Inclusion Criteria

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ABA585Articleretrieve4.pdf

Parent education and home-based behaviour

analytic intervention: an examination of parents’

perceptions of outcome

KAROLA DILLENBURGER 1

School of Social Work, Queen’s University of Belfast, Northern Ireland

MICKEY KEENAN

School of Psychology, University of Ulster at Coleraine, Northern Ireland

STEPHEN GALLAGHER

Parents’ Education as Autism Therapists, Northern Ireland

MARTIN MCELHINNEY

School of Social Work, Queen’s University of Belfast, Northern Ireland

There is convincing evidence that applied behaviour analysis (ABA) offers a

highly effective form of intervention for children with autistic spectrum disorder

(ASD). There is less evidence, however, about how parents perceive and

evaluate ABA programmes. In this paper an examination of parents’

perceptions of outcome is reported. Twenty-two questionnaires were completed

by two groups of parents. The first group had just completed an introductory

1Address for correspondence: Dr K. Dillenburger, School of Social Work, Queen’s University of Belfast, 7

Lennoxvale, Belfast BT9 5BY, Northern Ireland. E-mail: kdillenburger@bigfoot.com or

Dr M. Keenan, School of Psychology, University of Ulster at Coleraine, Cromore Road, Coleraine BT52 1SA,

Northern Ireland. E-mail: M.Keenan@ulster.ac.uk

Journal of Intellectual & Developmental Disability,

Vol. 29, No. 2, pp. 119–130, June 2004

ISSN 1366-8250 print/ISSN 1469-9532 online/04/020119-12 # 2004 Australasian Society for the Study of Intellectual Disability Inc.

DOI: 10.1080/13668250410001709476

course in ABA and were in the early stages of implementing ABA programmes

with their children. The second group had been involved in ABA education for

more than 2 years. Overall, both groups of parents reported a positive impact of

ABA on the lives of their children, their family life, and themselves. The long-

term group reported that they had achieved complex goals with their children,

whilst the short-term group reported an immediate positive impact on child and

family functioning and parental self-esteem. Conclusions are drawn in the

context of evidence-based practice.

Introduction

In common with many of the other natural sciences, behaviour analysis has a

conceptual, an experimental, and an applied strand (Baer, 1997; Chiesa, 1994). In this

paper we concentrate on the applied strand of behaviour analysis, that is, applied

behaviour analysis (ABA). ABA is defined as the use of knowledge gained within the

science of behaviour analysis for the improvement of behaviours that are socially

important (Baer, Wolf & Risley, 1968). It is used in many areas such as community

development, social work, nursing, industry, education, and medicine. For over 30 years

ABA has been employed successfully with children with autism spectrum disorder (ASD)

(Matson, Benavidez, Compton, Paclawskyj & Baglio, 1996). It is the aim of this paper to

add to the existing knowledge by exploring the views of parents who have been trained in

the use of ABA with their own children.

While the exact neurological differences between children with ASD and their typically

developing peers remain unclear, the diagnosis generally relies on observations of

differences in behaviour. Children are diagnosed with ASD if they engage in specific

behavioural excesses (e.g., ‘‘stimming’’, temper tantrums, stereotypic, emotionless play)

and particular behavioural deficits (e.g., lack of language, social interaction, social

initiation, and interactive play) (cf. DSM-IV, 1994). In behaviour analysis the term

‘‘behaviour’’ has a wide definition. Anything a person does is regarded as behaviour; this

includes publicly observable behaviours as well as ‘‘private’’ behaviours, such as feeling

and thinking (Reese, with Howard & Reese, 1978). This holistic perspective on being a

person means that the term ASD is viewed as a summary label for publicly observable

behaviour patterns as well as private responses (Holth, 2001).

ABA for children with ASD

The best-known applications of behaviour analytic knowledge for children with ASD are

discrete trial methods that were initially developed by Lovaas (1987). However, ABA

involves a wide range of other strategies, including Picture Exchange Communication

System (PECS), precision teaching, shaping and chaining of new behaviours, general-

isation and maintenance training to name but a few. It is not the aim of this paper to

describe in detail what is involved in a comprehensive ABA programme. Interested

readers are referred to the available literature (e.g., Keenan, Kerr & Dillenburger, 2000;

Maurice, 1993; Maurice, Green & Luce, 1996; Richman, 2001).

