Have Fun During Play

For many newly diagnosed children with autism, play may seem foreign and not enjoyable. Certain rigid patterns may form since they don’t know how to play. When an ABA therapist comes to work with children, they show how fun play is and how varied play can be. In the beginning, place low or no demands in order to build a rapport with the child. This is achieved with following the child’s lead during play and making fun contingent on your presence. Here are some examples of pairing yourself with fun things:

• Sing Songs The Child Likes – sing a variety of songs during play and if you get eye contact, start pausing to see if you can get some communication to sing more.
• Help The Child During Play – if the child likes putting shapes in a shape sorter, gather all the shapes and let the child request each piece either non verbally or verbally. This shows the child that they need you to complete a fun activity.
• For Older Children, Play Social Reinforcing Games – This includes pretending to sleep and having the child wake you up, or playing chase while you run around like an alligator ready to chomp. Games you can make “your own” will be powerful reinforcers for the child.
• Add Funny Noises During Play – Make cool sound effects when playing cars or be dramatic with play. Many children enjoy crazy fun play with toys such as stuffing your shirt with toys and sneezing them out or wrapping playdough on animals and pretending they got hurt and need a cast.
• Have A Bag Of Goodies – This is highly important when you become an ABA therapist. This bag of toys will come home with you and are your own personal reinforcing toys. Go to your local dollar store and pick up a variety of toys such as slime, squishy balls, bouncy balls, slinkies, vibrating toys, light up toys, toy cars, bubbles and stretchy toys. Continually add toys as you get to know your children. Some children may like Bob the Builder so finding a Bob The Builder book can be highly reinforcing.

Pair Yourself

The best tip to give new therapists is to pair yourself with good things. Try to make every activity you do with the child reinforcing only because you are there. Since many children with autism enjoy being alone, a therapist has to be extra fun in order to hold the attention of the child. Here are some activities to pair yourself:

• Bubble Fun – Many children don’t know how to blow bubbles but enjoy bubbles. This is a fun activity to encourage communication and to pair yourself with.
• Gross Motor Fun – Many children love jumps, spins, lifts and anything to do with gross motor. Blanket rides, magic carpet rides, tub rides are all great fun activities that a therapist can pair themselves with.
• Special Books – There are many touch-feel books that children love. If children love regular books then you can use them to pair yourself with reading their favorite books.

How Does Video Modeling Work?

Two studies* have been done in this area and they have concluded that videos depicting appropriate behaviors proves to be effective in helping children and adolescents with autism learn various social and daily living skills.

Getting Started

Usually the supervisor of your ABA program will suggest doing a video model of a social skill or daily living skill. Sometimes ABA therapists will act out in the video or get a brother or sister or even the child with autism to perform the behavior on video. Teams may also add an additional of reenacting the behavior after watching it on TV. Practice is essential in an ABA program.

There are also companies that supply videos of various social skills. Some great websites are -

• Model Me Kids
• Teach2Talk
• TD Social Skills
• Watch Me Learn

References

*Bellini, S., Akullian, J., & Hopf, A. (2007). Increasing social engagement in young children with autism spectrum disorders using video self-modeling. School Psychology Review, 36, 80-90.

*Bellini, S. & Akullian, J. (2007). A meta-analysis of video modeling and video self-modeling interventions for children and adolescents with autism spectrum disorders. Exceptional Children, 73, 261-284.

For a behavior to re-occur, reinforcement must be contingent on the desired behavior. As well, if a therapist wants to decrease inappropriate behavior, reinforcing APPROPRIATE behavior and ignoring the inappropriate behavior will decrease the frequency or duration of the inappropriate behavior and increase the likelihood of appropriate behavior.

In the beginning of an ABA program, reinforcement is delivered in high frequency in order to shape appropriate behavior and motivate the child to learn. Common reinforcers in the beginning are food and drink, as these are natural reinforcers for any living creature.

Social praise is always paired with food to teach the child to enjoy verbal praise, a type of secondary reinforcement.

