ay To what extent does Applied Behavioral Analysis, Neurofeedback, and Cognitive Behavioral Therapy alleviate the symptoms of children’ Autism Spectrum Disorder?
Abstract
According to statistics from Centers for Disease Control’s Autism and Developmental Disabilities Monitoring Network, 1 in 68 children identified with Autism Spectrum Disorder in 2012. (Autism Spectrum Disorder Data& Statistics) Furthermore, ASD is reported to occur in all racial groups, and it has become an epidemic disorder as society evolves. ASD is highly inheritable and environmental which the symptoms usually manifest before the age of three. There are three essential characteristics of the disorder: impairment in social and communication aspects and shows eccentric behavior. To what extent does Applied Behavioral Analysis, Neurofeedback, and Cognitive Behavioral Therapy alleviate the symptoms of children’ Autism Spectrum Disorder?
This paper initially addresses the difficulties ASD patients face to show the topic is worth researching. The extent of investigation includes the characteristics, genesis of ASD, and the benefits of early intervention. The study of Greer & McCorkle (2003) of 3 years Comprehensive Application of Behavior Analysis to Schooling, the study of Evan Jaffe on the use of Applied Behavior Analysis with an Autistic Adolescent (2010), the critiques of the effectiveness of Applied Behavior Analysis by William H. Yeaton, and the report of the New Zealand Ministry of Education are described and evaluated in great depth in terms of the pros and cons. In a cognitive approach, the study of Cognitive Behavioral and Neurofeedback of the brain development through the use of electroencephalographic and haemoencephalographic is also discussed.
The conclusion states that the Applied Behavioral Analysis is very much beneficial for people who have been diagnosed with Autism Spectrum Disorder by decreasing the severity of its symptoms. The conduction of Early Intensive Behavior Intervention had approximately benefited 90% case studies with children diagnosed with prescribed ASD characteristics (Maurice, Green, & Luce, 1996).
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Introduction:
Autism is reported to affect approximately 21.7 million people in 2013 and it is progressively becoming a common disease in every age group. Especially children, who need to have a thorough understanding of problems they face and how to conquer them. Every so often they accumulate unresolved issues that later lead to mental stress/disorders. This essay believes that this is an issue that must be addressed, and this is where the essay has started.
Autism Spectrum Disorder is classified as a pervasive, maladaptive neurodevelopment disorder characterized by impairment in social interaction, communication, limited interests and repetition in behaviors. ASD is highly heritable and environmental, which the symptoms usually become manifest before the age of thee. This essay aimed to discover to what extent does Applied Behavioral Analysis alleviates the symptoms of children’s Autism Spectrum Disorders. Since each individual has their unique functioning system, autism intervention plan should be tailored to address specific needs. ASD can be diagnosed as early as the age of three and research had shown such diagnosis of ASD could be seen as reliable, valid, and stable. This essay intends to awake people’s awareness of their mental conditions. The earlier autism is diagnosed and treated, the better chance a person’s condition will improve to be able to keep pace in regular educational with their developing peers.
What Is ASD?
In 1980, the third edition of Diagnostic and Statistical Manual of Mental Disorders (DSMMD-III) published by American Psychiatric Association perceived autism as a spectrum of behavioral disorders which results in a different extent of functional limitations.
“Impaired reciprocal social interaction, impaired communication skills, and restricted, repetitive, and stereotyped patterns of behavior, interests and activities” are the characteristics to be diagnosed of ASD. Given the complexity of ASD conditions and the symptoms of individuals cases vary, there are no single, definite cause that determiners the existence of the disorder. While autism is highly inheritable and sometimes the disorder is associated with birth detects, psychologists believe the causes of ASD can be categorized into two divisions: genetics and environment.
Viewing ASD through the biological level of analysis, autism affects information processing in the brain by altering alignment and connection between nerve cells and their intended synapses, which prevents neurotransmitters from reaching the synaptic terminals of the matched axons and binds with its right type of receptor sites and releases information to make an appropriate command. The study conducted by Coben R, Clarke AR, Huspeth W, and Barry RJ (2008) looked at the quantitative EEG findings in 40 students whom equally divided into the experimental and control group. The EEG recorded the differences in brain’s cerebral topography of absolute, relative, and total power, as well as intrahemispheric and interhemispheric coherences when participants’ eyes were closed. The results indicate the relationship between autistic behaviors and dysfunctions of frontal and posterior brain regions. Other modern technology such as MRI and fMRI also indicates the neural connectivity anomalies leads the autistic deficiencies. This study reports the power of EEG and coherence rate during a resting state of ASD children, and explains ASD from a biological level of analysis. Microbiological researchers at Arizona State University in 2014 reported gut bacteria might play a role in autistic behavior. They claimed, “evidence is mounting that intestinal microbes exacerbate some of the autism’s behavior”; Autistic children may be lacking bacterial species called “Bifidobacterium” functions as a promoter for good health. However, researchers do not yet fully comprehend how gut bacteria influences behavior.