Extensive research over 30 years shows that early intensive behavioural intervention

can lead to significant gains in cognitive, social, emotional, and motor functioning that

can be generalised to other situations and maintained in the long term (McEachin, Smith

& Lovaas, 1993). A review of over 500 studies shows that ABA consistently offers

120 Dillenburger, Keenan, Gallagher & McElhinney

positive outcomes in terms of educating children with ASD and enhancing life skills

(Matson et al., 1996). Even in cases of less intensive parent-managed behavioural

intervention, it was found that children were able to live in less restrictive environments

than if they had not received behavioural interventions (Bibby, Eikeseth, Martin,

Mudford & Reeves, 2002). The level of ABA training and expertise of professionals

varies considerably, and ranges from having some training and experience with so-called

‘‘Lovaas’ methods’’ in the 1970s (Jordan, 2001) to rigorous internationally recognised

qualifications, such as those offered by the Certification Board for Behavior Analysis.

ABA treatment and parent education

The quality of ABA training is a crucial factor in the determination of treatment

outcome. Exact data relating to quality of training are generally unavailable (Bibby et al.,

2002) with the exception of one study which found that parent-employed therapists who

had received short-term training were less effective than college trained therapists (Smith,

Buch & Gamby, 2000). More research has concentrated on the quality of parent training

in general (Callias, 1994; O’Reilly & Dillenburger, 1997).

The approach to ABA training for parents differs between programmes (Keenan et al.,

2000; Richman, 2001). Some training programmes teach parents the use of distinctive

treatment procedures (Boyd & Corley, 2001) while others start by educating parents

about general behavioural principles (Keenan, 2001; Keenan & Dillenburger, 2000). The

former approach has been criticised as a ‘‘cookbook approach to practice’’ (Bronson &

Thyer, 2001, p. 193), likened to giving ‘‘recipes’’ for treatment, a ‘‘one fits all’’ approach.

The latter approach offers detailed knowledge of the broad spectrum of behavioural

principles so that parents are empowered to adapt interventions to the individual, ever-

changing needs of their own child (Webster-Stratton & Herbert, 1994). In the present

study the latter approach was used; in other words, parents were educated in general

principles of ABA to enable them to design individually tailored treatment programmes

for their children.

Parent training in ABA

Education in general principles of ABA begins by giving the parents a basic

understanding of the philosophy of the science on which ABA is based, namely,

behaviourism (Chiesa, 1994; Keenan & Dillenburger, 2000). Behaviourism encourages

the scientist to go to the root of traditional assumptions and beliefs by exposing the

futility of mind/body dualism inherent in much of contemporary psychology (Chiesa,

1994). This philosophy of science informs parents so they can recognise the tautology

inherent in the term ‘‘autism’’ and avoid the category mistakes (Holth, 2001). From this

basis parents are then taught some of the basic principles of behaviour and how these are

applied to children with autism (Maurice et al., 1996).

In the present study an introductory course in ABA that ran one evening per fortnight

in a local university for an 18-week period was designed for the parents. The topics

covered were: the philosophy of applied behaviour analysis, reinforcement, extinction,

increasing adaptive behaviours and decreasing maladaptive behaviours, shaping and

chaining new behaviours, stimulus discrimination training, observation and data

collection, designing and implementing an intervention, and a session dedicated to

revision. Parents read assigned chapters from a textbook (Grant & Evans, 1994) in

ABA programme evaluation 121

preparation for each session and were given a multiple-choice questionnaire at the end of

each session. The parents then carried out the applied practice of the theoretical skills

learned through the course at home as frequently as possible throughout the day. An

ABA professional visited each family on a weekly basis for approximately 2 hours to

supervise and adjust individualised programmes together with the parents.

Parental perception of outcome

To date there exists only one parental satisfaction survey of early intensive behavioural

intervention for young children with autism in a community setting (Boyd & Corley,

2001). In Boyd and Corley’s study tutors and supervisors in California were trained in

autism and ‘‘discrete trial’’ training; in other words, they were trained in one specific 1:1

treatment procedure (often referred to as Lovaas therapy) rather than in the full range of

applications of ABA. Weekly review meetings then were held with parents, tutors, and

supervisors. Boyd and Corley reviewed 22 cases (mean length of treatment: 23 months;

mean age of child: 41 months). Two children were in home programmes; the remainder

received discrete trial training in schools. Boyd and Corley found that although all

children had made progress they did not achieve ‘‘recovery’’ (Lovaas, 1987). Parents were

generally satisfied or very satisfied with the implementation of their child’s programme

and outcome.

