Selected Articles on ABA, TEACCH and Colorado Health Science Program
Below list includes outcome studies (linked to PDFs) cited by Svein Eikeseth in the 2009 review article "Outcome of comprehensive psycho-educational interventions for young children with autism." Research in developmental disabilities 2009;30(1):158-78.
A few errors noticed in the titles, author or journal names were corrected.
Other selected reviews on autism therapies can be found here
Anderson, S. R., Avery, D. L., DiPietro, E. K., Edwards, G. L., & Christian, W. P. (1987). Intensive home-based early intervention with autistic children. Education and Treatment of Children, 10, 352–366.
Although several descriptions of educational programs for young autistic children exist in the
literature, most have focused on one model of service delivery, the preschool classroom. Unfortunately, this model fails to meet the educational needs of some autistic children because
of limitations in the amount of direct instruction it can provide, the lack of generalization of
treatment effects, and the absence of comprehensive parent training. The current study developed and evaluated a home-based alternative to the preschool setting. Essential features of the model include: (a) systematic use of behavioral teaching techniques and treatment procedures; (b) intensive training conducted in each child's natural home; and (c) extensive parent training. Most of the 14 children who participated in the study demonstrated significant gains in their language, self-care, social, and academic development, as evidenced by the results of standardized assessments and individual treatment data. The results also indicated a change in the parents' ability to teach their handicapped children. These results are compared and contrasted to previous findings reported in the literature.
Bibby, P., Eikeseth, S., Martin, N. T., Mudford, O., & Reeves, D. (2001). Progress and outcomes for children with autism receiving parent-managed intensive intervention. Research in Developmental Disabilities, 22, 425–447.
Parent-managed behavioral interventions for young children with autism are underresearched.
We analyzed data from 66 children served by 25 different early intervention
consultants. After a mean of 31.6 months of intervention IQ scores had not changed (N =
22). Vineland adaptive behavior scores had increased significantly by 8.9 points (N = 21).
No children aged > 72 months attained normal functioning, i.e., IQ > 85 and unassisted
mainstream school placement (N = 42). Progress for 60 children across 12 months was
found for mental age (5.4 months), adaptive behavior (9.7 months), and language (5.1
months). The interventions did not reproduce results from clinic-based professionally directed programs. The effectiveness of the parent-managed intervention model as it has
developed and the adequacy of professional services in that model are discussed.
The goal of the Murdoch Early Intervention Program (MEIP) was to replicate the intensive
early intervention program designed by Lovaas for children with severe developmental disability
and autism. This paper describes the objectives, methods, and the results as of 24 months.
Although MEIP differs from Lovaas's model in several respects, and the children have been
generally less capable at the outset, results are interpreted tentatively as being as predicted.
Four of 9 experimental children have shown signs of approaching normal levels of functioning
whereas 1 of 5 control children has made significant progress. Improvements in the remainder
of the children are rated as moderate to minimal. These preliminary results are presented to
encourage others working with children with autism and other difficult-to-teach children to
publish their methods and results. The small number of children in any one locality, and the
high cost of controlled studies indicates the necessity for accumulating findings across service
Although previous studies have shown favorable results with early intensive behavioral
treatment (EIBT) for children with autism, it remains important to replicate these findings, particularly in community settings. The authors conducted a 3-year prospective outcome study that compared 2 groups: (1) 21 children who received 35 to 40 hours per week of EIBT from a community agency that replicated Lovaas’ model of EIBT and (2) 21 age- and IQ-matched children in special education classes at local public schools. A quasi-experimental design was used, with assignment to groups based on parental preference. Assessments were conducted by independent examiners for IQ (Bayley Scales of Infant Development or Wechsler Preschool and Primary Scales of Intelligence), language (Reynell Developmental Language Scales), nonverbal skill (Merrill-Palmer Scale of Mental Tests), and adaptive behavior (Vineland Adaptive Behavior Scales). Analyses of covariance, with baseline scores as covariates and Year 1-3 assessments as repeated measures, revealed that, with treatment, the EIBT group obtained significantly higher IQ (F = 5.21, p = .03) and adaptive behavior scores (F = 7.84, p = .01) than did the comparison group. No difference between groups was found in either language comprehension (F = 3.82, p = .06) or nonverbal skill. Six of the 21 EIBT children were fully included into regular education without assistance at Year 3, and 11 others were included with support; in contrast, only 1 comparison child was placed primarily in regular education. Although the study was limited by the nonrandom assignment to groups, it does provide evidence that EIBT can be successfully implemented in a community setting.