Social impairment of interaction skills is the most common symptoms in all three types of ASD. This can be identified by abnormal non-verbal behaviors. For example, avoiding eye contact, displaying prosaic facial expressions, and resisting physical contact. Failure to development peer friendship and ASD children often appear aloof and indifferent to peers and indifferent to other contemporaries. Moreover, a lack of “social and emotional reciprocity” often corroborates the diagnosis of ABA impairment that patients are intellectually incompetent of being cognizant of personal and other people’s personal borders, and they often show little interests in building bonds with others, including their parents. Impairment in verbal and non-verbal communication skills is also one essential symptom of ASD. A delayed, (e.g. inability to form sentences at the age of two or unable to speak at all) monotonous, frequent repetition of single phrases or a total lack of spoken language development is determined to be the characteristics. Nonetheless, if an individual does not possess the above-described features and still had diagnosed with ASD by professionals; there may be impairment in spontaneously initially conversations. Restricted, repetitive, and stereotyped patterns of behaviors” are another kernel of ASD symptoms. Such behavior can be described as children having an abnormal focus such as unusual sensory interests, and such “preference” usually accompanies with “preoccupation with one or more” of abnormalities. Or children who themselves have a “repetitive motor mannerisms” and shows a “persistent fixation with unusual parts of an object.”
At least one of the three above categories of characteristics must be identified by professional pediatrician for children to be considered as genuinely autistic.
Applied Behavior Analysis
Applied Behavior Analysis is a process modification of behaviors. It has been verified scientifically to be an effective early intervention for children with developmental disorders such as autism. Applied Behavior Analysis is defined as “ a scientific discipline concerned with analyzing the principles of learning theory and systematically applying this technology to change behavior of social significance.”
ABA focuses on reinforcing learning tasks to bring positive changes in behavior, an “educational interventions should incorporate principles of positive behavior support, particularly a focus on understanding the function of the child’s behavior.” Baer, Wolf, and Risely (1967) outlined 4 essential criteria of ABA. 1. The method must be applied so the learned behavior has some social significance for application. 2. The method must be behavioral to allow precise record for environmental and physical events. 3. The method must be analytic to allow relatively objective collection of analyzed data. And the intervention of ABA should present causality with a change in behavior. 4. The method must be conceptually systematic for establishment of relevant principles.
One study conducted by B.F. Skinner, the pioneer in the field of psychology of Applied Behavior Analysis, reveals animals’ behavior adaptation through the process of reinforcement. The result of his experiment shows that food rewards lead to animal behavior changes. There are mainly three types of operant conditioning: the reinforcement, the extinction, and the punishment. Reinforcement is defined as the action of giving encouragements and rewards for a particular behavior, which will help to aids in the recurring pattern of the behavior. Whereas extinction procedure is the withholding reinforcement of one behavior, resulting the decrease of the behavior, and ends with the behavior extinguishing. Extinction procedure is often preferred over punishment procedure because some punishing actions may be unethical to implement, and sometimes punishment procedure is prohibited to certain states’ law. Another reason punishment procedure is not a traditional approach in ABA is that behavior analysts believe it is best to concentrate on the positive, rather than rigidly altering the problematic behavior. The punishment acts as stimuli to reduce the probability of behavior that they flow. By neglecting the negative behavior, psychotherapists believed that the negative behavior would gradually be in checked. Neglecting the behavior itself serves as a punisher because the attention children desire has refrained. Early Intensive Behavioral Analysis is an individualized, structured ABA program to address full spectrum of autism symptoms designed before the age of 4, and lasts for 24 to 40 hours per week for 1 to 3 years.
