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The Effectiveness of the Nova Scotia EIBI Program

The effectiveness of the Nova Scotia EIBI ProgramThe Government of Nova Scotia, a province in Canada, introduced a new treatment program in 2005, for young children diagnosed with autistic spectrum disorder (ASD). The program was developed based on Early Intensive Behavioural Intervention (EIBI) principles and was launched in the summer of 2005. As this treatment program introduced a new clinical model of service delivery, the NS Department of Health initiated an independent program evaluation whose purpose was to determine whether the model provided effective treatment for children with ASD. This unique model and the treatment outcomes of the first families involved in the program are described below.

 

The Traditional Treatment Model

Early treatments aim at decreasing autism symptoms and increasing young ASD children’s ability to behave in a less disruptive manner in family, child care, school and community settings. Effective treatment methods are based on the scientific study of learning, called Applied Behaviour Analysis (ABA). ABA-based treatment usually involves many hours of specialized one-to-one teaching, the goal being to build up the basic skills that many children with ASD do not have.

 

One of the pioneers of the field: Dr Ole Ivar LovaasThe most-researched EIBI model for autism was developed by Ivar Lovaas, a psychologist at UCLA. In studies using his model, about half of the children with ASD showed large improvements, but encountered difficulties in transferring the learned skills in their everyday lives (Reichow and Wolery, 2009). For the remaining half of the children, gains were more modest. Moreover, in practice, implementing EIBI programs in communities presents some difficulties: 1) finding experts to ensure high quality treatments is not always possible and; 2) some studies have shown that EIBI programs run by private agencies actually had little or no effect on children’s skills (Bibby et al., 2002). These concerns led to the design of a new ABA-based intervention model.

 

The Unique Treatment Model Developed in Nova Scotia

The Nova Scotia Early Intensive Behavioural Intervention (NS EIBI) model was developed by Dr. Susan Bryson, Craig Chair in Autism Research at Dalhousie University, with the participation of the Koegel Autism Center (University of California) and the NS Department of Health. It is based on Pivotal Response Treatment (PRT), a teaching method that uses highly motivating activities based on the child’s own interests to provide the child with opportunities for incidental learning within an ABA framework. PRT presents a number of advantages as a basis for EIBI.

 

PRT is used to teach children in their natural environments (home, playground, preschool) and thus can be used during everyday activities.

PRT in natural environments

 

Evidence has shown that PRT teaches children to communicate and interact with others (Koegel & Koegel, 2005).

Interaction with others

 

Parents can easily learn to use it (Coolican, 2008; Schreibman & Koegel, 2005).

Can be used by parents

 

When PRT is used, the skills that children gain generalize to other areas, which mean that they are deployed in different situations with a variety of people.

Deployed in different situations

 

The NS EIBI model combines intervention by therapists and parents to make treatment more intense. Parent training helps to generalize skills, since they interact with their children in all sorts of daily activities. Though PRT is a well-established method for teaching children with ASD, it had never been used before in a community-based EIBI model.

 

The Evaluation Results

The evaluation focused on the outcomes for the 45 families in three areas of NS who completed a 12 months NS EIBI program between 2005 and 2007. As is usual in ASD, children presented a wide range of abilities. Some had no speech at all while others talked, but did not necessarily use social language. On average, the children were 4 and a half years old when they began treatment with overall abilities of just above 2-year-old level, based on standardized developmental testing (Merrill-Palmer-Revised scales). Children’s progress was assessed in two ways: 1) by using standard tests of understanding and using spoken language (e.g. answering questions, talking about pictures); 2) by using problem solving tests without words (e.g. solving puzzles, copying patterns). Since children with ASD often show varying levels of ability in different situations, parents were asked to complete questionnaires about their children’s everyday skills and behaviours.

 

Improving the ability to communicateThe main focus of the NS EIBI Program is to increase children’s ability to communicate. Like in other EIBI programs, the children who started the program with better developed skills showed the biggest improvements. However, on average, children in the program gained more than a year’s worth of language in 12 months. Not only did they match the developmental rate of children with no ASD, but in some cases, they actually surpassed it. This resulted in the children acquiring skills closer to the level of their peers with no ASD. Some learned to talk during treatment while others’ speech became less repetitive and was used to interact more with people. Improvements were seen both in the children’s ability to speak and in their ability to understand what other people said (e.g., following directions).

 

After a year of EIBI program, children were performing, on average, much better than expected on standard problem solving tests. Since their development before treatment was much slower than children with no ASD, this fast rate of learning is even more impressive. Improvements in children’s attention, awareness, and compliance were also noticed. Parents commented that their children were more aware of what went on around them, played more appropriately with toys, and showed more interest in people.

 

Spin off effects

  • Other positive effects of participation in the EIBI program were noticed, among which was the decrease of disruptive behaviours such as aggression. Since disruptive behaviours may be caused by children’s difficulties to express what they want or feel, improvements in their ability to communicate may contribute to reduce frustration and anger.

  • Some parents also reported decreased severity of symptoms such as repetitive behaviours, need for sameness and limited interests.

  • The EIBI program was also helpful to other family members. Many parents felt less stressed over their children’s difficult behaviour. They gained confidence in their own ability to help them and were able to engage in social and leisure activities, and to carry out errands with their children. Parents also reported more positive interactions between children with ASD and their siblings.

  • In an anonymous survey, 95% of them stated they would recommend the EIBI program to other parents with no or very few concerns.

 

Thus, the evidence so far supports the effectiveness of the NS EIBI model for young children with ASD. But there is more to come since these evaluation results are part of an ongoing nationally-funded research being conducted by Drs. Smith and Bryson and their colleagues.

Author : Isabel M. Smith, Ph.D.
Assistant Professor
Department of Pediatrics and Psychology
Dalhousie University
Adapted by : Myriam Hivon, Ph.D.

 

REFERENCES

  • Bibby, P., Eikeseth, S., Martin, N.T., Mudford, O.C. & Reeves, D. (2002). Progress and outcomes for children with autism receiving parent-managed intensive interventions. Research in Developmental Disabilities, 23 (1), 81-104.

  • Bryson, S.E., Koegel, R.L., Koegel, L.K., Openden, D., Smith, I.M., & Nefdt, N. (2007). Large scale dissemination and community implementation of Pivotal Response Treatment: Program description and preliminary data. Research and Practice for Persons with Severe Disabilities, 32, 142-153.

  • Coolican, J. (2008). Brief Parent Training in Pivotal Response Treatment for Preschoolers with Autism. Unpublished doctoral dissertation, Dalhousie University, Halifax NS.

  • Koegel, R.L., & Koegel, L.K. (2005). Pivotal response treatments for autism: communication, social & academic development. Baltimore MD: Brookes.

  • Reichow, B. & Wolery, M. (2009). Comprehensive synthesis of early intensive behavioural interventions for young children with autism based on the UCLA Young Autism Project model. Journal of Autism and Developmental Disorders, 39, 23-41.

  • Schreibman, L. & Koegel, R.L. (2005). Training for parents of children with autism: Pivotal responses, generalization, and individualization of interventions. In E.D. Hibbs, & P.S. Jensen (Eds), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice, 2nd ed. (pp. 605-631). Washington, DC: American Psychological Association.

 

Un commentaire

  1. monica o'neil dit :

    My son was non-verbal when he began in July of 2009 and is still non-verbal. It was not worth the effort and time that I put into it. Expecting families to put their other children out of their own home is not natural. Not to mention that dealing with the people who call themselves professionals was an added stress. Parents should also receive all documents that are written by these people as I have found that not everything that is put in these documents is true.

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