Exceptional Children

Vol. 73, No. 4, pp. 417-433.

2007 Council for Exceptional Children.

The Real-World Effectiveness

of Early Teaching Interventions
for Children With Autism
Spectrum Disorder
PHIL REED
LISA A. OSBORNE
Swansea University

MARK CORNESS
Children, Young People, and Families Directorate, Oxford

ABSTRACT: The effectiveness of 3 early teaching interventions (applied behavior analysis [ABA],

special nursery placement, and portage) for children with autism spectrum disorder was studied
in a community-based sample over 10 months. Measures of autism severity as well as intellectual,
educational, and adaptive behavioral function were administered. In contrast to reports in some
previous research (Lovaas, 1987), there was no evidence of recovery from autism. Children in the
ABA condition made greater intellectual and educational gains than children in the portage
program. They also made greater educational gains than students in the nursery program. Fur-
thermore, the nursery program produced larger gains than the portage program in adaptive
functioning.

E ducationally based programs

are often the only form of in-
tervention given to children
with autism spectrum disorder
(ASD) and are often the only
form of support that their families receive (e.g.,
see Howlin & Moore, 1997; Osborne & Reed, in
press, for surveys). Often these interventions are
offered early in the childs development, and
there is a perception that interventions offered
early are more effective than those offered later
(Lovaas, 1987). However, despite the ubiquity
and perceived importance of educational ap-
proaches to the management of ASD, there are
relatively few quantitative investigations of the
comparative efficacy of such programs.
A number of early-teaching interventions
have been suggested as offering benefit to some
children with ASD. Applied behavior analysis
(ABA) approaches have been widely investigated
(e.g., Eikeseth, Smith, Jahr, & Eldevik, 2002;
Howard, Sparkman, Cohen, Green, & Stanislaw,
2005; Lovaas, 1987; Smith, Annette, & Wynn,
2000). In addition, special nursery placements