Social Approach of Applied Behavior Analysis Case Studies:
A pilot study conducted by Beth A Pfeiffer, Kristie Koening, Moya Kinnealey, et al studied the effective of ABA intervention in children with ASD. The experiment included 37 participants showed an extent degree of ASD symptoms. 20 participants and 17 participants were randomly assigned to received ABA therapy (experimental group) or to received no treatment without their awareness (control group) for 45 minutes per week for 6 weeks. The experiment used single-blind technique, so participants don’t know which group they are involved with. The results indicate the experimental group demonstrated significantly fewer autistic mannerisms compared to the control group at the end of the 6-week study.
To evaluate the above pilot study, it is reliable because the implementation of single-blind technique so participants does not aware which design group they participated in to avoid demand characteristics. Therefore, participants would not falsify their results in an attempt to please the researchers or to sabotage the experiment. The result is high in generalizability because randomization was used to assign participants into different design groups to avoid subjectivity of researchers bias. Observation period of the experimental outcome only lasted for a limited amount of time and the sample size of the experiment were small and performed within a certain region, therefore the experiment lacks ecological validity and it is difficult to conclude the results the behaviors will continue to improve after the termination of the training program. To conclude, researchers may agree ABA treatment alleviates the symptoms of ASD to some degree, but a definite causality of ABA is the can fully cured the symptoms of ASD cannot be drawn.
The seminal case study of Lovaas of the Young Autistic Project investigated the effectiveness of ABA technique for children’s learning progress, and later proof ABA to be the most effective approach of curing ASD symptoms. 19 ASD children who are generally 3 years old received an intensive training of 40 hours per week of one-to-one-at-home ABA treatment for 2 years. Two control groups were also studied for indication to determine the effects of natural maturational of ASD symptoms alleviation. The first control group consisted of 19 children at the age of 3 receiving significantly lower hours of behavioral treatment. And the second control group consisted of 21 children at the age of 3 who received the general, community treatment. All children participated in this project had been previously identified with autistic behaviors by pediatrician. 3 years later, children were re-evaluated at the age of 7 by social researchers. The results showed the IQ scores for children who received intensive ABA therapy plummeted significantly from an average of 53 to 83 (out of 120). And 9 out of 19 (47%) children had even completed their regular first-grade education. However, the results for control groups remain relatively statics: from 46 to 58 (out of 120). Furthermore, the 9 participants from the experimental group who passed the first grade reported having an average IQ score of 107 compared to the universal IQ average of 100. The 9 children were considered to be fully recovered.
To evaluate Lovaas’ study of Young Autistic Project, the study has high credibility because social researchers rated children’s IQ scores to avoid researchers bias so findings are not unconsciously influenced by researchers’ own expectations. The findings demonstrated significant gains in IQ intellects that affirms the effectiveness of ABA for reducing eccentric behaviors. The case study gathered numerous of detailed, both qualitative and quantitative information, so it is a highly detailed and thoroughly comprehensive study with in-depth, rich, and valid findings. Lovaas used IQ scores as an indicator of behavioral improvements that measured prior and after the study. It is an objective, quantitative indicator for behavioral improvements as it is a universal measurement for children’s development and it has a set rule of how each section should be scored. Therefore, social validity of the experiment increases as there is no subjective interpretation by researchers own sets of standards. The study possess high reliability results of control groups receiving few hours of ABA treatment or other therapies serves as an indicator of the effectiveness of ABA treatment given the experiment lasted for 3 years and all children were approximately at the age of 3 when participated in. A control group of the same size and same age so researchers can say with certainty there are no confounding factors affecting the dependent variable of what researchers intended to measure. The findings corroborates with other empirical studies showing the efficacy of Applied Behavioral Analysis the treatment of Autism Spectrum Disorders.
However, the study may lacks ecological validity as the study only took place in America. The findings may not applied to else countries. While Lovaas study was in the form of highly-detailed studies, while these generally provide rich sources of information and Lovaas’s were method triangulated. It is dangerous to generalize the results to other circum1stances as findings are unique to the case being studied. The experiment showed a correlation between the alleviation of ASD symptoms and the return to normal education to the use of ABA therapy. However, there can be other confounding variables such as the 9 children reported to have an average IQ scores of 107 who had mitigating circumstances at the beginning of the 3-years-trial. Their significant recovery may due to natural maturation that their ASD symptoms would gradually relieve when their biological age increases. Therefore, a definite conclusion of the use of ABA to the recovery of ASD cannot be drawn.
