Autism Behavioral Interventions

Autism Society of America
7910 Woodmont Avenue Suite 300 • Bethesda, MD 20814-3067

301.657.0881 • fax: 301.657.0869
www.autism-society.org
Intensive Behavioral Intervention

Applied Behavior Analysis (ABA) is a science that seeks to use empirically validated behavior
change procedures for assisting individuals in developing skills with social value. The procedures used
in intensive behavioral intervention programs for children with autism are drawn primarily from the rich
base of research generated by practitioners of ABA. The constellation of procedures typically includes
use of “discrete trial instruction” but is not limited to that method of instruction. Terms that denote the
comprehensiveness of the intervention include intensive behavioral intervention (IBI), behavioral
therapy, and behavioral treatment. Currently, ABA intervention for children with autism consists of a
tremendous amount of structure and reinforcement provided at high intensity using precise teaching
techniques. This type of intervention is most accurately referred to as intensive behavioral intervention.
Because Professor O. Ivaar Lovaas published a landmark study, which is very well known, many
people have used the term ‘Lovaas Therapy’ interchangeably with ‘intensive behavioral treatment’.
Although ‘Lovaas Therapy’ may be viewed as a subset of ABA the terms are not strictly synonymous.
Only a practitioner who is directly affiliated with Lovaas can properly be said to implement ‘Lovaas
Therapy’. The terms ‘ABA’ or ‘intensive behavioral intervention’ are generic terms used by the
numerous other professionals who have contributed to the growing body of research on the effectiveness
of behavioral intervention.
Discrete trial teaching may also be called the “ABC model,” whereby every “trial” or task given to
the child to perform consists of:
• Antecedent: a “directive” (or SD*) or request for the child to perform an action
• Behavior: a “response” from the child — including anything from successful performance, non-
compliance, or no response.
• Consequence: a “reaction” from the therapist, including a range of responses from strong positive
reinforcement, faint praise, or a negative reaction (i.e. “no”).
• …and a pause to separate trials from each other (called the inter-trial interval).
*The technical term SD refers to an event or instruction, which, if followed, will produce a
reinforcing event. An SD controls behavior when the reinforcement it is associated with is
sufficiently motivating for the individual to learn to produce the desired behavior.
When behaviors are followed by consequences that the individual finds desirable, those
behaviors are more likely to be repeated in the future. This is called reinforcement. When consequences
are negative, behavior is less likely to be repeated. In discrimination training, which is a core component
of an ABA program, and discrete trial teaching in particular, children learn which response to make in
the presence of specific words and environmental stimuli. The teacher arranges consequences that lead
to the increase of correct responses and the decrease of incorrect responses. The negative consequence
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“Intensive Behavioral Intervention”
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may consist simply of a “no” delivered neutrally. Also used are “differential consequence” schemes in
which both the positive and negative consequences are more natural, and graduated. Examples might be
strong positive reinforcement for a perfect response compared to a simple “OK” for a partially correct
answer; on the other hand, incorrect responses may be greeted by “not quite” or “pay attention”.
Different providers of ABA services employ different rules regarding what consequences should be
employed.
A key element of this approach is that services are highly intensive: typically 30-40 hours a week
of potential learning opportunities, the majority of which are conducted on a one-on-one basis with a
trained therapist or paraprofessional. ABA’s goal is to minimize the child’s failures and maximize his or
her successes. The therapist must provide the prompts necessary for the child to understand what is
expected of them and learn the new skills. A prompt is assistance provided by the teacher to facilitate
the correct response. Hand-over-hand guidance is an example of a prompt.
Targeted skills are broken down into small attainable tasks. When the child does well on these
targeted skills, a lot of reinforcement must be provided. The therapy proceeds in small, carefully
planned steps that build additional skills. For example, one of the first tasks may be to get the child to
sit in a chair. The therapist would provide physical prompts to put the child in the chair where they sit in
the correct position, and immediately provide a reinforcer.
Skills that are prerequisites to language are heavily emphasized. Such skills are attention,
cooperation, and imitation. This is a good example of how the steps must build on one another — if you
are not able to achieve the attention and cooperation of the child, it will be practically impossible to
teach language.
Properly designed and executed ABA programs contain many if not all of the components of
effective treatment approaches found to be most successful in treating children with autism, namely:
individualized instruction tailor-made to address the specific needs of the child, behaviorally based
methodology, low student-teacher ratio, early treatment, and family involvement.
In ABA therapy, emphasis is placed on acquiring new behaviors, because when children have a
repertoire of constructive behaviors, problem behaviors often occur less frequently. Therapists are
trained to ignore undesired or disruptive behavior but to promote compliance and good behavior
(“praise the best, ignore the rest”) by use of carefully chosen rewards or “reinforcers.” Reinforcers are
chosen to be whatever the child wants most. Many young children initially respond to tangible or
concrete reinforcers such as candy, or perhaps the chance to play with a favorite toy. Such tangibles are
“extrinsic” in the sense that they are not typically part of the chain of events that produce a behavior
(teachers do not normally allow a child to go play or have a piece of candy for giving the correct
answers). Concrete rewards are faded as fast as possible and replaced with “social” rewards such as
praise, tickles, hugs, or smiles.
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The purpose of intensive behavioral intervention is to teach children how to learn, be it academic
skills or behavioral skills. Behavioral methods enhance learning not only by teaching the child but also
by replacing challenging behaviors with more appropriate ones. The child’s success is closely monitored
by detailed data collection. Skills that have been mastered (successfully performed with some stated
frequency, e.g. 80% or better across two or more therapists) are placed on maintenance so that the child
does not regress in them as new tasks are introduced. A maintenance schedule allows for periodic
revisiting of “learned skills” to keep them fresh while the day-to-day progression of new skills continues.
ABA programs can be highly tailored to the individual needs of the child; therapy involves a
range of different tasks for each child, using a range of locations in which to conduct the therapy (this
allows for generalization) and particular strategies to cope with challenging behaviors where necessary.
Newly mastered skills are adapted to ensure that these skills are generalized to different people, settings,
and materials. Changes in instruction are made if the numbers gotten from data collection indicate that
modification is needed for the child to achieve successful mastery of the skills.
Depending on the needs and age of the child ABA can involve a range of placements including
an inclusion classroom, special education, or a completely home based program. For very young
children, much of the therapy is often conducted in the home (the natural learning environment for
young children), and gradually moves to more educational and community settings as social and
communication skills develop. On the other hand, some programs prefer school-based options, even
during the first year of therapy, on the grounds that the structure and time involved in running a
completely home-based model makes it difficult to incorporate into family life. These programs believe
that school based options can be effective for students, even during the first year of therapy, if the
principles of ABA are adhered to precisely. Whichever route is chosen, the necessity of performing at
least some of the therapy at home implies a great deal of parent involvement, and awareness, which is
key to the long-term success of the child. Whether center- or home-based, most instruction remains 1:1
and highly intensive.
While ABA programs are highly structured, young children still need “down-time” and the
chance to be a kid. Some programs incorporate ABA principles into structured play and less demanding
activities as an important component to the therapy in that learning should be made fun for the child. It
is also important to address the child’s need for age-appropriate play skills and social behavior. Through
play and incidental learning, skills can be generalized to progressively less structured settings and more
naturalistic situations.
The actual implementation of ABA therapy varies with the service provider. Often a consultant
from a university program trained in the appropriate techniques will oversee the program. Coordinators
who receive their training from the Young Autism Project at UCLA must have a master’s degree to be
considered for the 9-month internship, consisting of 30 hours per week of training. The UCLA
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curriculum contains 500 individual tasks to be taught, and usually therapy lasts, on average, for 2 years.
Children progressing through the Lovaas program often begin preschool 6-12 months after beginning
therapy, while continuing some programming in the home. Although not confirmed by research, it is
believed that the best age to begin intensive ABA therapy is between 24-42 months or before 3 ½ years
of age. Most children are between the ages of 2 and 6 when they enter the program.
Research and anecdotal evidence indicate that ABA programs produce comprehensive and
lasting improvements in many important skill areas. ABA methods have shown success in educating
persons with autism at any age. However, studies have shown that early, intensive instruction using the
methods of ABA in young children produces successful integration in regular schools for many.
Developed by the Autism Society of America 5/98
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The Pros and Cons of Discrete Trial Training:

Is the “Lovaas” behavior modification method appropriate for my student?
Originally appearing in ACCESS Express Vol. 4 #1 August 1996
By Julie A. Donnelly, Ph.D., Senior Autism Resource Specialist, Project ACCESS
Discrete trial training consists of a series of distinct repeated lessons taught one-to-one with a
student. The behavior trainer presents a task and reinforces the student for completing the task, even if
the trainer has to assist the student through the lesson in the initial stages. Data is kept on the multiple
trials and the student moves on to additional tasks as the old ones are mastered.
Although this technique is currently identified with the work of O. Ivar Lovaas at the University
of California Los Angeles (UCLA), discrete trial training has been used by many other professionals. It
has been referred to as the Clinical/Prescriptive method and as formal compliance training (Donnellan -
Walsh, Gossage, La Vigna. Schuler & Traphagen, 1976: Myles & Simpson, 1990) and is a variation of
basic behavior modification techniques.
O. Ivar Lovaas has made this technique controversial by publishing articles that suggest that
using this method intensively with young children can cure autism. I do not intend to address the
questions about the validity of that research in this article. The more pressing question is: Would the
individual with autism you work with and care for respond to these methods?
Discrete trial training can be an important tool in teaching children with autism. Many times
students with autism are not learning because their attention is not focused on the learning task and they
are unable or unwilling to cooperate with the lesson the teacher has chosen. Discrete trial training begins
at the developmental level of the child and focuses on gaining his/her attention and reinforcing any
attempt at compliance. It goes at the child’s speed, building skills as quickly or slowly as that individual
can progress. As the discrete trial procedure is repeated the student develops a process for learning,
establishes communication skills, learns to interact with the trainer and gains some basic life and
academic skills. An essential part of the Lovaas program is to train the parents in these procedures so
that there is 24-hour consistency. A well-structured intensive behavior program such as this can help a
child to begin responding and learning.
However, this is not a gentle method. It is a persistent demand that he/she focus on our selected
goals and learn our chosen skills. My son, who has autism and did not communicate when he was
young, resisted our attempts to get him to comply and our interruptions of his preoccupations. We
decided that is was important for him to learn to communicate and take care of his basic needs, even if it
made him temporarily unhappy. We had not heard of Lovaas, but we used behavior modification
techniques with my son’s fixations on food as a reinforcer. Rather than a series of artificially designed
tasks, we worked on the language and skills needed in his daily life. Siblings provided models of
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appropriate behavior. We were insistent, persistent, and consistent twenty-four hours a day. Slowly, he
began responding and learning from us and his environment. My, now adult, son is able to tell me,
“Thank you” for these efforts. I still wonder at times if a gentler way would have worked, but I am
convinced that breaking through to him early was the key to his current high functioning status.
Behavior methods should be a part of most programs for children with autism, but must if be the
Lovaas program? One problem is that Lovaas seems to indicate that only he and his trained workers can
do this method correctly. Many of the UCLA trainers are excellent, but most families then put together
teams of volunteers with minimum of training to assist in their child’s program. The quality of these
team members and their understanding of positive principles can vary. Getting the UCLA training and
stamp of approval can be very expensive and can drain family finances. Many families want schools to
pay the cost of hiring these outside experts. ACCESS has been teaching discrete trial or compliance
training as a part of an overall education program for its 10 years of existence. We believe that it is
possible for people not directly identified with Lovaas to learn these skills.
Is the training only for the very young individual and must it be 30-40 hours a week? Early
intervention can make huge differences, but that does not mean discrete trial training can’t be beneficial
for older children. The adage, “Better late than never,” applies. The intensity level, or number of hours
per week needed, varies with the child. High intensity would be for a short initial period. Dawson &
Osterling (1995) recommended at least 15 hours a week of instruction for an effective early intervention
program. Once the child begins to speak and learn, the program must be broadened so that skills can
generalize to more natural situations.
Unfortunately, focus on the one-to-one discrete trial format exclusively can train behavior that is
not meaningful, generalized or spontaneous. The child may develop “splinter skills” but not make
general applications. This training model does not take into account sensory problems that may underlie
the unusual behaviors and communication difficulties. Some individuals experience increased anxiety,
perseveration and rigidity from this intense level of programming.
Children need time for spontaneous play and learn to be a child. They need social interaction
with other children. They need to understand how to learn in groups and not become one-to-one prompt
dependent. If we want these individuals to be able to function in our schools and in society, they will
need to move past the one-to-one discrete trial format into a structured classroom with the opportunity
for typical childhood experiences.
The children who seem to benefit most from intensive behavior training are those who are
nonverbal and non-compliant. Children with milder problems may benefit from the use of discrete trial
training in combination with social integration, structured teaching, sensory integration and/or other
support services. Discrete trial training is an excellent tool, but is only one of the tools we have which
help individuals with autism.
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References
Dawson, G. & Osterling, J. (1995). Early intervention in autism: Effectiveness and common elements of current
approaches. In M.J. Guralnick (Ed.), The effectiveness of early intervention: Second generation research.
Donnellan-Walsh, A., Gossage, L.D., LaVigna, G.W., Schuler, A.L., & Traphagen, J.D. (1976). Teaching Makes
a Difference. Sacramento, CA: California State Department of Education.
Myles, B.S., & Simpson, R.L. (1990). A clinical/prescriptive method for use with students with autism. Focus
on Autistic Behavior. 4,1-14.
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Reprinted with permission from American Association on Mental Retardation
Treatment Outcome is Encouraging

Gary B. Mesibov, University of North Carolina at Chapel Hill
McEachin, Smith, and Lovaas (1993) is a follow-up of Lovaas (1987), in which he reported that
an experimental group of 19 preschool-age children with autism following an intensive behavioral
intervention program achieved less restrictive school placements and higher IQ’s than did subjects in
control groups.
It is not my goal to question the overall findings. For many years, behavioral approaches have
been effective with students who have autism, and this intensive intervention should bring about positive
and enduring changes. What is at issue is the magnitude of the changes and what they mean.
One must be careful in interpreting these results because the subjects were not randomly
distributed between the groups. Although McEachin et al. (1993) tried hard to demonstrate that the
control and experimental groups were similar, the only sure way to avoid the possibility of biased groups
is random assignment of subjects.
Concerns about the representativeness and comparability of the sample group are raised because
(a) different cut-off ages were used for echolalic and mute children, and the authors did not state how
these ages were selected; (b) the control group had fewer higher functioning clients than one would
expect in groups of this size: typically, 20% to 30% of people with autism are higher functioning,
irrespective of the services that they receive; and (c) different testing protocols were used for clients in
different groups.
The other concern with McEachin et al.’s (1993) study is that readers might jump to the
conclusion that the children have been cured. This has been an unfortunate consequence of other
presentations and studies published by these authors. Although their results are impressive they fall far
short of demonstrating normal functioning.
The main measures used in this study were restrictiveness of school placements, IQ’s and
adaptive behavior. Though gains in these areas are significant and important, they do not indicate
normal or even near-normal functioning. There are many high-functioning people with autism with
near-normal IQ’s and adaptive behavior participating in regular public school programs who remain
severely handicapped. To think otherwise is to minimize the severity of the social, cognitive, and
communicative aspects of autism.
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Many skills required for normal functioning have not been measured by McEachin et al. (1993).
They did not report on the students’ social interaction, friendships, conceptual abilities, and social
communication, skills likely to differentiate children with autism from their peers without handicaps.
These are important aspects of the autism syndrome and deserve more scrutiny in further studies.
In summary, the study confirms that behavioral interventions are effective in the long run. How
effective, we still do not know. Long-suffering parents of children with autism should take heart from
what McEachin et al. (1993) have reported, but they should also remember that much work remains to
be done.
References
Lovaas, O.I. (1997). Behavioral treatment and normal educational/intellectual functioning in young autistic
children. Journal of Consulting and Clinical Psychology, 55, 3-9.
McEachin, J.J., Smith, T., & Lovaas, O.I. (1993). Long-term outcome for children with autism who received
early intensive behavioral treatment. American Journal on Mental Retardation, 97, 359-372.
Interview with Ivar Lovaas

