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Posted by Dad on August 25, 2000 at 06:22:13:


M. Does the UCLA project focus on stimulus control and functional
Analysis?
A recent grant funded by the Office of Education for the amount of
$750,000 to Heartland Area Education Agency (AEA) of Iowa is entitled
"Development, Testing, and Dissemination of Nonaversive Techniques for
Working with Children with Autism: Demonstration of a 'Best Practices'
Model
for Parents and Teachers." This project is intended to improve upon the
UCLA project. The grant proposal, however, is replete with errors similar
to those described above, and it has serious methodological problems as
well. What is new is the assertion that the UCLA project does not focus on
stimulus control and functional analysis of behaviors. In reality, the
UCLA
project pioneered work in these areas (e.g., Lovaas, Freitag, Gold, &
Kassorla, 1965) and has continuously presented additional empirical data
published in peer-reviewed and readily available journals for the last
thirty years.
The grant notes that the UCLA project uses "consequent-based
techniques" and "ignores the behavior management literature that emphasizes
control of antecedents." The misleading nature of these statements can be
seen in the many studies from the UCLA project in which discrete trials and
"consequent techniques" are used to enhance verbal and nonverbal imitation.
The child's acquisition of imitation, a product of discrete trial teaching
techniques, allows adults and typical children to model behaviors for the
child with autism. A model for a behavior is one kind of antecedent
stimulus.
Another example is conversation, which clearly involves antecedent
stimuli (responding appropriately to statements made by others and varying
responses depending on these statements). Antecedent stimuli are always
present in discrimination learning, which is the major learning-based
intervention underlying the UCLA programs. Reinforcement withdrawal
instigates frustration which is a major antecedent of tantrums and
self-injury, and has been the subject of research by the UCLA project for a
number of years, starting with Lovaas, et al (1965). Thus, we have devoted
extensive research to antecedent stimuli. In order for the child to learn
discriminations, however, "consequent techniques" (reinforcement for
correct
responses, no reinforcement for incorrect responses) must be utilized.
Without such techniques, children have no way of knowing what skills they
are supposed to acquire, and no incentive to find out. It is dismaying
that
the authors fail to recognize this, yet intend to embark on a project which
includes the employment of consequent (i.e., reinforcement) techniques.

It is also stated in the grant that the UCLA project relies "heavily
on aversives and negative reinforcement." The combination of concepts such
as "aversives" and "negative reinforcement" in this sentence is
unfortunate.
First of all, the UCLA project has not used aversives for years. Secondly,
all therapists, teachers and parents use negative reinforcement when they
reduce a child's stress or discomfort contingent on the child's behaviors.
The behavior is reinforced (strengthened) when it results in the removal of
an aversive event. For example, if a child is hurt and seeks out the
parents who then reduces the hurt, then this is likely to strengthen
closeness to the parents.
Of considerable concern is the use of federal moneys to fund research
projects based on distortions of the UCLA project. In addition to
containing distortions of the UCLA project, the proposal contains numerous
serious methodological and conceptual problems. For a review of these, see
Smith and Lovaas (1997).

N. Do discrete trial procedures result in limited generalization?
Misleading statements about the use of operant, discrete trials are
common. A recent example is provided by Mesibov (1997) which states, "the
children following these techniques have been unable to generalize what
they
have learned" (p.27). This is in contrast to the TEACCH curriculum which
facilitates communication 'in many situations.'" On the basis of the data
reviewed earlier (see the Vineland data reviewed earlier in this paper),
and
Mesibov's familiarity with the McEachin, Smith, & Lovaas (1993) follow-up
study it appears that Mesibov is providing misleading information to
parents
and colleagues.

