Updated by: Grace Broten, BS & Catherine McHugh, BCBA-D, LBA
Atlas Autism Health

Editor’s Note: There are many interventions used during the stage of early childhood by early intervention providers (e.g., Early Intensive Behavioral Intervention, Early Start Denver Model, Pivotal Response Training). Some of these interventions are also used across the lifespan to support individuals with autism (e.g., Pivotal Response Training). By publishing this update to the Early Intensive Behavioral Intervention (EIBI) treatment summary, we do not intend to ignore other literature that has developed over the last many years with early learners. In this article, we are focusing only on EIBI, which has specific characteristics associated with its use – prominently the intensity of intervention, which is not consistently observed in other early intervention models (e.g., Early Start Denver Model). If you are interested in these other interventions, we have treatment summaries devoted to them, which can be found in the links below the article. –Dr. Kimberly Marshall, Treatment Summary Coordinator

 

Description

Autism Treatments SummaryRecent estimates suggest that 1 in 31 children are diagnosed with autism spectrum disorder (ASD) (Centers for Disease Control and Prevention, 2025). With more accurate and developmentally sensitive screening tools, individuals with ASD are being diagnosed at a younger age, which creates an increased need for effective treatments catered towards the developmental stage of early childhood starting from ages as young as one year-old (Centers for Disease Control and Prevention, 2025). Considerable research has demonstrated that providing services and therapy to young children is associated with better outcomes, including higher IQ, stronger language development, and enhanced social skills (MacDonald et al., 2014). One treatment targeted for young children (2-6 years-old) that has been significantly researched is Early Intensive Behavioral Intervention (EIBI). EIBI is an evidence-based treatment grounded in the principles of Applied Behavior Analysis (ABA). EIBI’s aims are twofold: (1) to address skill deficits (e.g., language skills, social play, fine and gross motor skills) and (2) to decrease challenging behaviors (i.e., behaviors that interfere with daily living and access to reinforcement, such as physical aggression, property destruction, self-injury) (MacDonald et al., 2024).

There is a myriad of characteristics that define and describe EIBI. One key feature is that the treatment is highly individualized to each child. Prior to intervention, clinicians conduct comprehensive assessments evaluating various domains, including but not limited to receptive language, imitation skills, group instructions, play, and challenging behavior. This allows for highly detailed and individualized programming aimed at addressing each child’s strengths, skill deficits, and challenging behaviors rather than using a standardized set of programs that might not be appropriate for the child.

Two, EIBI is implemented in a one-on-one setting, where one trained therapist works directly with a single child (Eldevik et al., 2009). This one-on-one model allows the therapist to focus their attention solely on the client, implementing programming, and collecting accurate data. In contrast, other settings may have a small group of children where one teacher is tasked to divide their attention and manage the classroom as a whole. This kind of group environment requires that most children engage in activities relatively independently. While tolerating divided attention and independence would be a goal for children with ASD eventually, one-to-one instruction allows for more support and direct teaching until they are able to successfully attend school without intensive support.

Three, EIBI interventions are developed based on evidence-based research and grounded in empirically supported practices (Lovaas, 1993). Seminal outcome studies have demonstrated significant gains in language development, adaptive functioning, and IQ in children with ASD who receive early intervention (Eikeseth et al., 2012; Lovaas, 1993; MacDonald et al., 2014). These foundational findings will be discussed in greater detail later in this paper.

Four, data collection is a major component of each session both in a clinical setting or in-home. Collecting data allows clinicians to continuously evaluate the effectiveness of the treatment and to quickly modify programs when necessary.

Five, EIBI uses core teaching strategies such as discrete trial training (DTT), natural environment teaching (NET), and other techniques based on ABA to help children acquire skills across a variety of domains, including language development, social skills, fine and gross motor skills, self-care, and many more (MacDonald et al., 2024).

Six, intensive treatment is administered year-round and typically involves 20 to 40 hours of therapy per week. This dosage allows the child to receive many opportunities to succeed by practicing their new skills, thereby ensuring accurate and fluent responses across the day.

