Tuesday, September 24, 2019

How much behavioral therapy does an autistic child need?

In 1987, psychologist Ole Ivar Lovaas reported that the optimal ‘dose’ for an autism therapy he had developed was 40 hours a week. The intensive therapy, a type of applied behavior analysis (ABA), led to “normal” functioning for 9 of 19 children with autism in his study, he said1. Just 10 hours of the therapy produced small benefits. Small controlled trials of Lovaas’ therapy, however, did not fully replicate his findings on dose2,3.
The form of ABA Lovaas tested has become the most widely used autism therapy — despite controversy about its approach and findings — and 40 hours became a treatment goal for many families. ABA agencies typically market services at that intensity. And this year, that goal was formalized by the Behavior Analyst Certification Board, which recommended 30 to 40 hours of treatment per week for autistic children who need help in several areas, such as cognition, communication or social functioning. (They recommend fewer hours for children with fewer needs.)
Receiving 40 hours of weekly therapy is essentially a full-time job for a 3-year-old.
Still, people tend to believe that, regardless of the treatment, more is always better. But is it?