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"If a child can't learn in the way that we teach, then we must teach in a way he can learn."Ivar Lovaas, Ph.D
FMFEAT

(Fargo Moorhead Families for Effective Autism Treatment)


"Serving Fargo Moorhead and Surrounding Area"


Autism &Treatments:

What is Autism? Autism is a developmental disability that typically appears during the first three years of life. The result of a neurological disorder that affects the brain, autism and its associated behaviors occur in approximately 15 of every 10,000 individuals. Autism is classified by the American Psychiatric Association as a Pervasive Development Disorder (APA, 1994). It is defined by symptoms appear before the age of three which reflect delayed or abnormal development in Language Development, Social Skills and Behavioral Repertoire.

Children and adults with autism typically have deficiencies in verbal and non-verbal communication, social interactions, and leisure or play activities. The disorder makes it hard for them to communicate with others and relate to the outside world. They may exhibit repeated body movements (hand flapping, rocking) unusual responses to people or attachments to objects and resist any changes in routines. In some cases, aggressive and/or self-injurious behavior may be present.

It is conservatively estimated that nearly 400,000 people in the U.S. today have some form of autism. Its prevalence rate now places it as the third most common developmental disability - more common than Down's Syndrome. Yet the majority of the public, including many professionals in the medical, educational, and vocational fields are still unaware of how autism affects people and how to effectively work with individuals with autism.


The following areas are among those which may be affected by autism:


Indicators of Normal Development
Recognizing Autistic Tendencies
DSM IV Diagnostic Criteria for Autism
The CHecklist for Autism In Toddlers
Will I Grow Out Of It?
Autism and Behavioral Research Summaries
FEAT of Sacramento Editorial Page


APPLIED BEHAVIOR ANALYSIS  DISCRETE TRIAL THERAPY

 

1.0 WHAT IS APPLIED BEHAVIOR ANALYSIS / DISCRETE TRIAL THERAPY

Applied Behavior Analysis / Discrete Trial Therapy (ABA/DTT) is an intensive one-on-one
behavioral intervention program for children with autism spectrum disorders.  ABA/DTT is often
referred to as “Lovaas Therapy” due to the fact that it was Dr. O. Ivar Lovaas of UCLA and his
colleagues who published the preeminent study in the field of ABA/DTT and treating children with
autism documenting the efficacy of early intensive behavioral intervention in 1987.  The authors of
the study reported that 47% of the children who received treatment in the clinical model achieved
normal intellectual functioning levels and were educated in regular education classrooms without
any supports.  Since the publication of the 1987 study, other researchers in the field of autism
treatment have studied and documented the efficacy of ABA/DTT programs.  Also, other clinical
sites in the United States and Europe are in the process of trying to replicate the findings of the 1987
study.
 
Whether or not one chooses to refer to the therapy as ABA/DTT or Lovaas, the fact remains that the programs are based upon the assumption that appropriate skills “ranging from rudimentary self-care
tasks to complex skills such as interactive social language, can become permanent parts of a child’s
repertoire if they are broken down into components that the child can handle, taught well enough,
learned early enough, and practiced consistently enough” (Maurice et.al. 1996).  Early intensive
behavioral programs center around the fact that the therapy is much more than correcting behavior.
ABA/DTT “entails a comprehensive program for teaching skills across all domains” ranging from
basic self help skills to the more complex social interaction skills (Lovaas 1987).  ABA/DTT
programs are able to teach increasingly difficult skills to a child by presenting “a set of teaching
steps, very similar to those employed for normal children, but certain features are temporarily
exaggerated and the teaching process is slowed down”  (Lovaas 1987).  The discrete trial approach
teaches children with autism through a process of breaking skills down to minute or “discrete”
elements and teaching these discrete elements of information to the child using positive
reinforcement.  Eventually, the children who achieve optimum benefits from the treatment develop
the skills necessary to learn from their environment naturally and do not require special education
supports and services.
 

2.0 IS ABA/DTT EFFECTIVE?

Numerous studies in peer review journals document that early intensive behavioral intervention can
result in hitherto unprecedented outcomes for young children with autism spectrum disorders
(Maurice et.al. 1996).  The 1987 Lovaas study illustrates that 47% of children who received early
intensive behavioral intervention attained normal cognitive and intellectual functioning and were
able to complete first grade with typical peers and without special education supports (Lovaas
1987).  A follow up study on the children who comprised the 47% revealed that they maintained
their gains into adulthood and were indistinguishable from their peers.