As the child ages in an ABA program, the style of programming changes. Programs taught formally at the table have been moved and generalized in the environment.

As well, time sitting at the table will resemble the time the child must sit at school. Reinforcement during this time is faded in frequency and in type.

Big reinforcers such as computer time are saved after long periods of program work and smaller toy, food, or verbal praise occur intermittently within programs.

Food should be faded so that the child only receives food during snack time or for behaviors that need to be heavily praised such as peeing in the toilet.

Once the child can approximate some part of a correct response with the use of a prompt, the therapist then “ups the anty” by giving a lesser type of reinforcement (“good job”) and fading their prompt until the child responds correctly. For this response, reinforcement is delivered in larger quantities (when compared to the teaching phase) in order to increase the likelihood of the behavior.

This teaching strategy is called differential reinforcement. If the child responds independently without any assistance from the therapist, the quality and quantity of reinforcement is stronger than reinforcement at prompted trials.

Differential Reinforcement:
Using stronger reinforcement for independent success and using lesser reinforcement for non-success. Think of Differential Reinforcement as giving EXCELLENT feedback to an EXCELLENT response, GREAT feedback to a GREAT response, OKAY feedback to an OKAY response, and CORRECTIVE feedback to an incorrect or non-response that is poor in attention and motivation.

Choose your EXCELLENT reinforcer by finding food or items that the child loves but rarely gets. If you choose a food or item that the child normally gets, it will not be a powerful motivator for EXCELLENT responses and the child will not comply to the instruction given.

For anything less than an EXCELLENT response, the child will receive other reinforcers that will make him or her happy and content.

Remember that therapists need to avoid satiation by not always giving one type of food or item for responses. Therapist should have a variety of food and toys that the child absolutely loves and use them throughout their session. You can decide what type of food and toys to use to shape a desired behavior by doing a Reinforcement Sampling where you hold up two objects and see what the child chooses. From there you pair the chosen item with another item and see what they choose. From this sampling, you can get an idea of what the child really wants at that time.

An Example of Teaching the Label, “Apple” in an Expressive (Object) Labels Program by using differential reinforcement

If a therapist wants to teach the child the label, “apple,” the therapist or team must first decide what a correct response is. For verbal children it will be the full word, for non-verbal children, it may be picking the correct PEC, and for children who have a hard time with pronunciation, an approximation to the label can be considered a correct response.

During each teaching trial, a therapist must deliver a consequence for the child’s behavior. If the consequence is correct, reinforcement is given.

First Sitting:

Therapist: “What is it?—APPLE” (APPLE is a verbal prompt- voice is slightly above normal speaking voice)

Child: “Apple”

Therapist: “Good! That’s apple!” (reinforcement is appropriate for a full prompted response)

Therapist: “What is it?—Apple” (voice is normal speaking voice when giving verbal prompt)

Child: “Apple”

Therapist: “All right, that’s an apple!” (repeating the label is called an expressive follow-up and can be used to help learn the label)

Therapist: “What is it?—-Ahh…” (normal speaking voice when delivering a partial verbal prompt)

Child: “Apple”

Therapist: (lifts child up in the air, or gives food, toy etc..) “You did it! It’s apple!”

Therapist lets child go for a correct response with a faded prompt.

Second Sitting:

Therapist: “What is it?—Ahh” (whispers verbal prompt)

Child: “Apple”

Therapist: “Good!” (gives child tickles or some form of physical reinforcement for a correct response with a faded prompt)

Reinforcement at this level is quick as the pace of drills is essential to catch children “off guard.” If you run your drills fast, you can easily fade your prompt completely and hope that the child will automatically say the label. This method is called behavioral momentum.

Therapist: “What is it?—therapist mouths the sound “Ahh”

Child: “Apple”

Therapist: “Holy-Molly!”

Therapist: “What is it?

Child: “Apple”

Therapist: “Woo-Hoo, that’s apple!” let the child go play/ give food/ special toy.

Children learn at different paces, so this example can be stretched to several days at a certain level of prompting, such as a verbal prompt of, “Ah” over two or three days.

