Intensive autism program makes 'huge' difference: First major study finds nearly half became non-autistic

National Post

Nov 11, 2006

Page: A6

Section: News

Edition: All but Toronto

Dateline: MARKHAM, Ont.

Byline: Joseph Brean

MARKHAM, Ont. - Ontario 's program of intensive behavioural intervention for young autistic children is so effective that nearly half -- 41%-- of the mild to moderate autistics left the program as non-autistics, according to a new analysis.

It is the first accounting of success rates for the provincially funded program, which seeks to improve the social and cognitive functioning of autistic children by breaking down skills into discrete steps, and then teaching those through repetitive reinforcement.

Among severe autistics, 59% left the IBI program in the mild/moderate category, and 15% were classified as non-autistic. In all, three out of four children showed some measurable improvement, while a small but significant number, 7%, got worse, and 19% showed no change.

"Children are clearly having a lot more skills after the program than when they came," said Adrienne Perry, a York University psychologist who prepared the review independently with funding from the province. She presented the results yesterday to a conference in Markham, Ont., calling the success rates "a huge, huge effect size."

Children who started the IBI program at a younger age tended to do better, as did those who stayed in it for longer.
The results, compiled from the case files of 332 autistic children between the ages of two and seven (with five times as many boys as girls) showed that, across the board, their rates of development -- as measured by a psychological test -- roughly doubled during the treatment.

In her report to the province, Prof. Perry described it as "the largest (and one of the only) studies which demonstrates the effectiveness of IBI in a large and diverse community sample [as opposed to in ideal conditions with ideal candidates]. "

Intensive Behavioural Intervention is a type of autism treatment specifically for young children, based on the wider practice of Applied Behavioural Analysis. It aims to track the behaviour of autistics, observe how changes to their environment change their behaviour, and then use those trends to teach practical skills by breaking them down into simple, repeatable steps.

It has been criticized for creating "robot-like" behaviour, and because it typically involves 20-40 hours of therapy per week, it is also very expensive.

It is also the only autism treatment that is experimentally proven to be effective, as opposed to other methods, such as psychoanalysis or treatments based on diet or drugs.

"Parents are desperate, so they try these, and by the time they get to a good behaviour analyst, they've wasted a lot of time," said Larry Williams, a professor of psychology at the University of Nevada , Reno , and a longtime autism researcher.

IBI "is worth it if you look at the long-term cost of an autistic child," he said.
In Ontario , IBI is run by nine centres across the province, each of which are contracted to the government.
The program has been controversial in Ontario because of its cost, and the role of the government in funding it, as was argued in the case of Wynberg et. al. v. Ontario . In that case, the Ontario Superior Court initially ruled that the province must extend autism treatment to children aged six and over, because to refuse treatment reinforced the notion that these children were "unredeemable. " That decision was overturned this summer by the Ontario Court of Appeal, which ruled the government does not have to pay for extended treatment. This week, the plaintiffs filed leave to appeal that decision.

Prof. Perry acknowledged that her analysis of IBI's effectiveness has several shortcomings. It did not include a comparison group, for example, such as children who received no treatment or a different kind. It was based only on the first and final evaluations, and did not chart progress during the treatment. And because the results are new, there has been no long-term follow-up.

jbrean@nationalpost .com
Black & White Photo: Ozier Muhammad, The New York Times / The Intensive Behavioural Intervention program for autistic children in Ontario produced dramatic improvements in functioning in many cases, but it has become the subject of a court battle over government responsibility to pay the high costs.