Misleading Autism Treatment Statements at About.com Autism

Lisa Jo Rudy at About.com Autism, for reasons unknown to me has made misleading statements about the evidence in support of the efficacy of various autism treatments. Coming on the heels of the recent Deborah Fein study showing that 10-20% of subject children with autism recovered from their autism with Intensive Early Behavioral Intervention ... ABA ... it is surprising to see About.com Autism apparently react to that study with the assertion that all autism therapies are created equal. Ms Rudy and About.com Autism appear to have turned their backs on evidence based assessments of autism treatments.

Ms Rudy stated in Can All Positive, Intensive Therapies Help Kids with Autism?:

As a result, there's no good way to know whether a child who received Floortime would have done better with RDI or ABA. Certainly, evidence shows that most children with autism improve to varying degrees with intensive therapy, no matter what its name.

Apart from the recent Fein study demonstrating full recovery as set out above other studies and reviews of those studies have unequivocally indicated that only ABA enjoys a solid evidence basis in support of its effectiveness:

The MADSEC (Maine) Autism Task Force assessed the evidence basis in support of various autism interventions as of 2000 and found that only one, ABA, met the highest standard:

"Based upon a thorough examination of numerous methodologies considered as interventions for children with autism, the MADSEC Autism Task Force has characterized the interventions reviewed as follows:

• Substantiated as effective based upon the scope and quality of research:
Applied behavior analysis.

In addition, applied behavior analysis’ evaluative procedures are effective not only with behaviorally-based interventions, but also for the systematic evaluation of the efficacy of any intervention intended to affect individual learning and behavior. ABA’s emphasis on functional assessment and positive behavioral support will help meet heightened standards of IDEA ‘97. Its emphasis on measurable goals and reliable data collection will substantiate the child’s progress in the event of due process.

In describing the evidence backed benefits of ABA the MADSEC Report noted that:

There is a wealth of validated and peer-reviewed studies supporting the efficacy of ABA methods to improve and sustain socially significant behaviors in every domain, in individuals with autism. Importantly, results reported include “meaningful” outcomes such as increased social skills, communication skills academic performance, and overall cognitive functioning. These reflect clinically-significant quality of life improvements. While studies varied as to the
magnitude of gains, all have demonstrated long term retention of gains made.

Other major contributions of ABA to the education and treatment of individuals with autism include:

• a large number of empirically-based systematic instruction methods that lead to the acquisition of skills, and to the decrease/elimination of aberrant behaviors;

• a technology for systematically evaluating the efficacy of interventions intended to affect individual learning and behavior; and

• substantial cost/benefit.

Over 30 years of rigorous research and peer review of applied behavior analysis’ effectiveness for individuals with autism demonstrate ABA has been objectively substantiated as effective based upon the scope and quality of science. Professionals considering applied behavior analysis should portray the method as objectively substantiated as effective. Methods of applied behavior analysis should be considered to evaluate the effectiveness of any intervention used to help individuals with autism. Researchers should continue to vigorously investigate behavioral intervention as the most promising area of research and treatment benefiting individuals with autism known today. Early interventionists should leverage early autism diagnosis with

The American Academy of Pediatrics Management of Children with Autism Spectrum Disorders (2007) report described the level of evidence of ABA effectiveness in a manner that no other treatment mentioned in the report even remotely approximated:

Applied Behavior Analysis

Applied behavior analysis (ABA) is the process of applying interventions that are based on the principles of learning derived from experimental psychology research to systematically change behavior and to demonstrate that the interventions used are responsible for the observable improvement in behavior. ABA methods are used to increase and maintain desirable adaptive behaviors, reduce interfering maladaptive behaviors or narrow the conditions under which they occur, teach new skills, and generalize behaviors to new environments or situations. ABA focuses on the reliable measurement and objective evaluation of observable behavior within relevant settings including the home, school, and community.

The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology21,25,27,28 and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings.29–40 Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.31–40

To these reviews of studies supporting ABA effectiveness in treating autism can be added the US Surgeon General and the NY State Department of Health. Now the Fein study on autism recovery would add to the information basis of such reports.

We are decades past the point where About.com Autism can claim that all autism interventions are created equal as long as they are positive and done early and intensively. There is no evidence to support the About.com position. The About.com Autism position is in essence a rejection of an evidence based approach to assessing autism interventions.

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Further Notes On Alan Griswold's Bizarre Autism Rant

I have to admit I was very startled reading Alan Griswold's bizarre rant about the Deborah Fein study being a "fictitious study" and the intervention involved not being ABA (yeah right 40 hours a week of intensive early behavioral intervention and it wasn't really ABA?) .

I also found it odd that AG would single me out for fame and misfortune in his blog post. (rant). His fellow Neurodiversity blogger Kristina Chew at the Change.org's Neurodiversity page, and with whom I usually disagree, concurred with my interpretation of the word "study" (it means "study" Alan) and IEBI as being ABA:

An ongoing study involving children on the autism spectrum aged nine to 18 is finding that "the range for children recovering from autism is 10 percent to 20 percent." As reported in yesterday's Telegraph, University of Connecticut psychology professor Deborah Fein is studying the effects of intensive behavior therapy---Applied Behavior Analysis (ABA)---on children on the spectrum. The study is still in its preliminary stages and is funded by the NIMH:

Of course Ms Chew supports the Neurodiversity ideology Mr Griswold subscribes to so she wasn't on the receiving end of the AG rant. Where I have never drunk from the ND Kool-Aid I was singled out for Mr. G's weird little outburst.

