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Abstract | Summary
| Original Article
Intensive behavioural treatment at school for 4- to 7-year-old children with autism.
A 1-year comparison controlled study.
Eikeseth S, Smith T, Jahr E, Eldevik S.
Behavior Modification 26(1):49-68 2002.
Bottom Line
Is a school-based ABA program
effective with children aged
4 to 7?
- On testing, intelligence
had improved significantly
in the ABA group.
- The ABA group showed better language use.
- There was no improvement in social skills.
- It may be that another type of programming is necessary to improve social skills.
- Higher IQ at entry to the program predicted a better outcome.
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Question: Do 4- to 7-year-old children make significant
gains after one year in a school-based applied behavioural analysis
program?
Background: Many children with autism make significant gains
when engaged in applied behavioural analysis treatment programs.
The programs are, however, frequently restricted to clinical or
treatment-centre environments, and in some jurisdictions end by
age six. Little is known about what effects behavioural programs
have on slightly older children and whether their effects are similar
when offered in a school setting.
Design: Non-randomized controlled trial (two groups are
assigned to different treatments based on availability and are followed
over time, with baseline data and outcomes measured).
Setting: Kindergartens and elementary schools in two counties
in Norway.
Participants: School children aged 4 to 7 with a diagnosis
of childhood autism, IQ over 50, with no other major medical problems.
Intervention: Intensive behavioural intervention was compared
to an intensive eclectic treatment based on best practices for teaching
children with autism. Each was administered in a school setting.
Parental involvement in the classroom was strongly encouraged for
the behavioural treatment group.
Main Outcome Measures: Intelligence tests (WPPSI-R or WISC-R),
the Merrill-Palmer Scale of Mental Tests; the Reynell Developmental
Language Scales, and the Vineland Adaptive Behavior Scales.
Main Results:
At intake, the group assigned to eclectic treatment was likely
functioning at a slightly higher level than the group assigned to
intensive behavioural intervention; otherwise, there were no significant
differences between the two groups. At the end of one year follow
up the results were as follows.
Intensive Behavioural Intervention:
Intelligence (WPPSI-R or WISC-R): The children achieved an increase
of an average of 17 I.Q. points, an increase of 13 points on tests
of language comprehension, 23 points for tests of expressive language,
and 11 points on the Vineland.
Intensive Eclectic Treatment:
Intelligence (WPPSI-R or WISC-R): The mean I.Q. at intake for this
group was 65.17 and 69.50 at follow up, an increase of 4 points.
The children also lost 1 point in language comprehension, 2 points
in expressive language, and gained no points in adaptive behaviour.
The results are based on age combined with scores, so the loss of
points is evidence not of loss of function but rather that the children
made no actual gains.
Conclusions: The children given the intensive behavioural
treatment in the school setting showed greater improvements than
the children given an eclectic treatment, but only in the realms
of intelligence and language skills; none was seen in socialization
skills.
Although the behavioural group’s change in cognitive functioning
(both I.Q. and language) was significantly greater than that of
the eclectic group, their overall scores at the end of treatment
were not clinically different.
This study demonstrated that I.Q. at baseline predicts better outcome.
What is new is that this study provides some evidence that children
between the ages of 4 and 7 can make significant gains in I.Q. in
community-based programs. It is likely that a different type of
program is needed to improve socialization skills.
Further research using RCTs is needed to confirm the findings.
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