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(see Charman, Howlin, Berry, & Prince, 2004;
Gabriels, Hill, Pierce, Rogers, & Wehner, 2001),
floortime (Greenspan & Wieder, 1997), and
portage (e.g., Smith, 2000) have been offered as
approaches to managing the problems associated
with ASD. Some of these latter approaches have
the benefit of being reasonably cost effective, but
they suffer from the problem of having a scant ev-
idence base with respect to their effectiveness in
promoting the childs intellectual, educational,
and social functioning.
The effectiveness of placement in specialist
nursery provision has been studied, often as con-
trol conditions in the assessment of ABA pro-
grams. Such programs are often referred to in this
literature as generic (e.g., Lovaas, 1987) and/or
eclectic (e.g., Howard et al., 2005) programs.
This is typically because such approaches do not
follow a particular brand name approach to ed-
ucation, and they offer a variety of teaching meth-
ods (e.g., picture exchange systems, activities
drawn from the TEACCH [Treatment and Edu-
cation of Autistic and Related Communication
Handicapped Children] model, circle time, social
stories) that do not necessarily adhere to a single
underlying philosophy, as do ABA approaches.
The results from these studies of special nursery
placements have not been particularly encourag-
ing. Three studies have shown small improve-
ments in intellectual functioning following special
educational placement. Sheinkopf and Siegel
(1998) found a 2-point increase in IQ across a
year in children in special school provision, and
Eikeseth et al. (2002) found a 4-point improve-
ment in IQ over a year (using one-to-one tech-
niques such as TEACCH and sensory-integration
therapy). However, there was no improvement in
adaptive behavior (as measured by the Vineland
Adaptive Behaviour Scale). Gabriels et al. (2001),
in a retrospective, 3-year study of children with
ASD undergoing an eclectic approach to inter-
vention, found a 5-point increase in IQ over 3
years.
In contrast, four studies have found no im-
provement in functioning. Shallows and Graup-
ner (1999) found a 7-point decrease in IQ over a
year. The remaining three studies in this latter
group found no overall change in the standard-
ized score of children in special educational place-
ments with an eclectic approach to intervention.
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Howard et al. (2005) compared two groups of
children with ASD undergoing either an intensive
program in an autism special school or a less in-
tensive program in a local community special ed-
ucation classroom. In neither case was there any
change in a variety of assessments of intellectual
functioning. Lovaas (1987) found no improve-
ment for children undergoing generic educational
interventions over a 3-year period. Charman et al.
(2004) found no improvement in adaptive behav-
ior scores as measured by the Vineland Adaptive
Behaviour Scale (see also Eikeseth et al., 2002).
Unfortunately, the usefulness of many of
these studies in assessing the impact of special ed-
ucational provision on children with ASD is lim-
ited by the fact that many of these groups are
derived from archive records (e.g., Gabriels et al.,
2001; Sheinkopf & Siegel, 1998), rather than
being studied contemporaneously with the other
children in the study. Additionally, many of these
studies employ different measurements both
across participants and at baseline and follow up
(e.g., Howard et al., 2005; Lovaas, 1987), thus,
reducing the reliability of the data (see Magiati &
Howlin, 2001). There are few studies of special
educational placement that are prospective in na-
ture and that use the same tests at baseline and
follow up, which was the first aim of the current
study.
There are few studies of special educational
placement that are prospective in nature
and that use the same tests at baseline and
follow up, which was the first aim of the
current study.
Portage is an approach offered by numerous
local education authorities in the United King-
dom for children with ASD. Portage is a home-
based, parent-administered early intervention for
developmental disabilities. Smith (2000) provides
some data to suggest that portage programs can
have an impact on social development of children
with autism, and Reed, Osborne, and Gibson
(2000) discuss some possible developments and
limitations of this approach. However, this ap-
proach, although commonly used in practice, suf-
Summer 2007
fers from a great paucity of empirical evidence re-
garding its effectiveness.
Much current debate in educational litera-
ture has centered on ABA techniques as an inter-
vention for ASD problems (see Connor, 1998;
Mudford, Martin, Eikeseth, & Bibby, 2001).
There are a number of different ABA approaches
that have been outlined in a variety of sources
(e.g., Greer, 1997; Koegel & Koegel, 2006; Lo-
vaas, 1981; Lovaas & Smith, 1989; Sundberg &
Michael, 2001; Twyman, 1998). In general, these
approaches share a number of common features:
(a) the one-to-one teaching of children with
autism by adult tutors; (b) a discrete-trial rein-
forcement-based method; and (c) an intensive
regime (up to 40 hr a week, for 3 years, in some
instances). The initial results reported by Lovaas
(1987) concerning the effectiveness of such an ap-
proach were remarkable. The children undergoing
this approach made gains of up to 30 IQ points (a
finding noted in some children with ASD under-
going special educational programs, see Gabriels
et al., 2001), and just less than half of these chil-
dren appeared to recover, that is, they were not
noticeably different from normally developing
children after 3 years of the intervention (a find-
ing yet to be replicated).
There have been a number of critiques of this
original piece of research (i.e., Lovaas, 1987) that
have focused on problems both with the internal
and external validity of the study (e.g., Connor,
1998; Gresham & MacMillan, 1997; Mudford et
al., 2001). In terms of the internal validity of the
Lovass (1987) study, it should be noted that dif-
ferent IQ tests were used at baseline and at follow
up to assess the childrens intellectual functioning,
thus reducing the reliability of the measurement
(Magiati & Howlin, 2001). This is not a unique
problem with ABA studies (see earlier text). In
terms of the threats to the external validity of the
Lovaas (1987) study, the reliance on IQ as a sole
measure may be questioned, given that IQ is not
necessarily the main problem in autism function-
ing. Second, the sample chosen for the study re-
ported by Lovaas (1987) were verbal, relatively
high-functioning participants, who may have per-
formed equally well with any intervention of a
reasonable input (such as some of those noted
earlier). Finally, the study reported by Lovaas
(1987) was a clinic-based study and may not gen-
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eralize to interventions as they are typically used
in the parents home, severely compromising the
usefulness of the study. This issue has been high-
lighted in a number of recent reports of home-
based ABA programs, which have questioned the
extent to which the results of clinic-based assess-
ments can be generalized to the type of ABA pro-
gram that occurs in the community (Mudford et
al.).
Although several of these critiques have been
addressed in subsequent research, few, if any,
studies have addressed them in a single investiga-
tion. For example, Eikeseth et al. (2002), and
Howard et al. (2005), have used community-
based rather than clinic-based samples, but nei-
ther used the same tests at baseline and at follow
up. In light of this, a second aim of the current
study was to assess the effectiveness of ABA ap-
proaches on a more typical sample of children
with ASD, using the same instruments at baseline
and follow up.
[A] second aim of the current study was
to assess the effectiveness of ABA approaches
on a more typical sample of children with
ASD, using the same instruments at
baseline and follow up.
Thus, there are a number of issues that are
clearly unresolved concerning the effectiveness of
educational interventions for ASD. It appears
critical to be able to assess the effectiveness of the
ABA approach in community-based, rather than
clinic-based, settings with participants more typi-
cally representative of those who present to local
service providers (i.e., more severe symptoms, less
linguistically able). It also appears important to
utilize a wide range of instruments in the assess-
ment procedure, not only to examine intellectual
functioning, but also educational functioning,
and adaptive behavior. Simultaneously providing
evidence on the effectiveness of other interven-
tions than ABA would not only allow these inter-
ventions to be assessed, but also would allow a
well-matched alternate-treatment control group
for the ABA studies, a comparison so far missing
(Hohmann & Shear, 2002).
419
 Given the previous considerations, the cur-
rent study directly compared the impact of exist-
ing ABA, special nursery placements, and portage
programs on a variety of aspects of the childrens
abilities. The latter two were selected because spe-
cial nursery placement is a commonly occurring
program offered to children with ASD, which has
received little direct assessment in terms of its ef-
fectiveness. Portage was chosen as, again, it is in-
creasingly offered to children with ASD (see Reed
et al., 2000; Smith, 2000). The portage interven-
tion also allows comparison of a very intensive
intervention (ABA) with a less intensive interven-
tion (portage) in a community-based setting. This
comparison formed part of the original clinic-
based study conducted by Lovaas (1987), and the
current comparison allows assessment of the gen-
eralization to a community-based sample.
METHOD
P A R T I C I PA N T S
Participants were selected on the basis of four cri-
teria. They were (a) 2:6 (2 years 6 months) to 4:0
years old, (b) at the start of their first teaching in-
tervention, (c) receiving no other major interven-
tion during the period of the assessment, and (d)
they had an independent diagnosis of ASD made
by specialist pediatricians following initial referral
from a general medical practitioner. In addition
to this independent diagnosis, several of the scales
that were administered allowed further indepen-
dent assessment of the degree of the autism sever-
ity (Gilliam Autism Rating Scale [GARS];
Gilliam, 1995) and the degree of behavioral prob-
lems (Conners Rating Scale [CRS-R]; Conners,
1997).
A total of 53 participants were identified in
conjunction with local authorities in the south-
east of England during 2002 to 2004. None of
the families contacted refused to participate in the
study. Of the participants initially recruited, five
were excluded from the study: three for compro-
mised treatment integrity (i.e., at the follow-up
assessment it became apparent that the child had
received both ABA and special nursery interven-
tions in two cases, and portage and special nurs-
ery interventions in one case); one for missing
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data; and one for highly discrepant GARS scores
at baseline and ceiling effects on follow up).
Assignment to a group was on the basis of
the intervention being offered to the child in their
particular area. For example, if a child was in an
area that offered a special nursery placement, then
that child was assigned to that group. The areas
involved in the study offered a similar socioeco-
nomic profile, all being in southeast England.
Thus, although the allocation to group was not
truly random, the childs characteristics did not
influence group assignment, and the groups of-
fered a well matched profile (see Results and Table
2). Ethical approval for the study (University Col-
lege London Hospital Trust Ethics Committee)
was granted based on this understanding.
In terms of the estimated sample size
required for finding statistical effects, previous
studies have employed between 11 and 19 partici-
pants per group. Given the average effect size in
these studies of about 1.0, the minimum number
of participants for a study with high power (0.8)
would be approximately 8. Given this, the num-
ber of participants per group (12 to 20) was
thought to be adequate in this study.
INTERVENTIONS
Three early educational interventions for autism
were studied (i.e., they were not part of a specially
organized trial)applied behavior analysis
(ABA), special nursery placements, and portage.
These interventions were selected as they repre-
sent some of the most commonly occurring com-
munity-based interventions, and they provided a
broad spectrum of the types of approach currently
offered in the United Kingdom.
Applied Behavior Analysis. The ABA programs
included in this study were provided by a range of
organizations, and followed one of a number of
well recognized ABA procedures: (a) UCLA Lo-
vaas-type approaches (see Lovaas, 1981; Lovaas &
Smith, 1989); (b) verbal behavior (see Sundberg
& Michael, 2001); or (c) Comprehensive Appli-
cation of Behavior Analysis to Schooling
(CABAS; see Greer, 1997). All of these programs
were overseen by appropriately trained supervisors
(who were either Board Certified Behavior Ana-
lyst [BCBA] accredited or who had master
teacher-level CABAS qualifications). The inter-
Summer 2007
TABLE 1
Characteristics of the Three Interventions Studied
Variable ABA Special Nursery Portage