Here is an old video of a child learning some basic sounds using the so-called “lovaas method” of language acquisition.

* appropriate behavior
* task completion
* imagination
* turn taking
* building relationships
* joint attention
* imitation
* appropriate language
* tolerance to a variety of ways to play with toys
* reciprocal interaction

and most of all to have fun. Play, essentially, is an important skill that compliments ABA and generalizes skills taught formally.

Below are brief summaries of clients that I have worked with who, after years of dedication, learned to have fun with toys.

One child I worked with started with no play skills and did not enjoy formal teaching of play. After three years of rigorously playing with a variety of toys, he now has favorite toys and will spend time independently playing.

Although there are kids who must be taught formally on how to play by putting play tasks in an ABA program, this particular child was not having fun. The team worked especially hard to motivate this child to play. This particular play program was taught informally and had to be fun. Attention to a task was also difficult for this child, as he would not sit for more than a few seconds at a time.

During countless sessions, I did everything possible to make this child ENJOY play and not just go through a rote script that was taught to him. I used a lot of social reinforcement, as this was something he liked. As an example, the child and I would build blocks and then crash them. When the blocks crashed, I fell back and pretended that I was dead. This sparked laughter, so we did it again and again. Another instance that I can recall is playing a bead maze. As a way to prolong sitting and playing, I would make funny noises or change the tone of my voice when talking. This child enjoyed this tremendously. I was able, through social interaction, to pair this enjoyment with playing.

Sitting down to play with a toy has also gradually increased and he now sits for up to 15 minutes playing with a variety of toys.

This child is now 5 years old. Through years of dedication, our team was able to drop our SD voice and formal teaching style and have fun with play. In turn, this child learned that playing IS fun and it is not a chore that must be completed.

Now, when I do therapy, this little boy will sit happily playing with one of his favorite toys while I set up a program. Every time I see this, I smile and always treasure these precious moments.

Since each child with autism is unique and possess different strengths and weaknesses, I have had other clients in which there was a formal toy play program. Play was geared towards appropriate usage of certain toys. For example, when teaching play-dough, certain tasks were targeted such as rolling play-dough with a rolling pin, cutting play-dough and making shapes from cookie-cutters. For these children, SD voices were used, but in a natural tone of voice.

After targeting task in play, this child will now naturally roll play-dough with a rolling pin and enjoys making countless shapes from cookie-cutters. As well, therapists have also taught numerous other play tasks for play-dough in a natural manner such as making snakes, balls, or spaghetti from the play-dough machine.

For other children, certain rigidity patterns were targeted in a toy play program. For instance, a child may string beads in a certain order, or must complete the whole task of beading and cleaning up with no interruptions. For children that have rigidity behaviors, therapists work at breaking these patterns by interrupting a child’s play sequence, or changing it up. As an example, to disrupt a ritualistic behavior I often play “dumb” and do other things with the toy. For example, if a child always has to put the basket ball through the hoop, I put a block through the hoop or bounce the basket ball around. In the beginning, children with autism will resist any change in their play, and therefore will try anything to make a therapist stop. It is the therapist’s job, however, that once a goal has been set, to go through with whatever you are doing. It is important, however, to follow the program supervisors suggestion on the amount of disrupting rigidity behavior as to not overwhelm the child. Children with autism will soon learn to tolerate other ways to play with a toy and may even find it entertaining and fun along the way.

In her book, “Let Me Hear Your Voice: A Family’s Triumph over Autism” (Maurice, 1993), Catherine Maurice shared her uncertainty, confusion, and immediate hopelessness upon hearing the word autism as a description of her daughter, Anne-Marie. Indeed, many mothers and fathers feel a sense of uncertainty when their child is lining up cars instead of pushing them and confusion when their child does not respond to their own name. Most of all, parents are heart broken and feel hopeless when hearing that their beloved child has autism, for when a child is deemed autistic, they are also deemed to a, “‘severely, lifelong disability’” (Maurice, 1993, p.22). As well, parents are thrust into an unknown world that is autism and must form a path out by researching what autism is and finding appropriate treatment to help their child. Parents will soon learn that autism covers an array of characteristics and that the word “autism” lies on a continuum along with disorders such as Rhett’s, Pervasive Developmental and Asperger’s (Diagnostic Statistical Manual of Mental Disorders, Fourth Edition, 1994). They must also weave through countless approaches to treating autism until they come across Applied Behavioral Analysis, a form of behavior modification that is scientifically proven to be successful in treating autism (Lovaas, 1987).

