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News and Notes about Scientific Research on Autism and other Developmental and Behavioral Disorders
Editor:
Bill Ahearn, Ph.D., BCBA
Director of Research, New England Center
for Children
Wading
Through the Minefield of Autism Treatments
A child diagnosed with
autism presents a challenge first and foremost
to the childŐs family but also to their
physician, teachers, and many others. Once
a diagnosis is made the family must decide
what they will do for their child and they
may be, at least initially, guided by their
pediatriciansŐ advice. The well-read physician
may be aware of the scientific evidence
pointing to genetics and early, perhaps
prenatal, environmental influences that
culminate in the abnormal brain development
that seems to occur in children with autism
(see October 2004, May/June 2003, May 2002
newsletters here
for more information on etiology) but what
about treatment? Because autism is a developmental
disability and not a "distinct disease entity"
(Lancaster, 2005), it may be apparent that
educational strategies will be necessary
to address the childŐs skill deficits and
behavioral excesses (e.g., self-injury,
stereotypic behavior). Perhaps the physician
has read the Surgeon GeneralŐs report (USDHHS,
1999) stating that autism can be treated
through the application of behavior analysis.
However, many pediatricians and others are
not aware of this information. Reports in
the news media, such as the series on autism
that has recently aired on NBC and MSNBC
and the February 28, 2005 Newsweek
article on autism, foster unsupported speculation
that there are numerous effective treatments
for autism.
Gina Green, the former
Director of Research at NECC, suggests that
a starting point is to critically evaluate
the evidence for any suggested intervention
(Green, 1996). Only objective demonstrations,
involving direct measurement of each childŐs
skill deficits and behavioral excesses before
and after intervention, should be considered
as sound evidence of a treatmentŐs efficacy.
Objective demonstrations are necessary for
a number of reasons. One of the most important
of these is that often the persons touting
a treatment are in the position of financially
benefiting from providing service. This
is no different for the behavior analyst
than it is for the hippotherapist (horse
riding or equine facilitated therapy). However,
applied behavior analysis, ABA, has over
three decades of scientific demonstrations
(USDHHS, 1999) of improved skills and reduced
behavioral excesses using direct measurement
for each child while hippotherapy, facilitated
communication, auditory integration, sensory
integration, secretin injection, and many
other therapies do not.
Most unfounded therapies
provide evidence for the benefits of their
therapies that is subjective. Here is one
example:
"Personally, I have found
in treating children with hippotherapy who
have a diagnosis of autism that not only
language is improved but gross motor, fine
motor, motor planning skills and long term
and short term memory, as well as eye contact,
interaction with their environment and ability
to transition activities as well as carry
over into many other educational and social
goals." (Hyperion Farm, Inc., retrieved
2/05)
Such extraordinary claims
are not uncommon but extraordinary evidence
is necessary to back up such remarks. Professional
testimonials of a treatmentŐs effectiveness,
in the absence of controlled demonstrations
of the outcome of therapy, should be considered
as unreliable at least partly due to the
financial benefit of providing service.
Testimonials by a childŐs caregivers must
also be questioned as a valid source of
information. Understandably, such beliefs
are significantly influenced by the caregiverŐs
desire for an improvement in the childŐs
condition. Many therapies are very costly
and also influence a caregiverŐs opinion
towards a belief in its benefit. Testimonials
can also be influenced by actual gains a
child is making. In these cases a misattribution
of the source of the improvement may occur.
For example, a child may be making steady
progress through clinical and educational
services they are receiving but the family
attributes these gains as being due to secretin
because they have paid several thousand
dollars for these injections.
It is a good idea for
all parents and any person responsible for
procuring funding for service to require
solid, objective evidence before selecting
an intervention of any kind. As to the criteria
for evaluating clinical and educational
services for individuals diagnosed with
autism, knowledge of the scientific evidence
for behavioral intervention is one step.
Another critical step is to evaluate the
specific service provider to ensure that
the services they provide match up with
the service shown to produce improvement.
One excellent resource is Dawson and OsterlingŐs
(1997) chapter evaluating the common elements
of effective intervention services for children
with autism. Neither author is a behavior
analyst. Every program offering clinical
and educational service should be expected
to have:
1. A curriculum that addresses
social, verbal, and other key deficit areas
2. Highly structured teaching
that is generalized to the natural environment
3. Predictable routines
4. A functional approach
to treating problem behavior
5. Preparation of the
child for transitioning to public school
services
6. Familial involvement
in providing intervention .