Mean intervention (hr) 30.4 12.7 8.5

Range (hr) 2040 323 215
Interquartile range (hr) 2834 1215 39
One-to-one teaching (hr) 28.3 3.1 6.5
Group teaching (hr) 2.1 9.6 2.0
Tutors (family tutors) 4.4 (1.0) 4.0 (1.0) 4.0 (2.0)
Service providers 5 7 7
Treatment characteristics
Based Home School Home
Teaching One-to-one Group One-to-one
Led by Tutor Tutor Parent
Methods Reward Various Reward
Intensity High Moderate Low

ventions were conducted by tutors trained in ac-
cordance with the appropriate intervention man-
uals associated with the ABA approach offered.
All of these programs shared key ABA fea-
tures. All were home-based and offered almost ex-
clusively one-to-one teaching for the child with
autism, and the intensity (hours per week) of the
interventions were typically quite high (see Table
1). Typically, a session would last 2 to 3 hr, and
would comprise approximately 8 to 14 tasks or
drills per session (depending on the particular
needs of the child). Typically these tasks would
last about 5 to 10 min each and would be re-
peated until some criterion performance was
reached. Each task would be separated by a 5- to
10-min break, or down time. The programs used
an antecedent (question/task), behavior (re-
sponse) sometimes prompted if necessary, and
consequence procedure as outlined in the various
manuals. Reinforcement was usually a tangible
such as food, but could also be praise and activi-
ties depending on what was effective with the in-
dividual child. No aversive stimuli were used in
any of the programs.
Special Nursery Placements. The special nurs-
ery placements (Nursery) occurred across several
school provisions (see Table 1). The classes were
small, with about six to eight children in each. All
classes were under the supervision of a teacher
with postgraduate qualifications in teaching and
specialist training in special educational needs. All
curriculum and practices had been approved by
Ofsted Reports (U.K. government inspection re-
ports given regularly to all schools). In addition to
the teacher, each class had two or three learning
support assistants, who would help work with the
children in small groups. Thus, most teaching was
conducted in small groups rather than individu-
ally (about four times as much group work as in-
dividual work). The intensity of the intervention
(hours per week) was moderate compared to the
ABA group.
The children attended the nursery for a
number of 2- to 3-hr sessions per week, depend-
ing on the severity of the childs autism (see Table
1 for the range of time inputs). Typically, a session
would start and end with six to eight children in a
group with the teacher at the front. The teacher
usually guided a song, or other introduction, and
the children were encouraged to take turns in an-
swering their names or responding, often involv-
ing doing an individual activity (e.g., picking up
name card, shaking an instrument, etc.), while
the others were encouraged to respond and com-

