Home Early Intervention

INTENSIVE HOME-BASED EARLY INTERVENTION WITH AUTISTIC CHILDREN
Author(s): Stephen R. Anderson, Debra L. Avery, Ellette K. DiPietro, Glynnis L. Edwards and
Walter P. Christian
Source: Education and Treatment of Children, Vol. 10, No. 4, SPECIAL ISSUE: New Developments
in the Treatment of Persons Exhibiting Autism and Severe Behavior Disorders (NOVEMBER 1987
), pp. 352-366
Published by: West Virginia University Press
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ANDTREATMENT
EDUCATION OF CHILDREN 1987
Vol.10,No.4,NOVEMBER,
INTENSIVE HOME-BASED EARLY INTERVENTION

WITH AUTISTIC CHILDREN
Stephen R. Anderson, Debra L. Avery,

Ellette K. DiPietro, Glynnis L. Edwards,
and Walter P. Christian
The May Institute

Chatham, MA
ABSTRACT
Although severaldescriptionsofeducational
programs foryoung autistic
children inthe
exist
mosthavefocused
literature, ononemodel ofservice thepreschool
delivery, classroom.Un-
fortunately,thismodelfailstomeettheeducational needsofsomeautistic childrenbecause
oflimitationsintheamount ofdirect itcanprovide,
instruction thelackofgeneralizationof
treatment
effects,andtheabsence ofcomprehensiveparent Thecurrent
training. studydeveloped
andevaluated a home-based alternative
tothepreschool Essential
setting. features
ofthemodel
include: useofbehavioral
(a) systematic teaching
techniques andtreatment (b)in-
procedures;
tensive
training conductedineachchild's
naturalhome; and(c)extensive
parent Most
training.
ofthe14children whoparticipatedinthestudydemonstratedsignificant
gainsintheir
language,
social,andacademic
self-care, development,as evidenced bytheresults of standardized
assessmentsandindividual treatmentdata.Theresultsalsoindicated
a changeintheparents'
toteach
ability their
handicapped children.
Theseresults
arecomparedandcontrastedtoprevious
findings
reported intheliterature.
The efficacyof earlyintervention has been the subject of much debate

(Dunst, 1985; Meisels, 1985). Althoughreviewsof thesubjecttypicallycon-
clude thatearlyintervention resultsin positivetreatment most also
effects,
indicatethattheanalysesarewoefully inadequate(Carta & Greenwood, 1985).
Furthermore, conclusionsregarding efficacyhavegenerallybeendrawnfrom
studiesinvolvingenvironmentally at-riskchildren(Casto & Mastropieri,1986;
Simeonsson,Cooper, & Schuner,1982), leavingto questionthe impactof
earlyintervention withseverelyhandicappedchildren.
This findingis even morestrikingwhenone examinesthe literaturerele-
vantto the educationof youngautisticchildren.Althoughseveraldescrip-
tionsof educationalprogramsforautisticchildrenexistin theliterature (e.g.,
Knoblock,1982),mostremainat thelevelof programdescription, providing
Thispaper
wassupported
bygrantsfrom theU.S.Department
ofEducation,
thePublic
Welfare
andtheMabelLouiseRiley
Foundation, Trust.Wegratefully
acknowledgethecontributions
ofNyemade Baker,Juliet
Burger,DeniseCallahan,Charlene
Foley,Janice
Geddes,Anne
Patricia
Williams, McCarthy, SusanRisi,RichardHook,Jeff SusanLynds,
Withstandley, and
theBoston
Children's
Hospital.
Requests forreprints
should
besenttoStephenR. Anderson,
TheMayCenter,188North BeaconStreet,Watertown,MA02172.
Pages 352-366
HOME-BASEDEARLYINTERVENTION 353
verylittleempiricalevidenceof effectiveness. In theirreview,Simeonsson,

