Research Papers & Useful Docs
Following are some useful research studies which demonstrate how well ABA can work for children with autism. When making a case for ABA, these can be helpful. However, you will also need to prove that ABA works for your own individual child, so keep meticulous data over the course of your programme and make sure you video everything too. Below these are some other useful documents that you may find useful, such as presentation slides. *= studies covering older kids/adults
If you are building a case to your LA for ABA or facing a tribunal, it is worth considering submitting some research papers as part of your evidence.
Title: Reducing Pupils' Barriers to Learning in a Special Needs School: Integrating Applied Behaviour Analysis into Key Stages 1-3
Author: Pitts L, Gent S and Hoerger M (2019), Published in The British Journal of Special Education
Summary: There are few studies incorporating older children so this one looked at ages four to 13. Pupils made "significant gains in learning skills, language and communication, social and play skills and self-help skills. Pupils of all ages acquired essential 'learning to learn' skills which have reduced their barriers to learning and are enabling them to learn more effectively."
Title: A Multisite Randomized Controlled Two-Phase Trial of the Early Start Denver Model Compared to Treatment as Usual
Author: Rodgers, S et al (2019), Published in The Journal of the American Academy of Child and Adolescent Psychiatry
Summary: This big new randomised study shows ESDM improves language skills. This study is a partial replication of Dawson et al's 2010 study testing effects of the ESDM.
Title: Where is the Evidence? A Narrative Literature Review of the Treatment Modalities for Autism Spectrum Disorders
Author: Medavarapu S, Marella L, Sangem A et al (2019), Published in Cureus 11(1): e3901.do:10.7759/cureus.3901
Summary: ABA comes out tops in this review of non-biological therapies and biological therapies. Biological therapies discussed includes chelation, hyperbaric oxygen therapy and gastrointestinal therapies. Non-biological therapies includes TEACCH, Sensory Integration Therapy and music therapy. Includes a very useful diagram.
Title: Reducing Challenging Behaviour of Adults with Intellectual Disabilities in Supported Accommodation: A Cluster Randomised Controlled Trial of Setting-wide Positive Behaviour Support
Author: McGill et al, Published in Research in Developmental Disabilities, Vol 81, October 2018, Pages 143-154
Summary: The findings show challenging behaviour was reduced by two-thirds in the experimental group.
Title: The Effectiveness of Applied Behavior Analytic Interventions for Children with Autism Spectrum Disorder: A Meta-Analytic Study
Author: Makrygianni, Gena, Katoudi and Galanis (2018), Published in Research in Autism Spectrum Disorders, 51, 18-31
Summary: The findings show ABA programmes as moderately to highly effective, specifically in improving intellectual ability and communication skills.
Title: Comparison of Behavioral Intervention and Sensory Integration Therapy on Challenging Behavior of Children with Autism
Author: Lydon, Healy and Grey (2017), Published in Behavioral Interventions, November 2017, Vol 32, Issue 4 by Wiley
Summary: An "AB" study from University of Ireland, Galway, measures Sensory Integration Therapy (SIT) against ABA for the same autistic children - on an alternating basis. The results show ABA as more successful for moderating challenging behaviours.
*Title: ONTABA (Ontario Association for Behaviour Analysis) Evidence-based practices review - autism, April 2017
Summary: Comprehensive summary of the evidence base for ABA and why it's considered gold standard therapy in Canada, incl evidence for older autistic kids/adults up to and over 22 too: "It was clear from the comprehensive reports, which considered over 38,000 studies and systematically reviewed more than 2000, that almost all the interventions for ASD determined to be evidence-based were either behaviour analytic interventions or included components derived from behaviour analytic principles."
"Importantly, 20 ABA interventions have been demonstrated to be evidence-based across three age ranges (i.e., 0-5, 6-14, and 15-22). This suggests that for focused ABA interventions in particular, age is not likely to be a major determining factor in which interventions will be effective."
Title: Telehealth and Autism: Treating Challenging Behavior at a Lower Cost
Author: Lindgren, Wacker, Suess et al (2016), Published in Paediatrics, February 2016, Vol 137, Supplement 2, USA
Summary: Data showed the reduction in problem behaviour using ABA procedures for all three methods of implementation - in-home therapy, therapy delivered by remote video coaching at a clinic and therapy delivered by remote video coaching at home. The costs for video coaching were significantly less, suggesting that this could be a cost-effective choice for parents.
