In their Seminar on autism (Nov 7, p 1627),1 Susan Levy and colleagues claim that intensive programmes based on applied behaviour analysis (ABA) “were highly effective for up to half of children enrolled in about ten randomised clinical trials done in the past 20 years”.
The review that Levy and colleagues cite for this claim, by Rogers and Vismara,2 describes five randomised controlled trials, three of which do not involve trials of intensive ABA-based programmes. In one of the two other trials, by Sallows and Graupner,3 the intended comparison between randomised groups was not done. As Rogers and Vismara accurately report, Sallows and Graupner “merged data from both groups, changing the design into a noncontrolled pre–post design”.
This leaves a study reported by Smith and colleagues,4 which in fact is the only published randomised controlled trial to study intensive ABA-based programmes for autistic children. As Rogers and Vismara note, the results of this one very small study (intervention group n=15) do not support the claim that intensive ABA-based programmes are “highly effective”, especially not for children with the specific diagnosis of autism.
Thus, the claims made by Levy and colleagues, with respect to intensive ABA-based programmes for autistic children, have no basis—either in the review they cite or in any other published study.
Acknowledgments
MAG has been supported by grants NIH RO1 MH069793 and NIH R01 DC007223. She has been invited to give oral presentations to several organisations reviewing autism research. Some of these organisations have paid her an honorarium and reimbursed her for travel expenses related to making her invited presentation. MD has autism and therefore has direct interest in the accurate reporting of autism research.
References
- 1.Levy SE, Mandell DS, Shultz RT. Autism. Lancet. 2009;374:1627–38. doi: 10.1016/S0140-6736(09)61376-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Rogers S, Vismara L. Evidence-based comprehensive treatments for early autism. J Clin Child Adolesc Psychol. 2008;37:8–38. doi: 10.1080/15374410701817808. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Sallows GO, Graupner TD. Intensive behavioral treatment for children with autism: four-year outcome and predictors. Am J Ment Retard. 2005;110:417–38. doi: 10.1352/0895-8017(2005)110[417:IBTFCW]2.0.CO;2. [DOI] [PubMed] [Google Scholar]
- 4.Smith T, Groen AD, Wynn JW. Randomized trial of intensive early intervention for children with pervasive developmental disorder. Am J Ment Retard. 2000;105:269–85. doi: 10.1352/0895-8017(2000)105<0269:RTOIEI>2.0.CO;2. [DOI] [PubMed] [Google Scholar]