Eikeseth, S., Smith, T., Jahr, E., & Eledevik, S. (2002). Intensive behavioral treatment at school for 4–7-year-old children with autism: A 1-year comparison controlled study. Behavior Modification, 26, 49–68.
This study was designed to evaluate 1 year of intensive treatment for 4- to 7-year-old children with autism.An independent clinician assigned children to either behavioral treatment (n = 13) or eclectic treatment (n = 12).Assignment was based on availability of personnel to supervise treatment and was not influenced by child characteristics or family preference.The two treatment groups received similar amounts of treatment (M = 28.52 hours per week at the child’s
school).Children in the behavioral treatment group made significantly larger gains on standardized
tests than did children in the eclectic treatment group.Results suggest that some 4- to 7-year-olds may make large gains with intensive behavioral treatment, that such treatment can be successfully implemented in school settings, and that specific aspects of behavioral treatment
(not just its intensity) may account for favorable outcomes.
Eikeseth, S., Smith, T., Jahr, E., & Eledevik, S. (2007). Outcome for children with autism who began intensive behavioral treatment between age four and seven: A comparison controlled study. Behavior Modification, 31, 264–278.
This study extends findings on the effects of intensive applied behavior analytic
treatment for children with autism who began treatment at a mean age
of 5.5 years. The behavioral treatment group (n = 13, 8 boys) was compared
to an eclectic treatment group (n = 12, 11 boys). Assignment to groups was
made independently based on the availability of qualified supervisors. Both
behavioral and eclectic treatment took place in public kindergartens and elementary
schools for typically developing children. At a mean age of 8 years,
2 months, the behavioral treatment group showed larger increases in IQ and
adaptive functioning than did the eclectic group. The behavioral treatment
group also displayed fewer aberrant behaviors and social problems at follow-up.
Results suggest that behavioral treatment was effective for children with
autism in the study.
Eldevik, S., Eikeseth, S., Jahr, E., & Smith, T. (2006). The effects of low-intensive behavioral treatment for children with autism and mental retardation. Journal of Autism and Developmental Disorders, 36, 211–224.
We retrospectively compared 2 groups of children receiving either behavioral treatment
(n=13) or eclectic treatment (n=15) for an average of 12 hours per week. Children were
assessed on intelligence, language, adaptive functioning and maladaptive behavior at
pretreatment and 2 years into treatment. The groups did not differ significantly at
pretreatment. After 2 years of treatment, the behavioral group made larger gains than the
eclectic group in most areas. However, gains were more modest than those reported in
previous studies with children receiving more intensive behavioral treatment, and it is
questionable whether they were clinically significant.
Handleman, J. S., Harris, S. L., Celbiberti, D., Lilleheht, E., & Tomchek, L. (1991). Developmental changes in preschool children with autism and normally developing peers. Infant Toddler Intervention, 1, 137–143.
The Battelle Developmental Inventory and Learning Accomplishment Profile were used to assess
changes in developmental rate of preschool children with autism and their normally developing
peers over one school year. Althought the normally developing children were at a higher
developmental level before and after treatment, the children with autism made significant gains
in their relative rate of developmental progress and no longer differed from peers on these
measures after treatment. The data support the notion that very young children with autism are
capable of important developmental progress.
Harris, S. L., Handleman, J. S., Gordon, R., Kristoff, B., & Fuentes, F. (1991). Changes in cognitive and language functioning of preschool children with autism. Journal of Autism and Developmental Disorders, 21, 281–290.
