Community-based Intensive Behavioral Intervention
Leaf, R. B., Taubman, M. T., McEachin, J. J., Leaf, J. B., & Tsuji, K. H. (2011). A program description of a community-based intensive behavioral intervention program for individuals with autism spectrum disorders. Education and Treatment of Children, 34, 259-285.
Reviewed by: Jessica Rothschild, MA, BCBA, Caldwell College
Why research this topic?
One of the most empirically supported treatments in improving functional skills, intellectual scores and reducing problem behaviors in individuals with autism is intensive behavioral intervention (IBI). IBI is a treatment approach that is based on the principles of applied behavior analysis. There is an abundance of research on IBI that is delivered by university-affiliated funded programs, but little on community-based agencies that provide the majority of IBI to children with autism. It is, therefore, important to describe and evaluate the effectiveness of agencies that provide IBI to children with autism.
What did the researchers do?
Researchers conducted a 10-year analysis on the effects of a community based IBI intervention program across 64 participants at four different sites located in southern California, the United Kingdom, Australia, and Hong Kong. Sites were identical in structure, consultation, staff roles and training, treatment implementation, philosophy, and intake. Differences between sites were based on funding and cultural differences. For example, more public funding was available in California than in Australia. Also, nannies tended to have a larger role in caregiving in Hong Kong than at the other sites. The program was modeled after Lovaas’s UCLA Young Autism Project, with changes including an increase in parent training, supervision of intervention in schools, and more advanced language programming. Another emphasis was on the use of behavior-increasing strategies rather than behavior-reductive strategies. Intervention hours averaged at 21.7 hours per week with treatment lasting between 12 and 16 months.
What did the researchers find?
Results indicated that participants fell into one of three groups based on IQ scores and school placement at follow up: best outcome, best outcome-revised, or not best outcome. Best outcome included individuals with IQs 85 or above and who successfully completed grade level work in a regular education class with no supports. Best outcome-revised included individuals with an IQ 85 or above, receiving minimal support in the general education classroom.
The third group included individuals with IQs lower than 85 and not placed in a general education class. Overall, out of the 64 individuals 39% met best outcome criteria and 31% met best outcome-revised. Treatment integrity scores showed that staff were competent in providing instructions, giving appropriate feedback, appropriate pacing, setting and implementation of tasks.
What are the strengths and limitations of the study?
This is one of the first studies to report outcomes of an evidence based model for community based programs. The study also identified core features for IBI treatment packages, adaptations needed to implement IBI in different countries, and strategies for training staff and maintaining a high level of treatment integrity in the context of an international agency. Thus, the study extends prior research on the effectiveness of IBI based programs.
Limitations of the study are that it did not incorporate an experimental design (i.e., there was no control group) and that it did not include measures of autism severity and levels of disruptive behavior prior to and after intervention. Also, outcome measures were administered by agency personnel rather than outside evaluators; the reliance on agency personnel may have biased the results to some extent.
What do the results mean?
This study suggests that community IBI based programs for individuals with autism can be effective in a variety of settings. Further studies with control groups and assessments by outside evaluators are needed to confirm these promising findings.