Title: Intensive Early Intervention using Behavior Therapy is the Single Most Widely Accepted Treatment for Autism
Author: Eric V. Larsson (2008), Executive Director, Clinical Studies, Lovaas Institute for Early Intervention, USA
Summary: A very useful compendium of the research backing ABA
Title: Applied Behavior Analytic Intervention for Autism in Early Childhood - Meta-analysis, Meta-regression and Dose-response Meta-analysis of Multiple Outcomes
Author: Virues-Ortega (2010), Published in Clinical Psychology Review
Summary: Results in this Spanish meta-analysis concluded that comprehensive ABA intervention leads to (positive) medium to large effects in terms of intellectual functioning, language development, acquisition of daily living skills and social functioning in children with autism.
Title: Autism and ABA - The Gulf Between North America and Europe
Author: Keenan et al (2015), Queen's University, Belfast, Published in the Review Journal of Autism and Developmental Disorders
Summary: How European children have been denied ABA, despite its prevalence in the US
Title: Using Participant Data to extend the Evidence Base for Intensive Behavioral Intervention for Children with Autism
Author: Eldevik et al (2010), Published in the American Journal of Intellectual and Developmental Disabilities
Summary: Great ABA meta analysis - "More children who underwent behavioral intervention achieved reliable change in IQ (29.8%) compared with 2.6% and 8.7% for comparison and control groups, respectively, and reliable change in adaptive behavior was achieved for 20.6% versus 5.7% and 5.1%, respectively".
Title: A Comparison of Intensive Behavior Analytic and Eclectic Treatments for Young Children with Autism
Author: Howard et al (2005), Published in Research in Developmental Disabilities
Summary: ABA is better than eclectic, even when eclectic methods are used to the same intensity. This important Howard study is good for tribunals.
Title: Comparison of Behavior Analytic and Eclectic Early Interventions for Young Children with Autism After Three Years
Author: Howard et al (2014), Published in Research in Developmental Disabilities
Summary: A follow-up study to the above which showed that ABA worked better than eclectic and that some children in the eclectic group actually went backwards.
Title: Overview of Meta-Analyses on early Intensive Behavioral Intervention for Young Children with Autism Spectrum Disorders
Author: Reichow (2011), Published in the Journal of Autism and Developmental Disorders
Summary: One RCT and four CCTs with a total of 203 participants were included: "There is some evidence that EIBI is an effective behavioral treatment for some children with ASD. However, the current state of the evidence is limited because of the reliance on data from non-randomized studies (CCTs) due to the lack of RCTs. Additional studies using RCT research designs are needed to make stronger conclusions about the effects of EIBI for children with autism." This is high praise for a Cochrane collaboration study, see end for comparison with all other therapies).
This study was updated in May 2018, concluding that "There is weak evidence that EIBI may be an effective treatment for some children with ASD; the strength of the evidence in this review is limited because it mostly comes from small studies that are not of the optimum design." This highlights the need for more research, while presenting there is evidence nonetheless although small.
*Title: Behavioral Interventions in Children and Adolescents with Autism Spectrum Disorder - A Review of Recent Findings
Author: Dawson and Burner (2011), Published in Current Opinion in Paediatrics
Summary: Overview of EIBI studies - "Behavioral interventions are effective for improving language, cognitive abilities, adaptive behavior, and social skills, and reducing anxiety and aggression. Medication combined with behavioral intervention appears to be more effective for reducing aggressive behavior than medication alone."
Title: Early Intensive Behavioral Intervention: Outcomes for Children with Autism and their Parents after two years
Author: Remington et al (2007), Published in American Journal of Mental Retardation
Summary: This report, produced by the charity Research Autism, using the work of SCAMP (Southampton Early Autism Programme based at the University of Southampton) describes how early intervention using structured teaching based on the principles of ABA led to significant, positive changes amongst children with autism, including gains in intelligence, language and daily living skills, as well as motor and social skills.
Title: Outcome of Comprehensive Psych-educational Interventions for Young Children with Autism
Author: Eikeseth (2009), Published in Research in Developmental Disabilities
Summary: This study compared different early interventions for children with autism and found ABA to be demonstrably better established as an efficacious intervention than alternative methods such as TEACCH.
