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Early Intensive Behavioural Intervention (UCLA YAP Model) and Autism Ranking: Strong positive evidence

Father and child

The University of California at Los Angeles Young Autism Project model (sometimes known as the UCLA YAP model, ABA, early intensive behavioural intervention, EIBI or the Lovaas method) is a comprehensive, highly structured and intense programme designed to help very young autistic children.

Programmes such as the UCLA YAP model are based on the idea that autistic children struggle to understand and to communicate with other people, and react to such frustrations with tantrums and other challenging behaviours. The teaching team therefore constructs a teaching environment which is designed to maximise the child's success and minimise failure.  Desired behaviour, such as use of language or socialisation, is positively reinforced and accompanied by lots of praise. Negative behaviour, such as self harm or aggression towards others, is not reinforced.

The UCLA YAP model uses a variety of specific teaching methods including discrete trial training, discrimination training and incidental teaching although the therapists may also use a wide range of other interventions, such as sign language and the Picture Exchange Communication System, to suit the needs of the individual child.

The UCLA YAP model is very intensive (up to 40 hours training a week) and is usually delivered by parents and one or more consultants. The consultant develops and oversees a programme personalised to the needs of the individual child and designed to cover all relevant developmental areas.

Please note: There are some other models (such as the Murdoch Early Intervention Program) which are very similar to the UCLA YAP model and we have included them in this evaluation.

Our Opinion

  • There is strong research evidence to suggest that some early intensive behavioural interventions – such as the UCLA YAP model – appear to help some autistic children.

  • However, each autistic child is different and will respond differently to the treatment, with some making more gains in some areas than others.

  • For some children, alternative interventions, such as those focusing on parent child interaction or specialist pre-school placements, may produce very positive results; school based programmes also offer greater opportunity for interactions with peers.

  • If any type of EIBI is undertaken, it is important to consider any benefits against the possible impact on the child (in terms of the intensity and possible stress of the intervention) and on the families (in terms of time, finances, organisation, and effects on siblings).

  • It is also important to identify the rewards that are likely to work for the individual child, as many children with autism do not find verbal praise, clapping or touching to be rewarding.

Disclaimer

Please read our Disclaimer on Autism Interventions


Audience

The Lovaas Institute recommends that treatment should begin as early as possible, preferably before the child is five years old and, ideally, before the child reaches 3½ years old.  However it also suggests that this intervention may be beneficial for children up to the age of eight and beyond.

The Lovaas Institute website, accessed on 15 June 2016, states:

"The Lovaas Model of Applied Behavior Analysis is a behavioral treatment model typically started with children between the ages of two and eight. Children typically transition to different services as they progress through elementary school and no later than the age of twelve."

Some research suggests that this intervention is likely to benefit children with higher IQs and language skills, although it is sometimes used with children with a lower IQ who are non-verbal.

Aims and Claims

Aims

The aim of the intervention is to build positive behaviours such as language and socialisation, and to reduce unwanted behaviours such as self-stimulatory or aggressive behaviours.

According to Eikeseth, Hayward and Gale (2011)

"It is assumed that children with autism fail to understand what well-meaning adults have been able to communicate successfully to their typically developing children. As a consequence, such children have encountered continuous failure in learning situations and understandably react to such frustrations with tantrums and other attempts to escape or avoid future failures. Every effort is therefore made to construct a teaching situation so as to maximise the child's success and minimise failure. This is accomplished by simplifying requests, prompting the child to make the correct response and providing abundant reinforcement for socially appropriate behaviours. At the same time, failures are minimised. Ensuring the child's motivation to participate in the learning process is a key element in behavioural interventions."

Claims

- Research claims

A number of research studies have made significant claims for the EIBI – UCLA YAP Model. For example

  • Lovaas et al (1987) claimed that 47% of children treated in his original study functioned normally and were able to attend mainstream school by the age of 5. He also claimed that a further 40% of the children made substantial progress but still displayed autistic characteristics. In addition he claimed that those children who followed the programme for two years or more gained an average of 30 IQ compared with the other groups in his study who made no IQ gains.
  • Eikeseth et al (2002) claimed that "Results suggest that some 4- to 7-year-olds may make large gains with intensive behavioral treatment, that such treatment can be successfully implemented in school settings, and that specific aspects of behavioral treatment (not just its intensity) may account for favorable outcomes."
  • Granpeesheh et al (2009) claimed that "Our study corroborates the finding that some children with autism who receive early intensive behavioral intervention achieve functioning in the average range."