Interview appearing in the Advocate Nov-Dec 1994 conducted by Catherine Johnson
Professor Ivar Lovaas of UCLA is best known for his long-term study of 19 autistic children
whom he treated in the early 1970’s with 4,000 hours of intensive behavioral therapy, far more treatment
time than anyone had ever put into small children before. Not surprisingly, his finding that 9 of these
children, all now grown, went to achieve “normal functioning” — that fully 47% of the sample could be
said to have recovered from autism — has been the subject of much controversy. Some authorities in
the field are convinced, some are not; as with any research the issue cannot be resolved until others have
replicated his findings. Replication studies are currently being set up at four sites. It is important to
point out that Professor Lovaas does not claim to have found a cure for autism. As he says, “I don’t
claim a cure because we haven’t gotten to the organic variable that is causing the autism. But the
nervous system is pretty adaptable, and with intensive therapy the child may be able to work around his
organic deviation.”
Professor Lovaas has turned his attention to the “other half”; he is concentrating on the children
who do not respond well to his language-based treatment. These are the children whom he calls visual
learners, whose spoken language remains very poor or absent even after years of training. “In a sense,”
he says, “the kids who are recovered aren’t interesting anymore. In the next 5 years a lot of things will
happen with the visual learners; we’ll begin to understand how to teach them, too.”
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ADVOCATE: Why don’t we begin at the beginning?
LOVAAS: I first became interested in psychology during the German occupation of Norway — the
country where I grew up — during World War II. I was a boy then, and I wondered whether such
destructive actions were caused by genetics or by the environment. I hoped for the latter, because that
would be easier to change. So you could say that my own childhood environment determined my
eventual interest in the behavioral treatment of children with autism.
ADVOCATE: Jumping forward 20 years, how did you come to the idea of intensive behavioral therapy for
children with autism?
LOVAAS: We began treatment research in 1963. We institutionalized 20 children at UCLA’s

