Studies on ABA/VB


1. Maximizing the potential for infants at-risk for autism spectrum disorder through a parent-mediated verbal behavior intervention

Summary of the study
Amy Tanner & Katerina Dounavi

The human brain under­goes the most trans­for­ma­tive deve­lo­p­ment period in all post-natal life from birth to 36 months, going from simple connec­tions to complex connec­tions respon­sible for social beha­vior, commu­ni­ca­tion and cogni­tion (Courchesne & Pierce, 2005). Over the past five years, an increase in pre-diagno­stic inter­ven­tion for Autism Spec­trum Disorder (ASD), also known as pre-emptive inter­ven­tion (prior to 18 months of age), has been noticed. During this time, neuro­pla­s­ti­city is at its peak, allo­wing for more rapid changes in deve­lo­p­ment and ulti­m­ately more effec­tive inter­ven­tion (Brad­shaw, Steiner, Gengoux, & Koegal, 2015). It is essen­tial to begin inter­ven­tion while these connec­tions are still being formed rather than trying to change maladap­tive neural connec­tions once they are estab­lished (Pierce et al., 2016). In fact, findings from previous studies indi­cated that children diagnosed with ASD who began beha­vi­oral inter­ven­tion prior to two years of age were 60% more likely to make signifi­cant gains in their first year of inter­ven­tion compared to those who began after 30 months of age (MacDo­nald et al., 2014).

Rese­arch studying the effi­cacy of pre-emptive inter­ven­tions utilized early scree­ning tools and a parent-mediated service deli­very model that aims to improve key parental skills that can miti­gate ASD symptoms. Target beha­viors selected for increase included among others: joint atten­tion, respon­si­vity to parent, social smiling and social orien­ting along with recep­tive and expres­sive language, while the seve­rity of prodromal autism symptoms have been targeted for a decrease.

The present study assessed the effec­ti­ve­ness of a 12-week parent-mediated pre-diagno­stic inter­ven­tion program aiming to reduce autism symptoms and increase appro­priate social commu­ni­ca­tion and play beha­viors in high risk infants.


The rese­arch design was a multiple base­line design across five parent-child dyads. The inter­ven­tion consisted in twelve 1‑hour coaching sessions deli­vered by a Board Certified Beha­vior Analyst (BCBA®), followed by a 1 and 3‑month follow-up session.

Child parti­ci­pants were between 12 and 16 months of age and comprised three girls and two boys, while the primary parent parti­ci­pant of each dyad was the child’s biolo­gical mother. Three of the five children were an “only-child”, while two were “high-risk siblings” (they had an older sibling with a confirmed ASD diagnosis).


Α BCBA® conducted all coaching sessions follo­wing a Beha­vior Skills Trai­ning (BST) protocol incor­po­ra­ting instruc­tion, model­ling, rehearsal and feed­back into each session. At the end of each session, specific goals were selected for parents to prac­tice during the upco­ming week. Topics were framed using Skinner’s analysis of verbal beha­vior (Skinner, 1957) with target beha­viors inclu­ding verbal operants such as mands, tacts and echoics, as well as imita­tion and play skills.


For data coll­ec­tion, three primary and four secon­dary varia­bles were measured. Primary varia­bles included parental and infant beha­viors. Parental target beha­viors were: (1) the number of lear­ning oppor­tu­ni­ties the parent presented by provi­ding the infant with an oppor­tu­nity i) to respond to a discri­mi­na­tive stimulus, ii) to mand for an item or acti­vity, iii) to imitate a motor or vocal response, and iv) to respond to a clear instruc­tion. Infant target beha­viors included: (1) the frequency of eye contact directed towards the parent and (2) the frequency of respon­ding to the lear­ning oppor­tu­nity presented by the parent.

Parental fidelity of imple­men­ta­tion was assessed, as well as social validity.


The outcomes with regard to eye-contact demons­trated the most signifi­cant increase out of all three infant target beha­viors, with a mean increase of 40% across all five infants and results main­tai­ning at the 3‑month follow-up.

Infants’ respon­si­vity to lear­ning oppor­tu­ni­ties also showed a signi­fi­cant increase of 41% on average compared to base­line across all infants. The effect size esti­ma­tors for children respon­si­vity, children eye contact and parent beha­vior indi­cated a large or very large impro­ve­ment. Addi­tio­nally, all five infants showed a decrease in autism symptoms and an increase in appro­priate acqui­si­tion beha­viors within the 12-week inter­ven­tion period. However, four of the five infants still received a diagnosis of ASD between 18 and 22 months of age.

Social vali­dity assess­ments were also conducted during the 3‑month follow-up and showed that the inter­ven­tion was widely accep­table by parents, with 96% of ques­tions rating the inter­ven­tion as either posi­tive or very positive.


The aim of the present study was to assess the effi­cacy and accep­ta­bi­lity of a pre-emptive beha­vi­oral inter­ven­tion for infants at risk of ASD. The five infants showed appro­xi­m­ately a 10-month gain of skills that would not be accounted for by matu­ra­tion alone. The goal of pre-diagno­stic inter­ven­tion is not to elimi­nate the future diagnosis of ASD but rather to maxi­mize the poten­tial of infants who are showing early signs of ASD and alter their deve­lo­p­mental trajec­tory. The study is unique in that it provides direc­tions on how to deliver such an inter­ven­tion buil­ding capa­city among beha­vior analysts and allo­wing more fami­lies to access pre-diagno­stic services, ther­e­fore impro­ving the well-being of indi­vi­duals. Beha­vior analysts are trained to iden­tify soci­ally signi­fi­cant target beha­viors and should begin treat­ment regard­less of the presence or absence of an ASD diagnosis and as soon as the first concerns around the child’s deve­lo­p­ment are expressed.

The results of the present study add to the massive lite­ra­ture that has examined the effect of beha­vi­oral inter­ven­tions on a child’s outcomes showing that Applied Beha­vior Analysis (ABA) is the scien­tific basis of the treat­ment of choice for ASD. Addi­tio­nally, the present study provides support to the exis­ting lite­ra­ture in the use of low-inten­sity parent-mediated inter­ven­tion, which can be imple­mented by any parent or entry-level profes­sional, under the guidance of a quali­fied profes­sional (i.e., BCBA®).


Original article here.

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2. ABA- based interventions for individuals with Down’s syndrome

Summary of the study
Katerina Dounavi
Clinical director of Melody Learning Center, lecturer at school of education, Queen’s University Belfast.

More than forty years of rese­arch have well docu­mented that inter­ven­tions based on the science of Applied Beha­viour Analysis (ABA) are the best available choice for children with Autistic Spec­trum Disor­ders (ASD). This can be claimed since ABA-based inter­ven­tions have proven to effec­tively develop social and commu­ni­ca­tion skills, reduce inap­pro­priate beha­viours (e.g., aggres­sive beha­viours, stereo­typed beha­viours), and faci­li­tate meaningful inclu­sion. (e.g., New Zealand Guide­lines Group, 2008; Surgeon General, 1999).

The fact that evidence-based inter­ven­tions driven from ABA have shown to be effec­tive for children with ASD has often lead to the miscon­cep­tion that ABA is synony­mous to a “therapy for autism” and that it can only be used to design inter­ven­tions for children with ASD. As some authors have already pointed out (e.g., Dillen­burger & Keenan, 2009), this is a myth. ABA is the science that focuses on soci­ally signi­fi­cant human beha­viour (Cooper, Heron, & Heward, 2007), thus it can and should be the basis for the design of an effec­tive inter­ven­tion for impro­ving any aspect of human beha­viour (e.g., incre­asing commu­ni­ca­tion, social, or academic skills and decre­asing inap­pro­priate beha­viours such as aggres­sive or self-inju­rious beha­viours) for any popu­la­tion (e.g., adults with aphasia, children with ASD, adults lear­ning a second language, children with Down’s syndrome, etc.) In the last decades, and as the scien­tific evidence for the effec­ti­ve­ness of ABA-based inter­ven­tions for indi­vi­duals with ASD has drama­ti­cally increased, there is a parallel increase of rese­arch acti­vity in rela­tion to the effec­ti­ve­ness of ABA-based inter­ven­tions for other popu­la­tions. This rese­arch acti­vity has included children with Down’s syndrome, children with lear­ning disor­ders, indi­vi­duals with eating disor­ders, indi­vi­duals exhi­bi­ting gambling beha­viours, adults with depres­sion, post-stroke aphasia pati­ents, and nume­rous other areas (e.g. respec­tively, Athens, Vollmer, Sloman, & St Peter Pipkin, 2008; Sidman & Kirk, 1974; Seiver­ling, Williams, Sturmey, & Hart, 2012; Nastally, Dixon, & Jackson, 2010; Kanter, Callaghan, Landes, Busch, & Brown, 2004; Baker, LeBlanc, & Raetz, 2008).

More in detail, rese­arch on the effec­ti­ve­ness of specific proce­dures derived from the science of ABA for teaching diffe­rent skills to children with Down’s syndrome have yelled consis­t­ently posi­tive results. In 1973, Dalton, Rubino, and Hislop showed how the imple­men­ta­tion of a token economy system could effec­tively produce impro­ve­ments in the perfor­mance of 13 children with Down’s syndrome with ages ranging from 6 to 14 years old. In 1978, Farb and Throne put in place a trai­ning program with the aim to improve the gene­ra­lized mnemonic perfor­mance (i.e., memory) of a 7 years old girl with Down’s syndrome. In 1989, Drash, Raver, Murrin, and Tudor compared three proce­dures aiming to increase the early vocal responses of 25 children with Down’s syndrome and concluded that light- dimming and scree­ning combined with posi­tive rein­force­ment produced the most signi­fi­cant increases. In a study published in 1993 (Lalli, Browder, Mace, & Brown) inclu­ding a 10 years old boy with Down’s syndrome, the authors proved the effec­ti­ve­ness of a beha­viour-analytic proce­dure in decre­asing students’ problem beha­viour and concurr­ently incre­asing their verbal skills during natural class­room acti­vi­ties taking place in a public school. In a study conducted with five children among whom two boys with Down’s syndrome, McComas, Thompson, and Johnson (2003) showed how func­tional analysis metho­do­logy, one of the most rigo­rously tested metho­do­lo­gies in beha­viour analysis, can prove effec­tive in iden­ti­fying the under­lying causes of problem beha­viors and thus assist in putting effec­tive inter­ven­tions in place. For a detailed review on the use of analysis, assess­ment, and inter­ven­tions derived from ABA to treat chal­len­ging beha­viours shown by indi­vi­duals with Down’s syndrome, the reader is encou­raged to visit Feeley and Jones’ (2006) study. Finally, some other authors (Athens, Vollmer, Sloman, & St Peter Pipkin, 2008) demons­trated how to reduce vocal stereo­ty­pies of an 11-year old boy with Down’s syndrome and autism. The list of studies testing the effec­ti­ve­ness of beha­viour-analytic proce­dures with children, teen­agers, and adults with Down’s syndrome is not infi­nite yet. But there are already robust rese­arch results indi­ca­ting the bene­fi­cial effects that can be gathered from using ABA-based inter­ven­tions for this popu­la­tion. The above mentioned studies consti­tute only a small number out of the entire exis­ting lite­ra­ture; thus, rese­ar­chers, prac­ti­tio­ners, parents, and policy-makers are encou­raged not to rely only on these sources. A detailed inves­ti­ga­tion should be conducted in order to iden­tify all the available evidence up to this moment in rela­tion to the use of ABA with indi­vi­duals with Down’s syndrome.


  • Athens, E. S., Vollmer, T. R., Sloman, K. N., & ST Peter Pipkin, C. (2008). An analysis of vocal stereo­typy and thera­pist fading. Journal of Applied Beha­vior Analysis, 41, 291 297.
  • Baker, J. C., LeBlanc, L. A., & Raetz, P. G. (2008). A beha­vi­oral concep­tua­liza­tion of aphasia. The Analysis of Verbal Beha­vior, 24, 147- 158.
  • Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied beha­vior analysis. 2nd edition. Pearson, Merrill: Pren­tice Hall.
  • Dalton, A. J., Rubino, K. A., & Hislop, M. W. (1973). Some effects of token rewards on school achie­ve­ment of children with Down s syndrome. Journal of Applied Beha­vior Analysis, 6, 251–259.
  • Drash, P.W., Raver, S.A., Murrin, M.R., & Tudor, R.M. (1989). Three proce­dures for incre­asing vocal response to thera­pist prompt in infants and children with Down syndrome. American Journal on Mental Retar­da­tion 94, 64–73.
  • Dillen­burger, K. & Keenan, M. (2009). None of the As in ABA stands for autism: Dispel­ling the myths. Journal of Intellec­tual & Deve­lo­p­mental Disa­bi­lity. 34, 193–195.
  • Farb, J. & Throne, J. M. (1978). Impro­ving the gene­ra­lized mnemonic perfor­mance of a Down s syndrome child. Journal of Applied Beha­vior Analysis, 11, 413–419.
  • Feeley, K. M. & Jones, E. A. (2006). Addres­sing chal­len­ging beha­viour in children with Down syndrome: The use of applied beha­viour analysis for assess­ment and inter­ven­tion. Down Syndrome Rese­arch and Prac­tice 1, 64–77.
  • Kanter, J. W., Callaghan, G. M., Landes, S. J., Busch, A. M., & Brown, K. R. (2004). Beha­vior Analytic Concep­tua­liza­tion and Treat­ment of Depres­sion: Tradi­tional models and recent advances. The Beha­vior Analyst Today, 5, 255–274.
  • Lalli, J. S., Browder, D. M., Mace, F. C., & Brown, D. K. (1993). Teacher use of descrip­tive analysis data to imple­ment inter­ven­tions to decrease students problem beha­viors. Journal of Applied Beha­vior Analysis, 26, 227–238.
  • Nastally, B. L., Dixon, M. R., & Jackson, J. W. (2010). Mani­pu­la­ting slot machine prefe­rence in problem gamblers through contex­tual control. Journal of Applied Beha­vior Analysis, 43, 125–129.
  • New Zealand Guide­lines Group. The effec­ti­ve­ness of applied beha­viour analysis inter­ven­tions for people with autism spec­trum disorder. Syste­matic Review. Wellington; 2008
  • Sidman, M. & Kirk, B. (1974). Letter Rever­sals in Naming, Writing, and Matching to Sample. Child Deve­lo­p­ment, 45, 616–625.
  • Surgeon General. (1999). Mental health: A report of the Surgeon General. U.S. Public Health Service. Retrieved on 21/11/2012 from http://​profiles​.nlm​.nih​.gov/​p​s​/​r​e​t​r​i​e​v​e​/​R​e​s​o​u​r​c​e​M​e​t​a​d​a​t​a​/​N​N​B​BJC. Seiver­ling, L., Williams, K., Sturmey, P. & Hart, S. (2012). Effects of beha­vi­oral skills trai­ning on parental treat­ment of children s food selec­ti­vity. Journal of Applied Beha­vior Analysis, 45, 197–203.

Great thanks to Kate­rina Dounavi for writing this report and giving permis­sion to post it on the MLC website.

Thanks to Xenia Wein­mann for trans­la­ting the report from English to German.

Thanks a lot for allo­wing this study to be summa­rized, trans­lated and published to: Kathy Hill, busi­ness manager of JABA

For the summary and the trans­la­tion a heart­felt thank you to Anne Burzinski.

Down­load the summary as PDF
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3. An experimental analysis of facilitated communication (FC)

Summary of the study
Barbara B. Montee, Raymond G Miltenberger, David Wittrock (North Dakota State Universität)

Faci­li­tated commu­ni­ca­tion is a method of physical assis­tance to help an intellec­tually impaired person to commu­ni­cate. The faci­li­tator supports the hand of the client, who uses his index finger to point to letters on a letter board or to type on en elec­tronic keyboard. Accor­ding to Biklen and others, faci­li­tated commu­ni­ca­tion enables indi­vi­duals with autism and those with other deve­lo­p­mental disa­bi­li­ties to commu­ni­cate. They were suggesting that they are not intellec­tually impaired. Other rese­ar­chers, such as Wheeler, Jacobson, Paglieri, Schwartz and others, argued hat faci­li­tator control of the typing was the most plau­sible expl­ana­tion for the messages typed during faci­li­tated commu­ni­ca­tion sessions. To prove this there were proceeded a lot of experiments. 

Expe­ri­ments in which clients who had demons­trated unex­pected literacy were shown pictures. They were asked to type the names of the pictures using faci­li­tated commu­ni­ca­tion support this assump­tion. These expe­ri­ments demons­trate that the name of the picture was typed in correctly only when the faci­li­tator was shown the same picture. When the faci­li­tator was shown a diffe­rent picture or no picture at all, the client-faci­li­tator pair never typed in the correct name. Biklen in return criti­cized the results by supporting that too many expe­ri­mental arran­ge­ments can make clients anxious, that testing destroys trust between the pair, that neither the faci­li­tator nor the pair had received enough trai­ning and that the parti­ci­pants had aphasia.

Adres­sing Biklen’s commen­ta­ries, in the present study Montee et al analysed 7 client-faci­li­tator pairs that had been using faci­li­tated commu­ni­ca­tion for 6 to 18 months. The clients were adults diagnosed with mode­rate or severe mental retar­da­tion with secon­dary diagnoses such as cere­bral palsy, epilepsy, autism, atten­tion deficit hyperac­ti­vity disorder or perva­sive deve­lo­p­mental disorder. They used two evalua­tion formats: describing acti­vi­ties and naming pictures. 

They addressed the criti­cism raised by Biklen former in the follo­wing ways: 1) They used client-faci­li­tator pairs that already had a lot of expe­ri­ence with faci­li­tated commu­ni­ca­tion. 2) A base­line condi­tion was always conducted to estab­lish successful commu­ni­ca­tion and to make sure there are no word-finding problems. 3) The clients did not have to exactly name an object. It was also okay to describe it. Als rich­tige Antwort wurde auch eine rich­tige Umschrei­bung gezählt. 4) Anxiety and escape beha­viours were measured in every expe­ri­mental session. If such beha­viour was measured, the expe­ri­mental data were not used. 5) All sessions were conducted in their usual loca­tions, at the usual time and with the usual faci­li­tator in order to reduce the poten­tial for anxiety or other nega­tive reac­tions to the expe­ri­ment. 6) Any time that the faci­li­tator was not comfor­table for any reason, the expe­ri­mental trial was terminated. 

The basic expe­ri­mental mani­pu­la­tion was the control of the facilitator’s access to infor­ma­tion about an acti­vity or a picture. There were three expe­ri­mental condi­tions: known (the faci­li­tator had know­ledge of the acti­vity or the picture), unknown (the faci­li­tator did not have know­ledge of the acti­vity or picture) and false infor­ma­tion (the faci­li­tator was given false infor­ma­tion about the acti­vity of picture). 

In the acti­vity format the client engaged in a fami­liar acti­vity for about 5 minutes. Examples of acti­vi­ties included drin­king coffee, looking at a maga­zine, eating soda crackers, playing cards and putting toge­ther a puzzle. Imme­dia­tely after the acti­vity the rese­ar­cher either told the faci­li­tator what the acti­vity was (known), provided no infor­ma­tion (unknown) or gave the faci­li­tator infor­ma­tion on an acti­vity that did not take place (false). In the picture format the client and faci­li­tator were shown the same picture (known), only the client was presented a picture (unknown) or the pictures presented to the client and faci­li­tator were diffe­rent. After the expe­ri­mental trials the faci­li­ta­tors were asked to fill out a ques­ti­on­n­aire that assessed the degree to which they believed that they influenced the faci­li­tated commu­ni­ca­tion during the expe­ri­mental sessions. 

The results show no great diffe­rence between the two evalua­tion formats naming a picture and describing an acti­vity. The percen­tage of correct responses was high for all clients in the known condi­tion and was at or near zero in the unknown and false condi­tion. The results for the faci­li­tator ques­ti­on­n­aire show that the faci­li­ta­tors esti­mated that the clients performed better when the faci­li­tator had know­ledge of the correct answer, but they also esti­mated that the clients answered correctly more often than not in false and unknown condi­tions. They were convinced that the clients largely controlled the commu­ni­ca­tion during sessions. 