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ment. A key feature was the use of materials and
methods appealing to children with ASD, such as
bright colored visual materials, glitter, water,
paint, sand, or musical instruments. Much of the
schools environment and many of the tasks given
to the children were presented in a highly struc-
tured method as outlined by the TEACCH
methodology (Mesibov, Schopler, & Hearsey,
1994).
Thus, the focus was on learning and motiva-
tion, developing shared attention, and participa-
tion (with support from up to two or three other
adults). Other sessions included a free choice of
activities for the children, with adults focusing
their support on children working toward their
learning objectives, all the time encouraging and
prompting social interaction, turn-taking, shared
attention, and responding. Another session in-
volved outdoor group activities, such as running
across the playground, together in pairs, to prac-
tice physical coordination, group participation,
and so forth. Most of the reinforcers were social
(e.g., saying good boy, or clapping, or providing
the opportunity to play with a desired toy, etc.,
but always in the context of the group).
Portage. Portage is a home-based teaching
program for preschool children with special educa-
tional needs. The portage program has been exten-
sively used with children with developmental
delay (see Cameron, 1997), but has recently been
developed to accommodate children with ASD (see
Reed et al., 2000; Smith, 2000). This program
involves slightly increased time input, and a focus
on developing attentional responses, such as joint
attention and attention sharing behaviors. The in-
tervention is a relatively low-intensity program,
with the majority of the work being conducted
one-to-one with the child, although about 25% of
the time involves group work (see Table 1).
The portage program is supervised by a
trained portage supervisor, who has graduate-level
qualifications and who attended training courses
in the delivery of portage for children with ASD.
The program typically follows a manual written
by the portage service provider. The supervisor
visits the parents once every 1 to 2 weeks, and
parents and caregivers are shown how to apply
this system during these visits.
The training sessions conducted with the
child are brief, usually about 40 to 60 min per
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day, and are scheduled when the parent believes
the child will be at his or her most receptive.
Thus, the program shares some common ele-
ments with more motivationally oriented ap-
proaches such as floortime (Greenspan & Wieder,
1997). Typically, the parent will teach the child in
a one-to-one situation and will target several skills
per week. The children are taught new skills
through the use of questions and tasks, prompts,
and rewards. The skills to be taught are outlined
in the portage manuals, and each skill acquired is
used to build larger and more complex behavioral
responses. Monitoring and evaluation of progress
occurs at the supervisors visits.
Comparison of Approaches. The key character-
istics of the different interventions, along with a
description of their main features (overall hours
per week, hours of one-to-one and group, num-
ber of tutors involved, etc.) reported by tutors in
pre- and poststudy questionnaires are shown in
Table 1. These questionnaires were given at the
start of the intervention and at the end and were
compared to check the degree to which the
planned intervention was adhered to over the
course of the program. In all cases, the descrip-
tions of the program given in the postinterven-
tion questionnaires were used for the data in
Table 1, but it should be noted that in most cases
the postintervention descriptions adhered to those
outlined at the start of the intervention. Similarly,
the descriptions of the program given by the su-
pervisors and the parents were very similar to one
another. To this extent, the data obtained on the
characteristics of the intervention were verifiable
from multiple sources, and fidelity to the initial
aims of treatment, insofar as it can be achieved in
home-based settings, was reasonable.
Thus, inspection of Table 1 shows that the
ABA program had the highest time intensity, fol-
lowed by nursery, and portage. The ABA and
portage approaches delivered mainly one-to-one
teaching, whereas the nursery placements offered
mainly group instruction. All of the programs of-
fered exposure to a range of adult tutors in addi-
tion to the teacher/supervisor. It should be noted
that all of the supervisors/teachers leading the var-
ious programs were professionally accredited.
That is, the ABA supervisors were all BCBA or
CABAS accredited, the nursery teachers were all
certified teachers, and the portage home visitors
Summer 2007
had all been trained and held Portage certificates.
Each intervention was conducted in accordance
to either the appropriate manual or in accordance
with best teaching practice in special schools.
MEASURES
Gilliam Autism Rating Scale. The GARS
(Gilliam, 1995) comprises four subtests, each de-
scribing behaviors symptomatic of autism (Stereo-
typed Behaviors, Communication, Social
Interaction, and Developmental Disturbances).
The raw scores from these subscales can be con-
verted into standard scores (M = 100, SD = 15).
These subscales combine to give an Autism Quo-
tient, high scores meaning greater autistic severity
(M = 100 [average autistic severity], SD = 15).
The scale is appropriate for persons ages 3 to 22
years and is completed by parents or professionals
in about 10 min. Its internal reliability is 0.96,
and it has high criterion validity with the Autism
Behavior Checklist (0.94).
Psychoeducational Profile (Revised). The Psy-
choeducational Profile Revised (PEP-R; Schopler,
Reichler, Bashford, Lansing, & Marcus, 1990) is a
developmental test designed for assessing both the
typical strengths and characteristic weaknesses of
children with autism. The test measures function-
ing in seven developmental domains: Imitation,
Perception, Fine and Gross Motor Skills,
EyeHand Coordination, and Nonverbal and
Verbal Conceptual Ability. The mental age re-
quired to perform the tests ranges from 1 to 72
months. The test also gives an overall develop-
mental functioning score that can be converted
into an overall score (mental age/chronological
age ! 100). The internal reliability of the PEP-R
for children with autism ranges from 0.85 (Per-
ception) to 0.98 (Cognitive Verbal Performance),
and it has high criterion validity with other tests
for intelligence, such as the Merrill Palmer Scale
of Mental Tests (0.85). The PEP-R was used be-
cause its low floor and high ceiling made it appro-
priate to administer to the current sample both at
baseline and at follow up. This avoids one major
criticism of previous work that different tests are
administered at these times reducing the reliabil-
ity of the measure (Magiati & Howlin, 2001).
British Abilities Scales II. The British Abilities
Scales: Second Edition (BAS II; Elliott, Smith, &
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McCulloch, 1996) is a battery of tests of cognitive
abilities that index educational achievement. It is
suitable for use with children and adolescents ages
2 years, 6 months (2:6) to 17 years, 11 months
(17:11). For the current purposes, the Early Years
Battery was employed, which is designed for chil-
dren under the age of 6 years. The present use of
the test concerned educational achievement, so
the Verbal Comprehension, Early Number Con-
cepts, Picture Matching, and Naming Vocabulary
subscales were used. These scales allow the calcu-
lation of a General Cognitive Ability scale (M =
100, SD = 15), which represents early educational
achievement.
Vineland Adaptive Behavior Scales. The
Vineland Adaptive Behavior Scales (VAB; Spar-
row, Balla, & Cicchetti, 1984) is a semistructured
interview, administered to a parent or other care-
giver of the child. It can be used for children from
birth to 5:11 years, making it suitable for the pre-
sent cohort. The VAB scales assess childrens day-
to-day adaptive functioning. Scores from four
domains of adaptive behavior were used in the
present study (Communication, Daily Living
Skills, Socialization, and Motor Skills). The raw
scores can be converted to standard scores, and a
Composite Overall score can be derived based on
sum of scale standard scores (M = 100; SD = 15).
The internal reliability of the Overall Composite
score is 0.93.
Conners Rating ScalesRevised. The Conners
Rating ScalesRevised (CRS-R; Conners, 1997)
assess children (ages 317) for behavioral prob-
lems and attention deficit/hyperactivity disorder.
The short version of the form was used, which
takes 5 to 10 minutes to complete. The short ver-
sion of the CRS-R comprises 28 items for the
teacher, using a 0 (Not True at All) to 4 (Very
Much True) Likert-type scale. There are four sub-
scales of the test: (a) Oppositional Behaviorin-
dicative of rule breaking, authority problems, and
ease of anger; (b) Cognitive Problemsindexing
inattention, difficulty in organizing work, or con-
centrating for sustained periods; (c) Hyperactiv-
itysuggesting difficulties in sitting still,
restlessness, and impulsivity; and the (d) ADHD
indexidentifying children likely to suffer from
ADHD. The range of internal reliability of the
subscales is from 0.77 to 0.96. Although not used
primarily for autism per se, this tool has been
423
identified as important in the assessment of the
effects of interventions on behavioral difficulties
for children with autism (see, Handen, Johnson,
& Lubetsky, 2000).
PROCEDURE
The children were visited by an experienced and
qualified senior educational psychologist (10 years
postqualification), who completed the PEP-R and
BAS II assessments. These first set of measures
took about 120 to 180 min to complete, and all
the measures were completed in a single session.
In addition, the educational psychologist helped
the parent to complete the GARS and VAB mea-
sures during this visit. After 9 months, the follow-
up measures were taken by the same educational
psychologist, who again completed all of the mea-
sures as previously described. At this time, the ed-
ucational psychologist also helped the parent to
complete the follow-up GARS and VAB mea-
sures. The educational psychologist had no previ-
ous experience of the children being tested in this
study and was not informed of the childs group
status (but may have been able to obtain that in-
formation by the location of the visit or through
the parents).
In addition to these measures, the supervisors
or teachers delivering the interventions were
asked to complete a CRS-R concerning the childs
behavior and a questionnaire concerning the na-
ture of the intervention. The supervisors/teachers
were asked to complete these forms at the start of
the intervention (at baseline) and again after 9
months (follow up). These questionnaires were
completed at the same time as the baseline and
follow-up child assessment. Finally, the parents
were also asked to complete a questionnaire re-
garding the characteristics of the program that
their child had experienced.
RESULTS
D ATA A N A LY S I S
The data analysis was divided into a number of
sections for ease of understanding. Initially, the
baseline scores of the children were analyzed with
respect to the main outcome measures: autistic
severity (GARS), intellectual functioning (PEP-
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R), educational functioning (BAS II), and adap-
tive behavioral functioning (VAB). These data
were analyzed to ascertain whether the groups
were well matched. The analysis was conducted
by means of a multivariate analysis of covariance
(MANCOVA) with the three intervention groups
as independent variables, the overall baseline
scores for the four scales as dependent variables,
and the participants age as a covariate. To docu-
ment further the precise nature of the problems
experienced by the children at intake, their scores
on the four subscales of the GARS, and the four
subscales of the CRS-R, at baseline, were analyzed
separately using univariate analysis of covariance,
with group as an independent variable and age at
intake as a covariate.
The next series of analyses dealt with the
changes that occurred in the overall functioning
scores over the period of the intervention. First,
the changes in autistic severity were analyzed to
determine if any of the three interventions had an
impact on the severity of the autistic characteris-
tics (separately from changes in intellectual or ed-
ucational functioning). Therefore, this analysis
was conducted by analysis of covariance (AN-
COVA), with the three intervention types as the
independent variable, change in the overall GARS
as a dependent variable, and participants ages at
intake as a covariate.
Following this analysis, the changes in the
overall scores for intellectual (PEP-R), educational
(BAS II), and adaptive behavioral functioning
(VAB) were analyzed by MANCOVA, with the
intervention group as an independent variable,
the three overall outcome measures as the depen-
dent variable, and the participants ages and autis-
tic severities at intake as covariates. The changes
in the subscales of these measures across the three
intervention groups were also analyzed separately
by ANCOVA, using age and autistic severity as
covariates, where the initial overall differences had
proved to be statistically significant.
Finally, changes in the behavioral problems
experienced by the children, as noted by the
CRS-R, were analyzed by means of a MAN-
COVA, with the intervention group as an inde-
pendent variable, the four Conners subscales as
the dependent variable, and the age and autistic
severity at intake as covariates.
Summer 2007
TABLE 2
Mean (Standard Deviation) Baseline, Follow Up, and Change Scores for the Three Intervention Groups
Group Scale Baseline Follow Up Change

ABA GARS 90.5 (13.9) 88.5 (15.4) 2.0 (8.4)

