Re: ABA at school? FOR GERALDINE

October 13, 2004

Thank goodness for Singleton, who saved a copy of the ABA position

paper on her computer!!!

Here it is:

A Position Paper in Support of Developing ABA-Based Classrooms

What is autism spectrum disorder?

The Autism Society of America defines autism as a " complex developmental

disability that typically appears during the first three years of life. The

result of a neurological disorder that affects the functioning of the brain,

autism impacts the normal development of the brain in the areas of social

interaction and communication skills " (ASA, 2003, ¶ 1).

What is the scope of the problem?

The CDC reports that using the most conservative criteria, rates of autism

in children between 3 and 10 years of age range between 3.4 of every 1,000

children in Atlanta (Yeargin-Allsopp, Rice, Karapurkar, Doernberg, Boyle, &

, 2003) and 6.7 of every 1,000 children in Brick Township (Bertrand,

Mars, Boyle, Bove, Yeargin-Allsopp, & Decoufle, 2001). These rates are 10

times higher than statistics obtained from previous studies. The Autism

Society of America reports that " Based on statistics from the U.S.

Department of Education and other governmental agencies, autism is growing

at a rate of 10-17 percent per year " (ASA, 2003, ¶ 4).

In an editorial in JAMA, Fombonne, a professor of child and adolescent

psychiatry at Montreal's McGill University in Canada, suggested the true

number of children struggling with the developmental disorder was likely to

be much greater than 34/10,000 results found by the CDC in Atlanta. Given

the difficulty of diagnosing higher functioning autistic children, or

children with milder forms of the disorder, the true prevalence could be 6

children per 1,000 (Fombonne, 2003).

The numbers of children in Texas, aged 6-21, served by IDEA, who have autism

increased from 1,444 during 1992-1993 to 7,099 in 2001-2002. These numbers

are probably much lower than the actual numbers of children who have autism,

since many children with autism spectrum disorders qualify for special

education services under a speech impairment or other classification.

However, the growth rate of nearly 400% puts into perspective the increased

demand for special education services in public schools.

What is the cost of the problem?

Researchers estimate the lifelong costs of specialized education, family

support, adult services and Social Security benefits for people with autism

spectrum disorders is between $3.4 million to $4.4 million (son, Mulick

& Green, 1998).

Addressing ASD kids' needs in public schools

Unlike many other developmentally disabled children, young children with

autism generally lack the functional skills required to be successful in an

inclusion setting. Social deficits common in many young children with

autism spectrum disorders can make it all the more difficult to learn from

peers. Successful programs first focus on basic skills like attending,

sitting during circle time, being around other children, imitation and

speaking. Once the child has gained a basic repertoire of skills, he or she

can then begin to benefit from inclusion just as other developmentally

disabled children.

What is ABA?

ABA is an acronym for applied behavior analysis, or the application of the

science of behaviorism. Like any other science, ABA relies on the

principles of observation, identification, description, testing hypotheses,

and theoretical explanation of phenomena - in this case, behavior. ABA is

used widely in increasing or decreasing behaviors or teaching new skills.

Baer, Wolf, and Risely (1967) outlined seven essential elements of an

ABA-based program:

a.. The program must be applied. The behaviors that one chooses to focus

upon should have some social significance.

b.. The program must be behavioral. The environment and physical events

should be recorded with precision.

c.. The program must be analytic. There should be clear and convincing

evidence, through carefully collected data, that the intervention is

responsible for a change in a behavior.

d.. The program must be technological. The techniques that one uses should

be described completely enough to allow for duplication by another

individual.

e.. The program must be conceptually systematic. There should be relevance

to established and accepted principles (for example, the principle of

operant conditioning).

f.. The program must be effective. The program should seek to change the

targeted behavior to a meaningful degree.

g.. The program should display some generality. A change in behavior

should be seen in a wide variety of environments, or should spread to a wide

variety of related or similar behaviors.

How does ABA work?