I wonder if Alan Griswold is capable of admitting his errors?

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Fein's Autism Study: Alan Griswold's Bizarre Commentary

Anti-ABA blogger Alan Griswold appears to have consumed too much coffee, before publishing his comment "Harold Doherty's Fictitious ABA Study". In his silly rant, Mr Griswold contends that the study was fictitious, that there is no ongoing study, etc. He claims that I took some words about what he calls a non-existent study out of context from a Washington Post article.

Here is what I said about the study itself in my comment Autism Recovery: More Evidence of ABA Effectiveness :

a study was presented at an autism conference by University of Connecticut psychology professor Deborah Fein showing recovery of between 10 and 20% of subjects originally diagnosed as autistic who were later determined to have lost the autism diagnosis after years of intensive applied behavioral analysis.

The full WP article, in fact makes several references to a study conducted by Professor Fein:

She presented research this week at an autism conference in Chicago that included 20 children who, according to rigorous analysis, got a correct diagnosis but years later were no longer considered autistic ... The study, funded by the National Institute of Mental Health, involves children ages 9 to 18.

...

The children in Fein's study, which is still ongoing, were diagnosed by an autism specialist before age 5 but no longer meet diagnostic criteria for autism. The initial diagnoses were verified through early medical records.

The WP article also indicates clearly that children recovered after years of intensive behavioral therapy. If the study pertained to an intensive behavioral therapy other than ABA I don't know what that would be and Mr. Griswold does not identify any such therapy.

I am not sure if Mr. Griswold actually read the WP article or not but it clearly indicates that Ms Fein conducted a study as I indicated and contrary to Mr. Griswold's strange commentary.

Despite his tortured interpretation of the WP article the whole point was that it demonstrated, recovery from autism, which in the real world outsdie of Mr. Griswold's blog, is a measure of the effectiveness of the intervention.

Mr. Griswold also mocks the 10-20% results but glosses over the fact that the 10-20% figure refers to full recovery, children assessed as autistic who no longer met the criteria for an autism diagnosis after years of behavioral intervention. The WP article does not state that the other children did not benefit from ABA. It was silent as to whether the children who did not lose their diagnosis acquired benefits short of full recovery.

I did not state that the study as reported was a comparative study with any other interventions. What I did do was refer again to the AAP 2007 comments which appear on the sidebar of this blog and which I repeat again:

The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology21,25,27,28 and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings.29–40 Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.31–4

American Academy of Pediatrics, Management of Children with Autism Spectrum Disorders, 2007

File Alan Griswold's blog under B in your blog lists, B for bizarre. But leave room. Any time a study, report, article, analysis or commentary suggests that some children can recover from autism those who have made a fetish out of the neurological disorder will start buzzing hysterically. Griswold's is only one of many such rants' to come.

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Autism Recovery: More Evidence of ABA Effectiveness

It has been a very bad week for the anti-ABA, anti-autism treatment crowd.

Laurent Mottron, Morton Ann Gernsbacher and Michelle Dawson, amongst others, are probably not happy with the latest autism research news out of Chicago where a study was presented at an autism conference by University of Connecticut psychology professor Deborah Fein showing recovery of between 10 and 20% of subjects originally diagnosed as autistic who were later determined to have lost the autism diagnosis after years of intensive applied behavioral analysis.

The recovery story itself is not knew. The highly respected Dr. Doreen Granpeesheh and other researchers and clinical psychologists, who actually work with autistic children, have presented stories of autistic children who have recovered after years of ABA treatment. What is most significant in this instance is the rigour of the analysis which resulted in the initial autism diagnosis and the thorough documentation involved in the study as reported in the Washington Post:

Autism researcher Geraldine Dawson, chief science officer of the advocacy group Autism Speaks, called Fein's research a breakthrough.

"Even though a number of us out in the clinical field have seen kids who appear to recover," it has never been documented as thoroughly as Fein's work, Dawson said.

Previous studies have suggested between 3 percent and 25 percent of autistic kids recover. Fein says her studies have shown the range is 10 percent to 20 percent.

But even after lots of therapy _ often carefully designed educational and social activities with rewards _ most autistic children remain autistic.

Recovery is "not a realistic expectation for the majority of kids," but parents should know it can happen, Fein said.

Fein is being responsible in cautioning that recovery will not happen for most children with autism who receive ABA. But that does not mean that it is an all or nothing proposition either. Gains in reducing problem behaviors as in self injurious behavior and aggression, and skill acquisition with ABA use are well documented as noted in the American Academy of Pediatrics Management of Children with Autism Spectrum Disorders report (2007):

The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology21,25,27,28 and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings.29–40 Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.31–4

ABA for autism. The evidence of ABA effectiveness in treating autism has grown over the past decade despite the ideological obstinacy of those who condemn ABA. This week that evidence grew yet again.

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