Study Suggests
A new study provides confirmation that some young autistic children can make remarkable progress when they participate in a specially designed intensive behavioral intervention program.
The study by Ohio State University researchers is one of few that have rigorously examined the success of the Early Intensive Behavioral
Intervention program, which some believe is the best way to treat autistic children.
The preliminary results show the value of EIBI, said James Mulick,
co-author of the study and professor of pediatrics and psychology at Ohio
State University. He and his colleagues presented results of the research
August 7 in Toronto at the annual meeting of the American Psychological
Association.
The eight children enrolled in the study all had been diagnosed with
mental retardation – which is often associated with autism — before
participating in EIBI. Six of the eight children showed at least average
IQ scores after treatment and two had improved to mild mental retardation.
Most also showed improvements in other areas of functioning, such as behavior and a reduction in autistic symptoms.
Autism is a complex developmental disability that typically is
diagnosed within the first few years of life. Autistic children often have
trouble with verbal and non-verbal communications, with social
interactions, and may not be affectionate with others. Because autism involves problems with language, it is often associated with mental retardation.
Mulick, who is also associated with Children’s Hospital in Columbus,
cautioned that EIBI isn’t a miracle cure, and isn’t strongly effective for
many – maybe most – autistic children. But he said it is remarkable that
some children could go from being quite correctly labeled mentally
retarded to being labeled of average intelligence after the program.
“We were taught at one time that it couldn’t happen – people who
were mentally retarded couldn’t become average,” Mulick said. “But we found it can happen among at least some with autism.”
Mulick said EIBI for autism was first developed in the 1970s at the
University of California, Los Angeles by O. Ivar Lovaas. Lovaas first
reported in 1987 that 47 percent of 19 autistic children who undergone his
program achieved normal intellectual and educational functioning. The
success was seen as remarkable, Mulick said. While psychologists around
the country have put variations of EIBI into practice since then, there has
been little academic study of its success. Part of the reason is that EIBI is
such a long, intensive process that studies can be very difficult and
expensive.
How long and intensive is EIBI? Lovaas recommended 40 hours per week
for three years. “That’s a lot of time to commit for the program,” Mulick
said.
EIBI is a highly structured approach to learning. Autistic children
are first taught to imitate their instructors. Children are rewarded when
they can imitate arm motions or other actions. They are then taught how to
match identical items, such as shapes. They then learn to match similar
items, and then categories. Lessons continue with gradually more complex
tasks, including using language, and skills needed to attend school.
Some of the keys for success are to reward appropriate behavior and
to not allow the autistic child to socially withdraw, as he or she might try
to do, according to Mulick.
For this study – dubbed the Ohio Autism Recovery Project – Mulick
and his colleagues, including Dr. Bernard Metz of Children’s Hospital in
Columbus and Eric M. Butter, Senior Fellow in Pediatric Psychology and
Neurodevelopmental Disabilities at Ohio State, recruited children and
parents from around the country. In order to be eligible for the study,
the children had to have been reliably diagnosed before treatment as being
mentally retarded and autistic. They then had to have successfully
participated in an EIBI program that followed the UCLA format for
intensive treatment.
“We wanted to see if children who had gone through the program
really did achieve the level of success that had been reported,” Mulick said.
There are no controls in this study to compare the treatment group with, Mulick said. That’s because the early results of EIBI have been so promising that it would be unethical to have some children not receive EIBI treatment for long periods of time.
The participating students are 4 to 8 years old and have received
EIBI treatment for at least a year.
Mulick said they began the study about one year ago and only have
preliminary results at this time. The researchers compared records of the
students before they received EIBI treatment with new Assessments made
when they had completed EIBI and had joined this study. They are just beginning to evaluate results from one year later. During this past year, some of the children have received additional special treatment. Those who are school age are in mainstream classes and those who are younger are on path to also be in standard schools.
The researchers did a variety of assessments to see what effect EIBI
had on the children. Results included: Before EIBI treatment, all students
had IQ scores below 51, which puts them in the moderately mentally
retarded range. After EIBI, all of the children had IQ scores above 70, with one child reaching 114. The researchers have preliminary results of three
students one year after enrollment in this study. All three had made more
gains in IQ scores: 4 points, 8 points and 30 points, respectively.
Seven of the eight students had made significant gains in adaptive
behavior, such that they are ready for mainstream schools. This means they
can do things like dress themselves and wash their hands.
All of the students showed borderline to normal scores on nonverbal
cognitive skills (an example being knowing how to unlock a door or solve a
puzzle).
Language skills remained a problem for at least four of the students.
“Language is one of the most impaired areas in autism,” Mulick said.
All eight students showed academic skills to a level where they were
ready for school. While their language skills were not up to par with
their peers, Mulick said they were good enough for school.
Only one of the eight students had autistic symptoms severe enough
to be classified as autistic by the time of this study. This suggests a
marked improvement.
Only one of the eight children showed emotional or behavioral
problems at a level well above normal.
Overall, the results of this study were positive for EIBI. But
Mulick cautions against seeing EIBI as a cure-all.
“We saw autistic children with some of the rosiest outcomes, but
there were still residual symptoms,” he said. Moreover, he is skeptical that
nearly half the children who participate in an EIBI program can achieve
normal functioning, as the original UCLA study suggests.
This study recruited subjects from around the country but only found
eight who met the criteria of being mentally retarded and who had
successfully completed and EIBI program.
“Our study shows this program can work, but I don’t know that half
the people who participate can achieve normal functioning,” he said.