Given the entire range of therapeutic options that face parents when deciding what options will best address their child’s needs, ABA/DTT intervention is the single most effective approach supported by controlled studies.  There are many treatment options, however, early intensive behavioral intervention is supported by data rather than anecdotal evidence.

It is should be noted, however, that intensive behavioral intervention is by no means a “cure” for
autism.  No amount of behavioral therapy can cure the underlying and heretofore unknown etiology
of autism.  Intensive behavioral intervention is effective in remediating many symptoms of autism
thereby recovering children in that their behavior may become “indistinguishable from their peers.”
 

3.0 IS ABA/DTT RIGHT FOR MY CHILD?

ABA/DTT is an intensive therapy that requires a tremendous amount of resources, emotional
energy, time, and money.  It is important to research the therapy as much as possible to decide if it is
right for your child.  Parents researching this treatment option should network with other families
who have their children enrolled in a program.  Several families in the Fargo Moorhead area allow
other parents to observe a therapy session and discuss the treatment program from a parental rather
than clinical perspective.

There are several books that FMFEAT recommends for parents who are considering ABA/DTT as a treatment option for a child with autism.
 

There are Internet sites and mailing lists that present a wealth of information for parents considering
ABA/DTT programming.

Me-List:  a private e-mail list composed of parents an professionals for the discussion of
ABA/DTT.  To subscribe, e-mail Ruth Allen at rallen@indyvax.iupui.edu explaining why you
want to be on the mailing list.
 
4.0  HOW MANY HOURS AND WHERE IS THERAPY CONDUCTED?

ABA/DTT is reported to be most effective when the child receives 30-40 hours of one-on-one
therapy per week.  Many families start the program at a reduced number of hours and gradually
increase the number of therapy hours the child receives.  Initially, therapy is usually conducted
within the child’s home during the first year of therapy.  During the second year, many children
attend pre-school and continue to receive home therapy with a reduced number of hours.

5.0 HOW DO I FIND THERAPIST AND HOW MUCH DO THEY COST?

There are two main components that contribute to the cost of ABA/DTT programs, assistant
behavioral therapists (ABT’s)  and consultants.

1.  ABT’s are the individuals who actually provide the one-on-one therapy to the child.  An average
of four to six ABT’s are needed to deliver 30-40 hours a week of intervention.  Using several
therapists prevents burn-out and helps the child generalize new skills.  Too many therapists,
however, is not recommended due to the need for consistency in the program.  Therapists should
work an average of 6-12 hours per week at the most.

ABT’s are often college students with a background in psychology, speech, or a related field.
Generally, ABT’s have no prior training in ABA/DTT which necessitates the families need to
provide professional training from a consultant which is discussed below.  ABT’s are generally paid
between $7-$11 per hour. 

2.  Consultants are an essential ingredient for a successful in-home ABA/DTT program.  Books and
research provide useful information and direction, but a consultant provides individualized
programming for a child with autism.  Consultants are also necessary to thoroughly and effectively
train ABT’s and parents.  Thorough hands-on training is provided by a consultant during initial
start-up workshops as well as follow-up consultations.  Regularly scheduled follow-up consultations
are necessary to ensure a child benefits from updated programming and to provide ABT’s ongoing
expert training.

Finding a consultant can be difficult for several reasons.  Many consultants have long waiting lists.
Parents must also make sure that a consultant has the adequate training and an extensive
background working with children with autism spectrum disorders.  The following information will
guide parents through the process of locating and choosing a consultant.

6.0  HOW SHOULD I CHOOSE A CONSULTANT?

The first step in deciding what consultant to choose is to compile a list of potential candidates or
organizations who provide workshop services.  Parents should call each of the candidates and
request to be placed on their waiting list.  Being placed on a waiting list does not commit parents to
hiring the consultant and it does not cost any money.  Once parents are on several waiting lists, they
should focus on researching the credentials of the potential candidate or agency.

While researching credentials, parents should find out what consultants are providing services to
other families who live in the area.  Long waiting lists sometimes do not apply to parents who
already live within a close proximity to other families who are already receiving workshop services.
Once parents have this information, they can talk with the consultant to discuss the possibility of
“tagging” on with other families in the area.  Networking with other families in the area also enables
parents to make a more informed decision when choosing a consultant.

The following is a compilation of Lovaas Replication Sites or sites that have received approval from Dr. Lovaas.  Inclusion on the list does not constitute endorsement or guarantee of quality and legitimacy.
 