The findings of Sallows & Graupner et al’s study (2001) demonstrated 45% of children receiving ABA improved on intellectual functioning. The study of Eikeseth, Smith, Jahr, & Eldevik (2002) had 2 experimental groups. Children in the first group received 28 hours per week of study and children in the second group received 40 hours per week of study. They results showed children receiving more hours of therapy performed better, such as having higher scores on standardized tests, than children received less hours of treatment which they showed relatively poorer performance in communication, social skills, and independent behaviors.
The case study of Olive Healy, Jennifer O’ Connor, Geraldine Leader, and Neil Kenny investigated on the effect on autistic children for three years of intensive Applied Behavior Analysis on an individual whom at the time was 3 years old. During the 3 years intervention, the child was evaluated by the same psychologist using Gilliam Autism Rating Scales which assess the child behavior based on stereotypes behaviors, communication, social interaction, and developmental disturbances. Comments was made continuously by the same psychologist annually, and at the end of the 3 years training period the report indicated the child “could be actively spent in preparing her for that transition with support to mainstream school.”
This study demonstrated the significance of provision of an early intensive ABA program to ASD children. To evaluate Olive’s three years interval study, abundant qualitative information was gained by researcher’s incessant observation of the child for follow-ups and updated instructions. All these detailed instructions make the study high in reliability for replication. However, the sample was not representative. There was only one child being studied so findings were drawn from an individual case. Although Olive’s study was thoroughly comprehensive with in-depth details, only one researcher assessed the child. All rich sources of information can be researcher triangulated as him or her may subconsciously expects child’s improvement over the three years course. Therefore, researchers bias is inevitable and decreases the validity of the study’s findings. To summarize, the study was vulnerable to researcher bias so it is difficult to generalize the findings from Olive’s study to other children as only one child is being studied so the findings may unique to the specific case.
Examining Autism Spectrum Disorder through the biological level of analysis, Autism Spectrum Disorder has been identified to be a pathophysiological in cerebral organizations which are dysfunctional.
Biological Approach of EEG & Neurofeedback: Case Studies
Electroencephalography is defined as a noninvasive electrophysiological monitoring method to record the electrical activity of the brain. One helmet are placed outside of a person’s head and electrodes detect changes in electrical activity. EEG produces a graphical representation of the activity from each electrode when areas of the brain are active. Neurofeedback is defined as a direct training of brain function which measures brain waves using EEG technology to inform people the regulation of brain function. Neurofeedback develops brain’s self regulation for independent functioning.
The study done by Rober Coben and Ilean Padolsky (2007) investigated the effectiveness of nuerofeedback for Autism Spectrum Disorder. 37 ASD children participated in the study of the experimental group which comprised of 84% males and 16% females, and 12 ASD children served as control group. The experimental design of the study was match pairs based on age, gender, race, and severity of ASD rated by Autism Treatment Evaluation Checklist (ATEC). The study lasted for 20 sessions. The results showed 89% of improved ratings among the experimental group who received neurofeedback and 40% reduction of autistic symptomatology compared to the control group. Therefore, evidence from multiple means demonstrated that nuerofeedback can be an effective treatment for ASD symptoms.
To evaluate Rober’s study on the effectiveness of neurofeedback: the findings confirms the efficacy by showing 89% of success rate with a 40% reduction in core ASD symptoms. Researchers used matched pair design for participants allocation. This is good because comparison of people with similarities can be drawn to see the relationship between neurofeedback to the alleviation of the ASD symptoms. The findings of the research also corroborates with the findings of the study conducted prior by Jarusiewicz in 2002, therefore the occurrence of Rober’s study was no coincidence. However, the study may be venerable to the accusation of gender bias. The Child Guidance Clinic usually consisted of 60% boys and 40% of girls whereas the study fo Rober’s had 84% of boys and 16% of girls. So the experimental group were not representative of the usual intake and gender composition. The racial composition of the study consisted of 97% of Caucasian, and 3% of Asian American, so the findings may not be less likely to apply to other racial regions. Therefore, the study lacks ecological validity.
Cognitive Approach of Cognitive Behavior Therapy: Case Studies
Apprehending Autism Spectrum Disorder through a cognitive level of analysis, to what extent does cognitive Behavioral Analysis be able to alleviate Autism Spectrum Disorder? Cognitive Behavioral Therapy is a combination of basic principles of behavioral and cognitive psychology for treating ASD. The famous study of Pavlov’s research on classical conditioning was an example of such.
