**6. Endorsement**

The review by [43] is the notable exception, in that it does not fully concur with these conclu‐ sions. Howlin et al. concluded that 'this review provides evidence for the effectiveness of EIBI for some, but not all, preschool children with autism' (p. 20). Given that this review is fre‐ quently cited in the UK as a basis against the roll-out of EIBI for all children with ASD who need it [42], it is important to note here that Howlin et al. misinterpret a number of important points. First, it is in the mathematical nature of all group average data (such as those calculated for RCTs) that some individual data are above while others are below the average; such is the nature of group averages (see also [77]; second, Howlin et al. 'cherry pick' results by ignoring the fact that obviously some children must do extremely well, otherwise the group average would not be what it is. Thus, Howlin et al. contradict themselves in their conclusions. First they call for large sample comparisons and group averages (i. e., RCTs) and then they do not

In a subsequent paper, Howlin and colleagues [99] report extremely poor long-term outcomes in a 40-year follow-up study of children diagnosed with autism at the Institute of Psychiatry/ Maudsley Hospital, London between 1950 and 1979. Intriguingly, they explicitly link these findings to the fact that none of these children had received early intensive behavioural interventions and claim that EIBI is available now. Praising the potential positive effects of EIBI stands in contrast to their earlier conclusions [42, 43]. It will be interesting to see how this

Given that group average scores are neither sensitive to individual differences nor offer sufficient generality, most behaviour analytic researchers prefer to rely on replicated singlesystem designs (SSD) instead of group averages [14, 18, 29]. Clearly, SSD research data cannot be ignored and should find their rightful place in future reviews of autism intervention

*Social Validity* studies assess the social significance, appropriateness, and importance of treatment goals, procedures, and intervention effects [93]. Social validity measures are

A number of studies have shown clear evidence of high social validity of ABA-based inter‐ ventions, especially those that include parent participation and training [18, 92]. Interestingly, while there is evidence of increased parental stress in families affected by ASD [10, 17], there is evidence of parental stress reduction when effective interventions for children are in place

*Neuroscience* studies, including MRI scans are useful tools to bolster evidence-based practice in particular in the area of ASD, where the plasticity of the brain during early childhood constitutes an important focus of intervention [11]. There is evidence of differences in brain activity between individuals diagnosed with ASD and those who do not have an ASD

There is further evidence that early behaviour analytic intervention can lead to measurable change in brain activity [12]. For example, [28] found that ABA-based interventions not only lead to behavioural improvements, with some optimal outcome individuals becoming

increasingly becoming integral part of research into interventions in ASD [27, 53].

new evidence will translate into advice given to government bodies.

accurately interpret group data.

252 Autism Spectrum Disorder - Recent Advances

guidelines, such as NICE Guideline 170 [64].

[17]. This is also true for education staff [26].

designation [13, 35].

In the USA, interventions for individuals with ASD that are based on ABA are endorsed as medically, as well as educationally, necessary and covered by health insurance in the vast majority of States [2]. In fact, they are now considered 'treatment as usual' [28]. As early as 1999 the [84] endorsed ABA-based interventions:

Thirty *[now 45]* years of research demonstrated the efficacy of applied behavioural methods in reducing inappropriate behaviour and in increasing communication, learning, and appro‐ priate social behaviour. (p. 164)

More recently, [94] recommended

that principles of applied behaviour analysis (ABA) and behaviour intervention strategies be included as important elements in any intervention program for young children with autism. (p. 33)

[8] recognized that:

in areas such as social engagement, language, coping, and reduction of difficult behaviours… Applied behavioural analysis is usually needed to assist a child to gain skills and reduce negative or undesirable behaviours. (p. 10)

The Federal U. S. Office of Personnel Management responsible for all federal government employees concluded that ABA-based interventions should be covered not only for educa‐ tional but also for medical reasons:

based on ample scientific and empirical evidence, ABA therapy qualifies as a medical treatment, rather than purely educational. [5], p. 1)

In Canada, ABA-based interventions are supported, for example by the Ontario Department of Education Policy/Program Memorandum [73] that support[s] incorporation of ABA methods into school boards' practices. . . The use of ABA instructional approaches may also be effective for students with other special education needs. (p. 1)

The Maine Administrators of Services for Children with Disabilities confirmed their support in the Report of the Autism Task Force [6]

It is important to note that ABA is frequently perceived to be synonymous with discrete trial teaching. However, ABA is comprised of a broad scope of empirically derived behavioural principles used in interventions. (p. 25)

Despite this general endorsement of evidence-based behaviour analytic interventions across most of the English speaking world, the highly controversial approach taken by governments across the UK and Ireland is to support an 'eclectic' approach. There are no clear guidelines as to what an 'eclectic' approach entails and not a single study is published anywhere to show the effectiveness of an eclectic approach being equal or superior to ABA-based interventions [14]. In fact, [21] and [39] findings show clearly that ABA-based interventions are superior to an eclectic approach. Individually tailoring behavioural interventions to match child charac‐ teristics is key to effectiveness [82].

Yet in the UK, the National Institute for Clinical Excellence's [64] response to stakeholders, who asked for ABA-based interventions to be included in the NICE guidelines for the management of children with ASD, was the following:

In the review of evidence, the Guideline Development Group found no evidence to support ABA, and therefore could not make a recommendation about ABA. (pp. 5& 8)

They also asserted that:

NICE clinical guidelines are based on the best quality evidence and are developed according to rigorous and robust methodologies. The developers were unable to identify high quality evidence of effectiveness of the ABA approach in managing children and young people with autism. (pp. 5 & 8)

This view is informed mainly by relatively few, but well rehearsed anti-ABA arguments that continue to circulate misinformation and misleading anti-ABA propaganda. As [33] points out:

The most concerning issue affecting the quality of practices and policies in the helping professions is the play of propaganda, which misleads us regarding what is a problem, how (or if) it can be detected, its causes, and how (or if) it can be remedied. Propaganda is defined as encouraging beliefs and actions with the least thought possible. Censorship is integral to propaganda including hiding wellargued alternatives and lack of evidence for claims. Evidence-based practice was developed in part because of misleading claims in the professional literature. If propaganda is an integral part of our society, we cannot escape its influence. But we can become aware of it, encouraged by ethical obligations to avoid harming in the name of helping. (p. 302)