Olley, and Rosenthal (1985) reportonly a handful of studiesinvolvingautistic
childrenthat met theircriteriaof providingongoingtreatmentwhile also
documentingtreatmenteffects.
This group of studies,as well as manyconcernedwitha broader range
of severelyhandicappedchildren(e.g., Bricker& Dunn, 1980),typically have
focused on one model of servicedelivery,the preschoolclassroom. This
model,particularly whenitinvolvestheintegration of handicappedand non-
handicapped children (Strain,1983), seems appropriatealong mostdimen-
sions. However,it failsto meettheeducationalneedsof someyoungautistic
childrenbecause of thelimitationsin theamountof directinstruction it can
provide, the failureof childrento generalize treatment effects from school
environments to home, and the absence of comprehensiveparenttraining
and support. As a result,few autisticchildrenremain in public school
placements(DeMyer, Barton,DeMyer,Norton,Allen,& Steele, 1973; Lot-
ter, 1974) and manyare eventuallyinstitutionalized (Rutter,1970).
One alternativeto thepreschoolmodelis thehome-basedtrainingmodel,
as describedin studiesby Howlin (1980) and Schoplerand Reichler(1971).
However,even in thesestudies,fewresourcesweredevotedto providinga
significantlevelof directinstructionand ensuringthecontinuationof inten-
sive programmingin the home by parents.
One notablesuccessfulexampleof a home-basedtrainingmodelhas been
describedin a paper by Lovaas (1987). The outcomeof earlyintervention
was comparedfora group of childrenwho receivedintensiveintervention
(40 or morehoursperweek)providedby studenttherapistsand parentsand
a groupof childrenwho receivedlessintensive intervention (lessthan10 hours
per week). Lovaas reported that47% of the children in the intensivetreat-
mentgroup recovered(i.e., advanced to firstor second grade in a regular
classroomand obtainedan averageor above score on an intelligencetest),
while none of the childrenin the less intensivegroup recovered.
Althoughtheseresultsare impressive, itis unclearwhether thismodelcould
be successfullyreplicated.The Lovaas model reliedon a large population
of students,who providedmassivehoursof home-basedtrainingovera long
intervention period (two or more years). An importantunansweredques-
tionis whethersimilareffects could be obtainedby modifying themodel to
involvesignificantly fewerstaffprovidingfewerintervention hours over a
shorterintervention period.Such a practicalapplicationof themodelcould
have farreachingpotentialforservingchildrenin ruraland less populated
areas and would increasethe generalityof the previousresults.
The purposeof thepresentstudywas to partiallyreplicatethehome-based
trainingmodel describedby Lovaas and to establishtheeffectiveness of the
model in producingmajor gains in the childrenas measuredby objective
norm-referenced testscores,reliablebehavioralobservationmeasures,and
educationalplacementratings.The studyalso evaluatedthe effectsof the
home-basedintervention on theabilityof parentsto teachtheirhandicapped
354 ANDERSON,AVERY,DIPIETRO,EDWARDS,AND CHRISTIAN
children.In doing so, the studyattemptedto examinea morepracticalap-

plicationof thehome-basedmodeland to add to thesmall,butgrowingbody
withpreschool-agedautisticand
of literaturerelevantto earlyintervention
severelyhandicapped children.
Method
Childrenand Setting
The primarysourcefortheidentification and diagnosisof participantsin
the study was the DevelopmentalEvaluation Clinic located at Boston
Children'sHospital.The clinicprovideda thoroughassessmentof each child,
includingpsychological, speechand hearing,and medicalevaluations,to help
determine programeligibility. Criteriaforacceptanceintotheprogramwere
based upon a diagnosisof autism(or autistic-like), age (lessthan72 months),
to and
parents'willingness participate, geographicproximity to theclinic(i.e.,
withina 35 mile radius).
Fourteenchildrenand theirfamiliesparticipatedin thestudy.Table 1 in-
dicatesthechronological-age(C.A.), mental-age(M.A.), social-age(S.A.),
and language-agescores forthe childrenat the timeof theirentryinto the
study.The mean age of thechildrenat thetimeof admissionwas 43 months
(range: 18 to 64 months).The childrenexhibitedbehaviorsrepresentative
of the definition of autismprovidedby the AmericanPsychiatricAssocia-
tion(1980), includingthefollowingprimaryand associatedfeatures:(a) lack
of responsivenessto otherpeople (93% exhibitedgaze aversion); (b) im-
pairmentsin communication(43% were nonverbal and 50% exhibited
echolalia); (c) bizarreresponsesto theenvironment (86% resistedchangeand
86% engagedin self-stimulation); (d) aggression(43%); (e) self-injury(50%);
(0 noncomplianceto instructions (93%); and (g) severetantrums(100%).
The childrenall lived at home withtheirnaturalparents.Eleven of the
childrenalso participated in preschoolprogramsprovidedbytheirlocal public
schools.
An analysisof the socioeconomiclevelof the familiessuggestedthatthe
major providerwas likelyto be engagedin a supervisory or professionaloc-
cupation, had at least a high school degree,and lived in an area in which
thepercapita incomewas averageor above. All butone of thechildrenwere
fromtwo parentfamilies.Motherswerethe primaryparticipantfor 11 of
the 14 familiesand fathersand mothersparticipatedequallyin the remain-
ing families.
Procedures
individualswith
. Therapistswerebachelor's-and master's-level
Therapists
trainingin psychology,specialeducation,speech,or earlychildhoodeduca-
tion.Priorto workingwiththechildren, thetherapists train-
receivedinservice
ing(approximately 30 hours)to aquaintthemwithbehavioralteachingtech-
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niquesand treatment procedures,as wellas behavioranalysismethods(e.g.,

