The journal Research in Autism Spectrum Disorders published in 2008 an article by Matson and Smith that provides an review of existing reviews and data-based EIBI studies to do specific analysis of strengths, shortcomings, and trends in data.
There has recently been published some review articles, I have commented on some of them on this blog, and the need for these reviews may be fulfilled soon. But as this review has a slightly different angle than the others I find it quite an interesting reading. And I will recommend it to readers interested in ASD and EIBI.
Based on their review the authors finds that the child factors affecting outcome is, in order of importance; severity of ASD symptoms, intellectual functioning (IQ), and comorbid psychopathology.
This review again points out the shortcoming of EIBI research that it now seems that all researchers and practitioners agree up on; the limited use of outcome data. The studies should of course measure more then IQ and school placement.
The review then have similar descriptions and comments as Eikeseth (2009), and points out the need for further research. I would really see some of the research pointed out by several authors be done!
As I have started to assess many of the children with ASD using Sundbergs VB-MAPP, I constantly gather more and more experience. And to day one of my colleagues pointed out a possible strange aspect of the VB-MAPP.
As we had finished the milestone-assessment we moved on to the skill-tracing and discovered that there may be some logical difficulties in the link between them. As the milestone is if the child uses 4 adjectives and 4 adverbs in sentences, one of the skills in the skill-tracing is the ability to name relatives. This child mastered the milestone, but not the mentioned skill. How do this relate?
Of course one explanation is that the skills from the skill-tracing are skills that facilitate the development of the milestones, and this makes sense. But on the other hand it´s not making total sense that you can master a milestone, but not master the skills that are supposed to facilitate it.
Professor Svein Eikeseth has published an good article in Research in Developmental Disabilities (2009) evaluation the scientific value and the outcome of 25 studies on psycho-educational interventions for young children with autism; 20 behavioral studies, 3 TEACCH- studies and 2 studies evaluated the Colorado Health Sciences Project.
Professor Eikeseth has done a solid evaluation of the scientific strength and the magnitude of the results of all these studies, and based on this he concludes “Based on these guidelines interventions based on ABA will be considered ‘‘Well Established’’. TEACCH and Colorado Health Science model will be considered neither ‘‘Well Established’’ nor ‘‘Probably efficacious’’.”
He also gives directions for future research, and states that it should consider:
- There is a need for additional outcome research
- Whenever an approach is documented effective, there is a need to identify effective treatment parameters and mechanisms responsible for change. This applies in particular to ABA-research
- There is a need to identify characteristics that interact with outcome.
- There is a need to improve treatment for those children who respond less favorable.
- Research could examine the efficacy of biomedical treatments in combination with psychosocial treatments.
- Research could develop criteria for discontinuing or changing treatment approach.
- Research could be conducted to examine the cost-effectiveness and cost–benefits of the interventions.
And some others. He also concludes with:
Recommended practice parameter:
- ABA treatment is demonstrated effective in enhancing global functioning in pre-school children with autism when treatment is intensive and carried out by trained therapists
- ABA treatment is demonstrated effective in enhancing global functioning in children with PDD-NOS
Guideline practice parameter:
- ABA can be effective for children who are up to 7 years-of-age at intake
Love, Carr, Almason and Petursdottir has just published an article where they trough an internet-based survey assessed different EIBI programs different characteristics and practises. The article is to be published in Research in Autism Spectrum Disorders.
The survey reveals several interesting results, and I´m pleased to see that several programs reports to use different sources to their curriculum, even if I would like to se the number even higher. With the large extent of research done in ABA, it´s useful to combine different curriculum as the different published manuals show different results in different areas. But as I think this is a strength so far, it should be a future goal to standardize the EIBI treatment to the largest extent possible, also in terms of curricula and manuals. A total and absolute standard would not be possible as far as I see, the core of a good ABA-program is the analysis of behavior, not the implementation of predefined procedures!
The article also discuss other interesting features, and it´s goal according to the authors is to start assessing the differences in EIBI-programs. This is an important start, and for the field of EIBI to evolve and uphold a strong position in the field of autism and other developmental disorders, it is crucial to better describe the characteristics of the programs and investigate the effects of these characteristics.
So it´s an important start on a important work, and a good article that should guide much further research!
As providing therapy and interventions to children and adults with ASD, I will claim that communication is the core element of every intervention and therapy. One of the core-symptoms of ASD is problems related to communication, and interventions in as good as every other area, must have a basis in communication; social skills, problem behavior etc.
But from time to time I meet children with autism, and also adults, who in spite several years of different interventions does not have a means of communication. They are left up to the people around´s interpretation of their behavior, and as a consequence the person with ASD have extremely limited possibility to interact and influence their own life. This is always devastating to see, and I will strongly uphold that our first goal as professionals is to contribute to the development of communication, preferably through speech, alternatively thorough signs, PECS or other AA…