PEP-R 55.6 (13.8) 69.2 (19.8) 13.6 (12.7)
BAS II 56.8 (16.6) 74.5 (22.4) 17.8 (15.0)
VAB 58.2 (8.0) 61.1 (10.6) 2.9 (6.5)
Nursery GARS 96.8 (10.4) 97.2 (11.0) 0.5 (9.3)
PEP-R 51.9 (20.1) 62.0 (21.9) 10.2 (13.6)
BAS II 57.8 (12.8) 65.7 (15.5) 7.9 (8.6)
VAB 53.0 (4.6) 56.2 (8.1) 3.3 (6.3)
Portage GARS 91.3 (14.3) 92.8 (14.9) 1.5 (5.9)
PEP-R 53.3 (16.1) 54.8 (19.2) 1.6 (11.2)
BAS II 53.4 (10.9) 60.0 (13.9) 6.6 (9.1)
VAB 58.6 (6.0) 57.2 (7.7) 1.4 (4.0)

Note. Gilliam Autism Rating Scale = GARS; Psychoeducational Profile Revised = PEP-R; British Ability Scales: Second
Edition = BAS II; Vineland Adaptive Behavior = VAB. All standard scores (mean = 100, standard deviation = 15).

B A S E L I N E D ATA specific behavioral problems through the sub-

The baseline data from the 48 participants who
completed the study are described in Tables 2, 3,
and 4. Inspection of these baseline data shows
that the participants in each of the three groups
were well matched in terms of their baseline
scores on all overall measures. In terms of the
group composition: the ABA group had 12 par-
ticipants (11 male and 1 female), with a mean age
of 40 months (range 3247 months) at intake;
the special nursery group had 20 participants (18
male and 2 female), with a mean age of 43
months (range 4148 months); and the portage
group had 16 participants, with a mean age of 38
months (range 3045 months). A MANCOVA
was conducted on the baseline scores for the
GARS, PEP-R, BAS II, and VAB as dependent
measures, with intervention group as an indepen-
dent variable, and age as a covariate. The Pillais
Trace criterion was adopted as the most conserva-
tive of the MANOVA test statistics (Olson,
1979). This analysis revealed no statistically sig-
nificant differences between the groups at base-
line, Pillais Trace = .244, F(8,84) = 1.46, p > .10.
In addition to these overall cognitive and be-
havioral functioning measures, it is important to
note that the children were also assessed on their
scales of the GARS and the CRS-R. This allows
further documentation of the subject equivalence
across the groups.
The subscales of the GARS deal with the de-
gree of stereotyped behaviors, communication
difficulties, social interaction, and developmental
disturbances shown by the children. All of these
scales offer standardized scores, with a mean of 10
and standard deviation of 3 (with high scores
meaning more problems). The group means for
stereotyped behaviors at baseline are shown in
Table 3. Inspection of these data shows that none
of the groups were discrepant from one another
on any of the subscales for the GARS. Separate
ANCOVAs conducted on the baseline scores
across group, with age at intake as a covariate, re-
vealed no statistically significant difference for
any scale, all ps > .30.
The scores from the baseline CRS-R also
offer a standardized T score (M = 50 and SD =
10, with high scores meaning more problems).
The group means for the four subscales (opposi-
tional behavior, cognitive problems, hyperactivity,
and ADHD) are shown in Table 4. Inspection of
these data shows that none of the groups were dis-
crepant from one another on any of the subscales

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TABLE 3
Mean (Standard Deviation) Baseline, Follow Up, and Change Scores for Each Subscale for
the Three Intervention Groups
Group and Scale Baseline Follow Up Change

ABA
GARS (M = 10, SD = 3)
Stereotyped behaviors 8.1 (2.8) 7.1 (3.0) 1.0 (1.5)
Communication 1.6 (3.3) 5.4 (4.8) 3.8 (5.5)
Social interaction 7.4 (2.7) 7.0 (2.9) 0.4 (1.6)
Developmental disturbance 9.2 (2.3) 9.2 (2.4) 0 (1.1)
PEP-R (M = 100, SD = 15)
Imitation 45.5 (30.9) 76.5 (24.9) 31.0 (22.8)**
Perception 78.2 (24.6) 99.8 (35.6) 21.6 (20.1)**
Fine motor 71.5 (18.7) 75.3 (19.2) 3.8 (19.5)
Gross motor 60.3 (17.5) 91.1 (31.7) 30.8 (25.0)**
Hand-eye 64.8 (21.7) 77.3 (22.5) 12.4 (16.4)*
Cognitive 40.7 (23.2) 59.3 (22.2) 18.6 (17.4)**
Verbal 41.9 (22.6) 61.7 (24.9) 19.8 (24.5)*
BAS II (M = 50, SD = 10)
Verbal comprehension. 23.3 (6.8) 32.8 (17.6) 9.5 (14.3)*
Picture matching 33.8 (13.3) 42.3 (15.3) 8.6 (8.8)**
Naming 22.4 (8.3) 35.6 (13.5) 13.2 (11.9)**
Early number skills 26.3 (5.3) 34.8 (10.9) 8.6 (9.6)**
VAB (M = 100, SD = 10)
Communication 57.1 (7.6) 64.1 (14.9) 7.0 (11.6)
Daily living skills 61.6 (6.7) 64.3 (10.8) 2.7 (6.2)
Socialization 62.1 (9.3) 66.1 (9.2) 4.0 (7.3)
Motor skills 73.8 (16.6) 71.8 (15.7) 2.0 (11.6)

Special Nursery
GARS (M = 10, SD = 3)
Stereotyped behaviors 9.3 (2.3) 9.6 (3.2) 0.3 (2.1)
Communication 5.9 (5.6) 4.6 (5.3) 1.3 (5.8)
Social interaction 9.1 (2.8) 8.6 (2.9) 0.6 (2.5)
Developmental disturbance 9.6 (1.9) 9.7 (1.9) 0.2 (1.2)
PEP-R (M = 100, SD = 15)
Imitation 52.9 (30.3) 61.0 (30.5) 8.2 (21.2)
Perception 80.4 (45.6) 81.2 (30.0) 0.8 (34.6)
Fine motor 59.9 (21.0) 63.6 (18.2) 3.7 (13.1)
Gross motor 67.2 (28.2) 80.5 (28.9) 13.3 (19.7)**
Hand-eye 66.0 (31.3) 71.0 (25.4) 5.0 (21.9)
Cognitive 42.5 (20.2) 56.3 (24.3) 13.9 (16.0)**
Verbal 43.8 (23.8) 55.3 (26.8) 11.5 (15.3)**
BAS II (M = 50, SD = 10)
Verbal comprehension 23.3 (6.8) 26.0 (7.0) 1.8 (4.1)
Picture matching 33.8 (13.3) 37.1 (11.9) 7.9 (10.9)**
Naming 22.4 (8.4) 29.7 (10.1) 2.7 (4.0)**
Early number skills 26.3 (5.3) 32.1 (9.9) 4.3 (7.6)*

continues

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T A B L E 3 (Continued)

Group and Scale Baseline Follow Up Change

Special Nursery - cont.