The study reported here differs in a number of respects. First, parent training did not

concentrate on one particular method of intervention. Instead parents were educated in

general principles of ABA that enabled them to tailor individual training programmes

according to the changing needs of their own children using the full range of strategies

developed within ABA. Second, it includes older children. Third, all children were on

home programmes; and fourth, the effect of treatment duration was assessed.

Methodology

Sample

A total population of 50 families were actively engaged in home-based ABA programmes

in Northern Ireland at the time of the study. All of these families were invited to

participate (see procedure). A total of 22 families took part in the study. The length of

time they had been involved in ABA training was used to differentiate between two

equivalent groups of families. The long-term group (LTG) (n~12) had been involved in

ABA programmes for an average of 35.5 months (range 18–72 months); the short-term

group (STG) (n~10) had been involved in ABA programmes for an average of 6.1

months (range 2–12 months). Although the age range of children in both groups was

virtually the same (3–12/13 years) more of the older children were in the LTG

(mean~125 months) than in the STG (mean~52 months). The mean age of children at

the start of ABA was 91 months for the LTG and 46 months for the STG.

Parents in the LTG were slightly older (mean age 41 years, range 31–52) than those in

the STG (mean age 36.6 years, range 32–43). The groups were equivalent with regard to

employment status (8 LTG parents vs. 5 STG parents in employment, the remainder

unemployed) and with regard to socio-economic status. The reasons parents were not

employed were similar between the two groups and were mainly related to caring for a

child with autism.

In regard to gender of parents and children the groups were equivalent (LTG: 5

122 Dillenburger, Keenan, Gallagher & McElhinney

fathers, 7 mothers, 10 boys, and 2 girls; STG: 3 fathers, 7 mothers, 9 boys, and 1 girl).

All families were two-parent families except for one father-led one-parent family in the

LTG. All families had other children. In the LTG the average number of other children

was 3 (range 1–4) and mean age of other children was 11 years (range 7–19). In the STG

the average number of other children was 2.5 (range 1–3) and mean age of other children

was 7.1 years (range 1–19). Both groups had one family in which the siblings of the child

with autism did not live in the same household. In both cases the father had custody of

the child with ASD while the mother had custody of the other siblings. Generally, all

parents reported good relationships with their children, although one mother (LTG)

stated that she had a strained relationship with her other child ‘‘because of the autistic son’’.

Procedure

ABA evaluation questionnaires were designed and circulated to the families. The

questionnaires evaluated the validity of ABA, including significance of goals of

the intervention, appropriateness of the intervention strategies, and importance of the

outcomes (Kazdin, 1977; Wolf, 1978). Questionnaires were sent by post to all 25 LTG

families who were in receipt of ABA at the time. Twelve of these families returned

questionnaires by post in a pre-paid addressed envelope, constituting a return rate of 48%.

Twenty-five STG families were in receipt of ABA education at the time of the study.

The questionnaires were distributed at the end of the final ABA training session. Ten

of the STG parents completed the questionnaire in the training room and returned

it anonymously to a table for collection, constituting a return rate of 40%. While the

return rate for postal questionnaires (LTG) is average, the relatively low return rate of

collected questionnaires (STG) can be explained by the fact that parents who had just

finished a training session were eager to get home to their children rather than fill in

questionnaires.

Ethical considerations

Written, informed consent was obtained from parents prior to the study. A letter was

given to the parents explaining the purpose of the study and assuring them that their

participation was voluntary and that non-participation would in no way affect the

services they received. The letter outlined that their response to the questionnaire was

confidential and would be used for research purposes only.

Results

Did the intervention make a difference?

Table 1 shows that ABA was perceived to have made a difference to a number of

mutually agreed goals, such as independence, quality of life, skills development and

maintenance, and interaction in virtually all of the children’s lives. Only one LTG

parent, who had stated that ABA made a great difference in the other categories, did not

know if ABA had made a difference in the ‘‘quality of life’’ category for her 10-year-old

child with a severe disability. One STG parent (who had received ABA education for less

than 2 months) reported that ABA had made a difference already in all the categories,

apart from her 3-year-old child’s independence. There were no statistically significant

differences between LTG and STG parents’ perceptions.