Due to these results three main conclu­sions were drawn from the study. First, consis­tent with prior rese­arch, faci­li­tated commu­ni­ca­tion did not lead to commu­ni­ca­tion that came from the client. Second, the faci­li­ta­tors controlled the commu­ni­ca­tion even though all of them believed that the client was autho­ring the messages. Regar­ding the issue of faci­li­tator control it is note­worthy that there was a 23% refusal rate to answer in the unknown condi­tion compared to refusal rates of 3% and 7% in the known and false condi­tion. Also, when the faci­li­tator did not have know­ledge of the picture or acti­vity, it took longer for most pairs to respond than in the other two condi­tions. A third conclu­sion is that anxiety and avoid­ance beha­viours can not be counted as a reason for the failure to find faci­li­tated commu­ni­ca­tion. Only three of 320 trials were termi­nated due to such beha­viour. Finally the fourth conclu­sion is that there was no diffe­rence in responses to the acti­vity and picture scena­rios. Ther­e­fore word-finding diffi­cul­ties are no reason to ques­tion the vali­dity of the results. 

These results and the results of previous studies come to the conclu­sion that faci­li­tated commu­ni­ca­tion is not a valid means of impro­ving commu­ni­ca­tion. Ther­e­fore the faci­li­tated commu­ni­ca­tion should not be used any more. Those who continue using faci­li­tated commu­ni­ca­tion should consider the follo­wing impli­ca­tions: First, every message produced through faci­li­tated commu­ni­ca­tion should be veri­fied through other means such as verba­liza­tions or sign language. Second, the client and legal guar­dian should be informed of the risk of the facilitator’s influence when using faci­li­tated commu­ni­ca­tion. Third, it is important that other exis­ting ways to commu­ni­cate are not ignored in favor of faci­li­tated communication. 

Finally, faci­li­tated commu­ni­ca­tion for the first time led to the belief that persons with disa­bi­li­ties have more normal intel­li­gence than thought. They were treated with more dignity and respect by their care­gi­vers and family. Agen­cies must ensure that staff members continue to treat indi­vi­duals with dignity and respect in the absence of faci­li­tated communication. 

For reading the Compre­hen­sive version and for More infor­ma­tion, please down­load JABA’S study.(JOURNAL OF APPLIED BEHAVIOR ANALYSIS, 1995,282189–200, NUMBER2 (SUMMER195))

Thanks a lot for allo­wing this study to be summa­rized, trans­lated and published to: Kathy Hill, busi­ness manager of JABA 

For the summary and the trans­la­tion a heart­felt thank you to Anne Burzinski.

Down­load the summary as PDF
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4. ABA for older children — Supporting evidence

Summary of the study
By Dr. Katerina Dounavi, BCBA‑D

Applied Beha­viour Analysis (ABA) is the applied branch of the science called Beha­viour Analysis. The term “Applied” refers to the appli­ca­tion of the findings of the scien­tific study of beha­viour to soci­ally rele­vant targets. ABA has proven effec­tive with diffe­rent popu­la­tions and in diffe­rent areas, such as in trea­ting indi­vi­duals with autism and adults with aphasia, in the area of busi­ness orga­niza­tion, in desig­ning effec­tive inter­ven­tions for children with lear­ning disa­bi­li­ties, in trea­ting phobias, etc. 

One of the prin­cipal areas where ABA has demons­trated its effec­ti­ve­ness is in teaching skills to and trea­ting beha­vioural problems of children with autism. There is an exten­sive scien­tific lite­ra­ture based on rese­arch conducted during the last 40 years appro­xi­m­ately, which supports ABA as the ideal inter­ven­tion for indi­vi­duals with autism (e.g., Kuppens & Onghena, 2011; Eldevik, Hastings, Hughes, Jahr, Eike­seth, & Cross, 2009; McEa­chin, Smith, & Lovaas, 1993; Reichow & Wolery, 2009), demons­trates its supe­rio­rity over eclectic treat­ments (Dillen­burger, 2011a; Howard, Sparkman, Cohen, Green, & Stanislaw, 2005; Osborne & Reed, 2008; Zachor, Ben-Itschak, Rabi­no­vich, & Lahat, 2007) and shows that parental stress declines after the inter­ven­tion (Dillen­burger, Keenan, Gallagher, & McEl­hinney, 2004). 

Most of this rese­arch is conducted with pre-school and school-age children but in the last years there is a growing number of studies focu­sing on treat­ment of adole­s­cents, youths and adults with autism. The results are equally inte­res­ting for proving that ABA can be effec­tive inde­pendently of the individual’s age. One miscon­cep­tion that has up to date guided govern­ment poli­cies related to funding but fort­u­na­tely not clinical prac­tice and scien­tific rese­arch is that ABA is effec­tive only with children of pre-school age. There is now enough supporting evidence suggesting that if an inter­ven­tion based on ABA starts before the age of 4 years, the outcomes are higher than starting later. This conclu­sion has led to the false belief that ABA is not effec­tive in children of school age, adole­s­cents, youths and adults. There is no scien­tific evidence up to date clnclu­ding that inter­ven­tion should be stopped at a specific age due to its lack of effec­ti­vity. Instead there is growing rese­arch evidence for the oppo­site conclu­sion, posi­tive and valuable gains. For example, McEa­chin, Smith and Lovaas (1993) indi­cate that it took six years for one of the best-outcome children to reach typical functioning. 

The miscon­cep­tion that ABA is not effec­tive after the age of 7 can be very preju­di­cial to thou­sands of children, adole­s­cents, youths and adults, as decis­ions related to their treat­ment directly influence their quality of life and the quality of life of their broader social network. Limi­ting a bene­fi­cial inter­ven­tion due to a miscon­cep­tion that is not evidence-based would lead to a child acqui­ring fewer skills than possible, main­tai­ning non-desired and non-adap­tive beha­viours in his reper­toire due to the lack of specia­lized treat­ment, showing decreased inde­pen­dent skills, redu­cing his possi­bi­li­ties of inte­gra­tion, etc. 

Given the above, there is a clear need for conduc­ting more rese­arch studies showing how methods based on the science of ABA can be effec­tive with older children, adole­s­cents, youths and adults. In the follo­wing para­graphs, we will do a very brief revi­sion of the exis­ting body of lite­ra­ture supporting the effec­ti­ve­ness of ABA with children older than 7 years old, adole­s­cents, youths and adults. Also, we will provide some data on brain deve­lo­p­ment as it has been described in studies that use neuro-imaging, in order to give a clear picture of the lear­ning possi­bi­li­ties of an indi­vi­dual inde­pendently of his age. 

Several review articles and meta-analyses have been published summa­ri­zing the large body of lite­ra­ture (thou­sands of studies) supporting ABA-based inter­ven­tion as the most effec­tive one for indi­vi­duals with autism (e.g., Eike­seth, 2009; Howard, Sparkman, Choen, Green, & Stanislaw, 2005; Koegel, Koegel, Harrower, & Carter, 1999; Krantz & McCl­an­nahan, 1993; Lovaas, 1987). These studies describe effec­tive proce­dures deve­loped across a wide range of skills and problem beha­viours, such as language and commu­ni­ca­tion (e.g., Carr & Durand, 1985; Durand, & Carr, 1992; Hago­pian, Fisher, Sullivan, Acquisto, & LeBlanc, 1998), daily living skills (e.g., Horner & Keilitz, 1975), academic skills and school inte­gra­tion (e.g., Koegel, Koegel, Hurley, & Frea, 1992; Daly & Martens, 1994; McComas, Wacker, & Cooper, 1996), reduc­tion of stereo­ty­pical beha­viour (e.g., Dounavi, 2011) and other. 

In these studies, parti­ci­pants are indi­vi­duals with autism of all ages, from pre-school children to adults, so demons­t­ra­ting the effec­ti­ve­ness of the ABA-based proce­dures inde­pendently of the individual’s age. One of the most inte­res­ting studies offe­ring support to ABA-based inter­ven­tion at a later age, is the one conducted by Harris and Hand­leman (2000) in which the authors clearly state that great bene­fits were observed follo­wing ABA inter­ven­tion with older children as well. Addi­tio­nally, there is a large number of small sample sized studies, which have demons­trated the effec­ti­ve­ness of ABA to teach specific skills in diffe­rent areas and reduce problem beha­viours of various types to adole­s­cents, youths and adults with autism. Here, we will only mention some of them. Haring, Roger, Lee, Breen and Gaylord-Ross (1992) demons­trated the effec­ti­ve­ness of a social network inter­ven­tion for youths with mode­rate and severe disa­bi­li­ties, inclu­ding autism, by measu­ring the frequency, number and appro­pria­teness of social inter­ac­tions. There has been used a multiple base­line design and showed that the inter­ven­tion was successful in incre­asing the quan­tity and quality of inter­ac­tions and promo­ting friend­ships. Other studies have also demons­trated effec­tive ABA-based proce­dures for youth popu­la­tion (e.g., Haring, Roger, Lee, Breen, & Gaylord-Ross, 1984; McMorrow & Foxx, 1986; Gena, Krantz, McCl­an­nahan, & Poulson, 1996; McGee, Krantz, Mason, & McCl­an­nahan, 1983). 

School age children between the age of 7 and before the start of adole­s­cence have also been signi­fi­cant in proving the importance of follo­wing an evidence-based inter­ven­tion, ABA. For example, Taylor & Levin (1998) demons­trated the effec­ti­ve­ness of a promp­ting tech­nique for a 9‑year-old student with autism to make verbal initia­tions about his play acti­vi­ties. Blew, Schwartz and Luce (1985) described how older children with autism were taught commu­nity skills, such as crossing the street, making purchases, and checking out books from the library, and other. 

During these years, most of the children that have already followed an ABA-based inter­ven­tion during preschool age are now in need of an ABA-inter­ven­tion that will guide their inte­gra­tion in main­stream schools, design effec­tive indi­vi­dua­lized educa­tional programmes for social inter­ac­tions with peers and teach academic skills in an effec­tive way. Frequently, adole­s­cents are in need of similar support provided through ABA-based services. There are plenty of examples of rese­arch studies that focus on the acqui­si­tion of these skills, such as how to train shadow teachers to support the inte­gra­tion of children with autism in the main­stream class­room (Monahan & Bryer, 2004). 

Studies focu­sing on adole­s­cents have been nume­rous. They have demons­trated signi­fi­cant effects of ABA-based inter­ven­tions to improve skills acqui­si­tion and reduc­tion of problem beha­viour (e.g., Miller & Neuringer, 2000). For example, Delano (2007) showed how to improve language perfor­mance of adole­s­cents with Asperger Syndrome. Palmen, Didden and Arts (2008) showed how to improve ques­tion asking in high-func­tio­ning adole­s­cents with autism. 

The rese­arch about adults is also exten­sive and focuses on diffe­rent areas, such as sign language (Schepis, Reid, Fitz­ge­rald, Faw, VanDenPol, & Welty, 1982) inde­pen­dent life skills [Haring, Kennedy, Adams, & Pitts-Conway, 1987), job skills for laboural inte­gra­tion [Smith & Coleman, 1986], reduc­tion of aggres­sive beha­viour (Hago­pian & Adelinis, 2001; Thompson & Iwata, 2001; Lalli, Mace, Wohn, & Livezey, 1995) and other. 

Regar­ding brain deve­lo­p­ment, one of the argu­ments often used to support the non-evidence based view that funding should be stopped at a certain age is that after early child­hood the human brain is not flexible and, ther­e­fore, further deve­lo­p­ment is negli­gible. Here, we briefly summa­rize the scien­tific conclu­sions that broadly show that ABA-based inter­ven­tion brings very signi­fi­cant gains to indi­vi­duals with autism of all ages. Recent rese­arch using advanced imaging tech­no­lo­gies is consis­t­ently showing that brain deve­lo­p­ment conti­nues well at least into adole­s­cence and early adult­hood (e.g., Horska, Kauf­mann, Brant, Naidu, Harris, Barker, 2002). Namely, Thompson, Giedd, Woods, MacDo­nald, Evans and Toga (2000) reported the crea­tion of networks of growth patterns in the deve­lo­ping human brain in children aged 3–15 years, which seems to decline only after puberty. Sowell, Thompson, Tessner and Toga (2001) mapped continued post adole­s­cent brain growth. Keshavan, Diwadkar, DeBellis, Dick, Kotwal, Rosen­berg, Sweeney, Minshew andd Pette­grew (2002) assessed age-related changes in the size and signal inten­sity of the corpus callosum of indi­vi­duals aged 7–32 years and found that signal inten­sity decreased during child­hood and adole­s­cence and stabi­lized in young adult­hood. Further­more they showed that the size of the corpus callosum increases through young adult­hood indi­ca­ting conti­nuing maturation. 

Based on the above mentioned empi­rical evidence, many scien­tific, govern­ment and profes­sional agen­cies and orga­niza­tions have concluded that ABA-based proce­dures repre­sent best prac­tices for indi­vi­duals with autism, are highly recom­mended and should be publicly funded. Examples of such agen­cies and orga­niza­tions in the United States and other count­ries (e.g. Canada, Australia, the UK, etc.) are the National Insti­tute of Mental Health, the National Acade­mies Press, the Asso­cia­tion for Science in Autism Treat­ment, Autism Speaks, the Orga­niza­tion For Autism Rese­arch, the Surgeon General of the United States, the New York State Depart­ment of Health and other (Dillen­burger, in press). 

Taking into conside­ra­tion the medium and long-term bene­fits for a commu­nity from the deve­lo­p­ment of an individual’s skills and analy­zing the cost bene­fits for tax-payers, local autho­ri­ties, states and count­ries by effec­tive inter­ven­tions (Knapp, Romeo, & Beecham, 2009; Moti­wala, Gupta, Lilly, Ungar, & Coyte, 2006). Any decision regar­ding funding inter­ven­tions should be data-driven, should take into account ethical conside­ra­tions and should guarantee that the best known scien­tific prac­tice up to date is deli­vered to indi­vi­duals needing it. An example of a cost-benefit analysis is the fact that in the USA savings of appro­xi­m­ately $200,000 per child by the age of 22 years and $1,000,000 by the age of 55 years were regis­tered follo­wing beha­viour analytic inter­ven­tion (Dillen­burger, in press).

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For the trans­la­tion a heart­felt thank you to Anne Burzinski.


5. The Emperor’s new clothes: Eclecticism in autism treatment

Summary of the study
(Karola Dillenburger, 2011; Research in Autism Spectrum Disorder 5 (2011) 1119–1128, originally published online 22 January 2011; DOI 10.1016/j.rasd.2010.12.008)

Although ABA is more and more reco­gnized as the scien­tific way to go, many Euro­pean govern­ments prefer an eclectic model as they argue that it is more children-centred and prag­matic. This paper shows why ABA is truly prac­tical and child-centred. This article shows how false infor­ma­tion leads to less effec­tive treat­ments being chosen rather than supporting evidence-based treat­ments such as ABA, which is actually uniform, prac­tical and child-centric.

This article first describes diffe­rences in govern­ment recom­men­da­tions under A, then both the eclectic approach (see B) as well as ABA (see C) declared to then explore reasons for the diffe­rent recom­men­da­tions of govern­ments (see D).

People with autism spec­trum disorder are impaired in social inter­ac­tion, their flexi­bi­lity and in their beha­vior (APA, DSM-IV-TR, 2000). Autism can only be diagnosed until now, despite a wide range of rese­arch, if possible affected persons are observed in their beha­viour and their refe­rence persons are inter­viewed (Keenan, Dillen­burger, Doherty, Byrne & Gallagher, 2010).

As the number of children with autism has risen drama­ti­cally (Fombonne, 2005). The costs are as high as 3.2 million $ per indi­vi­dual if he or she is not properly treated (CDC, 2010), That’s why it’s important to find out the most successful treat­ment method. Mental health and the quality of life of affected fami­lies can also suffer from autism (Dillen­burger, Keenan, Doherty, Byrne, & Gallagher, 2010).

Even though, it is crucial to accept diffe­rences that will continue to exist, one must also educate and inter­vene further (Baron-Cohen, 2008; Helt et al., 2008; Jordan, 2008; Lamb, 2009; Markram, Rinaldi, & Markram, 2007). Although these diffe­rences must ther­e­fore be accepted, it is appro­priate at the same time to continue to deal with them. Unesco Sala­manca State­ment (CSIE, 2010) shows that inclu­sion is the best possi­bi­lity to show accep­tance. How can children with autism learn skills that are required for social inter­ac­tion (CSIE, 2010; Oxoby, 2009)?
There are many inter­ven­tions that origi­nally come from various profes­sions (Archart-Trei­chel, 2010). Further­more, there are parents who have deve­loped their own inter­ven­tion. Some of them are described in books some require exclu­sive trai­ning.

A: Recom­men­da­tions from govern­ments
Many govern­ments have discussed the most successful inter­ven­tions, results vary (NSP, 2009, Mudford et al., 2009; Task Group on Autism, 2002; Task Force on Autism, 2001; Dunlop et al., 2009; Wein­mann et al., 2009; Perry & Condillac, 2003). The recom­men­da­tions are diffe­rent. Some recom­mend treat­ments based on ABA, some prefer treat­ment to be eclectic.

Govern­ment recom­men­da­tions in North America
Clinical and social results, as well as finan­cial effi­ci­ency in North America suggest that inter­ven­tions based on prin­ci­ples of beha­vior are the way to go (Cooper, Heron, & Heward, 2007). They justify their decision with clinical and social evidence (Howar, Sparkman, Cohen, Green, &Amp; Stanislaw, 2005; Reichow & Wolery, 2009; Zachor, Ben-Ichak, Rabi­no­vich & Lahat, 2007); Foster & Mash, 1999) and the finan­cial effec­ti­ve­ness of the method (Knapp et al., 2007). Syste­matic reviews of rese­arch lite­ra­ture demand that health insu­rances cover diagnosis and treat­ment of autism, inclu­ding ABA (ATAA, 2010). Many states have already signed it while others are still waiting for intro­duc­tion. The same is true for Canada. Many US states have already complied with this demand, and more are about to be intro­duced. A similar situa­tion exists in canada.

Recom­men­da­tions from Euro­pean govern­ments
The govern­ments in most of Europe, except Norway, promote the eclectic approach which allows for a range of inter­ven­tions, as there is no defi­ni­tive evidence that supports one treat­ment over the other (Task Force Autism, 2001, p.117). What is the eclectic approach? Many diffe­rent inter­ven­tions are selected from diffe­rent available inter­ven­tions, accor­ding to iden­ti­fied needs (Glad­well 2010). The approach is viewed as flexible and child-centred. Ther­e­fore, it is finan­ci­ally supported in Europe.

B: The eclectic approach
Why is this child-centric and prag­matic approach now being criti­cized with various treat­ment options? Why isn’t the eclectic approach also advo­cated in North America?
In order to under­stand this and the conse­quence of the eclectic approach, various points of view need to be examined:

  • What to think about:
    An eclectic model inte­grates new methods, but it won’t develop them themselves.
  • Are eclectic treat­ments successful?
    Some methods in an eclectic model are evidence-based; some might even be contro­ver­sial (Jacobson et al, 2005; Perry, 2000; Perry & Condillac, 2003; Tweed, Connolly, & Beau­lieu, 2009).
  • What is the benefit of a combined treat­ment method?
    Whether a combi­na­tion of diffe­rent approa­ches is more promi­sing than the sole appli­ca­tion of indi­vi­dual approa­ches is ques­tionable. Howard et al (2005) found, however, that the appli­ca­tion of a form of teaching based on ABA is more promi­sing than a treat­ment that is eclectic (Osborne & Reed, 2008).
  • What are the theo­re­tical foun­da­tions on which eclectic approa­ches are based?
    Some of the treat­ment approa­ches have a theo­re­tical basis; However, this often contra­dicts each other. Ther­e­fore, an eclectic approach has no common conclu­sive theo­re­tical basis.
  • Can staff learn how to use eclectic treat­ments? Since the successful approa­ches often require a master’s degree and are very exten­sive, a person cannot possibly be suffi­ci­ently profi­cient in all treat­ment methods.