O. Quality Control on Treatment.
Sheinkopf and Siegel (1998) article introduces a number of
misunderstandings about what constitutes replication of the Lovaas (1987)
study. The 1987 study was based on clinic-supervised treatment, not on
workshop based consultant services which comprise the focus of the
Sheinkopf-Siegel article. Both clinic-based and workshop based services
take place in the home, the difference being the amount of supervision and
the quality of staff-training. This difference is substantial and there
are
no data to suggest that the treatment outcomes would be similar. To
illustrate, clinic-based services allows for daily supervision of treatment
by senior staff and employs one-on-one therapists who have been selected on
basis of superior performance in academic and practicum work and stayed on
the project for 6 months to several years. The intensity of the supervision
and demands for quality control on treatment has limited the maximum number
of clients to 15 per site at any one time. We have earlier warned that "it
is unlikely that a therapist or investigator could replicate our treatment
program for the experimental (intensive treatment) group without prior
extensive theoretical and supervised practical experience in one-to-one
behavioral treatment....." (Lovaas, 1987, p. 8). Given these
considerations, various statements in the Sheinkopf and Siegel article can
be dealt with as follows:
1. (Page 16) "Parents reported that their children had received
treatment
based explicitly on the methods outlined by Lovaas and colleagues" (Lovaas
et al. 1981). Correction: As we have already stated, reading the
teaching manual (Lovaas et al. 1981), attending a workshop led by UCLA
certified consultants, practicing behavioral therapy on several families or
spending a short time at the UCLA affiliated site, does not make a person
qualified to provide UCLA based treatment. Even professional behavioral
analysts who have not completed an internship at UCLA affiliated
replication-site would also not, in our judgment, have appropriate
experience to replicate the UCLA program. In the same context, Sheinkopf
and Siegel claim (Page 18) that "We were unable to directly observe
therapy
and as such to account for treatment fidelity." It is highly unlikely that
neither the parents, or Sheinkopf and Siegel, would be able to ascertain
whether children were receiving the UCLA based treatments because neither
have been trained in these procedures.
2. (Page 18) The parents received services from "Three behavior
therapists in the San Francisco Bay area for guidance in treatment
implementation." Correction: So far as we can determine, none of the
therapists who treated the children in the Sheinkopf and Siegel article had
been trained at UCLA with the possible exception of one who served as a
senior therapist on the UCLA program some 15 or more years ago.
Consequently, we think it is quite unlikely that they would be able to
serve
competently as a consultant to families in home-based programs. Such
therapists, when they are working with us, are not permitted to conduct
workshops, and we recommend that they not do so in the future. Several
have
become workshop consultants and have opened clinics on their own despite
our
recommendation, and this is a source of great concern to us if they claim
to
provide services based on the UCLA model. Data show that without updates
and
regular refresher courses, service providers fail to maintain quality
control standards on treatment (Wolf et al. 1995). We would expect less
than
10% rate of normal functioning as a result of children receiving workshops
of a unspecified nature from unspecified consultants.
3. (Page 21) "It is possible that Lovaas overestimated the minimum
number of treatment hours per week needed for therapeutic effect."
Correction: There are no data to support that an intervention of less than
40 hours per week will result in 47% rate of normal functioning. If we had
evidence that 30 hours or less a week would generate the same outcome, then
we would have been able to serve that many more children which would be the
goal of any treatment agency. Furthermore, given the unknown and
non-optimal nature of the treatment provided in the Sheinkopf and Siegel
article, we are in no position to argue that more or less of that form of
treatment would make a difference. Finally, Pomeranz (1998) questions
Sheinkopf and Siegel's assertion that children who received 20 hours a week
of therapy gained as much as those who received 30 hours a week. Dr.
Pomeranz comments that the children who received 20 hours a week received
many more months of therapy. It is a major mistake to delete such
information. There also remains a question of the children's treatment
history, prior to the treatment provided by the therapists in the Sheinkopf
and Siegel study.

We are greatly concerned that when these children are assessed as
teenagers (as in McEachin, et al. 1993) outcome data will in all likelihood
show that the children have not maintained their treatment gains, but
regressed unless the workshop services were continued. One can protect a
child from regressing by helping the child develop friendships with typical
children, learning to play and talk with them, and learning to learn in a
classroom environment with typical children. It takes a lot of skill and
numerous hours of treatment to achieve this end, and we have no reasons to
believe that the workshop-based program by persons described in the
Sheinkopf and Siegel article, who do not adhere to the UCLA program, will
be able to do so.
It is difficult to ascertain the full effect of the Sheinkopf and
Siegel article on parents and service providers. It is worth noting that
Dr. Schopler used the Sheinkopf and Siegel article to once more discredit
the UCLA project (Schopler, 1998, pp. 3-4).