The study of Nikki Collingwood investigated on the effectiveness of Cognitive Behavior Therapy based treatments with ASD. The study comprised 50 participants randomly assign either to intervention group or control group to ensure group equivalence. Study used standardized measures to assess prior and post autistic level to compare the effectiveness of CBT. The duration of CBT treatment lasted for 7 weeks. The results showed participants received CBT scored higher in standardized exams than the control group.
To evaluate the study of Nikki, CBT is a modification of maladaptive thoughts to improve children’s cognitive development. The study indicates the effectiveness CBT and promotes the usage of intervention for real life application. Because of the small sample size and limited investigation duration, researchers cannot be certain if ASD symptoms will continue to improve after the termination of the investigation. Therefore, the findings may vulnerable to low generalizability. Also, parents of the ASD children were involved to report their child’s behavior before the intervention took place for the purpose of comparing the progress made. Some parents may have not responded the researcher’s questions honestly in an attempt to show their children with a better image. Therefore, the study was also vulnerable to social desirability bias.
Evaluation:
To evaluate the Applied Behavior Analysis, there are consistent studies evidenced its effectiveness of alleviating symptoms of Autism Spectrum Disorders of children benefit from improved language skills, adaptive behavior, IQ scores, and showed towards a wider range of individual responses. All studies reported the extremely intensified therapies were the success of ABA. Control groups of receiving fewer training hours had a significantly lower or even static improvement than experimental group which received an intensive, thorough, structural ABA treatment. The study of Maurice, Green, and Luce (1996) indicated approximately 90% of autistic children benefited from early intensive behavior intervention of ABA. However, critics for ABA exist as well. ABA can be accused of creating mechanical robots because the incessant repetition of particular skills makes children less likely to develop independent critical thinking. The monotonous and continuous inculcation of set words and phrases for ease of verbal communication of ASD children may benefit them from learning, however the extent of benefits are limited because of the monotony which strangled children’s potential. Moreover, 40 hours per week of intensive training for years long are extremely stressful, and not all families have the economic ability to furnish their children with such frequency. Also, children’s improvement may not seen quickly during programs duration so it is hard to determine whether the implementation of ABA had benefited children or simply because of their natural maturation helps them alleviate the symptoms. Moreover, procedures used in Olive Healy’s study inevitably faced discriminations of social validity. The results gained from a single researcher used for 3 years follow-ups and rating the behavior of child’s development are highly subjected to researchers bias. And it is challenging to utilize findings gained from an unreliable source of social validation and develops a solid conclusion based on an inadequacies of supporting evidence. Also, different studies, whether in ABA, Neurofeedback, or CBT, all used disparate normative approaches in an assistance of the judgment for improvement of ASD symptoms. Therefore, no set social validation standards were establishes which makes it difficult to make comparison deciding which is a better approach across. The sample size of all described studies were very small as all of them are under 100 participants. Therefore, the generalizability of experiments’ findings are questionable. Also, none of the above described studies presented a cost analysis of the implementation of methods as the frequent training therapies are very much labor-intensified: requires numerous of hours of works by professionals. The costs frequent requires of professionals may not be affordable to all families. Therefore, it is ambiguous for individual families to consider which therapy is most suitable for their child and for the whole family expenditure.
Conclusion:
In conclusion, impairment behavior in communication, social and linguistics skills are the prerequisite of being diagnosed as ASD. Its symptoms become explicit before the age of three. Since ASD can be identified at such an early stage of and the symptoms largely affect the living quality of the patients, Applied Behavior Analysis, Neurofeedback, and Cognitive Behavioral Therapy are developed to assist patients to overcome the disorder.
However the above three described therapies does not guarantee the recovery of ASD, in fact there is no single treatment which does. Neurofeedback based on biological principles which develops brain’s independent self regulation. And Cognitive Behavior Therapy combined the core principles described in the behavioral and biological field. ABA appears to be the therapy that is most successful in alleviating the symptoms of ASD, by having a team of expertise observing the behavior of the child, having the behavior measured and traced down in-depth, and develops tailored treatments and task for the child to complete. Thus, Applied Behavior Analysis is the most recommendable therapy because it has diverse classifications which are applicable for individuals cases and its chances of recovery. Even it fails to eliminate ASD symptoms, such therapy can largely reduce the symptoms and there are no after-effect like medicine does. The positive outcome of ABA outweighs its negative.
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