Behavior analytyic applications for the assessment and treatment of children with autism

The present article discusses the assessment and treatment of children with autism from a behavior analytic perspective.

The aim of the experimental analysis of behavior is to improve behavior, through the manipulation of environmental events, following careful analysis of both manifested and underpinning relations between antecedent stimuli, behavior, and consequences. The behavior analytic approach is functional, since it analyzes functional relations between behavior and environmental events, rather that the structure of behavior per se. Furthermore, it focuses on measurable aspects of behavior and aims at its objective evaluation. Finally, it recognizes that private events, such as thoughts and emotions, are important for the analysis and appreciation of external manifestations of behavior, but treats those private events as rule-governed behavior, governed by the same principles and laws as manifested responses. The research endeavors of the science of Behavior Analysis include both basic and applied work. Basic research sets as its main goal to advance the theoretical aspects of the science, whereas, applied aims to use theoretical findings toward the advancement of the quality of life of humans and animals. The basic aspects that define applied behavior analytic research include the qualities of applied, behavioral, analytic, technological, conceptually systematic, effective, and generalized.

Behavioral assessment is conducted in relation to treatment premises and has to be valid, reliable, setting objective criteria, individualized, precise, and clear. The emphasis in behavioral assessment is placed upon identifying the ways in which behavior operates in relation to the environment. The assessment before and after intervention use the same criteria to ensure accurate measures of intervention effects. Even though behavioral assessment is multifactor and multifaceted, it focuses progressively on few, and most important, variables. The traditional types of behavioral assessment (which investigated how the environment influences behavior) have been replaced by ecological-behavioral approaches to assessing behavior, which recognize the bidirectional relation between behavior and environmental events, which sets the complex frame of ecological factors that influence and are influenced by behavior. Thus, for a concise and complete evaluation several aspects need to be investigated, including the assessment of the individual's overall needs, providing a clear and objective definition of the behavioral target, identifying an appropriate methodology for the evaluation purposes, quantifying the assessment criteria of the target behavior, and setting up the criteria for evaluating generalization and follow up of the intervention outcome.

There is extensive research conducted in the area of assessing challenging behavior, such as acting out or self-injurious behavior. This research has yielded interesting results, such as the causes that often underlie aberrant behavior, which include: receiving attention, obtaining sensory-types of reinforcement, usually in the form of stereotypic behavior, having access to desirable objects or engaging in desirable activities, and escaping or avoiding non-preferred conditions. Functional assessment is the type of behavioral assessment that has been used for the evaluation of problem behavior and it aims to assist in the modification of challenging behavior by revealing the causes of such behavior and thus replace it by alternative, socially acceptable responses, which serve the same function as the inappropriate behavior.

Regarding the application of behavior analysis toward the treatment of children with autism, it is worth reviewing the impressive outcome of Lovaas' (1987) study, in which 47% of children with autism, after 2 years of intensive behavior analytic intervention, acquired such cognitive and social skills that allowed them to enter school and to advance academically and socially at an equal basis with their typically developing counterparts.

The examination of behavior analytic literature, pertaining to the treatment of autism longitudinally, has yielded 14 studies conducted in the last 10 years. Across those studies, a total of about 300 children, 3 to 6 years old, with the diagnosis of autism and with IQ scores ranging from 28 to 62 before intervention, received behavior analytic treatment. Treatment was received for time periods of 1 to 4 years and for 12 to 40 hours per week. At the end of intervention, the children demonstrated a 17-point improvement in their IQ scores, on the average. At the same time, important gains were obtained in other areas of functioning, such as language, adaptive behavior, visual-spatial coordination, and motor skills. The majority of those children were included in mainstream schools and received either minimal or no support from escort teachers. Moreover, the intervention was positively evaluated by parents, who in many cases worked as co-therapists after receiving special training. As the present literature review revealed, the intensive behavior analytic intervention administered in specialized centers had the best results of all types of intervention, such as parent-directed behavioral intervention, less intensive intervention programs, and other types of interventions such as traditional or eclectic approaches.

The final section of the present review discusses outcome predictors for autism, which are broadly categorized according to whether they pertain to the child per se (e.g., IQ, cognitive skills, and rate of learning), the type of intervention, or to other variables associated with the child's family.

Key words: Pervasive developmental disorders, autism, behavior analysis.