Preschool children with autism and their normally developing peers were compared
on the Stanford-Binet IV and Preschool Language Scale before and
after I school year. Both measures showed that although the children with
autism functioned at a lower level than their normally developing peers, the
children with autism had narrowed this gap after treatment, making a nearly
19-point increase in IQ and an 8-point gain in language quotient. The IQ
measure remained stable for the normally developing peers while their language
showed a 7.73-point increase. The data support the notion that young
children with autism can make very significant developmental gains.
Harris, S. L., Handleman, J. S., Kristoff, B., Bass, L., & Gordon, R. (1990). Changes in language development among autistic and peer children in segregated and integrated preschool settings. Journal of Autism and Developmental Disorders, 20, 23–31.
Five young children with autism enrolled in a segregated class, five other
children with autism in an integrated class, and four normally developing
peer children in the integrated class were compared for developmental changes
in language ability as measured by the Preschool Language Scale before and
after training. The results, based on Mann-Whitney U tests, showed that (a)
all of the children as a group made better than normative progress in rate
of language development, (b) the scores of the autistic children were significantly
lower than the peers before and after treatment, and (c) there were
no significant differences in changes in language ability between the autistic
children in the segregated and integrated classes.
Hoyson, M., Jamieson, B., & Strain, P. S. (1984). Individualized group instruction of normally developing and autistic-like children: A description and evaluation of the LEAP curriculum model. Journal of the Division of Early Childhood, 8, 157–181.
This paper focuses on a description of an approach to Individualize
group Instruction and an evaluation of preacademic/academic program
effects for normally developing and autistic-like children. Essential
features of the individualized group instruction procedure include:
individualized curriculum for each class participant; frequent
assessment of intervention impact; opportunities to revise curricular
objectives; planning lessons that include objectives for each child;
management of behavior in a group; and daily review of goal pians. The
results of program evaluation on 13 normally developing and 6
autistic-like children showed that: (a) normally developing children
achieved, on the average, a twofold increase in their rate of
development during program participation; (b) autistic-like children
achieved, on the average, a twofold increase in their rate of
development during program participation; and (c) autisticlike
children's intervention rate of performance was above that for normally
developing children at program entry.
Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatment for young children with autism. Research in Developmental Disabilities, 26, 359–383.
We compared the effects of three treatment approaches on preschool-age children with autism spectrum disorders. Twenty-nine children received intensive behavior analytic intervention (IBT; 1:1 adult:child ratio, 25–40 h per week). A comparison group (n = 16) received intensive ‘‘eclectic’’ intervention (a combination of methods, 1:1 or 1:2 ratio, 30 h per week) in public special education classrooms (designated the AP group). A second comparison group (GP) comprised 16 children in non-intensive public early intervention programs (a combination of methods, small groups, 15 h per week). Independent examiners administered standardized tests of cognitive, language, and adaptive skills to children in all three groups at intake and about 14 months after treatment began. The groups were similar on key variables at intake. At follow-up, the IBT group had higher mean standard scores in all skill domains than the AP and GP groups. The differences were statistically significant for all domains except motor skills. There were no statistically significant differences between the mean scores of the AP and GP groups. Learning rates at follow-up were also substantially higher for children in the IBT group than for either of the other two groups. These findings are consistent with other research showing that IBT is considerably more efficacious than ‘‘eclectic’’ intervention.
Lord, C., & Schopler, E. (1989). The role of age at assessment, developmental level, and test in the stability of intelligence scores in young autistic children. Journal of Autism and Developmental Disorders, 19, 483–499.
Longitudinal comparisons were made of intelligence and developmental quotient
(IQ/DQ) scores for three age groups of 70-72 autistic children aged
2 to 3, 4 to 5, and 6 to 7 years at initial assessment and reassessed at least
2 years later. Stability and predictability over a mean follow-up period of
5 years were related to age, developmental level and test used at initial assessment.