Title: Cost Comparison of Early Intensive Behavioral Intervention and Treatment as Usual for Children with Autism Spectrum Disorder in the Netherlands
Author: Peters-Scheffer et al (2012), Published in Research in Developmental Disabilities
Summary: Early intervention programmes of high intensity can be controversial because of their high cost. The compelling argument for the provision of EIBI is long-term savings of more than one million euros per individual with ASD from ages 3 to 65 in the Netherlands. Particularly useful to use with those Local Authorities who are always talking about costs.
Title: Assessing Progress and Outcome of Early Intensive Behavioral Intervention for Toddlers with Autism
Author: MacDonald et al (2014), Published in Research in Developmental Disabilities
Summary: This US research study of one, two and three year olds shows that EIBI works, with the greatest gains achieved with the toddlers who began intervention prior to age two.
Title: Evidence Base Update for Autism Spectrum Disorder
Author: Smith and Iadarola (2015), Published in the Journal of Clinical Child and Adult Psychology
Summary: Important study showing ABA's improving evidence base for children younger than five years old.
Title: Pivotal Response Treatment Parent Training for Autism: Findings from a 3-month Follow-up Evaluation
Author: Gengoux et al (2015), Published in the Journal of Autism and Developmental Disorders
Summary: Kids do great and maintain skills if parents given 12 weeks of training in PRT (ABA-based intervention)
Read here (abstract only, unfortunately it costs to access full document)
*Title: Translating Evidence-based Practice into a Comprehensive Educational Model within an Autism-specific Special School
Author: Lambert-Lee et al (2015), Published in the British Journal of Special Education
Summary: Over 50 children were tested over 12 months at London school, TreeHouse. Evidence shows that ABA can produce postive results.
*Title: Using Applied Behaviour Analysis as Standard Practice in a UK Special Needs School
Author: Foran et al (2015), Published in the British Journal of Special Education
Summary: How ABA can be implemented effectively and affordably in a UK maintained special needs school - Ysgol Y Gogarth in North Wales. Children of ages three to 18 are making significant gains in this cost-effective model.
Title: Effect of Parent Training Vs Parent Education on Behavioral Problems of Children with ASD
Author: Bearss et al (2015), Published in the JAMA, the Journal of the American Medical Association
Summary: A comparison study of providing parent training with specific strategies for managing disruptive behaviour with parent training where information about autism is given without behaviour management strategies. Suggests to us that the NAS Early Bird course should be replaced by ABA parent training.
Title: When All you have is a Hammer...: RCTs and Hegemony in Science
Author: Keenan and Dillenburger (2011), Published in Research in Autism Spectrum Disorders
Summary: A UK paper on the problems of using randomised controlled trials (RCTs) in the autism research field.
Title: Findings and Conclusions: National Standards Project, Phase 2
Author: National Autism Center, April 2015
Summary: A huge US study: "One common finding... is that interventions based on the principles of Applied Behavior Analysis, or ABA, have a track reord of effectiveness when incorporated in well-designed programs for individuals with ASD." ABA shows, for children aged 0-9 years, increased skills in play, academic and learning success, communication, higher cognitive functions, interpersonal and personal responsibility and motor skills. Shows decreases in general symptoms and problem behaviours.
Title: Long-term Outcomes of Early Intervention in Six-Year-Old Children with ASD
Author: Estes et al (2015), Published in Journal of the American Academy of Child and Adolescent Psychiatry
Summary: The effectiveness of the Early Start Denver Model at ages 18 to 30 months delivered intensively at home for two years was examined at age six, two years after the intervention ended. The study shows that the gains were maintained.
Read here (abstract only, unfortunately it costs to access full document)
The following are the accompanying slides from professionals, which give useful information.
Some excellent presentation slides summarising the main ABA research studies.
By Dr Mecca Chiesa, President of UK Society for Behaviour Analysis and ABA MSc Course Leader at University of Kent
Title: Applied Behavior Analysis Interventions for Autism - Summaries of Evidence
Author: Gina Green (2015), Association of Professional Behavior Analysts, USA
Summary: A definitive list of ABA research studies
Other research and useful documents
Title: Article titled Autism is the Most Costly Medical Condition in the UK
Author: London School of Economics and Political Science (LSE) study by Knapp et al 2014.
