A review of assessments for determining the content of early intensive behavioral intervention programs for autism spectrum disorders
Gould, E., Dixon, D.R., Najdowski, A.C., Smith, M.N., Tarbox, J. (2011). A review of assessments for determining the content of early intensive behavioral intervention programs for autism spectrum disorders. Research in Autism Spectrum Disorders, 5(3). 990-1002. http://dx.doi.org/10.1016/j.rasd.2011.01.012
- Evelyn Gould
- Dennis R. Dixon
- Adel C. Najdowski
- Marlena N. Smith
- Jonathan Tarbox
- Research in Autism Spectrum Disorders (2011)
- Volume 5, Issue 3,
- Early Intensive Behavioral Intervention
A large proportion of national education and treatment centers for persons with autism spectrum disorders (ASD), including those providing applied behavior analysis (ABA)-based services, show a relatively high percentage of agreement among practitioners on the instruments they routinely use for a variety of purposes, including curriculum design and treatment evaluation. In this paper, several assessments are reviewed and evaluated in terms of their utility for designing comprehensive early intensive behavioral intervention (EIBI) curriculum programs for children with ASD. The assessments found to be most useful for this purpose are reported. A general critique regarding the available pool of assessment tools is provided and the need for a comprehensive assessment directly linked to curricula is discussed.
Early Intensive Behavioral Intervention (EIBI)
- Commonalities among programs include:
- 1:1 instruction for up to 40 hrs per week
- Initiated in home and later generalized to school or community
- Behavior analytic instruction targeting specific skill deficits
- Treatment for behavior excesses
- Ongoing data collection and analysis
- Despite commonalities, programs are variable in which specific interventions are implemented and which skills are targeted
- Assessments can help ensure the program is tailored to each child’s needs, specifying a curriculum that addresses important behavioral cusps and prerequisite skills, and is developmentally sequenced
Components of Assessment of EIBI Programs
- Comprehensive: targeting all areas of development including social, motor, language, daily living, play, executive functions, social cognitions, and academic skills
- Target early childhood development
- Consider behavior functions
- Should be a direct link from behavior assessment to specific curricula targets
- Should be useful for tracking child progress over time
Strengths and Weaknesses of Current Assessments
- Some yield specific behavioral targets and skills but lack psychometric data (e.g. VB-MAPP)
- “others may be more comprehensive (e.g., Brigance IED-II) or have excellent psychometrics (e.g., VABS-II), but do not provide sufficient information to identify specific behavioral targets for treatment” (Gould et al., 2011)
- Thus, new assessments are welcome that can help clinicians develop assessment-based behavioral programming
- Those that identify specific behavioral, function-based, deficits and goals
- Those that have psychometric data to support their validity and reliability
VB-MAPP (p. 998)
- Designed to be used for creating EIBI programming.
- Addresses 5 skill areas – Social, Motor, language, Play, and Academic Skills for ages 0-4.
- Assessment items
- Progress by age of typical development of skills
- Operationally defined
- Consider the function of behavior
- “Assesses verbal operants associated with language such as echoics, mands, tacts, and intraverbals.”
- Limitation #1 (Greatest limitation) – lack of psychometric evaluation
- (NOT from this journal article) What are psychometric tests
Psychometric tests are a standard and scientific method used to measure individuals’ mental capabilities and behavioural style. Psychometric tests are designed to measure candidates’ suitability for a role based on the required personality characteristics and aptitude (or cognitive abilities). They identify the extent to which candidates’ personality and cognitive abilities match those required to perform the role. Employers use the information collected from the psychometric test to identify the hidden aspects of candidates that are difficult to extract from a face-to-face interview.
- (NOT from this journal article) What are psychometric tests
- Limitation #2 – “… administration can be lengthy because it requires the assessor to test the child on each item, although the manual states that caregivers can be interviewed in lieu of direct administration if the report of the caregivers is deemed likely to be accurate.”
- Results are easily obtained and interpreted
- Provided assessor with a list of skills to teach, with some direction about which order to teach the skills
- No presentation of prerequisites for each item
- Items meant to guide curriculum design (although not directly linked)
- Should significantly aid curriculum design if EIBI program supervisor has expertise in translating specific skills deficits into lessons to teach skills
- Comes with tracking charts to view skill strengths and measure progress over time.
