Exploratory

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Exploratory Studies in the Prevention of Autism: An Analysis of Five Successful Cases

Authors: Philip W. Drash, Ph.D., BCBA,
Autism Early Intervention & Prevention Center, Tampa, FL
and
Roger M. Tudor, Ph.D.
Westfield State College, Westfield, MA

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Exploratory

  1. 1. Exploratory Studies in the Prevention of Autism: An Analysis of Five Successful Cases Philip W. Drash Autism Early Intervention & Prevention Center Roger M. Tudor Westfield State College
  2. 2. Table 1. Individual Subject Data* <ul><ul><li>Category Sub 1-M Sub 2-F Sub 3-M Sub 4-M Sub 5-M </li></ul></ul><ul><ul><li>CAA 14mo 22mo 2-10 2-0 2-6 </li></ul></ul><ul><ul><li>CA Dis 17mo 2-6 3-6 IT 2-8 3-6 </li></ul></ul><ul><ul><li>CA FwU 3-0 2-6 3-6 8-5 2 nd 7-3 1 st </li></ul></ul><ul><ul><li>VBT Hrs Wk 0 1 3 1-2 1 </li></ul></ul><ul><ul><li>Tot VBT Sess 0 27 77 34 36 </li></ul></ul><ul><ul><li>Dur Thpy 3mo 7mo 7mo 8mo 12mo </li></ul></ul><ul><ul><li>Type Thpy Parents VBT VBT VBT VBT </li></ul></ul><ul><ul><li>Neg Beh None Moderate None Mild Mild </li></ul></ul><ul><ul><li>*The type of therapy used in this Prevention Program was ABA Verbal Behavior Therapy (VBT). </li></ul></ul>
  3. 3. Table 2. Results of Intervention: Gains in ELA and IQ <ul><ul><li>Category Sub 1-M Sub 2-F Sub 3-M Sub 4-M Sub 5-M </li></ul></ul><ul><ul><li>CAA 14mo 22mo 2-10 2-0 2-6 </li></ul></ul><ul><ul><li>CA Dis 17mo 2-6 3-6 IT 2-8 3-6 </li></ul></ul><ul><ul><li>CA FwU 3-0 2-6 3-6 8-5 2 nd 7-3 1 st </li></ul></ul><ul><ul><li>Dur Thpy 3mo 7mo 7mo 8mo 12mo </li></ul></ul><ul><ul><li>Pre Wds 0 25-30 0 25-30 0 </li></ul></ul><ul><ul><li>Pre ELA 12mo 14mo 11mo 16mo 12mo </li></ul></ul><ul><ul><li>ELA Dis --- 2-11 2-9 3-1 4-2 </li></ul></ul><ul><ul><li>Gain ELA --- 21mo/7mo 22mo/7mo 21mo/8mo 3-2/12mo </li></ul></ul><ul><ul><li>FwU ELA Avg Lo Avg Lo Avg Avg Avg </li></ul></ul><ul><ul><li>IQ Dis 112 114 98 125 112 </li></ul></ul>
  4. 4. Table 3. Levels of Intervention in the Prevention of Autism <ul><li>Level 1. Minimal Intervention (#1) </li></ul><ul><li>Younger sibling of child with autism receiving ABA therapy </li></ul><ul><li>Symptoms : Child exhibits no symptoms of autism </li></ul><ul><li>Level 2. Minimal Intervention (#2) (Subject 1, CAA 14 mo) </li></ul><ul><li>Younger sibling of child with autism receiving ABA therapy </li></ul><ul><li>Symptoms : Child may exhibit some mild symptoms of autism, </li></ul><ul><li>such as delayed language and/or social isolation </li></ul><ul><li>Level 3. Moderate Intervention (Subject 2, CAA 22 mo) </li></ul><ul><li>Younger sibling of child with autism receiving ABA therapy </li></ul><ul><li>Symptoms : Child exhibits definite symptoms of onset of autism, </li></ul><ul><li>including loss of language, isolation, severe negativism and task-refusal </li></ul>
  5. 5. Table 3. Levels of Intervention in the Prevention of Autism Continued <ul><li>Level 4. Moderate Intervention (Subject 4, CAA 2-0) </li></ul><ul><li>Symptoms : Child not diagnosed with autism, but serious language delay and resistance to learning language recognized by grandparents </li></ul><ul><li>Level 5. Moderate Intervention (Subject 5, CAA 2-6) </li></ul><ul><li>Symptoms : Child not diagnosed with autism, but serious delay in language, and strong resistance to acquisition of language </li></ul><ul><li>Level 6. Moderate Intervention (#2) (Subject 3, CAA 2-10) </li></ul><ul><li>Symptoms : Child not diagnosed with autism, but shows definite pre-autistic symptoms such as severe language delay, mannerisms, and unresponsiveness to speech therapy after a full year of treatment </li></ul>