Summary: Autism is the UK's single most costly condition, costing more than cancer, heart attack and stroke combined. The bulk of the £32bn it costs per year goes on lifelong adult residential care.
Title: Leaflet for Professionals on Treating ASD and Other Developmental Delays
Summary: A handy explanatory leaflet you can print off and give to anyone involved in the care of your child or young person. Of particular interest here are the last two pages which summarise the best research backing for ABA
Title: The Top 10 Reasons Children with Autism Deserve ABA
Author: Mary Beth Walsh, in a 2011 edition of US journal Behavior Analysis in Practice
Summary: An easily accessible case for ABA for parents, moving beyond simply stating that science supports this intervention.
Title: Applied Behaviour Analysis for Autistic Spectrum Disorder website article
Author: Peninsula Cerebra Research Unit (PenCRU), a university and NHS-funded research group in the UK
Summary: Good independent document re ABA, following a parent enquiry about ABA and its effectiveness. "Evidence suggests that therapies using the principles of ABA, such as EIBI, can have positive effects on adaptive behaviour, language skills and IQ for many children with ASD."
Research Autism: what this independent and NHS-accredited UK charity says about ABA
If you refer to the Research Autism site, you will find that it gives 'green tick' approval ratings to several ABA-based therapies, including early ABA, DTT and PRT. It also says : "..there is very strong positive evidence for some individual interventions that use applied behaviour analysis, such as early intensive behavioural intervention. There is less strong but still positive evidence for other approaches which use applied behaviour analysis, such as incidental teaching and pivotal response training."
This is important as Research Autism is an independent assessor of autism therapies, and has been given the NHS 'Information Standard' award, meaning it is ranked as the UK's go-to website for valid information on autism.
As regards other educational interventions (such as SPELL or Son-Rise) you will find all are all either unranked by RA (due to lack of research) or marked poorly. I give a link here (http://researchautism.net/autism-interventions/our-evaluations-interventions) to their rankings summary. You will note that - apart from drugs - very few therapies receive green ticks at all, save for CBT (behaviourally based) and Teacch. You will note that neither SALT nor OT attract rankings and in its section on these therapies, under their generic term 'Allied Health Professionals' (http://researchautism.net/autism-interventions/types/standard-health-care/allied-health-professionals-and-autism), Research Autism acknowledges their lack of research backing: "Although there are very few studies that evaluate interventions provided by Allied Health Professionals, most families wish their child to receive this assistance alongside appropriate educational and local authority provision. Some attempts are now being made to assess the value of these interventions but difficulties arise in designing appropriate research studies." Yet SALT and OT are not banned from use in schools for lack of evidence; it seems odd therefore that there is a double standard for ABA
ABA gains last: study into effects of ESDM 2 years later (ESDM = Early Start Denver model, ABA plus early developmental curriculum . http://t.co/VtoX7f1Ev8
2013 Research, Ontario Canada. It's not perfect in Ontario, but imagine a day when our NICE publishes something like this: not whether to do ABA but how to get it to the most children in the best way. https://t.co/P638ECOyir
ABA works better than drugs for ADHD too, says US health regulator CDC. https://t.co/6T6fxHtT12
Behavioural interventions come out very well in new research into sleep difficulties. #ABAnotdrugsplease... https://t.co/YV5DSgf4Pb
ABA comes out well in several categories a 5-year study commissioned from the University of Manchester by Ireland's NCSE .. https://t.co/g3NNYQpCwH
Another study showing behavioural methods work for getting speech/communication going, others don't: guess which... https://t.co/tUtbri5E8W
Interesting study which drills down into what actual characteristics at age 2 will lead to 'optimal progress' via ABA. https://t.co/jErt7lwszu
New study in 2016 (RCT) shows the JASPER method (ABA plus developmental/joint attention) works really well in pre-schools... https://t.co/KmDB1vOyNL
Nice to see behavioural interventions recommended by both Research Autism and NICE for autism sleep problems.... https://t.co/T4dIbxe1sM
Good summary of autism overall in highly reputable journal, The Lancet (2013). ABA mentioned positively. https://t.co/wvEjtahGOQ
Good new article (Jan 2016) on efficacy of ABA across the lifespan: different skills needed in older kids, adults .. https://t.co/rQhvjlLONQ