C: Applied Beha­vior Analysis (ABA)
Propon­ents of the eclectic approach often say ABA should be inte­grated into an eclectic model, but see ABA as too one-sided in itself. This is because they often equate ABA with a parti­cular method, such as discrete trial trai­ning or treat­ment accor­ding to Lovaas. 

What is ABA?
“In mact, ABA is not a specific method of treat­ment but” a scien­tific approach that seeks to uncover envi­ron­mental condi­tions that reliably influence soci­ally signi­fi­cant beha­viors and, based on this, a method of beha­vioural change. Deve­loped that prac­ti­cally imple­ments these disco­veries. ” (Cooper et al., 2007, p3). ABA can be described as a way of teaching. ABA has shown that it can bring about signi­fi­cant beha­vioural changes in both Indi­vi­duals and the Group.
Once ABA is applied, know­ledge of the basics of beha­vior is used. Since one cannot behave (even feelings are and bhavior), know­ledge of beha­vior should be used to address soci­ally rele­vant beha­vior (Baer, Wolf, & Risley, 1968; Newman, 1992; 4. 1998).
For this to happen, the target beha­vior must first be defined. This is done by talking to the person concerned and their care­gi­vers. The target beha­viour is soci­ally or pedago­gi­cally important (Lamb, 2009). It is always appro­priate and indi­vi­du­ally tail­ored for each child, also curri­cula may be used as a base (ACE, 2011). Second, the func­tion of beha­vior is analyzed by looking for contin­gen­cies, ther­e­fore, appro­priate inter­ven­tions can be deve­loped (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994). As a result, effec­tive teaching stra­te­gies can be created. After­wards, a base­line is estab­lished and inter­ven­tion is intro­duced while more data is coll­ected to be able to ensure the effec­ti­ve­ness of inter­ven­tion or to be able to adjust them to new requi­re­ments. As the lessons are intro­duced, Data will continue to be coll­ected to assess effec­ti­ve­ness or adjust the teaching accordingly. 

Once the beha­vior has been learned by the person with autism, the goal is to gene­ra­lize it. This means that the person with autism learns to show the newly acquired beha­vior in other people, in other situa­tions and over long periods of time. 

As ABA is built on the basis of beha­viour and indi­vi­du­ally tail­ored to the needs of children, the number of possible teaching stra­te­gies is unli­mited. However, some of them, such as discrete trial teaching or natural envi­ron­ment teaching, are parti­cu­larly popular as they have proven to be reliably successful. All teaching methods have in common that they are based on a func­tional analysis of the beha­vior and are indi­vi­du­ally tail­ored to each child (Iwata et al., 1982/1994)

Is ABA effec­tive?
There exist a lot of scien­tific papers about the evidence of ABA (Eldevik et al., 2010) and there are also more and more meta-analyses. Some people who are favoring the eclectic approach claim nevert­heless that one can’t tell the effec­ti­ve­ness of ABA without Rando­mised Controlled Trials (RCT). RCTs are also referred to as the gold stan­dard of studies due to clear state­ments on a ques­tion. At the same time, however, these advo­cates do not require RCTs for the eclectic approach (Morris, 2009). At the same time they don’t demand RCTs for the eclectic approach (Keenan & Dillen­burger, 2011). But RCTs were desi­gned to test drugs not medical proce­dures. So it is diffi­cult to demand them. None­theless, there are some RCTs that have compared ABA with parts of eclectic treat­ments ” ABA was more effec­tive in all of these in chan­ging a range of beha­viors (Birdn­brauer & leach, 1993; Cohen, Amarine-Dickens, & Smith, 2006; Eike­setz, 2009; Eike­setz, Smith, Jahr & Eldevik, 2007; Eldevik et al., 2009, 2010; Howard et al., 2005; Magiati, Charman, & Howlin, 2007; Rogers & Vismara, 2008; Shein­kopf & Siegel, 1998; Smith, Groen & Wynn, 2000; Zachor et al., 2007). 

When using ABA-based proce­dures it is neces­sary to include a well quali­fied beha­vior analyst to plan a child-centred and indi­vi­dua­lized treat­ment. Beha­vior Analysis is a profes­sion that is reco­gnized inter­na­tio­nally (BACB, 2010). 

Criti­cism from propon­ents of the eclectic approach to ABA
Despite all of that, ABA is still criti­cized. It’s said that ABA is a single approach that is infle­xible and rigid in compa­rison to an eclectic approach (McConkey 2007). his opinion is based on misin­ter­pre­ta­tion and bad know­ledge about ABA (Jordan 2001) that doesn“t consider that ABA is a unified parsi­mo­nious approach that is flexible, indi­vi­dua­lized and firmly rooted in data-based, scien­tific rese­arch evidence. 

D: Reasons for diffe­rences in reports and guide­line
When a child is diagnosed with Autism, parents are faced with a “forced choice”. Either they go for ABA, which is seen as to rigid (Jordan, 2008) or as best prac­tise (Chiesa, 2005). Or they mix diffe­rent inter­ven­tions toge­ther in an eclectic approach, which is seen as more flexible (McConkey et al., 2007) or incon­sis­tent and inef­fec­tive (Howard et al, 2005). 

A reason for diffe­rent opinions about which treat­ment to use is more often based on “work expe­ri­ence” than on scien­tific findings (DfES, 2002; NIASA 2003). But when spen­ding that amount of taxpayers” money it should be best prac­tice to base decis­ions on rese­arch than on opinions. And if experts are included in the decision making they should be highly know­led­geable. Unfort­u­na­tely, all of the reports from Euro­pean govern­ments are written without consul­ting adequa­tely quali­fied experts in ABA. The lack of that was pointed out several times, without resul­ting effec­tive change (Glad­well 2010, Mattaini, 2008; PEAT, 2008). Ther­e­fore, guide­lines are inac­cu­rate.
Only the Scot­tish govern­ment (Dunlop et al., 2009) reacted on this kind of criti­cism (about inac­cu­rate and out-dated descrip­tion of ABA, as well as mentio­ning no recent rese­arch papers) from parents so far. And it has with­drawn their initial recom­men­da­tions. Now they revise their report with the help of a well-known beha­vior analyst. 

Cate­gory mistakes
ABA is not one specific kind of inter­ven­tion. Instead it is a whole amount of diffe­rent approa­ches based on prin­ci­ples of beha­vior. Unfort­u­na­tely, many Euro­pean govern­ments make the mistake to consider ABA to be one method (Chiesa, 2005; Cooper et al., 2007; Dillen­burger & Keenan, 2009. In fact ABA is a child-centred and prag­matic approach, which could also be called eclectic (Leider­mann, 2010) as a beha­vior analyst uses a “broad range of inter­ven­tions resources and deve­lops and adjusts indi­vi­du­ally tail­ored addi­tional inter­ven­tions on the basis of conti­nuous data coll­ec­tion.” In reality it isn’t called eclectic as ABA is not applying inter­ven­tions by chance, but is to be planned carefully. Selected inter­ven­tions are based on conti­nuously recorded data to be able to adjust to momen­ta­rily problems. 

Autismus-spec­trum disorder and its treat­ment has since often been rese­ar­ched, a lot of money has been spent. Even if there is a lot of rese­arch about Autism Spec­trum Disorder and its treat­ment and even if a lot of money is spent, there are studies who report that parents are twice as likely to expe­ri­ence psycho­lo­gical problems (Keenan et al, 2002), stress (Burrows 2010) as well as some uncer­tainty about which treat­ment to use (Lamb, 2009). 

Why govern­ments don’t admit flaws
So why don’t govern­ments admit flaws and mistake in their reports for the sake of parents and children? The reason might be, that it is diffi­cult to admit that a lot of time and money and belief has been spent on less effec­tive treat­ment in the past, or that it is diffi­cult to admit a marginal know­ledge of beha­vior analysis. 

This paper tried to reveal reasons for diffe­rent opinions from American and Euro­pean govern­ments regar­ding the most effec­tive treat­ment of autism. When paying more atten­tion on these reasons in the future it might be possible to deliver best treat­ment possible for children with autism. And ther­e­fore, to increase the quality of life for affected fami­lies as well as to decrease asso­ciated costs (decre­asing the amount of help required in special school by trea­ting a child with ABA, mounted to 208 500$ per child for 18 years) (Chasson et al., 2007). 

Summing up, the eclectic approach is a fancy name for pseu­do­sci­en­tific ways of working, ABA is science. 

To read the full study, please click here.

For the permis­sion to post this study we thank Dr Karola Dillen­burger BCBA‑D; Clinical Psycho­lo­gist (HPC) .


6. Normal Peer Models and children with autism’s learning

Summary of the study
(Andrew L. Egel, Gina S. Richman, and Robert L. Koegel , Normal Peer Models and autistic
children´s learning, Journal of Applied Behavior Analysis, 141,3–12, Nr. 1, Spring 1981)

As federal legis­la­tion has set up passages asking for educa­tion in least rest­ric­tive envi­ron­ment. there is considerable rese­arch regar­ding the possi­bi­lity of inte­gra­ting children with autism in a “normal school” (Russo & Koegel, 1977). Can children with autism benefit from the inte­gra­tion by successfully model­ling their peers without disa­bi­li­ties? There is a vast variety of rese­arch demons­t­ra­ting that peer models lead to changes in the beha­vior of children without autism (Elliot & Vasta, 1970; Hartup & Coates, 1967; Igelmo, 1976; Koba­sigawa, 1968; Miran, 1975; Bandura & Kupers, 1964; Clark, 1965; Debus, 1970; Ridberg, Parke & Hethe­rington, 1971; Bandura, Grusec, & Menlove, 1967; Bandura & menlove, 1968).

Ther­e­fore, it might be considered that similar results are true for children with disa­bi­li­ties. Several studies showed that responses could be brought under stimulus control of neuro-typical children (Apol­loni, Cooke, & Cooke, 1976; Barry & overman, 1977; Peterson, Peterson, & Scriven, 1977; Rauer, Cooke, & Apol­loni, 1978; Talkington, Hall, & Altman, 1973). Es wurde eben­falls unter­sucht, inwie­fern es hilf­reich ist, wenn Kinder mit Autismus solche ohne Autismus beobachten.The effec­ti­ve­ness of children with autism obser­ving others has been studied as well. A case history by Coleman and Stedman (1974) described the successful model­ling of voice loud­ness and increased label­ling voca­bu­lary.
Other studies couldn’t affirm this finding and suggested that it cannot be held for all types of children with autism. E.g. stimulus over-selec­ti­vity in low-func­tio­ning children with autism may account for a failure in lear­ning through obser­va­tion. This might get less for higher-level children with autism (Varni, Lovaas, Koegel & Everett, 1979).

This study tested if at least some children with autism benefit from expo­sure to neuro-typical peers.

4 children with autism between 5–10 years (mental age 3–5 years) took part in this study. They made general overall progress but had diffi­cul­ties in acqui­ring certain tasks in their class­room curri­culum.
Not all of them were able to speak and most of them produced echo­lalia. All of them showed low to mode­rate amount of self-stimu­la­tory beha­vior and some threw tantrums. Most of them had considerable problems in appro­priate play, social beha­vior and self-help skills. 

Peer models
Three neuro-typical children from neigh­bou­ring class­rooms, as well as one very high func­tio­ning child with autism (Child 3, Task 2), who weren’t older than two years of their attri­buted subjects, were selected as role models as they could answer all tasks correctly and were respon­ding to adults request. 

The expe­ri­ment took place in an area of the class­room. Sessions took between five and fifteen minutes with 10–40 trials per session. There was a session at least every three days and with a maximum of two sessions per day. The second author, and an in beha­vior modi­fi­ca­tion expe­ri­enced under­gra­duate who didn’t know about the hypo­thesis of this study were the therapists.

Target beha­vior
The target beha­vior was some acti­vity from the curri­culum the child had diffi­culty in acqui­ring (discri­mi­na­ting between two colors, shapes, use of prepo­si­tions, affir­ma­tive yes/no picture). 

Base­line (no mode­ling)
The base­line was measured through the thera­pist asking the child to perform a task (e.g. “give me the circle”, “give me blue”). Correct responses were rein­forced (e.g. “good boy”) while incor­rect responses were followed by a verbal “no”. If the child was incor­rect for about three succes­sive trials, prompt fading proce­dures (e.g. manu­ally guiding the child’s hand) were used. 

Mode­ling condi­tions
Iden­tical teaching proce­dures as in base­line, but the thera­pist worked first with the model child who responded correctly and who got rein­forced imme­dia­tely. The model sat beside the child with autism or oppo­site the child who was instructed to look at the stimulus mate­rial. The child with autism was asked to look at the work mate­rial, while the “model child” solved the tasks correctly and was imme­dia­tely praised as a result. After­wards, the thera­pist presented the same stimuli mate­rial and instruc­tion to the child with autism. Conse­quences for incor­rect answers were the same as in base­line. Task counted as acquired if the child answered correct 8 out of 10 times without need of prompting. 

Addi­tional no model trials
The proce­dure was the same as in base­line. The reason for this trial was to control if the child with autism would answer conse­quently correct on 30 trials without a model two days later. 

Data recor­ding and relia­bi­lity
Each test run was assessed by the thera­pist as correct or incor­rect. The thera­pist scored the answer and an inde­pen­dent observer moni­tored the score. There was a relia­bi­lity of 100%. 

Base­line showed very low levels of correct respon­ding (24–50% correct respon­ding (50% equals chance level)). Correct Responses increased very fast in model­ling condi­tion. The children achieved 8 out of 10 correct answers after a maximum of 20 trials. Some of them even achieved 100% correct answers (10 out of 10). 

These results were successfully repeated at the no-model­ling condi­tion. The percen­tage stabi­lised or even increased at the rate of model condition. 

Peer model­ling increased perfor­mance on discri­mi­na­tion tasks for parti­ci­pa­ting children with autism. 

Children with autism differ in pre-teaching and in deve­lo­p­mental level. Parti­ci­pa­ting children were not as deeply impaired than that in Varni et al. (1997) study who were at the level of severe retar­da­tion and had high self-stimu­la­tory beha­vior. Parti­ci­pa­ting children in contrast were good in imita­ting, had large recep­tive language abili­ties and were acqui­ring a small func­tional expres­sive voca­bu­lary. Ther­e­fore, it might be neces­sary to expose children with autism to some pre-teaching before using peer model­ling.
Parti­ci­pa­ting children had an intel­li­gence quotient of 50–87 that might be the precon­di­tion for bene­fit­ting from model­ling. A lot of children with autism func­tion at that level. 

Simi­la­rity of peer models to learner
Children with autism might benefit from same age children compared to adults (Barry & Over­mann, 1977; Hicks 1965; Kazdin 1974; Korn­haber & Schroeder 1975). Age and sex of the model and the observer may influence the proba­bi­lity of the model being imitated (Bandura, Ross, & Ross, 1963; Hartup & Lougee, 1975; Rose­krans 1967). Ther­e­fore, lear­ning didn’t take place when adults were model­ling (base­line).

Model­ling children was novel to the children with autism and this kind of lear­ning might have increased the sali­ency of the required responses and rein­forcer. When it is diffi­cult to direct children with autism respon­ding to rele­vant cues, this type of teaching might ther­e­fore be a possi­bi­lity for the children. 

Class­room impli­ca­tions
The results show that it may be effec­tive to put modera­tely impaired children with autism into class­rooms with peers without autism (two children of the study are in a normal class­room in the mean­time and seem to keep on imita­ting peers).
The language ability, affects of children with autism on normal peers, overall func­tio­ning level, teacher know­ledge of applying modi­fi­ca­tion tech­ni­ques may influence successful inte­gra­tion and need to be studied therefore. 

As model­ling peers seems to be an effec­tive way to learn for children with autism, it has to be evaluated deeper in future. 

Please note that every effort has been made to condense and provide a broad over­view of this rese­arch. However in order not to lose the key infor­ma­tion some of the infor­ma­tion in this summary has been copied directly form the original article. All credits of the summary whether directly worded or re-worded are solely given to the rese­ar­chers. Please contact your ABA/VB consul­tant before imple­men­ting any of the proce­dures conducted in this paper on your child.

To read the full study, please down­load the orginal study from JABA.

Down­load the summary as pdf

PDF Download

Thanks a lot for allo­wing this study to be summa­rized, trans­lated and published to: Kathy Hill, busi­ness manager of JABA

For the summary and the trans­la­tion a heart­felt thank you to Caro­line Diziol.


7. Using Aberrant Behaviors as reinforcers for children with autism

Summary of the study
(Marjorie H. Charlop, Patricia F. Kurtz, Fran Greenberg Casey, veröffentlicht in JABA Summer 1990, 239 163–181, Nr. 2 Using Aberrant Behaviors as reinforcers for autistic children)

Finding rein­forcers for children with autism can be diffi­cult as they are often not inte­rested in toys or social rein­forcers. Using food as rein­force­ment can be proble­matic because of diffi­cul­ties in admi­nis­tra­tion and satiation.

Aberrant beha­viors as stereo­typy (Lovaas, Koegel, Simmons and Long 1972) are a highly preferred acti­vity and might ther­e­fore be used as a rein­forcer (Premack 1959). First studies showed initial support (Hung 1978, Sugai and White 1986, Wolery, Kirk and Gast 1985). No nega­tive side effects such as an increase of stereo­ty­pical beha­vior. (Wolery 1985)
Many children with autism spec­trum disorder also exhibit delayed echo­lalia (Lovaas, Varni, Koegel, Lorsch, 1977, Prizant and Rydell, 1984) and perse­ve­ra­tive beha­vior (Epstein, Taumban, Lovaas, 1985; Lovaas, Newsom, Hickman, 1987) that may possess rein­for­cing functions.

This study that consists of 3 expe­ri­ments evaluates the effi­cacy of using aberrant beha­vior (stereo­typy, delayed echo­lalia, perse­ve­rate beha­vior) as rein­forcers. The study also considers possible nega­tive side effects as the increase of aberrant beha­vior in detail.

Expe­ri­ment 1 compares:

    • the use of stereotypy
    • with the use of food/edibles and condi­tions of
    • varied conse­quences (food or stereo­typy) (as Egel 1981 suggested that using more than one rein­forcer in a varied format might raise their effectiveness).

Expe­ri­ment 2 compares

    • the use of delayed echolalia
    • with the use of food/edibles and condi­tions of
    • condi­tions of varied conse­quences (food or delayed echolalia).

Expe­ri­ment 3 compares the use of perse­ve­rate behavior

    • with the use of
    • with the use of food/edibles and condi­tions of
    • and condi­tions of varied conse­quences (food or perse­ve­rate behavior.)


Parti­ci­pants were diagnosed as autistic. They attended biweekly therapy session. They attended at an after school beha­vior modi­fi­ca­tion program for a least six months. They were described as unmo­ti­vated to learn (and enga­ging in aberrant behavior).

Setting and Tasks
The room had several toys and educa­tional stimuli. The room could be seen by obser­vers through a one-way mirror. Every child got three tasks that were from their curri­culum and that they haven’t had mastered for several months.

The effec­ti­ve­ness of the rein­forcers (food, aberrant beha­vior, varied conse­quences) was assessed in a multi-element design. Every expe­ri­mental condi­tion was presented at the most three times one after another. In addi­tion, the total number of meetings was varied in order to measure changes in perfor­mance over time.


The selected tasks were presented in a typical 15 min work session. Base­line was coll­ected over a 6 ? to 8 month period (expe­ri­ment 1 & 2) and in the weeks before the expe­ri­ment 3 for 1–2 times per week.