The final distinguishing factor of EIBI programs is the role and inclusion of caregivers in their child’s development (Eldevik et al., 2009). Skills gained through EIBI would hold little value if they could not be generalized across settings and maintained by caregivers in the child’s everyday environment. Therefore, it is important that clinicians train caregivers on ABA techniques, collaborate on goal setting for their child, and invite them to provide feedback and information on their child’s behavior and growth during the interventions. Treatment should always be considered meaningful and beneficial to both the child and their family, with caregivers’ involvement playing a crucial role in its effectiveness (Eldevik et al., 2009; Lovaas, 1993).

Research Summary

EIBI has become a central focus for research on early intervention for children with ASD. Clinical psychologist Ole Ivar Lovaas (1993) is considered a pioneer in the field of ABA and early intervention. His work focused on the importance of evidence-based treatment and emphasized data-driven decision-making (Lovaas, 1993). One key feature of his model was his implementation of single-case work, where therapists who administered treatment closely monitored and tracked data with an individual child (Lovaas, 1993). This model allowed the therapist to consistently evaluate the impact of the programs and adjust over time based on quantifiable evidence. Moreover, his research stressed the importance of generalization, noting that learned skills must be transferable into natural settings, such as the caregivers’ and client’s home environment to facilitate lasting changes (Lovaas, 1993). His early intervention project conducted in 1987 demonstrated that children who received intensive treatment (40 hours per week of one-on-one therapy) achieved the best outcomes in regard to IQ, language development, and social skills compared to children who began treatment later. His research is considered foundational to modern ABA practice and laid the groundwork for EIBI as an evidence-based treatment model. However, some of Lovaas’ procedures to reduce unwanted behavior involved physical punishment, including using electric shocks or lightly slapping a child’s thigh (Lovaas, 1993). These methods, although allowed at the time, are now considered unethical and inconsistent with modern behavioral practice due to the psychological and physical distress they may cause, as well as their disregard for assent-based practice (BACB, 2020). While Lovaas’ work is regarded as instrumental to the field of ABA, contemporary clinicians acknowledge the harm that was caused by his methods. Since that time, behavior analysts have established ethical standards and guidelines aimed at eliminating aversive practices and supporting client autonomy. The most recent version of these ethical standards is the Behavior Analyst Ethics Code (Behavior Analyst Certification Board, 2020).

Following Lovaas’ seminal work, subsequent research has continued to demonstrate the effectiveness of EIBI across a wide domain of developmental outcomes and environmental settings. MacDonald et al. (2014) investigated the effectiveness of EIBI on the developmental skills of children with ASD between the ages of one to three-years old. Eighty-three children with ASD were recruited for the study, and fifty-eight typically developing children were recruited as a control group. Using teaching strategies such as DTT and NET in both home-based and preschool settings, they saw significant gains in social play, imitation, joint attention, and language skills for the children with ASD (MacDonald et al., 2014). Notably, children who were between the ages of approximately one to two years significantly improved compared to children who started treatment one year later. This study highlights the importance of early intervention and demonstrates the effectiveness of EIBI treatment in relation to skill acquisition. Although significant outcomes were found, the researchers acknowledged that their control group of typically developing children might have been too small in comparison to the group that received treatment. This makes it difficult to determine if changes observed were a result of EIBI treatment or maturation through aging. Additional research should seek to utilize a standardized control group to allow researchers to more definitively attribute differences to treatment.

Additional research has demonstrated EIBI’s effectiveness when applied in community and school settings (Eikeseth et al., 2012; Eldevik et al., 2012). Eikeseth et al. (2012) examined the use of EIBI with three- to six-year-old children with ASD in school communities, where staff, after brief training in ABA, implemented treatment over the course of two years. Despite the staff’s limited background in the science of ABA, children showed significant improvements in adaptive behavior within the first year alone (Eikeseth et al., 2012). In the second year of treatment, gains in adaptive behavior continued to increase, although at a slower rate than in the first year (Eikeseth et al. 2012). This study faced practical limitations, such as lack of a control group or true random assignment (Eikeseth et al., 2012). Overall, it demonstrated that EIBI implemented within mainstream communities and educational settings has beneficial effects on adaptive behavior for children with autism, but future research should further clarify this relationship through randomized controlled trials.