The Occurrence of Autism

Autism afflicts approximately 5 children per 10,000. Ritvo et al. (1989) has indicated a genetic basis in autism, but it is not considered a causal factor in the etiology since none has yet to surface. Ritvo et al. (1989) cited 20 families out of 207 having more than one autistic child. They also noted that there is no correlation between autism and racial makeup, religious affiliation, parental employment and education (Ritvo et al., 1989). Thus, autism can “crash” into a family of any race and educational background and crush any hopes and dreams they may have had for their child. While autism is blind to race, religion, and socioeconomic status (SES), it is not blind to the sex of the child. Autism afflicts more boys than girls with a ratio of 4:1 (DSM IV, 1994). Girls are also at an increased risk of severe mental retardation and maladaptive behavior problems such as face hitting, a form of self-injurious behavior (DSM IV, 1994).

Characterizing Autism

The varied behaviors of autism make the disorder extremely difficult to detect. While some children acquire language and can play appropriately, others can be mute and play in odd eccentric ways. As with many other parents, Catherine Maurice (1993) was puzzled by her daughter’s peculiar behaviors at 1 year of age. Maurice (1993), however, brushed off any of her daughter’s behaviors to, “the uniqueness of [Anne-Marie’s] personality,” since, “she was passing her regular pediatric checkups with flying colors” (p.5). It is true, as in Maurice’s (1993) case, that in approximately 20% of children, development is normal in the first 2 years of life (DSM IV, 1994). Between the second and third year of life, however, parents report a regression of language and then finally an abrupt stop in development (DSM IV, 1994). According to the DSM IV (1994), there are core deficits and excesses in autism that must occur before the age of 3 for a proper diagnosis.

Main deficits in children with autism can affect communication, play and social interaction (DSM IV, 1994). Impairments in communication are primarily associated with expressive and receptive language. Language can be delayed (DSM IV, 1994), or non-existent in which other forms of communication such as Picture Exchange Communication (PEC) might be used (Bohdanna Popowycz Kvam, personal communication, November 1, 2002). Language can also be impaired in the form of a lack of spontaneity (i.e. “I see a car”) or reciprocal statements (i.e. “Tickle my tummy”), pronoun reversal (i.e. “This is your [instead of my] bedroom”), echolalia in which children repeat words said to them and in, “pitch intonation, rate, rhythm [and] stress” (DSM IV, 1994; Schopler, Riechler, DeVellis & Daly, 1980). When children do acquire some language, it can be extremely limited and can largely encompass an array of unique idiosyncrasies such as phrases from books, movies, songs or funny sounding words like “gasoline” which can be spoken during inappropriate times (DSM IV, 1994). Not only is expressive language affected, but so is receptive understanding of spoken language. An impairment of receptive understanding may cause enormous frustration for children trying to understand language and for parents who ask children to do simple commands such as, “go get your shoes and coat” (DSM IV, 1994). Parents often complain that the first sign of something wrong was that their child did not respond to their own name (Bohdanna Popowycz Kvam, personal communication, November 1, 2002).

The areas of parallel, associative, cooperative, imaginary and interactive play can also be impaired in children with autism (DSM IV, 1994). Some children with autism unfortunately do not know how to play since they may lack imitation skills. When they do play they usually engage in perseverative play of doing the same actions over and over again. They can also form ritualistic patterns during play in which play sequences must be exactly the same each and every time (Bohdanna Popowycz Kvam, personal communication, November 1, 2002).