measurement). The specificdutiesof the positionand the desiredlevel of
performance were specifiedin the formof work performancestandards
&
(Christian Hannah, 1983).
Child training. A therapistwas assignedto an individualchildand his or
herfamilyfor20 hoursa week(15 hoursweredevotedto directinstruction
withparentsand child; 5 hours for programdevelopmentand planning).
Throughthecombinedefforts of thechild'stherapistand parents,he or she
receiveda total of 15-25hoursof individualizedinstruction per week. The
specifichoursof trainingwereflexibleto allow both parentsto participate
wheneverpossible and to permitthe therapistto be presentwhenproblem
behaviorswere most likelyto occur.
Aftera carefulbehavioralassessmentwas completedforeach child,the
therapistand parentdevelopedtrainingobjectivesand programsto address
skilldeficitsand behaviorproblemsin each of themajordevelopmental areas
(i.e., language,behavioral,self-help,motor/play, preacademic,and social).
Progresstoward the completionof these objectiveswas monitoredcon-
tinuouslythroughreliablyobtainedmeasurescollectedby thetherapistand
parents.The specificstrategiesused to effectbehaviorchange have been
describedin detailelsewhereand willnotbe repeatedhere(e.g., Koegel,Rin-
cover, & Egel, 1982). Each child and familyparticipatedin the studyfor
a minimumof one year.Six of the 14 childrenhad completeda secondyear
of involvementat the timethe studywas completed.
Therapistsalso engagedin liaison activitieswiththe school programfor
mostof the children36 monthsor older. This includedmeetingswitheach
child'steacherto shareinformation about intervention and, in some
efforts
cases, also involvedmoreextensiveconsultationand trainingto teacherswho
lacked the repertoireof skillsneeded to work withautisticchildren.
Parent training . A major focus of the studywas to trainthe parentsin
theskillsnecessaryto managemaladaptivebehaviorsand to teach adaptive
skillsto theirhandicappedchild.Theirinvolvement proceededgraduallyfrom
observerto primarytherapistfortheirchild'seducationalprogram.As part
of theiragreementto participatein the study,one or both parentswerere-
quiredto be involvedin trainingat least 50% of thetimethatthetherapist
was in thehome and to providea minimumof 10 hoursa week of training
at othertimes(theirtotal involvementwas 15-25hours a week).
Parentparticipationbegan by workingwiththetherapistto completethe
behavioralassessmentof the childand to develop specificgoals and objec-
tivesfortraining.A varietyof instructional techniquesincludingmodeling,
feedback,and training manuals(Baker,Brightman, Heifetz,& Murphy,1976;
Lovaas, 1981) were used to trainthe parentsto correctlyuse behavioral
teaching procedures. Modified versions of the parent and child games
(Forehand& McMahon, 1981) also wereused to help teach attendingand
praisingskills.
DependentMeasures
Child. Measureswerecollectedon a varietyof behaviorsexhibitedby the
children.One measureof child performancewas gain in standardizedtest
scoresyieldedbyannualpsychologicaland speechand languageassessments.
Formal evaluationswere completedby personsnot directlyinvolvedwith
the operationof the programnor the summaryof its researchfindings.
A school psychologistadministereda standardizedintelligencetest(i.e,
Stanford-Binet IntelligenceScale forChildren,FormL-M or BayleyMental
Scales of InfantDevelopment)and a test of adaptive development(i.e.,
VinelandSocial MaturityScale or VinelandAdaptiveBehaviorScales, In-
terview,SurveyForm). Language developmentscores were obtained by a
speechpathologistwho administered a combinationof instruments (i.e., Sym-
bolic Play Test; Peabody Picture Vocabulary Test, Form L; Preschool
Language Scale; Sequenced Inventoryof CommunicationDevelopment).
Anotherarea of potentialimprovement was progressmade bythechildren
on theirindividualizedsequenceof behavioralobjectives.The trainersand
parentsrecordedcorrectand incorrectresponsesof thechildrenacrosstrials
or stepsof each program,as well as frequency,duration,or timesampling
of maladaptivebehaviors.These data wereobtaineddailyand used to deter-
mine progresstowardthe achievementof individualizedobjectives.
A thirdmeasureof programeffectiveness was the children'sprogresson
theUniformPerformanceAssessmentSystem(UPAS) (White,Edgar, Har-
ing,Afflick, & Hayden, 1978),a norm-referenced assessmentinstrument that
lists skills (i.e., comunication, social/self-help,preacademic, motor,
behavioral)in a normaldevelopmentalsequence. Performancewas assessed
by determining wherein the sequence each child fell. The UPAS was ad-
ministeredby the trainerand parent. The resultsof the communication,
social/self-help, and preacademicsectionswereused to evaluatetreatment
effects.
Finally,school placementratingswere completedalong a 6-pointscale
based upon the amountof integrationwithnonhandicappedpeersand the
locationof theeducationplacement(publicschool versusprivateschool set-
ting).An integrated classroomsettingwithina regularpublicschoolbuilding
was consideredideologically mostdesirable(Bricker,1978),whilea segregated
placementin a privateschool settingwas consideredleast desirable.
Parentmeasures.The parents'abilityto use behavioralteachingtechniques
(Koegel, Russo, & Rincover,1977) was the primarymeasureof the effects
of the intervention on parentbehavior.Parentswereinstructed to conduct
a specifictrainingprogramfortheirchildren(e.g., brushingteeth)whilethe
trainingwas videotaped. Five-minutevideotaped samples of the parents'
behaviorwereobtainedat the timeof theirchildren'sentryinto the study,
after6 monthsof participation,and again after12 monthsof participation.
Observers(thesecond and thirdauthors)laterviewedthe5-minutesamples
and coded, in 30-secondintervals,whetherthe parentsprovidedclear and
conciseinstructions,effective prompts,and unambiguousand immediatecon-

