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

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

C 21 38.4 - 62.3 113.6 (r) - - TAU 15.3 24

C 37 24.2 23, 14 71.0 - - - TAU - 12

**Table 2.** Summary of EIBI studies 2000-2010, M, F (male, female), VABS (Vineland Adaptive Behaviour Scale), EL

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‐

Tx 23 35.7 - 61.4 114.8 (r) - - Intellectual

578 Recent Advances in Autism Spectrum Disorders - Volume I

Tx 44 27.3 43, 1 74.8 - - - Intellectual

(Expressive Language), RL (Receptive Language), (r) (raw scores)

Remington et al. (2007)

Ben-Itzchak et al. (2008)

ing than the EIBI group.

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

Functioning; Intellectual Functioning; Adaptive Functioning; Comorbid Problems

Functioning; Language Functioning; Adaptive Functioning; Behaviour; Nonverbal Social Communication; Parental Wellbeing

Functioning; Autism Symptomatology (Tx group only)

**Duration**

EIBI 25.6 24 The Tx group

EIBI 45 12 The Tx group

greater gains than the portage group on intellectual functioning and made greater gains than both C groups on educational functioning.

showed significantly greater increases in mental age, intellectual functioning, language functioning, adaptive functioning, and positive social behaviours.

made significantly greater gains in IQ than the C group.

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 over the course of treatment.

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 predict better EIBI treatment outcomes.

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 adaptive functioning.


**Study Intake Characteristics Outcome**

Strauss et al. 2012

Control 63 42.79 53, 10 - 55.49 - - Functioning;

Tx 23 55.67 22, 2 58 78.33 32.95 52.60 Autism

**Measures**

Intellectual Functioning

Symptomatology; Intellectual Functioning; Adaptive Functioning; Language Functioning; Challenging Behaviours; Parental Stress

Waitlist Control

Early Intensive Behavioural Intervention in Autism Spectrum Disorders

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

C 20 41.94 19, 1 66.91 66.92 16.88 47.87 Eclectic 12 6

**Table 3.** Summary of EIBI studies between2011-2012, M, F (male, female), VABS (Vineland Adaptive Behaviour Scale),

Eikeseth et al. (2012) examined the outcomes of 35 children receiving EIBI and 24 children receiving TAU after one year of treatment. Children in the EIBI group received 23 hours of intervention per week, on average, and parent training was provided. Children in the "eclectic" group were attending special education settings where teachers incorporated a va‐ riety of interventions. The children in the EIBI group made significantly greater gains in

adaptive functioning. They also demonstrated reduced autism symptomatology.

EL (Expressive Language), RL (Receptive Language)

**Treatment Characteristics Group Differences**

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

**Duration**

EIBI 35 6 Tx group showed


subscales. They achieved significantly higher IQ scores and scored significantly lower on a measure of autism symptomatology.

581

significantly greater gains in intellectual functioning, expressive language, and social interactions. They showed significantly greater reductions in autism symptomatology and challenging behaviour. Both groups made significant gains in receptive language and adaptive behaviour. Parents in the Tx group were significantly more stressed.

#### Early Intensive Behavioural Intervention in Autism Spectrum Disorders http://dx.doi.org/10.5772/54274 581


**Study Intake Characteristics Outcome**

580 Recent Advances in Autism Spectrum Disorders - Volume I

Tx 12 52.0 10,2 62.1 63.3 33.7 48.6 Autism

Tx 35 47 29, 6 - 67 - - Adaptive

Tx 31 42.2 25, 6 51.7 62.5 - - Intellectual

Tx 79 42.93 69, 10 - 55.38 - - Autism

C 24 53 20, 4 - 63.6 - - Eclectic - 12

C 12 46.2 8, 4 51.6 58.9 - - TAU 5+ 24.6

Fava et al. (2011)

Eikeseth et al. 2012

Eldevik et al. (2012)

Flanagan et al. 2012

**Measures**

Symptomatology; Intellectual Functioning; Adaptive Functioning; Language Functioning; Challenging Behaviours; Comorbid Psychopathology; Parental Stress

Functioning; Autism Symtomatology

> Functioning; Adaptive Functioning;

Symptomatology; Adaptive

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

C 10 43.7 9,1 69.1 44.3 29.0 84.5 Eclectic 12 6

**Treatment Characteristics Group Differences**

**Duration**

EIBI 14 6 Tx group showed

UCLA 23 12 Tx group scored

EIBI 13.6 25.1 The Tx group made

EIBI 25.81 27.84 The Tx group made

significantly higher on all VABS subscales. The Tx group showed significant reductions in autism symptomatology

significantly larger gains on intellectual functioning and adaptive behaviour.

significantly more gains on all VABS

significant changes in autism severity, intellectual functioning, adaptive behaviour (except for on the VABS socialization subscale), and on ADHD symptomatology. A significant decrease in challenging behaviours was also observed. The C group showed significant changes on all subscales of the VABS. Parents of children in the C group reported significantly less stress.