Dawson,
G., & Osterling, J. (1997). Early intervention
in autism. Guralnick MJ (ed). The Effectiveness
of Early Intervention. Baltimore, MD: Paul
H. Brookes Publishing Co, 307-326.
Green,
G. (1996). Evaluating claims about treatments
for autism. In Maurice, Green, and Luce
(Eds.), Behavioral Intervention for Young
Children with Autism. Austin, TX: Pro-Ed.
Hyperion
Farm, Inc. (retrieved 2/7/2005). Hippotherapy
FAQs Đ Hyperion Farm, Inc.: Question #5
(on the use of hippotherapy for improving
communication in children with autism).
http://www.hyperionfarm.com/faq.htm/
Lancaster,
B.M. (2005). Assessment and treatment of
autism. Indian Journal of Pediatrics [cited
2005 Feb 2]; 72, 45-52. http://www.ijppediatricsindia.org/.
United
States Department of Health and Human Services.
(1999). Mental Health: A report of the Surgeon
General. Rockville, MD: U.S. Department
of Health and Human Services, Substance
Abuse and Mental Health Services Administration,
Center for Mental Health Services, National
Institute of Health, National Institute
of Mental Health. http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec6.html
.
Readers'
Forum
Email your questions
to William
Ahearn.
Q: I have been asked
by a family to provide funding for hippotherapy
for a child diagnosed with autism. What
benefit could we expect from it?
A: Hippotherapy,
or therapeutic horse riding, has been suggested
as a useful intervention for many disabilities,
but understanding what this therapy entails
is necessary before one can evaluate its
potential usefulness for a child with autism.
Hippotherapy involves a child mounting a
horse with the horse then being directed
through a series of movements by an occupational
or physical therapist. Hippotherapy is typically
part of numerous physiotherapeutic interventions
with the goal of producing improvements
in range of motion and coordinated gross
motor movement (Keren, Reznik, & Grosswasser,
2001). The populations reported to benefit
from it are persons with traumatic brain
injury, spinal injury, cerebral palsy, multiple
sclerosis, and other neuromuscular disorders.
In the medical literature, there are only
20 articles that mention hippotherapy with
the majority of them consisting of descriptions
of the therapy with anecdotal reports of
its effectiveness. Two of these articles
involve somewhat systematic testing of the
effects of hippotherapy. In McGibbon, Andrade,
Widener, & Cintas (1998), 5 children with
cerebral palsy were exposed to hippotherapy
for 8 weeks and analysis of the pre- and
post-intervention scores on a number of
gross motor movement measures implied that
some modest effect on energy expenditure
during walking was attained. Benda, McGibbon,
& Grant (2003) exposed 15 children to either
hippotherapy or sitting on a barrel approximately
the width of a horse. They found improvements
in symmetrical muscle activity were present
in the children who had hippotherapy but
not those who sat atop a barrel. This implies
that movement is a necessary aspect of improvements
in physiotherapy which is not a surprising
finding. None of the articles on hippotherapy
involve demonstrations of the benefit of
this therapy on cognitive functioning in
any persons. Given that the goal of this
therapy is to improve range of movement
and gross motor functioning, it is presumptuous
to assume that it would have any impact
on communicative abilities or other deficits
that present in persons with autism. Certainly
many people enjoy horseback. It might even
be the case that these preferred activities
may provide motivation for one to request
engaging in the activity again, however,
allocating monetary resources to these types
of therapy in lieu of providing educational
services specifically geared towards teaching
a child the skills they need to be successfully
integrated into the community is difficult
to justify.
Benda,
W., McGibbon, N.H., & Grant, K.L. (2003).
Improvements in muscle symmetry in children
with cerebral palsy after equine-assisted
therapy (hippotherapy). Journal of Alternative
and Complementary Medicine, 9, 817-825.
Keren,
O., Reznik, J., & Grosswasser, Z. Combined
motor disturbances following severe traumatic
brain injury: An integrative long-term treatment
approach. Brain Injury, 15, 633-638.
