Autism Spectrum Disorders (ASD) are lifelong conditions which can be very debilitating. This disorder can be identified within the first two years of life, thus spurring the popularity of Early Intensive Behavioral Interventions (EIBI). Since 1987, the number of studies has been increasing as efficacy has been established. There has been a broad and inconsistent set of methods and procedures to establish experimental groups, evaluate treatment outcome, and assessing family reactions to treatment. In 2007, Matson noted that most EIBI studies failed to address many important dependent variables include the measurement of core symptoms of ASD. This study evaluates dependent variables used to assess the factors noted above, separated into studies published before 2008 compared to 2008 and later. Results are an indication that improvements are occurring, especially on the measurement of core symptoms of ASD; however, considerably more improvement is needed.
The prevalence of Autism Spectrum Disorders (ASD) has increased drastically in recent decades (Matson & Kozlowski, 2011). This point is underscored by the fact that the condition has a lifelong course (Fodstad et al., 2009, Horovitz and Matson, 2010, Matson et al., 2010a, Matson et al., 2009a and Matson et al., 2012a). ASD is pervasive, affecting communication, adaptive and social skills, and often overall cognitive functioning (Hattier and Matson, 2012, Matson et al., 2012b, Matson and Wilkins, 2009, Smith and Matson, 2010a, Smith and Matson, 2010b and Smith and Matson, 2010c). Additionally, the disorder is often co-morbid with a host of motor problems, challenging behaviors, and psychopathology (Matson et al., 2010b, Matson and Rivet, 2008, Matson et al., 2012c and Sipes et al., 2011). As a result of these factors there has been a concerted effort by many researchers to develop methods and procedures that would enhance the reliability, consistency, and validity of assessment. This problem is compounded by the complexity of the overall problem. Persons can range from intellectually gifted to profoundly intellectually impaired for example (Matson et al., 2008 and Matson and Wilkins, 2008). Not only is the condition heterogeneous but it is further complicated by comorbidities (LoVullo and Matson, 2009, Matson and LoVullo, 2008, Matson and Neal, 2009 and Matson et al., 2009b; Rojahn et al., 2009). This heterogeneity has led to the use of packaged interventions referred to as Early Intensive Behavioral Interventions (EIBI).
The EIBI field is now well established and still picking up speed. As this area of study matures, priorities should and do change. One of the most important of these changes is the improvement in the range, specificity, and variability of measures used to evaluate treatment outcomes. In this review and analysis, 8 basic areas of assessment have been addressed. It is encouraging that the greatest improvement has been in core symptoms of ASD. More recent EIBI studies now include this measure. Adaptive behavior continues to be seen as a priority, and rightly so, and is addressed in most studies.
On a less encouraging note, no studies have addressed side effects, and even for recent studies, less than half address parent/consumer satisfaction. Much work needs to be done in this area. Another big issue is describing how the diagnosis is determined. Only 47% of the most recent papers addressed this issue and for 4–7 papers there was overlap between methods used for diagnosis and those used to determine treatment effectiveness. Using different measures for these two purposes eliminates the potential confound of dual purpose. Perhaps more importantly, strong change on different measures assessing the same construct further strengthens the validity of the reported treatment effects. Psychopathology and challenging behaviors need a good deal more attention. When psychopathology measures were present they often were not tailored to the ASD population. With respect to challenging behaviors, screening methods were used, but rarely, and a functional assessment was conducted in only one instance. U.S. federal special education guidelines specify that functional assessment should be used for special populations who evince challenging behaviors. That requirement does not seem to be unreasonable for EIBI. Additionally, challenging behaviors should be included in the target behavior category in all instances where they are present. All and all, the trend in assessment methodology for EIBI research is promising, but further improvements are still warranted.