IQ/DQs during preschool years were quite stable and predictive
of later IQ scores, except when early scores on the Barley Scales of Mental
Development were compared with later scores on performance or nonverbal
tests. As for other populations, predictability for young autistic children was
strongest when the same test was used at both assessments, and when children
were 4 years or older at initial assessment.
Autism is a serious psychological disorder with onset in early childhood. Autistic children show
minimal emotional attachment, absent or abnormal speech, retarded IQ, ritualistic behaviors, aggression, and self-injury. The prognosis is very poor, and medical therapies have not proven effective. This article reports the results of behavior modification treatment for two groups of similarly constituted, young autistic children. Follow-up data from an intensive, long-term experimental treatment group (n = 19) showed that 47% achieved normal intellectual and educational functioning, with normal-range IQ scores and successful first grade performance in public schools. Another 40% were mildly retarded and assigned to special classes for the language delayed, and only 10% were profoundly retarded and assigned to classes for the autistic/retarded. In contrast, only 2% of the control group children (n = 40) achieved normal educational and intellectual functioning; 45% were mildly retarded and placed in language-delayed classes, and 53% were severely retarded and placed in autistic/retarded classes.
Luiselli, J. K., Cannon, B. O., Ellis, J. T., & Sisson, R. W. (2000). Home-based behavioral intervention for young children with autism/pervasive developmental disorder. A preliminary evaluation of outcome in relation to child age and intensity of service delivery. Autism, 4, 426–438.
Sixteen children with diagnoses of autism and pervasive developmental disorder who participated in home-based behavioral intervention were evaluated retrospectively to determine whether the ‘intensity’ of service delivery (hours per week, duration in months, total hours) and the age at which intervention was introduced (before and after 3 years of age) influenced developmental rating scale assessments of progress. Children who were involved in services before and after 3 years of age all demonstrated significant changes on six developmental domains when assessed before and following intervention but there were no significant differences between these groups. Overall improvement in the areas of communication, cognitive and socialemotional functioning was predicted by the duration of time (months) that a child spent in home-based intervention. These findings are discussed in light of recommendations for the ‘intensive’ behavioral treatment of young children with autism.
Magiati, I., Charman, T., & Howlin, P. (2007). A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders. Journal of Child Psychology and Psychiatry, 48, 803–812.
Background: This prospective study compared outcome for pre-school children with autism spectrum disorders (ASD) receiving autism-specific nursery provision or home-based Early Intensive Behavioural Interventions (EIBI) in a community setting. Methods: Forty-four 23- to 53-month-old children with ASD participated (28 in EIBI home-based programmes; 16 in autism-specific nurseries). Cognitive, language, play, adaptive behaviour skills and severity of autism were assessed at intake and 2 years later. Results: Both groups showed improvements in age equivalent scores but standard scores changed little over time. At follow-up, there were no significant group differences in cognitive ability, language, play or severity of autism. The only difference approaching significance (p ¼ .06), in favour of the EIBI group, was for Vineland Daily Living Skills standard scores. However, there were large individual differences in progress, with intake IQ and language level best predicting overall progress. Conclusions: Home-based EIBI, as implemented in the community, and autism-specific nursery provision produced comparable outcomes after two years of intervention.
After a very intensive behavioral intervention, an experimental group of 19
preschool-age children with autism achieved less restrictive school placements and
higher IQs than did a control group of 19 similar children by age 7 (Lovaas,
1987). The present study follou>ed-up this finding by assessing subjects at a mean
age of 11.5 years. Results showed that the experimental group preserved its gains
over the control group. The 9 experimental subjects who had achieved the best
outcomes at age 7 received particularly extensive evaluations indicating that 8 of
them were indistinguishable from average children on tests of intelligence and
adaptive behavior. Thus, behavioral treatment may produce long-lasting and
significant gains for many young children with autism.
