Autism advocacy and aversives (part three)

In parts one and two I looked at some of the claims made in Sabrina Freeman's book, "Science for Sale in the Autism Wars", in the section called "The Classic Aversives Ruse".

Another of her claims is that behaviour analysts didn't stop systematically using physical aversives in early ABA programs because this practice became unacceptable. Instead, behaviour analysts found that aversives weren't genuinely effective, and altered their practices accordingly. To support this view, Dr Freeman provides evidence from a 1996 Canadian TV documentary in which Ivar Lovaas appeared and explained the methodological reasons why he abandoned aversives. She also provides a quote from Smith and Lovaas (1997), and also lists three "replication studies" in which aversives weren't used, but which had "significant and impressive" results.

Is Dr Freeman right?

Re Dr Lovaas' turn on TV, using a TV program as a credible source for scientific information seems like a bad idea. But it's consistent with the standards that our finest autism advocates have decided are good for autistics. Autism advocates in Canada have also used education numbers as epidemiology. They've promoted the use of legal decisions, opinion polls, "fact" sheets, political speeches and media reports as credible sources of information about autism and autism treatment, often without bothering with primary sources in peer-reviewed science (see an example here).

Setting aside Dr Lovaas' TV appearance, Smith and Lovaas (1997) is a published rejoinder to criticisms of the UCLA Young Autism Project. It doesn't contain data reporting the success of a non-aversive early ABA program. Instead, in responding to concerns that Lovaas (1987) depended on the use of physical aversives, Smith and Lovaas state that since the time that study began (in the early 1970s), advances in research have "rendered such procedures unnecessary". However, this paper provides no evidence, and no references, indicating what these advances might may be, when they were introduced, when they replaced aversives at UCLA, etc.

As for the three "replication studies" cited by Dr Freeman, one is an uncontrolled trial (Anderson et al., 1987), one is a retrospective study (not a true experimental design) which has been roundly condemned by Dr Lovaas (Sheinkopf & Seigel, 1998; Lovas, 2002), and one is a non-randomized controlled trial which now has a presented follow-up showing that the few autistic children who did well did not maintain this ten years later (Birnbrauer & Leach, 1993, 2006). Not one of these three studies reports even one child who achieved normal functioning in the short term, by the criteria in Lovaas (1987).

So what other evidence is there, besides Dr Freeman's, about why and when aversives stopped being used at UCLA in ABA programs for autistic kids? Is there any evidence for when those advances in research, the ones making aversives obsolete, actually occurred?

Lovaas (2002) writes:

Contingent aversives were employed in the Lovaas (1987) study. Many states now prohibit the use of aversives, and many parents object to such treatment. Either of these factors could prevent replication of the Lovaas (1987) study. However, although the UCLA Young Autism Project no longer uses aversives, we have taken advantage of alternatives to aversives developed during and after the time of the 1987 study was completed (treatment in the Lovaas, 1987, study took place between 1970 and 1984).

Again, there are no references pointing to primary sources reporting data from non-aversive early ABA programs. However, Dr Lovaas doesn't appear to be claiming, as Dr Freeman does, that the unacceptability of aversives (including their illegality) played no role at all in altering the practices of behaviour analysts.

Then there's Smith, Groen and Wynn (2000, 2001). This is the only existing randomized controlled trial of an early ABA program. This study took place at UCLA, involved researchers trained and overseen by Dr Lovaas, and involved, in sequence, all children who were referred to the UCLA YAP between 1989 and 1992. The authors report how their treatment differed from the treatment in Lovaas (1987):

Finally, though contingent aversives were employed briefly with the first 4 children, they were then stopped for all children, whereas Lovaas (1987) employed this intervention more extensively.

So we now know when aversives stopped being used at UCLA: sometime between the 4th and 5th referred child in Smith et al. (2000). It seems unlikely that the original plan was to use aversives with some children and not others; there is, in any case, no mention of this by the authors, who report other abandoned plans. Instead, it seems more plausible that the authors had started by using aversives with the intention of having this as part of the treatment for all the experimental group children. Something then happened between child 4 and child 5 such that child 5 (and all the children after) didn't receive aversives at all, and aversives were removed from the treatment of the first 4 children.

This seems to narrow down the time when, apparently, there were these reported advances in research, and it was decided that they should supplant the use of the now unnecessary and ineffective aversives. Or possibly something else happened. In 1991, a law was passed in California, making the use of physical punishment in behaviour programs illegal. This law was first introduced in 1990. In 1989, it may have already been known that such a law was going to be proposed.

So we know that aversives were considered "effective" at UCLA at least into 1989. If they were not, it would have been grossly unethical to use them on the first 4 children in Smith et al. (2000). It's possible that sometime between child 4 and child 5 in Smith et al. (2000), there was suddenly an advance in research allowing for the abandonment of the suddenly non-effective and unnecessary aversives (for which these researchers must have received the requisite institutional review board permission). Or it's possible that this was about the time it became known that this procedure--physical punishment--was likely to become illegal in California.

Dr Freeman's book was published in 2003, but she doesn't mention Smith et al. (2000), the only direct evidence of exactly when aversives were abandoned by the UCLA YAP. As to why, there is no way precisely to know, unless Drs Lovaas or Smith decide to disclose this information. However, the evidence doesn't entirely support Dr Freeman's account. There's still the problem of Dr Lovaas taking the trouble to prove how effective contingent aversives were in his famous 1987 paper. And the available evidence does strain the credibility of the assertion that it was advances in research which solely were responsible for the UCLA YAP's apparently sudden about-face re aversives.


References:

Anderson, S.R., Avery, D.L., DiPietro, E.K., Edwards, G.L., & Christian, W.P. (1987). Intensive home-based intervention with autistic children. Education and Treatment of Children, 10, 352–366.

Birnbrauer J.S., & Leach, D.J. (1993). The Murdoch Early Intervention Program after two years. Behaviour Change, 10, 63-74

Birnbrauer J.S., & Leach, D.J. (2006, June). The Murdoch Early Intervention Program at 10 years. Association for Behavior Analysis Annual Conference abstract. Atlanta, GA.

Freeman, S.K. (2003). Science for sale in the autism wars. Lynden, WA: SKF Books.

Lovaas, O.I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.

Lovaas, O.I . (2002) Teaching individuals with developmental delays: Basic intervention techniques. Austin, TX: Pro-Ed.

Sheinkopf, S.J., & Siegel, B. (1998). Home-based behavioral treatment of young children with autism. Journal of Autism and Developmental Disorders, 28, 15–23.

Smith, T., Groen, A.D., & Wynn, J.W. (2000, 2001). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal on Mental Retardation, 105, 269-85. Erratum in American Journal on Mental Retardation, 105, 508. Erratum in American Journal on Mental Retardation, 106, 208.

Smith, T., & Lovaas, O.I. (1997). The UCLA Young Autism Project: A reply to Gresham and McMillan. Behavioral Disorders, 22, 202– 218.