**1. Introduction**

Autism spectrum disorder (ASD) is a developmental disorder characterised and diagnosed by behavioural symptoms that mark impairments in social and communication behaviour along with a restricted range of activities and interests. ASD is considered a heterogeneous and complex disorder impacting many areas of development including intellectual, commu‐ nication, social, emotional, and adaptive (Makrygianni & Reed, 2010). This disorder can present considerable challenges to both the individual and their family across their lifespan.

A myriad of intervention approaches have been highlighted to treat this condition. Some in‐ clude therapies that have been developed by parents independent of any particular discipline (e.g., Son-Rise Program and Hanen). Others are based on biological approaches (e.g., special and restricted diets, secretin) or alternative medicine (e.g., homeopathy, chelation therapy). Some more prevalent treatment approaches are available and differ in their etiological, meth‐ odological and philosophical interpretation of ASD. These include for example, Applied Be‐ haviour Analysis (ABA; sometimes referred to as behaviour therapy), Treatment and Education of Autistic and related Communication Handicapped Children (TEACCH), Picture Exchange Communication System (PECS), sensory integration therapy, occupational therapy, music therapy, auditory integration therapy and speech therapy. Despite the considerable number of various treatment approaches to ASD available to parents and professionals, the majority of empirical support relating to many of these programs remains at the "level of de‐ scription" (Makrygianni & Reed, 2010; Matson & Smith, 2008), and for many of these proposed interventions there is limited or no evidence provided to demonstrate any effective outcomes with their use (Metz, Mulick, & Butter, 2005; Mulloy et al. 2010; Lang et al. 2012).

Despite the many debates that exist amongst researchers and practitioners with regard to effi‐ cacy of intervention approaches, one consensual fact that is recognised across the board is that

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early intervention is the best response to the treatment of ASD. Providing treatment of symp‐ toms immediately will result in more favourable treatment outcomes (Dawson, 2008; Howlin, Magiati & Charmin, 2009; Reichow & Wolery, 2009). Many have argued that this early inter‐ vention will allow greater opportunities for a young child to move towards a more typical de‐ velopmental trajectory because of malleability or plasticity of the developing young brain (see for example Dawson 2008). From a learning theory account, teaching new behaviour or re‐ placement behaviour to a very young child presenting with behavioural deficits or excesses, will result in desirable consequences that impacts behavioural repertoires and learning history from the outset. In this way early intervention for the condition may affect the onset of addi‐ tional secondary problem behaviours which are often not seen at diagnosis. As such these may be minimised or even prevented (Mundy, Sullivan & Mastergeorge, 2009).

that health insurers cover the diagnosis and treatment of autism spectrum disorders, includ‐

Early Intensive Behavioural Intervention in Autism Spectrum Disorders

http://dx.doi.org/10.5772/54274

569

EIBI is based on the scientifically applied principles of learning and behaviour, and has the dis‐ cipline of behaviour analysis (Cooper, Heron, & Heward, 2007) at its core. The approach gener‐ ally targets preschool children and is provided intensively, often in a 1:1 student/teacher ratio, for 20-50 hours per week. Dawson (2008) and Green (1996) summarise many of the common

and conspicuous features of successful EIBI programs. These include the following:

**1.** the EIBI program should be initiated as early as 2 years and before the age of four;

**2.** intensive delivery of the program involving a minimum of 25 hours per week for at

**3.** application of a comprehensive curriculum or various curricula, focusing on imitation, language, toy play, social interaction, motor, and adaptive behaviour targets;

**4.** the curricula and their implementation should show sensitivity to typical developmen‐

**5.** generalisation strategies should be incorporated to ensure new skills are practiced and demonstrated in novel environments outside those in which they were taught;

**6.** use of supportive and empirically validated teaching strategies and data-driven deci‐

**7.** implementation of behavioural strategies to reduce or eliminate major interfering be‐ haviours that are an impediment to learning new skills and repertoires (noncompliance, inattention, impulsivity, tantrum, aggression and self-injurious behaviours are exam‐

**12.** the provision of supervision by qualified over-viewers resulting in ongoing review and

According to Dawson (2008): *"When these features are present, results are remarkable for up to*

It is important to note that EIBI draws from the bedrock of a science- Applied Behaviour Analysis (ABA). This science constitutes over 300 procedures (Greer, 2002; Steege, Mace, Perry, and Longenecker, 2007) each of which have been tested and demonstrated to produce

sion protocols (notably those of Applied Behaviour Analysis);

ples of some of the most critical of these behaviours).

**8.** a functional analytic approach to treating problem behaviours; **9.** continual parental involvement and tailored parent education;

**11.** qualified and highly trained staff delivering the program and

systematic progression of the program.

**10.** progressive and gradual transition to increasingly naturalistic environments;

ing access to ABA therapy.

least two years;

tal sequences;

*50% of children"* (p.790).

**2. What constitutes EIBI?**

While a consensus that early intervention for ASD exists amongst researchers in this field, many argue that the actual approach applied during this critical period may be pivotal in producing the greatest outcomes and ensuring the best chance of attaining a typical devel‐ opmental trajectory. Over the past four decades, interventions based on the science of ABA have been thoroughly evaluated and shown to produce effective outcomes in targeting many of the challenges presented within this condition. Moreover, behavioural interven‐ tions drawn from this science can produce substantial gains in cognitive, adaptive and social behaviours in this population (Dillenberger, 2011). Indeed, this approach is internationally recognised as the most effective basis for treatment for children with ASD (Larsson, 2005).

Improving the core symptoms of ASD is a common goal for parents and professionals. Re‐ ports of large improvements in this condition have been documented. For example Smith (1999) provided a summary of published peer-reviewed studies involving seven independ‐ ent groups of researchers documenting dramatic gains when early intervention was applied. Importantly however, in all studies reviewed, interventions were underpinned by ABA methodology and theory and were intensive involving a range of 15 to 40 hours per week across studies. This approach to autism treatment, known as Early Intensive Behavioural In‐ tervention (EIBI) has generated much discussion and excitement, and continues to gather momentum impressing on policy makers the urgency of effective and substantiated provi‐ sion for individuals and families affected by the condition.

Studies on EIBI have reported the following gains: (1) average increases of approximately 20 points in IQ (e.g., Harris, Handleman, Gordon, Kristoff, & Fuentes, 1991; Lovaas, 1987; Sheinkopf & Siegal, 1998) (2) increases in standardised test scores (Anderson, Avery, DiPie‐ tro, Edwards, & Christian, 1987; Birnbrauer & Leach, 1993; Hoyson, Jamison, & Strain, 1984; McEachin, Smith, & Lovaas, 1993; Strauss et al. 2012), (3) increased gains in adaptive behav‐ iour (Eldevik et al., 2012; Strauss et al., 2012); (4) improved language scores (Eldevik et al., 2012; Strauss et al. 2012); (5) the need for less supports in school (Fenske, Zalenski, Krantz, & McClannahan, 1985; Lovaas, 1987), (6) reduced autism symptomotology (Eikeseth et al,. 2012) and (7) decreased challenging behaviour (Fava et al., 2012). Dillenberger (2011) refers to the increasing evidence of clinical, social and financial efficiency of intensive behavioural intervention in autism treatment which has resulted in "legally enshrining" such interven‐ tion in North America. For example, the Autism Treatment Acceleration Act (2010) requires that health insurers cover the diagnosis and treatment of autism spectrum disorders, includ‐ ing access to ABA therapy.