Expe­ri­mental condi­tions
Every child had two 15 min expe­ri­mental sessions per week (2–5 days apart). The expe­ri­menter sat oppo­site the child and presented tasks when he got eye contact and the child was sitting atten­tively. The order of the presen­ta­tion varied. When a child gave the correct response, the expe­ri­menter rein­forced with praise AND the chosen conse­quence. When a child gave the incor­rect response or didn’t respond within 5 s, he presented a verbal “No”. A correc­tion trial was presented after two conse­cu­tive incor­rect trials, these were not included in the data analysis. The expe­ri­menter recorded the answer of the child after each task. Beyond that the occur­rences of the aberrant beha­vior was recorded.

Conse­quence condi­tion
Direct obser­va­tions and discus­sions with parents and thera­pists reve­aled child specific aberrant beha­vior that was chosen as consequence.

    • Food: The child could choose from preferred food items Aberrant beha­vior: The child was allowed to engage in aberrant beha­vior (stereo­type, delayed echo­lalia, perse­ver­ance beha­vior) for 3–5 seconds after a correct answer. The child was prompted, if neces­sary Varied conse­quence: Child could choose food or aberrant behavior.

Expe­ri­mental Obser­va­tion
After obser­vers trai­ning there was an observer behind the one-way mirror who counted the occur­rence of the aberrant beha­vior (besides of the aberrant condi­tion) stereo­type and off-task beha­viors with a 10 second partial interval scoring procedure.

Post-expe­ri­mental session obser­va­tion
The child was observed in a 15 min post-session obser­va­tion either in another work session with a diffe­rent thera­pist or in a free play situation.

Inter-rater relia­bi­lity was calcu­lated for at least 33 % of base­line and expe­ri­mental sessions as well as for stereo­typy and (off task) behavior.

Expe­ri­ment 1


4 autistic boys between 6 and 9 years (mental age between 2 and 4 years) took part in the expe­ri­ment. All of them were at least minimal verbal and showed diffe­rent stereo­typy, off-task beha­vior, tantrums and aggression.

Tasks and Proce­dure
The children had 3 diffe­rent tasks to master and received three conse­quence condi­tions (food, stereo­type, varied).

Addi­tional analysis
One child was chosen for more detailed analysis. He (and his aggres­sion?) got observed for 30 instead of 15 minutes. His trained mother observed his stereo­typy also at home before and during the expe­ri­ment. Inter-rated relia­bi­lity was between 92 and 100 %.

Results and discus­sion
The most effec­tive rein­forcer for all the children was stereo­typy. The food conse­quence was the least successful and was even below the base­line for one child. The varied conse­quence was also rein­for­cing for 2 children.

When compa­ring the number of stereo­typy, it didn’t increase during sessions with stereo­typy as a conse­quence and was less for two children compared to the food condi­tions. This is also true for the post-session obser­va­tions where stereo­typy increased less for stereo­typy conse­quences than for food. Addi­tional analysis of one child showed that aggres­sion and off-task beha­vior increased in post-session obser­va­tion. This might be the reason as stereo­typy decreased aggres­sion in the aberrant beha­vior condi­tion, incre­asing task-perfor­mance at the same time. The mother’s data showed that there were no side effects and that the stereo­typy beha­vior decreased at home. The decrease in stereo­ty­pical beha­viour at home must be viewed with caution, as this trend could be seen even before the expe­ri­ment began. However, the mother said she had not intro­duced any inno­va­tions that could explain this trend.

Expe­ri­ment 1 showed that stereo­typy as a rein­forcer was more effec­tive than food and than varied conse­quences. Further­more, it did not show any side effects but might have decreased inap­pro­priate behavior.

Expe­ri­ment 2
Delayed echo­lalia seems to have rein­for­cing quali­ties (Lovaas et al, 1977; Prizant & Rydell, 1984) and was ther­e­fore examined.


Subjects and Tasks
3 verbal boys between 8 and 10 years parti­ci­pated in this expe­ri­ment and had to work on three (one boy on two) tasks. Ther­e­fore, work session took 10–15 minutes each. The proce­dure was the same as of expe­ri­ment 1, except that the conse­quence was the encou­ra­ge­ment of delayed echo­lalia instead of stereo­typy. Inter-rater-relia­bi­lity was between 99–100%.

Results and discus­sion
Delayed echo­lalia was the most effec­tive rein­forcer for two children. But the varied condi­tion was very similar. One child had slightly better results for varied condi­tion than for delayed echo­lalia. Food was also slightly effec­tive more effec­tive than base­line for two children and brought worse effects than the base­line for one child.

There was hardly any diffe­rence between stereo­typy and off-task beha­vior as well as delayed echo­lalia in expe­ri­mental sessions compared to post expe­ri­mental work sessions.
One child had increases in stereo­typy and off-task beha­vior in the free play situa­tion another had increases in delayed echo­lalia in the free play situa­tion. This might have occurred because of the lack of struc­ture and super­vi­sion in free play, as it didn’t appear to be a func­tion of a parti­cular expe­ri­mental condi­tion. Detailed analysis for one child had similar results. There was a decrease in delayed echo­lalia at home. This is a trend that started before treat­ment and must be inter­preted with caution.

This expe­ri­ment also showed that delayed echo­lalia may act as an effec­tive reinforcer.

Expe­ri­ment 3
The effec­ti­ve­ness of perse­ve­ra­tion with specific object as a rein­forcer was compared to edibles and stereo­typy (instead of varied).


3 autistic boys between 6 and 10 (mental age 3 to 5) took part in the expe­ri­ment. They were allowed to access the perse­ve­r­ated object for 3 to 5 seconds upon a correct response, detailed data coll­ec­tion took place from all parents. All three boys were continued to be watched at home by their trained parents.
Inter-rater-relia­bi­lity was between 93 and 98 %.

Results and discus­sion
Perse­ve­rate beha­vior was the most effec­tive rein­forcer. For some children, stereo­typy was similar effec­tive. Food was close or beneath the base­line.
As in expe­ri­ment 1 and 2, there were no nega­tive side effects. The rese­ar­ched beha­vior increased in the begin­ning, but decreased below base­line later on.

General discus­sion

Aberrant beha­vior could be shown as effec­tive rein­forcers for diffi­cult task. Using aberrant beha­vior as a rein­forcer doesn’t seem to have nega­tive side effects (see results of them at home and after session).
Stereo­typy has some sensory and percep­tual proper­ties (rincover and newsom, 1985) that may serve as primary rein­forcers as they might stimu­late the central nervous system (Lovaas et al 1987).
The same might be true for delayed echo­lalia and perse­ve­rate beha­vior as shown by Rincover 1978 and Rincover et al (1979) found rein­for­cing visual, audi­tory and proprior-recep­tive sensory conse­quences that main­tain stereo­typic beha­vior in children with autism.
When children with autism get older, their low-level stereo­typy is replaced by perse­ve­ra­tion and echo­lalic speech (Epstein et al 1985). Ther­e­fore Lovaas (1987) and Epstein (1985) suggested that the same patterns may result in main­tai­ning the latter beha­vior. (they are repe­ti­tive, complex stimuli are produced, and they inter­fere with appro­priate behavior).


The expe­ri­ment showed that instead of trying to elimi­nate aberrant beha­vior, the rein­for­cing proper­ties of them might be used to result in better lear­ning.
And as the expe­ri­ment showed, there were no nega­tive side effects. The children even accepted the taking away of the object quite easily and were eager to work. This might ther­e­fore be a good alter­na­tive in beha­vior change programs.

Limi­ta­tions of the study are that some children with autism show hardly any stereo­ty­pical beha­vior, or beha­vior that is very diffi­cult to control by the thera­pist. No long-term effects have been observed.

Nevert­heless it might be a good method to moti­vate children in the future.

Please note that every effort has been made to condense and provide a broad over­view of this rese­arch. However in order not to lose the key infor­ma­tion some of the infor­ma­tion in this summary has been copied directly form the original article. All credits of the summary whether directly worded or re-worded are solely given to the rese­ar­chers. Please contact your ABA/VB consul­tant before imple­men­ting any of the proce­dures conducted in this paper on your child.

To read the full study, please down­load the original study from JABA.

Down­load the summary as pdf
PDF Download

Thanks a lot for allo­wing this study to be summa­rized, trans­lated and published to: Kathy Hill, busi­ness manager of JABA

For the summary and the trans­la­tion a heart­felt thank you to Caro­line Diziol.


8. Randomized, controlled trial of an intervention for toddlers with autism.

Summary of the study
(Geraldine Dawson, Sally Rogers, Jeffrey Munson, Milani Smith, Jamie Winter, Jessica Greenson, Amy Donaldson and Jennifer Varley Pediatrics 2010;125;e17-e23; originally published online Nov 30, 2009; DOI: 10.1542/peds.2009–0958)

In 1987 Lovaas’s study on an early beha­vi­oral inter­ven­tion for children with autism found that 49% of the parti­ci­pants were able to attend a regular class room setting in a main­stream school and had made signi­fi­cant IQ gains. This finding led to an increased inte­rest into the effects of early inter­ven­tion and raised ques­tions about early plas­ti­city in children with autism. Despite subse­quent early inter­ven­tion studies which have found gains in IQ for a subgroup of children, ques­tions regar­ding the effi­cacy of early inter­ven­tion persist, due to lack of metho­do­lo­gical rigor. Authors of meta-analysis of effi­cacy of early beha­vi­oral inter­ven­tion argue that stronger evidence that early beha­vi­oral inter­ven­tions yield better outcomes than stan­dard care is required. 

Aims of the study:
This study, The Early Start Denver Model, was a rando­mized controlled trial of early inten­sive beha­vi­oral inter­ven­tion. The authors hypo­the­sized that the early inter­ven­tion would result in signi­fi­cant impro­ve­ments in cogni­tive abili­ties of young children with autism. There were three major diffe­rences in this study in compa­rison to previous early beha­vi­oral inter­ven­tion studies. The first was that a high level of metho­do­lo­gical rigor. This includes gold- stan­dard diagno­stic criteria, rando­miza­tion, compre­hen­sive outcome measures conducted by naive exami­ners and measures of fide­lity of imple­men­ta­tion of a manua­lized inter­ven­tion was main­tained. The second was that all children who took part in the study were less than 30 months old at entry. Thirdly was a compre­hen­sive early beha­vi­oral inter­ven­tion for infants to preschool-aged children with ASD that inte­grates applied beha­vior analysis (ABA) with deve­lo­p­mental and rela­ti­onship-based approa­ches. The inter­ven­tion was provided in a toddler’s natural envi­ron­ment (the home) and was deli­vered by trained thera­pists and parents. In our study, children received struc­tured inter­ven­tion at high intensity. 

Pati­ents and Methods:

Study Proce­dures:
Forty-eight children between 18 and 30 months of age, diagnosed with autistic disorder or perva­sive deve­lo­p­mental disorder (PDD), not other­wise speci­fied (NOS), were randomly assi­gned to 1 of 2 groups: (1) the ESDM group received yearly assess­ments, 20 hours week of the ESDM inter­ven­tion parent trai­ning, and parent deli­very for 5 or more hours/week of ESDM, in addi­tion to whatever commu­nity services as chosen by the parents (2) the assess-and-monitor (A/M) group received yearly assess­ments with inter­ven­tion recom­men­da­tions and refer­rals for inter­ven­tion from commonly available commu­nity provi­ders in the greater Seattle region. 

Parti­ci­pants were recruited through pedia­trics centers, hospi­tals pre-schools and local autism orga­niza­tions. Inclu­sion criteria included age below 30 months at entry, met the criteria for autism diagnosis and willing­ness to parti­ci­pate in a two year intervention. 

Autism diagno­stic measures included; the autism diagno­stic inter­view-revised, autism diagno­stic obser­va­tion sche­dule, mullen sacles of early lear­ning, vine­land adap­tive beha­vior scales and repe­ti­tive beha­vior scale. 

Parti­ci­pants were placed into 2 groups on the basis of IQ and gender to ensure compa­rable IQ and gender ratios between groups. The inter­ven­tion groups did not differ at base­line in seve­rity of autism symptoms based on ADOS scores, chro­no­lo­gical age, IQ, gender, or adap­tive behaviors. 

Inter­ven­tion Groups:

ESDM Group:
The ESDM group was provided with inter­ven­tion by trained thera­pists for 2‑hour sessions, twice per day, 5 days/ week, for 2 years. A detailed inter­ven­tion manual and curri­culum were used. One or both parents were trained from the primary thera­pist twice monthly on the prin­ci­ples and specific tech­ni­ques of the ESDM were taught. Parents were asked to ESDM teaching stra­te­gies during daily acti­vi­ties and to keep track of the number of hours during which they used these stra­te­gies. Teaching stra­te­gies are consis­tent prin­ci­ples of ABA, such as the use of operant condi­tio­ning, shaping, and chai­ning. Each child’s plan is indi­vi­dua­lized. There is a strong parent-family role respon­sive to each family’s unique charac­te­ristics. The programs were super­vised graduate-level thera­pists who had a minimum of 5 years expe­ri­ence provi­ding early inter­ven­tion for young children with autism. On-going consul­ta­tion was provided by clinical psycho­lo­gist, speech-language patho­lo­gist, and deve­lo­p­mental beha­vi­oral pedia­tri­cian. An occu­pa­tional thera­pist provided consul­ta­tion as needed. The inter­ven­tion was deli­vered was deli­vered by thera­pists who typi­cally held a bache­lors degree, received 2 months of trai­ning from the lead thera­pist and met weekly with the lead therapist.

A/M Group:
Children who were randomly assi­gned to the A/M group received compre­hen­sive diagno­stic evalua­tions, inter­ven­tion recom­men­da­tions, and commu­nity refer­rals at base­line and again at each of the 2 follow-up assess­ments. Fami­lies were provided with resource and reading mate­rials at base­line and twice a year throug­hout the study. The children received an average of 9.1 hours of 1:1 therapy and average 9.3 hours per week of group inter­ven­tion across the 2‑year period during which the inter­ven­tion study was conducted. 

Data analysis:
The effect of ESDM inter­ven­tion was assessed by using repeated-measures analysis of vari­ance, base­line scores with 1- and 2‑year outcome scores. The primary outcome measures were the MSEL and the VABS compo­site stan­dard scores. 

Secon­dary outcome measures were the ADOS seve­rity score, the RBS, MSEL, and VABS subscale scores, and changes in diagno­stic status (autistic disorder, PDD NOS, and no diagnosis). 

No serious adverse effects related to the inter­ven­tion were reported during the 2‑year period. 

Year 1 Outcome:
The ESDM group demons­trated an average IQ increase of 15.4 points compared with an increase of 4.4 points in the A/M group. The ESDM group improved 17.8 points on recep­tive language compared with a 9.8‑point impro­ve­ment in the A/M group. The groups did not differ in terms of adap­tive beha­vior. The groups did not differ in terms of their ADOS seve­rity scores or RBS total score after 1 year of intervention. 

Year 2 Outcome:
Two years after the base­line assess­ment, the ESDM group showed signi­fi­cantly improved cogni­tive ability. The ESDM and A/M groups signi­fi­cantly differed in terms of their adap­tive beha­vior. The ESDM group showed similar stan­dard scores at the 1- and 2‑year outcomes, indi­ca­ting a steady rate of deve­lo­p­ment, whereas the A/M group, on average, showed an 11.2‑point average decline. Thus, the A/M group’s delays in overall adap­tive beha­vior became greater when compared with the norma­tive sample. 

The A/M group showed average declines in stan­dard scores that were twice as great as those in the ESDM group in the domains of socia­liza­tion, daily living skills, and motor skills. The groups did not differ in terms of their ADOS seve­rity scores or RBS total score after 2 years of intervention. 

At intake the diagnosis in each group were not signi­fi­cantly diffe­rent. After two years the diagnosis improved for 29.2% of the children in the ESDM group but only improved for one (4.8%) child in the A/M group. However, the diagnosis changed from PDD NOS at base­line to autistic disorder at year 2 for 2 (8.3%) children in the ESDM group and 5 (23.8%) children in the A/M group. Thus, children who received ESDM were signi­fi­cantly more likely to have improved diagno­stic status at the 2‑year outcome compared with children in the A/M group. 

The outcomes of this study, which involve an increase in IQ scores of 17 points and signi­fi­cant gains in language and adap­tive beha­vior, compare favor­ably with other controlled studies of inten­sive early inter­ven­tion which deli­vered discrete trial intervention. 

Link to original study click here

For the permis­sion to post this study, great thanks to: American Academy of Pedia­trics: Brad Rysz

For the summary great thanks to: Miss Geor­giana Eliza­beth Barzey. 

For the trans­la­tion a heart­felt thank you to Miri Zoller.


9. Outcome of comprehensive psycho-educational interventions for young children with autism

Summary of the study
(Svein Eikeseth, Akershus University College)

Aims of the study:

This study evaluated the outcomes of twenty-five compre­hen­sive-psycho educa­tional rese­arch papers on early inter­ven­tion for children with autism. Of these twenty-five studies, three studies were about beha­vi­oral treat­ment, two studies evaluated TEACCH, and two studies evaluated the Colo­rado Health Sciences project. 

Search Method:

Three search methods were used to iden­tify the rele­vant outcomes of all the studies. The first method was the use of elec­tronic search engines. The second method inspected recent publi­ca­tions to confirm that the search engines had iden­ti­fied the most recent studies. Finally, rese­ar­chers known to be involved with the studies were cont­acted via email and asked to produce refe­rences of published and in press articles. 

Criteria for assig­ning scien­tific merit:

Outcome of these studies were graded accor­ding to their scien­tific value and the magni­tude of results docu­mented. Scien­tific merit was evaluated based on: diagnosis, study design, depen­dent varia­bles and treat­ment fide­lity. Four levels were used to describe scien­tific merit: 

Level 1:
This repre­sented the highest possible rating. 

A level 1 was assi­gned if the parti­ci­pants were diagnosed accor­ding to current inter­na­tional stan­dards, which includes the use of the ICD-10 and the DSM-IV. Also, the diagnosis must have been set by clini­cians who were inde­pen­dent of the study, or the diagnosis must have been based on well-rese­ar­ched diagno­stic instru­ments inclu­ding ADI‑R.

Study Design:
A level 1 was given to the design of the study if a rando­mized design was employed, that is, if parti­ci­pants have been assi­gned randomly to two or more study groups. 

Depen­dent Varia­bles:
A level 1 was assi­gned if intake and outcome measures assessed both intellec­tual and adap­tive func­tio­ning. The instru­ments used to assess intellec­tual and adap­tive func­tio­ning must be norma­lized and stan­dar­dized. The IQ score must be derived from both language / commu­ni­ca­tion skills as well as visual spatial or perfor­mance skills. In addi­tion, to ensure objec­ti­ve­ness of the assess­ments, blind or inde­pen­dent asses­sors must have conducted the assessments. 

Treat­ment Fide­lity:
A level 1 was assi­gned to treat­ment fide­lity if it was (a) directly assessed, or (b) treat­ment was described in treat­ment manuals. 

Level 2:
This repre­sented a mode­rate scien­tific merit.

Criteria for achie­ving Level 2 scien­tific merit was iden­tical to that of Level 1 except that the study design was not random, so each parti­ci­pant did not have an equal chance of being placed in either of the study groups. Group assign­ment would be based on, for example, parti­ci­pants’ geogra­phical loca­tion, parental choice, or avai­la­bi­lity of treat­ment personnel. These are examples of non-random group designs.

Level 3:
This repre­sented a low scien­tific merit. 

A level 3 was given for diagnosis if the diagnosis (based on the ICD-10 or DSM-IV criteria) was not blind or inde­pen­dent; or the diagnosis was not based on diagno­stic instru­ments, or if the diagnosis was inde­pen­dent or blind but not based on ICD-10 or DSM-IV (or DSM-III for older studies); or if the study failed to specify which diagno­stic system was used. 

Study Design:
A level 3 was given to retro­s­pec­tive (archival) studies with compa­rison groups, or single­case expe­ri­mental studies where outcome measures were assessed pre and post. 

Depen­dent Varia­bles:
A level 3 was assi­gned when intake and outcome measures did not assess both intellec­tual and adap­tive func­tio­ning, or measures were not norma­lized and standardized. 