ABA programme evaluation 123

Effectiveness of the intervention strategies

Table 2 shows that overall the ABA strategies which had been jointly agreed with the

parents were effective and had an important impact on the life of all the children. The

overall perception of most parents was that ABA was very effective. Only two LTG

parents (who had scored high levels of effectiveness in the other categories) found ABA

not to have been effective in self-help; one of these parents also did not think ABA had

been effective with social skills. One of these was the parent of a 10-year-old boy with

profound autism.

Two STG parents did not know if ABA had been effective in terms of self-help; one of

these parents was also unsure about the effect on social skills. These were all parents who

had commenced ABA education only 3–8 months earlier; one of these parents added the

word ‘‘yet’’ to her answer, indicating her expectation that ABA would be effective in this

area in the longer term. Only one LTG parent did not know if ABA had been effective in

Table 1

Number of parental responses regarding difference that ABA made to a range of child behaviour categories

Behaviour category

Response alternatives

Great difference

Some difference

Little difference

No difference

Don’t know

Not applicable

LTG STG LTG STG LTG STG LTG STG LTG STG LTG STG

Independence 3 5 8 4 0 1 Quality of life 7 8 2 2 1 0 1 0 Skills development 8 8 3 2 Skills maintenance 6 6 5 4 Interaction 6 7 5 3

One LTG parent did not complete these items.

Table 2

Number of parental responses regarding perceived effectiveness of ABA in a range of child behaviour categories

Behaviour category

Response alternatives

Very effective Effective

Not effective

Don’t know

Not applicable

LTG STG LTG STG LTG STG LTG STG LTG STG

Self-help skills 6 4 3 4 2 0 1 2 Social skills 9 4 5 1 0 0 1 Problem behaviour 9 5 3 5 Obsessive behaviour 8 4 4 3 0 3 Gross motor skills 9 6 3 3 0 1 Fine motor skills 9 6 3 4 Communication 9 7 3 3 Concentration 10 9 2 1

124 Dillenburger, Keenan, Gallagher & McElhinney

terms of self-help skills. There was a tendency for LTG parents to evaluate ABA

effectiveness somewhat better than STG parents.

Importance of the outcomes in relation to family life

In response to the question ‘‘What impact has ABA had on your family life?’’ parents in

both LTG and STG considered that ABA had a positive effect on family life, although

one parent drew attention to the amount of work and finance necessary for an intensive

ABA programme (Table 3).

Importance of the outcomes in relation to parents

In response to the questions ‘‘What impact has ABA had on you/how you feel about

yourself?’’ all parents felt that ABA had positively impacted on them and how they feel

about themselves (Table 4).

Importance of the outcomes in relation to the child

In response to the question ‘‘What impact has ABA had on the life of your child?’’ all

parents responded that ABA had had a very positive impact on their child’s life

(Table 5).

Table 3

Examples of parents’ statements regarding the impact of ABA on family life

Categories Examples from LTG parents Examples from STG parents

Before ABA treatment

Autism equals disruption, loss of a bedroom, wife having to leave work, cannot book holidays ...

General effect on family life

Made it easier. Time with other children has been reduced although they understand this.Immense impact. Entirely positive. Great impact.We are now approaching

normal family life. Life is a bit calmer. We have a level of reasoning. More manageable.

Effect on family cohesion

We have a level of reasoning. ABA has improved family life immensely. We have a direction now.Entirely positive. Gives us hope.Brought the family tighter

to help child. Brought the family together to help child.Great impact, more normal

family life.

Work load Made it more manageable. A lot of time and energy used up on implementing ABA programmes.

Structure More structured than before. It has put a strain on it to organise sessions.It has helped give a focus.

Able to deal with difficult situation.

Finance Financially very stressful.

Freedom Made us able to go on more outings.

It has raised expectations of relations.

ABA programme evaluation 125

Discussion

In this paper we reported an examination of parents’ perceptions of the outcome of

home-based ABA programmes. It was found that parents considered ABA to have high

effectiveness in facilitating development of their children. In particular they expressed

that ABA outcomes were important and had made a substantial difference for the family

as a whole and raised the general level of parents’ confidence and empowerment. In

the context of other similar programme evaluations the findings reported here are

noteworthy for a number of reasons.