Beyond immediate outcomes, researchers have also studied whether the positive outcomes of EIBI treatments are sustained over time. Smith et al. (2021) found that skills learned through EIBI were maintained at a ten-year follow up, indicating that gains are sustained through adolescence. Smith et al. (2021) recruited participants between the ages of two and four, and assessed intellectual functioning, adaptive behavior, and autism symptoms prior to starting any treatment. Following assessment, the children received 36 hours of treatment at home per week for two years. Intellectual functioning and adaptive behavior were evaluated after two years, with both domains showing significant improvement in comparison to intake (Smith et al., 2021). After two years, each child continued to receive support from a tutor briefly trained on ABA techniques at a variety of different educational settings. Ten years later, a follow-up assessment was conducted, where intellectual functioning, adaptive behavior, and autism symptoms were assessed once more. At the ten-year follow-up, there was no significant change in cognitive functioning and adaptive behavior, suggesting that these skills were maintained between the end of the two-year treatment and ten years in another educational environment (Smith et al., 2021). These findings suggest that the benefits of EIBI extend beyond childhood and are not temporary. However, there was no control group included in this study, which makes it difficult to determine if the children who received EIBI treatment made significant improvements in comparison to other children who may have received different treatments. Smith et al. (2021) suggested further research could include a control group that evaluates the effectiveness of EIBI compared to other treatments or investigates how parental involvement might affect the outcome of skills acquired.

In addition to the literature evaluating the effectiveness of EIBI, several organizations have written position papers regarding the intervention. Many of these papers were written in response to public debates about the effectiveness of EIBI for children with ASD (e.g., Council of Autism Service Providers [CASP], 2025; Ontario Association for Behaviour Analysis [ONTABA], 2018). These papers and other task force reports include a thorough review of the strengths and limitations of the existing literature to evaluate outcomes following EIBI treatment (CASP, 2025, ONTABA, 2018; National Autism Center, 2015). This makes it possible for them to make recommendations based on the evidence available. Based on the results of these investigations, these task forces and organizations support EIBI as an effective treatment for young children with ASD.

Overall, research consistently demonstrates that EIBI is effective in improving outcomes for children with ASD. Studies highlight notable increases in social play, language development, and IQ performance, along with decreases in interfering behaviors, such as self-injurious or tantrum behaviors (Eikeseth et al., 2012; Frazier et al., 2021; Lovaas, 1993; MacDonald et al., 2014). With EIBI’s rich history of empirical support, EIBI is considered one of the most effective and widely recommended interventions for young children with ASD (Eldevik et al., 2009).

Recommendations

Much research has demonstrated EIBI as a successful intervention for children around one- to six-years-old with ASD. However, there is a lack of randomized controlled trials, which impacts the strength of the evidence (Agency for Healthcare Research and Quality, 2011). This makes it difficult to evaluate if the observed developmental gains are solely caused by EIBI. Many of the studies rely on pre-post designs without random assignment, making it difficult to rule out alternative explanations, such as parental involvement, maturation, or concurrent services (MacDonald et al., 2014; Smith et al., 2021). Future research should prioritize randomized control groups receiving alternative or lower-intensity treatment to strengthen the evidence for EIBI.

Based on current evidence, EIBI is most effective when initiated at the earliest feasible age for children who show deficits in a wide variety of developmental domains, such as language development, social skills, or adaptive functioning (Eikeseth et al. 2012, MacDonald et al., 2014). Research consistently demonstrates that the most significant gains occur when EIBI is delivered at a high intensity, typically around 40-hours per week of one-to-one therapy (Lovaas, 1993; ONTABA, 2018). The high number of hours per week allows for greater learning opportunities for the children and increased caregiver training, and it supports the generalization of skills across a myriad of different environments. Together, both treatment intensity and early intervention are key predictors of success in relieving symptoms of ASD (Eikeseth et al. 2012; Lovaas, 1993; MacDonald et al., 2014). The evidence highlights EIBI as a cornerstone of ASD intervention. When applied with high fidelity and family collaboration, it promotes lasting developmental progress and meaningful improvements that impact quality of life.

