Intensive Behavioral Treatment for Children with Autism - Essay Example

Critical Review: Intensive Behavioral Treatment for Children with Autism The study and treatment of autism as a form of mental retardation has been an area of scholarly and practical interest. Among the studies that have been conducted in recent years, the intervention program tested and studied by Sallows and Graupner deserve considerable attention. In this study, the impact of parent-directed and clinic-directed behavioral intervention in the early treatment of infants diagnosed with autism are scientifically investigated across a period of four years. Set within the context of recent successful researches conducted on the early intervention of autism, particularly that of the UCLA Young Autism Project, Sallows and Graupner's study reexamines the effectivity of the UCLA program developed by Lovaas and staff. (Sallows & Graupner: 2005, p.417) Their reexamination of the program's effectivity is not a simple and direct replication of the earlier program. Rather, they build on the research already conducted by Lovaas and other scholars by introducing new areas of inquiry to be considered in the course of their research. Two questions are most notable for their significance. First, they ask whether there would be any significant differences in the success rate of the intervention program if it is parent-directed and community-based, as compared to the clinic-directed, university-based program implemented by the UCLA Young Autism Project. (Sallows & Graupner: 2005, p.419) Second, the research is also directed towards the identification of pre-treatment variables in autistic infants that may predict the success of the early intervention program in treating autism and the symptoms that accompany it. (Sallows & Graupner: 2005, p.419) The first question poses significant implications for practical purposes in that the relative success of a community-based, parent-directed behavioral intervention program patterned after the UCLA program would translate into a cheaper, more feasible alternative for families seeking intervention treatment for their children. According to Sallows and Graupner, one of the significant criticisms against the behavioral intervention program developed by the UCLA Young Autism Project was that although it seemed to be effective in 50% of the cases, it was too expensive to be replicated for the access of low-income families with autistic children. (Sallows & Graupner: 2005, p.418) The search for a more affordable alternative has thus become a primary thrust in more recent researches, many of which attempted to lower the expense by cutting back on the total treatment hours. Unlike such studies, however, Sallows and Graupner's research differs in its strategy of cost-reduction and, more importantly, in its relative success in replicating the success rate of the original intervention treatment design. Practically the same percentage of autistic children from the two experimental groups were able to adapt and integrate into regular schooling programs at the end of the four-year program, regardless of whether they were from the professional clinic-directed group, or from the parent-directed group. The same trends were also shown to occur in both groups. There were no significant differences between the two groups in the pre-treatment and post-treatment scores of the children in the assessment tests that were conducted, and the Full Scale IQ scores for all 23 children in the study increased by an average of 25 points. (Sallows & Graupner: 2005, p.424) These results indicate that cheaper intervention programs which do away with the expensive clinical setting could be a viable alternative in the future, entailing access for a wider range of families and a larger number of infants diagnosed with autism. The practical relevance of this study for the treatment of autism among young infants is thus enormous especially for the low-income families who cannot afford expensive clinical treatments. In regards to the second significant question addressed by the study, that of predictive pre-treatment variables which may determine the outcome of the intervention program, it was shown that the pre-treatment variables assessed through the Early Learning Measures correlated significantly with three post-treatment measures: Full Scale IQ, Language, and Social Skill. (Sallows & Graupner: 2005, p.429) The children with higher pre-treatment measure scores displayed greater development in these three areas at post-treatment. This is significant in light of the fact that these three post-treatment measures are the very characteristics most associated with the diagnosis of autism. As stated by Volkmar et al, the learning disability of autism is "characterized by early onset of extreme impairments in social, communicative, and cognitive development.." (Volkmar et al: 1990, p.246) It may then be valid to conclude that at post-treatment, the children who had higher scores in the post-treatment measures of these three variables could be said to be "less autistic" than those children who still performed poorly in these three variables. Considering that these are the same children who performed better in the early learning measures at pre-treatment phase, we may then say that the treatment is selective in its effectivity, showing greater success among the infants who at the onset were already performing relatively better than the others. Although the intensity of the intervention treatment was as uniform as possible among all participating children, their results still differed among the children and rather than being random, the differences in the treatment's efficacy seems to be related to the severity of the disorder at the onset of treatment. The implications of the treatment's selective efficacy, as compared to a scenario of random efficacy, bears negatively on the behavioral perspective of learning. Under a behavioral theory of learning similar to that espoused by Watson, the efficacy of the behavioral intervention conducted to treat or alleviate autism in this study should have been uniform among the participants. Absent any difference in the intervention treatment within groups, no significant difference in the efficacy of the treatment should have emerged. Such a scenario would have been in line with the classic behavioral theory of learning, where "all change is caused by external environment, not by the child's own intrinsic activity". (Hodapp et al: 1990, p.5) This, however, is not the case that emerged in the study. Instead the results show a pattern of efficacy, with greater success rates for the infants who were already identified