Neuropsychiatric Institute, and we treated them intensively for a year. They were ages 5 to 12; they were
children, but not tiny. Many of them had already been institutionalized for a number of years. What we
found was that with intensive behavioral therapy they could learn some very advanced concepts:
abstract language, time concepts, prepositions, nouns — things people didn’t think autistic kids could
learn. But they fell apart at discharge, especially the ones who went back to the state hospital where they
lived. They lost everything they had learned. It was heartbreaking.
ADVOCATE: And the children who went back to their parents?
LOVAAS: For the most part they held onto their gains. The environment has a tremendous role to play in
either maintaining or suppressing new skills. This is true for all of us, by the way.
ADVOCATE: People will lose new skills if the environment does not sustain them?
LOVAAS: Yes. We are extremely adaptable, more than any other animal, and once we have acquired a
new skill we can lose it unless it is maintained by the environment. Nazi Germany shows us the critical
importance of the environment to behavior. Here was the German culture, a culture that had done more
to recognize and reward art and science than any other European nation, and yet it perpetrated some of
the most savage acts of slaughter in history. A normal person can be highly affectionate in one
environment, terribly destructive in another.
ADVOCATE: What you’re saying reminds me of a married couple I know who function pretty well inside
their therapist’s office, but who can’t “take it home”. The wife told me that just walking inside the door
of her house makes her feel like starting an argument, whether anything has happened to provoke her or
not. The environment sets her off. Drug treatment programs also use this principle when they warn
sober clients not to return to their former druggie environments.
LOVAAS: That’s what happened to the children who returned to the state hospitals. Going back to their
old autistic environments made them return to their old autistic behaviors. Now, of course, this kind of
statement can be misinterpreted to mean that autism is caused by the environment, which it is not. A
“bad” environment can’t make a child have autism. What the environment can do is either support or
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discourage behaviors associated with autism. Another thing about environment: because their nervous
systems are incredibly different from those of typical children, autistic children do not learn well from
the average environment. The average family environment in which we raise children has evolved over
thousands of years to meet the needs of these children. But the average environment doesn’t engage the
autistic child; it passes the child by. It’s neutral. So you have a child with little or no experience. Even
though he’s living in a rich family environment, it’s not a rich environment for that child.
After we saw the children in our first project lose their gains, our goal became to create an
environment that was as close to a normal environment as possible, but that worked for children with
autism. First, we took them out of the hospital and clinic settings and taught them at home. Originally
we had treated children in the hospital because of the widespread belief that in any experiment a
controlled environment is best — and a hospital is a controlled environment. But teaching them in the
hospital meant they didn’t transfer their learning to other environments. Second, we trained parents to
work with their children, too. Before this time the idea had been that a professional worked with the
child, then the parents fed, clothed, and loved him. But here, too, when the parents aren’t trained in the
techniques, the child can regress. The family environment doesn’t support the gains the child has made
with the professional.
ADVOCATE: We recently had an experience that illustrates exactly what you’re saying. We kept getting
reports from Jimmy’s teacher about all sorts of things Jimmy was saying at school, and how much
progress he was making in his language. And yet at home we weren’t seeing any change at all.
Obviously, in your terms, he wasn’t generalizing his school gains to home. Finally we put our foot
down: we started demanding that Jimmy use his new language at home, too. And he did.
LOVAAS: Our third innovation was to try to make the autistic child’s environment as intensive as that of
other children. The typical child learns 16 hours a day, every day, weekends and holidays included. His
environment is constructed so that he is always learning. So we created a treatment program that would
make sure the autistic child was always learning, too. We gave each child in the study 40 hours of
treatment a week, week-in, week-out. Eight hours a day isn’t as good as 16 hours a day, but it’s better
than what autistic children normally get, and their parents extended the treatment beyond those 40 hours.
So each child in the experimental group received an average of 4,000 hours of therapy over a course of
two years or more. And these children made dramatic gains. 47% were able to attend regular classes
and pass the first grade on their own. That group has maintained those gains throughout their
childhoods.
ADVOCATE: How normal is normal? Would these children look normal not just on paper-and pencil
tests, but out in the world?
LOVAAS: Unfortunately, until recently there haven’t been any good tests for residual signs of autism. So
for the second follow-up, when the children averaged 13 years of age, we designed an interview that
covered things like sense of humor, empathy, their ability to plan their day, whether they perseverated on
topics or should change subjects, whether they had friends and how they talked about those friends.
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Small, subtle things. We did this because most high-functioning adults with autism, while they are
doing extremely well, are still “different”. They tend to be socially awkward, they show not-quite-
reciprocal interacting, maybe they have a quaint way of putting things in terms of intonation and
wording. Anyone who meets them can see this. The psychologists who conducted the interviews with
the 13 year-olds were recruited by a clinician not associated with our clinic. They did not know that the
young people they would be testing had once been diagnosed with autism; nor did they know that we had
added teenagers with no history of psychiatric disturbance to the group. None of the psychologists
noticed a difference between the autistic children and the others.
ADVOCATE: This is probably the point at which to raise the question of whether your experimental
group was more “high-functioning” to begin with, as some critics have charged.
LOVAAS: Well that’s an interesting question, and we used a control group design to check for this
possibility. Originally we wanted to match each child who entered the experimental condition with a
child who entered the control group on the basis of intake IQ and chronological age. Then the procedure
would have been to toss a coin to decide which child entered the intensive treatment and which child
was to be placed in the control group. If the groups were different after treatment, this could then be
attributed to the treatment provided to the experimental, intensive treatment group. It didn’t work out
because the parents said they would strike. No parent would voluntarily allow his child to be put in the
control group where he would receive almost no treatment at all − though we did, by the way, give
control group children some behavior therapy. But it was always under 10 hours a week.
We had to move to a wait-list control group, which was a variant on the first-come-first-served
principle. We set up the two groups purely according to what staff were available just before the family
contacted us. If we had staff members ready to perform intensive therapy with a child when the parents
brought that child in, the child went into the experimental group. If we didn’t have staff available the
child went into the control group.
ADVOCATE: I’ve read commentaries on your work by experts who say that while this isn’t exactly a by-
the-books random assignment, it’s close enough − that your selection procedure was “functionally
random”.
LOVAAS: We believe that the children who received the therapy were equivalent at the beginning of
treatment to the children who did not. We had 20 “pre-treatment variables”: socioeconomic status of
the family, number of siblings, age at diagnosis, use of recognizable words, toy play, and so on. These
measures showed the groups to be equivalent at intake. We put together a second control group from
another agency by matching those children with the experimental group children on intake IQ and
chronological age. All groups had the same IQ at intake; there were just as many high-functioning
children in the control groups as in the experimental group. And in the control groups only one child out
of 40 achieved normal functioning by age 6.
ADVOCATE: What was the average IQ?
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LOVAAS: Sixty. But this question of high-functioning children is very complicated, because when
people say an adult is high-functioning, that judgment is retrospective. Today’s high-functioning adult
may not have looked high-functioning at all when he was two years old. You can’t tell going in which
child will succeed. I’ve been doing this for over 30 years, and I still can’t pick which child will do well
and which child will not. I can’t tell you how often a professional has come to me with a child and said,
“This child is going to do great, all he needs is some help with compliance.” And then that child turns
out to be one of the ones who does not progress. No one can tell.
ADVOCATE: So you’re saying that you couldn’t have picked high-functioning children even if you’d
wanted to?
LOVAAS: That’s right. Another aspect of the high-functioning idea: people think that a child who is
high-functioning at 2 or 3 will just naturally make a lot of progress. But this, too, isn’t supported by the
data, which show that, if anything, the children with highest IQ’s in the first place tend to regress to a
small degree. [See Freeman, B.J., et al. (1985), “The Stability of Cognitive and Linguistic Parameters in
Autism: A 5 Year Study” in the Journal of the American Academy of Child Psychiatry, Vol. 24, pages
290-311. Also see Lord, C. & Schopler, E. (1989), “The Role of Age at Assessment, Developmental
Level, and Test in the Stability of Intelligence Scores in Young Autistic Children” in Journal of Autism
and Developmental Disorders, Vol. 19, pages 483-499.] Their regression wasn’t statistically significant,
and it may have been simply a matter of the higher-IQ children being given tests with a larger proportion
of verbal items. But still, what you don’t see in these studies is the children with the highest-IQ showing
the major gains many people expect they would.
Looking at this issue from another angle: about 30% of any random sample of children with
autism will be called “high-functioning”. And yet only about 2% of all children with autism grow up to
live independently. What happened to all of those other high-functioning little children? Obviously they
did not make the progress people expect.
ADVOCATE: Did you find any factors that did predict success?
LOVAAS: IQ did correlate with outcome to an extent. We found a .58 correlation between IQ and
success, which means that you cannot predict improvement in individual cases. And Professor Tristam
Smith and I have completed a second study that found no correlation between IQ and success in the
treatment. In this study we were able to use a match-pair, random assignment procedure. The study is
not finished yet, but preliminary data show a comparable outcome to that of the 1987 study. The only
truly strong predictor we found was the child’s skill in verbal imitation at the end of 3 months of
treatment. 90% of the kids who learned verbal imitation at the end of 3 months of intensive treatment
reached normal functioning. We’ve developed a test we call the “Early Learning Measure” (ELM)
which is highly predictive. Essentially it measures how quickly the children learn. The child who starts
out the fastest, remains the fastest. The fastest learners − and this may not be the child with the highest
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IQ going in − do the best. 90% of the children who score well on the ELM will achieve normal
functioning.
ADVOCATE: What do you mean by verbal imitation?
LOVAAS: The children learn to echo an adult’s words or phrases, with correct pronunciation. These are
words like “baby”, “mommy”, “daddy”, “car”, etc. The enunciation was clear and succinct, like that of
typical children. Children go through an echoing stage; children with autism do also. This is at 35
months, average at beginning of treatment. The children who achieved normal-functioning became
echolalic within 3 months; they like to echo adults’ speech.
Echoing is much more than just a rote kind of parroting, by the way. It’s part of the process of
thinking. For example, if I say to you, “What is 2+2?” you’ll say “4”. But if I say to you, “What is 2+2
minus 3+6?”, you’ll echo it. You might echo it subvocally; you might not say it out loud because your
mother has taught you not to echo out loud. But in your mind you’ll be echoing my question so as to
hold onto it, to process it better.
ADVOCATE: That example could be a good exercise for teaching people about autism. I have to say,
when you just asked me “What is 2+2-3+6” I instantly echoed It in my mind, word for word. While we
don’t have a great deal of space, I think it’s important to try to tell parents something about what
teachers and aides were actually doing with those children for 4,000 hours. What is “behavior
therapy?”
LOVAAS: One thing it is not, is a method only for controlling bad behaviors such as tantrumming and
the like. That is the least interesting thing you can do with behavior modification techniques. People
also think of behavior modification as “Brave New World”, as a technique to make everybody fit one
mold. But that’s just the opposite of what we want to do. We help build behavioral variability in
children with autism, which increases their ability to adapt to new environments. When you study
behaviorism you are alerting people to the variables that control behavior so as to escape them. That
way people are less likely to be misled by tyrants, small or large.
Getting down to specifics, a “behavior” means anything you can observe. Social interactions are
behaviors; an emotion is a behavior − anything measurable is a behavior. So in our study we used
scientifically based principles of learning, adapted to autistic children, to teach the child everything he
was missing. We taught the children how to pay attention, how to imitate sounds, how to understand
what people were saying to them, how to use nouns, verbs, pronouns, prepositions, and other abstract
language. We taught them how to play with toys, to show and receive affection, to relate to another
child. We taught them everything.
We had to teach everything because we found that the autistic child needed teaching in
everything. But we didn’t realize this when be began. For a long time we also thought that if we taught
one critical skill, others would naturally follow − that, for instance, if you taught the child to be
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affectionate or emotionally attached to his parents, all kinds of other progress would automatically
happen. For a while we also thought that if you just got the child talking, all kinds of other good things
would follow. But none of this proved to be true; we could never find the “lever”. In autism there
appears to be no one, central deficit; the children had many, many deficits in many, many areas, and each
area had to be addressed specifically.
ADVOCATE: In reading The Me Book I was interested to see that you had even used operant
conditioning to teach children with autism spontaneity!
LOVAAS: Spontaneity, and the desire to learn. Our goal was to create a joy of learning in the children, to
make it more fun for them to tune in and learn than to spin or flap or wander around the room.
ADVOCATE: Watching your team work briefly with Jimmy, who has just turned 7, I was interested to see
that you would actually terminate a “trial”, or a teaching session, after only 30 seconds or so to keep
the student from becoming bored or resistant. At one point all Jimmy had to do was sit in his chair and
raise his hands in the air when the teacher asked him to, then pat his head when the teacher asked him
to. And that was it − he was up for a break. They kept it short and sweet.
LOVAAS: Almost all children we see respond with aggressive behaviors, when we try to teach them.
Some children are aggressive against their adult therapists, while others are self-injurious. This is
understandable, because for years these children have failed to understand what their parents and
teachers have wanted them to learn. Who would not act in a similar manner? Aggression is a sign of
healthy motivation, and this motivation can be used to build more socially appropriate behaviors for
controlling the environment. Therefore, a cardinal principle is to maximize success, to always end on a
success. And, make the learning steps easy enough that the child is sure to have a success.
ADVOCATE: That was another interesting concept I picked up from watching your team work; nothing is
ever considered too “easy” for the child. You always intersperse some incredibly easy tasks — tasks the
child is way beyond, like asking a 7 year old to raise his hands in the air — with the harder tasks.
LOVAAS: We ensure success to build confidence in the child that he can do it. Always, in every teaching
sessions, the two fundamental goals, apart from the content being taught, are to make the child want to
learn, and to make the child feel that he can learn. That he is competent.
ADVOCATE: So in every teaching session you are trying to increase the child’s motivation and
confidence, as well as his skills. I know parents would like to hear some of the specific techniques
involved.
LOVAAS: First of all, we taught all of the children one-on-one.
ADVOCATE: Sometimes two-on-one according to The Me Book. I remember several instances where
you talk about having the main teacher sitting in front of the child, with an assistant behind the child to
help him carry out the request.
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LOVAAS: Yes. These children do not learn in groups. They can be taught to learn in groups, but it may
take 1 or 2 years of intensive one-on-one training to reach that point. As I say, half of our children
eventually came to the point where they could learn well on their own in a regular classroom setting.
Another basic principle is to break down the content being taught into its smallest units, and then teach,
and reinforce, each unit separately.
ADVOCATE: I noticed that in The Me Book you list 11 separate steps to be taught just for putting on
pants.
LOVAAS: We also use “prompts”, which are a way of getting the child started following an instruction.
So, for instance, if you say to your child, “Raise arms,” you prompt him by raising his arms for him −
and then rewarding him lavishly. Gradually then you “fade back” the prompt on successive trials.
Instead of raising his arms all the way, you raise them part of the way. Then, instead of raising his arms
at all you might simple give his hands a small boost. You are fading back until the child can follow the
instruction on his own.
ADVOCATE: For our readers’ sake I’d like to add that some of this can be done quite easily just in the
course of the day. When Jimmy was two a speech therapist taught us a variation on the prompting
technique, which he called “motoring through.” Every time we asked Jimmy to do something, we were
to put our hands on him and walk him through the action. If we asked him to “close the door” we took
his hand and motored him through the action of closing the door — instead of standing around feeling
frustrated and upset that he wasn’t responding, which is what we had been doing. It was easy to do, and
Jimmy acquired a huge amount of receptive language that way, and incidentally quite a bit of
compliance. It was a wonderful teaching technique.
LOVAAS: “Shaping” is another important part of teaching through behavior therapy. When you shape a
child’s behavior you gradually demand more accurate and complex responses from the child in order to
receive the reward. With the “raise arms” instruction, at first you might praise and reward the child for
any upward movement at all. Then, as he gets the hand of it, you withhold the reward until he gets his
hands farther up. Eventually you have shaped the behavior to the point at which he can immediately
raise his arms all the way up and hold them there for a couple of seconds before he is rewarded.
ADVOCATE: Your book has a lot of interesting things to say about choosing reinforcers.
LOVAAS: Any child can be taught if an adult has patience and access to what the child wants.
Sometimes you have to be very creative about discovering what reward will work for your child. We
had one little boy who didn’t seem to want anything. No food, no hugs, no tickling; nothing worked. It
was pure effort trying to teach him. Then we found by accident that he liked to pour water from one
glass to another. This was his obsession in life. So we got him water and glasses and that was his
reward for learning. Every time he got a response right, he got to pour some water from one glass to
another. This is what we call getting control over the child.
