October 13, 2020 Applied Behavioral Analysis – An Evidence Based Therapy for ASD.
Autism spectrum disorder (ICD-10-CM -F84.0) is a neuro-developmental disorder characterized by two-pronged impairments: 1. Deficits in social behavior viz. communication and cognition; 2. Restricted repetitive patterns of behavior, interests and activities.
No medicines or diets have proven to have a definitive cure for ASD yet. However, behavioural therapies like Applied Behavioral Analysis (ABA) have shown sufficient clinical evidence as techniques to improve the functional and social capacity, as well as contribute to the quality of life of children on the ASD spectrum.
The caregivers to the child with ASD could be stressed due to lack of choices on therapies to treat their children. This often results in these caregivers falling prey to unproven therapies that yield negligible or poor results. ABA on the other hand has been subjected to scientific research and evaluation over many years.
In 2019, Medavarapu, a paediatric neurologist from Mount Sinai Hospital, NY and his colleagues reviewed approximately 1500 scientific publications from research journals and scientific databases which pertained to therapies used for ASD. Of these, 130 articles were selected and examined for biological therapies for ASD such as intravenous immunoglobin ( antibodies separated from the donors plasma), chelation ( process of eliminating toxins from the body often used in cases of poisoning), administration of hyperbaric oxygen ( oxygen at a higher atmospheric pressure), gastro-intestinal therapy as well as non-biological therapies ranging from sensory and auditory integration, to even horseback riding, transcranial magnetic stimulation (TMS) and finally music. These purported therapies were shown to have no proven benefits for the treatment of ASD.
It has been found that while medicines have shown limited symptomatic benefits for ASD, scientific evidence is needed before it can be administered as an established mode of treatment.
ABA is a method of teaching desired behaviour by breaking down the task into small discrete steps and training in a systematic manner. It involves immediate feedback and positive reinforcement.
Earliest study on ABA was conducted by a clinical psychologist, Ole Ivar Lovaas in 1987, which proved that children who received ABA had statistically significant improvements in IQ scores than the ones who did not receive ABA.
In 2009, a study was conducted by Brian Reichow, an autism researcher, on the comprehensive synthesis of EIBI (Early Intensive Behavioral Intervention) for young children with autism. It was based on the University of California Los Angeles Young Autism Project model. The findings suggested that EIBI is an effective treatment, for children with autism. Virués-Ortega, an applied behavior analysis researcher did a meta-analysis for 22 clinical studies in 2010. It shows a clear evidence for long-term ABA amongst the children on the ASD spectrum resulting in improvements in the intellectual functioning, language development, acquisition of daily living skills and social functioning. Language-related outcomes were the most superior when compared with other outcomes.
The National Autism Centre’s National Standards Report considers Behavioral intervention to be an “established” treatment. It has been endorsed by the US Surgeon General and the New York State Department of Health as well as other state and federal agencies (Medavarapu 2019).
Medavarapu, S., Marella, L. L., Sangem, A., & Kairam, R. (2019). Where is the Evidence? A Narrative Literature Review of the Treatment Modalities for Autism Spectrum Disorders. Cureus, 11(1), e3901. https://doi.org/10.7759/cureus.3901