Treat­ment Fide­lity:
Level 3 was given to treat­ment fide­lity if insuf­fi­cient assess­ment of treat­ment fide­lity, or treat­ment not based on treat­ment manuals 

Insuf­fi­cient Scien­tific Value — ISV:

This was assi­gned to studies where the eviden­tiary support was so low that outcome data gave insuf­fi­cient scien­tific meaning. 

Criteria for deci­ding magni­tude of results:

As with evalua­ting scien­tific merit, four levels were provided to evaluate the magni­tude of the treat­ment effects. Once again, Level 1 repre­sented the highest possible rating, and Level 4 repre­sented the lowest rating. 

Level 1:
Level 1 was given for the magni­tude of results, if signi­fi­cant group diffe­rences on IQ and adap­tive func­tio­ning (devia­tion or ratio scores) were reported. In addi­tion Level 1 was given, if the assess­ment included measures of empathy, perso­na­lity, school perfor­mance, friend­ship, and infor­ma­tion regar­ding diagno­stic changes. 

Level 2:
Level 2 status was provided for signi­fi­cant group diffe­rences on either IQ or adap­tive func­tio­ning (devia­tion or ratio scores). For both Level 1 and 2, the IQ measure must be based on language/communication skills in addi­tion to visual spatial or perfor­mance skills. 

Level 3:
Level 3 status was provided for signi­fi­cant group diffe­rences on deve­lo­p­mental (or mental) age, or signi­fi­cant group diffe­rences on assess­ment instru­ments that are not norma­lized stan­dar­dized (or signi­fi­cant group diffe­rences on improvement). 

Stufe 4:
Level 4 studies reported signi­fi­cant pre-post impro­ve­ments. In this review, only Levels 1–3 scien­tific evidence studies are evaluated accor­ding to magni­tude of treat­ment effect. Studies clas­si­fied with insuf­fi­cient scien­tific value are excluded because for metho­do­lo­gical reasons, they did not allow reliable conclu­sions regar­ding outcome to be drawn. 

Clas­si­fi­ca­tion of studies based on scien­tific merit and magni­tude of results:

For infor­ma­tion on each approach: TEACCH, The Denver Model and Applied Beha­vior Analysis, please down­load the PDF from this website (see link on bottom of this page). 

Level 1 Scien­tific Merit:
Of the three models only one study received a level 1 for scien­tific merit. This was conducted by Smith, Groen and Wynn (2000) and was desi­gned to evaluate ABA treat­ment. Results showed that the ABA treat­ment group scored signi­fi­cantly higher as compared to the parent trai­ning control group on intel­li­gence, visual-spatial skills, language and acade­mics, though not adap­tive func­tio­ning. However, as the study did not show a signi­fi­cant group diffe­rence on adap­tive func­tio­ning, it received a level 2 rating for magni­tude of results. 

Level 2 Scien­tific Merit:
Of the twenty-five studies that were evaluated, only four level 2 studies were iden­ti­fied and were all based on ABA treat­ment (Cohen, Amerine-Dickens, & Smith, 2006; Eike­seth, Smith, Jahr, & Eledevik, 2002, 2007; Howard, Sparkman, Cohen, Green, Stanislaw, 2005; Remington et al., 2007). Three of the studies showed that the parti­ci­pants in the ABA treat­ment groups scored signi­fi­cantly higher on intel­li­gence, language and adap­tive func­tio­ning as compared to compa­rison group children (Cohen et al., 2006; Eike­seth et al., 2002, 2007; Howard et al., 2005). As a result these studies received a level 1 for the magni­tude of the results. The Remington et al. study found that children in that ABA treat­ment group scored signi­fi­cantly higher as compared to children in the compa­rison group on intel­li­gence, but not on adap­tive func­tio­ning and language (as measured by stan­dard scores). Ther­e­fore, this study received Level 2 fir the magni­tude of the results rating. All four studies gained Level 2 scien­tific merit clas­si­fi­ca­tion because they lacked a rando­mized study design: three studies (Cohen et al., Howard et al., Remington et al.) based group assign­ment on parental preference. 

Level 3 Scien­tific Merit:
Eleven of the twenty-five studies received a level 3 rating. Two studies are based on the TEACCH model; (Mukaddes, Kaynak, Kinali, Besikci, & Issever, 2004; Ozonoff & Cath­cart, 1998) and both studies received Level 3 on the magni­tude of the results rating. Ozonoff and Cath­cart did not specify which diagno­stic system the children’s diagnosis was based on, whether or not the diagnosis was set inde­pendently, or whether any diagno­stic instru­ments was used. Also, number of one-to-one teaching sessions provided by the parents was unspe­ci­fied. This study also failed to employ a random assign­ment. The measures were not performed blind or inde­pendently, and did not include adap­tive func­tio­ning. Children in the treat­ment group improved signi­fi­cantly more over a period of months than those in the control group. The remai­ning nine studies evaluated ABA treat­ments (Andersen, Avery, DiPietro, Edwards, & Chris­tian, 1987; Birn­brauer & Leach, 1993; Eldevik et al., 2006; Lovaas, 1987; McEa­chin, Smith, & Lovaas, 1993; Magiati, Charman, & Howlin, 2007; Sallows & Graupner, 2005; Shein­kopf & Siegel, 1998; Smith, Buch, & Gamby, 2000; Weiss, 1999). The Lovaas (1987) and McEa­chin et al. (1993) studies received Level 3 scien­tific merit because intake measures did not include adap­tive functioning. 

Insuf­fi­cient scien­tific value:

Nine outcome studies were clas­si­fied as having insuf­fi­cient scien­tific value. Six studies evaluated ABA programs (Bibby et al., 2002; Handelman, Harris, Celbi­berti, Lille­heht, & Tomchek, 1991; Harris, Hand­leman, Gordon, Kris­toff, & Fuentes, 1991, Harris, Hand­leman, Kris­toff, Bass, & Gordon, 1990; Hoyson, Jamieson, Strain, 1984; Luiselli, Cannon, Ellis, Sisson, 2000), one evaluated TEACCH (Lord & Scho­pler, 1989), two evaluated the Colo­rado Health Science Program (Rogers & Dilalla, 1991; Rogers, Herbison, Lewis, Pantone, & Reiss, 1986). All studies used a pre-post design without a single-case control or compa­rison group. 


Only one study received Level 1 scien­tific merit (the highest possible rating) and four studies received Level 2 scien­tific merits. All these studies evaluated ABA treat­ment. Eleven outcome studies received Level 3 rating. Nine of the 11 studies evaluated ABA treat­ments and 2 studies evaluated TEACCH. Finally, nine outcome studies were clas­si­fied as having insuf­fi­cient scien­tific value. One evaluated TEACCH, two evaluated the Colo­rado Health Science Program, and six evaluated ABA

Evalua­ting magni­tude of treat­ment effects, four ABA studies received Level 1 rating showing that children recei­ving ABA made signi­fi­cantly more gains than control group children on stan­dar­dized measures of IQ, language and adap­tive func­tio­ning (Cohen et al., 2006; Eike­seth et al., 2002, 2007; Howard et al., 2005; Sallows & Graupner, 2005). Several studies also included data on maladap­tive beha­vior, perso­na­lity, school perfor­mance and changes in diagnosis. Three studies received Level 2 rating (Eldevik et al., 2006; Lovaas, 1987; Smith, Groen, & Wynn, 2000), demons­t­ra­ting that ABA treated children made signi­fi­cantly more gains than the compa­rison group on one stan­dar­dized measures of IQ or adap­tive func­tio­ning. Finally, five ABA studies and two TEACCH studies received Level 3 rating.

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’’. 

Future Direc­tion:

    • There is need for addi­tional outcome studies, parti­cu­larly those whose study designs are of level 1 standard.
    • Effec­tive treat­ment para­me­ters and mecha­nisms respon­sible for change need to be iden­ti­fied and should be prio­rity for ABA researchers.
    • Varia­bles that interact with or have an impact on outcomes should be iden­ti­fied. Treat­ment for children who respond less favor­ably needs to be established.
    • Further rese­arch evalua­ting the effi­cacy of bio-medical treat­ments combined with psycho-social treat­ment is required.
    • Rese­arch could examine the gene­ra­liza­tion and trans­por­ta­bi­lity of inter­ven­tions shown to be effi­ca­cious in controlled rese­arch settings to applied settings.
    • Rese­arch could be conducted to examine the effi­cacy of psycho-educa­tional treat­ments with older children and adults.
    • 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.


    • 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.
    • ABA can be effec­tive for children who are up to 7 years-of-age at intake.

Please note that every effort has been made to condense and provide a broad over­view of this rese­arch. However in order not to lose the key infor­ma­tion some of the infor­ma­tion in this summary has been copied directly form the original article. All credits of the summary whether directly worded or re-worded are solely given to the rese­ar­chers. Please contact your ABA/VB consul­tant before imple­men­ting any of the proce­dures conducted in this paper on your child.

Down­load the original study as PDF
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For the summary and the trans­la­tion a heart­felt thank you to Caro­line Diziol.

Thanks a lot for allo­wing this study to be summa­rized, trans­lated and published to: Kathy Hill, busi­ness manager of JABA

Great thanks for the permis­sion to post and trans­late to: Svein Eike­seth, Ph. D. Professor, NOVA Insti­tute for Children with Deve­lo­p­mental Disor­ders, www​.novaau​tism​.com, Phone: (+47) 33 61 42 97, (+47) 92 21 09 88, www​.novaau​tism​.com.

For the summary great thanks to: Miss Geor­giana Eliza­beth Barzey.

Respon­sible for the trans­la­tion: Silke Johnson


10. Movement analysis in infancy may be useful for early diagnosis of autism

Summary of the study


The idea that move­ment disor­ders play a role in autism has been debated. For example Rimland has argued the majo­rity of autistic indi­vi­duals are rela­tively unim­paired with regard to their gross motor skills capa­bi­li­ties and finger dexterity. Contrary autistic indi­vi­duals can be found to be parti­cu­larly coor­di­nated and dexte­rous. This has been espe­ci­ally noted in autistic children who build tower blocks higher than normal adults and can climb to extreme heights without falling. Accor­ding to Rimland this dismisses the notion that autism is or involves a move­ment disorder. 

However, Damasio, Maurer and Vilensky et al, found that autistic children aged between 3–10 walked more slowly with shorter steps than normal and walked like adults who suffered from Parkinson. In addi­tion, Courchesne et al, found that certain areas of the cere­bellar vermis are not fully deve­loped in autistic children. This supports the view that move­ment disor­ders may play a role in autism. 

The aim of the current study is to try to resolve the issue of whether move­ment disorder plays a role in autism or not. As move­ment disor­ders can be detected as early as the first few days after birth, a study inves­ti­ga­ting move­ment disor­ders in infancy may serve as an early indi­cator for diagno­sing autism in children. 


Parents of children with autism (diagnosed via conven­tional methods before age three) were asked to send in videos of their children when they were infants. 17 infants were compared in their patterns of lying, righting from their back to their stomach, sitting, craw­ling, stan­ding, and walking with 15 normal infants. Selected portions of these beha­viors were trans­ferred to rewri­teable soft­ware for still analysis. The normal infants were filmed by the rese­ar­chers at a stage when each pattern was just beginning. 



Lying is an active posture displayed by all newborn babies from the first few days of life. Constant digres­sion from normal patterns of lying can indi­cate abnor­ma­li­ties asso­ciated with autism. For example, one of the children when lying on his stomach always had his right arm caught under his chest. This was persis­tent through the first year of his life, causing him to fall to his right side when lying on his stomach, sitting, and even when he started to walk.

An autistic child, ‘3 months old, lacking the ability to rotate around the body midline during righting a), attempts to sit up by ventro­flexing his body in the midline plane (b).

Righting from spine to prone:

This is the ability to roll over from your back to stomach. This move­ment typi­cally begins at age 3 months. The rese­ar­chers of this study have found that in their expe­ri­ence impairm­ents in righting are common in autistic children. From the 17 videos of autistic children that were analysed for this study only 3 of them had filmed the righting of autistic children. However the pattern of righting conveyed by these 3 infants was diffe­rent from form shown by normal children. This abnormal pattern of righting was noted in the autistic children from age 3 months.

An autistic baby, 5 months old, cannot right by rota­tion. Instead, he arches the head and pelvis side­ways upward, moves the top leg forward, and topples over en bloc, without the sequen­tial segmental rota­tion in the righting move­ment charac­te­ristic of normal children.


From about age 6 months babies can sit in an upright posi­tion. Typi­cally, autistic children are unable to main­tain a stable sitting posi­tion. This study found that because an autistic child had an inabi­lity to distri­bute his/her weight equally on both sides the child falls over when reaching for objects. 

An autistic girl, 8.5 months old, shows no allied protec­tive reflexes when falling (e.g., exten­ding the arms and hands out to protect herself from striking her head when falling toward the ground).

Craw­ling on hands and knees:

Most babies begin to crawl about the same time they begin to sit. There are diffe­rent types of craw­ling inclu­ding cree­ping and craw­ling. This study examined craw­ling on hands and knees. When craw­ling forward on hands and knees, the arms and thighs move parallel to the midline axis of the body. That means that the arms stay shoulder width apart, and so do the thighs.

A normal baby, 6 months old, shows good support in the arms and legs while craw­ling forward.

Some autistic children show digres­sion from the normal patterns on craw­ling. One of the infants (3 months old) examined for this study supported himself on his fore­arms rather than his hands. With this parti­cular child one arm was crossed in front of the other meaning that his base of support on his arms are very narrow, ther­e­fore making the right arm weaker than the left. Reaching was done with the left arm as the right arm was caught under the body. At age 6 months the child’s arms had deve­loped support so the kegs could be used for craw­ling. However, the child exhi­bited a right side defi­ci­ency in the use of his legs for craw­ling; the left leg moved in the usual way, but the right leg did not move actively. This pattern was also noted in another autistic child in the videos.

An autistic baby, 5 months old, is unable to support himself on his hands and is unable to bring his knees toward his chest to crawl forward, so he lifts his rump up while trying to crawl but cannot move forward from the spot.


Typical deve­lo­ping infants begin to pull them self up to stand for a few minutes at about 8–10 months old. One autistic girl in the video about 8–10 months old was seen stan­ding in one place leaning against a piece of furni­ture for periods as long as 15 minutes. Such rela­tive akinesia may signal abnormality.

Typical child stan­ding at 10 months: holds his arms up at shoulder level as he is just begin­ning to learn to walk.


When a baby starts to walk, his walking pattern deve­lops through fixed stages which is controlled by diffe­rent segments of the leg, with more control from the hip and the pelvis. The thigh is the first to make active move­ments. There are three stages involved when a child begins to walk; waddling, inter­me­diate stage and final stage. These three stages can be observed in all children when they begin to walk. However, the amount of time children spend in each stage varies greatly from a few days to a few weeks. The walking pattern of autistic children differs from that of typical deve­lo­ping children. For example in typical deve­lo­ping children the arms and legs are symme­trical, in the autistic children these move­ments are asymmetrical. 

At the age of two or older the walking patterns of autistic children are delayed in compa­rison to their typi­cally deve­lo­ping peers. At the age of five abnormal patterns of walking could still be noted in one of the children in the video. In typical deve­lo­ping children the shift of weight usually occurs at the same time that the thigh and lower leg and the foot actively move forward. However, in the image of the autistic child this shift in weight occurred after the active move­ment forward of the thigh, lower leg and foot. 

The posi­tion of the arm can serve as an important mile­stone along the course of normal deve­lo­p­ment. For example, in a study conducted by Vilensky, Damasio, and Maurer, several autistic children (ages 3–10) exhi­bited more infan­tile posi­tions of the arms while walking: the forearm often was held parallel to the ground, poin­ting forward. 

Arm and hand flap­ping can also be noted in autistic children. This can also be noted in typi­cally deve­lo­ping children but it disap­pears after a few months. However, if this persists for a sustained period of time (2 years or more) the arm and hand flap­ping may be an indi­ca­tion of autism. 

(a) A 5‑year-old autistic boy has a fully deve­loped step gesture. All three segments of the leg move actively (see text), but his body weight does not shift at the same time, resul­ting in a form of goose-step. (b) The body weight only then is shifted so that the boy falls on to the outstret­ched leg at each step. This is a form of sequen­cing rather than super­im­po­si­tion of one move­ment on the other.


Autism is usually diagnosed at age three when parti­cular social skills fail to develop in children. However, social skills are not evident in the infancy stage, as the child largely relates to himself at this early stage. Although, the mother is usually aware during the early stages that some­thing may be wrong, she cannot specify beha­viors that are soci­ally rele­vant for a diagnosis to be provided. As rese­arch has shown that almost all autistic children at later stages have move­ment abnor­ma­li­ties, these rese­ar­chers in this study reasoned that such move­ment abnor­ma­li­ties will be evident from early infancy. The findings in this paper high­light the importance of detec­ting abnor­ma­li­ties in an infant’s move­ments from the early stages of life. If, as noted in this study and other studies, that children with move­ment abnor­ma­li­ties go on to be diagnosed with autism, it may be crucial for the purpose of early inter­ven­tion that abnor­ma­li­ties in move­ment are considered as an important indi­cator of autism. This study also noted that these abnor­ma­li­ties were typi­cally noted to occur on the right side of the body. An aware­ness of the abnormal move­ments as noted in this study should be of parti­cular importance to paed­ia­tri­cians who can fail to detect these early signs of autism. 

Down­load the summary as PDF
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This study is a summary of the original paper (Proc. Natl. Acad. Sci. USA Vol. 95, pp. 13982–13987, November 1998, Psychology)

Down­load the original study as PDF
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Please note that every effort has been made to condense and provide a broad over­view of this rese­arch. However in order not to lose the key infor­ma­tion some of the infor­ma­tion in this summary has been copied directly form the original article. All credits of the summary whether directly worded or re-worded are solely given to the rese­ar­chers. Please contact your ABA/VB consul­tant before imple­men­ting any of the proce­dures conducted in this paper on your child.

We received permis­sion to summa­rize, to post and to trans­late this study from PNF.

Copy­right: PNAS permis­sions 200826

For the summary great thanks to: Miss Geor­giana Eliza­beth Barzey. 

Respon­sible for the trans­la­tion: Silke Johnson


11. Study about Early Diagnosis

Summary of the study
Half of children with autism can be accurately diagnosed at close to one year of age, new study shows

In a study published in the Archives of General Psych­iatry, rese­ar­chers from the Kennedy Krieger Insti­tute in Balti­more, Mary­land found that autism can be diagnosed at close to one year of age, which is the earliest the disorder has ever been diagnosed. This is the earliest time this disorder has ever been diagnosed. The study, which evaluated social and commu­ni­ca­tion deve­lo­p­ment in autism spec­trum disor­ders (ASD) from 14 to 36 months of age, reve­aled that appro­xi­m­ately half of all children with autism can be diagnosed around the first birthday. The remai­ning half will be diagnosed later, and their deve­lo­p­ment may unfold very differ­ently than children whose ASD is diagnosable around the first birthday. Early diagnosis of the disorder allows for early inter­ven­tion, which can make a major diffe­rence in helping children with autism reach their full poten­tial.

Rese­ar­chers examined social and commu­ni­ca­tion deve­lo­p­ment in infants at high and low risk for ASD. Starting at 14 months of age and ending at 30 or 36 months (a small mino­rity of the children exited the study at 30 months). Half of the children with a final diagnosis of ASD made at 30 or 36 months of age had been diagnosed with the disorder at 14 months, and the other half were diagnosed after 14 months. Through repeated obser­va­tion and the use of stan­dar­dized tests of deve­lo­p­ment, rese­ar­chers iden­ti­fied, for the first time, disrup­tions in social, commu­ni­ca­tion and play deve­lo­p­ment that were indi­ca­tive of ASD in 14-month olds. Multiple signs indi­ca­ting these deve­lo­p­mental disrup­tions appear simul­ta­neously in children with the disorder. 