  6. 6. Table 4. Follow-Up Status of Children in ABA Prevention Program <ul><ul><li> CA CA Mos CA Current </li></ul></ul><ul><ul><li> Adm. Dis. Treat. Flw-up Status </li></ul></ul><ul><ul><li>S1-M 14mo 17mo 3 3-0 Normal for age </li></ul></ul><ul><ul><li> </li></ul></ul><ul><ul><li>S2-F 22mo 2-6 7 2-6 Low avg for age </li></ul></ul><ul><ul><li>S3-M 2-10 3-6 IT 7 3-6 Low avg for age </li></ul></ul><ul><ul><li>S4-M 2-0 2-8 8 8-5 Normal for age </li></ul></ul><ul><ul><li>S5-M 2-6 3-6 12 7-3 Normal for age </li></ul></ul>
  7. 7. Table 5. A Comparison of the ABA Prevention Model with the ABA Intensive In-Home Therapy Model in Terms of Duration of Therapy, Number of Treatment Hours and Total Cost of Therapy <ul><li>ABA Prevention Model ABA Intensive In-Home Therapy </li></ul><ul><li>Duration of </li></ul><ul><li>Treatment: Usually 1 yr or less Often 3 yrs or more </li></ul><ul><li># of Treatment </li></ul><ul><li>Hrs per Wk: 1 to 3 hrs 30 to 40 hrs </li></ul><ul><li># of Treatment </li></ul><ul><li>Hrs per Yr: 27 to 150 1500 to 2000 (30-40 X 50 wks) </li></ul><ul><li>Total # of </li></ul><ul><li>Treatment Hrs: 27 to 150 4500 to 6000 (3 yrs) </li></ul><ul><li>Annual Cost: $2,700 to $15,000 ($100/hr) $30,000 to $40,000 ($20/hr)* </li></ul><ul><li>Tot Cost X 3 Yrs: NA $90,000 to $120,000 ($20/hr)* </li></ul><ul><li>*Note: The hourly rates are approximations only. Actual hourly rates for ABA services may vary considerably depending on the prevailing rates in a given community and the skill level of the ABA therapists. </li></ul>
  8. 8. Table 6. Summary and Conclusions <ul><li>1) Prevention of autism in some young children at high-risk for autism/PDD appears to be possible by using the ABA prevention model presented in this paper. All five children in this study were functioning as average or near average after a year or less of treatment. </li></ul><ul><li>2) The total cost and the total number of therapy hours in this prevention model are far less that that in the ABA in-home treatment model. In some cases both the cost and time may be 10% or less than that required in the ABA in-home model. </li></ul><ul><li>3) The three primary components of this prevention program were: </li></ul><ul><li>(1) rapid development of age-appropriate expressive verbal behavior, (2) elimination of negative behaviors (i.e. crying, etc.) that function to prevent acquisition of language, and </li></ul><ul><li>(3) reinforcement of age-appropriate social behavior. </li></ul>
  9. 9. Table 6. Summary and Conclusions Continued <ul><li>4) This study illustrates that there are various levels of intensity in the continuum of prevention. The least intensive levels of intervention require relatively little effort when compared with direct treatment programs. </li></ul><ul><li>5) Differentiating between prevention and direct treatment models is critical. In direct treatment the diagnosis of autism/PDD is usually established before treatment begins . </li></ul><ul><li> In the prevention model it is only necessary to establish that the child exhibits behaviors that place him/her in a high-risk category or that he is in a high-risk category based on epidemiological factors . There is no assumption that any one specific child will become autistic without intervention. Rather, it is a probability model in which a certain percentage of the at-risk group will likely be diagnosed as autistic unless intervention occurs. </li></ul>

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