Site                                      Contact Person                                                                   Phone/Fax


UCLA                                   Ivar Lovaas, Ph.D.                                                   (310) 825-2319/(301) 206-6380
                                            
Northwest Young
Autism Project                      Tristram Smith, Ph.D., Director                                  (509) 335-2522
 
The May Institute
(Boston)                                Art Campbell, Ph.D., Vice President                         (508) 432-3478
 
Wisconsin Early
Autism Project                       Glen Sallows, Ph.D.                                                 (608) 288-9040/(608) 288-9042

Central Valley
Autism Project (CA)              Mila Amerine-Dickens, M.S.                                    (209) 613-7220/(209) 521-4794
                                              Howard Cohen, Ph.D.                                            

Barcelona Autism
Project                                    Asun Puche, M.A.                                                  3493-418-4850/3493-418-4850

 
Akershus College(Norway)           Svein Eikseth, Ph.D., Director                            67-11-74-22/67-11-74-01

Pittsburgh Young
Autism Project                        Patti Metosky, Ph.D., Director                                (412) 881-3902/(412) 881-3599

CSAAC (Maryland)               Christine Caselles, Ph.D., Director                           (301) 762-1650/(301) 762-5230

University of Houston              Gerald Harris, Ph.D., Director                                 (713) 743-8610/ (713) 743-8633

Iceland Autism Project             Sigridur Jonsdottir, Ph.D., Director                         354-554-5462/354-564-1753

Meredith College
(North Carolina)                      Doreen Fairbank, Ed.D.                                         (919) 760-8080/(919) 760-0854

Converse College
(South Carolina)                        Spencer Mathews, Ph.D.                                       (864) 596-9132/(864) 596-9201

P.E.A.CH.
(United Kingdom)                      Diane Hayward                                                   0208-891-0121 ex. 2257/0181-891-8209 
                                                

Autism Research Center
(South Carolina)                         Barbara Metzger, Ph.D.                                       (864) 260-9099

Minnesota Young
Autism Project                            Eric Larsson, Ph.D.                                             (952) 238-9063/(952) 238-0863
 
New Jersey Institute
for Early Intervention                   Scott Wright                                                       (865) 616-9442/(865) 616-9454
 


Intensive Behavioral Intervention Clinic
(Ohio State University)                  Jacqueline Wynn, Ph.D.                                      (614) 866-3473/(614) 866-4617
 
The following are some phone numbers for individuals who provide workshop services.
A ** indicates that the organization is a Lovaas replication site.
A * indicates that the consultant is currently being used by other families in the Fargo Moorhead area.

Ivar Lovaas - Lovaas Institute for Early Intervention - (310)358-6095
Young Autism Project UCLA - UCLA Dept. of Psychology - (310)825-2319
**Carryl Navalta - The May Center - (617)648-9268
**Scott Wright - Bancroft, Inc. - (865) 616-9442
***Eric Larsson, Ph.D - Minnesota Young Autism Project  - (952) 238-9063/ (612) 296-8317
**Pattie Metosky - (412) 881-3902 - Services only in Pittsburgh area
**Tristram Smith - Northwest Autism Project - (509)335-7750
**Glen Sallows - Wisconsin Early Autism Project - (608) 288-9040
Rutgers Center for Applied Psychology - (908)445-7778
Center for Autism and Related Disorders (CARD) CA - (818)995-4673
Building Blocks (formerly ECIC) - (212)606-2036
The Childhood Learning Center (TCLC) - 1-800-474-7788
Maisie Soetantyo - (415)343-7056
Center for Autism and Related Disorders (CARD) NY - (914)683-3833
Project Pace - (503)643-7015
Autism Partnership - (310)424-9293
Greg Buch - (510)938-4508
Partners in Therapy - (609)858-3673
Kenda Morrison - (913)842-8803
The Center for Early Education - (619)272-1708 or (619)272-2124

7.0 GETTING STARTED

Setting up an ABA/DTT for a child with autism is a rigorous process.  To aid in the process, the
following steps are suggested:
1.  Purchase and read the books described in Section 3.
2.  Network with local families who have behavioral programs already running for their children.
Fargo Moorhead Families for Early Autism Treatment (FMFEAT) can provide contacts for families.
3.  Attend FMFEAT support meetings.
4.  Schedule an initial training workshop as soon as possible.
5.  If a family would like to begin therapy before the initial training workshop, it is important to
watch other families training tapes and therapy sessions.  Training videos and resources are also
available from Different Roads to Learning at www.difflearn.com.
 