sequences(see Koegel et al. (1977) fora completedescriptionof definitions
and scoringprocedures).The performanceof the most involvedparentin
each familywas evaluated (usuallythe mother).
Parentsalso were asked to completea satisfactionsurveyat the end of
one yearof participation.The questionnaire included9 items,someconcerned
withproject staff(e.g., Are you satisfiedthat the therapistis effective in
teachingyourchild?)and othersconcernedwiththeservicesprovided(e.g.,
Are you satisfiedwiththetrainingyourchildis receiving?).Each itemwas
ratedon a 7-pointscale fromcompletelysatisfiedto completelydissatisfied.
Experimentaldesign. A one-group,pretest-posttest design(Campbell &
Stanley,1963) was used to evaluatetheeffectiveness of theintervention pro-
gramon childbehavior,as measuredbytheformalassessments.Assessments
(psychological,language,UPAS) of thechildren'sprogresswereconducted
at thetimeof each child'sentryintothe studyand after12 monthsof their
participation.Childrenwho participateda second yearreceiveda complete
batteryof tests at the end of theirfirstand second years. As indicated
previously, parentmeasureswereobtainedat thetimeof entryintothestudy
foreach child/family, after6 months,and after12 monthsof participation
in the study.
Multiplebaselinedesigns(Hersen& Barlow, 1976)wereemployedto help
establishwhethera relationshipexistedbetweenthe home-basedinterven-
tion and changesin the children'sbehavior.One or moremultiplebaseline
researchdesignswerecompletedforeach childacross a varietyof targeted
behaviors.At theveryleast,a baseline-treatment (AB) designwas employed
for any newlyintroducedprogram.
Checks of interobserver/ rateragreement . Reliabilitychecks were made
across descriptiveinformation about thechildrenand theirparentsand for
the outcomemeasures.The data fordescriptiveinformation wereobtained
by comparingratingsobtainedby two observers(firstand second authors)
who independentlyevaluated child characteristics, familysocioeconomic
status,and school placements.
Reliabilityscoresforchildcharacteristics(i.e., percentagesprovidedin the
descriptionof thechildren)averaged88% witha rangeof scoresbycategory
from79% to 100%. Ratersachievedan overallreliabilityscore of 82% for
S.E.S ratingswitha rangeof scores by category(i.e., occupation,educa-
tion,and livingconditions)from85% to 100%. Finally,theobserverswere
in agreement82% of the timeregardingschool placementratings.
Checks of interobserver agreementfor UPAS and the parents'use of
behavioral teachingtechniqueswere obtained by two observerswho in-
dependently and simultaneously conductedobservations.Agreement percent-
ages werecalculatedby dividingthe numberof agreementsby the number
of agreementsplus disagreements and multiplying by 100. Reliabilityscores
for the UPAS ranged from79% to 100% withan overall mean of 97%.
Observersagreed 86% of the timefor parents'use of behavioralteaching
acrosscategorieswas 90% agreement