The aim of the study was to evaluate and compare the efficacy of short-term psychoeducational treatment in children with autism and reactive attachment disorder (RAD). Ten boys with autism aged 24–66 months and 11 children with RAD (nine boys and two girls) aged 30–70 months were included in the study. The Ankara Developmental Screening Inventory was used to monitor progress following a 14-session psychoeducational programme. This focused on establishing a reciprocal-dyadic interaction between children and their caregivers and it also provided an educational programme for emotional, social, and language development. Although both groups showed significant changes on all scales of the ADSI, the children with RAD showed greater improvement than the autism group in their total development score, on the language-cognitive subscale, and in social/self-care abilities.
This project evaluated the effectiveness of a TEACCH-based home program intervention
for young children with autism. Parents were taught how to work with their preschool autistic
child in the home setting, focusing on cognitive, academic, and prevocational skills essential
to later school success. To evaluate the efficacy of the program, two matched groups of children were compared, a treatment group and a no-treatment control group, each consisting
of 11 subjects. The treatment group was provided with approximately 4 months of home
programming and was tested before and after the intervention with the Psychoeducational
Profile-Revised (PEP-R). The control group did not receive the treatment but was tested at
the same 4-month interval. The groups were matched on age, pretest PEP-R scores, severity
of autism, and time to follow-up. Results demonstrated that children in the treatment group
improved significantly more than those in the control group on the PEP-R subtests of imitation,
fine motor, gross motor, and nonverbal conceptual skills, as well as in overall PEP-R
scores. Progress in the treatment group was three to four times greater than that in the
control group on all outcome tests. This suggests that the home program intervention was
effective in enhancing development in young children with autism.
Remington, B., Hastings, R. P., Kovshoff, H., degli Espinosa, F., Jahr, W., Brown, T., et al. (2007). A field effectiveness study of early intensive behavioral intervention: Outcomes for children with autism and their parents after two years. American Journal of Mental Retardation, 112, 418–438.
An intervention group (n = 23) of preschool children with autism was identified on the
basis of parent preference for early intensive behavioral intervention and a comparison
group (n = 21) identified as receiving treatment as usual. Prospective assessment was undertaken before treatment, after 1 year of treatment, and again after 2 years. Groups did
not differ on assessments at baseline but after 2 years, robust differences favoring intensive
behavioral intervention were observed on measures of intelligence, language, daily living
skills, positive social behavior, and a statistical measure of best outcome for individual
children. Measures of parental well-being, obtained at the same three time points, produced
no evidence that behavioral intervention created increased problems for either mothers or
fathers of children receiving it.
Rogers, S. J., Herbison, J., Lewis, H., Pantone, J., & Reiss, K. (1986). An approach for enhancing the symbolic, communicative, and interpersonal functioning of young children with autism and severe emotional handicaps. Journal of the Division for Early Childhood, 10, 135–148.
An intervention approach emphasizing development of symbolic thought, communication, and
interpersonal relationships was Implemented with 26 children (ages 2 through 6) who had infantile autism, pervasive developmental disorder, or severe emotional handicaps. The main intervention strategy was the use of play in all its interpersonal, cognitive, and structural variety, imbedded in a reactive language environment. Over a six- to eight-month intervention period, the children demonstrated significant changes in several targeted developmental areas, including cognition, perceptual/fine motor, social/emotional, and language skills. The cognitive complexity of their play skills increased significantly in areasof symbolic complexity, symbolic agent, and symbolic substitutions. Additionally, significant improvement in the communicative and interpersonal characteristics of their play was found. These changes support the efficacy of this approach with young autistic and severely emotionally handicapped children when the children’s needs for high levels of structure, intensity, and consistency are met.
Rogers, S. J., & DiLalla, D. L. (1991). A comparative study of the effects of a developmentally based instructional model on young children with autism and young children with other disorders of behaviour and development. Topics in Early Childhood Special Education, 11, 29–47.
Compares the effects of a developmentally based instructional model on
children with autism and preschool children with other behavior disorders.
Key features of the model; Examination of the children's functioning after 8
to 12 months; Development gains.