However most researchers state that while the EIBI – UCLA YAP Model may produce significant results in some participants, individual response to treatment is variable and these programmes do not result in improvements in all areas of functioning.

-  Anecdotal claims

The Lovaas Institute website, accessed on 15 June 2016, claims

“With early intervention, a sizable minority of children diagnosed with autism, pervasive developmental disorders and related developmental disorders have been able to achieve normal educational and intellectual functioning by 7 years of age.

“These children have been mainstreamed into regular classrooms and have advanced successfully through the school system without additional assistance. They show significant increases in intellectual functioning and perform within normal ranges on standardized tests of intelligence. They also appear indistinguishable from their peers in measures of social and emotional functioning.

“Even for children who do not reach the level of typically-developing peers, their quality of life is greatly improved from what they learn; sizable decreases in inappropriate behaviors and acquisition of basic language skills are most often achieved. These children become more active members of their family and are usually able to learn in less restrictive special education classrooms or supervised regular education classrooms”.

Key Features

The UCLA YAP Model of Early Intensive Behavioural Intervention is a highly structured and intense form of applied behaviour analysis in which a child is taught a range of skills by the parents and one or more consultants in the home and/or in a nursery. 

The trainers use a wide range of techniques, many of which build on everyday routines, such as eating or getting dressed.

Specific teaching methods include:

  • Discrete Trial Training- a highly-structured form of training that involves a trainer instructing an individual using a series of learning opportunities or trials
  • Natural Environment Teaching – a form of teaching based around the interests and preferences of the learner rather than the teacher.
  • Incidental Teaching – a form of teaching in which a teacher takes advantage of naturally occurring incidents or situations to provide learning opportunities for the student.

However the trainers may also use a wide range of other interventions, such as sign language and the Picture Exchange Communication System, to suit the needs of the individual child.

Desired behaviour is positively reinforced, for example with bites of food, play with a favourite toy, hugs and lots of praise. Negative behaviour is ignored.

By using these techniques, the child can be helped to progress from simple to more complex behaviours (e.g. from basic to more complicated  self help skills, or from simple non-verbal and verbal imitation skills, which may need to be directly prompted,  to more complex  and spontaneous expressive and abstract language). He or she also leans how to play interactively first with an adult, then with peers, eventually moving from the home or clinic into the school or nursery. The aim is for a child to learn increasingly from his peers, the class teacher and the school curriculum.

It is important that any teaching matches the individual child’s needs and circumstances. For this to work, the therapists must assess the child and his or her environment on a regular basis. The curriculum and teaching techniques can then be adapted as appropriate.

It is important that all those involved in the child’s care are involved in the treatment programme, since the skills learnt in one setting (e.g. the home or clinic) tend not to transfer to other situations (e.g. the classroom) unless these are specifically taught

The success of the intervention depends on the interplay between the age of the child, his or her developmental level and personal characteristics, the intensity of the treatment, competency of the therapists and the ability of families to carry on the therapy at home.  It is important to understand that EIBI may not be appropriate for some children or parents.

Cost and Time

Cost

Because the instructors providing the EIBI training have to be trained and supervised, it can be very expensive. Costs vary depending on hours, location of instruction and the qualifications and number of therapists used. 

It can be very difficult to determine the likely costs. However

  • According to Eikeseth, Hayward and Gale (2011), the UK Young Autism project charges £43-45,000 per year for a full programme – not including any additional transport costs.
  • according to the ABA Educational Resources Ltd website, accessed March 2012 and the last occasion on which we were able to find this information, the annual cost of a home-based ABA programme in the USA is approximately $54,000.

Time

The UCLA YAP Model of EIBI is usually delivered over 2 or more years, on a one to one basis, for 6-8 hours per day, 5-7 days a week.

According to Eikeseth, Hayward and Gale (2011), in the model followed by the UK Young Autism project

‘The child is taught in a one-to-one situation for 7 hours per day, usually 5 days per week (amounting to 35 hours per week plus an additional 5 hours per week provided by the parents. In total 40 hours per week one-to-one teaching).

‘For most younger children, the majority of one-to-one teaching takes about two years, during which time a phased entry into a nursery or school environment might begin.’

The intensity of the therapy means that there is usually a need to establish a programme team, which typically consists of at least three people including one or more parents. All trainers should have undergone a full training programme.