Prior to the introduction of ABA, only one other treatment approach (Treatment and

Table 4

Examples of parents’ statements regarding the impact of ABA on themselves

Categories Examples from LTG parents Examples from STG parents

General impact Entirely positive. ABA works and that impresses me.I now feel like a normal person. I feel it is brilliant.

Communication A good impact through improved communications.

Confidence Made me more confident and relaxed. Given me confidence to help my child.I feel capable of helping my son. Gives me a sense of control in my child’s life.

It has made me feel confident.

Feel more focused. Confident as a mother.

I feel more in control. I feel as if I have done something constructive in helping my child.

Determination to change things.A sense of control over situations.

Coping More able to cope with situations at home.

Encouragement of X.

It has helped me in everyday situations and can cope better. Enables me to cope with life and not lost as I felt when my son was first diagnosed.

I am more hopeful. I feel I am actually doing something to help my child.

Gives me a greater understanding of my son and how to work properly with his needs.

Given me hope for the future. Has given me the hope that I can improve my daughter’s life without being dependent on professionals and their opinion.

Worry/stress Made me worry less and enjoy my child more.

It makes me realise what can be achieved but I sometimes feel inadequate to the task.Given hope and reduced stress levels. It has to some extent increased stress but as we become more familiar with the concepts, stress levels are decreasing slowly!

Given me some hope.

Self-esteem/ empowerment

Initially one feels rather inadequate in terms of what we had been doing to help X with his autism. However, undertaking ABA has been a definite step forward and constantly increases self-esteem.

It gives me skills.

Makes me feel more empowered.

It has given me the ability to help him.

126 Dillenburger, Keenan, Gallagher & McElhinney

Education of Autistic and Communications Handicapped Children, or TEACCH)

(Schopler, Mesibov, DeVillis & Short, 1981) had been available in Northern Ireland.

Sines’ (2001) evaluation of TEACCH showed that parents were generally satisfied with

the service they received for their child, although they were not convinced of the

effectiveness of TEACCH in achieving the goals that they were expecting. Data

presented here show that, when offered an alternative, parents reported very substantial

levels of satisfaction with the significance of goals of ABA intervention, the

appropriateness of ABA intervention strategies, and the social importance of ABA

outcomes for the child, the parents, and the family as a whole.

When compared with Boyd and Corley’s (2001) parental evaluation of ABA

programmes in California, findings reported here confirm a high level of parental

satisfaction with ABA. The subtle downward shift in terms of parental satisfaction

with treatment outcome noted by Boyd and Corley was not detected in this study. As

Table 5

Examples of parent’s statements regarding the impact of ABA on life of child

Categories Examples from LTG parents Examples from STG parents

General demeanour

Has controlled his outbursts and made him a happy child.

Calming influence, responds well to commands.

Improved tasks and difficult issues.

There has been a very big change in X.

Completely back in control and can deal with problem behaviours.

Communication/ speech

He is less frustrated and easier to manage.

It has improved his communication hugely. He is more settled, more spontaneous, speech much better. The improvements have been dramatic. Her language and awareness have exceeded all expectations.

Academic skills I don’t believe my child would be at mainstream primary school and coping academically without ABA.

Exceptional results. He has had nothing else. Better concentration and vast improvements in writing, reading and many other areas. He is starting to write/read and is doing things I would never dream he could do.

Independence Improved. He has learned to be more independent and acquired some basic skills.

He is now toilet trained.

She has learnt skills she did not have!

Taught my son that we expect him to participate/cooperate/interact/communicate.

Relationships Not only has it helped my child but also the whole family quality of life has improved dramatically.

ABA has certainly helped modify X’s behaviours and has had a positive impact on family life in general. Large impact. Lots of family life changes. Excellent positive effect.

ABA programme evaluation 127

mentioned earlier in this paper, parent education did not concentrate on one particular

method of intervention (e.g., 1:1 discrete trial training); instead, parents were educated in

general principles of ABA and then became involved in the development of individually

tailored treatment plans that encompassed the full range of methods developed within

ABA. It is possible that this difference accounts for the high levels of satisfaction.

