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

**Study Intake Characteristics Outcome**

572 Recent Advances in Autism Spectrum Disorders - Volume I

Tx 19 34.6 - 62.7 - - - Intellectual

Tx 9 38.1 5,4 51.3 46.1 - - Intellectual

Tx 11 36 11,0 28 50.3 - - Intellectual

Tx 11 33.8 - 62.8 - - - Intellectual

Lovaas et al. (1987)

Birnbauer & Leach (1993)

Smith et al. (1997)

Sheinkopf & Siegel (1998)

(Expressive Language), RL (Receptive Language)

**Measures**

Functioning; Academic Placement; Diagnostic Recovery

Functioning; Adaptive Functioning; Language Functioning; Psychopathology

Functioning; Speech; Behaviour Problems

Functioning; DSM Symptomatology

**Group n Age M, F IQ VABS EL RL Model Hr/wk Treatment Differences**

C 19 40.9 - 57.0 - - - UCLA 10 24+ C 21 <42 - 60.0 - - - TAU - 24+

C 5 33.2 5,0 54.5 51.5 - - - 24

C 10 38 8,10 27 - - - UCLA 10 26

C 11 35.3 - 61.7 - - - TAU 11.1 18

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

**Treatment Characteristics Group**

**Duration**

group achieved normal functioning as compared to 2% of the C groups.

increased by 8 points in the Tx group, but decreased by 3 points in the C group. The Tx group also made significantly more progress with their speech.

presented with significantly higher IQ following treatment. Symptom severity was also significantly lower in the Tx group.

UCLA 40 24+ 47% of the Tx

UCLA 18.7 21.6

UCLA 30+ 35 Mean IQ

UCLA 27.0 15.7 The Tx group

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 due to treatment were correlated with reductions in autism symptoms.

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, adaptive functioning and positive social behaviours.

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 functioning at follow-up.

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

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 that accounted for the differences in outcomes reported.

Magiati et al. (2007) conducted a prospective comparison of 28 children who received 32.4 hours EIBI each week and 16 children who received 25.6 hours of autism-specific nursery pro‐ vision each week. The EIBI group received parent-delivered intervention with training and su‐ pervision provided by clinicians. At follow-up, both groups achieved similar outcomes although the EIBI group scored significantly higher on the VABS Daily Living Skills subscale.

**Study Intake Characteristics Outcome Measures Treatment Characteristics Group**

C 13 35.8 11, 2 50.7 65.2 45.6 38.3 UCLA 15-20 24

C 12 65.0 11, 1 65.2 60.0 51.2 50.4 Eclectic 29.1 13.6

C 16 37.4 13, 3 53.7 69.8 43.9 45.4 Eclectic 25-30 13.3 C 16 34.6 16, 0 59.9 71.6 48.8 49.0 Eclectic 15 14.8

Tx 15 36.1 12, 3 50.5 63.4 41.9 37.3 Intellectual

Tx 13 66.3 8, 5 61.9 55.8 45.1 49.0 Intellectual

Tx 29 30.9 25, 4 58.5 70.5 51.9 52.2 Intellectual

Smith et al. (2000)

Eikeseth et al (2002).

Howard et al. (2005)

**Group n Age M, F IQ VABS EL RL Model Hr/wk Treatment Differences**

Functioning; Visual-Spatial Skills; Language Functioning; Adaptive Functioning; Socioemotional Functioning; Academic Achievement; Class Placement; Progress in Treatment; Parent Evaluation

Early Intensive Behavioural Intervention in Autism Spectrum Disorders

Functioning; Visual-Spatial Skills; Language Functioning; Adaptive Functioning

Functioning; Visual-Spatial Skills; Language Functioning; Adaptive Functioning

**Duration**

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

made significantly greater gains in IQ, visual-spatial skills, and language development. The Tx group tended to make greater academic achievements and to be in less restrictive academic placements.

575

achieved significantly higher scores that the C group on all measures, except the VABS socialization subscale and the daily living subscale. Children in the Tx group had significantly fewer disruptive behaviours than the C group at follow-up.

UCLA 24.5 33.4 The Tx group

UCLA 28.0 12.2 The Tx group

EIBI 25-40 14.2 The outcomes of

the two eclectic C groups did not differ. The Tx group performed significantly better on all measures, except motor skills than the C groups.

Eldevik et al. (2006) retrospectively compared the outcomes of 13 children receiving EIBI and 15 children receiving "eclectic" intervention. The EIBI group typically received 12.5 hours of intervention each week. Parent training was also provided to increase maintenance and generalisation of skills. The control group received 12 hours of intervention each week. The EIBI group outperformed the control group on measures of IQ, language functioning, and communication at the follow-up. They also presented with less symptoms of pathology than children in the control group.

