Intensive Behavioral Intervention
Not all children and adults may be candidates for intensive intervention.
General Information related to intensive intervention is provided below with full references available by clicking on the links shown after each excerpt.
Intensive behavioral and educational intervention programs involve systematic use of behavioral teaching techniques and intervention procedures, intensive direct instruction by the therapist, and extensive parent training and support.
Several studies done by independent groups of researchers have evaluated the use of intensive behavioral intervention programs for young children with autism. The four studies that met criteria for evidence about efficacy all compared groups of young children with autism who received either an intensive behavioral intervention, a comparison intervention, or no intervention. In all four of the studies reviewed, groups that received the intensive behavioral intervention showed significant functional improvements compared to the control groups.
While none of the four studies used random assignment of subjects to groups, there did not appear to be any evidence of important bias in group assignment. Within each study, the groups receiving different interventions had equivalent subject characteristics. Furthermore, all studies showed similar and consistent results.
Since intensive behavioral programs appear to be effective in young children with autism, it is recommended that principles of applied behavior analysis and behavioral intervention strategies be included as an important element of any intervention program.
It is recommended that intensive behavioral programs include a minimum of 20 hours per week of direct instruction by the therapist. The precise number of hours of behavioral intervention may vary depending on a variety of child and family characteristics. Considerations include age, severity of autistic symptoms, rate of progress, other health considerations, tolerance of the child for the intervention, and family participation. It is recommended that the number of hours be periodically reviewed and revised when necessary. Monitoring of progress may lead to a conclusion that hours need to be increased or decreased.
It is recommended that all professionals and paraprofessionals providing therapy to the child as part of an intensive behavioral program receive regular supervision from a qualified professional.
It is important that parents be included as integral members of the intervention team. It is recommended that parents be trained in behavioral techniques and be encouraged to provide additional hours of instruction to the child. It is also recommended that training of parents in behavioral methods for interacting with their child be extensive and ongoing, and that it include regular consultation with the primary therapist.
Although some of the intensive behavioral intervention programs that were effective included use of physical aversives (such as a slap on the thigh), other programs reported good outcomes without the use of any physical aversives. The panel does not recommend the use of physical aversives, especially given the small physical size and vulnerability of young children in the age group from birth to age three years.
Summary Advantages and Limitations
Full Reference and Guide Ordering Information:
Excerpt from Vincent J. Carbone, Barry Morgenstern, Gina Zecchin-Tirri & Laura Kolberg's Article - The Role of the Reflexive Conditioned Motivating Operation (CMO-R) During Discrete Trial Instruction of Children with Autism (2007)
Comprehensive intensive treatment based upon the application of behavior analytic principles has proven to be an effective form of intervention for children with autism (Green, 1996). Several comparative studies have demonstrated the superiority of behavior analytic programs over other approaches to autism treatment or differing levels of intensities of services (Birnbrauer & Leach, 1993; Cohen, Amerine-Dickens, & Smith, 2006; Eikseth, Smith, Jahr, & Eldevik, 2002, 2007; Howard, Sparkman, Cohen, Green, & Stanislaw, 2005; Lovaas, 1987; Sallows & Graupner, 2005; Remington et al., in press; Smith, Groen, & Wynne, 2000). This research has provided clear evidence that intensive intervention guided by behavior analytic principles can produce substantial benefits for children with a disorder that was once thought to be resistant to all forms of treatment. There are reports of children with autism entering regular education classrooms, achieving substantial cognitive gains and developing age appropr iate social skills after many years of intensive behavioral intervention (Lovaas, 1987). Recently, evidence has been gathered that suggests that school, community, and home applications of intensive behavioral intervention can be equally successful (Eikseth et al., 2002; Howard et al., 2005). At least five published manuals (Leaf & McEachin, 1999; Lovaas, 1981, 2003; Maurice, Green, & Foxx, 2001; Maurice, Green, & Luce, 1996) for parents and practitioners are available to provide a summary of the effective teaching methods discovered through controlled studies. These manuals have provided a userfriendly method of disseminating effective behavior analytic methods for teaching children with autism. The result may be greater acceptance and widespread application of behavior analytic methods with children with autism.
A copy of the full article as well as other related articles can be found in the Journal of Early and Intensive Behavior Intervention