> **Table 3.** Summary of EIBI studies between2011-2012, M, F (male, female), VABS (Vineland Adaptive Behaviour Scale), EL (Expressive Language), RL (Receptive Language)

> Eikeseth et al. (2012) examined the outcomes of 35 children receiving EIBI and 24 children receiving TAU after one year of treatment. Children in the EIBI group received 23 hours of intervention per week, on average, and parent training was provided. Children in the "eclectic" group were attending special education settings where teachers incorporated a va‐ riety of interventions. The children in the EIBI group made significantly greater gains in adaptive functioning. They also demonstrated reduced autism symptomatology.

Fava et al. (2011) compared the outcomes of 12 children receiving EIBI and 10 children re‐ ceiving "eclectic" intervention after six months of treatment. EIBI was delivered by trained therapists, in a clinic-based setting, and by intensively trained and supervised parents, in a home-based setting, with children receiving 14 hours per week on average. Children in the "eclectic" group typically received approximately 12 hours per week. After six months of in‐ tervention, the EIBI group showed significantly greater increases in intellectual functioning, and significantly greater decreases in autism symptomatology and challenging behaviour. Both groups, however, showed significant gains in adaptive functioning. Parents in the "eclectic" group showed significant reductions in stress over the course of treatment while no changes in parental stress were observed for the EIBI group.

vention work best for specific individuals and under what set of circumstances. Smith et al. (2010) also suggest that ongoing research is necessary in identifying key moderating varia‐ bles in EIBI outcomes. Specifically, they pose the question of what are the most effective components, and the amount of such components, in producing marked changes in core au‐ tism symptoms and additional problems. Other researchers have also emphasised this point (Alessandri, Thorp, Mundy, & Tuchman, 2005; Granpeesheh et al. (2009). For some, deter‐ mining predictor variables such as personal characteristics affecting outcomes has been a fo‐ cus. For example, Itzchak and Zachor (2009) demonstrated that the presence of an intellectual disability and significantly delayed adaptive skills in young children with au‐ tism was a major risk factor and a predictor of weaker outcomes for EIBI. They also showed that children who were 30 months of age or younger responded significantly better to early intervention. A more recent study by Perry et al. (2011) showed that variables including younger age and higher intellectual functioning at onset of intervention were predictors of greater positive effects. Not surprisingly, Perry et al. (2011) also found that duration of inter‐ vention was a predictor of positive outcomes for young children undergoing EIBI- the lon‐

Early Intensive Behavioural Intervention in Autism Spectrum Disorders

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

583

While EIBI programs provide strong adherence to the framework and foundational princi‐ ples of learning within ABA, some investigators have followed a particular "brand name" approach (Healy, Leader & Reed, 2010). There are a number of different ABA approaches that have been outlined in a variety of sources (some examples include: Greer, Keohane & Healy, 2002; Koegel & Koegel, 2006; Lovaas, 1981; Lovaas & Smith, 1989; Sundberg & Mi‐ chael, 2001). Often this "branding" can lead to obfuscation for the reader in interpreting what "type" of EIBI/ABA program is best. However, these approaches are all built on the same bedrock sharing important common features- intensity in program delivery (up to 40 hours weekly for at least three years), one-to-one teaching where the individual requires such intensive instruction, and discrete-trial reinforcement-based methods (in both massed trial formats and natural environmental teaching opportunities) incorporated within the sci‐

Magiati and Howlin (2001) have argued that many of the EIBI studies employ different measurements across participants and at baseline and follow up thereby compromising interpretation and reliability. For example, Eikeseth et al. (2002) and Howard et al. (2005) did not use the same tests at baseline and at follow up phases. Inconsistencies in partici‐ pant characteristics across groups (lack of matching: (e.g., Eldevik, Eikeseth, Jahr, & Smith, 2006; Fenske, Zalenski, Krantz, & McClannahan, 1985) have also been critiqued within the studies. In addition, different investigators examined various settings for EIBIsome were clinic-based (Ben-Itzchak et al., 2007; Eldevik et al., 2006) others were com‐ munity-based (Cohen et al., 2006; Eikeseth et al. 2002; Eikeseth et al., 2007; Eikeseth et al., 2012; Eldevik et al., 2012; Flanagan et al., 2012; Howard et al. 2005; Magiati et al., 2007), while others were home-based (Reed et al., 2007a; Reed et al., 2007b; Remington et al., 2007; Sheinkopf & Siegel, 1998;Smith et al., 2000). This variation in measures/settings across studies may provide challenges in the generalisation of intervention outcomes to

ger the child participated in the intervention, the better the outcome.

entific stringency of a behaviour analytic framework (Matson et al. 2012).

different environments (Mudford et al., 2009).