A promising study showing PBS (and they mention proper PBS, rooted in ABA) can help kids improve communication... https://t.co/mVyJFagXMd
Very useful document on bringing the best evidence-based practices (mostly ABA) into US schools https://t.co/QM0eYGxzC8
Big new study in eminent journal Pediatrics says. ABA mentioned as best practice. https://t.co/H0yxMoJtVj
Really useful article on how ABA and SALT combine forces in the US to help autistic kids with both the why and... https://t.co/fKwyzcrYP3
Very important study of the differences between the US and European approaches to ABA. https://t.co/cUytNnncTQ
More good research, including 2 RCTs, shows Early Start Denver Model (which is ABA-based) works at home and in clinics https://t.co/l1COSphag2
Important 2015 research: how to ensure ABA tutors' competency in UK schools http://t.co/l9fIrq4uRC
Useful new research paper on how ABA has moved away from the tabletop alone into more 'naturalistic' settings http://t.co/2gq4BrFEi2
A study shows ABA decreases stress levels for mums (though not Dads, oddly). http://t.co/Qs3LBwBaL2
Interesting new US study suggests that how sociable a child is to start with predicts success of early ABA http://t.co/0p4NWxGuAm
A 2015 summary post on their autism findings, including positives on EIBI (and not on much else):
"In the land of the blind, the one-eyed man is King" - For research into health and therapies, the Cochrane Collaboration is seen as the international gold standard for high quality, trusted information, even by our own NICE. It is often held against ABA that this important organisation only says there is "some" evidence that early ABA (EIBI) is effective for "some" children. In fact that line is often used (illogically) to justify giving ABA to no-one. But look at the rest of the evidence: apart from strong medication and a bit of music or group social therapy, nothing at all ranks even as highly as ABA's "some evidence of effectiveness". And interestingly (given our NHS huge spends in this area) there is zero research into OT or SALT with autism. Zero, nada. Just read all the summaries we've cut and pasted below.
Authors' Conclusions, EIBI (early ABA) - 2012
There is some evidence that EIBI is an effective behavioral treatment for some children with ASD. However, the current state of the evidence is limited because of the reliance on data from non-randomized studies (CCTs) due to the lack of RCTs. Additional studies using RCT research designs are needed to make stronger conclusions about the effects of EIBI for children with ASD.
Early Intensive Behavioral Intervention (EIBI) for kids with Autism A specific form of behavioral intervention, referred to as Early Intensive Behavioral Intervention (EIBI), is a highly structured teaching approach for young children with ASD. A recent Cochrane Review suggests that EIBI is an effective treatment for children with ASD. The evidence points to gains in the areas of IQ, adaptive behavior, socialization, communication, and daily living skills; with the largest gains made in IQ and the smallest in socialization.
Authors' Conclusions, Music Therapy - 2010
Music therapy may help children with ASD to improve their skills in important areas such as social interaction and communication. Music therapy may also contribute to increasing social adaptation skills in children with ASD and to promoting the quality of parent-child relationships. Some of the included studies featured interventions that correspond well with treatment in clinical practice. More research with adequate design and using larger numbers of patients is needed. It is important to specifically examine how long the effects of music therapy last. The application of music therapy requires specialised academic and clinical training. This is important when applying the results of this review to practice.
Authors' Conclusions, Prozac - 2010: There is no evidence of effect of SSRIs [Prozac] in children and emerging evidence of harm. There is limited evidence of the effectiveness of SSRIs in adults from small studies in which risk of bias is unclear.
Authors' Conclusions, parent interventions - 2013
The review finds some evidence for the effectiveness of parent-mediated interventions, most particularly in proximal indicators within parent-child interaction, but also in more distal indicators of child language comprehension and reduction in autism severity. Evidence of whether such interventions may reduce parent stress is inconclusive. The review reinforces the need for attention to be given to early intervention service models that enable parents to contribute skilfully to the treatment of their child with autism. However, practitioners supporting parent-mediated intervention require to monitor levels of parent stress. The ability to draw conclusions from studies would be improved by researchers adopting a common set of outcome measures as the quality of the current evidence is low.