Dr. Rebecca Landa, lead study author and director of Kennedy Krieger’s Center for Autism and Related Disor­ders, and her colle­agues iden­ti­fied the follo­wing signs of deve­lo­p­mental disrup­tions for which parents and pedia­tri­cians should be watching: 

Abnor­ma­li­ties in initia­ting commu­ni­ca­tion with others: Rather than reques­ting help to open a jar of bubbles through gestures and voca­liza­tions paired with eye contact, a child with ASD may struggle to open it them­selves or fuss, often without looking at the nearby person. 

Compro­mised ability to initiate and respond to oppor­tu­ni­ties to share expe­ri­ences with others: Children with ASD infre­quently monitor other people’s focus of atten­tion. Ther­e­fore, a child with ASD will miss cues that are important for shared enga­ge­ment with others, and miss oppor­tu­ni­ties for lear­ning as well as for initia­ting commu­ni­ca­tion about a shared topic of inte­rest. For example, if a parent looks at a stuffed animal across the room, the child with ASD often does not follow the gaze and also look at the stuffed animal. Nor does this child often initiate commu­ni­ca­tion with others. In contrast, children with typical deve­lo­p­ment would observe the parent’s shift in gaze, look at the same object, and share in an exch­ange with the parent about the object of mutual focus. During enga­ge­ment, children have many prolonged oppor­tu­ni­ties to learn new words and new ways to play with toys while having an emotio­nally satis­fying expe­ri­ence with their parent. 

Irre­gu­la­ri­ties when playing with toys: Instead of using a toy as it is meant to be used, such as picking up a toy fork and preten­ding to eat with it, children with ASD may repea­tedly pick the fork up and drop it down, tap it on the table, or perform another unusual act with the toy. 

Signi­fi­cantly reduced variety of sounds, words and gestures used to commu­ni­cate: Compared to typi­cally deve­lo­ping children, children with ASD have a much smaller inven­tory of sounds, words and gestures that they use to commu­ni­cate with others. 

For a toddler with autism, only a limited set of circum­s­tances — like when they see a favo­rite toy, or when they are tossed in the air — will lead to flee­ting social enga­ge­ment,” said Landa. “The fact that we can iden­tify this at such a young age is extre­mely exci­ting, because it gives us an oppor­tu­nity to diagnose children with ASD very early on when inter­ven­tion may have a great impact on development.” 

The current study reveals that autism often involves a progres­sion, with the disorder clai­ming or presen­ting itself between 14 and 24 months of age. Some children with only mild delays at 14 months of age could go on to be diagnosed with ASD. Landa and her colle­agues observed distinct diffe­rences in the deve­lo­p­mental paths, or trajec­to­ries, of children with early versus later diagnosis of ASD. While some children deve­loped very slowly and displayed social and commu­ni­ca­tion abnor­ma­li­ties asso­ciated with ASD at 14 months of age, others showed only mild delays with a gradual onset of autism symptoms, culmi­na­ting in the diagnosis of ASD by 36 months. 

If parents suspect some­thing is wrong with their child’s deve­lo­p­ment, or that their child is losing skills during their first few years of life, they should talk to their pedia­tri­cian or another deve­lo­p­mental expert. This and other autism studies suggest that the “wait and see” method, which is often recom­mended to concerned parents, could lead to missed oppor­tu­ni­ties for early inter­ven­tion during this time period. 

What’s most exci­ting about these important advance­ments in autism diagnosis is that ongoing inter­ven­tion rese­arch leads us to believe it is most effec­tive and least costly when provided to younger children,” said Dr. Gary Gold­stein, Presi­dent and CEO of the Kennedy Krieger Insti­tute. “When a child goes undia­gnosed until five or six years old, there is a tremen­dous loss of poten­tial for inter­ven­tion that can make a marked diffe­rence in that child’s outcome.” 

While there are curr­ently no stan­dar­dized, published criteria for diagno­sing children with autism at or around one year of age, Landa’s goal is to develop these criteria based on this and other autism studies curr­ently underway at the Kennedy Krieger Insti­tute. Landa and her colle­agues at the Insti­tute plan on releasing preli­mi­nary diagno­stic criteria for very young children with autism in an upco­ming report. 

Parti­ci­pants in the current study included infants at high risk for ASD (siblings of children with autism, n=107) and low risk for ASD (no family history of autism, n=18). Stan­dar­dized tests of deve­lo­p­ment and play-based assess­ment tools were used to evaluate social inter­ac­tion, commu­ni­ca­tion and play beha­viors in both groups at 14, 18 and 24 months of age. Rese­ar­chers assi­gned diagno­stic impres­sions at every age, indi­ca­ting whether there were clini­cally signi­fi­cant signs of delay or impair­ment. After their last evalua­tion at 30 or 36 months, each parti­ci­pant was then given a final diagno­stic clas­si­fi­ca­tion of ASD, non-ASD impair­ment, or no impair­ment. The ASD group was further divided into an Early ASD diagnosis group and a Later ASD diagnosis group based on whether they were given a diagnosis of ASD at 14 or 24 months. 

About Autism :

Autism spec­trum disor­ders (ASD) is the nation’s fastest growing deve­lo­p­mental disorder, with current inci­dence rates esti­mated at 1 in 150 children. This year more children will be diagnosed with autism than AIDS, diabetes and cancer combined. Yet profound gaps remain in our under­stan­ding of both the causes and cures of the disorder. Continued rese­arch and educa­tion about deve­lo­p­mental disrup­tions in indi­vi­duals with ASD is crucial, as early detec­tion and inter­ven­tion can lead to improved outcomes in indi­vi­duals with ASD.

Source: Kennedy Krieger Institute

Great thanks for the permis­sion to post and trans­late to: Dr. Rebecca Lang, Kennedy Krieger Institute . 

Down­load summary of the study as PDF
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Respon­sible for the trans­la­tion: Silke Johnson


12. A distinction between two behavior analytic approaches

Summary of the study
A summarization of the study BAT:

Beha­vi­oral Inter­ven­tion for Autism: A distinc­tion between two beha­vior analytic approa­ches
(Kelly Kates-McEl­rath and Saul Axelrod — Temple University) 

Purpose of the Article:

Applied Beha­vior Analysis (ABA) has come to be accepted as the treat­ment of choice for children with autism by profes­sio­nals and parents alike (Schreibman, 1997). With this accep­tance comes an incre­asing deman­ding for programs that employ the ABA metho­do­logy to be imple­mented for pre-school and school-aged children diagnosed with ASD in school settings. Ther­e­fore, it is vital for school personnel to under­stand the distinc­tion between diffe­rent types of programs that fall under the umbrella of ABA and what is implied when parents request discrete trial or applied verbal beha­vior programs. 

Gresham, Beebe-Fran­ken­berger and MacMillan (1999) evaluated a number of programs beha­vi­oral and educa­tional treat­ment programs for children with autism. These included, the UCLA Young Autism Project (YAP), based on the work by O. Ivar Lovaas (1987); Treat­ment and Educa­tion of Autistic and Related Commu­ni­ca­tion Handi­capped Children (Project TEACCH), based on the work of Scho­pler and Reichler (1971); and Lear­ning Expe­ri­ences Alter­na­tive Program (LEAP), based on the work of Strain and others (1977). Since this evalua­tion, other program that are beha­vi­oral analy­tical in nature have been employed. These include Pivotal Response Trai­ning (PRT) (Koegel, Koegel, & Carter, 1999) and Applied Verbal Beha­vior (AVB) (Sund­berg & Michael, 2001). 

Due to the number of inter­ven­tion programs under the umbrella of ABA, the purpose of this paper is to distin­guish between two popular approa­ches curr­ently provided for early inter­ven­tion and school-aged children in home- and school-based settings: Lovaas’ Young Autism Project (YAP), more commonly referred to as Discrete Trial Instruc­tion (DTI) or Discrete Trial Teaching (DTT), and B.F. Skinner’s Analysis of Verbal Beha­vior, more commonly referred to as Applied Verbal Beha­vior (AVB or simply VB). This paper refers to DTT as DTI

Back­ground and results from Lovaas:

All parti­ci­pants in the original Lovaas study (1987) had a diagnosis of autism and a chro­no­lo­gical age of less than 40 months if non-verbal, and less than 46 months if presented with echo­lalia. The expe­ri­mental group (n=19) received inten­sive one-to-one treat­ment for more than 40 hours per week for two years, whereas Control Group 1 (n=19) received minimal one-to-one treat­ment, charac­te­rized by 10 hours or less, also for two years. Parti­ci­pants were assi­gned to one of these two groups based on the number of available staff and the distance parti­ci­pants lived from UCLA. An addi­tional control group (Control Group 2) was comprised of 21 parti­ci­pants selected from those parti­ci­pa­ting in a previous study by Freeman, Ritvo, Need­leman, & Yokota (1985). Data from this control group helped to control for biased parti­ci­pant selec­tion. Parti­ci­pants were treated like Control Group 1 subjects but were not treated by the DTI team. The goal of this project was to maxi­mize treat­ment gains by provi­ding the inter­ven­tion for most of the parti­ci­pants’ waking hours. Results showed 47% of the parti­ci­pants in the expe­ri­mental treat­ment group achieved normal intellec­tual func­tio­ning as defined by normal-range IQ scores and successful perfor­mance in first grade in a public school setting (Lovaas, 1987). 

DTI, as imple­mented in the original Lovaas study (1987), is a specia­lized form of instruc­tion that breaks down tasks/instructions into smaller teachable units. This consists of a cue (SD), prompt, student response, and a conse­quence (i.e., rein­force­ment or feed­back in the form of error correc­tion). Gresham et al. (1999) define the core charac­te­ristics of DTI as a Discri­mi­na­tive Stimulus (SD)-response-consequence type of instruc­tional deli­very that includes discri­mi­na­tion trai­ning and compli­ance with instruc­tional commands (e.g., “Stand up” and “Touch your nose”). 

Back­ground to the AVB Approach:

The AVB approach to teaching children with autism incor­po­rates discrete trial instruc­tion; however, for language acqui­si­tion it relies on B.F. Skinner’s clas­si­fi­ca­tion of language with initial emphasis on teaching expres­sive language with manding (Carbone, 2003; Carbone, 2004; Sund­berg & Partington, 1998). Although this approach has not been promoted by profes­sio­nals as an educa­tional treat­ment package or method, consu­mers of this approach have taken it as such. 

This approach empha­sizes the formal and func­tional proper­ties of language and distin­gu­ishes between several diffe­rent types of func­tional control (Sund­berg, 2003). Skinner defined the mand as a type of verbal rela­tion whose response form is controlled by a moti­va­tional variable, termed estab­li­shing opera­tion (EO) (i.e. satia­tion, depri­va­tion, and aver­sive stimu­la­tion), or more recently termed, moti­va­tional opera­tion (MO) (Laraway, Snycerski, Michael, & Poling, 2003). The mand is a type of verbal beha­vior where the speaker asks for what he or she wants, resul­ting in specific rein­force­ment (i.e., access to a desired item specific to the request) (Sund­berg, 2003). Other verbal rela­tions proposed by Skinner are tacts (label­ling items in the envi­ron­ments), echoic (repea­ting what is said), intra­verbal (respon­ding to a verbal stimulus), textual (reading) tran­scrip­tive (writing).

Advo­cates of the AVB approach credit Lovaas and colle­agues for their contri­bu­tion and advance­ment to the field of ABA in autism treat­ment but criti­cize their work for failing to imple­ment the concepts and prin­ci­ples provided by Skinner in his book Verbal Beha­vior (1957). Parti­cu­larly, Lovaas and colle­agues’ failure to make use of early mand trai­ning and transfer control proce­dures to teach across all the verbal operants. 

Diffe­rences in the Curri­culum DTI and AVB approa­ches:

The curri­culum scope and sequence for DTI programs is derived from resources such as Teaching Deve­lo­p­men­tally Disabled Children, The Me Book (Lovaas et al., 1981), Beha­vi­oral Inter­ven­tion for Young Children with Autism (Maurice, Green, & Luce, 1996), A Work in Progress (Leaf & McEa­chin, 1999), and more recently, Teaching Indi­vi­duals with Deve­lo­p­mental Delays, Basic Inter­ven­tion Tech­ni­ques (Lovaas, 2003). Conside­ring, that there is no stan­dard assess­ment prac­tice and nume­rous curri­culum resources, each child’s program varies with regard to the order in which new tasks are presented. Skills gene­rally begin being taught in the simp­lest format and incre­asing in comple­xity. Gene­ra­li­sing each skill involves the children prac­ti­sing the skill across instruc­tors, mate­rials, and settings, as well as programming for common stimuli and using multiple exemplars. 

AVB programs rely on the Assess­ment of Basic Language and Lear­ning Skills (ABLLS) (Partington & Sund­berg, 1998) as a stan­dard assess­ment tool and base­line. The completed ABLLS provides a visual display of the learner’s strengths and weak­ne­sses across 26 skill domains. No other guides to curri­culum or teaching targe­ting this approach are commer­ci­ally available. 

Diffe­rences in Rein­force­ment and Moti­va­tion in DTI and AVB approa­ches:

DTI programs typi­cally employ a nega­tive rein­force­ment para­digm for learner moti­va­tion (i.e., the student can work for earned breaks from task) (Harris & Weiss, 1998). Addi­tio­nally, other compon­ents of an indi­vi­dua­lized moti­va­tional system such as token systems of rein­force­ment and choice boards comprised of photos of poten­tial rewards are incorporated. 

The AVB approach places emphasis on the teacher initi­ally beco­ming a condi­tioner rein­forcer for the child. This is gained through pairing the teacher with rein­force­ment and demand fading proce­dure. The AVB approach focuses on the issue of posi­tive rein­force­ment and moti­va­tion to increase on-task beha­viors. Dense sche­dules of rein­force­ment for initial mand trai­ning are conti­nuous; fading to thinner and/or variable sche­dules are imple­mented as quickly as possible during inten­sive teaching time (ITT) and faded as the learner is successful (Carbone, 2004). In an AVB program, there tends to be less reli­ance on token boards, choice boards, and other visual displays that are common to moti­va­tional programs in a DTI approach. 

Diffe­rences in the Deli­very of instruc­tion in DTI and AVB approa­ches:

In DTI programs, instruc­tion is typi­cally deli­vered via a 1:1 or 1:2 teacher-to-student ratios (Harris & Weiss, 1998). The teacher and student are usually situated at a desk or table facing one another. Instruc­tion is intro­duced in an envi­ron­ment where distrac­tions are mini­mized. Novel concepts are often intro­duced in isola­tion or mass trials. 

AVB programs also employ the 1:1 or 1:2 teacher-to student ratio, however, the initial phases of teaching take place in the natural envi­ron­ment and not at the table. AVB programs empha­sises Natural Envi­ron­ment Teaching (NET) also referred to as inci­dental teaching. This form of teaching relies on the student’s moti­va­tion for instruc­tion and there is no speci­fied teaching place. The deli­very of instruc­tion during ITT is the same as that of discrete trial instruc­tion. Both approa­ches would suggest a ratio of easy-to-hard tasks that is appro­xi­m­ately 8:2 or 7:3. In addi­tion, the AVB approach empha­sizes teaching skills to fluency and a quick pace of instruc­tion with shorter laten­cies for the learner to respond (0–2 seconds as opposed to a tradi­tional DTI approach of 5–7 seconds). 

Diffe­rences in promp­ting and Error Correc­tion Proce­dure in DTI and AVB approa­ches:

In DTI programs, initial reli­ance is on error­less teaching proce­dures such as a most-to least promp­ting sequence, constant and progres­sive time delay, stimulus fading, posi­tional cues, and blocked errors (Agnew & Kates-McEl­rath, 2004). As the learner acquires skills, the no-no-prompt error correc­tion proce­dure is intro­duced. This proce­dure presumes the student can respond correctly to the instruc­tion or self-correct follo­wing a “No” or no alter­na­tive (“Try again”) from the teacher. This approach allows for two errors before promp­ting is provided (Pelios & Kates-McEl­rath, 2002). 

Although both rely on error­less teaching methods as described above, the AVB approach does not employ the no-no-prompt model of error correc­tion. In addi­tion, it places added emphasis on transfer trials follo­wing errors of respon­ding (Carbone, 2003). 

Diffe­rences in Language acqui­si­tion in DTI and AVB approa­ches:

Tradi­tional DTI programs place an earlier emphasis on recep­tive iden­ti­fi­ca­tion and/or expres­sive label­ling (tacting) of objects or photos rather, than teaching students to request desired items (manding) as in AVB programs. In DTI listener skills are targeted before speaker skills. As stated earlier the initial stages of the AVB program involves stimulus-stimulus paring. During this stage the child’s natu­rally occur­ring vocalization(s) (i.e., babb­ling sounds) is estab­lished as a condi­tioned rein­forcer through the temporal pairing of a therapist’s vocal model with a desired item. 

Diffe­rences in Data Coll­ec­tion Proce­dures in DTI and AVB approaches:

Tradi­tional DTI programs rely on teachers and thera­pists to collect trial-by-trial data that reflect student perfor­mances during teaching (Harris & Weiss, 1998), often yiel­ding a percent correct in 10 or 20 trials. Task analytic data are coll­ected on skills targe­ting leisure, self-care, and voca­tional domains. 

AVB programs are charac­te­rized by first trial yes / no probe data. Probe data are often ideally coll­ected in the morning (school-based probe) and evening (home-based probe) for evidence of gene­ra­li­sa­tion across settings and mate­rials. Probe data allows the teacher to be available to focus on teaching as opposed to recor­ding each student response. It also faci­li­tates a quicker pace of instruc­tion (Carbone, 2003).

Both approa­ches rely on visual displays of data as well as data-based decis­ions regar­ding student progress and program changes (Harris & Weiss, 1998). 

The AVB approach however, favors cumu­la­tive graphing over tradi­tional percen­tages or number correct (Carbone, 2003). 

Recom­men­da­tions for future rese­arch:

Future rese­arch should involve outcome measures for both approa­ches. Compa­ra­tive rese­arch between both approa­ches is also needed to assess which if any of the approa­ches is better than the other at incre­asing language acqui­si­tion in children with autism.

For a more compre­hen­sive read and further infor­ma­tion please down­load the paper from Beha­vior Analyst Today, VOLUME 7, Issue 2, p.242: http://​www​.beha​vior​-analyst​-today​.net

For the permis­sion to post and trans­late this study from BAT great thanks to: Dr. Joe Cautilli.

For the summary great thanks to: Miss Geor­giana Eliza­beth Barzey.

Respon­sible for the trans­la­tion: Silke Johnson

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13. Study about early Intensive Behavioral Intervention

Summary of the study
A summarization of the study from AJMR:

Early Inten­sive Beha­vi­oral Inter­ven­tion: Outcomes for Children With Autism and Their Parents After Two Years

(Bob Remington, Univer­sity of Sout­hampton, UK; Richard P. Hastings, Univer­sity of Wales, Bangor, UK; Hanna Kovs­hoff and Fran­cesca degli Espi­nosa, Univer­sity of Sout­hampton, UK; Erik Jahr, Akershus Univer­sity Hospital, Norway; Tony Brown, Paula Alsford, Monika Lemaic, and Nicholas Ward, Univer­sity of Sout­hampton, UK


This study assessed the effects of Early Inten­sive Beha­vior Inter­ven­tions (EIBI) for preschool children with autism in Southern England. EIBI is a highly struc­tured and inten­sive teaching approach based on the prin­ci­ples of Applied Beha­vior Analysis (ABA). Children are taught a range of skills by trained thera­pists. They break down skills into small teachable units that are easily acces­sible for the lear­ners. Prior to this study there has been strong rese­arch evidence suggesting that EIBI is effec­tive for a wide variety of children with autism. However the majo­rity of this evidence is based on data from America. And prior to these findings there had been no data from a UK sample to support the effi­cacy of EIBI for use with preschool children with autism in the UK

The purpose of the rese­arch:

The authors of this rese­arch desi­gned this study to address three key questions: 

    • Can EIBI reduce the diagno­stics symptoms asso­ciated with autism?
    • Can EIBI have a posi­tive impact on the language, cogni­tive and beha­vi­oral defi­cits asso­ciated with autism?
    • Does EIBI contri­bute to increased family pressures?