According to Eikeseth, Hayward and Gale (2011)

"Parental involvement is essential to an optimal programme. Parents are involved as an active team member, typically with the primary carer taking two sessions of teaching per week, for about 5-7 hours. This parent should also overlap with each tutor, and the senior tutor, for an hour each week to ensure consistency of approach across the team and parents. Some parents recruit an additional tutor to assist in their role."

Risks and Safety

Hazards

Some critics claim that Early Intensive Behavioural Intervention does not enable children to generalise the skills they have learnt, that is, they can only do exactly what they have been taught to do, nothing else.

Others claim that the method can lead children to become very prompt- or cue-dependent whereby they can perform tasks when prompted but do not spontaneously use these skills in everyday interactions.

Some critics also claim that extensive use and over reliance on intensive intervention may be problematic because it is very time consuming and costly, leaving little time or money for other activities – additionally studies have shown that results reported under laboratory conditions frequently fail to be replicated in other (real life) settings.

There is also the moral debate about subjecting a child to such intensive therapy - some people argue that as adults we are only supposed to work 35 hours per week and yet we could be asking children with autism to work 40+ hours with little free or unstructured time.

Some autistic people object to any interventions which are based on the principle of applied behaviour analysis. For example, Milton objects to the “goal of the practice and its ideology; to its moribund [dying] theory; to the lack of good evidence in its support and a history of its advocates not answering criticisms; and to a disregard for reports of harm arising from its use”. (Source: personal correspondence with Research Autism, June 2013)

Contraindications

There are no known contraindications (something which makes a particular treatment or procedure potentially inadvisable) for the UCLA YAP Model of EIBI.

Suppliers and Availability

Suppliers

Variations of the EIBI UCLA YAP model are widely available and incorporated within many branded programmes throughout the world including the Lovaas Model of Applied Behavior Analysis, the Ontario Preschool Autism Initiative and the UK Young Autism Project.    

The Lovaas Institute website provides details of approved consultants who live in and travel to many parts of the USA to work with families and school districts.

In addition there are a number of websites in Europe, the USA and other countries that provide details of organisations and individuals that can provide UCLA YAP Model-type services.

Credentials

There are no universally accepted qualifications for providers of the EIBI UCLA YAP model, although many consultants have Bachelor’s or Master’s degrees in a related field, such as psychology or education and some may also have Master's degrees in applied behaviour analysis and be Board Certified Behaviour Analysts (BCBA).

These consultants may provide the whole of the EIBI programme or, more likely, may design a programme and then train the parents and any other instructors whom the parents have hired. According to the Lovaas Institute website the instructors hired by the parents do not need to have special credentials or previous experience but they do have to have the right attitude.

In the UK it is essential that the person is also properly insured and has a recent DBS (Disclosure and Barring Service) check. 

Related Suppliers and Availability


History

Intensive Behavioural Intervention has been in use since the mid-1980s. Applied behaviour analysis, from which it is derived, has its roots in behaviour therapy developed in 20th century.

Dr. O. Ivar Lovaas worked with non-verbal, institutionalised children with autism in the late 1960s and early 1970s in the USA. He concentrated on improving verbal skills using applied behaviour analysis.

Unfortunately most of the children lost their verbal skills when the programme ceased and they returned to institutional life. However those who moved back with their parents did much better.

Lovaas went on to work with younger children, aged 2 to 4, in their home setting to see if the skills learned by the children were maintained. He developed Early Intensive Behavioural Intervention (The Lovaas Method) from this work.

Current Research

We have identified more than 30 scientific studies of the Early Intensive Behavioural Intervention - UCLA YAP model (or very similar programmes such as the Murdoch Early Intervention Program) published in peer-reviewed journals. We have also identified a number of systematic reviews of those same studies, some of which used meta-analysis to evaluate those same studies.

The published studies included a total of more than 1,500 plus autistic children aged between 1 and 8 years old.

  • Some of the studies (such as Lovaas 1987; Smith et al. 1997) compared intensity of behavioral intervention (that is high intensity vs. low intensity).
  • Some of the studies (such as Birnbrauer and Leach 1993 ; Cohen et al 2006; Eldevik et al. 2006; Eikeseth et al.2007; Magiati et al. 2007 ; Sheinkopf and Siegel 1998 ) compared EIBI with other treatments (such as treatment as usual, specialist nursery school etc.).
  • Some of the studies (such as Sallows and Graupner 2005 ; Smith et al. 2000) examined two service coordination models (clinic vs. parent-coordination) of EIBI.
  • A minority of studies (such as Lovaas et al, 1987; Birnbrauer and Leach, 1993; Butter, Mulickand Metz 2006) reported significant improvements in IQ, along with claims that half of the children now function almost normally.
  • The vast majority of the other studies reported significant improvements in many areas (such as communication skills, social skills, adaptive behaviour, self-care, academic development and IQ).
  • A minority of studies (such as Birnbrauer et al, 1993; Boyd, 2001; Eldevik et al, 2006; Sheinkopf, 1999) reported limited positive results.
  • A minority of studies (such as Bibby et al, 2001; Smith, 1997; Smith 2000b) reported mixed or inconsistent results.

