Treatments and cures for autism appear in the professional and lay press on a regular basis. Unfortunately, the efficacy and safety of many of these interventions are based on individual beliefs and anecdotes rather than science or data. In contrast, well-controlled and validated studies have shown that there are some interventions that are quite effective for treating children with autism and related disorders, both to teach new skills and to reduce problem behaviors in children in these children. The strongest outcome data to date revolve around treatment programs based on the science of applied behavior analysis (ABA), particularly those that emphasize early and intensive behavioral intervention (also called Early Intensive Behavior Intervention or EIBI), with long term studies showing maintenance of gains over time.
As a science, ABA embraces the well-supported fact that autism is a biologically based neuro-developmental disorder with no clearly identified biological marker, nor a known cure. Research over the last 30 years, however, has proven that many specific impairing symptoms and barriers to learning can be significantly altered through the systematic application of behavioral interventions and behavioral instruction. Primary attention has been given to two goals:
- the decrease or elimination of inappropriate, stereotyped, or “maladaptive” behaviors that interfere with learning and social functioning; and
- the increase in appropriate or “functional” behaviors and skills, particularly in areas of communication, academic, adaptive, and/or vocational skills that will allow a child to be successful in an educational environment, and eventually the larger community.
All children experiment with their behavior over time, trying out new behaviors in various situations, some that are useful and some that are not, some that are acceptable to others and some that are not as acceptable. When a behavior results in a positive or negative reinforcement (i.e., getting something that is wanted or being able to escape or be removed from a situation that is considered unpleasant) that behavior is more likely to continue or increase. If a behavior does not get reinforced or results in something happening that is considered unwanted or unpleasant (e.g., being ignored or punished), the behavior is more likely to decrease. For most children, this teaching occurs very naturally, as they seek feedback and learn from these often-subtle behavioral interactions with the social world in which they live. Children with autism typically have difficulty accurately attending to, interpreting and utilizing the feedback that automatically exists in their world. Applied behavioral analysis and subsequent treatments analyze these interactions and sequences of behavior, making explicit the rules, consequences, and expectations that others understand more automatically, in an effort to teach more adaptive, useful, and maintainable behaviors and skills.
Behavioral intervention teaches a child not only to “know” the rules of what is expected, but to use their skills and behaviors more automatically, modifying behavior and adding new behaviors using well understood and established behavioral principles such as reinforcement, shaping, prompting and prompt-fading, and generalization. With this technology, target behaviors are broken into very small, separate components and each skill is taught systematically in a way that is likely to be effective for that child, typically individually at first, utilizing specific prompts and reinforcements (referred to “errorless learning”) until the child reaches a predetermined level of mastery that is designed to increase likelihood of maintenance and generalization. Successes are built upon, with constant systematic modification of the program as the child demonstrates progress, eventually adding a behaviorally sequenced generalization plan to transfer the skills into other settings and situations. The success of any behavioral program rests upon the clarity of target goals and objectives, the purposeful choice of teaching tools and lessons, the appropriate choosing of reinforcement and reinforcement schedules, the appropriate judicious use and fading of prompts and reinforcements, the purposeful inclusion of behavior generalization, and the consistent application of behavioral principles.
Behavioral treatment may be as intense and broad as the 35 – 40 hour per week of professionally managed applied behavior analysis (ABA) programs currently recommended for young children with autism or as limited as a behavioral analysis and treatment for one target goal, such as increasing the initiation of social contact with a peer. Greater gains have generally been shown for younger children who receive more intensive treatment.
Behavioral intervention, even intensive applied behavior analysis, is not magic nor is it a cure for autism. Such programs involve a great deal of time, energy, and hard work and often a significant change in behavior for the entire family. The research is quite promising, however, that with intensive behavioral intervention, most children with autism make significant gains in their skills and behaviors to better function within their family, school, and community, with some appearing quite similar to their “typical” peers.