Two groups of preschool children diagnosed with autism were recruited for this study. The first group of children consisted of 23 preschool children diagnosed with autism recei­ving EIBI for a period of two years. The second group consisted of 21 children diagnosed with autism recei­ving a stan­dard educa­tional provi­sion from their local educa­tion autho­rity for a period of two years. Assess­ments for both groups took place before, a year into, at the end, and two years after the rese­arch began. 


All children had received a diagnosis of autism and presented with no other medical or chronic illness. Children in both groups were aged between 30 months and 42 months and all lived in their family home. 


A range of stan­dar­dized tests was used to assess the children, inclu­ding IQ test. Parents were also assessed for their psycho­lo­gical well-being. 


Children in the EIBI group received one-to-one inter­ven­tion in their homes for an average of 25 hours per week over a two year period. The inter­ven­tion was deli­vered by 3–5 tutors from a range of service provi­ders and also by the parents of the children, who were all trained to teach using the prin­ci­ples of ABA. The EIBI inter­ven­tion group was taught a variety of key skills which included, play, language and cogni­tion and adap­tive behaviors. 

The children in the group not recei­ving EIBI, received stan­dard provi­sion from their local educa­tion autho­rity and some form of speech and language therapy. 


Results found 26% of the children recei­ving EIBI demons­trated substan­tial gains in IQ. Results further illus­trated that there were signi­fi­cant impro­ve­ments in intel­li­gence, daily living skills, motor skills, social skills, and in early social commu­ni­ca­tion and language. Rela­tive to the parents whose children received stan­dard provi­sion, no increase in psycho­lo­gical adjus­t­ment problems were noted with the parents whose children received EIBI. Die Results also found a decrease in the problem beha­viors and diagno­stic symptoms asso­ciated with autism. Diffe­rences between the two groups were still noted after 12 months. 


The findings from this study demons­trated that EIBI can be effec­tively imple­mented in the UK. Although the inter­ven­tion fell short of the recom­mended 40 hours per week, results were on the whole compa­rable to those provided by the US. Although the key ques­tions of the rese­arch had been addressed, the findings also brought addi­tional ques­tions. For example, it remains unclear which children are most likely to benefit from EIBI, how to best evaluate and iden­tify effec­tive teaching metho­do­lo­gies and curri­cula, the long term effects of EIBI and whether EIBI can provide better outcomes than those reported thus far. 

This study is a summary of the original docu­ments. For a more compre­hen­sive read and further infor­ma­tion please contact Bob Remington to receive the full study as PDF at: R.​E.​Remington@​soton.​ac.​uk

Please note that every effort has been made to condense and provide a broad over­view of this rese­arch. However in order not to lose the key infor­ma­tion some of the infor­ma­tion in this summary has been copied directly form the original article. All credits of the summary whether directly worded or re-worded are solely given to the rese­ar­chers. Please contact your ABA/VB consul­tant before imple­men­ting any of the proce­dures conducted in this paper on your child.

Down­load summary of the study as PDF
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We received permis­sion to summa­rize, to post and to trans­late this study from AJMR.

Order Detail ID: 19908526

AMERICAN JOURNAL OF MENTAL RETARDATION by R.E. Remington. Copy­right 2007 by American Asso­cia­tion on Intellec­tual Deve­lo­p­mental Disa­bi­li­ties. Repro­duced with permis­sion of American Asso­cia­tion on Intellec­tual Deve­lo­p­mental Disa­bi­li­ties in the format Internet posting via Copy­right Clearance Center.

For the summary great thanks to: Miss Geor­giana Eliza­beth Barzey.

Respon­sible for the trans­la­tion: Silke Johnson


14. The Role of the Reflexive Conditioned Motivating Operation (CMO‑R) During Discrete Trial Instruction of Children with Autism

Summary of the study
A summarization of the study from JEIBI:

The Role of the Refle­xive Condi­tioned Moti­vating Opera­tion (CMO‑R) During Discrete Trial Instruc­tion of Children with Autism

(Vincent J. Carbone, Barry Morgen­stern, Gina Zecchin-Tirri & Laura Kolberg)


There has been strong scien­tific evidence to indi­cate that the imple­men­ta­tion of the prin­ci­ples (Rein­force­ment, Extinc­tion, Punish­ment, Stimulus Control and Moti­vating Opera­tions) Applied Beha­vior Analysis (ABA) is an effec­tive inter­ven­tion for children with autism over that of other interventions. 

Results from such rese­arch has demons­trated that children who are taught inten­si­vely (25–40 hours per week) follo­wing the prin­ci­ples of beha­vior analysis (as listed above) can make substan­tial gains in cogni­tive abili­ties and deve­lo­ping age appro­priate social skills, Lovaas (1987).

The purpose of the rese­arch:

Much of the rese­arch into the appli­ca­tion of ABA for children with autism has empha­sized the importance moti­vating these children to comply with and respond to teacher directed instruc­tional tasks. Accor­ding to Koegel, Carter and Koegel (1998) moti­va­tion is pivotal to the teaching of children with autism; its crea­tion can lead to the deve­lo­p­ment of a wide range of skills. 

A funda­mental compo­nent of inten­sive ABA programs for children with autism is the imple­men­ta­tion of discrete trial instruc­tion. Discrete trial instruc­tion follows the three-term-contin­gency arran­ge­ment as proposed by Skinner (1968). This involves: the presen­ta­tion of a stimulus by an instructor, the occur­rence of the response, and a conse­quence which follows the response, in order to streng­then or weaken the likeli­hood of that response occur­ring under similar condi­tions. Although discrete trial instruc­tion is highly bene­fi­cial in the acqui­si­tion of skills, the high demand requi­re­ments of this method are the same condi­tions that typi­cally evoke problem beha­vior in the form of tant­rum­ming, flop­ping, high rates of stero­ty­pies, aggres­sion, and self-injury. 

Conse­quently, a thorough concep­tual under­stan­ding and prac­tical reper­toire related to the modi­fi­ca­tion of instruc­tional varia­bles that reduce escape and avoid­ance main­tained problem beha­vior of children with autism appears essen­tial. The purpose of this paper is to provide an over­view of the beha­vi­oral analysis of moti­va­tion during discrete trial instruc­tion and a re-inter­pre­ta­tion of the effects of ante­ce­dent varia­bles as moti­va­tion opera­tions (MO), and more speci­fi­cally, the refle­xive moti­vating opera­tion or CMO‑R.

The Estab­li­shing Opera­tion

The term Estab­li­shing Opera­tion (EO) as defined by Michael (1993) describes an envi­ron­mental event or stimulus condi­tion that makes someone “want some­thing” and leads to actions that can produce to what is wanted. A large amount of problem beha­viors (as described earlier) in children with autism during discrete trial instruc­tion may result from a moti­va­tion of some­thing (EO), for example, atten­tion, toy, removal of tasks and demands. An EO that increases the value of a condi­tioned nega­tive rein­force­ment and evokes any beha­vior that has led to a decrease in the present aver­sive condi­tion is known as a Refle­xive Condi­tioned Moti­vating Opera­tion or CMO‑R.

The CMO‑R and Teaching Children with Autism

Respon­ding main­tained by escape and avoid­ance of instruc­tional demands accounts for up to 48% of self-inju­rious and aggres­sive beha­viors of persons with deve­lo­p­mental disa­bi­li­ties (Derby et al., 1992; Iwata et al., 1994). These types of escape and avoid­ance beha­viors inter­fere with lear­ning. This is further compli­cated when instruc­tions and demands during discrete trial instruc­tions act as a CMO‑R (Sund­berg, 1993). 

Methods to Reduce the Effects of the CMO‑R During Discrete Trial Instruc­tion:

1. Programming Compe­ting Rein­forcers

Beha­viors main­tained by nega­tive rein­force­ment (e.g. the removal of a demand or task to engage in a preferred acti­vity) can be weak­ened by programming diffe­ren­tial rein­force­ment of alter­na­tive beha­viors (DRA) or deli­ve­ring rein­force­ment non-contin­gently (via NCR proce­dures) during high demand situa­tions. Studies inves­ti­ga­ting parti­ci­pants whose problem beha­viors had been acquired and main­tained by nega­tive rein­force­ment. They found that by programming concur­rent sche­dules of rein­force­ment in which task demands were posi­tively rein­forced could lead to a decrease in problem beha­viors without modi­fying main­tai­ning contin­gen­cies or the use of extinc­tion for problem beha­viors. A study by DeLeon et al; (2002) inves­ti­gated the effects of posi­tive and nega­tive rein­force­ment on problem beha­viors main­tained by nega­tive rein­force­ment with a chained demand. A child with autism was provided the oppor­tu­nity to choose a posi­tive rein­forcer (i.e., potato chip) or nega­tive rein­forcer (i.e., break) after comple­ting a sche­duled number of responses. When the number of demands was rela­tively low, the parti­ci­pant reliably chose the posi­tive rein­forcer. It appeared that the presence of the posi­tive rein­forcer decreased the value of task termi­na­tion as a rein­forcer. However, her prefe­rence swit­ched to the break when the number of tasks required for rein­force­ment increased to more than 10. The authors concluded that the switch to the prefe­rence for a break when demands were increased indi­cated the demands had returned to their initial status as a CMO‑R and ther­e­fore increased the value of task removal and evoked the participant’s choice beha­vior of a break. 

2. Pairing and Embed­ding the Instruc­tional Envi­ron­ment with Posi­tive Rein­force­ment

McGill (1999) suggests paring and embed­ding the teaching context, mate­rials and personnel with an “impro­ving set of condi­tions” via the deli­very of posi­tive rein­force­ment. This would reduce the aver­seness of the teaching envi­ron­ment, thus making escape and avoid­ance beha­viors (often asso­ciated with problem beha­viors) less likely. 

3. Error­less Instruc­tion

Rese­arch has illus­trated that when students make frequent errors during an instruc­tional task, problem beha­viors often occur at a high rate. Instruc­tional methods that reduce the frequency of errors have been demons­trated to reduce the level of problem beha­vior. “An analysis of these results in terms of moti­va­tional varia­bles suggests that errors may func­tion as an MO and increase the rein­for­cing value of task removal or termi­na­tion. If the instructor prevents or at least mini­mizes errors during instruc­tion (i.e., error­less lear­ning) the CMO‑R is abolished and students engage in fewer problem beha­viors.” Error­less lear­ning has been employed via the use of response prompts, ante­ce­dent prompts. “The reduc­tion in errors probably func­tioned as an aboli­shing opera­tion that reduced the effec­ti­ve­ness of escape as a rein­for­cing conse­quence and as a result reduced escape-moti­vated problem behavior.” 

4. Stimulus Demand Fading

Instruc­tional demands are often asso­ciated with the CMO‑R in a number of studies. Such findings have demons­trated that escape moti­vated problem beha­viors can be drama­ti­cally reduced by remo­ving demands. However, such an approach would also signi­fi­cantly reduce the number of lear­ning oppor­tu­ni­ties. Several studies have high­lighted that demand fading wherein the instructor deli­vers one instruc­tional demand at about the midpoint of the session. Over succes­sive sessions, more demands were faded into the session. The results suggested that the fading proce­dures acce­le­rated the beha­vior reduc­tion effects of extinc­tion. These results were probably obtained because the original task demands func­tioned as a CMO‑R that increased the value of escape-moti­vated problem beha­vior. Removal of demands weak­ened the MO and decreased escape-moti­vated problem beha­viors. Their gradual re-intro­duc­tion in some cases did not create enough of a CMO‑R to increase escape moti­vated problem beha­viors. Modi­fying the rate, diffi­culty, and effort of responses during discrete trial instruc­tion appears to reduce escape- and avoid­ance-moti­vated problem beha­viors. Over time, instruc­tors may be able to fade in the rate, diffi­culty, and effort of demands until high levels of instruc­tional parti­ci­pa­tion are reached without problem behavior. 

5. Pace of Instruc­tion

Studies have illus­trated that short Inter-Trial-Inter­vals (ITI) are corre­lated with reduced stereo­typic beha­viors and higher correct rates of respon­ding when compared to long ITI. Fast paced instruc­tion has been corre­lated with less off-task beha­viors and higher skill acqui­si­tion. “Pace of instruc­tion probably func­tions as an aboli­shing opera­tion, redu­cing the value of escape and avoid­ance as rein­forcers. Speci­fi­cally, during the ITI, rein­force­ment is not available and with longer, as compared to shorter inter­vals, the child receives a lower rate of rein­force­ment for instruc­tional sessions of equal dura­tion. A recent study by Roxburgh and Carbone (2007) inves­ti­gated this issue directly and found that during instruc­tion of children with autism, shorter ITIs produced a higher rate of rein­force­ment and ther­e­fore less problem beha­vior. During long ITIs, the learner likely receives auto­matic rein­force­ment for stereo­typic beha­vior. In contrast, instruc­tional demands deli­vered at a brisk pace reduce the rate of rein­force­ment available through auto­matic rein­force­ment and increases the rate of soci­ally mediated posi­tive rein­force­ment available.” 

6. Inters­persal Instruc­tion

A number of studies have illus­trated that problem beha­viors can be decreased by inters­per­sing easy and diffi­cult tasks. Problem beha­viors can be reduced during this proce­dure as the inters­persal of “easy tasks func­tions as a CMO‑R because they are corre­lated with a worsening set of condi­tions related to low rates of rein­force­ment, high rates of errors, and higher rates of social disap­pr­oval. By inters­per­sing easy tasks with more diffi­cult tasks the value of the CMO‑R is reduced. It is recom­mended to combine extinc­tion with inters­persal instruc­tion to ensure its effec­ti­ve­ness (Zarcone, Iwata, Hughes, & Vollmer, 1993). It is also important to avoid presen­ting easy tasks imme­dia­tely follo­wing problem beha­vior. If this were to occur, problem beha­vior would likely be streng­thened by nega­tive reinforcement.” 


A thorough under­stan­ding of the prin­ciple of moti­va­tion and an analysis of instruc­tional methods as MOs can provide beha­vior analysts with a powerful tech­no­logy for redu­cing problem beha­vior during discrete trial instruc­tion. With know­ledge of the concept of the CMO‑R, beha­vior analysts may be better equipped to evaluate, select, and imple­ment instruc­tional methods that reduce escape and avoid­ance beha­vior exhi­bited by a large percen­tage of children with autism and related disabilities.” 

We hope that this has served as a useful intro­duc­tion and summary into the concept of the CMO‑R.

Down­load summary of the study as PDF
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For a more compre­hen­sive read and further infor­ma­tion please down­load the paper here.

For the permis­sion to post this study from JEIBI great thanks to: Dr. Joe Cautilli.

For the summary great thanks to: Miss Geor­giana Eliza­beth Barzey.

Respon­sible for the trans­la­tion: Silke Johnson


15. Study about Manding

Summary of the study
A summarization of the study from the Carbone Clinic:

Incre­asing Voca­liza­tions of Children with Autism Using Sign Language and Mand Training

(Vivian Atta­nasio, Lisa Delaney, Vincent J. Carbone, Gina Zecchin-Tirri, and Emily J. Sweeney-Kerwin) 


Manual sign language has been shown to support the deve­lo­p­ment of vocal verbal beha­vior in some indi­vi­duals with autism and deve­lo­p­mental disa­bi­li­ties. (Mirenda & Erickson, 2000; Mirenda, 2003; Tincani, 2004). However there is a subset of children with autism for whom sign language may not faci­li­tate vocal produc­tion (Mirenda, 2003). In those cases it may be neces­sary to add other beha­vi­oral inter­ven­tions to increase the deve­lo­p­ment of vocal respon­ding. Language trai­ning programs that mani­pu­late moti­va­tive varia­bles to teach manding have been shown to increase spon­ta­n­eity (Shafer, 1994) and voca­liza­tions (Charlop-Christy, Carpenter, LeBlanc & Kellett, 2002).

Skinner (1957) defined the mand as a verbal response which is evoked by some condi­tions of depri­va­tion, satia­tion, or aver­sion and which is rein­forced by a conse­quence specific to the moti­va­tional variable.

A time delay or prompt delay proce­dure follo­wing the presen­ta­tion of a vocal model to increase vocal spon­ta­n­eity and produc­tion, has been shown to be effec­tive. (Halle, Marshall, & Spradlin1979; Halle, Baer, & Spradlin, 1981; Carr & Kolog­insky, 1983; Charlop, Schreibman, & Thibo­deau, 1985; Bennett, Gast, Wolery, & Schuster, 1986; Matson, Sevin, Frid­eley, & Love, 1990; Ingenmey & Van Houten, 1991; Charlop & Trasowech,1991; Matson, Sevin, Box, & Francis, 1993).

The time delay proce­dures imple­mented in these studies had been shown to be effec­tive with parti­ci­pants who had a vocal reper­toire that was depen­dent upon promp­ting. The time delay proce­dure had not been previously tested for its value initia­ting new vocal responses in children with autism who used sign language as their primary form of commu­ni­ca­tion instead of voca­liza­tions, or had few vocalizations.

The purpose of the rese­arch:

The purpose of this study was to deter­mine the effects of sign mand trai­ning combined with a time delay, vocal prompt and diffe­ren­tial rein­force­ment proce­dure on the deve­lo­p­ment of voca­liza­tions in children with autism for whom sign language mand trai­ning alone had not produced vocal responding. 


Three male parti­ci­pants were used in this study. Two of the parti­ci­pants were age four (Tony) and six (Nick) and both diagnosed with autism. The third parti­ci­pant was age four, diagnosed with Down Syndrome (Ralph). All parti­ci­pants had limited recep­tive, tact and intra­verbal repertoires. 

Tony manded via American Sign Language (ASL) for 15 items, those were present and highly moti­vating. The Kaufman Assess­ment (Kaufman Speech Praxis Assess­ment, 1995) found that Tony had a weak echoic reper­toire which involved appro­xi­ma­tions to (consonsant — vowel — conso­nant (CVC) (CVC words for example, “oh no” and “oboe.”).

Nick required partial physical prompts or full physical prompts to produce his manual sign mands. However his manding reper­toire was considered as weak. During the modi­fied Kaufman Speech Praxis Assess­ment, Nick did not echo any vocal responses. 

Ralph used manual sign language to mand for 10 items that were present and highly motivating. 


The study was conducted in each of the participant’s class­room. Each room had six to eight children with at least three (3) adults. 

Defi­ning Responses:

This study measured the occur­rence of voca­liza­tions during sign manding, either follo­wing a time delay or after the presen­ta­tion of a vocal prompt. Any sound made by the parti­ci­pant was iden­ti­fied and recorded as a voca­liza­tion. A word appro­xi­ma­tion was defined as a vowel-conso­nant (VC) or conso­nant-vowel (CV) combi­na­tion that were in the name of the item presented. 

Recor­ding Proce­dure:

Voca­liza­tions and appro­xi­ma­tions were recorded by the participant’s instructor. Instruc­tors sat next to the child at a table with their data sheets. Six poten­tial rein­forcers, which included edibles, movies and toys, were placed in a random rota­tion throug­hout the session appro­xi­m­ately one foot away from the learner. Instruc­tors recorded voca­liza­tions or word appro­xi­ma­tions by writing the phonetic spel­ling of each vocal response with the prompt level neces­sary to evoke the vocal response. Inter-observer agree­ment was conducted for 30% of all sessions. Inter-observer agree­ment ranged between 96%-100% with an average of 99% percent agreement. 

Time Delay and Vocal Prompt:
During the inter­ven­tion phase, the examiner sat at a table appro­xi­m­ately two feet across from the parti­ci­pant in his class­room. The items the parti­ci­pant would poten­ti­ally mand for were on the table next to the expe­ri­menter. All parti­ci­pants had six diffe­rent rein­forcers present at every session. There were two sessions per day each consis­ting of 50 trials. Each trial began with the expe­ri­menter holding the item at eye level as a signal to the parti­ci­pant that rein­force­ment was available contin­gent on them signing for the item. When the parti­ci­pant signed, the rein­forcer was not imme­dia­tely deli­vered and instead a five second time delay was imple­mented. During the five second delay, any voca­liza­tion by the parti­ci­pant resulted in deli­very of the rein­forcer immediately. 

