Applied Behavior Analysis and Autism and Severe Intellectual Disability

Applied Behavioral Analysis & Autism

Applied Behavioral Analysis of Autism and Severe Intellectual Disability

Home-Based Behavioral Treatment of Young Children with Autism: A Review

The study conducted by Sheinkopf and Siegel exposes serious gaps in autism treatment knowledge rather than coming to specific conclusions about the effectiveness of home-based behavioral treatment (1998). The primary outcome of the study was the finding of positive therapeutic effects when treatment was implemented in the affected children's homes, outside the more closely controlled setting of an academic research center. It effectively showed that home-based behavior treatment for children with autism is plausible and appears to have a positive impact on the children's IQ and symptomatology. The study methodology, however, was compromised by a number of significant limitations and biases.

The largest limitation of the study consists of its failure to effectively isolate variables. The positive outcome of the study, therefore, cannot be attributed to any of the factors that played a role in implementing the home-based behavioral autism treatment: parental influence on the children, the treatment intensity and the modalities of the treatment.

This is not a randomized study. Parents of children in the study groups voluntarily participated in the study. More importantly, parents of children in the control group specifically chose not to commit to the home-based behavioral treatment. The authors address this confounding variable in their discussion but suggest that, "the similarity of the two groups in terms of paternal occupational status suggests that large differences were unlikely." Despite the proclaimed similarity, this remains a significant limitation. It presents the possibility that the observed positive effect of the treatment by comparison with the control group is partially biased by an untested negative effect of factors influencing the control group. These factors may include negligence of the children at home and lack of reiteration of skills acquired in school-based treatment. The possibility of a negative impact on the control is observed in the 2.3% increase in the symptoms count post-treatment. This suggests that the control group is not reliable for comparison to the treatment group. The lack of direct observational data significantly limits the study. An expert should be present during the home-based treatment to observe the interaction between the parent and child during the treatment to determine the influence that treatment administration has on the outcomes. From the conclusions, it appears that the parents as teachers had a larger impact on outcomes than the actual treatment modules.

Further, there exists a large disparity in treatment intensity between the two study groups. The experimental group received on average sixteen more hours of treatment across teaching modalities. The implications of this statement are two-fold. The authors argue that the variation in teaching intensity within the experimental group had no significant effect on outcomes. It must be noted that variation in this group is significantly lower than in the control group and that this claim has little relevance to the comparative outcomes that were measured. It appears rather that the intensity of the treatment would play a significant part in skills retention. Further, the experimental group received a combination of therapies, which makes it difficult to determine to which training and specifically to which aspects of the training to attribute the positive outcomes. The different IQ tests used in the pre and post-treatment examination of the subjects further confound this aspect of the study.

The study outcome that home-based behavioral treatment has a positive impact on children with autism is irrespective of the control group. Despite its limitations, the before and after testing approach showed reliable results. The family factor, however, emerges as the most significant variable that is not accounted for and must be further studied.

Studies have shown that high levels of parental stress reduce the effectiveness of early teaching interventions. Factors including family functioning and levels of parental education were found to have a significant impact on the child's progress in educational, adaptive behavior and social functioning (Osborne, McHugh, Saunders, & Reed, 2008). These implications are especially relevant for home-based behavioral treatment program because the effectiveness of the program relies entirely on the ability of the parent to conduct the treatment exercises. A study performed by Sawyer et al. corroborates this relationship (2008). It found that the quality of home-based care for children with autism might be adversely affected if time pressure experienced by caregivers compromises their well-being.

A study that took into account the effect of family dynamics and availability on the treatment found that a home-based intervention program reinforces and enhances the skills learned at the center-based program (Rickards, Walstab, Wright-Rossi, Simpson, & Reddihough, 2007). In its conclusions, this study supports Sheinkopf's assertions that an intensive home-based behavioral treatment has a positive influence on children with autism. A follow-up conducted by the same authors showed that significant clinical improvements in cognitive development, language skills and non-verbal areas were maintained one-year after the provision of the home-based intervention program. This study shows that skills acquisition can be directly traced to home-based treatment and that the learning is sustained over time, one of the major limitations of the Sheinkopf and Siegel study.

The authors address many of the limitations in the discussion but in so doing defend their study rather than actively supporting their conclusions. The outcomes should therefore be interpreted with caution. The neutrality of the paper's title supports this assertion, as it makes no positive or negative declarations with respect to the treatment. Nonetheless, this study remains very valuable by exposing many of the variables that must be considered in future studies and by showing that home-based treatment is a viable option for treating behavioral limitations of children with autism. This was a novel discovery and produced a large database of follow-up studies.