As well, social interaction can be severely affected since autism means to be isolated from others (Maurice, 1993). Deficits in social interaction can take the form of a lack of sustained eye contact, asking questions, nonverbal cues such as tapping a person’s shoulder to get their attention and including other people in their play (DSM IV, 1994). Children with autism also may not recognize other people as sources of social enjoyment and might prefer to be isolated from others since it is more reinforcing to be alone and comfortable than to be forced to engage with other people (Bohdanna Popowycz Kvam, personal communication, November 1, 2002).

Autism can also be characterized by a series of marked excesses. Besides perseverative and ritualistic behaviors, self-stimulatory behaviors can also exist in children with autism (Bohdanna Popowycz Kvam, personal communication, November 1, 2002; Lovaas, 1987). These behaviors appear to look odd to others since they do not represent normal development in children. Examples of self “stims” include verbal (i.e. repeating a word), visual (i.e. using your peripheral vision to look at everything) or tactile (i.e. licking books) (Bohdanna Popowycz Kvam, personal communication, November 1, 2002). Children with autism can also exhibit self-injurious behaviors or severe aggression and tantrums (DSM IV, 1994). As well, some children can be hypersensitive or hyposensitive to any of our five senses (DSM IV, 1994).

Screening Tests for Autism

There are many assessment tools for detecting autism in children, all of which have their strengths and weaknesses. One such test is the widely used Childhood Autism Rating Scale (CARS) which was developed in the 1980’s (Schopler et al., 1980). The CARS specifically looks at 15 behavioral based items in which children receive a score ranging from 1 as exhibiting normal behavior to 4 as indicative of autism on assessment of each of these 15 items (Schopler et al., 1980). Children with a total score of less than 30 are not considered autistic while a total score exceeding 36 and scores of 3 or higher on 5 of the behavioral items are considered to be severely autistic (Schopler et al., 1980). Although the CARS is an objective measure for assessing autism, suitable for children younger than 6, and measures severity of autism on a continuum, there are some flaws. Unfortunately, the CARS is relatively old and may not reflect current information on autism. As well, Schopler et al. (1980) had subjects widely dispersed in age from under 6 and over 10, making it difficult to examine young children who might have benefited from early detection. As a result, the CARS assesses children, such as at age 3, who obviously display noticeable deficits and excesses in language and social interaction. Very early detection of children less than 24 months old was thought to be difficult to find since autism affects a small proportion of children per year (Baron-Cohen, Allen & Gillberg, 1992). Baron-Cohen et al. (1992), however, have developed the Checklist for Autism in Toddlers (CHAT) which can detect autism in children as early as 18 months of age, making it an extremely useful assessment tool. The CHAT is a questionnaire for parents and looks at the behavior of the target child (Baron-Cohen et al., 1992). Parents are asked a variety of questions, some of which pertain to social play, joint attention, pointing to ask for something to indicate interest, and motor development (Baron-Cohen et al., 1992). The 3 key elements that indicate a possibility of autism are an absence of: (1) pointing at an object for joint attention; (2) gaze-monitoring or turning to look in the direction that others are looking; and (3) pretend play (Baron-Cohen et al., 1992).

