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

Promising Recent Studies of Behavioral Intervention for Autism

Two important studies of early intensive behavioral intervention for children diagnosed with autism spectrum disorders have been published. In the American Journal on Mental Retardation, Sallows and Graupner (2005) have replicated the ground-breaking findings of Lovaas and colleagues (Lovaas, 1987; McEachin, Smith, & Lovaas, 1993). Lovaas and colleagues provided between 2 and 3 years of intensive behavioral treatment to young children with autism 40 hours per week. Nearly 50% of these children demonstrated increased IQ scores into the range considered typical and were integrated without support into educational services provided in their home school district. The Lovaas studies have been criticized for referring to the successfully integrated children as having recovered from autism, as being too costly to implement for other children, and for having used aversive consequences for certain severe problem behaviors.

Sallows and Graupner (2005) sought to replicate Lovaas’ procedures, with the exception of providing aversive consequences for severe problem behavior. They also provided behavioral intervention through two service delivery models. One involved a senior clinician closely supervising treatment and the other was a less costly, parent-directed intervention in which a senior clinician provided less intensive clinical supervision. With both forms of service, direct care staff provided the same educational and clinical programming but children in the parent-directed group received fewer hours of service (an average of around 31 hours vs. 38 hours/week). It was found that all children made substantial gains in IQ score. After 2-3 years of treatment, 48% were receiving services in their home school district. Half of the children in the parent-directed group required a third year of service to attain this status. The authors also found that a positive treatment outcome was best predicted by a child’s pre-intervention language, imitation, and social skills.

The other study, Howard, Sparkman, Cohen, Green, & Stanislaw (2005), compared intensive behavior analytic intervention to standard early intervention services provided to children with developmental impairment and to “eclectic” treatment. Many children diagnosed with an autism spectrum disorder do not have access to intensive behavior analytic services. Oftentimes, these children receive generic early intervention services that are not specifically tailored to the needs of a child with autism. The authors refer to eclectic interventions as services that involve the incorporation of many different techniques such as sensory integration, pivotal response training, and discrete trial training. Such eclectic intervention is quite common in public schools and is also available through private service providers.

It was found that, after over a year of service delivery, children in the intensive behavioral treatment group had gained substantially more skills than either of the two comparison groups. Interestingly, there were no differences between the eclectic and generic treatment groups and neither of them produced the substantial increases in communication skills observed with the intensive behavior analytic intervention. It can be concluded from this study that conceptually pure behavior analytic intervention services are superior to eclectic intervention.

Howard, J.S., Sparkman, C.R., Cohen, H.G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359-383.

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.

McEachin, J.J., Smith, T., & Lovaas, O.I. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. AJMR, 97, 359-372.

Sallows, G.O., & Graupner, T.D. (2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors. AJMR, 110, 417-438.

Evidence of Harm

In August, the Pittsburgh Post-Gazette reported that a child with autism died during chelation therapy (Kane & Linn, 2005). Dr. Roy Kerry of Portersville, PA was administering the child’s third chelation treatment. Tragically, cardiac arrest followed and the boy, who was brought to Pennsylvania from England by his mother to receive chelation therapy, died. Though the form of chelation therapy administered to the boy is not the only procedure, no chelation therapy technique has been shown to provide benefit to children with autism through sound scientific study. Furthermore, chelation can result in minerals vital to neural functioning being removed from the body. It is possible that this is what caused the child’s heart to stop beating but final autopsy results have not been released.

As noted in the last research newsletter (Ahearn, June, 2005), chelation is used as a treatment because claims have been made that thimerosal included as a preservative in childhood vaccines can cause autism. Linn (2005) reported in a follow-up to the Post-Gazette’s initial article:

(Some parents) “see chelation as a logical option because they believe there is a connection between their children's autism and the mercury preservative in childhood vaccinations. And that is what so disturbs Dr. Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia. Scientific study after scientific study ha(s) found no connection, and it's unethical for any doctor to give chelation for this purpose, he said. He said doctors need to work harder to convince parents that the whole reason to use chelation is pointless. ‘I wish there was more outrage with this death. This boy was sacrificed on the altar of bad science and that was unconscionable,’ he said.”