Twenty-four children with autism were randomly assigned to a clinic-directed group, replicating the parameters of the early intensive behavioral treatment developed at UCLA, or to a parent-directed group that received intensive hours but less supervision by equally well-trained supervisors. Outcome after 4 years of treatment, including cognitive, language, adaptive, social, and academic measures, was similar for both groups. After combining groups, we found that 48% of all children showed rapid learning, achieved average posttreatment scores, and at age 7, were succeeding in regular education classrooms. Treatment outcome was best predicted by pretreatment imitation, language, and social responsiveness. These results are consistent with those reported by Lovaas and colleagues (Lovaas, 1987; McEachin, Smith, & Lovaas, 1993).
This study evaluated the impact of intensive behavioral treatment on the development of
young autistic children. The treatment reported in this study was home based and was implemented by parents of autistic children with the assistance of community-based clinicians.
Although treatment was unable to be observed directly, parents reported that therapy was
based on methods developed by Lovaas et al. (1981). Treatment differed from that described
in previous reports of intensive behavior therapy for this population in that it was implemented
outside an academic setting and for a shorter period. In addition, children received
fewer hours per week of therapy than in previous reports. Children in the experimental treatment group were pairwise matched to children in a control group (who received conventional school-based and brief one-on-one interventions) on the basis of pretreatment chronological and mental age, diagnosis (autism vs. PDD), and length of treatment. The groups did not differ on pretreatment IQ. Children receiving the experimental treatment had significantly higher posttreatment IQ scores. Smaller, but still statistically significant effects on symptom severity were also found, though experimental subjects still met diagnostic criteria for autism or PDD.
We examined parent-directed, intensive early intervention for children with Pervasive
Developmental Disorder. Children’s parents recruited paraprofessional therapists and
requested consultations on how to implement the UCLA treatment model in their homes
(Smith & Lovaas, 1998). Parents and therapists then received six one-day workshops over
a five-month period, with additional consultations for the next 2–3 years. Six boys
participated (intake age 35–45 months, intake IQ 45–60). The study addressed 1) the
children’s skill acquisition during the first five months of treatment; 2) outcome 2–3 years
later; 3) treatment quality; and 4) parents’ impressions. Five of 6 children rapidly acquired
skills when treatment began, but only 2 clearly improved on standardized tests at the 2–3
year follow-up. Therapists usually employed correct treatment procedures but were less
consistent than therapists employed at a clinic. Parents reported high satisfaction with
treatment. These mixed results highlight the need for multimodal assessment of parentdirected
Smith, T., Groen, A. D., & Wynne, J. W. (2000b). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal on Mental Retardation, 105, 269–285. (Errata appended)
Young children with pervasive developmental disorder were randomly
assigned to intensive treatment or parent training. The intensive treatment
group (7 with autism, 8 with pervasive developmental disorder not otherwise
specified—NOS) averaged 24.52 hours per week of individual treatment for
one year, gradually reducing hours over the next 1 to 2 years. The parent
training group (7 with autism, 6 with pervasive developmental disorder NOS)
received 3 to 9 months of parent training. The groups appeared similar at
intake on all measures; however, at follow-up the intensive treatment group
outperformed the parent training group on measures of intelligence, visualspatial
skills, language, and academics, though not adaptive functioning or
behavior problems. Children with pervasive developmental disorder NOS
may have gained more than those with autism.
Intensive behavioral intervention for very young children with autism has received increased
attention in recent years. Researchers have documented unprecedented success in educating some young children with autism, although not every child makes dramatic developmental gains. It might be useful to identify early in treatment those children who will bene®t most from the current methodology and who might require slight variations in instructional format or curricular focus. The present study suggests that initial learning rates are moderately correlated with treatment outcomes after two years. Among 20 children receiving early, intensive behavioral intervention, initial acquisition of skills was correlated with later learning rates, severity of autism symptomatology and adaptive behavior pro®les two years into treatment. Implications are discussed, especially in light of the universal need for intensive intervention in this population.