Indeed, through this kind of education in ABA it is likely that in general parental

interactions with the child change, and that this change affects the child on a 24-hours-a-

day/7-days-a-week basis. If this were found to be the case it would have implications for

an analysis of treatment intensity. The intensity of behavioural intervention has been

found to be important for treatment outcome (Lovaas, 1987). Is it possible that

educating parents in ABA achieves increased levels of treatment intensity? Future studies

should include direct assessment of parental programme implementation as well as a

component analysis of parent education to shed more light on this tentative conclusion.

Previous research had shown that the age of the child at the onset of treatment is an

important factor in treatment success (Fenske, Zalenski, Krantz & McClannahan, 1985).

Results reported here confirm Eikeseth, Jahr and Eldevik’s (1997) findings that, while

there may be an optimum age for starting behaviour analytic treatment (STG), late

treatment onset (LTG) still has high levels of validity from a parental point of view.

Further studies should be conducted with older children who receive home-based ABA

interventions based on parent education programmes in order to establish exactly what

variables are responsible for the achievement of treatment goals with these children.

Length of treatment is also usually viewed as a decisive factor with long-term

treatment achieving better results than short-term treatment (Smith, 1999). Results

reported here however, show that parents educated in ABA in the short term can achieve

significant changes. The present study was based on the premise that there was no time

limit on ABA intervention. Instead the approach was to work with the child as long as it

takes to achieve the desired outcomes.

To the authors’ knowledge the study reported here is the first examination of parents’

perceptions of the outcome of home-based ABA programmes. Usually more rigorous

objective scientific research methodologies are harnessed to measure the effect of ABA

on various indices associated with a child’s development (Keenan, 2003; Keenan et al.,

2000). Despite the wealth of quantitative research reported in the literature (e.g.,

Anderson, Avery, DiPietro, Edwards & Christian, 1987; Smith, 1996, 1999; Weiss, 1999),

it is argued by some that the jury is still out on whether ABA is as effective as it is

purported to be (Ives & Munro, 2002; Jordan, Jones & Murray, 1998; Task Force

Report, 2001). Although the present study did not include evaluative, continuous data

on behaviour changes in the child, the tentative findings reported here mean that there is

a strong indication that parents are satisfied with the outcomes achieved through basic

ABA training. This group of parents was satisfied and perceived ABA to be valid in

terms of significance of behavioural goals, appropriate in relation to intervention

strategies, and important as regards outcomes for the quality of life for the children, their

own confidence and feeling of empowerment, and the impact on family life as a whole.

References

Anderson, S. R., Avery, D. L., DiPietro, E. K., Edwards, G. L., & Christian, W. P. (1987). Intensive home-based early intervention with autistic children. Education and Treatment of Children, 10, 352–366.

128 Dillenburger, Keenan, Gallagher & McElhinney

Baer, D. M. (1997). Foreword. In K. Dillenburger, M. O’Reilly, & M. Keenan (Eds.), Advances in behaviour analysis (pp. vii–x). Dublin: University College Dublin Press.

Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, 91–97.

Bibby, P., Eikeseth, S., Martin, N. T., Mudford, O. C., & Reeves, D. (2002). Progress and outcomes for children with autism receiving parent-managed intensive interventions. Research in Developmental Disabilities, 23, 81–104.

Boyd, R. D., & Corley, M. J. (2001). Outcome survey of early intensive behavioral intervention for young children with autism in a community setting. Autism, 5, 430–441.

Bronson, D. E., & Thyer, B. A. (2001). Behavioral social work: Where has it been and where is it going? The Behavior Analyst Today, 3, 192–195.

Callias, M. (1994). Parent training. In M. Rutter, E. Taylor, & L. Hersov (Eds.), Child and adolescent psychiatry: Modern approaches (pp. 918–935). Oxford: Blackwell.

Chiesa, M. (1994). Radical behaviorism: The philosophy and the science. Boston: Authors Cooperative.

DSM-IV. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

Eikeseth, J., Jahr, E., & Eldevik, S. (1997). Intensive and long term behavioural treatment for four to seven-year-old children with autism: A one-year follow-up. Paper presented at PEACH Early Intervention Conference, 12 September.

Fenske, E. C., Zalenski, S., Krantz, P. J., & McClannahan, L. E. (1985). Age at intervention and treatment outcome for autistic children in a comprehensive intervention program. Analysis and Intervention in Developmental Disabilities, 5, 49–58.

Grant, L., & Evans, A. (1994). Principles of behavior analysis. New York: HarperCollins College.

