Eikeseth, S., Klintwall, L., Jahr, E., & Karlsson, P. (2012). Outcomes for children with autism receiving early and intensive behavioral intervention in mainstream preschool and kindergarten settings. Research in Autism Spectrum Disorders, 2, 829-835. doi: 10.1016/j.rasd.2011.09.002
Reviewed by: Casey L. Nottingham
Caldwell University
Why review this topic?
Early and intensive behavioral intervention (EIBI) is widely implemented with individuals with autism spectrum disorder (ASD) as in-home or center-based specialized settings. Several studies support the use of EIBI for improving academic and adaptive behaviors. However, limited research exists on the effectiveness of EIBI implemented in community settings such as preschools and kindergarten classrooms. This may be because EIBI is intensive and comprehensive and trained instructors and supervisors are necessary. Additionally, caregiver involvement is typically required. To add to the evidence of the effectiveness of community-based EIBI, the authors compared EIBI in public preschools or kindergarten classrooms to treatment as usual in these settings.
What did the researchers do?
Participants included 59 children who were diagnosed with autism and had not previously received EIBI services. Thirty-five participants received EIBI services in mainstream classrooms. Twenty-four received treatment as usual. All children received services in their local, publicly funded preschools or kindergartens. Children in the EIBI group also received services at their homes.
Most of the EIBI therapists had no prior training or experience. Their supervisors had a minimum of a bachelor’s degree, some had master’s degrees, and one was a Board Certified Behavior Analyst. EIBI was based on the UCLA model developed by Ivar Lovaas and colleagues. This model begins with highly structured, one-to-one teaching such as discrete trial training and gradually moves toward more child-led interactions and inclusion in group settings. Although the curriculum is standardized in a manual, the intervention goals are individualized for each child. Treatment intensity ranged from 15 to 37 hours per week of intervention for the EIBI group (average = 23 hours per week), and weekly supervision meetings were held that included the child, primary therapist, caregiver, and supervisor.
In the treatment as usual group, the primary therapists were special education teachers who had a minimum of a bachelor’s degree; teacher assistants sometimes also provided intervention. Treatment in this group was eclectic including alternative communication (e.g., signs, symbols), sensory-motor therapies, behavioral analytic techniques, and procedures that the special education teachers created based on personal experience.
The authors measured adaptive and interfering behavior with the Vineland Adaptive Behavior Scales (VABS) and the Childhood Autism Rating Scale (CARS). These assessments were given at the start of the study, after one year of treatment, and (for the EIBI group only) after two years of treatment.
What did the researchers find?
The researchers found that the EIBI group and treatment as usual group did not differ in the adaptive and interfering behavior measurements at the start of the study. After one year of treatment, the children receiving EIBI showed larger gains in adaptive behaviors and greater reductions in interfering behaviors and behaviors characteristic of ASD than did the children receiving treatment as usual. The EIBI group continued to improve from Year 1 to Year 2, although the improvements were smaller than those seen from Intake to Year 1.
What are the strengths and limitations of the study? What do the results mean?
Several limitations exist in the current study. First, the individuals who completed the assessments for children in EIBI were the therapists providing services. Because the therapists were responsible for the outcome of the children, they may have been inclined to assign lower scores on the intake assessments and higher scores on the later assessments. Second, the participants in the study were not randomly assigned to either the EIBI or treatment as usual group. This is a problem because although the two groups did not differ with regard to their adaptive and interfering behavior scores at the beginning of the study, they might have differed on other variables; random assignment to groups would allow for greater confidence that the groups were comparable. Nevertheless, the study does add to the limited evidence of the effectiveness of community-based EIBI and suggests that public school educators can deliver EIBI effectively.
Citation for this article:
Nottingham, C. (2015). Research Synopsis: EIBI in community settings: public preschool and kindergarten. Science in Autism Treatment, 12(2), 38-40.
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