Robert F. Kennedy, Jr., David Kirby, Bernard Rimland, and many others have been outspoken proponents of the thimerosal-autism connection. If the death of this child was caused by chelation then there is clear evidence of harm on the part of these individuals.

Ahearn, W. H. (June, 2005). Readers forum. NECC Research Newsletter.
(http://www.necc.org/research/newsletter_june_2005.asp)

Kane, K., & Linn, V. (August 25, 2005). Boy dies during autism treatment. Pittsburgh Post-
Gazette. (http://www.post-gazette.com/pg/05237/559756.stm).

Linn, V. (August 29, 2005). Parents of children with autism discuss results of chelation:
Debate over controversial treatment heats up after death of 5-year-old boy. Pittsburg
Post-Gazette. (http://www.post-gazette.com/pg/05241/561879.stm).

NIH and advocacy groups’ join to support genetic research

DIn October 2005, the National Institutes of Health (NIH) released an announcement of the formation of a consortium to fund a five-year effort to better understand the genetic factors involved in autism spectrum disorders. Nearly $11 million in funding has been allotted towards this endeavor. Several of the NIH institutes and three autism advocacy groups, including the National Alliance for Autism Research (NAAR), are working together to fund and monitor several grants that have been awarded to three teams of investigators. Two of the awards will seek to specifically analyze autism susceptibility genes while the third award is focused on studying familial inheritance involving the X chromosome. These three teams will complement some currently funded research being conducted at Johns Hopkins University. This work, headed by Aravinda Chakravarti, Ph.D., has indicated that there are candidate genomic regions on chromosomes 7, 10, and 19.

To read the press release, go to:
http://www.nimh.nih.gov/press/autismconsortiumgrants.cfm

Readers' Forum

Email your questions to William Ahearn.

Q: My son is a picky eater. He eats very few foods and they are mostly starchy (bagels, pasta, grilled cheese, and chicken nuggets). Should I be concerned about what he eats?

A: Picky eating is the most common pediatric feeding problem. It has been estimated by investigators that as many as 50% of toddlers exhibit picky eating at 24 months of age(Carruth, Ziegler, Gordon, & Barr, 2004). However, the primary function of eating is to provide enough calories for growth and most children who eat selectively seem to meet their daily caloric intake needs (e.g., Skinner et al., 1999). Children with autism have been found to be more likely than typically developing peers to have a pediatric feeding problem (Schreck et al., 2004) and Ahearn et al. (2005) estimated that at least 50% of children with autism have selective food acceptance. So to more directly answer this question, it is important to precisely assess a child’s growth, the variety of foods they accept, and determine whether there are potential adverse consequences given the child’s current diet. If a child’s growth is not within normal limits, treatment should follow in-depth assessment and focus on producing adequate caloric intake. If the child is severely selective and eats fewer than five or six foods then it is probably a good idea to consider developing intervention procedures to encourage acceptance of a broader range of foods. However, beyond these two situations it is more difficult to make a recommendation. If the number of foods a child is accepting is decreasing steadily but they are still accepting a modest variety of foods, it would be a good idea to attempt to foster acceptance of a
wider variety. Some children may be experiencing chronic constipation and increasing
fiber in their diet would be an appropriate goal for them that may also impact this
potentially related difficulty. For other children, there may be other problem behavior or skill deficits that are more pressing concerns. If this is the case the primary focus of care should be on addressing these problems. It is likely that any improvement in selective eating will require that a child be exposed to a variety of foods over a period of time. In fact, many studies (e.g., Carruth et al., 2004) have found that a child’s diet is strongly correlated with the diet of their family. Picky eaters tend to have parents who are also selective. One good first step for all children is to be exposed to many different foods repeatedly. It might also be helpful for the child’s parents to eat a variety of foods, particularly vegetables and fruit, thus modeling healthy eating.

Ahearn, W.H., Castine, T., Nault, K., & Green, G. (2001). An assessment of food acceptance in children with autism or pervasive developmental disorder-not otherwise specified. Journal of Autism and Developmental Disorders, 31, 505-511.

