Note: Recently, Dr. Tristram Smith was misquoted in a MSNBC article by the Associated Press (http://www.msnbc.msn.com/id/27276558/). We have reposted his response to this article below:
The article, “Parents Press States for Autism Insurance Laws,” quotes me as saying that the evidence for applied behavior analysis (ABA) after the age of 6 or 7 years is “sparse.” Actually, I said there are many studies showing that ABA is effective for children for autism at all ages. Toddlers and preschoolers benefit the most, and the intensity of ABA intervention should diminish as children progress and enter school. However, studies show that ABA is still valuable for older children and adolescents. For example, it can be used to design specialized classrooms, support inclusion in other educational settings, and address particular areas of need such as social skills. These services are vital to children with autism and their families, and they deserve our support.
Tristram Smith PhD
Associate Professor of Pediatrics
University of Rochester Medical Center
Comments
I am looking for studies that show that ABA therapy is useful for adolescents. I have found multiple references to the fact that it is effective, but I haven't been able to find links to any studies that show this. Can anyone point me in the direction of those studies? (I'm looking for something that says that it is useful to give ABA therapy to adolescents with autism--not that the effects of early intervention last into adolescence). Thanks.
Meagan
Thank you for your inquiry, Meagan. I think it is important to consider what you mean by ABA therapy. Obviously, behavioral treatment for adolescents sometimes focuses on different skills than those taught to young children with autism. Also, the number of hours of therapy may not be the same. There are no studies of which I am aware that have used “intensive behavioral intervention” (i.e., 20-40 hours per week of therapy) with adolescents; however, there are many studies demonstrating the effectiveness of the techniques utilized in Applied Behavior Analysis with older children with autism. These studies often focus on one particular issue that is addressed behaviorally rather than designing a comprehensive program.
You can find more information about research on behavioral treatment with older children and a list of specific studies in the following Lovaas Meeting Point article: Data-Based Research in Applied Behavior Analysis for Older Children with Autism, http://www.lovaas.com/meetingpoint-2007-06-article-04.php
To view some of the recent studies for free, do the following:
1) Go to the Journal of Applied Behavior Analysis: http://seab.envmed.rochester.edu/jaba/
2) Click on "Conduct full-text searches"
3) Change the type of search to "All Words"
4) Enter "autism" and "adolescent" in the search field.
5 articles from 1990 should appear.
Does ABA really make children recover from autism? or is this a way for providers to get money from desperate parents?
Yes, some children have achieved remarkable gains, to the point that they ultimately lost their diagnosis of autism. Many others have made very meaningful progress but still require support to some degree. And a small percentage show minimal gains despite our best efforts. We strive to empower parents through this process, so they, too, learn how to effectively teach their children and manage behaviors and so that their child can participate in family and community life to the greatest extent possible. Funding for ABA services comes from many sources...school districts, early intervention agencies, regional centers, and yes, sometimes parents/families. We recognize the commitment that this entails for all of them, and we believe in the vast majority of cases, the return that they get on their investment is well worth it.
Whether or not the term "recovery" should be used has been a heated discussion since the word appeared in the 1987 Lovaas study. On one hand, Dr. Lovaas himself cautioned in the study that “…questions can be asked about whether the children truly recovered from autism” adding that “…certain residual deficits may remain in the normal functioning group that…can only be isolated on closer psychological assessment, particularly as these children grow older”. On the other hand, in the 1993 follow up study, these same children were reassessed at 13 years of age. The “recovered” children were put through a more lengthy series of tests, including an examination of areas likely to be difficult for children with autism of average intelligence (compulsive or ritualistic behavior, empathy for and interest in others, a sense of humor). The study found that 8 out of 9 of the children continued to be successful in regular education classes and were indistinguishable from their peers on all of the tests that were conducted.
I personally continue to work with some children who go on to a regular education classroom without an aide, participate in extracurricular activities, and have friends over to their home on the weekends. However, following the lead of the 1993 study, I and the behavior consultants I know have used the term “best outcome” to describe these children’s progress.
Whether or not the term "recovery" should be used is, in my opinion, the wrong question to ask. A better question is, "Does ABA really make enough of a difference in a child's life to make it worth the effort, time, and cost?" There are numerous studies demonstrating the effectiveness of ABA compared to other treatments for many, but not all, children. I'm proud that at the Lovaas Institute we help parents realistically answer that question by continuing to reassess a child's progress and discuss with parents the benefits of continuing treatment vs. the benefits of transitioning to other services.
The school District refuses to take my son if I do not put him in the ABA program. I am very concerned because I do not know ABA enough and they were unable to provide me with the peer reviewed publications, besides Dr Lovaas study, justifying that a public institution would prescribe a treatment and not give me option.
I have searched the medical journals and libraries and don't find any articles testifying that this is the only good option for my child.
Please, give me references which do not mention ABA in the text, but do validate that this is the best and even only valid treatment for autism.
This would make the demand of the school district totally acceptable and would of course relief me of all worry.
I have asked other parents and they have been in the same situation where they had no choice but ABA if they wanted to put their child in public school. Most are trusting that this means it is the best treatment. I am less impressed and feel my rights and my child's rights are not protected. However, if I read scientific evidence, i will not mind being so strongly directed. The School did not have any of the abundant evidence in publications which they talk about and I have not been able either to access any articles. Thanks so much for providing references for me and for the parents whom I believe I unsettled with my concerns.
We hope the following list of resources might be helpful while you evaluate the options for your son's treatment. These are non-biased discussions of treatment options:
Mental Health: A Report of the Surgeon General:
http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec6.html
The National Academies Press:
http://www.nap.edu/openbook.php?record_id=10017&page=140
The New York State report: http://www.health.state.ny.us/community/infants_children/early_intervention/disorders/autism/app_c.htm#APPENDIX_C
AutismSpeaks.org (Treatments for Autism)
http://www.autismspeaks.org/whattodo/index.php
Although we can't comment on the specific program offered by your school district, we encourage you to observe the program, speak to the staff, ask parents of the students about their experiences.
Please also visit the research page of our website for more information about research conducted by Dr. Lovaas and colleagues, including recent replication studies.
http://www.lovaas.com/research.php
Best Regards.
Currently, I am researching teaching adaptive skills, based on ABA, to autistic adolescents and adults. Unfortunately, I cannot find research that shows the effectiveness of ABA with adolescents and adults, and teaching adaptive skills through ABA to adolescents and adults.Who can help me with this, refer me to articles/research? Thank you
I just heard of Dr. Lovass' passing. I just wanted to express sadness and gratitude. Without his inspiring work, our son would be no where near the functioning level he has reached today. We will be forever grateful.
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