Applied Behavioral Analysis & Autism Applied Behavioral Analysis of Autism and Severe Intellectual Disability

Home-Based Behavioral Treatment of Young Children with Autism: A Review

The study conducted by Sheinkopf and Siegel exposes serious gaps in autism treatment knowledge rather than coming to specific conclusions about the effectiveness of home-based behavioral treatment (1998). The primary outcome of the study was the finding of positive therapeutic effects when treatment was implemented in the affected children's homes, outside the more closely controlled setting of an academic research center. It effectively showed that home-based behavior treatment for children with autism is plausible and appears to have a positive impact on the children's IQ and symptomatology. The study methodology, however, was compromised by a number of significant limitations and biases.

The largest limitation of the study consists of its failure to effectively isolate variables. The positive outcome of the study, therefore, cannot be attributed to any of the factors that played a role in implementing the home-based behavioral autism treatment: parental influence on the children, the treatment intensity and the modalities of the treatment.

This is not a randomized study. Parents of children in the study groups voluntarily participated in the study. More importantly, parents of children in the control group specifically chose not to commit to the home-based behavioral treatment. The authors address this confounding variable in their discussion but suggest that, "the similarity of the two groups in terms of paternal occupational status suggests that large differences were unlikely." Despite the proclaimed similarity, this remains a significant limitation. It presents the possibility that the observed positive effect of the treatment by comparison...

These factors may include negligence of the children at home and lack of reiteration of skills acquired in school-based treatment. The possibility of a negative impact on the control is observed in the 2.3% increase in the symptoms count post-treatment. This suggests that the control group is not reliable for comparison to the treatment group. The lack of direct observational data significantly limits the study. An expert should be present during the home-based treatment to observe the interaction between the parent and child during the treatment to determine the influence that treatment administration has on the outcomes. From the conclusions, it appears that the parents as teachers had a larger impact on outcomes than the actual treatment modules.
Further, there exists a large disparity in treatment intensity between the two study groups. The experimental group received on average sixteen more hours of treatment across teaching modalities. The implications of this statement are two-fold. The authors argue that the variation in teaching intensity within the experimental group had no significant effect on outcomes. It must be noted that variation in this group is significantly lower than in the control group and that this claim has little relevance to the comparative outcomes that were measured. It appears rather that the intensity of the treatment would play a significant part in skills retention. Further, the experimental group received a combination of therapies, which makes it difficult to determine to which training and specifically to which aspects of the training to attribute the positive outcomes. The different IQ tests used in the pre and post-treatment examination of the subjects further confound this aspect of the study.

The…