VAB (M = 100, SD = 10)
Communication 57.1 (7.6) 58.3 (10.1) 3.1 (6.4)*
Daily living skills 61.6 (6.9) 60.9 (11.0) 3.1 (8.6)
Socialization 62.1 (9.3) 61.6 (9.0) 5.0 (8.8)*
Motor skills 73.8 (16.6) 64.5 (14.0) 3.2 (10.7)

Portage
GARS (M = 10, SD = 3)
Stereotyped behaviors 8.9 (3.1) 8.8 (3.7) 0.1 (2.5)
Communication 0.4 (1.8) 1.6 (3.5) 1.2 (3.1)
Social interaction 8.3 (2.9) 8.1 (2.6) 0.1 (1.1)
Developmental disturbance 9.2 (1.8) 9.6 (2.0) 0.5 (1.5)
PEP-R (M = 100, SD = 15)
Imitation 39.4 (22.1) 49.4 (26.8) 10.1 (23.6)
Perception 74.8 (31.3) 76.8 (26.7) 1.9 (20.8)
Fine motor 65.0 (19.9) 63.9 (21.6) 1.1 (15.1)
Gross motor 68.3 (20.2) 79.3 (36.4) 11.0 (26.0)
Hand-eye 64.7 (28.0) 63.8 (31.1) 0.9 (18.9)
Cognitive 38.3 (17.6) 44.1 (23.4) 5.9 (14.3)
Verbal 42.6 (15.9) 45.6 (18.7) 3.1 (17.7)
BAS II (M = 50, SD = 10)
Verbal comprehension 21.7 (4.3) 22.3 (3.9) 0.7 (3.4)
Picture matching 28.8 (8.0) 35.8 (11.1) 6.9 (7.6)**
Naming 22.3 (6.3) 24.0 (8.5) 1.7 (4.6)
Early number skills 26.1 (7.8) 27.8 (8.8) 1.8 (8.6)
VAB (M = 100, SD = 10)
Communication 57.1 (4.9) 54.8 (4.9) 2.3 (4.1)*
Daily living skills 64.6 (6.2) 63.1 (10.4) 1.5 (6.6)
Socialization 61.0 (5.8) 60.7 (7.3) 0.3 (3.9)
Motor skills 70.9 (11.1) 70.0 (13.7) 0.9 (10.3)

Note. Gilliam Autism Rating Scale = GARS; Psychoeducational Profile Revised = PEP-R; British Ability Scales:
Second Edition = BAS II; Vineland Adaptive Behavior = VAB.
*p < 0.05. ** p < 0.01.

for the CRS-R. Separate ANCOVAs conducted
on the baseline scores across group, with age at in-
take as a covariate, revealed no statistically signifi-
cant difference for any scale, all ps > .10.
CHANGE IN OV E R A L L AU T I S M S E V E R I T Y
The overall autism severity of the participants was
assessed at baseline and follow up using the
GARS. A change in a negative direction indicated
an improvement (i.e., a lessening) in the severity
of autistic symptoms, whereas a positive change
indicated a worsening of the symptoms over time.
Analysis of the difference score between the over-
all GARS score obtained at baseline and follow-
up revealed very little change over this period for
any of the intervention groups (see Table 2).
These difference scores were analyzed by an AN-
COVA, with intervention type (ABA, Nursery,
and Portage) as a between-subject factor and age
at intake as a covariate. This analysis revealed no
statistically significant difference between the
groups, F(2,44) = .56, p > .60.

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TABLE 4
Mean (Standard Deviation) Baseline, Follow Up, and Change Scores for the Three Intervention Groups
for Connors Scales
Group Scale Baseline Follow Up Change

ABA Oppositional 62.1 (9.9) 61.3 (12.6) 0.8 (10.1)

Cognitive 72.4 (19.4) 61.6 (16.1) 10.4 (26.6)
Hyperactivity 63.2 (8.2) 55.8 (8.8) 7.0 (7.1)
ADHD 64.6 (7.2) 57.8 (10.2) 6.9 (8.0)
Nursery Oppositional 70.4 (13.0) 59.8 (14.1) 10.7 (11.4)
Cognitive 78.9 (10.9) 62.7 (12.7) 16.1 (14.1)
Hyperactivity 68.6 (9.9) 62.0 (13.6) 6.5 (8.5)
ADHD 69.0 (9.3) 62.3 (11.7) 6.7 (6.2)
Portage Oppositional 68.3 (6.1) 58.4 (1.8) 9.9 (6.3)
Cognitive 74.9 (13.6) 74.8 (2.1) 0.4 (13.2)
Hyperactivity 68.4 (6.3) 63.1 (0.6) 4.8 (6.4)
ADHD 66.9 (7.1) 63.3 (0.9) 3.8 (7.1)

CHANGE IN OV E R A L L F U N C T I O N I N G ery, and portage) as the independent variable; and

Table 2 displays the mean change scores (follow-
up standardized score minus baseline standardized
score) for all three intervention types, along with
the mean baseline and follow-up scores. Intellec-
tual functioning was measured by the overall
PEP-R score ([developmental age/chronological
age] ! 100), educational functioning was mea-
sured by the general cognitive ability score of the
BAS II, and adaptive behavior change was mea-
sured by the composite VAB.
Inspection of Table 2 shows that for intellec-
tual functioning (PEP-R), the ABA and nursery
interventions produced gains of around 10 to 13
points over the 9-month period, which were
somewhat higher than the gains produced by the
portage intervention. Educational functioning
(BAS II) showed the biggest gain in the ABA
group (approximately 18 points), which exceeded
the change in the other three interventions (ap-
proximately 58 points). For adaptive behavioral
functioning, the nursery placements produced the
largest gain, followed by ABA, with no gains
being shown for portage.
These data were analyzed by a MANCOVA
with the intellectual (PEP-R), educational (BAS
II), and adaptive behavior (VAB) measures as de-
pendent variables; intervention type (ABA, nurs-
the participants ages and their autistic severity
(GARS) at the start of the intervention as covari-
ates. This analysis revealed a statistically signifi-
cant effect of intervention, Pillais Trace = .30,
F(6,84) = 2.47, p < .05, partial eta2 = .150. Sepa-
rate univariate analyses of covariance (ANCO-
VAs) were performed on each of the three
dependent scores (PEP-R, BAS II, and VAB),
with intervention as the independent variable,
and age and GARS as covariates. These analyses
revealed a statistically significant effect of inter-
vention type on intellectual functioning (PEP-R),
F(2,43) = 3.88, p < .05, partial eta2 = .153; edu-
cational functioning (BAS II), F(2,43) = 4.52, p <
.05, partial eta2 = .174; and adaptive behavior
(VAB), F(2,43) = 3.80, p < .05, partial eta2 =
.150. Tukeys honestly significant difference
(HSD) tests were conducted, which revealed sta-
tistically significant pairwise differences between
the ABA and portage for intellectual functioning
(PEP-R), p < .05, between ABA and each of the
other two interventions for educational function-
ing (BAS II), ps < .05. The Tukeys HSD tests for
the adaptive behavior score (VAB) revealed a sta-
tistically significant difference between the nurs-
ery and portage interventions, p < .05. None of