Systematic Review of Scientific Studies

Eldevik, S., Hastings, R. P., Hughes, J. C., Jahr, E., Eikeseth, S., & Cross, S. (2009). Meta-analysis of early intensive behavioral intervention for children with autism. Journal of Clinical Child & Adolescent Psychology, 38(3), 439-450. https://doi.org/10.1080/15374410902851739

Selected Scientific Studies

Eikeseth, S., Klintwall, L., Jahr, E., & Karlsson, P. (2012). Outcome for children with autism receiving early and intensive behavioral intervention in mainstream preschool and kindergarten settings. Research in Autism Spectrum Disorders, 6(2) 829-835. https://doi.org/10.1016/j.rasd.2011.09.002

Eldevik, S., Hastings, R. P., Jahr, E., & Hughes, C. (2012). Outcomes of behavioral intervention for children with autism in mainstream pre-school settings. Journal of Autism and Developmental Disorders, 42(2), 210-220. https://doi.org/10.1007/s10803-011-1234-9

Frazier, T. W., Klingemier, E. W., Anderson, C. J., Gengoux, G. W., Youngstrom, E. A., & Hardan, A. Y. (2021). A longitudinal study of language trajectories and treatment outcomes of early intensive behavioral intervention for autism. Journal of Autism and Developmental Disorders, 51, 4534-4550. https://doi.org/10.1007/s10803-021-04900-5

Lovaas, O. I. (1993). The development of a treatment-research project for developmentally disabled and autistic children. Journal of Applied Behavior Analysis, 26(4), 617-630. https://doi.org/10.1901/jaba.1993.26-617

MacDonald, R., Parry-Cruwys, D., Dupere, S., & Ahearn, W. (2014). Assessing progress and outcome of early intensive behavioral intervention for toddlers with autism. Research in Developmental Disabilities, 3632-3644. http://dx.doi.org/10.1016/j.ridd.2014.08.036

Smith, D. P., Hayward, D. W., Gale, C. M., Eikeseth, S., & Klintwall, L. (2021). Treatment gains from early and intensive behavioral intervention (EIBI) are maintained 10 years later. Behavior Modification, 45(4), 581-601. https://doi.org/10.1177/0145445519882895

Task Force Findings

Agency for Healthcare Research and Quality (2011). Therapies for children with autism spectrum disorder: Executive summary. https://asatonline.org/wp-content/uploads/asatdocuments/General-Therapies-for-Children-with-Autism-Spectrum-Disorders.pdf

Council of Autism Service Providers. (2025). Evidence about ABA treatment for young children with autism: The impact of treatment intensity on outcomes. https://assets-002.noviams.com/novi-file-uploads/casp/pdfs-and-documents/evidenceaboutabatreatment.pdf

National Autism Center. (2015). Findings and conclusions: National standards project, phase 2. Author.

Ontario Association for Behaviour Analysis, Inc. (2018). Evidence-based practices for individuals with autism spectrum disorder: Recommendations for caregivers, practitioners, and policy makers. https://ontaba.org/wp-content/uploads/2021/11/ONTABA-Evidence-Based-Practices-for-Individuals-with-Autism-Spectrum-Disorders-Caregiver-Brief-Report.pdf

Other Works Cited Above

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://www.bacb.com/wp-content/uploads/2022/01/Ethics-Code-for-Behavior-Analysts-240830-a.pdf

Centers for Disease Control and Prevention. (2025). Data and statistics on autism spectrum disorder. https://www.cdc.gov/autism/data-research/index.html

Centers for Disease Control and Prevention. (2025). Clinical screening for autism spectrum disorder. https://www.cdc.gov/autism/hcp/diagnosis/screening.html

Reference for this article:

Broten, G., & McHugh, C. (2026). A treatment summary of Early Intensive Behavioral Intervention. Science in Autism Treatment, 23(2).

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