**4. Studies published before 2000 (4 Studies)**

behaviour change. The careful selection and application of these procedures to treat the be‐ havioural symptoms of autism delivered within the scientific framework of ABA (outlined in Baer, Wolf & Risley, 1968; 1987) is what defines an EIBI approach. It is critical to recognise how ABA and EIBI are interwoven because the science of ABA and the various behaviour change strategies therein, have a very long history of substantiated documentation (see for example Matson, Benavidez, Compton, Paclawskyj, & Baglio, 1996, who reviewed behavior‐

The history of this early intervention approach to autism has been well documented over the last three decades. For example, Matson and Smith (2008) trace the origins of this ap‐ proach in autism treatment to what they refer to as a "seminal paper" (p.61) published as early as 1973 by Lovaas, Koegel, Simmons, and Long (1973). Matson and Smith argue that this paper demonstrated a visionary conceptual framework for early intervention with ASD.

*"The true significance of the study was the authors' efforts to formulate an overarching treatment of children with autism on a multitude of behaviours including self-stimulation/stereotypies, echolalia, appropriate verbal behaviour, social behaviour, appropri‐*

Trends in EIBI, to this day, are based on this original template involving the delivery of idio‐ syncratic treatment packages constituting evidence-based behavioural interventions to tar‐ get core symptoms as well as expansive groups of behaviours. Numerous studies have been published since this seminal paper in 1973 examining EIBI outcomes in autism. One of the most distinguished and considered published papers which resulted in the acclamation of EIBI involved that of Lovaas (1987). This well-reviewed study which reported an average difference of 31 points on IQ test scores between the ASD treatment group and control group, and classified nine of 19 (47%) participants as having achieved recovery (defined as post-intervention IQ in the normal range). To this current day, the findings of this study have caused much debate among researchers with criticisms focusing on particular meth‐ odological limitations (see for example, Gresham and MacMillan 1998; Short & Mesibov,

To date, a substantial number of studies have been conducted and published to demonstrate the effectiveness of EIBI in autism treatment. Moreover, six illustrative review papers and one "mega-analysis" (a combination of all of the data into one single analysis) have been published (see below), each providing somewhat varying angles in exploring the outcomes. Steady growing rates of publications on the findings of EIBI in autism have been evidenced and concise descriptions of methodology have appeared to improve in most recent years, particularly with respect to the inclusion of control–no treatment groups and random as‐

The current chapter will provide a synopsis of EIBI studies published between 1987-2012. Systematic searches were conducted using the following databases: Scopus, Psychology &

*ate play, intelligence quotient (IQ), and adaptive behaviour"* (Matson & Smith, 2008, pp. 61-62).

ally based treatments for autism over a 16-year span).

570 Recent Advances in Autism Spectrum Disorders - Volume I

1989). We will return to this study in a later section.

signment of participants across experimental conditions.

Behavioral Sciences Collection, and PsycINFO

**3. History of EIBI**

Lovaas (1987) conducted the first evaluation of EIBI for children with Autism. The outcomes of 19 children receiving EIBI, for a minimum of 40 hours per week, were compared to those of two control groups. The first control group, consisting of 19 children, received low inten‐ sity (10 hours or less) behavioural intervention and the second control group, consisting of 21 children, received TAU. After two years of treatment, 47% of the EIBI group achieved IQ scores in the normal range and were enabled to integrate fully into mainstream educational settings while only 2% of children in the control group achieved similar outcomes. In this case, almost half of children in the EIBI appeared to recover from their diagnosis of autism.

Birnbauer and Leach (1992) compared the outcomes of nine children receiving EIBI and five children in a control group (no treatment). Children in the EIBI group received an average of 18.7 hours of EIBI per week delivered by trained volunteers in their homes. Children in the EIBI group achieved significantly higher non-verbal IQ scores and language levels. Four of the nine children in the EIBI group achieved IQ scores within the normal range following treatment.