Through observation, what happens before (antecedents), during (behavior)

and after (consequences) are documented. Chart #1 at the end of the paper

summarizes the steps of ABA. The Cambridge Center summarizes the " how-to's "

of ABA in this way:

Skills that the person does not demonstrate are broken down into small

steps.

To teach each step:

§ A - give a clear instruction, provide assistance in following the

instruction (for example " prompt " by demonstration or physical guidance),

and use materials that are at the person's level.

§ B - get a correct response.

§ C - give a positive reinforcer (a consequence that will lead the

person to do the behavior again in the future).

Many opportunities or trials are given repeatedly in structured teaching

situations and in the course of everyday activities. Instruction emphasizes

teaching a person how to learn -- to listen, to watch, to imitate. As the

person progresses, guidance is systematically reduced so that the person is

responding independently; prompts are faded out. As steps are acquired, the

person is taught to combine them in more complex ways and to practice them

in more situations. Problem behavior is not reinforced. The person is not

allowed to escape from learning and is redirected to engage in appropriate

behavior. The person's responses during every lesson are recorded. These

data are used to determine if he or she is progressing at an acceptable

rate. If not, that part of the program needs changing. The " therapist's "

(teacher's, parent's) behavior is also observed continuously at first and

then less frequently and as needed to ensure that procedures are being

applied correctly and safely. Recording client and therapist behavior is

essential, because we need to SEE that the program is working as well as it

can be. Even highly experienced behavior analysts need feedback in the form

of detailed, rigorous performance data. Observing therapist behavior tells

us that the procedures are being followed correctly and consistently. The

information adds to our knowledge about the effectiveness of procedures and

how to avoid and overcome problems that may arise in practice (CCBS, 2002, ¶

2-12).

How much does ABA cost?

Studies estimate the average cost of an intensive private ABA program to be

around $33,000 per year per child. However, several studies have shown that

there is a significant cost savings to the public over the long run (Green,

1996, pp.39-44). Average savings during a child's public school years were

calculated to be between $274,709-$298,651. Over a lifetime, the savings

were calculated to range from $1.7 million to $2.8 million, depending on the

level of social services required for individuals (son, Mulick & Green,

1998). While no data seem to be available on the costs of delivering ABA

services through the public education system, the fact that many school

districts are developing ABA-based classrooms would indicate that the

benefits outweigh the costs. Children who are mainstreamed earlier, with

fewer supports and less dependence on special services simply are not as

expensive to support as those who need life-long interventions.

Additionally, the costs of reimbursing families for private ABA therapy and

legal costs for these settlements could easily exceed the cost of developing

ABA-based classrooms.

How effective is ABA?

Autism specialists typically recommend ABA as the most effective treatment

for children with autism. " The most important intervention in autism is

early and intensive remedial education that addresses both behavioral and

communication disorders " (Rapin, 2002).

A report from the surgeon general summarizes " Thirty years of research

demonstrated the efficacy of applied behavioral methods in reducing

inappropriate behavior and in increasing communication, learning, and

appropriate social behavior " (U.S. Department of Health & Human Services,

1999).

Children who receive early intervention with ABA have very high rates of

improvement. In Ivar Lovaas' landmark 1987 study, 47% of the children who

received early intensive ABA achieved gains substantial enough that they

were indistinguishable from typically-developing peers by first grade.

Another 47% made significant gains as well, and only 6% did not progress

significantly. In contrast, only 2% of the control group children (who

received regular special education and/or minimal ABA) achieved normal

intellectual and educational functioning. Early intervention with ABA

yields long-term gains for children with autism. In a longitudinal study,

Lovaas et al found that the children who made the most substantial gains in

his first study had maintained those gains and were indistinguishable from

their typically-developing peers at age 11.5 in intelligence and adaptive

behavior (McEachin, & Lovaas, 1993).

