atypicality (autistic features), but one has an IQ average of 100 and the other 40 to 55, the atypicality will shrink for the child with the higher IQ but not for the child with the lower IQ - regardless of the type of intervention.

...There have been at least ten long-term follow-up studies of persons with ASD, going back nearly 40 years and totalling over 1000 subjects, that bear out this fact. In 1976, one researcher correctly concluded "In terms of scholastic progress, social competence, and work opportunities, the child's IQ level is as influential as the presence of autism."(Copeland Article)

During research into ABA type programming by Lovaas, IQ became a controversial issue. Perhaps the possibility that initial IQ measures many times dictates later outcome, had influenced the underpinnings of that study. The results were questioned because the term recovery was used to describe children whose measured ability fell into the average range (upon initiation of programming) and (also to those) who were being educated within mainstream schools. Children with higher functioning autism could well achieve such outcomes via other interventions, and (furthermore) a follow-up of some of the recovered children at age 13 revealed a continuation of significant behavioral issues. (M.J. Conner Notes) The term recovery was used based on measures that hadn't really improved, and long term follow up indicated continued significant behavioral features of autism.

Follow-up seems to be the sticking point when it comes to researching what might be of long term benefit for those within the autism spectrum, as far as intervention. What study or scientific finding has validated long term outcome, initiated from an earliest intervention program?  Remember, JAAPA concluded that the long term benefit had not been determined for the ESDM. The ESDM study did seem to show us that over half of the children involved, remained within the autism spectrum - albeit with some improvements in language and adaptive behavior while the autistic features remained.

From IQ and Autism Onset Patterns: Completion of study into earliest intervention from ESDM showed that 71% of children in a control group remained within the autism spectrum after programming,  and 56% of the children in the ESDM group remained. The biggest advantage in the programming studied, was that of improved language development and adaptive behavior. Scores on repetitive behavior showed no improvement for either group...Children as young as eighteen months were included in the study.

Incidentally, from years' long personal experience of watching my daughter and our neighbors son, who are both within the spectrum, I have found that IQ measures most definitely did indicate probable outcome. My daughter had low IQ measures, and earliest interventions did provided initial benefit similar to what was described in the ESDM. However, the benefit was not prolonged and she did regress after the programming. There was not a way to provide ABA type teaching for next grades and harder concepts, and her mind could not entertain the harder concepts. She remains severely autistic. My neighbor's son who had higher IQ measures, was not involved in earliest intervention, and he is currently mainstreamed in high school. The other day, I saw this young man and we did some catching up. I jokingly mentioned that Sarah might start asking for her driver's license and he replied, "Yeah, but isn't she a little autistic?" and had a worried look on his face.

Many individuals in the spectrum try to teach us from their early experiences.

Explained in A Uniform Approach to Autism Just Doesn't Work, ...The sensory diet of people with autism cannot be satisfied with a one-box-fits-all mentality. A quote from Linda Messbauer, a lecturer and the subject of the article;“When you get to the point that you understand you can manipulate the environment, then you are going to hear, and you are going to see and you are going to be able to listen,” she said. “I am telling you, you need to listen.”

A news station did a profile on a young boy (Matt) and mother, who together, learned to communicate via a facilitated communication. After utilizing their form of communication for a while, one day the boy typed, "I'm so glad you found me in here." Matt Hobson is now 28 years old and getting ready to graduate from college. He and his mother have co authored a book called, I'm So Glad You Found Me In Here. There have been recent reports of others within the autism spectrum who successfully utilize the keyboard for communication.

Yes, it is important to do all that we can.  It is important to give children within the autism spectrum teaching, time and graceful space. They all develop in their own way, and not on the same schedule as the typically developing child; many times, regardless of intervention. There needs to be room to consider both diligence and then acceptance, when all is said and done.


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