at the onset as rapid learners. The uniformity by which these "rapid learners" developed in the course of the four-year treatment (Sallows & Graupner: 2005, p.424-427) as well as the fact that this pattern is displayed consistently in both parent-directed and clinic-directed groups also negates any defense of confounding factors. Although the study makes use of behavioral methods such as positive reinforcement and role-playing (Sallows & Graupner: 2005, p.422-423), its end result actually reinforces the developmental perspective of learning. The extent by which the treatment effected successful learning was determined by innate factors within the autistic child. The participants who displayed better cognitive development at the very start consistently showed better progress in the course of the four-year program as compared to the "moderate learners". When interpreted under a developmental perspective, it may be valid to state that the treatment simply developed abilities only to the extent that such abilities could be developed in each child. It would also follow that a child lagging behind in one stage of development may as a consequence continue to lag behind as he progresses to the next stages. Since the developmental stages of learning are said to follow a similar sequence among all persons, (Hodapp et al: 1990, p.5-6) then those infants whose mental development were already lagging behind at the start of the study would continue to lag behind for as long as the intensity of treatment is kept uniform among all participants. The relative consistency of the participant children's developmental progress in the course of the four-year program also runs counter to observations of uneven development previously associated with autism. (Volkmar et al: 1990, p.261-262) Though the results of the study support developmental theories of learning more than that of the classical behavioral school of thought, the relative success of the intervention program applied in the study further bolsters the role of applied behavior analysis in the treatment of learning disabilities. The application of behavioral methods has become popular in the past decades for the learning of socially relevant behavior by persons with learning disabilities. Through the years, clinical responses to the problem of learning disability have become less concentrated on the development of intelligence, and more often aimed at the learning of socially acceptable behavior. The rationale behind this change is explained below: "..it is the person's ability to adapt to the society in which he lives, rather than simply his score on an intelligence test, which is crucial to the concept of mental retardation.. By adaptive behavior we mean the degree to which an individual can function effectively, maintaining himself or herself independently in society, and how well he or she is able to meet satisfactorily the culturally imposed demands of personal and social responsibility." (Jenkinson: 1984, p.27) The reviewed study thus epitomizes this new emphasis on behavior modification and behavior learning that has now become the trend for the treatment of mental retardation. Rather than concentrating solely on cognitive development, the development of social skills is also accorded significant attention in the reviewed study, as has been the trend in many others. Interventionist programs built towards the learning of social behavior vital to the individual's interaction and survival in the outside world are being accorded careful study. This trend is not limited only to the learning of socially desirable behavior, but also involves the development of interventionist programs aimed at unlearning problem behaviors. (Schindler & Horner: 2005, p.37) Such intervention treatments do not necessarily operate in support of the behavioral theory of learning. Rather, behavior is perceived as a possible solution that may alleviate the distress and social exclusion commonly associated with learning disabilities. The practical benefits of the paradigm outlined above, however, do not redound in scientific benefits that may be directed towards the prevention of learning disabilities. The current focus on behavior intervention and learning for individuals with learning disabilities is useful for learning-disabled individuals only in so far as they allow them to function adequately in society, but these intervention programs do not really treat their disabilities. They only work to help these mentally retarded individuals live with their disabilities. The intervention program studied and tested in the reviewed journal article, may, however, be an exception. The significant progress of some participants in the study indicate the possibility that early intervention in autism may actually have future use not only for behavior teaching but for actual treatment as well. As may be gleaned from the results of the study, the success of such treatment may be limited only to a small group of "rapid learners", those who at the onset already displayed less severe symptoms of autism and who at the end of the program were already performing as well as children with no learning disabilities. Having reached a "normal level" of cognitive and social development for their age, the possibility of sustained normalcy may exist. The potential of early interventionist programs such as the one employed in the study for actual treatment of autism must thus be further studied. In the case of the 23 children-participants in Sallows and Graupner's study, the sustainability of the "rapid learners" developmental progress with and without further treatment must thus be accorded further research. Bibliography Hodapp, R., Burack, J. & Zigler, E. (1990) The Developmental Perspective in the Field of Mental Retardation. Chapter 1, In R. Hodapp, J. Burack, & E. Zigler (Eds.), Issues in the developmental approach to mental retardation. Cambridge: Cambridge University Press. Jenkinson, J. (1984) What is mental retardation Victoria, Australia: Victoria College Press Sallows, G., & Graupner, T. (2005) Intensive Behavioral Treatment for Children with Autism: Four-year Outcome and Predictors. American Journal on Mental Retardation, 110, 417-438. Schindler, H. & Horner, R. (2005) Generalized reduction of Problem Behavior of Young Children with Autism: Building Trans-situational Interventions. American Journal on Mental Retardation, 110, 36-47. Volkmar, F., Burack, J., & Cohen, D. (1990) Deviance and developmental approaches in the study of autism. Chapter 10, In R. Hodapp, J. Burack, & E. Zigler (Eds.), Issues in the developmental approach to mental retardation. Cambridge: Cambridge University Press. Read More