While ABA is also extremely effective for teaching older children, the

greatest potential for gains occurs during the preschool and early

elementary years. The success of autism-treatment programs is dependent on

intensive intervention begun before age six (Fenske, Zalenski, Krantz &

McClannahan, 1985). Trying one educational strategy after another to find

something that works is a disservice to those children for whom there is a

fairly narrow window of opportunity to catch up with their peers.

" Resources and time are too scarce to be wasted on treatments that have not

been shown to be effective. " (Birnbrauer, 1999)

ABA has clearly been shown to be more effective than other programs designed

for children with autism. Although some children may benefit from other

educational programs, such as TEACCH or Colorado programs, most children

with autism show minimal improvement in those programs. A comparison of 12

peer-reviewed outcome investigations showed ABA-based programs increase

adaptive behavior, reduce maladaptive behavior, raise IQ scores and

standardized test scores, and reduce the need for special services (,

1999). IQ scores were found to increase between 7-28 points with ABA but

only 3-9 points with Colorado or TEACCH programs. Among ten top model

autism treatment programs evaluated by the National Academies, seven were

based on a behavioral approach (Lord & McGee, 2001, p. 147). Incidentally,

the programs were evaluated because " [t]he national challenge is to close

the gap between the quality of model programs and the reality of publicly

funded early educational programs. " (Lord & McGee, 2001, p. 140)

A Review of Case Law

A review of case law indicates a recent tendency for trial courts to find in

favor of families seeking reimbursement for private ABA therapy based on the

merits of ABA. In Malkentzos v. DeBuono, the trial court acknowledged the

efficacy of ABA. Judge Motley wrote:

New York City currently has no early intervention program specifically

designated to help autistic children. Rather, the only services available to

them are those created for otherwise developmentally disabled children. H.

56-61. Clearly, such an arrangement is expedient for the city. However,

serious questions exist about whether any benefit whatsoever is derived from

placing autistic children in the sort of structured-play environment

routinely used with disabled children (f8). H. 24. Such placement ignores

the special difficulties of autistic infants and children and can harm their

development. H. 23-24; Tr. 58-59.

In Zachary Deal v. Hamilton County Department of Education, Judge s

wrote:

[T]he Hamilton County Department of Education consistently rejected

providing ABA to Zachary or any other student [even though] Hamilton County

does not even have a methodology for educating autistic children.Experts on

both sides testified that selecting the wrong methodology for an autistic

child can mean the difference between an independent adult life and a

lifetime of dependency and support.

Judge s found that ABA " may be cost-effective over time by allowing a

higher percentage of autistic children to become normal functioning,

productive adults. "

Incorporating ABA in public schools

Several years ago, it may not have been convenient to develop ABA-based

public school classrooms, however, ABA has evolved, making a classroom a

much more expedient way of delivering ABA services. Chart #2 at the end of

position paper shows how ABA has evolved.

Model programs

Quite a few schools offer ABA programs. Among the most well known in the

nation are: Princeton Child Development Institute in Princeton, NJ; New

England Center for Children in Boston, MA; ABC School in Sacramento, CA; and

STARS School in Pleasant Hill, CA. Most of these programs also have

consulting divisions that work with public schools to develop quality

ABA-based classrooms. In the Central Valley Autism Project in Modesto,

California, the Central Valley school district worked together with the

local Lovaas replication clinics to form a public/private partnership where

the school district splits the ABA clinic costs with the state.

In Houston, several day learning centers offer private ABA programs: The

Shape of Behavior (http://www.shapeofbehavior.com/ ), Including Kids

(http://www.feathouston.org/includingkids.htm), and The Learning Repertoire

(http://www.learningrepertoire.org/). These private programs could provide

models and training resources for how ABA methods can be easily integrated

and applied in public school classrooms. In addition, school districts in

the Houston area, including Humble ISD, Alief ISD, and Cy-Fair ISD, have

developed autism programs that incorporate at least some ABA. Katy ISD has

developed a full ABA program using the Verbal Behavior model.

Recommendation

Based on the efficacy of ABA, the long-term cost-savings, and the benefits

to our children, we urge you to commit the district to developing ABA-based

classrooms for PPCD and elementary school children.