Effective Treatment for Autism

Once parents have a diagnosis, research must begin for intervention, since it has been proven that early intervention greatly benefits children (Lovaas, 1987). While the types of intervention vary in their approach to helping diminish the signs of autism, most of them are not scientifically proven to be effective. Applied Behavioral Analysis (ABA), however, is the only scientifically based treatment available for autistic children (McEachin et al., 1994; Lovaas, 1987). As an experienced ABA therapist, ABA incorporates discrete trial teaching in which skills are broken down into minute components and systematically taught to children on a one-to-one basis. For example, since many autistic children lack imitation, ABA first teaches imitation of objects, then of body movements to finally following the leader as a way for them to naturally imitate from others (Bohdanna Popowycz Kvam, personal communication Novemeber 1, 2002). In 1987, Ivar Lovaas conducted a study on the effects of ABA on autistic children under the age of 4 with IQ scores falling in the mild to retarded category. The experimental group of 19 children received 40 hours a week of one-to-one intensive therapy while the first control group only received 10 hours a week and the second control group did not receive intensive behavioral treatment through Lovaas’ Young Autism Project (Lovaas, 1987). His short-term goals consisted of teaching compliance, imitation and appropriate toy play that many autistic children lack, generalizing treatment in the community, and reducing self-stimulatory behaviors such as hand-flapping (Lovaas, 1987). Long-term goals that were emphasized in years two and three of therapy consisted of teaching receptive and expressive language, playing with peers, teaching emotions, pre-academic skills such as reading and writing, and observational learning (Lovaas, 1987). Results and follow-up data reveal that subjects in the experimental group gained an average of 30 IQ points, and were higher than both control groups in school and intellectual functioning (Lovaas, 1987). Of the 19 children in the experimental group, 47% achieved normal or above average IQ scores, went on to a normal first grade, and were indistinguishable from their peers (Lovaas, 1987). Subjects in both control groups had IQ scores that remained stable over time (Lovaas, 1987). McEachin, Smith and Lovaas (1993) went on to evaluate the long-term outcome of children in Lovaas’s 1987 study at a mean age of 11 ½. McEachin et al. (1993) found that the 19 children in the experimental group maintained their level of intellectual functioning and had higher scores than the control groups on adaptive behavior and personality. The children in the control groups did not gain such an outcome. In contrast, they fared poorly, which coincides with the poor prognosis of autistic children if no early intervention was administered (McEachin et al., 1993). McEachin et al. (1993) went on to state that there is reason to believe that alterations in neurological structures are possible as a result of change in the environment in the first few years of life for young children with autism, based on past studies on laboratory animals (as cited by Rutter & Schopler, 1987).

Early assessment and detection can make an extraordinary difference in the lives of autistic children. Although there was no standardized list for diagnosing autism prior to the Diagnostic Statistical Manual of Mental Disorders, Third Edition, many new assessment tools have been developed such as the CARS and CHAT (Baron-Cohen et al.,1992; Ritvo et. al, 1989) in helping with early detection. As well, before Lovaas’ research experiment on ABA, the prognosis of autism was considered to be, “very poor, and medical therapies [did] not [prove] effective” (Lovaas, 1987, p.3). Upon testing the effectiveness of ABA, Lovaas (1987) soon witnessed that behavior modification does work with autistic children to a point of bringing some of them to a normal IQ level. Currently, Lovaas (1987) revolutionized the way we think about autism; no longer is autism thought of as a, “[severe], lifelong disability” (Maurice, 1993, p.22), but is now viewed as a temporary halt in development in which ABA can “re-map” the brains of children with autism to learn from their environment.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.,

text revision). Washington, DC: Author.

Baron-Cohen, S., Allen, J., & Gillberg (1992). Can Autism be Detected at 18 months? The Needle, the

Haystack and the CHAT. British Journal of Psychiatry, 161, 839-843.

Lovaas, O.I. (1987). Behavioral Treatment and Normal Educational and Intellectual Functioning in Young

Autistic Children. Journal of Consulting and Clinical Psychology, 55, 3-9.

Maurice, Catherine (1993). Let Me Hear Your Voice: A Family’s Triumph Over Autism. New York:

Ballantine Books.

McEachin, 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, 359-372.

Rivo, E., Freeman, B.J., Pingree, C., Mason-Brothers, A., Jorde, L., Jenson, W., et al. (1989). The UCLA-

University of Utah Epidemiologica Survey of Autism: Prevalence. American Journal of Psychiatry, 146,

194-199.

Schopler, E., Reichler, R.J., DeVellis, R.F., & Daly, K. (1980). Toward Objective Classification of

Childhood Autism: Childhood Autism Rating Scale (CARS). Journal of Autism and Developmental

Disorders, 10, 91-103.

The use of ABA therapy to teach a child with autism has changed the way we look at treatment for these individuals. In the past, some parents were told that these children did not learn and will not function in society. Limited options were given to parents of children with autism such that most children were institutionalized.