Authors' Conclusions, complementary/alternative therapies - 2008: Research has shown of high rates of use of complementary and alternative therapies (CAM) for children with autism including gluten and/or casein exclusion diets. Current evidence for efficacy of these diets is poor. Large scale, good quality randomised controlled trials are needed.
Authors' Conclusions, social skills groups - 2012
There is some evidence that social skills groups can improve social competence for some children and adolescents with ASD. More research is needed to draw more robust conclusions.
Authors' Conclusions, Theory of Mind training - 2014
While there is some evidence that Theory of Mind (ToM), or a precursor skill, can be taught to people with ASD, there is little evidence of maintenance of that skill, generalisation to other settings, or developmental effects on related skills. Furthermore, inconsistency in findings and measurement means that evidence has been graded of 'very low' or 'low' quality and we cannot be confident that suggestions of positive effects will be sustained as high-quality evidence accumulates. Further longitudinal designs and larger samples are needed to help elucidate both the efficacy of ToM-linked interventions and the explanatory value of the ToM model itself. It is possible that the continuing refinement of the ToM model will lead to better interventions which have a greater impact on development than those investigated to date.
Authors' Conclusions, vitamin B6 - 2007
Due to the small number of studies, the methodological quality of studies, and small sample sizes, no recommendation can be advanced regarding the use of B6-Mg as a treatment for autism.
Authors' Conclusions, risperidone - 2007
Risperidone can be beneficial in some features of autism. However there are limited data available from studies with small sample sizes. In addition, there lacks a single standardised outcome measure allowing adequate comparison of studies, and long-term followup is also lacking. Further research is necessary to determine the efficacy pf risperidone in clinical practice.
Authors' Conclusions, AIT - 2011
There is no evidence that auditory integration therapy or other sound therapies are effective as treatments for autism spectrum disorders. As synthesis of existing data has been limited by the disparate outcome measures used between studies, there is not sufficient evidence to prove that this treatment is not effective. However, of the seven studies including 182 participants that have been reported to date, only two (with an author in common), involving a total of 35 participants, report statistically significant improvements in the auditory intergration therapy group and for only two outcome measures (Aberrant Behaviour Checklist and Fisher's Auditory Problems Checklist). As such, there is no evidence to support the use of auditory integration therapy at this time.
Authors' Conclusions, acupuncture - 2011
Current evidence does not support the use of acupuncture for treatment of ASD. There is no conclusive evidence that acupuncture is effective for treatment of ASD in children and no RCTs have been carried out with adults. Further high quality trials of larger size and longer follow-up are needed.
Authors' conclusions, fish oils - 2011
To date there is no high quality evidence that omega-3 fatty acids supplementation is effective for improving core and associated symptoms of ASD. Given the paucity of rigorous studies in this area, there is a need for large well-conducted randomised controlled trials that examine both high and low functioning individuals with ASD, and that have longer follow-up periods.
Authors' conclusions, secretin - 2012
There is no evidence that single or multiple dose intravenous secretin is effective and as such currently it should not be recommended or administered as a treatment for ASD. Further experimental assessment of secretin's effectiveness for ASD can only be justified if there is new high-quality and replicated scientific evidence that either finds that secretin has a role in neurotransmission in a way that could benefit all children with ASD or identifies important subgroups of children with ASD who could benefit from secretin because of a proven link between the action of secretin and the known cause of their ASD, or the type of problems they are experiencing.
Authors' Conclusions, aripiprazole - 2012
Evidence from two randomized controlled trials suggests that aripiprazole can be effective in treating some behavioral aspects of ASD in children. After treatment with aripiprazole, children showed less irritability, hyperactivity, and stereotypies (repetitive, purposeless actions). Notable side effects must be considered, however, such as weight gain, sedation, drooling, and tremor. Longer studies of aripiprazole in individuals with ASD would be useful to gain information on long-term safety and efficacy.
Authors' Conclusions,tricylic anti-depressants - 2012
Clinicians considering the use of TCAs [Tricyclic anti depressants] need to be aware of the limited and conflicting evidence of effect and the side effect profile when discussing this treatment option with people who have ASD and their carers. Further research is required before TCAs can be recommended for treatment of individuals with ASD.