8.0 LOCATING RESOURCES TO PAY FOR ABA/DTT

Medicaid waiver provides Medicaid coverage for individuals with developmental disabilities.
Income is not a restriction for this program.

Some health insurance policies may cover some or all of the costs of ABA/DTT.  Some families
have had some costs of ABA/DTT reimbursed by health insurance so be sure to read the fine
print of an insurance policy careful.

The Individuals with Disabilities Education Act (IDEA P.L. 94-142), entitles a child to a Free and
Appropriate Education.  Numerous families around the country have won court cases forcing school
districts to pay for the cost of ABA/DTT programming. 

Supplemental Security Income (SSI) is a federal source of support distributed to disabled
individuals based on income.  For more information contact your local Social Security office.
If a child qualifies for SSI, he or she may qualify for a state disability Medicaid card.  In order to
apply for a Medicaid card, contact the county department of human services.  It may be possible for
children to access behavioral intervention with a Medicaid card.

9.0 USEFUL DATA IN SUPPORT OF ABA/DTT

 

Autism / Pervasive Developmental Disorders Assessment and Intervention
for Young Children (Age 0-3 Years), Sponsored by New York State Department of Health
Early Intervention Program
Which is available on the web
http://www.health.state.ny.us/nysdoh/eip/menu.htm

And also in the Mental Health: A Report of the Surgeon General
Which is available on the web
http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec6.html#autism

Maine Administrators of Services for Children with Disabilities (MADSEC)
Autism Task Force Report
http://www.madsec.org/madsec/ATFReport.doc

The Oregon Department of Education
Autism Task Force Report
http://www.ode.state.or.us/sped/spedareas/autism/finalrec1.pdf

SPECIAL REPORT:
Dr. Lovaas Comments on the Mistaking of his Work

http://www.feat.org/lovaas/

COST-BENEFIT ESTIMATES  FOR  EARLY INTENSIVE BEHAVIORAL INTERVENTION  FOR YOUNG CHILDREN WITH AUTISM--GENERAL MODEL AND SINGLE STATE CASE by John W. Jacobson, James A. Mulick and Gina Green http://www.business.gatech.edu/users/bmiddlebrook/ABAAnalysis.html

Thanks to FEAT of NC:

1) Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children
by O. Ivar Lovaas
http://www.featofnc.org/research1.html

2) Tristram Smith, Washington State University
http://www.featofnc.org/research3.html

Anderson, Avery, DiPietro, Edwards, & Christian (1987). "Intensive home-based early intervention with autistic children." Education and Treatment of Children, 10, 352-366.

Birnbrauer & Leach (1993). "The Murdoch Early Intervention Program after 2 years". Behaviour Change, 10, 63-74.

Campbell, Schopler, Cueva, & Hallin (1996). "Treatment of autistic disorder." Journal of the American Academy of Child and Adolescent Psychiatry, 35, 134-143.

Fenske, Zalenski, Krantz, & McClannahan (1985). "Age at intervention and treatment outcome for autistic children in a comprehensive interevention program." Analysis and Intervention in Developmental Disabilities, 5, 49-58.

Harris, Handleman, Gordon, Kristoff, & Fuentes (1991). "Changes in cognitive and language functioning of preschool children with autism." Journal of Autism and Developmental Disorders, 21, 281-290.

Lovaas (1987). "Behavioral treatment and normal educational and intellectural functining in young autistch children." Journal of Consulting and Clinical Pscyhology, 55, 3-9.

McEachlin, Smith, & Lovaas (1993). "Long-term outcome for children with autism who received early intensive behvavioral treatment." American Journal on Mental Retardation, 97, 359-372.

Perry, Cohen, & DeCarlo (1995). "Case study: Deterioration, autism, and recovery in two siblings." Journal of American Academy of Child and Adolescent Psychiatry, 34, 232-237.

An Open Letter From O. Ivar Lovaas


  • The letter reproduced below is a discussion by Dr. Lovaas regarding what is considered an appropriate therapeutic intervention for children with autism.

  • November 3, 1993

    To Whom It May Concern:

    This letter is intended to address the question of what constitutes an appropriate therapeutic intervention for a child diagnosed as autistic.