techniques.Mean reliability forinstruc-
tions(range:60% to 100%), 84% forprompts(range:60% to 100%), and
82% for consequences(range: 10% to 100%). Reliabilityscores were not
obtained for formalpsychologicaland language assessments.
Results
Child Behavior
A one-tailed,t-testof dependentmeans was performedon the resultsof
scores obtained fromstandardizedand age-referenced assessments(i.e.,
psychological, language,UPAS). Table 1 presents data forchangesin mental-
age, social-age, and language-age scores. Table 2 providesa summaryof
UPAS scores.
Each table displaysscores obtained at the timeof entryinto the study
(within3 months),afterone yearof training,and aftertwoyearsof training
whenapplicable.The data are presented byindividualsas wellas group.Note
thatthenumberof childrensummarizedin thegroupanalysesvarieswithin
and across tables (i.e., some childrenfailedto receivefollowup testingin
some areas or theyreceivedincompletescores).Onlythosedata forchildren
who completeda fullsecondyear(12 months)wereincludedin theanalyses
forYear 2. Numbersprovidedin parentheses indicatemeans,standarddevia-
tions, and group size (n) used to compare firstand second year scores.
The resultsshown in Table 1 indicatea statisticallysignificant change
(p< .0005) in thechildren'smental-ageafterone yearof participationin the
study.Significant changeswerealso observedbetweenfirstand secondyear
scoresforthefivechildrenwho completeda fullsecondyearand forwhom
testscoreswereavailable. A closerlook at the data forindividualchildren
showsthat 12 of the 13 childrentestedat theend of one yeardemonstrated
a positivechangein theirmental-agescores(Darrylwas theexception).Gains
rangedfrom2 to 23 monthschangein one yearwitha mean of nearly10
months.Forty-sixpercentof thechildrenexhibitedat leasta 13-monthgain
in theirmental-agescores withina singleyear.
Similarresultswereobtainedforsocial-agescoresas measuredbythead-
ministration of the VinelandSocial Maturityor AdaptiveBehaviorScales,
withtheparentas informant (see Table 1). Firstyearscoresweresignificant
<
(p .0005) for group means. Changes in social-agescores forindividuals
ranged from no change(Ben) 23 months(Elaine),witha meanof 9 months.
to
Four of the 13 children(31%) demonstrated12 or moremonthschangein
theirsocial-agedevelopment.Gains for5 childrenwho completeda second
yearof involvement weremoresignificant, rangingfrom4 to 17 monthswith
a mean of 10 months.
Results also indicate a statisticallysignificantchange in the children's
languageperformance forbothYear 1 and Year 2 (see Table 1). Pretest/post-
testdata wereavailable foronly 11 of 14 children.Afterone year,9 of the
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11 childrenshowed a positivetreatment changewithgains rangingfrom3

to 18 months,witha mean of 10 months.Changes in scores for children
who completeda secondyearof participationrangedfrom8 to 22 months,
witha mean of 12 months.A closerexaminationrevealedthatstatistically
significantgainsweremade in boththereceptiveand expressivedomains(not
shown in table).
Scores obtainedby the completionof the UPAS are presentedin Table
2 across threedomains(thesedata indicatethepercentageof itemspassed).
Similarto otheroutcome data, theseresultsindicatethatthe intervention
producedstatistically significantchangesin the children'sperformancebe-
tweenpretestand Year 1 scores.
An examinationof resultsforindividualchildrenindicatesthat 12 of the
13 childrendemonstratedimprovements across all domains (Darrylis the
exception).The mostsignificant gains occurredin the social/self-help area
withsome childrenperforming at or nearage level. Less dramaticgains oc-
curredin the communicationarea whereall childrencontinuedto perform
well below age-level.
Second year scores were available for 7 children.Most of the children
demonstrated positivetreatment gainsin each area withtheexceptionof Jerry
in the area of social/self-helpand Sean in the area of communication.
Differences betweenYear 1 and Year 2 group means were not statistically
significantfor the social/self-help and communicationareas.
Althoughstatistically significant,it cannotbe concludedwithconfidence
thatpositivechangesin the children'stestscoreswerea resultof the treat-
mentintervention. Therefore,thedata weresubjectedto further analysisto
determinewhetherthechildrenexhibiteda morerapidrateof development
duringthe intervention period. Developmentalratios were establishedby
dividingchangesin the testscoresby the numberof monthselapsed since
birthor the last assessment.A higherdevelopmentalratio score following
a periodof intervention (typically12 months)could indicatean accelerated
period of learning.
Figure1 providesa summaryof developmental ratioscores(groupmeans).
The figureshows higherdevelopmentalratiosat the end of one yearof in-
terventionwhencomparedto initialscores. Individualdifferences for for-
mal tests(psychologicaland language)wereevident,witheightchildrenex-
hibitingconsistently elevatedratiosafterintervention. All six of thechildren
who participateda secondyearexhibitedhigherdevelopmentalratioscores
whencomparedto thepre-intervention condition.The resultsfortheUPAS
weremoredramatic,withonlyone child(Darryl)failingto demonstratean
increasein the developmentalratio score afterintervention.
As indicatedpreviously, continuousmeasuresof childprogresson specific
trainingobjectiveswerealso obtained.A summaryof thesedata indicatethat
274 behavioralobjectiveswereachievedbythefourteenchildrenduringthe
firstyearof participation(mean: 20 per child; range:7-29 per child). These
objectivesaddressedlanguage(31%), readinessskills(18%), self-help(13%),
ratio
ofdevelopmental
1.A summary
Figure tests
forformal
scores ofmental, andlanguage
social,
ontheUPAS.Barsrepresent
aswellasforprogress
development, group forallchildren
scores
andafter
tointervention
prior oneandtwoyears inthestudy.
ofparticipation
social/behavioral(17%), preacademic(13%), and motor/play concerns(9%).