Eikeseth et al. (2007) compared the outcomes of 13 children who received 28 hours of EIBI weekly with 12 children who received 29.1 hours of "eclectic" intervention each week. At follow-up, the children who had received EIBI showed significantly greater improvements in IQ, adaptive functioning, and presented with less social and behaviour problems.

Cohen et al. (2006) compared the outcomes of 21 children receiving 35-40 hours of EIBI per week to a control group of 21 children receiving "eclectic" interventions. Parents imple‐ menting EIBI received training so that they could use behavioural techniques in the home setting. Following the treatment phase, the EIBI group achieved significantly higher scores on measures of IQ, adaptive functioning, and receptive language. 17 children from the EIBI group transitioned to mainstream education settings as compared to 1 child from the control group.

Sallows and Graupner (2005) compared the effects of clinic-directed EIBI and parent-direct‐ ed EIBI. This study was the only study we found in our search that directly compared the mode of EIBI delivery. All others either employed an alternate treatment comparison or a control-no treatment comparison. The 13 children in the clinic-directed EIBI group received an average of 37.6 hours of intervention weekly while the10 children in the parent-directed EIBI group typically received 31.6 hours of intervention. Both groups received a UCLAbased intervention (often referred to "Lovaas therapy" based on the original study in 1987). The groups made similar gains on outcome measures suggesting that the less costly parentdirected intervention was equally effective. It was found that 48% of participants showed rapid learning, achieved normal scores on outcome measures, and, at follow-up, were suc‐ ceeding in mainstream classrooms. Pre-treatment imitation, language, daily living skills, and socialization were found to be predictive of outcome.

Howard et al. (2005) compared the effects of EIBI, intensive "eclectic" intervention, and low-in‐ tensity "eclectic" intervention. The 29 children assigned to the EIBI group received 25-40 hours of EIBI each week and their parents received training so that teaching could extend to the home setting. The 16 children in the intensive "eclectic" intervention group received 25-30 hours of intervention each week, while the 16 children in the low-intensity "eclectic" group received 15 hours of intervention each week. The EIBI group achieved significantly higher scores on meas‐ ures of intellectual functioning, visual spatial skills, language functioning and adaptive func‐ tioning. The outcomes of the two "eclectic" control groups did not differ.

#### Early Intensive Behavioural Intervention in Autism Spectrum Disorders http://dx.doi.org/10.5772/54274 575


Magiati et al. (2007) conducted a prospective comparison of 28 children who received 32.4 hours EIBI each week and 16 children who received 25.6 hours of autism-specific nursery pro‐ vision each week. The EIBI group received parent-delivered intervention with training and su‐ pervision provided by clinicians. At follow-up, both groups achieved similar outcomes although the EIBI group scored significantly higher on the VABS Daily Living Skills subscale. Eldevik et al. (2006) retrospectively compared the outcomes of 13 children receiving EIBI and 15 children receiving "eclectic" intervention. The EIBI group typically received 12.5 hours of intervention each week. Parent training was also provided to increase maintenance and generalisation of skills. The control group received 12 hours of intervention each week. The EIBI group outperformed the control group on measures of IQ, language functioning, and communication at the follow-up. They also presented with less symptoms of pathology

Eikeseth et al. (2007) compared the outcomes of 13 children who received 28 hours of EIBI weekly with 12 children who received 29.1 hours of "eclectic" intervention each week. At follow-up, the children who had received EIBI showed significantly greater improvements

Cohen et al. (2006) compared the outcomes of 21 children receiving 35-40 hours of EIBI per week to a control group of 21 children receiving "eclectic" interventions. Parents imple‐ menting EIBI received training so that they could use behavioural techniques in the home setting. Following the treatment phase, the EIBI group achieved significantly higher scores on measures of IQ, adaptive functioning, and receptive language. 17 children from the EIBI group transitioned to mainstream education settings as compared to 1 child from the control

Sallows and Graupner (2005) compared the effects of clinic-directed EIBI and parent-direct‐ ed EIBI. This study was the only study we found in our search that directly compared the mode of EIBI delivery. All others either employed an alternate treatment comparison or a control-no treatment comparison. The 13 children in the clinic-directed EIBI group received an average of 37.6 hours of intervention weekly while the10 children in the parent-directed EIBI group typically received 31.6 hours of intervention. Both groups received a UCLAbased intervention (often referred to "Lovaas therapy" based on the original study in 1987). The groups made similar gains on outcome measures suggesting that the less costly parentdirected intervention was equally effective. It was found that 48% of participants showed rapid learning, achieved normal scores on outcome measures, and, at follow-up, were suc‐ ceeding in mainstream classrooms. Pre-treatment imitation, language, daily living skills,

