Dr. O. Ivar Lovaas, father to Erik Lovaas, founder of The Lovaas Center
“I would like to be remembered in the tradition of other empiricists and educators who put a good deal of faith in the power of the environment to shape human behavior. I’d like to be remembered as one who worked to free those whose minds enslaved them…and as a person who challenged the notion that variables that we used to consider to be stable and unchanging, like IQ and autism, aren’t really as unchanging as many had thought them to be.” Ivar Lovaas
Dr. Lovaas began his work in institutional settings where treatments using Freudian approaches were used. Individuals engaging in self-injury were often hugged and given love, as it was theorized they were acting out towards their parent’s that did not, or were not, capable of loving them. As recently as 1960, Dr. Leo Kanner described parents of autistic children as “happening to defrost enough to produce a child,” hence the term, “refrigerator parent.” Bruno Bettelheim promoted the use of the “refrigerator mother” theory of autism. He felt the children would benefit from a “Parent-ectomy” (i.e., removed from the home) and be better served in a clinical/ institutional setting. This marked the pinnacle of autism viewed as a disorder of faulty parenting, and the pinnacle of hopelessness for improvement.
It was during this time clinicians such as Don Baer, Montrose Wolf, Sid Bijou, Todd Risley, James Sherman and Ivar Lovaas were establishing behavior modification at the University of Washington (UW). Dr. Lovaas subsequently introduced behavior modification to institutions for individuals engaging in severe forms of self-injury. The self-injury was severe enough to cause premature death and a significant decrease in the quality of life.
Treatment consisted of no longer providing hugs and love as patients engaged in self-injury (i.e., extinction), instead, love and hugs were given at times patients were not engaging in self-injury, or applying punishment (i.e., electric shock) upon occurrences. The results of the data indicated, on most occasions, self-injury was a result of prior learning, not traumatic childhood events, and could be modified by altering the contingencies following their occurrence. As self-injury was acquired via positive social attention, and reduced when removed, attention, first behavior function, was identified.
While the use of electric shock on individuals with intellectual delays issues may seem inhumane or archaic, its effectiveness in changing behavior could not be disputed. At the time it was considered cutting edge work and changed the direction of treatment. The shift in treatment from a Freudian theory-based practice, to one based solely on empirical evaluations and reliable data created what today is known Applied Behavior Analysis (ABA).
In the mid 1960’s Dr. Lovaas attempted to help children avoid the path to institutions altogether by constructing an intervention designed to teach language to children with autism in hopes language would generalize to other core autism deficits such as play and self help skills. Some of the children received up to 40 hours per week of 1:1 instructions for an average of 13 months.
There were two treatment phases in this study, “Some Generalization and Follow Up Measures on Autistic Children in Behavior Therapy (the “1973 Study”).” The first treatment phase for this study lasted approximately 13 months, at which time the children with were discharged to their home or institution. The second treatment phase with the same participants occurred years later. The treatment/ no treatment/ treatment phases were a result of loss and acquisition of funding. The phases were an unintended result of money, but led to a sound research design known as AB-AB reversal. Because of this unintended design, and it’s effect on the children, terminating treatment due to lack of social funding, or alternating treatment phases is now unethical.
Several factors determined the effectiveness of the treatment.
The study was to the first to demonstrate that young children with autism could learn at an accelerated rate, so new and exciting parameters for treatment were discovered. As well, as it was the first intensive early intervention research article, it was not without its limitations. Limitations identified in this study were remediated in subsequent studies.
- Early intervention: the younger the child, the better the outcome.
- Intensive: the children who received more of 1:1 instruction per week did better than those receiving fewer hours.
- Duration: the children who were in therapy longer did better than those who were in therapy for only a short time.
- Parent involvement: those children that parents were involved did better than those supported by institutional settings.
- Duration: the length of time the children were in treatment was not sufficient for them to catch up to their same age peers (i.e. they did not lose the autism diagnosis).
- Comprehensive: as the treatment was primarily language based, the children did not make significant gains in other areas (i.e. playing with peers).
- Hours: not all the children received 40 hours per week.
Working off the strengths and limitations from the “1973 Study,” significant steps were taken to alter the way children with autism received treatment. A study labeled; “Behavioral Treatment and Normal Intellectual Functioning in Young Children with Autism” or the “1987 Study” was published. Sixty children were divided into three groups, a 40-hour per week group or the “experiential group,” and two control groups; “control group one” received 10 hours per week of the same therapy as the experimental group with special education, “control group two” received special education only. Dr. Lovaas became known as the “father of ABA” primarily as a result the package identified from the “1973 Study.” However, the “treatment package” became widely known when the outcomes for the “87 Study” were published. Because of the success of Early Intensive Behavior Intervention (EIBI) or Lovaas model, and the decades of empirical research Dr. Lovaas has been called “The Father of ABA.”
The results of the “1987 Study” were as follows:
Experimental Group: The children in this group received 40-hours per week, and the treatment lasted two-to six-years. The outcomes indicated 47% of the children (i.e., 9/19) became indistinguishable from their peers or “best outcome,” many were able to have their “autism” label removed. Eight (i.e., 42%) moved from a self-contained or autism room to a language-delayed room, and two of the children or 10% saw little improvement. As a whole, 89% of the children in the experimental group saw substantial improvement (e.g., significant gains in IQ and socialization).
Control Group One:
The children in this group received 10-hours per week with special education, and the treatment lasted two-to six-years. The outcomes indicated none of the children achieved best outcome with 42% of the children seeing improvement.
Control Group Two:
The children in this group received special education, and data was taken over the course of four-years. One child or 5% in this group went on to reach “best outcome.”
Following this study, many people stated implementing “Lovaas Therapy.” Lovaas therapy consisted of the following package:
- Early and intensive intervention
- Parent involvement
- Comprehensive and developmental programming
- Adherence with the principles and procedures of Applied Behavior Analysis
- Individuated as all children with autism are different
- Use of discrete trials
- Home based
The “Lovaas treatment package” went on to be called Early Intensive Behavior Intervention or EIBI as more people began using the model developed by Dr. Lovaas.
The U.S. Surgeon General
Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior. A well-designed study of a psychosocial intervention was carried out by Lovaas and colleagues. Nineteen children with autism were treated intensively with behavior therapy for two years and compared with two control groups. Follow-up of the experimental group in first grade, in late childhood, and in adolescence found that nearly half the experimental group but almost none of the children in the matched control group were able to participate in regular schooling.
U.S. Congress. (1997). The individuals with disabilities education act amendments.
In 1993, Dr. Lovaas published; Long-Term Outcome for Children With Autism Who Received Early Intensive Behavioral Treatment, the “1993 Study.” To answer the question, “What happens to the children after they receive therapy?” follow up measures were given to the experimental group. The findings indicated eight of the nine best outcome children had maintained had their gains. These children, now adults, have been interviewed by the British Broadcasting Company, the LA Times and other reputable news sources. They are productive members of society and can attribute their opportunity to success to the treatment.