Behavioural intervention has proven benefits for autistic children but is being held back by inflexible policies, says Penny Wallace
Applied Behaviour Analysis (ABA), sometimes referred to as the Lovaas programme of early behavioural intervention, has been in existence since the 1970s. Dr Ivar Lovaas carried out early research, claiming that just under half of the autistic children in the group receiving ABA achieved "normal functioning" by the age of seven at mainstreaming.
The treatment involves breaking down social, emotional and cognitive goals into small units, which are taught discretely and are differentially reinforced by a team of tutors led by a consultant fully qualified in developmental psychology and in the principles of ABA.
Despite its extensive use worldwide and the significant benefits reported by parents and some professionals, the educational establishment in Scotland continues to have reservations about the methodology because it is highly structured, adult-led and operates on the principles of Pavlov's conditioned response. Many professionals also recall hearing about the early use of aversive stimuli to reduce negative behaviours - a strategy no longer used in modern practice.
Described in such terms, it is not surprising that the mere mention of the word "Lovaas" evokes a negative reaction. However, a good programme is tailored to the individual's needs, spends around half of the time in co-operative child-centred play and focuses intensively on generalising learned skills into every facet of the child's everyday environment.
This in turn, creates serious implications for the type of support these children receive in the formal education system, which is where the ethological cracks really start to show.
Parents continuing with this treatment at home expect their local primary school to make reasonable adjustments under the auspices of the Standards in Scotland's Schools, etc Act by providing support that takes account of and builds on the child's previous successful learning.
Experts in the field of ABA assert that support for learning would be best provided by someone working with the child at home who can place appropriate expectations in terms of behaviour and academic ability to maximise the child's success and to minimise the potential for regression.
Parents report that authorities are not keen to concede to requests relating to ABA support for these children in school. The reasons for investing significant funding to support pre-school programmes, then failing to see the process through, are not entirely clear. One would suspect that either over-committed special needs budgets or the previously mentioned ideological concerns about the methodology might have some bearing on the decision.
Assuming professionals agree that a particular child requires one-to-one support, then money is not the issue. It costs the same to employ an ABA-trained learning support assistant as it does one without specialist training, leading one to conclude that authorities are reluctant to offer provision that does not fall within the remit of traditional service delivery. This challenges legislative guidance to ensure that education is directed to the talents and abilities of the individual child.
Success for an autistic child with moderate difficulties is largely dependent on managing behaviours, modifying language to make the curriculum accessible and providing ongoing analysis of the child's progress. This is not possible with any kind of diluted provision.
The new Additional Support for Learning Act provides for disputes resolution and national tribunal mechanisms, and the issue of specialist learning support is a prime example of the type of problem that should ultimately be referred. However, criteria for agreeing provision rest on the concept that the proposed treatment is "practicable at reasonable cost".
It is eminently practicable to have children entering mainstream with appropriate support already in place, coupled with consistency between home and school. Since it costs no more than that which would normally be provided, it is hard to see what justification there would be for refusing parents' requests.
Meanwhile, parents of children who hold a record of needs must still ultimately rely on the Scottish Executive to determine their child's future. Nevertheless, legislative rhetoric already technically exists to make ABA support in the classroom a feasible option. All it takes is an innovative approach and some flexible thinking.
Penny Wallace is a former nurse who provides information for parents of autistic children.