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the other pairwise differences proved to be statis-
tically significant.
CHANGES IN THE SUBSCALES OF EACH
MEASURE OF FUNCTIONING
The mean change scores (follow-up standard
score minus baseline standard score) for the indi-
vidual subscales of each test of functioning (i.e.,
PEP-R, BAS II, and VAB) can be seen in Table 3,
along with the mean baseline and follow-up
scores. The top panel of Table 3 shows the change
in the standard scores for the subscales of the in-
tellectual functioning (PEP-R) measure. In gen-
eral, the ABA intervention showed the greatest
change scores of the interventions. Table 3 also
shows that there were statistically significant im-
provements in six of the subscales of the PEP-R
for the ABA intervention (imitation, perception,
gross motor skills, handeye coordination, cogni-
tive performance, and cognitive verbal perfor-
mance). There were statistically significant
changes in three of the subscales for the nursery
intervention (gross motor skills, cognitive perfor-
mance, and cognitive verbal performance). How-
ever, in only the imitation score was there a
statistically significant difference between the in-
terventions, F(2,39) = 3.34, p < .05, partial eta2 =
.146. Tukeys HSD tests revealed that ABA pro-
duce a greater change than nursery on this mea-
sure, p < .05, but none of the other pairwise
comparisons proved statistically significant.
For the subscales of the educational function-
ing (BAS II) measure, the ABA intervention pro-
duced statistically significant gains in all the
subscales. The nursery intervention produced sta-
tistically significant gains in all the subscales, ex-
cept verbal comprehension. Across the
interventions, ABA produced statistically signifi-
cantly greater improvements than the other inter-
ventions, these being statistically significant for
both verbal comprehension, F(2,39) = 5.00, p <
.01, partial eta2 = .204 and naming vocabulary,
F(2,39) = 10.08, p < .001, partial eta2 = .341. For
both measures, follow-up Tukeys HSD tests
showed that the ABA intervention outperformed
both the nursery and portage interventions.
For the subscales of the VAB scale there was a
mixed pattern of results. The nursery intervention
produced statistically significant improvements
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for the communication and socialization scales,
and the nursery intervention tended to outper-
form the other two interventions marginally on
all the scales, except communication. However,
only this latter scale showed a statistically signifi-
cant difference between the interventions, F(2,39)
= 4.95, p < .01, partial eta2 = .191, with the ABA
intervention outperforming the portage interven-
tion, p < .05.
CHANGES IN MEASURES OF B E H AV I O R A L
D I F F I C U LT I E S
In addition to the overall intellectual and cogni-
tive changes, the changes in behavioral problems
as indexed by the CRS-R are shown in Table 4,
along with the group means at baseline and fol-
low up. In terms of oppositional behavior, nursery
and portage programs showed more improvement
than the ABA group; whereas for cognitive prob-
lems, ABA and nursery showed more change than
portage. All groups showed similar improvements
for hyperactivity and ADHD problems.
These data were analyzed by a MANCOVA
with intervention group as a dependent variable,
and the age and autistic severity of the partici-
pants as covariates. This analysis showed a statisti-
cally significant difference between the groups,
Pillais Trace = .521, F(8.82) = 3.61, p < .001,
partial eta 2 = .260. Separate ANCOVAs con-
ducted on each subscale revealed significant dif-
ferences on the oppositional problems scale,
F(2,43) = 5.22, p < .01, partial eta2 = .195. Here
both the nursery and portage groups showed sig-
nificantly greater improvements than the ABA
group (Tukeys HSD tests, p < .05). There were
also statistically significant differences between
the groups on the cognitive problem scale,
F(2,42) = 3.82, p < .05, partial eta 2 = .151.
Tukeys HSD tests showed that the nursery group
differed statistically significantly from the portage
group, p < .05. There were no group differences
on either of the hyperactivity and ADHD scales,
both ps > .20.
DISCUSSION
The current study examined the effectiveness of
three early-teaching interventions for children
with ASD. The primary aims of this study were to
429
examine the impact of these interventions as they
occur in the community rather than the clinic,
and to examine their impact on a set of partici-
pants not heavily selected on criteria designed to
maximize possible outcome efficacy. In this way,
it was hoped to produce a study with a high exter-
nal validity. In addition, it was hoped to show
some of the factors that contribute to the success
of these interventions. In summary, the results
shed new light on the real-world effectiveness of
several of the educational interventions. Particu-
larly, they partially replicated the effectiveness of
previous studies of clinic-based ABA programs in
a community-based sample. They also showed
strong gains over a relatively short period of time,
and demonstrated the effectiveness of nursery
placements in promoting aspects of intellectual
and adaptive behavioral functioning.
The participants in this study tended to have
moderate autistic symptoms, being in the mid
range of the standard scores generated by the
GARS. The participants intellectual functioning,
educational functioning, and adaptive behavioral
functioning, measured at the start of the interven-
tion, all showed quite severe impairments; the
mean scores were around 50 on each standardized
instrument, indicating that these participants
were at the severe end of those taken on previous
studies of ABA (e.g., Lovaas, 1987, excluded chil-
dren with IQs lower than 50). To this extent, the
current participants were more representative of
children with ASD who present for intervention
at local authorities (see Conner, 1998).
The present results indicated that, on the
basis of the GARS rating of autism symptom
severity, none of the interventions produced re-
covery, as noted in some previous studies (e.g.,
Lovaas, 1987). This finding corroborates a num-
ber of other studies of the effectiveness of ABA
approaches and adds to the current weight of evi-
dence that this approach will not cure autism.
However, it should be noted that there are a num-
ber of possible reasons for this discrepancy be-
tween this study and that of Lovaas (1987); the
length of time of the intervention (9 months vs.
36 months), the place of intervention (commu-
nity vs. clinic), and the severity of the participants
symptoms (severe vs. milder). Whatever the rea-
son for this difference, it appears that in a typical
community-based intervention, over 9 months,
430
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there is no sign of recovery from the symptoms of
autism.
Irrespective of the impact on the autistic
severity of the participants ASD, the ABA pro-
gram produced significant gains on both intellec-
tual and educational functioning, and the nursery
intervention produced a strong impact on all
three measures of functioning, with the improve-
ments resulting from portage being limited to
only a few measures. The comparison between the
ABA intervention and the portage intervention in
the current study offers a chance to replicate the
original comparison in the Lovaas (1987) study
between a high intensity and low intensity treat-
ment program, with the same results; the high-in-
tensity program produced stronger improvements
(see also Smith, Eikeseth, Klevstrand, & Lovaas,
1997).
[I]t appears that in a typical community-
based intervention, over 9 months, there is
no sign of recovery from the symptoms of
autism.
With respect to the ABA intervention, these
data show that ABA has a strong impact on intel-
lectual and educational functioning. These gains
in functioning replicate, in part, the effects of pre-
vious ABA studies, which were conducted in a
clinic, on a home-based sample (Eikeseth et al.,
2002). The gains are also of a similar size to previ-
ous longer period studies of ABA (Lovaas, 1987),