As well, mothers in the Bettleheim era were told that they were the cause of autism in their child. With such negative outlooks, it is no wonder that many parents felt hopeless in making a difference in the lives of their children.

Fortunately, Bettleheim’s “refrigerator mother” theory was disproved since autism is found to be a developmental, rather than a psychological, disorder.

Other theories about autism have surfaced since the time of Bettleheim. One such theory, behaviorism, became popular in the 1960’s, since it promoted change in children with autism.

The basic principles on which behaviorism uses is to introduce a stimulus as a method to increase or decrease the likelihood of a behavior. Since autism is objectively characterized by a series of behaviors, theorists of behaviorism felt that by changing maladaptive behaviors and teaching behaviors that were lacking in these children might result in increasing the likelihood of age-appropriate behaviors.

Applied Behavioral Analysis

One such theorist, Ivar O. Lovaas used behaviorism to teach children with autism. As well, he used a form of a teaching strategy called Discrete Trial Teaching (DTT) to maximize learning in children with autism.

In 1987, he organized the Young Autism Project to study the effects of ABA on autistic children under the age of 4 with IQ scores falling in the mild to retarded category.

His experimental group of 19 children received 40 hours a week of one-to-one intensive therapy and a control group only received 10 hours a week.

Lovaas’ short-term goals in an ABA program consisted of teaching compliance, imitation and appropriate toy play, generalizing treatment in the community, and reducing self-stimulatory behaviors such as hand-flapping. In essence, Lovaas was teaching these children skills that they lacked due to their diagnosis.

Long-term goals that were emphasized in years two and three of ABA therapy consisted of teaching language, playing with peers, emotions, pre-academic skills such as reading and writing, and observational learning.

His results revealed that children in the experimental group gained an average of 30 IQ points, and were higher than the control group in school and intellectual functioning.

Of the 19 children in the experimental group, 47% achieved normal or above average IQ scores, went on to a normal first grade, and were indistinguishable from their peers. This is a remarkable statistic considering that before the Lovaas Young Autism Project, the future of autistic individuals was bleak.

Children in the control group had IQ scores that remained stable over time (Lovaas, 1987).

In 1993, McEachin, Smith and Lovaas wanted to evaluate the long-term outcome of the children in Lovaas’ 1987 study.

They found that the 19 children in the experimental group maintained their level of intellectual functioning and had higher scores than the control group on adaptive behavior and personality at a mean age of 11.

The children in the control group did not gain such an outcome. In contrast, they fared poorly, which coincides with the poor prognosis of autistic children if no early intervention was administered.

These two reports prove that ABA is the only scientifically based treatment available at this time for children with autism.

While there are many other therapies out there for children with autism, there is no data to support them. This does not mean that ABA does not incorporate other forms of teaching.

ABA is a broad category that is not specific to children with autism. When it is applied to these children, ABA incorporates DTT, operant conditioning, with the possible use of Picture Exchange Communication (PEC) developed by Andrew Bondy, Ph.D. and Lori Frost, fluency teaching endorsed by Michael Fabrizio, errorless learning developed by Terrace, verbal behavior that is promoted by Dr. Vincent Carbone, Mark Sundberg and Jim Partington, or social stories developed by Carol Gray.
Autism Information References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed. text revision). Washington, DC: Author.

Bondy, A. & Frost, L. (1994). The Picture Exchange Communication System. Focus on Autistic Behavior, 9, 1-19.

Grey, C. (2000). The New Social Stories Book. Future Horizons.

Lovaas, O.I. (1987). Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children. Journal of Consulting and Clinical Psychology, 55, 3-9.

Maurice, C. (1993). Let Me Hear Your Voice: A Family’s Triumph Over Autism. New York: Ballantine Books.

McEachin, 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, 359-372.

Terrace, H.S. (1966). Stimulus control. In W.K. Honig (Ed.), Operant behavior: Areas of research and application. New York: Appleton-Century-Crofts.