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ADVOCATE: I was interested to read in your book how vitally important you consider compliance to be.
LOVAAS: It is impossible to expose the child to any higher skills when he will not cooperate.
ADVOCATE: Before we go on, I’d like to add that, speaking as a parent, you do have to do some studying
to grasp these techniques. Read books, watch videotapes of teaching sessions, perhaps take a course or
workshop. My husband and I had a few hours of training in behavior modification three years ago,
which frankly was not enough, and we realized we would never have come up with this approach on our
own. Behavior therapy doesn’t just come to a parent “naturally;” you really have to work at it if you’re
going to do it in any kind of comprehensive way.
LOVAAS: That is the Golden Rule of autism treatment: does the therapist need training to perform the
treatment? If no real training is needed, the treatment is not going to work. That was what was wrong
with all the Bettelheim-based theories of curing the children by giving them love. Anyone can love
these children, you’d be heartless not to. But it takes training to use love in a constructive manner. If
you love a child with autism when he is self-injurious, you escalate self-injury. It takes a minimum of 9
months of closely supervised training in one-on-one therapy to learn how to build complex behavior, like
languages. And then you have to be updated periodically, because new and better programs are
continually being developed.
Beyond this, we find it’s important for trained staff to work in groups. Our therapists meet at
least once a week to demonstrate their teaching techniques to each other. We structure it this way to
prevent what we call “drift off criterion” − to keep the therapists on track. It’s very easy for any one
therapist working alone to drift away from the programs. Regular meetings keep people from getting
sloppy; they keep everyone’s motivation high.
ADVOCATE: Unfortunately, I can relate to this issue all too well. My husband and I are constantly
setting up little “home programs” for Jimmy. We make a plan: we’re each going to do so much “table
time, “ so much story-reading, so much toy play with him every single day. We start out great, then we
hit the “drift off” point about three weeks later. It’s like going on a diet. Actually, it’s harder than
going on a diet. Burnout is a real danger with these kids.
LOVAAS: That’s what we want to avoid. And at UCLA we have the added incentive that the student
therapists will be getting a grade in my course at the end of the quarter!
ADVOCATE: Before we finish with techniques, we should raise the issue of aversives.
LOVAAS: Putting it in historical perspective: when we started working with these children back in the
60’s, very little was known about how to treat children with autism. We were asked to consult on some
extreme forms of self-injury that were occurring in the large institutions. These were kids who were
poking their eyes out, breaking their noses. What we found, again quite by accident, was that
“contingent aversives” − in other words punishments − put a stop to it.
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ADVOCATE: You discovered this accidentally?
LOVAAS: We noticed how panicked the extremely self-injurious children were by the thought of getting
a shot.
ADVOCATE: You were seeing children who were suffering terrible pain at their own hands every day,
and yet they were afraid of a shot?
LOVAAS: Yes. So we hypothesized, and then tested the hypothesis, that a punishment might work to
stop the self-injurious behavior.
ADVOCATE: An external punishment might stop a self-punishment.
LOVAAS: The Problem was that it turned out the children adapted to the aversives. The self-injurious
behavior would stop, maybe for two days, two hours, two months, and then it would pop right up again.
We’d have to apply the aversives again, only this time we’d have to be more aversive. The aversives
became like butchery; the more you learned about the client the more you thought that applying the
aversives would be like being a butcher.
ADVOCATE: What were the aversives?
LOVAAS: A smack on the butt or an electric shock. Before we tried that the institutions had used
restraints and chloral hydrate, and the children adapted to the drugs, too. They were taking doses of
chloral hydrate that would kill you or me and it still wasn’t working. The problem was that we did not
know enough about how to build alternative behaviors, like language, at that time. The child controlled
his environment through self-injury, the only way he knew how. If all positive approaches have failed,
the only use for aversives is to stop the self-injury long enough to teach alternative behaviors like
language — if aversives are going to be used at all. But I’m afraid that most people who use aversives
do not know how to teach these alternative behaviors.
ADVOCATE: We should mention here that when parents bring their children to the UCLA program they
agree to the use of only two negative consequences for disruptive or “inappropriate” behaviors: saying
“No”, and giving time-outs.
LOVAAS: Yes. But in actual practice the main strategy we use is to avoid negatives altogether. Our
therapists “work through” the child’s behavior, keeping him on task even if he’s tantrumming or trying
to bite. Certainly no negative interventions are implemented until parents have been informed of what
the procedures consist of and the reasons for their use, and have given their explicit verbal consent for
them.
ADVOCATE: Moving on, a lot of the debate about your work revolves around the question of whether
47% of autistic children could really achieve normal functioning through your program. It’s such an
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extraordinary result, but as my editor pointed out, even if 47% did recover, that still leaves 53% who did
not. What are your thoughts on those children?
LOVAAS: 2 of the 19 showed no change at all even after 4,000 hours of treatment. The rest weren’t
doing badly; they all made gains. But they were still autistic, that would still be their diagnosis. In our
program, skill in auditory matching is the only predictor at the end of three months: can they imitate
sounds like words? This shows the limitation of the program because it is really focused on vocal
language. That’s why I don’t like to talk about high or low functioning kids, because we have some kids
in the reading and writing program who are very smart, but very handicapped in the auditory program.
At present there are few good programs for visual learners, but there is a beginning.
ADVOCATE: How do you know which kind of child you have?
LOVAAS: If he is becoming echolalic, he’s an auditory learner. You can safely make that assumption.
But if a child is mute you cannot assume that he is a visual learner unless you have given him a chance
to learn to imitate sounds and words. By the way, there are only a handful of professionals who can
teach verbal imitation. It is the most difficult program to master, both for the therapist and the child.
We’re working on the visual learners now, as are many other professionals throughout the
country. We had one little boy who had not mastered verbal imitation, so we began teaching him the
beginnings of writing. One of the things we taught him was to match the letters a-p-p-l-e to a card with
the word “apple” spelled out on it, and we had also taught him to match the word-card “apple” to the
apple itself. One day he sat sown at the table with the apple in front of him along with 10 or 12 alphabet
cards, each with a different letter on it. He spontaneously, and very carefully, separated out the letters a-
p-p-l-e, and discarded all the rest. We didn’t teach him to do that, and I don’t think you would ever see
it in an average 2 or 3 year old. It was a stroke of genius; he spontaneously organized his workplace
without ever having been taught to do so. And yet this little boy had an intake IQ of 47 on the Bayley.
There are nonverbal kids who love numbers and letters. Back in the ‘60’s, for instance, we found
one nonverbal, extremely self-injurious boy at a local state hospital who learned the alphabet in one and
a half hours of teaching. Some of the children were extremely smart. People can’t make the assumption
that the child already has it all inside of him and you don’t have to do much treatment. People have
wished this for 200 years, that it’s all inside and you just have to find a way to let it spring out. That was
Bettelheim’s thinking, too, that a little warmth would let a fully-developed child jump out. How easy!
But the truth is, it takes hours and hours and hours of intensive work to teach these children.
Human behavior − all human behavior, not just autistic behavior − changes very, very slowly, and in
small increments. Darwin put it best: Nature does not make leaps. Throughout the history of autism
treatments, people have always looked for sudden “breakthroughs”. We looked for them, too, in the
beginning. But we found that the children never have breakthroughs. They just keep moving forward,
slowly, steadily, with tremendous effort on everyone’s part.
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ADVOCATE: Speaking as a parent, that is the most daunting aspect of your program how completely it
could absorb every moment of your waking life.
LOVAAS: This is where parents need to become political. In Norway if you give birth to a child with
autism and the disorder is diagnosed early, you are assigned a special ed teacher, one-on-one, for the
child’s entire childhood up to age 18. It’s a good investment for the state, because the child can stay at
home and in the community for longer. We need that here. Supplying each child with autism with his
own special education teacher would be expensive; it would cost somewhere in the neighborhood of
$30,000 a year per child. But the savings in terms of housing and support costs for children who go on
to live independently would be enormous, somewhere between 2 to 3 million dollars over a lifetime.
Intensive one-on-one teaching for developmentally disabled children starting at the age of 2 should be an
entitlement.
ADVOCATE: It’s going to have to be an entitlement, since the cost of trying to do this on your own, with
no help from the government, is going to be out of reach for most families.
LOVAAS: People who want to become politically involved can contact FEAT, Families for Early
Autism Treatment, in Sacramento. In the meantime, individual families can hire an attorney and sue the
state for these educational benefits. The parents I know who have done this have gone through an
extremely stressful set of court proceedings.
They can also take advantage of local volunteers. I can’t tell you how many families we know
who have been able to recruit volunteers from family, schools, and churches to put in the necessary
hours. Sometimes a family will pay one person around $15,000 to oversee the whole program on a 20
hour a week basis, and that person then oversees the volunteers. Families who hire students pay them
somewhere in the range of $5.00 to $8.00 an hour.
ADVOCATE: I think it would be good to point out that although you do need training in the techniques,
most people can learn how to do this.
LOVAAS: Some people take to the training right away; others don’t. But many people can do this
without years of expensive training. In our own program we charge parents $1,400 for a two day
workshop to teach the methods. Then we usually follow up with a second workshop two months later
for $600 or $700. Some families have been able to get this paid for by the school district.
I’d also like to point out that there are many behavior therapists helping develop programs across
the country. The wonderful thing about behavior therapy is that it’s not tied to one expert; there is no
Freud. These techniques have been built up by many behaviorists working with many children over
many years’ time. It is a constantly developing system. For instance, we know that these children have a
crucial deficit in what we call “observational learning”. That is, they don’t learn by watching what the
child next to them is learning − which is critical in a classroom setting. So a teacher will say to one
child, “Where do you live?” and the child will answer, “Chicago”. Then you ask the autistic child,
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sitting beside him in the same classroom, “Where does he live?” and the autistic child will not answer
because he may not even have heard the other child respond to the teacher.
This is a basic principle in a classroom environment: a child must be able to learn from what he
hears another child learning. So now we are setting up steps to teach autistic children how to do this −
but we are only beginning this now! It took us 30 years to figure out how to do this. That is what I mean
when I say it is a constantly evolving field. The field of behaviorism is a lot of people working together
contributing to effective treatments in a step-by-step, cumulative manner. And that is what you need for
your child. A lot of people working together.
ADVOCATE: I think the question that is probably on a lot of people’s minds at this point is: if you can’t
do it full-time, is it worth even bothering? Is a little better than none?
LOVAAS: A little is definitely better than none. The children in the control group, who had only a little
behavior therapy each week, like being toilet-trained and gaining some compliance, may have made
important gains. These techniques are worth knowing and practicing to the extent that you can.
ADVOCATE: And what about age? Parents can get the impression, reading your work, that if they
didn’t begin behavioral therapy by age 4 all is lost.
LOVAAS: There is no age cut-off for behavioral therapy. As I said, behavior therapy is incremental; it
goes step by step. So you start where you are today, and you move forward in tiny steps. Say you have
an 8 year old who likes to echo: well, he’s part of the way into the program. Half of the kids never
became echolalic. Take the program and begin where he is.
On the other hand, early intervention is important because it allows the children to develop
friendships at age 3 and 4, when children’s friendships are not yet enormously complicated. The idea is
to hook the autistic child on other children early on so that the other children provide a treatment. The
parents “fade out” and the peers “fade in”.
ADVOCATE: Before meeting you for this interview I canvassed my friends for questions, and one of the
biggest ones that came up had to do with social skills. How do you use behavior therapy techniques to
help your child develop friendships? It seems so much more complex than teaching nouns and
prepositions.
LOVAAS: Social ineptness is the definition of autism; it’s the one thing all autistic children have in
common. They don’t have IQ in common; they don’t have problems with emotional attachment in
common. But they all have social delays. They do not play with peers.
With the children in our study, first we work with them intensively for around 6 months to get
them to the point where their language skills were pretty good. They might be 3 or 4 years old now, and
they can sit in a chair when an adult tells them to, sit in a circle when an adult asks them to do that, and
they have gotten over their tantrums.
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Then we look for a school. We go with the mom to a neighborhood and find a pre-school with
one or two teachers in a class of 10 children and we ask them, “Would you accept a child who has
difficulties playing with other children?” We don’t mention autism at first, because it blows teachers
off, giving them ideas of Bettelheim, or the “cold” parent, or of institutionalization forever. We just ask
if they can take a child who doesn’t play with other kids too well, and whose language isn’t that great.
And we always look for a teacher whose style is structured. Autistic children do better with these
teachers than with the teachers who let things free-flow.
Then we ask the teacher, “Can we be present when the child is here?” When she says yes, we
say, “Can we suggest new ways of handling him if things don’t go well?” If she says yes again, we settle
on that school.
Then we decide what portion of the day the child is going to attend. Maybe we decide that he
will go for circle time; if so we practice circle time at home. Or maybe we decide the free play period is
the best place to start, so we practice free playtime at home. Ring around the rosy is an easy game for
any child to learn, and we practice it at home with the mom and the student therapists playing the other
kids. One good thing about pre-school, in terms of integrating an autistic child, is that pre-school
activities are mostly high level, socially acceptable forms of self-stim. “Itsy-Bitsy-Spider” is a good
example, and there are many more.
Then the child goes to the school, with his therapist or mom as a “shadow”, and he stays there for
only half an hour so he’s successful. Then gradually we extend the time in school, and fade the
“shadow’s” prompts. The problem is that as long as the aide is there things look real good, but what do
you do when the mom or therapist begins to fade back? If the teacher is willing to take over her
functions, that’s OK, but not all teachers will do that. The critical thing at this point is that you don’t
want the child to regress. So the child may need his aide for a long, long time, which is what the
Norwegian system is based on. Once the child is getting along in pre-school and the regular teacher and
peers have control over him, then he’ll on his way. Half of our kids could do this, half could not.
The ultimate goal is to transfer control from the teacher to the other children. I believe that this
is why the normal-functioning children in our study did not regress: we brought them to the point where
other children now controlled their behavior. As I say, it’s easier to do this in pre-school because the
social skills of preschoolers are not very advanced.
ADVOCATE: How do you go about helping the child transfer control from his aide to other children?
LOVAAS: Say the child doesn’t talk to other kids. He’ll only talk to adults. We ask the teacher which
child in class seems to like the kid best, and wants to play with him. The teacher tells us, “Chuck likes
Billy a lot”.
So we go to Chuck’s mother and we say, “Can Chuck come and play with Bill?” If she says yes,
we ask if Chuck can come over for two or three afternoons a week, with his mother, if she wants to join.
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Then we teach Billy to talk to Chuck, and Chuck to talk to Billy − since Billy can already talk and play
with us. We teach them to play together. We transfer control from the adult to the peer. We use board
games a lot because the children have to take turns rolling the dice, which is a good model for the back-
and-forth of conversation. We look for games that depend on language − always remembering it is a
very slow process, with no sudden breakthroughs.
ADVOCATE: What are your thoughts on the notion that autism is a spectrum, that there are people with
mild cases of autism who move through life without ever being diagnosed? This is an idea that intrigues
a lot of people in the wider public; TIME MAGAZINE ran a tongue-in-cheek piece they called
“Diagnosing Bill Gates”. They put Gates side-by-side with Temple Grandin and listed all the
similarities between them.
LOVAAS: I find the idea of mild autism extremely interesting. In the Scandinavian countries there are a
lot of mildly autistic individuals, because they selected themselves out for that climate. They like to be
alone in the dark; they thrive on it. Some people kill themselves in those cold, isolated regions, but a
mildly autistic person might like it. When you talk to these people they don’t look in your eyes, they
look at your shoes, and the conversation is a bit echolalic. You’ll say, “The weather’s pretty good
today,” and they’ll say, “Yeah, pretty good today.”
If you think of autistic children as being on a continuum with the rest of us, then you stop seeing
them as pieces of pathology; they fit into the natural order of things. I believe that the unusual persons
come into our world as people who are here to protect us against an uncertain future. There is strength
in variability. If you look at the great scientists, they have allowed us to survive in a future we could not
have predicted. And if you look at the great artists, the great artists have defined the future for us. Van
Gogh is a good example: someone who cuts off his ear to impress his girlfriend is definitely lacking in
social skills. What a loss to the world if we had sensitized him to social reinforcers and taught him the
skills to get them.
In general, Society depends on us average persons. We pay the taxes, we raise the kids, we go to
work. But if everybody were like us we wouldn’t be assured of survival. Part of the future belongs to
the individuals who are autistic-like − to the people we think of as “nerds”. A “nerd” is a person who is
awkward in social situations, which could certainly be a sign of mild autism. But without nerds perhaps
we wouldn’t have computer science.
I see autistic children as extremely interesting. I work with them 40 hours a week, and the more I
get to know the, the more interesting they are. We are learning something new every day.
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301.657.0881 • fax: 301.657.0869
© 1996 by Pro-Ed, Adapted with permission from the original appearing in the book Behavioral Intervention for Young Children with Autism
General Overview of A.B.A. Curriculum
Beginning Curriculum Guide
Attending Skills — sits independently, eye contact