but were achieved over a somewhat brief period
(9 months). In addition, they show that ABA can
be effective for children with relatively severe dif-
ficulties (see also Smith et al., 2000).
Although ABA also showed some impact on
adaptive behavioral functioning, it was the special
nursery program that had the greatest impact on
this aspect of functioning (with an impact also on
intellectual and educational functioning). This as-
pect of the data was borne out by the teachers
ratings of behavioral problems, which showed
that nursery placement affected these problems to
the greatest extent. Thus, these data show, for the
first time, the impact of special nursery placement
on these measures, and offer support for other
studies that have shown some improvement that
Summer 2007
is due to special nursery placement (Gabriels et
al., 2001). They also stand in contrast to the often
reported failures to produce gains in the nursery
control groups of ABA intervention studies (see
Howard et al., 2005; Lovaas, 1987). It is difficult
to be precise about the reasons why the current
study produced gains whereas other studies did
not, although there are some differences that
might bear subsequent investigation. In the cur-
rent study, the special nursery placement was
heavily reliant on group-teaching approaches,
whereas in previous studies (e.g., Howard et al.)
this has not always been the case. There also re-
mains the possibility that there are individual dif-
ferences between the effectiveness of special
nursery placements and the receptiveness of the
children to the approach. The precise nature of
the special nursery placements is, of course, diffi-
cult to determine on a day-to-day basis, and they
did contain elements of ABA and TEACCH ap-
proaches. A precise description of special nursery
placement, often characterized as an eclectic ap-
proach would be a useful step in this field, as it
remains a very widely used early intervention for
children with ASD. Thus, disentangling these in-
fluences remains a key objective, but it is an ob-
jective that may be very difficult to implement in
a natural setting.
In addition, they show that ABA can be
effective for children with relatively severe
difficulties.
That ABA has a strong impact on intellec-
tual/educational gains, and special nursery on
adaptive behaviors, may reflect the difference in
teaching approaches between the two interven-
tions (one-to-one vs. group). This pattern of data
might lead to the suggestion that any program
should include both relatively intense one-to-one
work, followed by group work such as occurs in a
special nursery intervention.
The current study was primarily concerned
with determining whether a number of interven-
tions would produce gains in children with ASD
when they were conducted in the community. It
was not a study designed to answer the question
of why those interventions worked; given the
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state of knowledge of outcome effectiveness in the
community this approach seems a reasonable first
step.
There are a number of caveats to be made
when interpreting these data. The main caveat
concerns the fact that the groups were not ran-
domly selected for each of the interventions. The
participants received whatever intervention was
being provided in their locality. This aspect of the
design was a deliberate part of the study, adopted
to ensure a high external validity. Low external va-
lidity has been a criticism of many previous stud-
ies (see Conner, 1998); children with ASD are
not randomly allocated to treatment in the real
world. However, despite this concern, inspection
of the groups of participants reveals that they
were very evenly matched, suggesting that there
were no preexisting systematic biases in the par-
ticipants across the groups. This should be the
case, as the geographical location of the partici-
pant, rather than any characteristic, determined
their allocation to intervention. Additionally, this
study was not designed to address exactly what as-
pect of the intervention was responsible for any
observed effectiveness. The nature of the interven-
tions was characterized by the tutors and parents,
and some variables, such as time input, were iden-
tified as important. However, further work will be
needed to establish which aspects of these com-
plex interventions are critical in generating intel-
lectual and behavioral change in the participants.
Additionally, further measures perhaps tailored to
particular curriculums would be helpful for as-
sessing the impact of specific early teaching inter-
ventions, although these would limit the
generality of findings to particular locations. (For
example, curriculum key stages may well differ
between the United States and the United King-
dom, and certainly with other regions.)
One issue that should be commented on in
this study concerns the fidelity of the treatment
regimes in the current study. This study was an
investigation into how the programs sometimes
studied in the clinic fared when placed in the
community. This is a key issue about the effec-
tiveness of such programs, especially ABA (see
Mudford et al., 2001). As the programs were con-
ducted in the home, their day-to-day fidelity was
not directly measured. It should be noted that all
programs were conducted by trained supervisors
431
in accordance with the program manuals, which
should ensure some treatment fidelity, as in other
studies. However, the lack of direct observation
may present a limitation on the current work. It
should be noted that it is not clear the degree to
which any program has fidelity to the manual in
the face of specific demands of individual chil-
dren, and that many programs are individually
tailored to the child, and therefore vary from in-
dividual-to-individual, and from day-to-day
within individuals. Of course, stronger measures
of the treatment fidelity would improve the inter-
nal validity of the study and would be welcomed
in future work, but if the characteristics of the
program conducted in a study with high internal
validity do not correspond to the way such a pro-
gram would be conducted in the majority of
cases, the findings would be of limited external
value.
[T]he current report failed to note any
evidence of recovery from autism produced
by any early intervention.
In summary, the current report failed to note
any evidence of recovery from autism produced
by any early intervention. In terms of intellectual
functioning, applied behavior analysis and special
nursery interventions produced gains (of the same
magnitude as many gains produced by previous
longer term clinic-based ABA programs). The re-
sults from clinic-based ABA trials were partially
replicated on a community-based sample; specifi-
cally with respect to intellectual and educational
skills. Special nursery placement was also found
to be effective for improving adaptive behavior
and educational skills. Of course, the relative im-
portance of educational skills versus adaptive be-
havioral skills at preschool for subsequent school
functioning and school inclusion needs to be in-
vestigated.
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ABOUT THE AUTHORS
PHIL REED Professor; and LISA A. OSBORNE,
Senior Research Assistant, Department of Psychol-
ogy, Swansea University, Swansea, U.K. MARK
CORNESS, Principal Educational Psychologist,
Children, Young People, and Families Direc-
torate, Macclesfield House, Oxford, U.K.
Address correspondence to Phil Reed, Depart-
ment of Psychology, Swansea University, Single-
ton Park, Swansea, SA2 8PP, U.K. (e-mail:
p.reed@swansea.ac.uk).
This research was funded by a grant from the
South East Regional Special Educational Needs
Partnership (SERSEN, U.K.), and we thank them
for their support during the course of this re-
search. Also, we are very grateful to the children,
parents, teachers, and schools who kindly partici-
pated in this study. Some of these data were ini-
tially discussed at the European Association for
Behaviour Analysis Conference held in Parma,
Italy, 2003, and at the Behavioural Association of
Ireland Conference held in Galway, Ireland,
2004.
Manuscript received June 2006; accepted October
2006.
433