McGibbon,
N.H., Andrade, C.K., Widener, G., & Cintas,
H.L. (1998). Effect of an equine- movement
therapy program on gait, energy expenditure,
and motor function in children with spastic
cerebral palsy: A pilot study. Developmental
Medicine and Child Neurology, 40, 754-762.
Research
Activities at NECC
EditorŐs note: New
England Center for Children staff have recently
had two articles accepted for publication
that IŐm providing the abstracts for below.
The first study examines some aspects of
teaching vocal responses to children. Intraverbals
are chains of verbal behavior like reciting
the alphabet or the pledge of allegiance.
The results of this study imply that chained
verbal behavior of this sort is not linked
to a childŐs expressive labeling and that
this skill needs to be specifically taught.
The first author, Caio Miguel, has recently
joined NECC as a Program Specialist after
completing his Ph.D. at Western Michigan
University. His research specialty is in
the area of verbal behavior. The second
study suggests an improved means of analyzing
preferences when using a common preference
assessment procedure. This studyŐs first
author, Frank Ciccone, has recently moved
from NECCŐs residential program to join
our consulting department.
Miguel, C.F., Petursdottir,
A.I., & Carr, J.E. (in press). The effects
of multiple-tact and receptive discrimination
training on the acquisition of intraverbals.
The Analysis of Verbal Behavior.
The purpose of this study
was to determine whether multiple-tact training
and receptive-discrimination training could
be used to teach thematically related vocal
intraverbals to typically developing preschool
children. Multiple-tact training involved
teaching a child to name both the item and
the category to which the item belonged.
Receptive-discrimination training consisted
of teaching a child to select a picture
card in the presence of a question from
the experimenter regarding the item or its
category. When neither of these strategies
resulted in substantial increases in intraverbal
responses, a typical intraverbal training
protocol using tact prompts was implemented.
Six typically developing children participated
in the study. A multiple-baseline design
across word categories was used to evaluate
the effects of the three training procedures.
Results indicated that both multiple-tact
and receptive-discrimination training had
minimal effects on the strength of the intraverbal
repertoire, whereas direct intraverbal training
had a more substantial effect. The results
provide some evidence of the functional
independence of verbal operants, as well
as the independence of listener and speaker
repertoires. Receptive-discrimination and
multiple-tact training may have facilitated
acquisition of intraverbals; however, further
research is needed to assess how these repertoires
might interact with each other.
Key Words: intraverbal,
tact, receptive discrimination, verbal behavior,
language development, and typically-developing
children
Ciccone, F.J., Graff,
R.B., & Ahearn, W.H. (in press).An alternate
scoring method for the multiple stimulus
without replacement preference assessment.
Behavioral Interventions.
DeLeon and Iwata (1996)
described the difficulties in applying the
percentage approached scoring method to
the multiple stimulus without replacement
(MSWO) preference assessment relative to
its application in the paired stimulus assessment.
This scoring method may result in highly
preferred items being misidentified as moderate
or low preference. In the present study,
the results of 57 MSWO assessments were
scored using both the percentage approach
method and a point weighting method. More
items were identified as highly preferred
with the point weighting method. Reinforcer
assessments were conducted on a subset of
stimuli judged to be high preference using
the point weighting method but moderately-
or non-preferred when scored with the percentage
approached method; all stimuli functioned
as reinforcers.
DESCRIPTORS: preference,
preference assessment, autism, developmental
disabilities
Web
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or
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Research
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visit
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For
information
about
autism,
visit
the
National
Library
of
Medicine s
autism
site
www.nlm.nih.gov/medlineplus/autism.html.
"
For
information
about
applied
behavior
analysis
in
the
treatment
for
autism
visit
www.behavior.org.
"
For
science-based
information
on
biomedical
treatments
and
theories
in
autism
visit
www.autism-biomed.org.
"
For
information
on
health
issues
in
general
visit
the
World
Health
Organization
www.who.int.
"
For
professionally-screened
information
on
health
care
(including
some
treatments
for
autism
and
other
developmental
disabilities),
visit
www.quackwatch.com.
"
For
information
on
the
Berkshire
Association
for
Behavior
Analysis
and
Therapy,
visit
www.karsina.us/babat/.
"
For
information
on
the
Association
for
Behavior
Analysis,
visit
www.abainternational.org.
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