I was told that my child is too high-functioning to use Applied Behavior Analysis (ABA) because he is verbal and relates to other people. Instead, I was recommended to a developmental autism therapy. Is it true that ABA is best used with children who are lower functioning?
Short Answer:
Behavioral treatment is effective for many children with autism. The goal of behavioral treatment is to help children catch up to the skill level of typically developing peers. The program is individualized to incorporate areas of strength and areas of weakness specific to each child. Therefore, even high-functioning children can benefit from behavioral treatment.
Long Answer:
The term “high-functioning” is not defined well, making it somewhat difficult to answer this question. Some people use “high-functioning” to refer to those diagnosed with Aspergers. Others use the term to refer to any individual with autism whose IQ falls within the normal range. Some doctors will tell parents their child is “high-functioning” if he has any verbal language when diagnosed with autism.
Behavioral treatment has often attempted to use an average sample of children with autism. Ironically, one of the myths about the 1987 study is that children did well because a high-functioning sample group was used. However, in his study, Lovaas reported that 17 out of 19 patients scored in the mentally retarded range on IQ tests.
In the 2005 replication study, 10/23 children were nonverbal prior to treatment. In the 2006 replication study, all subjects had “developmental delays comparable to other children with autism”. Thus, in early intensive behavioral treatment studies, every effort is made to create a representative sample of children diagnosed with autism rather than one skewed with learners who have a normal IQ or are already verbal.
In general, there is little data available in peer-reviewed, research articles that compare outcomes of behavioral treatment for “low-functioning” and “high-functioning” children. Regardless, the following points should be made:
- The goal of behavioral treatment is to help children catch up to the skill level of typically developing peers. Behavioral treatment is not just a program to teach a child to speak, or request, or label objects. It is a comprehensive program that also deals with teaching complex behaviors and social skills such as recognizing facial expressions and non-verbal behavior of others, development of cooperative social behavior, verbalizations of empathy, and conversing with peers on a variety of topics rather than a restricted range of interests.
- Behavior therapy may look very different for a “low-functioning” and “high-functioning” child with autism. In addition to discrete trials, other behaviorally sound procedures such as incidental teaching, video modeling, and generalization in the natural environment may be more strongly emphasized.
- Behavioral therapy attempts to help a child so that he can learn in less structured settings in the future (for example, in peer groups). However, even in these less structured settings, the principles of applied behavior analysis are often key to a child’s success. Some of these principles include: 1) defining measurable behaviors for change, 2) investigating the function of inappropriate behaviors, 3) reinforcing appropriate behaviors, and 4) measuring progress routinely.
In summary, parents who dismiss behavioral treatment because they are told their child is already “high-functioning” may miss out on an effective intervention. A reputable organization that specializes in behavioral treatment for children with autism should be able to assess a child and then discuss with the parents specific objectives and teaching strategies based on their child’s particular strengths and needs. Parents can then decide on the appropriateness of behavioral treatment for their son or daughter.
Sources:
Cohen, Howard, Amerine-Dickens, Mila, Smith, Tristram. (2006). Early Intensive Behavioral Treatment: Replication of the UCLA Model in a Community Setting. Journal of Developmental & Behavioral Pediatrics, 27 (2), 145-155.
Downs, Andrew & Smith, Tristram. (2004). Emotional Understanding, Cooperation, and Social Behavior in High-Functioning Children with Autism. Journal of Autism and Developmental Disorders, 34 (6), 625-635.
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.
Smith, T., Groen, A. D., Wynn, J. W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal of Mental Retardation, 105, 269-85.
Sallows, Glen O. & Graupner, Tamlynn D. (2005). Intensive Behavioral Treatment for Children with Autism: Four-Year Outcome and Predictors. American Journal on Mental Retardation,110 (6), 417-438.