P. Additional Misunderstandings
With the opening of a UCLA replication site (P.E.A.CH.) in London,
the
United Kingdom, we are witnessing a flurry of misunderstandings about the
UCLA Project in newspapers and technical journals in Europe. One such
publication by Dr. Patricia Howlin (1997) appeared in the prestigious and
widely circulated journal European Child and Adolescent Psychology. The
major errors in this article are as follows:
1. (Page 60) "...the IQ of the control group children had risen by
only 8 points" (in the 1987 study). Correction: Both control groups lost
IQ points.
2. (Page 60) "McEachin, Smith, & Lovaas...reported on the same
children." Correction: Control Group II children were not made available
for assessment in that follow-up study.
3. (Page 61) "...the lack of random assignment." Correction:
Pre-treatment assessment showed the groups to be equivalent at intake which
is a test of whether random assignment was used and successful.
4. (Page 61) Findings should be questioned because of "...the
variability of measures used...before and after treatment." Correction:
Few would suggest that 3 year olds should receive the same assessment as 13
year olds.
5. (Page 61) There are questions about the
"...representativeness...of groups involved." Correction: Control Group
II
represents children from another agency; data show the children in the UCLA
study to be comparable to those in Control Group I.
6. (Page 61) "...the failure to use independent assessors in the
evaluation..." Correction: The McEachin et al. (1993) follow-up study
describes the double-blind assessment which involved independent assessors.
Dr. Howlin should be familiar with this study since it is referred to in
her
1997 article.
7. (Page 61) "By far the greatest controversy,...the use of terms
such as 'cure'..." Correction: The term "cure" has never been used by the
UCLA Project. To state that we claimed cure can only serve to undermine
others' confidence in our research.
8. (Page 61) "...there are no measures of social interaction,
friendships, conceptual abilities, social communication, obsessional and
ritualistic behaviors..." Correction: Dr. Howlin gives reference to the
McEachin et al. (1993) follow-up study and in Table 4 (p. 67) of Howlin's
article, the McEachin et al. study is described as reporting significant
improvements in social functioning and decreases in maladaptive behaviors.
9. (Page 66) In Table 4, it is stated that the Rogers (1991) study
demonstrated "significant changes in cognition." Correction: In fact,
when
the children's MA scores are converted to IQ scores, the gain is between 3
and 9 points. This is not a significant gain (Section G).

Q. How valid are the testimonies at Fair Hearings?
Many parents who have chosen the UCLA program for their children end
up in Fair Hearings to determine whether educational and other state
agencies will agree to pay for services. At such hearings, "expert
witnesses" representing the state are called in to testify for or against
the parent's requests. The number of misleading statements provided by
these expert witnesses is large indeed. One case may be of particular
interest, namely that of Robert P. vs. HISD in Houston, Texas, in which Dr.
B.J. Freeman provided testimony.
Dr. Freeman began her testimony by claiming that she was familiar
with
the UCLA project. If nothing else, she was a member of John McEachin's
Ph.D. committee, and approved of the research which formed the basis for
the
McEachin, Smith, & Lovaas (1993) follow-up study. During her testimony,
Dr.
Freeman repeated most or all of the misinformation provided earlier.
Specifically, she claimed that she was concerned about "subject selection
bias," referring to Schopler, Short, & Mesibov (1989). She added that
"measures of outcome were not adequate," that UCLA project used "untrained
graduate students" to examine for signs of autism, and implied that the
UCLA
project failed "to follow those children beyond the first grade,"
withholding her knowledge of the findings of the McEachin, Smith, & Lovaas
(1993) follow-up study.
When asked if she personally evaluated subjects from the Lovaas
(1987)
study, she answered, "Yes, I have." However, she has not evaluated the
best
outcome children, although she may have evaluated some of the non-best
outcome children. She also claimed that she has had patients who did as
well or better than the Lovaas (1987) children, even though her own outcome
data (Freeman et al. 1985) demonstrate that the children showed no
improvement, consistent with the Lord & Schopler (1989) data. IQ scores do
not increase over time with higher functioning children, as Dr. Freeman
also
claimed in her testimony, but in fact such children lose IQ points at
follow-up, as is shown in her own data (Freeman et al. 1985). She further
claimed that control group children were not matched in the UCLA project,
when in fact they were. She stated that she considers it "absurd" that
preschool activities are taught first in the home, and asserted that forty
hours a week of one-on-one treatment is "counterproductive for children
with
autism." She claimed that a few hours of one-on-one and group instruction
provides equally favorable results, but she has offered no data to support
this assertion. She argued that discrete trial learning results in
"failure
to generalize because it hasn't taught a concept." These statements are
not
only incorrect but also disturbing in view of her knowledge of the McEachin
et al. (1993) follow-up.
Sadly, Robert P. was denied funding and it is our opinion that the
inaccuracies in Dr. Freeman's testimony contributed to this denial. Note
that Dr. Freeman's distorted testimony is not unique in Fair Hearings.

Ivar Lovaas, Ph.D.
University of California, Los Angeles
Department of Psychology
1285 Franz Hall
Box 951563
Los Angeles, California 90095-1563
FAX (310) 206-6380
http://www.lovaas.com

Tomorrows Installment:

* Are the claims made of certain treatment aspects ignored?
* Is the treatment cost-effective?
* Are parents satisfied with intensive behavioral treatment?
* Does the UCLA project focus on stimulus control and functional
Analysis?
* Do discrete trial procedures result in limited generalization?
* Quality Control on Treatment.
* Additional Misunderstandings


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