Vista's Method - Applied Behavior Analysis ("ABA")

All of Vista’s programs employ the principles of applied behavior analysis (“ABA”), precision teaching (“PT”), and direct instruction (“DI”) within a culture that coordinates the efforts of the educational and behavioral health communities across all of the individual’s environments.  To accomplish this, Vista utilizes a comprehensive, pre-academic, ABA-based curriculum and staff training model, known as Competent Learner Model (“CLM”) (TucciLearningSolutions, Inc.).  Paramount within this curriculum is the adherence to, and the systematic use of, scientific principles related to learning and behavior change.  The CLM is an intensive, individualized teaching program designed to structure learning environments so that students acquire the competencies necessary to be successful across learning environments. Further, using the CLM for children with autism ensures (1) an on-going and careful selection and analysis of curriculum, (2) the use of dynamic intervention and instructional strategies (e.g. ABA, PT, DI), (3) training in, and the use of, data-based decision making processes, and (4) the use of only scientifically validated procedures or procedures that are based on scientifically validated principles for the development of effective repertoires and skills.

The techniques used at Vista are research based and are developed from the basic principles of ABA. Intervention strategies at The Vista School® are chosen because of their efficacy and basis in ABA literature. Interventions, regardless of modality or methodology, are only implemented and continued as long as they show behavioral efficacy. Specific techniques/intervention methods used may include:

• Discrete Trial Training ("DTT")

• Direct Instruction Curriculum

• Precision Teaching

• Group Instruction

• Community Based Instruction

• Social Skills Training Procedures

• Natural Environment Training

• Pivotal Response Training

What is ABA?

ABA is a science devoted to the understanding and improvement of human behavior, and has been used effectively as a treatment for the symptoms of Autism for more than 20 years.  ABA focuses on shaping behavior systematically, often in a highly structured environment.  Every skill a child with autism does not demonstrate – from relatively simple responses like looking at others to more complex acts like spontaneous communication and social interaction – is broken down into small steps.  Successful completion of each step is rewarded to encourage its mastery and data is carefully taken and evaluated to ensure the fastest rate of skill acquisition.  Problematic behavior, such as tantrums, self-injury, and withdrawal, are analyzed to determine what functions they serve and plans are developed to replace the challenging behavior with more functional, contextually appropriate behavior.  By tailoring reinforcement to each child, and by teaching replacement skills, many problem behaviors can be reduced or eliminated and many new skills gained.

The Efficacy of ABA

Lovaas, 1987

Dr. O. Ivar Lovaas of UCLA published the first controlled trial describing the efficacy of behavioral treatment in treating young children with autism.  Dr. Lovaas found that “47% [of those in the experimental group who received 40 hours/week of intensive behavioral treatment] achieved normal intellectual and educational function, 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” (Lovaas, p. 3).  Of children assigned to the control group, who received approximately 10 hours/week of behaviorally-based services, “only 2% … 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” (p. 3).

“These data,” Lovaas concludes, “promise a major reduction in the emotional hardships of families with autistic children. ... The treatment schedule of subjects who achieve normal function could be reduced from 40 hr per week to infrequent visits even after the first 2 years of treatment.  The assignment of one full-time special education teacher for two years would cost an estimated $40,000, in contrast to nearly $2 million incurred (in direct costs alone) by each client requiring life-long institutionalization” (p. 9).

McEachin, Smith & Lovaas, 1993

In 1993, John J. McEachin, Tristram Smith, and O. Ivar Lovaas carefully assessed the 9 children from the 1987 study who had achieved normal intellectual and educational outcomes.  Five years later, 8 of the 9 children who achieved the best outcomes showed that they had preserved their gains, and “at age 7 … 8 of them were indistinguishable from average children on tests of intelligence and adaptive behavior” (p. 359).  McEachin et al.’s findings support the lasting benefits of early, intensive behavioral treatment for children with autism. 

Sallows & Graupner, 2005

In 2005, Glen O. Sallows and Tamlynn D. Graupner of the Wisconsin Early Autism Project in Madison Wisconsin published their findings.  Sallows et al. aimed to answer questions including (1) whether a community-based program provides the same service without the support or resources as a clinic and (2) whether significant autistic symptoms remain in students that score in the normal range.    

They discovered that there was no significant difference in pre/post testing between intensive ABA services provided in a clinical setting and those delivered in parent-directed groups in home and community settings.  Average IQ increases were measured at 25 points, 48% of participants in both groups succeeded in regular education settings with increased IQs of 85 or higher, and 47% were able to participate in regular first/second grade school programs without supports.  Interestingly, of the 11 rapid learners, 8 no longer met the autistic criteria for diagnosis at a 3 year assessment.

It is important to note that Sallows’ and Graupner’s results are consistent with those reported by Lovaas in his 1987 seminal study (see above).

