Exploratory Studies in the Prevention of Autism: An Analysis of Five Successful Cases Philip W. Drash Autism Early Intervention & Prevention Center Roger M. Tudor Westfield State College Table 1. Individual Subject Data* Category Sub 1-M Sub 2-F Sub 3-M Sub 4-M Sub 5-M CAA 14mo 22mo 2-10 2-0 2-6 CA Dis 17mo 2-6 3-6 IT 2-8 3-6 CA FwU 3-0 2-6 3-6 8-5 2nd 7-3 1st VBT Hrs Wk 0 1 3 1-2 1 Tot VBT Sess 0 27 77 34 36 Dur Thpy 3mo 7mo 7mo 8mo 12mo Type Thpy Parents VBT VBT VBT VBT Neg Beh None Moderate None Mild Mild *The type of therapy used in this Prevention Program was ABA Verbal Behavior Therapy (VBT). Table 2. Results of Intervention: Gains in ELA and IQ Category Sub 1-M Sub 2-F Sub 3-M Sub 4-M Sub 5-M CAA 14mo 22mo 2-10 2-0 2-6 CA Dis 17mo 2-6 3-6 IT 2-8 3-6 CA FwU 3-0 2-6 3-6 8-5 2nd 7-3 1st Dur Thpy 3mo 7mo 7mo 8mo 12mo Pre Wds 0 25-30 0 25-30 0 Pre ELA 12mo 14mo 11mo 16mo 12mo ELA Dis --- 2-11 2-9 3-1 4-2 Gain ELA --- 21mo/7mo 22mo/7mo 21mo/8mo 3-2/12mo FwU ELA Avg Lo Avg Lo Avg Avg Avg IQ Dis 112 114 98 125 112 Table 3. Levels of Intervention in the Prevention of Autism Level 1. Minimal Intervention (#1) Younger sibling of child with autism receiving ABA therapy Symptoms: Child exhibits no symptoms of autism Level 2. Minimal Intervention (#2) (Subject 1, CAA 14 mo) Younger sibling of child with autism receiving ABA therapy Symptoms: Child may exhibit some mild symptoms of autism, such as delayed language and/or social isolation Level 3. Moderate Intervention (Subject 2, CAA 22 mo) Younger sibling of child with autism receiving ABA therapy Symptoms: Child exhibits definite symptoms of onset of autism, including loss of language, isolation, severe negativism and task- refusal Table 3. Levels of Intervention in the Prevention of Autism Continued Level 4. Moderate Intervention (Subject 4, CAA 2-0) Symptoms: Child not diagnosed with autism, but serious language delay and resistance to learning language recognized by grandparents Level 5. Moderate Intervention (Subject 5, CAA 2-6) Symptoms: Child not diagnosed with autism, but serious delay in language, and strong resistance to acquisition of language Level 6. Moderate Intervention (#2) (Subject 3, CAA 2-10) Symptoms: Child not diagnosed with autism, but shows definite pre- autistic symptoms such as severe language delay, mannerisms, and unresponsiveness to speech therapy after a full year of treatment Table 4. Follow-Up Status of Children in ABA Prevention Program CA CA Mos CA Current Adm. Dis. Treat. Flw-up Status S1-M 14mo 17mo 3 3-0 Normal for age S2-F 22mo 2-6 7 2-6 Low avg for age S3-M 2-10 3-6 IT 7 3-6 Low avg for age S4-M 2-0 2-8 8 8-5 Normal for age S5-M 2-6 3-6 12 7-3 Normal for age Table 5. A Comparison of the ABA Prevention Model with the ABA Intensive In-Home Therapy Model in Terms of Duration of Therapy, Number of Treatment Hours and Total Cost of Therapy ABA Prevention Model ABA Intensive In-Home Therapy Duration of Treatment: Usually 1 yr or less Often 3 yrs or more # of Treatment Hrs per Wk: 1 to 3 hrs 30 to 40 hrs # of Treatment Hrs per Yr: 27 to 150 1500 to 2000 (30-40 X 50 wks) Total # of Treatment Hrs: 27 to 150 4500 to 6000 (3 yrs) Annual Cost: $2,700 to $15,000 ($100/hr) $30,000 to $40,000 ($20/hr)* Tot Cost X 3 Yrs: NA $90,000 to $120,000 ($20/hr)* *Note: The hourly rates are approximations only. Actual hourly rates for ABA services may vary considerably depending on the prevailing rates in a given community and the skill level of the ABA therapists. Table 6. Summary and Conclusions 1) Prevention of autism in some young children at high-risk for autism/PDD appears to be possible by using the ABA prevention model presented in this paper. All five children in this study were functioning as average or near average after a year or less of treatment. 2) The total cost and the total number of therapy hours in this prevention model are far less that that in the ABA in-home treatment model. In some cases both the cost and time may be 10% or less than that required in the ABA in-home model. 3) The three primary components of this prevention program were: (1) rapid development of age-appropriate expressive verbal behavior, (2) elimination of negative behaviors (i.e. crying, etc.) that function to prevent acquisition of language, and (3) reinforcement of age-appropriate social behavior. Table 6. Summary and Conclusions Continued 4) This study illustrates that there are various levels of intensity in the continuum of prevention. The least intensive levels of intervention require relatively little effort when compared with direct treatment programs. 5) Differentiating between prevention and direct treatment models is critical. In direct treatment the diagnosis of autism/PDD is usually established before treatment begins. In the prevention model it is only necessary to establish that the child exhibits behaviors that place him/her in a high-risk category or that he is in a high-risk category based on epidemiological factors. There is no assumption that any one specific child will become autistic without intervention. Rather, it is a probability model in which a certain percentage of the at-risk group will likely be diagnosed as autistic unless intervention occurs.