4 Key Variables Common to Effective EIBI Programs
The common variables (features) of effective EIBI programs are summarized as Intervention, Treatment generalization, Programming development, and Programming goals and data collection. Interventions are implemented as early as possible and use intensive 1:1 therapy that typically involve a high frequency of intervention hours per week over multiple years. Treatment begins in the learner’s home, then is transitioned into other settings (e.g., classrooms, different areas of the community) to generalize programming. Programming is developed and implemented by Master’s level (or higher) clinicians with prior training and experience with both EIBI and working with those diagnosed with Autism. Programming goals are implemented by teaching component skills of composite skills goals, so the learner can build up the prerequisite skills necessary to master the overall target goals. Also, these goals plan for generalization, and use the collected data to show progress and make decisions about programming.
Despite these common features, the authors reported there are four key common variables (features) most important for effective EIBI programs: Intensity, Behavior principles, Qualified ABA supervision, and Individualized curriculum. Intensity consists of 30-hours of 1:1 intervention, or more, conducted weekly for at least 2-years. Behavior principles, simply state that all interventions should be based in behavioral principles, meaning that they should be functionally based, and found to be effective in similar conditions of the current client based on peer-reviewed empirical data. Qualified ABA supervision requires that the interventions should be supervised by someone with ABA training and expertise, capable of (experiences with) implementing ABA-based interventions across a variety of people. Lastly, individualized curriculum means that interventions should be built around each individual’s functional needs (deficits), based on the results of assessments.
Critical Components of an Assessment Used for EIBI Programming
The authors listed 5 critical assessment components of EIBI programming, which include Comprehensive assessment, Targeting of early childhood development, Behavior function, Direct link from assessment items to specific programming targets, and Progress tracking.
Comprehensive assessment means that the assessment should all areas of functioning, which includes social, communication, daily living, motor, social, functional academic, and executive functioning skills. This allows clinicians to create individualized programming that focuses on socially significant goals. Targeting of early childhood development is because EIBI programming focuses on early intervention, requiring assessments for children as early as 6-months or less, which can also extend until the child reaches school ages. The authors suggest assessments need to extend to the 1st or 2nd grade, which approximates to 7-years or 8-years-old.
Behavior function means importance is placed on ensuring that assessments focus on results that allow for programming based on the function(s) of behaviors, as EIBI requires function-based programming. Direct link from assessment items to specific programming targets that assessment items should be specific enough to allow for operational definitions to be created for EIBI programs based on assessment results. This should also include an ability to guide programming, with starting points to build programming on, then expand to allow for mastery and generalization. Progress tracking means the assessment allows for ongoing measurement and analysis of intervention programming, as the assessment should be reliable, valid, and repeatable. This allows for the assessor to track performance improvements (or reductions) over time through conducting the assessment again.
Assessments That Met Criteria To Be Included in Review
The four assessments listed as meeting the requirements (critical components of an assessment) for review were the VB-MAPP, VABS-II, CIBS-R, and Brigance IED-II. The VB-MAPP assesses a participant’s developmental (Social, Motor, Language, Play, and Functional Academic) skills. Language skills focus on the participant’s verbal operant skills, which include echoic, manding, tacting, listener responding (LR), intraverbal, and LR by function, feature, and class skills. These developmental skills are based on the average age of milestone achievement of typically functioning children, with milestone levels between the ages of 0 to 4-years. Advantages of using the VB-MAPP include its design being specific for EIBI programs and its use of assessment items that operationally define the specific skill being assessed, which considers the functions of behavior and allows for easier obtaining and interpreting of assessment results, leading to more effective and efficient implementation of target goals to address deficits reported by the assessment. Additionally, the VB-MAPP allows for easier measuring of a learner’s programming progress. Limitations of the VB-MAPP include the lengthy duration of conducting the assessment, lack of psychometric evaluation (which assessments like the VABS-II has), and reliability and validity that have not been fully investigated/researched. The limitation of being a lengthy assessment can result in using parent/caregiver reporting to complete the assessment, which makes the assessment potentially less reliable.