Imitation Skills — gross, fine, and oral motor skills
Receptive Language Skills — body parts, identification, one-step instructions
Expressive Language Skills — imitates sounds, labeling, yes/no, greetings, answers simple questions
Pre-Academic Skills — matching, completes activities independently, counting, and identifies shapes, colors and
letters
Self-help Skills — gets undressed independently, eats independently, toilet training
Intermediate Curriculum Guide
Attending Skills — sustains eye contact, responds to name

Imitation Skills — imitates sequences, copies simple drawings, pairs actions with sounds
Receptive Language Skills — two-step instructions, identifies attributes, pretends, identifies categories,
pronouns, propositions, emotions, gender, answers “wh-” questions, sequence cards
Expressive Language Skills — two- and three-word phrases, requests desired items, labels according to function,
simple sentences, reciprocates information, asks “wh-” questions
Pre-academic Skills — matches by category, gives specifies quantity of items, uppercase/lowercase letters,
more/less, simple worksheets, copies letters and numbers, writes name, cuts with scissors, colors
within a boundary
Self-help Skills — gets dressed independently, puts on shoes, puts on coat, self-initiates toileting
Advanced Curriculum Guide
Attending Skills — maintains eye contact during conversation, and group instruction
Imitation Skills — complex sequencing, peer play, verbal responses to peers
Receptive Language Skills — three-step instructions, same/different, identifies what doesn’t belong,
plural/singular, understands “Ask…” versus “Tell…”
Expressive Language Skills — utilizes “I don’t know”, retells story, recalls past events, asks for clarification,
advanced possessive pronouns, verb tense, asserts knowledge
Abstract Language — predicts outcomes, takes another’s perspective, provides explanations
Academic Skills — completes patterns, reading, names letter sounds, consonants, spelling, states word meaning,
simple synonyms, ordinal numbers, identifies rhyming words, writes simple words from memory,
adds single-digit numbers
Social Skills — follows directions from peers, answers questions from peers, responds to play-initiation
statements, initiates play statements to peers, offers and accepts peer assistance
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301.657.0881 • fax: 301.657.0869
School Readiness — waits turn, demonstrates new responses through observation, follows group instruction,
sings nursery rhymes, answers when called on, raises hand, story-time,
show and tell
Self-help Skills — brushes teeth, zippers, buttons, snaps
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301.657.0881 • fax: 301.657.0869
© 1996 by Pro-Ed, Adapted with permission from the original appearing in the book Behavioral Intervention for Young Children with Autism
Resources
Companies to contact for catalogs:
Company Phone Products (see below)
ABC School Supply 800.669.4222 AD, ADV, PR, EN, M, V

