Examining the Effects of Lower Intensity ABA Therapy on Meaningful Progress with Clients Diagnosed with Autism. Wendy Nebbia M.Ed.

Transcription

1 Examining the Effects of Lower Intensity ABA Therapy on Meaningful Progress with Clients Diagnosed with Autism. Wendy Nebbia M.Ed., BCBA

2 Focus of Presentation Examining the effects of 25 hours or less of ABA therapy on meaningful gains and progress with clients diagnosed with autism. Discussion of what research continues to need to be conducted

3 Background Several research studies have demonstrated the success of using hours per week of ABA therapy with young learners. However, client schedules and ability to participate in long sessions may limit hours available for therapy. Thus, the purpose of this study was to examine the effects of lower hours of ABA therapy provided on progress made as measured by VB MAPP milestones.

4 Background The best outcomes have been attained when a child receives 40 hours per week of behavioral treatment. Intervention should always be individualized, and some factors, such as a child s age and current skill level, will influence the number of hours recommended. But, 40 hours per week remains the standard from which to deviate. (Lovaas Institute) The BACB guidelines state Very young children may start with a few hours of therapy per day with the goal of increasing intensity..treatment hours are subsequently increased or decreased based on the client s response to treatment and current needs (p.25)

5 Research Review Primary research documented the effectiveness of intensive behavior analytic interventions for autism. Findings from early intervention research indicate that intervention that is intensive, long in duration, and delivered directly to children (rather than caregivers) produces better outcomes than intervention that lacks those elements. (*) Children receiving 40 hrs per week (for at least 2 years) of intensive behavior analytic intervention made significantly larger gains than those receiving only 10 hrs per week. (**) *Howard, Sparkman, Cohen, Green, & Stanislaw, (2005) ** Ivar Lovaas (1987)

6 Recent Studies A 2002 study delivered behavioral intervention to 13 children with autism (ages 4-7 at beginning of study) for 28 hrs per week for 1 year. Seven of the 13 children (58%), at follow up, achieved scores in the normal range for functioning.ⁱ Conducted a study with 27 young children diagnosed with autism spectrum disorders from 2 to 6 years of age at start of study. The children received from 1 to over three years of therapy ranging from 12 to 37 hours per week (average =22 hours). All of the children exhibited improvement and 2/3rds were in regular education placements at the conclusion of treatment. (1) Eikeseth, Smith, Jahr, & Eldevik (2002)

7 Study Protocol Clients were assessed initially with the VB-MAPP Milestones Assessment, The skills assessed include mand, tact, echoic, intraverbal, listener, motor imitation, independent play, social and social play, visual perceptual and matching-to-sample, linguistic structure, group and classroom skills, and early academics. Data was collected by reassessing clients using the VB MAPP every 3-4 months after clients participation in 25 hours or less per week of 1:1 therapy. None of the clients in this study had previously received ABA services.

8 Verbal Behavior Milestones Assessment and Placement Program criterion-referenced assessment tool includes curriculum guide skill tracking system designed for children with autism Also used with individuals who demonstrate language delays based on B.F. Skinner s (1957) analysis of verbal behavior, established developmental milestones, and research from the field of behavior analysis.

9 Client Age Hours per week Parent Involvement Score increase A 2 year old 25/17.5 Low 95.5 B 4 year old 15/6 Moderate 70.5 C 18 months old 25/ 12.5 High 93 D 2 years old 15/6 Moderate 70.5 E 3 year old 25 High 52 F 3 year old 25 High 66

10 Milestone Scores Milestones Scores A B C D E F Series1 Series2 Series3 Series4

11 Results of the Study Results indicate that clients who received 25 hours or less of quality ABA therapy were able to make significant progress as measured using the VB MAPP. Client gains ranged between an increase of 52 points and points. This study potentially impacts planning for individuals diagnosed with autism in terms of prescription of ABA hours.

12 Limitations of the Study Some limitations include: The same BCBA conducted all assessments. IOA data was not taken Not all clients were at the same level when first assessed Clients were/are at different functioning levels. Parent involvement varies between clients Techs working with clients are not same

13 What Variables Moderate and Mediate Gains? A 2009 (Howlin et al) study alludes to fact of IQ playing more of a part It found that at an individual level, however, there was considerable variability in outcome, with some evidence that initial IQ (but not age) was related to progress. it is clear that the field is still very early in the process of determining (a) what variables moderate and mediate treatment gains and improved outcomes following intervention, and (b) the degree of both short-term and long-term improvements that can reasonably be expected.

14 Correlation of Early Learning Rates with Outcomes Study (Weiss et al) showed highly variable outcomes for learners with autism exposed to intensive treatment. All children made extensive gains on measures of autism symptomatology, changes in adaptive behavior were more variable. Approximately half of the children were fully included in their educational placements. The remainder continued to require highly specialized instruction to learn skills. Impact of individualization of the programming is impossible to capture and may be a major factor A related possible source of impact is variability in the skill levels of teams.

15 Other Considerations Research also indicates that not all ABA provisions or programs are equally effective (Hayward et al. 2009) Lucelli et al in 2000 paper looked at the roles of age, number of hours per week, number of months of treatment and total hours of treatment, Only the number of months of treatment was significant to client gains.

16 Questions for Further Research Is it more about the quality of services or the number of hours of service? Might there be a need for a different number of hours for different levels of functioning? What is the impact of IQ on the number of hours of service? How can quality of program be measured? Current research appears to assume that the child is only learning during therapy What about the effects of parental involvement and follow through outside of sessions? How do we measure this?

17 References ABA Guidelines for ASD. Behavior Analyst Certification Board. Web, Lovass, O.I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology 55, p3-9. "Lovaas ABA Treatment for Children with Autism." Lovaas Institute. Web, McEachin, J. J., Smith, T., & Lovaas, O. I. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal on Mental Retardation, 97 (4), Sallows, Glen O. & Graupner, Tamlynn D. (2005). Intensive Behavioral Treatment for Children with Autism: Four- Year Outcome and Predictors. American Journal on Mental Retardation,110 (6), Travis Thomson Thompson, T (2010) Individualized autism intervention for young children; Blending naturalistic and discrete trial approaches. Baltimore: Paul H. Brookes, Inc Graff, Richard B., Green, Gina, & Libby, Myrna E. (1998) Effects of two levels of treatment intensity on a young child with severe disabilities. Behavior Interventions Volume 13, Issue 1, Howline, Patricia, Magiati,Iliana, and Charman, Tony (2009). Systematic Review of Early Intensive Behavioral Interventions for Children With Autism. American Journal on Intellectual and Developmental Disabilities: January 2009, Vol. 114, No. 1, pp Weiss, Mary Jane, and Lara Delmolino Rutgers (2006). The Relationship Between Early Learning Rates and Treatment Outcome For Children With Autism Receiving Intensive Home-Based Applied Behavior Analysis. Behavior Analyst Today: Winter, 2006, Vol. 7, No. 1, p107

18 Thank you! Wendy Nebbia, M.Ed., BCBA