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.
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.
Evidence has shown that PRT teaches children to communicate and interact with others (Koegel & Koegel, 2005).
Parents can easily learn to use it (Coolican, 2008; Schreibman & Koegel, 2005).
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.
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.
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.
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.