    A consensus has emerged among scientific researchers and practitioners that appropriate (not ideal) treatment contains the following elements (e.g., Simeonnson, Olley, and Rosenthal, 1987):

    1. A behavioral emphasis: This involves not only imposing structure and rewarding appropriate behaviors when they occur, but also applying some more technical interventions such as conducting discrete trials, producing shifts in stimulus control, establishing discriminations between SD's and S-deltas, and so forth (Koegel and Koegel, 1988).

    2. Family participation: Parents and other family members should participate actively in teaching their child. Without such participations, gains made in professional settings such as special education programs, clinics, or hospitals rarely lead to improved functioning in the home. (Bartak, 1978; Lovaas, Koegel, Simmons, and Long, 1973).

    3. One-to-one instruction: For approximately the first six months of treatment, instruction should be one-to-one rather than in a group because autistic children at this stage learn only in one-to-one situations (Koegel, Rincover, and Egel, 1982). This training need not be adminstered by degreed professionals, but can be just as effective if delivered by people who have been thorougly trained in the behavioral treatment of autistic children, such as undergraduate students or family members (Lovaas and Smith, 1988).

    4. Integration: When a child is ready to enter a group situation, the group should be as "normal" or "average" as possible. Autistic children perform much better when integrated with normal children than when placed with other autistic children (Strain, 1983). In the presence of other autistic children, any social behavior that they may have developed usually disappears within minutes (Lovaas and Smith, 1988), presumably because it is not reciprocated. Mere exposure to normal children, however, is not sufficient. The autistic children require explicit instruction from trained tutors on how to interact with their peers (Strain, 1983).

    5. Comprehensiveness: Autistic children initially need to be taught virtually everything. They have few appropriate behaviors, and new behaviors have to be taught one by one. This is because teaching one behavior rarely leads to the emergence of other behaviors that were not directly taught (Lovaas and Smith, 1988). For example, teaching language skills does not immediately lead to the emergence of other language skills, such as pronouns.

    6. Intensity: Perhaps as a corollary for the need for comprehensiveness, an intervention requires a very large number of hours, about 40 hours a week (Lovaas and Smith, 1988). Ten hours a week is inadequate (Lovaas and Smith, 1988), as is twenty hours (Anderson, Avery, Dipietro, Edwards, and Christian, 1987). The majority of the 40 hours, at least during the first six months of the intervention, should consist of remediating speech and language deficits (Lovaas, 1977). Later, this time may be divided between promoting peer integration and continuing to remediate speech and language deficits.

    I hope this information is helpful. If you have any questions, please do not hesitate to contact me.

    Sincerely,


    Ivar Lovaas, Ph.D.
    Professor of Psychology
    Director, Clinic for the Behavioral Treatment of Children



    References

    Anderson, S.R., Avery, D.L., Kipietro, E., Edwards, G.L., and Christian, W.P. (1987). "Intensive home-based early intervention with autistic children." Education and Treatment of Children, 10, 352-366.

    Bartak, L. (1978). "Educational approaches". In M. Rutter and E. Schopler (Eds.) Autism: A Reappraisal of Concepts and Treatment (pp. 423-438). New York: Plenum.

    Koegel, R.L., Rincover, A., and Egel, A.C. (1982). Educating and Understanding Autistic Children. San Diego, College Hill Press.

    Koegel, R.L., and Koegel, L.K. (1988). "Generalized responsivity and pivotal bvehaviors." Generalization and Maintenance: Life-Style Changes in Applied Settings (pp. 41-65).

    Lovaas, O.I. (1977). The Autistic Child: Language Development Through Behavior Modification. New York: Irvington.

    Lovaas, O. I., Koegel, R.L., Simmons, J.Q., and Long, J.S. (1973). "Some generalization and follow-up measures on autistic children in behavior therapy." Journal of Applied Behavior Analysis, 6, 131-166.

    Lovaas, O.I., and Smith, T. (1988). "Intensive behavioral treatment for young autistic children." In B.B. Lahey and A.E. Kazdin (Eds.), Advances in Clinical Child Psychology, Volume 11 (pp. 285-324). New York: Plenum.

    Simeonnson, R.J., Olley, J.G., and Rosenthal, S.L. (1987). "Early intervention for children with autism." In M.J. Guralnick and F.C. Bennett (Eds.), The Effectiveness of Early Intervention for At-Risk and Handicapped Children (pp. 275-296). New York: Plenum.

    Strain, P.S. (1983). "Generalization of autistic children's social behavior change: Effects of developmentally integrated and segregated settings." Analysis and Intervention in Developmental Disabilities, 3, 23-34.


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