Autism, intensive behavioural intervention (IBI), and the school

	Peter Chaban

By Peter Chaban

Recently, autism has received considerable media attention. Part of the reason is an apparent increase in the prevalence of autism. Although a rare disease at one time thought to affect two to four children per 10,000, some studies conducted since the late 1990s have reported prevalence rates up to 60 per 10,000. Against the backdrop of these increased estimates of frequency, much of the media focus has been on access to intensive behavioural intervention (IBI). IBI is a structured, rigorous, and labour-intensive treatment for children with autism. Parents want their autistic children to receive IBI therapy while at school but provincial governments have been reluctant to pay. In cases where the costs have been covered, school boards have been resistant to implementing IBI programs. IBI’s efficacy has been documented, and among professionals it is accepted as the most successful therapy for autism. So, why do governments and school boards resist? The reasons have to do with the complexity of autism, the nature of the deficits associated with the condition, and the costs associated with IBI programs.

What is autism?

Autism is a biologically based, lifelong, developmental disability that is present in the first few years of life. It is associated with a wide range of abilities, symptom patterns, and degrees of severity. For this reason, it is considered a spectrum disorder. Because of its complex nature, diagnosis can be difficult, and treatment can vary based on the background of the health care professional in charge of the child’s care.

There is no definitive medical diagnostic test for autism. Diagnosis is based on a child’s behaviour. In order to be diagnosed with autism, children must show marked impairment in social interaction and communication, and a restricted, repetitive pattern of behaviour, activity, and interests. The behaviour of a child with autism is clearly and qualitatively different than that of a typically developing child.

Many children with autism meet the criteria for mental retardation; however, cognitive impairments exist on a continuum from very low functioning to high functioning. In addition, some cognitive functions might be impaired, while others remain intact. As a result, many autistic children have what has been called ‘islands of ability’. An extreme example of this is the presence of the savant abilities that occur in a low percentage of individuals with autism. In some cases, the savant’s abilities will be at an average level in the presence of global impairment, but in the cases that capture the attention of the media, these abilities are at the level of a prodigy. Savant abilities are more likely in certain areas: music, drawing, and calendar or other specific forms of mathematical calculation.

Up to half of the children diagnosed with autism will not develop useful language. Where language has developed it is usually idiosyncratic. Autistic children have difficulty using language in social and communicative contexts, and understanding non-literal statements. Even high-functioning children with autism have a great deal of difficulty understanding the thoughts, feelings, and intentions of others.

What is IBI?

IBI uses Applied Behavioral Analysis (ABA) techniques to improve behaviour associated with impairments in the areas of socialization and communication skills. ABA techniques are based on principles of behavioural psychology. According to this approach, behaviour and learning are influenced by events in the environment. The environmental situation that precedes the behaviour contains cues that initiate the behaviour. Once the behaviour has occurred, positive consequences that follow the behaviour will increase the likelihood the behaviour will occur again, while negative consequences will reduce the likelihood of the behaviour recurring. In some cases, it can be quite difficult to understand what the initiating cues of behaviour might be, or how a particular set of consequences could be perceived as positive. Instructors trained in IBI are able to analyze these causal chains, devise an approach to increase the frequency of adaptive behaviours, and reduce the frequency of dysfunctional behaviour. This involves breaking down specific behaviours into small learnable components and then teaching the desired behaviours components using positive reinforcement. Every response is recorded and evaluated. This allows for adjustments to the teaching process when desired outcomes are not achieved. As a result, each IBI program is individually designed and very labour intensive.

IBI in the school

Research has shown that autistic children who develop some language and communicative skills before school age have a better prognosis than those who do not. As a result there is a strong push to develop these skills as soon as possible. It wasn’t until the 1960s that researchers were able to teach speech to autistic children using systematic, carefully programmed interactions. Since then, research has continued to show that autistic children can learn a great deal with appropriate instruction.

Though pre-school children have access to IBI programs or variations based on ABA techniques through provincially funded programs in Ontario, these programs are not readily available once they enter school. There are many reasons for this. One of the main reasons is the cost. IBI programs can cost up to $50,000 per year per child. This is because these programs demand up to 40 hours of intensive programming per week with a well-trained instructor under close clinical supervision. As well, IBI programs don’t work for all autistic children, and good indicators to identify who would benefit from them have not been developed.

As an alternative to IBI, many schools do have special education programs that try to address learning issues for autistic children. If these programs have good behavioral management in place, they can control problem behaviours. As well, if they are highly structured and follow a step-by-step program they can have a positive impact. But often because of lack of training and resources, schools are unable to offer intensive programs such as IBI.

As well, schools teach social skills and communication skills through a covert learning model. That is, they assume that children have the gist of these skills, but may need refinement of these skills through teacher modeling or group interactions. The idea of a step-by-step individualized training model is foreign to the school culture.

This does not mean that IBI does not have a place in the school community. It does mean that there is a need to find a way to integrate the highly specialized interventions of IBI with the grouped learning processes of schools in order to reduce costs and provide universal access to this type of program to children with autism.

Peter Chaban is a teacher researcher, head of the School Liaison Team, Community Health Systems Resource Group at the Hospital for Sick Children, and learning disabilities representative for the Ontario Minister's Advisory Council on Special Education. Learning & Education columns by Peter Chaban