It should be noted that AB researchdesigns (baseline/treatment) were
employed to analyzemost training/treatment Similar
effects. were
results ob-
tainedaftertwo yearsof intervention with85 objectivesachieved(mean: 17
per child; range: 10-30per child).
As previouslyindicated, multiplebaseline designs were used to help
demonstrate therelationshipbetweenpositivetreatment and thepro-
effects
gramintervention. multiplebaselinedesignsweresuccessfully
Thirty-six com-
pleted(i.e., demonstrating controlacrossat leasttwoconsecutive
experimental
tiers).
The resultsof schoolplacementratingsindicatethatonlyone child(n = 11)
participatedin sociallyintegratedschool placementat the timeof her ad-
missionintotheprogram.At theend of one yearof participationin thepro-
gram,23% of thechildren(n = 13) wereintegrated at leasttwohoursa week.
This percentagehad increasedto 31% (n = 13) bythetimethestudyhad been
completed.Nevertheless,all childrencontinuedto requirespecializedser-
vicesand none weremainsteamedfull-time in a regularkindergartenor first
grade classroom.
Parent Behavior
The resultsindicatethatparentssignificantlyimprovedin theirabilityto
correctly use teachingtechniques.Duringbaselinesessions,parents
behavioral
averaged 17.5%, 21.8%, and 48.5% correctin theiruse of instructions,
prompts,and consequences,respectively. After6 monthsof participation
in the study,thesepercentagesincreasedto 91.7%, 81.9%, and 88.7%. A
t-testof dependentgroupmeansindicatedthatthesechangesweresignificant
(p < .01). Resultsalso indicatethatparentsmaintainedtheircorrectuse of
behavioralteachingtechniquesas evidencedby theresultsof an evaluation
after12 monthsof participation.Scores of 88.3%, 85.6%, and 82.7% were
obtained for the correctuse of instructions,prompts,and consequences,
respectively.
ConsumerSatisfaction
Eighteenparentsrepresenting 13 of 14 familiescompletedand returned
theConsumerSatisfactionSurvey.Ninety-nine percentof theresponseswere
ratedas eithercompletelysatisfiedor satisfiedwiththe programstaffand
servicesprovided.Identicalresultswereobtainedat theend of two yearsof
participation(n = 3).
Discussion
Home-based earlyintervention resultedin positivetreatmenteffectsfor
themajorityof autistic(autistic-like)childrenparticipating in thestudy.In-
dividualdifferencesin themagnitudeof thetreatment effectswereevident,
includingtwochildrenwhodemonstrated littleor no change(Darryland Ben)
as measuredbystandardizedinstruments. Bothchildrenexhibitedentrylevel
mental-age,social-age,and language-age scores below 12 monthsand neither
showed much change afterintervention.This findingis consistentwith
previousreportsindicatinga poor treatment prognosisforseverelydisabled
children(Lovaas, 1987; Rutter,1966).
Theseresultspartiallysupportthefindings of Lovaas (1987),demonstrating
positivetreatment effects for the children who participatedin home-based
Unlikethefindingsof Lovaas, however,none of thechildren
intervention.
in thepresentstudyrecovered(i.e., wereplaced in a classroomwithnonhan-

