An Open Letter From O. Ivar Lovaas

 

 

 

The letter reproduced below is a discussion by Dr. Lovaas regarding

what is considered an appropriate therapeutic intervention for children

with autism.

 

                                

 

November 3, 1993

 

To Whom It May Concern:

 

This letter is intended to address the question of what constitutes an

appropriate therapeutic intervention for a child diagnosed as autistic.

 

A consensus has emerged among scientific researchers and practitioners that

appropriate (not ideal) treatment contains the following elements (e.g.,

Simeonnson, Olley, and Rosenthal, 1987):

 

1. A behavioral emphasis: This involves not only imposing structure and

rewarding appropriate behaviors when they occur, but also applying some more

technical interventions such as conducting discrete trials, producing shifts

in stimulus control, establishing discriminations between SD's and S-deltas,

and so forth (Koegel and Koegel, 1988).

 

2. Family participation: Parents and other family members should participate

actively in teaching their child. Without such participations, gains made in

professional settings such as special education programs, clinics, or

hospitals rarely lead to improved functioning in the home. (Bartak, 1978;

Lovaas, Koegel, Simmons, and Long, 1973).

 

3. One-to-one instruction: For approximately the first six months of

treatment, instruction should be one-to-one rather than in a group because

autistic children at this stage learn only in one-to-one situations (Koegel,

Rincover, and Egel, 1982). This training need not be adminstered by degreed

professionals, but can be just as effective if delivered by people who have

been thorougly trained in the behavioral treatment of autistic children,

such as undergraduate students or family members (Lovaas and Smith, 1988).

 

4. Integration: When a child is ready to enter a group situation, the group

should be as "normal" or "average" as possible. Autistic children perform

much better when integrated with normal children than when placed with other

autistic children (Strain, 1983). In the presence of other autistic

children, any social behavior that they may have developed usually

disappears within minutes (Lovaas and Smith, 1988), presumably because it is

not reciprocated. Mere exposure to normal children, however, is not

sufficient. The autistic children require explicit instruction from trained

tutors on how to interact with their peers (Strain, 1983).

 

5. Comprehensiveness: Autistic children initially need to be taught

virtually everything. They have few appropriate behaviors, and new behaviors

have to be taught one by one. This is because teaching one behavior rarely

leads to the emergence of other behaviors that were not directly taught

(Lovaas and Smith, 1988). For example, teaching language skills does not

immediately lead to the emergence of other language skills, such as

pronouns.

 

6. Intensity: Perhaps as a corollary for the need for comprehensiveness, an

intervention requires a very large number of hours, about 40 hours a week

(Lovaas and Smith, 1988). Ten hours a week is inadequate (Lovaas and Smith,

1988), as is twenty hours (Anderson, Avery, Dipietro, Edwards, and

Christian, 1987). The majority of the 40 hours, at least during the first

six months of the intervention, should consist of remediating speech and

language deficits (Lovaas, 1977). Later, this time may be divided between

promoting peer integration and continuing to remediate speech and language

deficits.

 

I hope this information is helpful. If you have any questions, please do not

hesitate to contact me.

 

Sincerely,

 

Ivar Lovaas, Ph.D.

Professor of Psychology

Director, Clinic for the Behavioral Treatment of Children

 

                                 References

 

Anderson, S.R., Avery, D.L., Kipietro, E., Edwards, G.L., and Christian,

W.P. (1987). "Intensive home-based early intervention with autistic

children." Education and Treatment of Children, 10, 352-366.

 

Bartak, L. (1978). "Educational approaches". In M. Rutter and E. Schopler

(Eds.) Autism: A Reappraisal of Concepts and Treatment (pp. 423-438). New

York: Plenum.

 

Koegel, R.L., Rincover, A., and Egel, A.C. (1982). Educating and

Understanding Autistic Children. San Diego, College Hill Press.

 

Koegel, R.L., and Koegel, L.K. (1988). "Generalized responsivity and pivotal

bvehaviors." Generalization and Maintenance: Life-Style Changes in Applied

Settings (pp. 41-65).

 

Lovaas, O.I. (1977). The Autistic Child: Language Development Through

Behavior Modification. New York: Irvington.

 

Lovaas, O. I., Koegel, R.L., Simmons, J.Q., and Long, J.S. (1973). "Some

generalization and follow-up measures on autistic children in behavior

therapy." Journal of Applied Behavior Analysis, 6, 131-166.

 

Lovaas, O.I., and Smith, T. (1988). "Intensive behavioral treatment for

young autistic children." In B.B. Lahey and A.E. Kazdin (Eds.), Advances in

Clinical Child Psychology, Volume 11 (pp. 285-324). New York: Plenum.

 

Simeonnson, R.J., Olley, J.G., and Rosenthal, S.L. (1987). "Early

intervention for children with autism." In M.J. Guralnick and F.C. Bennett

(Eds.), The Effectiveness of Early Intervention for At-Risk and Handicapped

Children (pp. 275-296). New York: Plenum.

 

Strain, P.S. (1983). "Generalization of autistic children's social behavior

change: Effects of developmentally integrated and segregated settings."

Analysis and Intervention in Developmental Disabilities, 3, 23-34.