Academic Therapy Publications 800.422.7249
Communication Skill Builders 800.866.4446 A, AD, ADV, PR, N, V, Wh
Constructive Play Things 800.448.4115 EM, S
Continental Press 800.233.0759 AC,
Different Roads to Learning 800.853.1057
Discovery Toys, Inc. 800.426.4777 EN, G,
Ebsco Curriculum Materials 800.633.8623 AC,
ECL Publications 602.246.4163 Wh
Edmark Corporation 800.362.2890 AC,
Imaginart Communication Products 800.828.1376 A, AD, ADV, C, G, I, N, PR, S, VE
Kaplan School Supply 800.334.2014 S
Lakeshore Learning Materials 800.421.5354 C, EM, M, S
Laureate Learning Systems, Inc. 800.562.6801 CO
LinguiSystems, Inc. 800.776.4332 ADV,
Mayer-Johnson Company 619.550.0084
Oriental Trading Company, Inc. 800.228.2269
Paul Brookes Publishing Co. 410.337.9580
Prentice Hall 800.223.1360
Prentke Romich Company 800.262.1984
PRO-ED 512.451.3246 I, N, V, VE, Wh
Ravensburger 201.831.1400 G
Research Press 217.352.3273
Super Duper School Company 800.277.8737 G, I
Associations ACademic Curriculums ADjectives ADVanced Categories/ COmputer

Language Classification Software
EMotions ENvironmental Sounds Games Irregularities Matching Noun Cards
Picture Books PRepositions Sequencing Verb Cards VErb Tenses “Wh-”
Questions
Page 26 of 32
301.657.0881 • fax: 301.657.0869
Books
Teaching Developmentally Disabled Children: The ME Book

Dr. O. Ivar Lovaas, Pro-Ed ©1981
Behavioral Intervention for Young Children with Autism
Catherine Maurice, Pro-Ed ©1996
Let Me Hear Your Voice: A Family’s Triumph Over Autism
Catherine Maurice, Random House, Inc. ©1993
Applied Behavior Analysis
John O. Cooper, Timothy E. Heron, and William L. Heward, Merrill ©1987
Right From the Start: Behavioral Intervention for Young Children with Autism:
A Guide for Parents and Professionals
Sandra L. Harris, Ph.D. and Mary Jane Weiss, Ph.D., Woodbine House © 1998
Teach-ME Language
Sabrina Freidman © 1996
Communication and Language Intervention Series
Steven F. Warren and Joe Reichle, Eds., Paul H. Brookes Publishing ©1990
The Good Kid Book: How to Solve the Sixteen Most Common Behavior Problems
Howard Sloan, Research Press ©1988
The How to Teach Series
Vance Hall, Nathan Azrin, Victoria A. Besalel, R. Vance Hall, and Marilyn C. Hall
PRO-ED
Negotiating the Special Education Maze: A Guide for Parents and Teachers, 3rd Edition
Winifred Anderson Stephen Chitwood, and Dierdre Hayden, Woodbine House ©1997
Steps to Independence: A Skills Training Guide for Parents and Teachers of Children with Special
Needs, 2nd edition, Bruce L. Baker and Allen J. Brightman, Paul Brooks Publishing ©1989
Steps to Independence: Behavior Problems
Bruce L. Baker, Allen J. Brightman, Louis J. Heifetz, and Diane M. Murphy, Research Press
©1976
Systematic Instruction of Persons with Severe Disabilities
Martha Snell, Prentice Hall, ©1993
Toilet Training in Less Than a Day
Nathan Azrin and Richard Foxx, Simon and Schuster ©1974
Toilet Training Persons with Developmental Disabilities
Richard Foxx and Nathan Azrin, Research Press ©1973
Page 27 of 32
301.657.0881 • fax: 301.657.0869
Journals
Behavior Analysis And Developmental Disorders Focus on Autism and Other Developmental
rd
JABA REPRINT SERIES, VOLUME 1, 3 EDITION Disabilities
Department of Human Development Pro-Ed, Inc.
University of Kansas 8700 Shoal Creek Boulevard
Lawrence, KS 66045-2133 Austin, TX 78757
785.843.0008 800.897.3202 or 512-451-3246
900-page bound volume comprised of the best fax: 512.451.8542
articles from the Journal of Applied behavior www.proedinc.com
Analysis over the past 28 years. Fee.
Journal of Autism and Developmental Disabilities Journal of Applied Behavior Analysis

