Early Intensive Behavioral Treatment: Replication of the UCLA Model in a Community Setting
Cohen, H., Amerine-Dickens, M., & Smith, T. (2006). Early intensive behavioral treatment: Replication of the UCLA Model in a community setting. Journal of Developmental and Behavioral Pediatrics, 27, 5145-5155
Reviewed by Kathleen Moran, MA
Why research this topic?
In 1987, Ivar Lovaas reported a study on a behavioral treatment that took place 30-40 hours a week for two years, beginning before the age of 4. The treatment resulted in large IQ gains and placement in general education classrooms for half of the group of 19 children with autism who received it. A follow-up study of the same children showed that the gains were maintained. Lovaas’s study, however, was conducted in a university setting, and many people questioned the feasibility of offering treatment at such intensity in a community setting. This concern grew as mixed results were obtained in subsequent studies of Early Intensive Behavioral Treatments (EIBT) implemented in the community. Because treatment in most of these studies was less intensive and less closely supervised than in Lovaas’s study, Cohen et al. sought to replicate Lovaas’s model more closely in a community setting and evaluate outcomes.
What did the researchers do?
The study consisted of 42 children with autism and PDD-NOS. Children were split into two different groups, each group receiving a different treatment. Parents chose which treatment his/her child received. One group received early intensive behavioral treatment based on Lovaas’s previous study for 35-40 hours of behavioral intervention, 47 weeks per year for 3 or more years. As children gained skills in this group, their early intensive behavioral treatment progressed from one-to-one home instruction to a focus on peer play and finally to inclusion in a general education classroom. The other group of children received services from a local public school for 3 to 5 days a week for up to 5 hours a day for three or more years. Children in this group also received related therapies such as speech and language therapy varying from 0 to 5 hours a week from community agencies. Children from both groups were assessed before treatment began and after the first, second, and third year of treatment on measures of IQ, language, nonverbal skills, adaptive behaviors, and classroom placement.
What did the researchers find?
The early intensive behavioral treatment group had significantly higher IQ and adaptive behavior scores than the other group. It also had higher scores on communication and daily living skills, though this advantage was not statistically reliable. At the end of the study, 6 children from the early intensive behavior treatment group were fully included into a general education classroom and 11 were included with support. Only 1 child from the other group was placed in a general education classroom.
What are the limitations and strengths of the study? What do the results mean?
This study showed that Lovaas’s early intensive behavioral treatment could be effectively used in a community setting with similar results to his original study, in that children who received this treatment obtained higher test scores and were much more likely to attend a general education classroom than children in the other group. One reason for the especially large difference in classroom placement could be that the early intensive behavioral treatment group received social skills training while the other group did not. A limitation of the study was that groups were not randomly assigned but placed in one group or another by their parents; thus, pre-existing differences between groups such as family factors may have contributed to the differences observed in the outcome assessments.