Holth, P. (2001). The persistence of category mistakes in psychology. Behavior and Philosophy, 29, 203–219.

Ives, M., & Munro, N. (2002). Caring for a child with autism: A practical guide for parents. London: Jessica Kingsley.

Jordan, R. (2001). Book review. Journal of Child Psychology and Psychiatry, 42, 421–423. Jordan, R., Jones, G., & Murray, D. (1998). Educational interventions for children with autism: A

literature review of recent and current research. Final Report to the DfEE. Birmingham: University of Birmingham, School of Education.

Kazdin, A. E. (1977). Assessing the clinical or applied importance of behavior change through social validation. Behavior Modification, 1, 427–451.

Keenan, M. (2001). Power to the parents. Cambridge Centre for Behavioral Studies. Retrieved 20 November from http://www.behavior.org/

Keenan, M. (2003). Autism in Northern Ireland: The tragedy and the shame. British Psychological Society Annual Conference, Award for Promoting Equality of Opportunity Lecture, 13–16 March.

Keenan, M., & Dillenburger, K. (2000). Behaviour analysis: A primer. Computer software. New York: Insight Media.

Keenan, M., Kerr, K. P., & Dillenburger, K. (2000). Parents’ education as autism therapists: Applied behaviour analysis in context. London: Jessica Kingsley.

Lovaas, O. I. (1987). Behavioral treatment and normal intellectual and educational functioning in autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9.

Matson, J. L., Benavidez, D. A., Compton, L. S., Paclawskyj, T., & Baglio, C. (1996). Behavioral treatment of autistic persons: A review of research from 1980 to the present. Research in Developmental Disabilities, 17, 433–465.

Maurice, C. (1993). Let me hear your voice: A family’s triumph over autism. London: Hale. Maurice, C., Green, G., & Luce, S. C. (Eds.) (1996). Behavioral intervention for young children with

autism: A manual for parents and professionals. Austin, TX: Pro-Ed. McEachin, S. J., Smith, T., & Lovaas, O. I. (1993). Long-term outcome for children with autism

who receive early intensive behavioral treatment. American Journal of Mental Retardation 97(4), 359–372.

O’Reilly, D., & Dillenburger, K. (1997). Compliance training as an intervention strategy for anti- social behaviour: A pilot study. In K. Dillenburger, M. O’Reilly & M. Keenan (Eds.), Advances in behaviour analysis (pp. 135–156). Dublin: University College Dublin Press.

ABA programme evaluation 129

Reese, E. P., with Howard, J., & Reese, T. W. (1978). Human operant behavior: Analysis and application (2nd ed.). Iowa: W. C. Brown Company.

Richman, S. (2001). Raising a child with autism: A guide to applied behavior analysis for parents. London: Jessica Kingsley.

Schopler, E., Mesibov, G. B., DeVillis, R., & Short, A. (1981). Treatment for autistic children and their families. In P. Mittler (Ed.), Frontiers of knowledge in mental retardation. Vol. 1: Special educational and behavioral aspects (pp. 293–301). Baltimore: University Park Press.

Sines, D. (2001). Evaluation study of the Northern Ireland TEACCH project. Jordanstown, NI: University of Ulster.

Smith, T. (1996). Are other treatments effective? In C. Maurice, G. Green, & S. C. Luce (Eds.), Behavioral intervention for young children with autism: A manual for parents and professionals (pp. 45–49). Austin, TX: Pro-Ed.

Smith, T. (1999). Outcome of early intervention for children with autism. Clinical Psychology: Science and Practice, 6, 33–49.

Smith, T., Buch, G. A., & Gamby, T. E. (2000). Parent-directed intensive early intervention for children with pervasive developmental disorder. Research in Developmental Disabilities, 21, 297–309.

Task Force Report. (2001). Educational provision and support for persons with autistic spectrum disorders: The report of the Task Force on Autism. Retrieved 30 October from http:// www.gov.ie/educ/publications/autism.pdf

Webster-Stratton, C., & Herbert, M. (1994). Troubled families—Problem children. Chichester: Wiley.

Weiss, M. J. (1999). Differential rates of skill acquisition and outcomes of early intensive behavioural intervention for autism. Behavioral Interventions, 14, 3–22.

Wolf, M. M. (1978). Social validity: The case for subjective measurement or how applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis, 11, 203–214.

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