If the parti­ci­pant did not voca­lize during the time delay interval, the expe­ri­menter would say the name of the desired item as a vocal prompt and wait two seconds for a response. 

If a voca­liza­tion occurred within two seconds of the presen­ta­tion of the vocal stimulus (prompt) the rein­forcer was deli­vered immediately. 

If no voca­liza­tion occurred, the vocal prompt was re-presented two more times.

The rein­forcer was deli­vered imme­dia­tely upon hearing any voca­liza­tion or word appro­xi­ma­tion from the parti­ci­pant follo­wing the vocal prompts. 

If no voca­liza­tion or word appro­xi­ma­tion occurred the rein­forcer was deli­vered at the end of the sequence of presen­ta­tions of the vocal prompts. 


Main­ten­ance data was coll­ected ten months follo­wing the comple­tion of the expe­ri­mental condi­tion. Four sessions of main­ten­ance data were conducted during which each targeted item was presented once. Each session consisted of six trials and there was one session a day for four conse­cu­tive days. Each trial began with the expe­ri­menter holding up the item to the participant’s eye level in order to signal the avai­la­bi­lity of the reinforcer. 

If the parti­ci­pant signed for the item correctly within five seconds of the presen­ta­tion the item was deli­vered immediately. 

If the parti­ci­pant did not sign for the item imme­dia­tely or signed incor­rectly, the expe­ri­menter provided a manual or gestural prompt to evoke the response. Using the same response defi­ni­tion as in the expe­ri­mental condi­tion, the expe­ri­menter recorded the occur­rence of any voca­liza­tion or word appro­xi­ma­tion that the parti­ci­pant produced when he signed. Inter-observer agree­ment was 100% across all participants. 


When the expe­ri­mental condi­tion was intro­duced Tony’s voca­liza­tions or word appro­xi­ma­tions went from an average of about 20% during base­line to about 95% in treat­ment. Tony main­tained an average of about 95% of voca­liza­tions or word appro­xi­ma­tions while manding during main­ten­ance sessions. 

The frequency of voca­liza­tions or word appro­xi­ma­tions for Ralph imme­dia­tely increased to appro­xi­m­ately 70% from a base­line percen­tage of near zero upon ente­ring treat­ment and then stabi­lized with about 95% of trials contai­ning vocal responses for the last few treat­ment sessions. 10 month follow-up data indi­cates that Ralph’s voca­liza­tions during sign manding were main­tained at a level substan­ti­ally higher than baseline. 

Nick’s voca­liza­tions imme­dia­tely increased to appro­xi­m­ately 10% during treat­ment and steadily increased to 40% throug­hout treat­ments sessions as compared to a base­line percen­tage of near zero. The ten month follow-up data indi­cated that Nick’s voca­liza­tions while sign manding were main­tained at a level substan­ti­ally higher than baseline. 


The results of this study demons­trate that sign mand oppor­tu­ni­ties combined with a prompt delay proce­dure and vocal promp­ting with diffe­ren­tial rein­force­ment for sound produc­tion can increase the frequency and variety of voca­liza­tions in children with autism and other deve­lo­p­mental disabilities. 

Tony demons­trated the highest percen­tage of trials with voca­liza­tions and word appro­xi­ma­tions and was the only parti­ci­pant to develop the produc­tion of the word “movie” as a mand to view a video. He entered the study with the stron­gest vocal reper­toire in that he produced the grea­test number and variety of sounds during the base­line sound inventory. 

Main­ten­ance data show that Tony and Ralph continued to voca­lize at a high rate while sign manding despite no treat­ment for a ten month period. The fact that the time delay proce­dure produced a rela­tively higher rate of voca­liza­tions as compared to the vocal prompt proce­dure impli­cates the role of extinc­tion. It appears that failure to rein­force the sign mand imme­dia­tely during treat­ment may have led to response varia­tion in the form of vocal responses consis­tent with the side-effects frequently asso­ciated with extinc­tion (Lerman and Iwata, 1996). 

This article is a summary of the original paper which can be down­loaded from www​.carbo​ne​clinic​.com/​r​e​s​e​a​r​c​h​.​a​spx

Please note that every effort has been made to condense and provide a broad over­view of this rese­arch. However in order not to lose the key infor­ma­tion some of the infor­ma­tion in this summary has been copied directly form the original article. All credits of the summary whether directly worded or re-worded are solely given to the rese­ar­chers. Please contact your ABA/VB consul­tant before imple­men­ting any of the proce­dures conducted in this paper on your child.

Please contact your ABA/VB consul­tant before imple­men­ting any of the proce­dures conducted in the paper on your child.

Down­load summary of the study as PDF
PDF Download

Read the original study here

For the permis­sion to post this study we thank: Dr. Vincent Carbone, Ed.D., BCBA

For the summary great thanks to: Miss Geor­giana Eliza­beth Barzey.

Respon­sible for the trans­la­tion: Silke Johnson


16. Study about Fluent Teaching

Summary of the study
A summarization of the study from the Carbone Clinic:

The Effects of Varying Teacher Presen­ta­tion Rates on Respon­ding during Discrete Trial Training

(Carole A. Roxbo­rough, BCABA, Vincent J. Carbone, BCBA, and Gina Zecchin, BCABA


A signi­fi­cant amount of children diagnosed with autism engage in high rates of escape and avoid­ance beha­viors (Koegel, Koegel, Frea and Smith, 1995) during instruc­tional sessions. Addi­tio­nally, self-stimu­la­tory beha­vior (such as rocking and hand flap­ping) in children with autism often inter­feres with acqui­ring new skills and conduc­ting simple discri­mi­na­tion tasks (Covert and Koegel, 1972). When self-stimu­la­tory beha­vior is reduced lear­ning occurs at a higher rate (Covert and Koegel, 1972).

Ther­e­fore, one of the funda­mental aims for many children with autism may parti­ally depend on teachers mani­pu­la­ting instruc­tional varia­bles. Those lead to improved learner atten­tion to teacher directed acti­vi­ties for reasonable periods of time each day. (Drash & Tudor, 1993).

Discrete Trial Trai­ning (DTT) is a method which is modelled after Skinner’s (1968) three term contin­gency arran­ge­ment. whereby a stimulus is presented by a teacher, a response is evoked, and a conse­quence follows the response in order to streng­then or weaken its likeli­hood of occur­ring again under similar conditions.

The imple­men­ta­tion of DTT has yielded long term bene­fits for children with autism (Lovaas, 1987, Smith, 1999, McEa­chin, Smith & Lovaas, 1993). However, the high demand requi­re­ments of Discrete Trial Trai­ning may evoke problem beha­vior such as tant­rum­ming, flop­ping, high rates of self stimu­la­tory beha­viors, aggres­sion, and self injury. Smith (2001) explains “… children with autism may attempt to escape or avoid almost all teaching situa­tions, as well as any requests that adults make of them” (p. 89).

Conse­quently, a thorough concep­tual under­stan­ding and prac­tical reper­toire related to the modi­fi­ca­tion of instruc­tional varia­bles that reduce escape and avoid­ance main­tained problem beha­vior of children with autism appears essential.

Mani­pu­la­tion of instruc­tional varia­bles related to the conse­quence of beha­viors such as rein­force­ment and extinc­tion have been exten­si­vely studied in the beha­vior reduc­tion lite­ra­ture. Recently, addi­tional emphasis has been placed upon the mani­pu­la­tion of ante­ce­dent varia­bles to reduce inter­fe­ring beha­viors when teaching persons with deve­lo­p­mental disa­bi­li­ties and autism (Carbone, Morgen­stern & Zecchin (2006).

Little rese­arch has focused on the effects of teacher rate of presen­ta­tion of instruc­tional demands as an ante­ce­dent variable. Only two studies that included autistic children have measured the effects of teacher rate of presen­ta­tion of instruc­tional demands. Both of these studies (Koegel, Dunlap, & Dyer, (1980) and Dunlap, Dyer & Koegel (1983)) mani­pu­lated the dura­tion of inter trial inter­vals (ITI) resul­ting in either slow or fast pace presen­ta­tion of instruc­tional demands. ITI was defined as the dura­tion of time between the deli­very of the conse­quence for one beha­vior and the presen­ta­tion of the next instruc­tional stimulus or demand.

Koegel et al (1980) inves­ti­gated the func­tional rela­ti­onship between ITI dura­tion and correct learner respon­ding in children with autism. The rese­ar­chers used both long dura­tions which ranged from 4 seconds to 26 seconds and short dura­tions which range from 1 to 4 seconds. Results demons­trated that shorter dura­tion of ITIs produced a higher rate of correct responses and a decrease in self stimu­la­tory behaviors.

Dunlap et al (1983) repli­cated Koegel et al’s (1980) study and then extended the findings by precisely measu­ring occur­rences of self-stimu­la­tory responses in their parti­ci­pants who were children with autism. Results from this study found that self-stimu­la­tory responses decreased with shorter ITI and correct respon­ding increased.

The effects of teacher presen­ta­tion rates on other topo­gra­phies and func­tions of problem beha­vior frequently emitted by children with autism during inten­sive teaching sessions has been inves­ti­gated with various mani­pu­la­tions of ITI’s (down­load article for a full review).

The purpose of the rese­arch:

There were four aims of this study:

    • To repli­cate the findings of other rese­ar­chers regar­ding the effects of alte­ring the pace of instruc­tional demands on the occur­rences of problem beha­vior and correct respon­ding during instruc­tional settings with children with autism.
    • To examine the effects of teacher rate of presen­ta­tion of instruc­tional demands with children with autism who exhi­bited self-stimu­la­tory beha­vior and responses that appeared to be main­tained by a history of social reinforcement.
    • To measure oppor­tu­ni­ties to respond and magni­tude of rein­force­ment as a func­tion of faster vs. slower rates of teacher presen­ta­tion of demands.
    • To measure three rates of presen­ta­tion commonly recom­mended in instruc­tional programs for children with autism.



Two children with a diagnosis of autism recei­ving a combi­na­tion of school and home based inter­ven­tion using Applied Beha­vior Analysis (ABA) with emphasis upon teaching commu­ni­ca­tion skills using B.F. Skinner’s analysis of verbal beha­vior were used in this study. 

Both children’s program included one-on-one inten­sive teaching in the form of Discrete Trial Trai­ning inters­persed with lear­ning oppor­tu­ni­ties in the more natu­ra­lized envi­ron­ments in the home setting. A similar program was imple­mented for both children in the school setting for part of the instruc­tional day. 

Both parti­ci­pants exhi­bited high rates of disrup­tive beha­vior during instruc­tional sessions and ther­e­fore were selected to parti­ci­pate in this study. 


All of the expe­ri­mental sessions were carried out in the home of each parti­ci­pant. The instruc­tional setting for each child was in the family living room where a tele­vi­sion was available to display videos as a form of rein­force­ment. Each child was seated at an instruc­tional table. A video camera was also set up on a tripod next to the instruc­tional table for purposes of recor­ding each session. 

Depen­dent varia­bles, Response Defi­ni­tions and Measu­re­ment Proce­dures:

The depen­dent varia­bles which were measured were:

    • Frequency of problem beha­vior (self-stimu­la­tory beha­vior; aggres­sion / self inju­rious beha­vior, bolting from the instruc­tional table) that inter­fered with instruc­tional demands were exhibited
    • Frequency of teacher presented instruc­tional demands
    • Magni­tude or dura­tion of reinforcement
    • Percen­tage of correct responses.

Each of the depen­dent varia­bles was measured follo­wing each expe­ri­mental session by tran­scribing the responses from the video recor­ding of the session. A data recor­ding sheet deve­loped speci­fi­cally to measure frequency of problem beha­vior, frequency of instruc­tional oppor­tu­ni­ties, frequency of responses per session, magni­tude of video presen­ta­tion as a form of rein­force­ment, and percen­tage of correct and incor­rect responses was used.


Using an alter­na­ting treat­ment design teacher demands were presented at the rate of every second, every five seconds or every 10 seconds during expe­ri­mental sessions. For example, a teacher might hold up a picture of an object and ask the learner “what is it?”. Instruc­tional demands which were presented 1 second after the parti­ci­pants responded were referred to as the fast teacher presen­ta­tion condi­tion. Instruc­tional demands which were presented 5 seconds after the parti­ci­pants responded were referred to as the medium teacher presen­ta­tion condi­tion. Instruc­tional demands which were presented 10 seconds after the parti­ci­pants responded were referred to as the slow teacher presen­ta­tion condi­tion. A non base­line alter­na­ting treat­ments design between 1, 5 and 10 second was imple­mented randomly. 


Two sessions were conducted a day each lasting 10 minutes. Throug­hout each session the instructor presented instruc­tional demands either every one, five or ten second interval. Instruc­tional tech­ni­ques inclu­ding error correc­tion, promp­ting proce­dures, types of skills presented, number of demands before a rein­forcer (sche­dule of rein­force­ment), inters­persal of mastered and target skills and mixing of skill domains were held constant for each parti­ci­pant across all three expe­ri­mental condi­tions. All problem beha­vior during teaching trials was recorded as instances of problem beha­vior. The oppor­tu­nity to view about a minute of a preferred video was used as reinforcement. 


Results indi­cated that both lear­ners engaged in higher rates of problem beha­vior during the slow teacher presen­ta­tion. Both lear­ners were presented with more instruc­tional demands during the fast presen­ta­tion. Both lear­ners received more rein­force­ment during fast presen­ta­tion than the medium and slow paced condi­tions. Results also indi­cated that both lear­ners produced more responses during fast paced condi­tion that the medium or slow paced condi­tions. Results also showed that there was no diffe­rence in percen­tage of correct responses for either learner during the three conditions. 


Consis­tent with findings from previous studies, the results of this study illus­trated that fast paced instruc­tion produced posi­tive outcomes on the frequency of problem beha­vior, magni­tude of rein­force­ment, number of instruc­tional demands and the number of responses for the parti­ci­pants in this study. However, the results of this study failed to illus­trate that faster rates of instruc­tional presen­ta­tion increases correct respon­ding. Despite this, the results promote the importance of fast paced instruc­tion for children with autism. 

A limi­ta­tion of this study is that only a small number of parti­ci­pants were used; future rese­arch inclu­ding a func­tional analysis of problem beha­vior prior to the imple­men­ta­tion will add to an analysis of the diffe­ren­tial effects of pace of instruc­tion related to the func­tions of problem behavior. 

Down­load summary of the study as PDF
PDF Download

Please note that every effort has been made to condense and provide a broad over­view of this rese­arch. However in order not to lose the key infor­ma­tion some of the infor­ma­tion in this summary has been copied directly form the original article. All credits of the summary whether directly worded or re-worded are solely given to the rese­ar­chers. Please contact your ABA/VB consul­tant before imple­men­ting any of the proce­dures conducted in this paper on your child.

Please contact your ABA/VB consul­tant before imple­men­ting any of the proce­dures conducted in the paper on your child.

Read the original study here.

For the permis­sion to post this study we thank: Dr. Vincent Carbone, Ed.D., BCBA

For the summary great thanks to: Miss Geor­giana Eliza­beth Barzey.

Respon­sible for the trans­la­tion: Silke Johnson


17. Reducing pupils’ barriers to learning in a special needs school: integrating applied behavior analysis into Key Stages 1–3

Summary of the study
Laura Pitts, Stacey Gent and Marguerite L. Hoerger


Inter­ven­tions based on applied beha­viour analysis (ABA) have been shown to improve outcomes for young children with autism spec­trum disorder (ASD), but there is very little rese­arch into outcomes for older pupils. This study evaluated the effec­ti­ve­ness of an ABA inter­ven­tion for pupils with ASD and addi­tional lear­ning diffi­cul­ties in a UK special needs school. The aim of the inter­ven­tion was to reduce barriers to lear­ning for indi­vi­duals aged four to 13 years old. Beha­vior analysts colla­bo­rated with school-based teaching teams to design and imple­ment func­tion-based beha­vior support plans, indi­vi­dual educa­tion programs and ABA teaching stra­te­gies, and to promote the gene­ra­liza­tion of skills. Pupils were assessed at base­line and again follo­wing one academic year of inter­ven­tion. The pupils demons­trated signi­fi­cant gains in lear­ning skills, language and commu­ni­ca­tion, social and play skills and self-help skills. Pupils of all ages acquired essen­tial ‘lear­ning to learn’ skills which have reduced their barriers to lear­ning and are enab­ling them to learn more effec­tively. The article discusses how a beha­vi­oral model was successfully and afford­ably imple­mented across key stages within a special educa­tional needs school.

Link to the full article: https://onlinelibrary.wiley.com/doi/full/10.1111/1467–8578.12251


18. Using applied behavior analysis as standard practice in a UK special needs school

Summary of the study
Denise Foran, Marguerite Hoerger, Hannah Philpott, Elin Walker Jones, J. Carl Hughes and Jonathan Morgan


This article describes how applied beha­vior analysis can be imple­mented effec­tively and afford­ably in a main­tained special needs school in the UK. Beha­vior analysts colla­bo­rate with class­room teachers to provide early inten­sive beha­vior educa­tion for young children with autism spec­trum disor­ders (ASD), and func­tion based beha­vi­oral inter­ven­tions for children between the ages of three and 18 years. Data are presented that show how the model is effec­tive. Children with ASD under the age of seven made signifi­cant gains on intel­li­gence quotient and on a range of skills inclu­ding language, social and play, and academic skills follo­wing three academic terms of inter­ven­tion. Case study data for two children reveal a marked decrease in chal­len­ging beha­vior follo­wing a func­tion based beha­vi­oral inter­ven­tion. These inter­ven­tions have led to greater inde­pen­dence, inte­gra­tion and access to curri­cular acti­vi­ties. These data show that children are making signifi­cant gains within this cost-effec­tive model.

Link to the full article: https://onlinelibrary.wiley.com/doi/full/10.1111/1467–8578.12088


19. Keep it to yourself? Parent emotion suppression influences physiological linkage and interaction behavior

Summary of the study
Sara F. Waters, Helena Rose Karnilowicz, Tessa V. West, Wendy Berry Mendes


Parents can influence children’s emotional responses through direct and subtle beha­vior. In this study we examined how parents’ acute stress responses might be trans­mitted to their 7- to 11-year-old children and how parental emotional suppres­sion would affect parents’ and children’s physio­lo­gical responses and beha­vior. Parents and their children (N = 214; Ndyads = 107; 47% fathers) completed a labo­ra­tory visit where we initi­ally sepa­rated the parents and children and subjected the parent to a stan­dar­dized labo­ra­tory stressor that reliably acti­vates the body’s primary stress systems. Before reuni­ting with their children, parents were randomly assi­gned to either suppress their affec­tive state—hide their emotions from their child—or to act natu­rally (control condi­tion). Once reunited, parents and children completed a conflict conver­sa­tion and two inter­ac­tion tasks toge­ther. We measured their sympa­thetic nervous system (SNS) responses and observed inter­ac­tion beha­vior. We obtained three key findings: (a) suppres­sing mothers’ SNS responses influenced their child’s SNS responses; (b) suppres­sing fathers’ SNS responses were influenced by their child’s SNS responses; and © dyads with suppres­sing parents appeared less warm and less engaged during inter­ac­tion than control dyads. These findings reveal that parents’ emotion regu­la­tion efforts impact parent–child stress trans­mis­sion and compro­mise inter­ac­tion quality. Discus­sion focuses on short-term and long-term conse­quences of parental emotion regu­la­tion and children’s social-emotional deve­lo­p­ment. (Psyc­Info Data­base Record © 2020 APA, all rights reserved)

Refe­rence and link to the article:
Waters, S. F., Karni­lo­wicz, H. R., West, T. V., & Mendes, W. B. (2020). Keep it to yourself? Parent emotion suppres­sion influences physio­lo­gical linkage and inter­ac­tion beha­vior. Journal of Family Psycho­logy. Advance online publi­ca­tion. Link to the full article