dicappedpeersand testedin thenormalrangeof intelligence). Thisdiscrepen-
cy may be a resultof differences betweenthe studies,including:(a) the
chronologicaland mentalage of childrenat thetimeof entryintothestudy,
(b) thenumberof traininghoursprovided,(c) thelengthof theintervention
period, and (d) the use of physicallyaversive proceduresto controlsome
maladaptivebehaviors.
A comparisonof treatmentgroups suggeststhatchildrenin the Lovaas
studywereyounger(X = 32 monthsold) at thetimeof theirentryintothe
programthanthe childrenin the presentstudy(X = 43 monthsold). Fur-
thermore,childrenin the Lovaas study exhibitedan average 13-month
differencebetweentheirchronological-ageand mental-agescores at entry,
whilechildrenin thepresentstudydemonstrated a 19-month difference.
Com-
in
parisonsalso showedthatchildren thepresentstudyreceived average an
of 20 hoursperweekof trainingforone or twoyears.Lovaas' intensive treat-
mentgroupreceived40 hoursor moreperweekprovidedovera 2- to 6-year
period. Finally,Lovaas reportsthe use of an aversiveconsequence(e.g., a
loud "No" and a slap on the thigh)to controlaggression,noncompliance,
and self-stimulatory behaviors. No physicallyaversive procedureswere
employedin the currentstudy.Althoughspeculative,one or moreof these
differencesmayexplainthediscrepancy betweentheresultsof thetwostudies.
The findingsof thisstudyshouldbe interpreted withcautiondue to several
methodologicaldifficulties. One is theinabilityto separatetheeffects of many
potentiallyimportantvariables that may have affectedindividual child
differences(e.g., levelof cognitivefunctioning at admission,numberof hours
of treatmentreceived,age at admission,level of parentinvolvement).
Anotherdifficulty was the lack of a treatment-control group design to
analyze treatmenteffects.An agencypolicyto accept and serveany child
in need of services,and who meetthecriteriaforadmission,contributedto
the inabilityto identifya controlgroup. Currently,the authorsare trying
to identifyand tracka smallgroupof childrenwho metthespecificcriteria
foradmissionbutwhosefamilieslivedoutsidethegeographicregioncovered
by the program.These data will help to establishthe validityof the data
presentedhere.
Fortunately,the outcomeof singlesubjectdesignshelps to establishthe
possiblerelationshipbetweenpositivetreatment and participationin
effects
thestudy.It is importantto reiteratethat 11 of the 14 childrenparticipated
in traditionalpreschoolprogramswhenbaselineswereestablished,as well
as duringthecourseof homeintervention. Nevertheless, thesedata indicate
thatthechildren'scorrectresponding(or decreasein maladaptivebehaviors)
did not occur untilthe intervention was systematically introducedforeach
behaviorspecified.Furthermore, a comparisonof developmentalratiossug-
geststhatmostof thechildrendemonstrated acceleratedlearningduringthe
intervention period.This analysisadds further evidenceof thepossiblerela-
tionshipbetweenmeasuredgains and the treatmentintervention.
The resultsof thestudysuggesttheneed to utilizea varietyof dependent

measuresto evaluatetreatment effects.Standardizedassessmenttools used
to evaluatemental-age,social-age,and language-ageequivalenceswerenot
sensitiveto some treatmentgains indicatedby the resultsof the UPAS or
the continuous measures used to evaluate progress on individualized
behavioralobjectives.
In summary, theresultsappearto supporttheliterature
indicatingthesocial
of
significance early interventionwith severelyhandicapped and autistic
children.Clearly,additionalresearchis neededto delineatethevariablesthat
are mostimportant forpredicting treatment outcome,effectingpositivetreat-
mentchange, maintainingtreatmentgains, and evaluatingoutcome.
References
American Psychiatric Association (1980). Diagnostic and statistical manual(3rded.).