Carruth, B.R., Ziegler, P.J., Gordon, A., & Barr, S.I. (2004). Prevalence of picky eaters among infants and toddlers and their caregivers’ decisions about offering a new food. Journal of the American Dietetic Association, 104, 57-64.

Schreck, K.A., & Williams, K., & Smith, A.F. (2004). A comparison of eating behaviors
between children with and without autism. Journal of Autism and Developmental
Disorders, 34, 433-438.

Skinner, J.D., Carruth, B.R., Houck, K.S., Bounds, W., Morris, M., Cox, D.R., Moran III, J., & Coletta, F. (1999). Longitudinal study of nutrient and food intakes of white preschool children aged 24 to 60 months. Journal of the American Dietetic Association, 99, 1514-1521.

Research at NECC

Editor’s note: The New England Center for Children has recently had several articles accepted for publication. In this issue of the newsletter, I’m highlighting three studies conducted by NECC Program Director Rick Graff. Rick and his colleagues have published, or had accepted for publication, 5 articles in the past two years. His primary area of interest is assessing preference and motivation in persons with developmental disabilities. The first study involved determining the skills necessary for a student to reliably express their preferences through pictures. Many of our verbally limited students are assessed with similar procedures. It was found that picture to object matching is a crucial prerequisite skill.

Clevenger, T.M., & Graff, R.B. (2005). Assessing object-to-picture and picture-to-object matching as prerequisite skills for pictorial preference assessments. Journal of Applied Behavior Analysis, 38, 543-547.

Tangible and pictorial paired-stimulus (PPS) preference assessments were compared for 6 individuals with developmental disabilities. During tangible and PPS assessments, two edible items or photographs were presented on each trial, respectively, and approach responses were recorded. Both assessments yielded similar preference hierarchies for 3 participants who could match pictures and objects but different hierarchies for 3 participants who could not. Reinforcer assessments verified that items identified as high preference on PPS assessments functioned as reinforcers only for participants with matching skills.

Editor’s note: This study involved comparing the preferences of students when the choice between foods was presented with the actual items or with line drawings (i.e., PECS pictures). It was found that students’ preferences could be identified reliably with line drawings; however, line drawing to object matching is likely a necessary prerequisite skill.

Graff, R. B., Gibson, L., & Galiatsatos, G. (in press). The impact of high and low preference stimuli on relevant vocational and academic performance of youths with severe disabilities. Journal of Applied Behavior Analysis.

Pictorial and tangible paired-stimulus preference assessments were compared with 4 adolescents with developmental disabilities. In the tangible assessment, 2 stimuli were placed in front of the participant on each trial; in the pictorial assessment, 2 line drawings were placed in front of the participant on each trial. Approach responses were recorded for each assessment. The assessments generated similar preference hierarchies for all participants. Reinforcer assessments confirmed that response rates were higher when access to high-preference items was available versus when low-preference items were available. Implications for assessing preferences and selecting items to be used in training programs are described.

Editor’s note: Identifying many preferred items and activities for a student allows us to provide the proper motivation for them to learn. In this study, an analysis of an initial preference assessment occurred. Items identified as highly preferred were removed and an additional preference assessment was conducted. It was found that items previously identified as not highly preferred were found to be highly preferred during an additional follow-up assessment. The results of this study suggest that following-up results obtained during initial assessment can help us to identify more potent reinforcers for students.

Ciccone, F., Graff, R. B., & Ahearn, W. H. (in press). Stimulus preference assessments and the utility of a moderate category. Behavioral Interventions.

Recent studies have shown that moderate (Piazza, Fisher, Hagopian, Bowman, & Toole, 1996) and low (Taravella, Lerman, Contrucci, & Roane, 2000) ranked items on stimulus preference assessments may function as reinforcers. Following an initial preference assessment the current study analyzed whether moderate or low preference items were more likely to be ranked as high preference on subsequent preference assessments. Results show that for five of the seven participants additional high preference items were identified from the moderate preference set, while additional high preference items were identified from the low preference set for only one participant. Results are discussed in terms of the need to identify multiple reinforcers and the composition of the stimulus array during preference assessment.

Web Resources

For information about The New England Center or to access and electronic version of this or previous NECC Research Newsletters, visit our Web site www.necc.org.

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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