A number of systematic reviews of the EIBI UCLA YAP model (and similar models) have suggested that the model provides significant benefits for some autistic children.

For example

  • Eldevik S. et al. (2009) concluded that “EIBI produces large to moderate effect sizes for changes in IQ and ABC [Aberrant Behaviour Checklist] scores for children with ASD when compared with no intervention controls and eclectic provision. These results support the clinical implication that EIBI at present should be an intervention of choice for children with ASD.”
  • Makrygianni M. K. Reed P. (2010) concluded that “behavioural [early intervention programmes]are very effective in improving the intellectual, language, communication and social abilities of children with ASD, while they had a moderate to high effect on the adaptive behavioural improvement of the children.”

However, Spreckley and Boyd (2009) concluded that “Currently there is inadequate evidence that [EIBI programmes have] better outcomes than standard care for children with autism. Appropriately powered clinical trials with broader outcomes are required.”

Status Research

There are a number of limitations to all of the research studies published to date. For example

  • Some of the studies (such as Perry, Cohen and DeCarlo, 1995; Smith et al, 2000; Butter Mulick and Metz, 2006) had a small number of participants (less than 10).
  • Some of the studies (such as Granpeesheh et al, 2009; and Perry et al, 2008) had large numbers of participants (several hundred in each case) but were retrospective case studies.
  • Some of the studies (such as MacDonald et al, 2014; and Smith et al. 2000) used single case design methodologies (such as multiple baseline or pre-post test).
  • Some of the studies (such as Farrell, Trigonaki and Webster, 2005) used comparative designs (comparing one intervention against another) but did not ensure that the participants in each intervention group were evenly matched.
  • Most of the controlled studies (such as Hayward et al, 2009; Magiati, Charman and Howlin, 2007; Remington et al, 2007) where participants were evenly matched were non-randomised.
  • The two randomised controlled studies (Sallows et al, 2005; Smith et al, 2000 b) were non–blinded, although the study by Smith did use blinded assessors who were independent of the research team.
  • Some of the studies (such as Eikeseth et al, 2007; and  McEachin, Smith, & Lovaas, 1993 were follow up studies of previous studies and reported on the same participants from those other studies.
  • Some of the studies (such as Mudford et al, 2001) did not report any useful outcome data.
  • Some of the studies (such as Birnbrauer and Leach, 1993) examined EIBI programmes that are similar to but not identical to the UCLA YAP model (such as the Murdoch Early Intervention Program). In other studies (such as Bibby et al, 2001) which looked at programmes which approximated to the UCLA YAP model, it was not clear how closely the programmes actually matched that model.
  • Some of the studies (Reed, Osborne and Corness, 2007) compared a number of ABA-based interventions, (such as the UCLA YAP model and the Complete Application of Behavior Analysis to Schools approach) with a range of other programmes but without differentiating the results between the different ABA-based interventions. This makes it difficult to evaluate the efficacy of the UCLA-YAP results.
  • Some of the studies (such as Eldevik et al, 2006) looked at less intensive forms of the UCLA YAP model (12 hours per week) making it difficult to know if the  usual, intensive version of the model is effective.
  • Some of the identified trials (Eikeseth et al, 2002; Lovaas, 1987; McEachin et al, 1993; Smith et al, 2000) were carried out by staff at the Lovaas Institute or by former colleagues of Lovaas. Those researchers may therefore have been biased towards the intervention, however unconsciously.

A number of systematic reviews have reported the following limitations to some of the studies:

Eldevik S. et al (2009) “First, although not accurately reported in some of the studies, they estimated that the EIBI groups on average received significantly more hours of intervention than did control groups. Second, a variety of assessment instruments were used across children and studies that made it difficult to compare results across studies and may have led to results being spuriously positive. Third, in some studies it was unclear at what points in time the assessments were conducted, particularly at posttreatment when in some cases assessments were undertaken years after treatment had ended. Fourth, the studies reported test scores in different ways that included standard scores, age equivalents, and raw scores.”