Howard et al. (2005) compared the effects of EIBI, intensive "eclectic" intervention, and low-in‐ tensity "eclectic" intervention. The 29 children assigned to the EIBI group received 25-40 hours of EIBI each week and their parents received training so that teaching could extend to the home setting. The 16 children in the intensive "eclectic" intervention group received 25-30 hours of intervention each week, while the 16 children in the low-intensity "eclectic" group received 15 hours of intervention each week. The EIBI group achieved significantly higher scores on meas‐ ures of intellectual functioning, visual spatial skills, language functioning and adaptive func‐

and socialization were found to be predictive of outcome.

tioning. The outcomes of the two "eclectic" control groups did not differ.

in IQ, adaptive functioning, and presented with less social and behaviour problems.

than children in the control group.

574 Recent Advances in Autism Spectrum Disorders - Volume I

group.


**Study Intake Characteristics Outcome Measures Treatment Characteristics Group**

C 12 65.0 11, 1 65.2 60.0 51.2 50.4 Eclectic 29.1 33.3

C 16 42.5 12, 4 65.2 55.4 1.7 (r) 2.9 (r) Eclectic 25.6 26.0

C 13 40.8 13, 0 56.6 56.5 - - EIBI 12.6 9-10

C 20 43 18, 2 57.8 53.0 - - Eclectic 12.7 9 C 16 38 - 53.4 58.6 - - Portage 8.5 9

Tx 13 66.3 8, 5 61.9 55.8 45.1 49.0 Intellectual

Tx 28 38.0 27, 1 83.0 59.6 2.2 (r) 4.9 (r) Visual-Spatial Skills;

Tx 14 42.9 14, 0 60.1 59.3 - - Autism

Tx 12 40 11, 1 56.8 58.2 - - Autism

Eikeseth et al. (2007)

Magiati et al. (2007)

> Reed et al. (2007a)

> Reed et al. (2007b)

**Group n Age M, F IQ VABS EL RL Model Hr/wk Treatment Differences**

Functioning; Adaptive Functioning; Socioemotional Functioning

Early Intensive Behavioural Intervention in Autism Spectrum Disorders

Intellectual Functioning; Adaptive Functioning; Language Functioning; Play Skills; Autism Symptomatology

Symptomatology; Developmental Functioning; Intellectual Functioning; Adaptive Functioning

Symptomatology; Developmental

**Duration**

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

showed significantly greater improvements in IQ, adaptive functioning, social behaviour, and aggressive behaviour.

577

showed comparable improvements. However, the Tx group achieved significantly higher scores on the VABS Daily Living Skills subscales. Large intra-group variation in response to treatment was observed.

made significantly greater gains on intellectual functioning and educational functioning, although the C group did show significant improvements on educational functioning.

> group made significantly

UCLA 28.0 31.4 The Tx group

UCLA 32.4 25.5 Both groups

EIBI 30.4 9-10 The Tx group

EIBI 30.4 9 Those in the Tx

#### Early Intensive Behavioural Intervention in Autism Spectrum Disorders http://dx.doi.org/10.5772/54274 577


**Study Intake Characteristics Outcome Measures Treatment Characteristics Group**

C 21 33.2 17, 4 59.4 70.6 52.8 52.7 Eclectic - -

C 15 49.0 14, 1 47.2 52.5 41.6 33.2 Eclectic 12.0 21.4

Tx 13 35.0 11, 2 50.9 59.5 47.9 38.9 Intellectual

576 Recent Advances in Autism Spectrum Disorders - Volume I

Tx 21 30.2 18, 3 61.6 69.8 52.9 51.7 Intellectual

Tx 13 53.0 10, 3 41.0 52.5 33.8 37.3 Intellectual

Sallows & Graupner (2005)

Cohen et al. (2006)

Eldevik et al. (2006)

**Group n Age M, F IQ VABS EL RL Model Hr/wk Treatment Differences**

Functioning; Language Functioning; Adaptive Functioning; Social Functioning; Academic Functioning

Functioning; Visual-Spatial Skills; Language Functioning; Adaptive Functioning; Academic Placement

Functioning; Language Functioning; Adaptive Functioning; Visual Spatial Skills; Pathology; Degree of Intellectual Disability

**Duration**

UCLA 37.6 48 Both Tx groups

UCLA 35-40 36 The Tx group

UCLA 12.5 20.3 The Tx group

performed similarly on all outcome measures.