Cohen, Amerine-Dickens & Smith, 2006

In 2006, Howard Cohen, Mila Amerine-Dickens, and Tristram Smith sought to determine whether Lovaas’ model implemented by a community agency yielded results comparable to Lovaas’ 1987 study, when compared to children served in public school special education programs who received fewer than 9 hours/week of behaviorally-based intervention.  Those children in the experimental, intensive behavioral group, achieved an average increase in IQ of 25 points and an average increase in language comprehension test scores by 20 points.  11 of the 21 children in the experimental group were placed in regular education programs by the third year with support, and 6 of the 21 were placed in regular education placements without need for support.  By contrast, those in the control group receiving less intensive behavioral services achieved less impressive gains and only 1 of the 21 children in the control group were placed in regular education programs with support by the end of their third year of intervention (p. S145).

Like Sallows et al. above, Cohen et al.’s findings suggest that the UCLA/Lovaas Model of intensive behavioral treatment “can be implemented in a non-university community-based setting” with increases in test scores “similar to those reported in Lovaas’ EIBT study” (p. S152). 

Howard, Sparkman, Cohen, Green & Stanislaw, 2004

In 2004, Jane S. Howard, Coleen R. Sparkman, Howard G. Cohen, Gina Green, and Harold Stanislaw published results of their research “A comparison of intensive behavior analytic and eclectic treatments for young children with autism.”  The article describes their comparison of intensive behavioral treatment with both an “eclectic” classroom designed for students with autism and a general special education classroom.  As in previous studies, the behavioral group achieved higher mean scores in all domains, normal ranges in cognitive, nonverbal, communication, and motor skills, and normal to above average learning rates in all domains.

Howard et al. found no significant differences between the “eclectic” autism special education and the general special education groups.  Children in both control groups achieved normal range in motor skills only and close to normal average range in non-verbal domains only.  Howard et al.’s findings are consistent with prior research showing that intensive behaviorally-based interventions are significantly more effective than “eclectic” special education interventions (p. 359).

Eikeseth, Smith, Jahr & Eldevik (2007/2002)

In 2002, Eikeseth et al. published outcome data comparing the results of intensive, behaviorally-based interventions for thirteen 4 to 7 year old children diagnosed with autism to a comparison group of twelve children with similar initial test scores receiving “eclectic” special education services in a school environment. 

The intensive behavioral group experienced results similar to the studies summarized above, with average gains in IQ of 25 points, and increases to Vineland scores averaging (1) 12 points in Adaptive Functioning, (2) 20 points in Communication, (3) 9 points in Daily Living Skill, and (4) 12 points in Socialization domains.  At the beginning of the treatment, all thirteen participants in the behavioral group scored in the Mentally Retarded range.  Following treatment, seven out of thirteen participants in the behavioral group scored in the normal IQ range.

In contrast, the “eclectic” group experienced small gains in IQ (averaging 7 points) but actually experienced decreases in all the Vineland domains as follows: (1) Adaptive Functioning decreased 10 points, (2) Communication decreased 7 points, (3) Daily Living Skill scores decreased 6 points, and (4) Socialization scores decreased 12 points.  Only two of the twelve scored in the average IQ range post-treatment.

At follow-up in 2007, students in the behavioral group maintained gains made after intensive behavioral treatment.  Eikeseth et al.’s research demonstrates (1) that behavioral treatment is effective when delivered to older children, with results statistically similar to those in earlier controlled studies of younger children and (2) that “eclectic” approaches similar to those employed by most special education programs are not only ineffective in yielding outcomes of intensive behavior analytic services, but also may be deleterious to the adaptive functioning, communicability, daily living skill, and social ability of young persons with autism.

Eldevik, Eikeseth, Jahr & Smith, 2006

In 2006, Sigmund Eldevik, Svein Eikeseth, Erik Jahr, and Tristram Smith published an article examining the “Effects of Low-Intensity Behavioral Treatment for Children with Autism and Mental Retardation.”  Eldevick et al. compared lower-intensity behavioral treatment (<20 hours/week) to “eclectic” special education services delivered at a similar level of intensity.  As in previous studies, the behavioral group attained stronger results in all domains when compared to the “eclectic” group.  Because, however, the gains realized by the behavioral group were significantly smaller than intensive behavioral groups in other studies, Eldevik et al. question the clinical meaningfulness of the gains. 

Summary

The above research underscores the importance of intensive behavioral interventions for children with autism, that children with autism require access to behavioral health services, and that "eclectic" special education programs may not be the most appropriate means by which the needs of children with autism are met.  The bottom line, given our current knowledge of autism and effective treatment modalities, is that without intensive ABA therapy, the prognosis of children with autism cannot be expected to improve.  With intensive ABA therapy, children with autism and their families can expect gains that ultimately improve the quality of life for both the child and his or her family.
 

U.S. Surgeon General: Department of Health and Human Services (1999). Mental Health: A Report of the U.S. Surgeon General. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health