Reichow and Wolery (2009) “In the comparative studies reviewed, little is known about the comparison conditions, and little uniformity appears to exist across studies. These groups often lacked standardization within the group, were poorly defined, had no measures of procedural fidelity, and had no data on whether participants received supplemental treatments. Some studies of this synthesis described the comparison group as eclectic (e.g., Cohen et al. 2006; Eikeseth et al. 2007 ; Eldevik et al. 2006 ). By definition, eclectic treatments can vary across participants within a group, thus creating variability within the comparison group. This variability creates a situation in which the treatment effect might be over- or underestimated, and does not create a situation where treatment components can be compared.”

For a comprehensive list of potential flaws in research studies, please see "Why some autism research studies are flawed."

Future Research

Summary of Existing Research

  • Programmes based on Early Intensive Behavioural Intervention – UCLA YAP Model are amongst the most best evaluated interventions for children with ASD.
  • There is good evidence that the EIBI - UCLA YAP Model results in important improvements for many children with an IQ above 35.
  • The EIBI – UCLA YAP Model does not result in significant changes in all areas of children’s functioning or produce similar gains for all children.
  • Individual response to intervention is variable and outcome is poorest for children of lower levels of intellectual and linguistic ability.
  • Studies comparing the EIBI – UCLA YAP Model with other autism- specific early provision have produced inconsistent findings. Some indicate that early specialist pre-school provision produces comparative results to the EIBI- UCLA YAP Model.
  • There is no evidence to support claims that the EIBI –UCLA YAP Model results in cure or recovery from autism.

Recommendations for Future Research

  • Research is needed to evaluate the longer term effects of EIBI - most studies involve only relatively short follow-up periods.
  • There is a need for more comparative studies of EIBI vs. other high quality, autism specific pre-school programmes.
  • Although some randomised control trials have been conducted these are small in number and the quality of the alternative intervention has not necessarily been of a high standard.
  • Any new research will need more focus on fidelity (of both the EIBI and the comparison interventions). There is also a need to explore in much greater detail moderators and mediators of treatment effectiveness.
  • In particular, the characteristics of the children who do, and do not respond to intervention require systematic investigation.

Studies and Trials

This section provides details of scientific studies into the effectiveness of this intervention for people with autism which have been published in English-language, peer-reviewed journals. 

If you know of any other publications we should list on this page please email info@informationautism.org

Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.

Related Studies and Trials


Other Reading

This section provides details of other publications on this topic.

You can find more publications on this topic in our publications database.

If you know of any other publications we should list on this page please email info@informationautism.org

Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.

Related Other Reading


Personal Accounts

This section provides details of personal accounts of the use of the UCLA YAP model for autistic people.

Personal accounts can be useful sources of information about the intervention but are not as scientifically valid or reliable as research trials. This may be especially true where the accounts are published by an organisation which might gain a financial advantage from the take-up of the intervention.

Please note that the views expressed in these personal accounts do not necessarily represent our views.


The Lovaas Institute website provides anecdotal reports about a number of children including one called Bryce

"Bryce's skills steadily progressed through an intensive, Applied Behavior Analysis program. Within a year, he was able to imitate others, identify objects when asked, and spontaneously request for a wide variety of desires – all skills he demonstrated difficulty with before treatment. Because of his ability to imitate, he learned how to play with toys more appropriately and began to play with them for longer periods of time. ABA therapy continued for a total of four years during which time Bryce made significant gains in all skill areas including communication, socialization, play, and cognitive abilities. A psychologist unassociated with the Lovaas Institute periodically re-evaluated Bryce. She noted his remarkable progress in achieving 1.5 to 2 years of developmental progress within a 1-year period of treatment."

Additional Information

The Lovaas Institute claims that Early Intensive Behavioural Intervention is an intensive form of applied behavioural analysis (ABA).

Lovaas recommends his method should begin as early as possible. This is necessary in order to teach basic social, educational and daily life skills. It can also reduce stereotypical and disruptive behaviours before they become established.

Some people believe that variables such as a child's IQ, developmental status and language abilities are meaningful predictors of whether the intervention is likely to be successful. In other words, the intervention is more likely to work with 'higher-functioning' children.

Related Additional Information


Updated
16 Jun 2022
Last Review
01 Sep 2016
Next Review
01 Jan 2023