made significantly greater gains in IQ, receptive language, and adaptive functioning. 17 children from the Tx group were included in mainsteam education settings as compared to 1 child in the C group.

significantly outperformed the C group on intellectual functioning, language functioning, and the communication subscale of the VABS. The Tx group also showed significantly less pathology at the follow-up


Smith et al. (2000) evaluated the outcomes of children with autism or pervasive develop‐ mental disorder not otherwise specified who were assigned to an EIBI group or parentdelivered behavioural intervention group. The 15 children in the EIBI group received, on average, 24.5 hours of intervention each week delivered by trained student therapists while parents were included in five hours of teaching each week. The 13 children in the parent-delivered behaviour received 15-20 hours of intervention each week. Their parents received bi-weekly training for 3-9 months and a minimum of one hour of supervision each week. At the end of the treatment phase, the EIBI group performed significantly better than the parent-trained group on measures of intellectual functioning, visual-spa‐ tial skills, language, and academic functioning. The groups did not differ on measures of adaptive functioning or challenging behaviours. Children with pervasive developmental disorder not otherwise specified tended to respond better to treatment than children

Early Intensive Behavioural Intervention in Autism Spectrum Disorders

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579

Strauss et al. (2012) compared the outcomes of 24 children receiving 35 hours of EIBI each week and 20 children receiving 12 hours of a mixed "eclectic" intervention each week after six months of treatment. EIBI was delivered by staff and by parents, follow‐ ing initial comprehensive parent training. At follow-up, the EIBI group outperformed the control group on IQ measures, early language measures, and also showed greater reduc‐ tions in autism severity. Both groups made significant gains in adaptive behaviour and receptive language. However, it was found that the "eclectic" intervention led to signifi‐ cant reductions in parental stress while parental stress in the EIBI group did not change

Flanagan et al. (2012) conducted a retrospective comparison of the outcomes of 61 children receiving EIBI for over two years and 61 children, matched on chronological age, who were on a treatment waitlist. Children in the EIBI group received, on average, 25.8 hours of treat‐ ment each week, typically at community treatment centres, and parent training was availa‐ ble and encouraged. The EIBI group made significantly greater gains in intellectual functioning and adaptive function, and scored lower on a measure of autism symptomatolo‐ gy. Furthermore, younger age at treatment onset, and higher adaptive skills, were found to

Eldevik et al. (2012) analysed the outcomes of 31 children receiving EIBI in a mainstream pre-school and 12 children receiving TAU in the form of an "eclectic" mix of interventions. The EIBI group typically received 13.6 hours of intervention each week and parents were en‐ couraged to use behavioural procedures at home to promote generalisation and mainte‐ nance. The TAU group received a minimum of five hours of treatment each week. After two years, the EIBI group achieved significantly greater scores on measures of intellectual and

**6. Studies published between 2011-2012 (5 Studies)**

with autism.

over the course of treatment.

predict better EIBI treatment outcomes.

adaptive functioning.

**Table 2.** Summary of EIBI studies 2000-2010, M, F (male, female), VABS (Vineland Adaptive Behaviour Scale), EL (Expressive Language), RL (Receptive Language), (r) (raw scores)

Eikeseth et al. (2002) compared the outcomes of EIBI and "eclectic" treatment for children with autism after one year of intervention. The 13 children in the EIBI group received an average of 28 hours of intervention each week in a school setting. Parents were trained for a minimum of four hours each week for three months so that they were able to extend their child's treatment to the home setting. Children in the "eclectic" group received an average of 29.1 hours of intervention each week. Following treatment, the EIBI group outperformed the control group on measures of intellectual functioning, visual-spatial skills, and language functioning. They also engaged in fewer disruptive behaviours than the "eclectic" group. However, the "eclectic" group showed significantly greater increases in adaptive function‐ ing than the EIBI group.

Smith et al. (2000) evaluated the outcomes of children with autism or pervasive develop‐ mental disorder not otherwise specified who were assigned to an EIBI group or parentdelivered behavioural intervention group. The 15 children in the EIBI group received, on average, 24.5 hours of intervention each week delivered by trained student therapists while parents were included in five hours of teaching each week. The 13 children in the parent-delivered behaviour received 15-20 hours of intervention each week. Their parents received bi-weekly training for 3-9 months and a minimum of one hour of supervision each week. At the end of the treatment phase, the EIBI group performed significantly better than the parent-trained group on measures of intellectual functioning, visual-spa‐ tial skills, language, and academic functioning. The groups did not differ on measures of adaptive functioning or challenging behaviours. Children with pervasive developmental disorder not otherwise specified tended to respond better to treatment than children with autism.