Brad and Geraldine Bliss and Pickrell

Singleton

Jantha Houston Marco R. Siqueiros and M. Vogel-Siqueiros,

M.D.

August 25, 2003

Chart 1. The ABC's of behavioral interventions

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Chart 2. The Evolution of ABA

Old ABA - often associated with Lovaas or Lovaas' early model of ABA

New ABA - often associated with " Verbal Behavior "

Environment

40 hours a week of 1:1 table-top teaching

1:1 teaching is mixed with teaching in the natural environment.

Learning in natural environments helps children generalize new skills.

How skills are targeted

Massed trialing

Teaching targets are mixed and varied (old, new, difficult, easy,

receptive, expressive). Mixing targets avoids rote learning.

Redirecting behavior

Aversives are used

Control of the discriminative stimulus (antecedent conditions) and

establishing operant (effectiveness of the reinforcer) is used to keep

motivation for appropriate behaviors high

Prompting

No No Prompt

Errorless learning avoids opportunities for learning errors, keeps

learning positive and reinforcing, and decreases prompt dependency.

Teaching Language

Initially focuses on verbal imitation

Language instruction is guided by Skinner's (1957) functional analysis

of language.

References

ASA (2003). What is autism? Retrieved Aug. 25, 2003, from

http://www.autism-society.org/site/PageServer?pagename=whatisautism

Baer, Wolf, and Risely (1967). Some current dimensions of applied behavior

analysis. JABA, 1, 91-97

Bertrand, J., Mars, A., Boyle, C., Bove, F., Yeargin-Allsopp, M., &

Decoufle, P. (2001). Prevalence of autism in a United States population: the

Brick Township, New Jersey, investigation. Pediatrics, 5, 1155-61.

J.S.Birnbrauer (1999). How to evaluate intervention programs. Retrieved

Aug. 25, 2003, from the Cambridge Center for Behavioral Studies.

http://www.behavior.org/

CCBS (2002). Autism and ABA, introduction and overview: what are the key

features of applied behavior analysis? Retrieved Aug. 25, 2003, from

http://www.behavior.org/

Fenske, E.C., Zalenski, S., Krantz, P.J., & McClannahan, L.E. (1985). Age at

intervention and treatment outcome for autistic children in a comprehensive

intervention program. Analysis and intervention in developmental

disabilities, 5, 49-58.

Fombonne, E. (2003). The prevalence of autism. JAMA, 1, 49.

Gill, A. & Rapin, I. (2001). Interventions for autism. JAMA, 286, 670-671.

Green, G. (1996). Early behavioral intervention for autism: what does

research tell us ? Austin: Pro.Ed., Inc.

son, J.W., Mulick, J.A., & Green, G. (1998). Summary: cost-benefit

estimates for early intensive behavioral intervention for young children

with autism. Behavioral interventions, 13, 201-226.

Lord, C. & McGee, J. (2001). Comprehensive programs. Educating children with

autism, pp.140-172. Washington: The National Academies Press.

Lovaas, O.I. (1987). Behavioral treatment and normal educational and

intellectual functioning in young autistic children. Journal of consulting

and clinical psychology, 55, No. 1, 3-9.

McEachin, J., , T., Lovaas, O.I. (1993). Long-term outcome for children

with autism who received early intensive behavioral treatment. American

journal on mental retardation, 4, 359-372.

Rapin, I. (2002). The autism spectrum disorders. New England journal of

medicine, 347, 302-303.

T. (1999). Outcome of early intervention for children with autism.

Clinical psychology: research and practice, 6, 33-49

U.S. Department of Health and Human Services. (1999). Children and mental

health. Mental health: a report of the surgeon general-executive summary.

Rockville, MD

Yeargin-Allsopp, M., Rice, C., Karapurkar,T., Doernberg, N., Boyle, C.,

, C. (2003). Prevalence of autism in a U

October 13, 2004