Plenum Publishing Corporation Department of Human Development
233 Spring Street University of Kansas
New York, NY 10013 Lawrence, KS 66045-2133
212.620.8468 fax: 212.807.1047 785.843.0008
www.plenum.com
Articles
Campbell, M., Schopler, E., Cueva, J., & Hallin, A. (1996). Treatment of autistic disorder. Journal of
the American Academy of Child and Adolescent Psychiatry. Vol. 35, 134-143.
Feinberg, E. & Beyer, J. (1997). Creating Public Policy in a Climate of Clinical Indeterminacy: Lovaas
as the Case Example du jour. Infants and Young Children. Vol. 10, No. 3.
Gresham, F.M., & MacMillan, D.L. (1997). Autistic recovery?: An analysis and critique of the
empirical evidence on the Early Intervention Project. Behavioral Disorders, Vol. 22, 185-201.
Gresham, F.M., & MacMillan, D.L. (1998). Early intervention project: Can its claims be substantiated
and its effects replicated? Journal of Autism and Developmental Disorders, Vol. 28, No. 1, 5-12.
Kazdin, A. (1993). Replication and extension of behavioral treatment of autistic disorder. American
Journal on Mental Retardation, Vol. 97, 377-379.
Lovaas, O. Ivar (1987).Behavioral treatment and normal educational and intellectual functioning in
young autistic children. Journal of Consulting and Clinical Psychology. Vol. 55, No. 1, 3-9.
Page 28 of 32
301.657.0881 • fax: 301.657.0869
Lovaas, O.I., Smith, T., & McEachin, J. (1989). Clarifying comments on the young autism study: Reply
to Schopler, Short, and Mesibov. Journal of Consulting and Clinical Psychology, Vol. 57, 165-167.
McEachin, J., Smith, T., & Lovaas, O. Ivar. (1993). Long-term outcome for children with autism who
received early intensive behavioral treatment. American Journal on Mental Retardation, Vol. 97,
359-372.
Ozonoff, S., Cathcart, K. (1998). Effectiveness of a home program intervention for young children with
autism. Journal of Autism and Developmental Disorders, Vol. 28, No. 1, 25-31.
Schopler, E., Short, A., & Mesibov, G. (1989). Relation of behavioral treatment to “normal
functioning”: Comment on Lovaas. Journal of Consulting and Clinical Psychology, Vol. 57, 162-164.
Sheinkopf, S. J., & Siegel B. (1998). Home-Based Behavioral Treatment of Young Children with
Autism. Journal of Autism and Developmental Disorders, Vol. 28, No. 1, 15-23.
Smith, T., McEachin, J. , Lovaas, O.I. (1993). Comments on replication and evaluation of outcome.
American Journal on Mental Retardation. Vol. 97, No. 4, 385-391.
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301.657.0881 • fax: 301.657.0869
The Multi-Site Young Autism Project Replication Sites

The UCLA Young Autism Project began in 1970, and efforts to replicate this work to other sites began in 1988.
Autism Research Center Central Valley Autism Project

301 Cater Street 1201 Patterson Road
Anderson, SC 29621 Modesto, CA 95356
864.260.9005 fax: 864.226.8902 209.578.4271 fax: 209.523.0171
CSAAC Lovaas Institute for Early Intervention

751 Twinbrook Parkway 52 Overland Avenue, Suite #530
Rockville, MD 20851 Los Angeles, CA 90064-3366
301.762.1650 fax: 301.762.5230 954.321.7393 fax: 310.840.5987
The May Institute Meredith Autism Program

940 Main Street Meredith College Psychology Department
PO Box 899 3800 Hillsborough Street
South Harwich, MA 02661 Raleigh, NC 27607-5298
508.432.5530 *211 fax: 508.432.3478 919.829.7560 fax: 919.829.2303
New Jersey Institute for Early Intervention Pittsburgh Young Autism Project
52 Haddonfield Berlin Road Intercare - Brentwood Office
Cherry Hill, NJ 08034 4411 Stilley Road / Route 51
609.616.9442 fax: 609.616.9454 Second Floor, Suite 202
Pittsburgh, PA 15227
412.881.3902 fax: 412.881.3599
REM Consulting & Services, Inc. UCLA Early Intervention Project

3101 West 69th Street, #121 Department of Psychology
Edina, MN 55435 PO Box 951563
612.926.9808 fax: 612.926.4002 Los Angeles, CA 90095-1563
954.321.7393 fax: 310.206.6380
University of Houston Psychology Department Washington State University

4800 Calhoun Department of Psychology
Houston, TX 77204 Pullman, WA 99164-4820
954.321.7393 fax: 713.743.8633 509.335.7750 fax: 509.335.2522
Wisconsin Early Autism Project, Inc.

6402 Odana Road
Madison, WI 53719
608.288.9040 fax: 608.288.9042
Page 30 of 32
301.657.0881 • fax: 301.657.0869
Other Sites Offering ABA Services or Information
ABC, Applied Behaviour Consultants Alta California Regional Center

800.435.9888 2031 Howe Avenue, Suite 100
Sacramento, CA 95825
916.929.0500
Autism Partnership Bancroft School

200 Marina Drive PO Box 20
Seal Beach, CA 90740 Hopkins Lane
562.431.9293 or 562.431.8386 Haddonfield, NJ 08003-0018
Behavioral Intervention Associates Greg Buch, Ph.D.

14 Crow Canyon Court, Suite 100 3116D Oak Road, Suite 106
San Ramon, CA 94583 Walnut Creek, CA 94596
510.855.1350 510.938.4508
Centers for Autism and Related Disorders Children’s Hospital, Inc.

(C.A.R.D.) Department of Pediatrics/Division of Psychology
(call for regional/local center) Ohio State University
23300 Ventura Boulevard 700 Children’s Drive
Woodland Hills, CA 91364 Columbus, OH 43205-2696
818.223.0123 614.722.4700
Early Childhood Autism Program The Early Childhood Intervention Center, Inc.
Department of Psychology (ECIC)
University of Nevada 2124 Broadway, #338
Reno, NV 89557 New York, NY 10023
702.786.1448 fax: 702.784.1126 212.606.2036
Innovative Developments for Educational New England Center for Children (NECC)
Achievement, Inc. 33 Turnpike Road
20 Washington Avenue, Suite 108 Southboro, MA 01772
North Haven, CT 06473 508.481.1015
(203) 234-7401
Page 31 of 32
301.657.0881 • fax: 301.657.0869
Oak Forest Psychological Services Partners in Therapy, Inc.

2834 Bill Owens Parkway 804 Park Avenue
Longview, TX 75605 Collingswood, NJ 08108
903.759.6588 609.858.3673
Project PACE Reaching Potentials, Inc.

9725 SW Beaverton Hillsdale Highway Suite 230 7390 NW 5th Street, #9
Beaverton, OR Plantation, FL 33317
503.643.7015 954.321.7393 fax: 954.321.1019
Rutgers Center for Applied Psychology Valley Mountain Regional Centers (CA)
41 Gordon Rd (call for local center)
PO Box 5062 PO Box 692290
New Brunswick, NJ 08903-5062 Stockton, CA 95269-2290
908.445.7778 209.473.0951 fax: 209.473.0256
You may wish to contact any of the above sites directly to receive information regarding their particular
programs, and inquire about the availability of services.
Important: References to treatment or therapy options, programs, services or providers are not intended
to be comprehensive statements of available options, programs, services or providers. You should
investigate any and all alternatives that may be more appropriate for a specific individual. ASA assumes
no responsibility for the use made of any information published or provided by ASA.
Page 32 of 32

Autism Behavioral Interventions

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Autism Society of America

7910 Woodmont Avenue Suite 300 • Bethesda, MD 20814-3067

Intensive Behavioral Intervention

Developed by the Autism Society of America 5/98

The Pros and Cons of Discrete Trial Training:

Reprinted with permission from American Association on Mental Retardation

Treatment Outcome is Encouraging

Interview with Ivar Lovaas

ADVOCATE: Why don’t we begin at the beginning?

LOVAAS: We began treatment research in 1963. We institutionalized 20 children at UCLA’s

ADVOCATE: And the children who went back to their parents?

ADVOCATE: What was the average IQ?

ADVOCATE: What do you mean by verbal imitation?

LOVAAS: First of all, we taught all of the children one-on-one.

ADVOCATE: You discovered this accidentally?

ADVOCATE: An external punishment might stop a self-punishment.

ADVOCATE: What were the aversives?

ADVOCATE: How do you know which kind of child you have?

General Overview of A.B.A. Curriculum

Beginning Curriculum Guide

Attending Skills — sits independently, eye contact

Intermediate Curriculum Guide

Attending Skills — sustains eye contact, responds to name

Advanced Curriculum Guide

Companies to contact for catalogs:

Company Phone Products (see below)

ABC School Supply 800.669.4222 AD, ADV, PR, EN, M, V

Associations ACademic Curriculums ADjectives ADVanced Categories/ COmputer

Teaching Developmentally Disabled Children: The ME Book

Journal of Autism and Developmental Disabilities Journal of Applied Behavior Analysis

The Multi-Site Young Autism Project Replication Sites

Autism Research Center Central Valley Autism Project

CSAAC Lovaas Institute for Early Intervention

The May Institute Meredith Autism Program

REM Consulting & Services, Inc. UCLA Early Intervention Project

University of Houston Psychology Department Washington State University

Wisconsin Early Autism Project, Inc.

Other Sites Offering ABA Services or Information

ABC, Applied Behaviour Consultants Alta California Regional Center

Autism Partnership Bancroft School

Behavioral Intervention Associates Greg Buch, Ph.D.

Centers for Autism and Related Disorders Children’s Hospital, Inc.

Oak Forest Psychological Services Partners in Therapy, Inc.

Project PACE Reaching Potentials, Inc.

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