Smith et al. (1997) compared the outcomes of 11 children receiving EIBI to 10 children who received a low intensity behaviour intervention. Children in the high intensity EIBI group received at least 30 hours of clinician-delivered treatment each week while the low intensity group received 10 hours of clinician-delivered behavioural intervention each week. At fol‐ low-up, the children in the EIBI group showed greater increases in IQ and expressive lan‐ guage than children in the control group.

Sheinkopf and Siegel (1998) evaluated the outcomes of 11 children receiving EIBI and 11 children receiving Treatment as Usual (TAU). EIBI was delivered by parents, supervised by clinicians, for 27 hours each week. Children in the control group received 11.1 hours of TAU in a school setting each week. Following treatment, the EIBI group achieved significantly higher IQ scores and significantly lower scores on a measure of symptom severity than the control group.


**5. Studies published from 2000-2010 (12 Studies)**

due to treatment were correlated with reductions in autism symptoms.

adaptive functioning and positive social behaviours.

functioning at follow-up.

Ben-Itzchak et al. (2008) compared the outcomes of 44 children with autism receiving 45 hours of EIBI weekly and 37children with other developmental disabilities receiving TAU. After one year, the children in the EIBI group made significantly greater gains in IQ than the control group. The authors also analysed whether EIBI outcomes were affected by initial cognitive lev‐ el. Children were categorised as being of normal, borderline, or impaired IQ. They found that baseline cognitive levels did not predict changes in autism symptoms. However, IQ increases

Early Intensive Behavioural Intervention in Autism Spectrum Disorders

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Remington et al. (2007) compared the outcomes of 23 children who received 25.6 hours of EIBI with a control group in which 21 children received an average of 15.3 hours of interven‐ tion weekly. After two years of treatment, children in the EIBI group made showed signifi‐ cantly greater increases in mental age, intellectual functioning, language functioning,

Reed et al. (2007a) compared the impact of high-intensity and low-intensity home-based EI‐ BI. The high-intensity group was composed of 14 children who each received 30.4 hours of intervention per week. There were 13 children in the low-intensity group who each received an average of 12.6 hours of intervention weekly. The high-intensity group made significant‐ ly greater gains on measures of intellectual and educational functioning. However, the chil‐ dren in the low-intensity EIBI group did show significant improvements in educational

Reed et al. (2007b) compared the outcomes of children who had received EIBI, "eclectic" in‐ tervention, or portage. The 12 children in the EIBI group received an average of 30.4 hours of home-based intervention each week, the 20 children in the "eclectic" group received a mean of 12.7 hours per week, and the 16 children in portage group received 8.5 hours of weekly intervention. At follow-up, the EIBI group outperformed both groups on measures of educational functioning while both the EIBI group and the "eclectic" group scored signifi‐

Given the previous considerations, the current study directly compared the impact of exist‐ ing ABA, special nursery placements, and portage programs on a variety of aspects of the children's abilities. The latter two were selected because special nursery placement is a com‐ monly occurring program offered to children with ASD, which has received little direct as‐ sessment in terms of its effectiveness. Portage was chosen as, again, it is increasingly offered to children with ASD (see Reed et al., 2000; Smith, 2000). The portage intervention also al‐ lows comparison of a very intensive intervention (ABA) with a less intensive intervention (portage) in a community-based setting. This comparison formed part of the original clinicbased study conducted by Lovaas (1987), and the current comparison allows assessment of the generalization to a community-based sample. However, the intensity of hours of treat‐ ment delivery varied greatly between the three interventions and this can make it difficult to "tease out" whether it was the nature of the intervention or simply the duration of treatment

cantly higher on measures of intellectual functioning than the portage group.

that accounted for the differences in outcomes reported.

**Table 1.** Summary of EIBI studies Pre-2000, M, F (male, female), VABS (Vineland Adaptive Behaviour Scale), EL (Expressive Language), RL (Receptive Language)
