Early and Intensive Behavioral Intervention: Addressing Behavior Excesses and Deficits in Young Children with ASD

Background

Early and Intensive Behavioral Intervention (EIBI) was pioneered by Dr. Ivar Lovaas and colleagues in the 1970s. Based on data from an outcome study published in 1973, Lovaas et al. hypothesized that treatment effects could be optimized if intervention was started early in the child’s life, and if intervention was comprehensive; that is, addressing all behavior excesses and deficits exhibited by a particular child. In addition, Lovaas argued that intervention had to be intensive; that is, it should provide a learning environment for the child throughout the whole day, be carried out in the child’s natural environment (such as at home and in school, rather than in an institution), and include persons who are part of the child’s natural environment (such as parents, teachers, peers). Finally, Lovaas argued that the children should enter typical classes to access typical peers to model appropriate behaviors, rather than attend special classes.

In his next outcome study, published in 1987, Lovaas evaluated the effects of this type of intervention and found that, as a group, children made significant progress in intellectual functioning and that almost half of the children succeeded in regular classes. Although creating a great deal of controversy, Lovaas’ seminal study provided hope for parents and professionals and opened up a whole new area of research.

What Defines Early and Intensive Behavioral Intervention?

A working hypothesis in contemporary EIBI is that children with autism have a learning deficit that is biologically based and is responsible for the behavioral deficits and excesses exhibited by these children. Moreover, it is argued that EIBI may help children overcome this learning deficit, enabling them to acquire behaviors demonstrated by typical children and eventually allowing some children to learn in a typical (non-behavioral) educational environment.

Intervention Methods

There are several key elements to an effective EIBI program. These elements must be included to have the best benefit for the child.

Parental Involvement

Parents are trained to become co-teachers for the child. They also learn how to manage the child’s challenging behaviors, and how to make the child use the skills he or she has learned during therapy sessions in everyday life. Parents are also taught how they can maintain a good family environment and how to care for siblings.

Teaching Methods

Discrete trial teaching is used to teach a wide variety of skills, such as language and communication, play, social skills, self-help skills and academic skills (Lovaas, 2003). Discrete trial teaching is carried out by presenting the child with the appropriate instruction and teaching material for the target behavior, prompting the target behavior if necessary and rewarding the child for emitting the target response.

In contrast to discrete trial teaching, natural environment teaching teaches skills in the situation they naturally occur. For example, during a mealtime, the child is rewarded for sitting nicely or is taught how to eat with a knife and fork. Many skills, such as learning to speak or tie shoelaces, may be difficult to learn from natural environment teaching because either the skill is complex and/or too few learning opportunities occur over the course of the day. Consequently, natural environment teaching is often combined with discrete trial teaching, where a particular skill (e.g., language) can be broken down into smaller components and practiced repeatedly until mastered.