Washington, DC: Author.
B.L.,Brightman,
Baker, A. L.,Heifetz,L. J.,& Murphy, D. M.(1976). Steps toindependence.
Champaign, IL: Research Press.
D. D. (1978). A rationale
Bricker, fortheintegrationofhandicapped andnonhandicapped
preschool children. InM. Guralnick (Ed.),Earlyintervention andtheintegration ofhan-
dicapped andnonhandicapped children. Baltimore:University ParkPress.
D.,& Dunn,
Bricker, M.(1980). Early intervention
with theyoung severelyhandicapped. Jour-
naloftheAssociation fortheSeverely Handicapped, 5, 130-142.
Campbell, D. T., & Stanley, J.C. (1963). Experimental andquasi-experimental designs
for
research. Chicago: RandMcNally.
J.J.,& Greenwood,
Carta, C. R.(1985). Expanding theevaluation ofearly interventionpro-
grams. TopicsinEarlyChildhood SpecialEducation, 5, 88-104.
Casto,G.,& Mastropieri, M.A. (1986). Theefficacy ofearly interventionprograms: A meta-
analysis. Exceptional Children,52,417-424.
W.P.,& Hannah,
Christian, G.T. (1983).Effective management inhuman services.
Englewood
Cliffs,NJ:Prentice-Hall.
DeMyer, M. K., Barton, S., DeMyer, W. E., Norton, J. A., Allen,J.,& Steele,R.
(1973). Prognosis in autism:A follow-up study. Journal ofAutism andChildhood
Schizophrenia, 3, 199-246.
Dunst,C. J. (1985). Editor's introduction.AnalysisandIntervention in Developmental
Disabilities, 5, 1-5.
Forehand, R.,& McMahon, B. (1981). Helping thenoncompliant child:A clinician's
guide
toparent training. NewYork:Guilford Press.
Hersen,M.,& Barlow, D. H. (1976). Single caseexperimental designs: Strategies
forstudy-
ingbehavior change. NewYork:Pergamon Press.
Howlin,P. (1980). Thehome treatmentofautisticchildren.InL. Hersev & M.Berger (Eds.),
Language andlanguage disordersinchildhood. Oxford: Pergamon Press.
Knoblock, P. ( 1982). Teaching andmainstreaming autistic
children.Denver : LovePublishing
.
Koegel,R. L., Rincover, A., & Egei,A. L. (1982). Educating andunderstanding autistic
children. SanDiego,CA: College-Hill Press.
Koegel,R. L., Russo,D.C., & Rincover, A. (1977). Assessing andtraining inthe
teachers
generalized useofbehavior modification
with children.
autistic Journal ofApplied Behavior
Analysis, 10,197-205.
V.( 1974). Socialadjustment
Lotter, andplacement ofautisticchildreninMiddlesex: A follow-
upstudy. Journal ofAutism andChildhood Schizophrenia, 4, 11-32.
Lovaas,0.1.(1981). Teaching developmentally disabled children:TheMEBook.Baltimore :

University ParkPress.
Lovaas,O. I. (1987). Behavioraltreatmentandnormal educationalandintellectual
function-
inginyoung autistic
children.Journal ofClinical andConsulting Psychology, 55,3-9.
S. J.(1985). Theefficacy
Meiseis, ofearlyintervention. Why arewestill askingthisquestion?
TopicsinEarlyChildhood SpecialEducation , 5, 1-11.
Rutter,M. (1966). Prognosis: Psychoticchildren inadolescence andearlyadultlife.InJ.K.
Wing(Ed.),Earlychildhood autism: Clinical,educational, andsocialaspects. London:
Pergamon Press.
M.(1970). Autistic
Rutter, children:Infancy toadulthood. Seminars inPsychiatry,
2,435-450.
E., & Reichler,
Schopler, R. J.(1971). Parents as co-therapistsinthetreatmentofpsychotic
children. JournalofAutism andChildhood Schizophrenia, 1, 87-102.
Simeonsson, R. J.,Cooper, D. H., & Schuner, A. P. (1982). A review andanalysis ofthe
effectivenessofearly interventionprograms. 69,635-641.
Pediatrics,
Simeonsson, R. J.,Olley,J.G.,& Rosenthal, S. L. (1985). Earlyintervention forchildren
with autism. InM. J.Guralnick & F. C. Bennet (Eds.),Theeffectiveness
ofearly interven-
tionforat-risk andhandicapped children. NewYork:Academic Press.
P. S. (1983). Generalization
Strain, ofautisticchildren'ssocialbehavior change: Effects
of
developmentally integratedand segregated settings.Analysis and Intervention in
Developmental 3, 23-24.
Disabilities,
White,O.,Edgar, N.G.,Afflick,
E., Haring, J.,& Hayden, A. (1978). Uniform performance
assessment system:Birth- 6 yearslevel.Seattle, WA:College ofEducation, University
ofWashington.

Home Early Intervention

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INTENSIVE HOME-BASED EARLY INTERVENTION WITH AUTISTIC CHILDREN

INTENSIVE HOME-BASED EARLY INTERVENTION

Stephen R. Anderson, Debra L. Avery,

The May Institute

The efficacyof earlyintervention has been the subject of much debate

verylittleempiricalevidenceof effectiveness. In theirreview,Simeonsson,

children.In doing so, the studyattemptedto examinea morepracticalap-

niquesand treatment procedures,as wellas behavioranalysismethods(e.g.,

conciseinstructions,effective prompts,and unambiguousand immediatecon-

acrosscategorieswas 90% agreement

11 childrenshowed a positivetreatment changewithgains rangingfrom3

social/behavioral(17%), preacademic(13%), and motor/play concerns(9%).

in thepresentstudyrecovered(i.e., wereplaced in a classroomwithnonhan-

The resultsof thestudysuggesttheneed to utilizea varietyof dependent

American Psychiatric Association (1980). Diagnostic and statistical manual(3rded.).

Lovaas,0.1.(1981). Teaching developmentally disabled children:TheMEBook.Baltimore :

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