The study by Ohio State University researchers is one of few that have rigorously examined the success of the Early Intensive Behavioral Intervention (EIBI) program, which some believe is the best way to treat autistic children.
"We were taught at one time that it couldn't happen – people who were mentally retarded couldn't become average," Mulick said. "But we found it can happen among at least some with autism."
The preliminary results show the value of EIBI, said James Mulick, co-author of the study and professor of pediatrics and psychology at Ohio State University. He and his colleagues presented results of the research August 7 in Toronto at the annual meeting of the American Psychological Association.
The eight children enrolled in the study all had been diagnosed with mental retardation – which is often associated with autism -- before participating in EIBI. Six of the eight children showed at least average IQ scores after treatment and two had improved to mild mental retardation. Most also showed improvements in other areas of functioning, such as behavior and a reduction in autistic symptoms.
Autism is a complex developmental disability that typically is diagnosed within the first few years of life. Autistic children often have trouble with verbal and non-verbal communications, with social interactions, and may not be affectionate with others. Because autism involves problems with language, it is often associated with mental retardation.
Mulick, who is also associated with Children's Hospital in Columbus, cautioned that EIBI isn't a miracle cure, and isn't strongly effective for many – maybe most – autistic children. But he said it is remarkable that some children could go from being quite correctly labeled mentally retarded to being labeled of average intelligence after the program.
"We were taught at one time that it couldn't happen – people who were mentally retarded couldn't become average," Mulick said. "But we found it can happen among at least some with autism."
Mulick said EIBI for autism was first developed in the 1970s at the University of California, Los Angeles by O. Ivar Lovaas. Lovaas first reported in 1987 that 47 percent of 19 autistic children who undergone his program achieved normal intellectual and educational functioning. The success was seen as remarkable, Mulick said. While psychologists around the country have put variations of EIBI into practice since then, there has been little academic study of its success. Part of the reason is that EIBI is such a long, intensive process that studies can be very difficult and expensive.
How long and intensive is EIBI? Lovaas recommended 40 hours per week for three years. "That's a lot of time to commit for the program," Mulick said.
EIBI is a highly structured approach to learning. Autistic children are first taught to imitate their instructors. Children are rewarded when they can imitate arm motions or other actions. They are then taught how to match identical items, such as shapes. They then learn to match similar items, and then categories. Lessons continue with gradually more complex tasks, including using language, and skills needed to attend school.
Some of the keys for success are to reward appropriate behavior and to not allow the autistic child to socially withdraw, as he or she might try to do, according to Mulick.
For this study – dubbed the Ohio Autism Recovery Project – Mulick and his colleagues, including Dr. Bernard Metz of Children's Hospital in Columbus and Eric M. Butter, Senior Fellow in Pediatric Psychology and Neurodevelopmental Disabilities at Ohio State, recruited children and parents from around the country. In order to be eligible for the study, the children had to have been reliably diagnosed before treatment as being mentally retarded and autistic. They then had to have successfully participated in an EIBI program that followed the UCLA format for intensive treatment.
"We wanted to see if children who had gone through the program really did achieve the level of success that had been reported," Mulick said. There are no controls in this study to compare the treatment group with, Mulick said. That's because the early results of EIBI have been so promising that it would be unethical to have some children not receive EIBI treatment for long periods of time.
The participating students are 4 to 8 years old and have received EIBI treatment for at least a year.
Mulick said they began the study about one year ago and only have preliminary results at this time. The researchers compared records of the students before they received EIBI treatment with new
Assessments made when they had completed EIBI and had joined this study. They are just beginning to evaluate results from one year later. During this past year, some of the children have received additional special treatment. Those who are school age are in mainstream classes and those who are younger are on path to also be in standard schools.
The researchers did a variety of assessments to see what effect EIBI had on the children. Results included:
- Before EIBI treatment, all students had IQ scores below 51, which puts them in the moderately mentally retarded range. After EIBI, all of the children had IQ scores above 70, with one child reaching 114. The researchers have preliminary results of three students one year after enrollment in this study. All three had made more gains in IQ scores: 4 points, 8 points and 30 points, respectively.
- Seven of the eight students had made significant gains in adaptive behavior, such that they are ready for mainstream schools. This means they can do things like dress themselves and wash their hands.
- All of the students showed borderline to normal scores on nonverbal cognitive skills (an example being knowing how to unlock a door or solve a puzzle).
- Language skills remained a problem for at least four of the students. "Language is one of the most impaired areas in autism," Mulick said.
- All eight students showed academic skills to a level where they were ready for school. While their language skills were not up to par with their peers, Mulick said they were good enough for school.
- Only one of the eight students had autistic symptoms severe enough to be classified as autistic by the time of this study. This suggests a marked improvement.
- Only one of the eight children showed emotional or behavioral problems at a level well above normal.
Overall, the results of this study were positive for EIBI. But Mulick cautions against seeing EIBI as a cure-all.
"We saw autistic children with some of the rosiest outcomes, but there were still residual symptoms," he said. Moreover, he is skeptical that nearly half the children who participate in an EIBI program can achieve normal functioning, as the original UCLA study suggests.
This study recruited subjects from around the country but only found eight who met the criteria of being mentally retarded and who had successfully completed and EIBI program.
"Our study shows this program can work, but I don't know that half the people who participate can achieve normal functioning," he said.
Contact: James Mulick, 614-722-4700; Mulick.1@osu.edu
Written by Jeff Grabmeier, 614-292-8457; Grabmeier.1@osu.edu