What is the Lovaas method?The Lovaas method is an early intensive behaviour therapy approach for children with autism and other related disorders. It is also known as the UCLA (University of California Los Angeles) Programme by Dr Lovaas, Home-Based Behavioural Intervention and UCLA Model of Applied Behavioural Analysis as developed in the Lovaas Institute for Early Intervention.
It is based on extensive clinical experience and research carried out over more than 30 years by psychologist Dr O. Ivar Lovaas, in the USA.
In the late 60s and 70s Lovaas worked with institutionalised, non-verbal children who had been diagnosed as autistic. He concentrated on verbal communication using the strategies of applied behavioural analysis.
At the time Lovaas' work was criticised by colleagues advocating the psychodynamic approach, because most of the children lost their verbal skills when the programme ceased and they returned to institutional life. However, those who moved back with their parents, who wanted to be informed about the treatment, did much better. This led to an increased importance of the role of parents in the education process.
Lovaas went on to work with younger children, aged two to four, in their home setting with parents involved in the treatment to see if he could ensure that the new skills learned were maintained. Children received 40 hours a week of structured input on a one-to-one basis from trained students whose work was closely supervised by Lovaas and his staff.
The results were published in 1987 and caused great interest as up until then there had been no studies to show that behavioural strategies could present such positive results.
Lovaas compared three groups of 20 children:
1. The experimental group of children who received 40 hours a week of treatment.
2. A first control group who received 10 hours behavioural treatment together with a variety of treatments from other sources such as those provided by small special educational classes.
3. A second control group who received no behavioural treatment.
Lovaas described his findings from the experimental group as follows:
a) A recoverable group of individuals, who, following intervention, no longer demonstrated the characteristics of autism. Lovaas claimed that 47% of children who worked 40 hours at home per week achieved normal functioning by the time they successfully entered full-time mainstream education at the age of seven.
b) An intermediate group (40%) who made substantial progress but who still displayed autistic characteristics. Many of them retained language difficulties or an intellectual disability.
c) A small number (10%) who received little or no benefit from the intervention.
The results also showed that those children who followed the programme for two years or more gained on average 30 IQ points compared with the other two groups who made no IQ gains.
A follow-up study carried out by McEachin, Smith and Lovaas in 1993 indicated that the majority had maintained their gains into adolescence. They appeared to be functioning normally and at blind interviews with clinicians were said to be indistinguishable from children with no history of autism.
What does the programme involve?Lovaas and his colleagues recommend that treatment should begin as early as possible, preferably before the child is five years old and, ideally, before the child reaches three and-a-half years. This is necessary in order to teach basic social, educational and daily life skills. It can also reduce stereotypical and disruptive behaviours before they become established.
The home-based programme consists of 40 hours a week of intensive therapy. Results of Lovaas studies show the importance of maintaining these hours in order to maximise the benefits to the child. The therapy is on a one-to-one basis for six to eight hours per day, five to seven days a week, for two or more years. Teaching sessions usually last two to three hours with breaks. The intensity of the therapy means that there is usually a need to establish a programme team which normally consists of at least three persons. These people have all undergone a full training programme.
Family participation is a very important element of the treatment as researchers at the time found that skills learned in clinics and special classrooms would not transfer to a home setting unless there had been parental involvement in the child's treatment programme. All skills are broken down into small tasks that are achievable and taught in a very structured manner and accompanied by lots of praise and reinforcement. Examples of reinforcers are small bites of food, play with a favourite toy, social rewards such as verbal praise and hugs and tickles. Gradually food and other artificial reinforcers are replaced, if possible, by more social and everyday reinforcers. Aggressive or self-stimulatory behaviours are reduced or replaced by ignoring them or by introducing more socially acceptable forms of behaviour.
The intervention programme progresses very gradually from teaching basic self help and language skills to teaching non-verbal and verbal imitation skills, and establishing the beginnings of toy play. Once the child has mastered basic tasks, the second stage teaches expressive and early abstract language and interactive play with peers. In more advanced stages of the intervention the child can be taught at home and school.
Behaviour modificationBehaviour modification is based on the fact that pleasant consequences can promote good behaviour and unpleasant consequences, such as punishments, can reduce unacceptable behaviour. In the 60s and 70s aversive procedures had been used by behaviour analysts of all sorts when alternative treatments had failed and if the behaviour of the client was dangerous to himself or others. For this reason behaviour modification has been criticised. In his early work Lovaas defended its use in situations when a child used self-injurious or self-stimulatory behaviours. He contended that aversive procedures constituted no more than 1% of the typical interactions in his programme and that they are not generally required after the first few weeks.
The UCLA project no longer employs physical aversives and there is more of an emphasis on positive reinforcement procedures.
Lovaas and his colleagues believe that with early intervention a sizeable minority of children with autism and related disorders are able to achieve normal educational and intellectual functioning by the age of seven. For those children who do not achieve normal functioning it is claimed there are usually substantial decreases in inappropriate behaviours and acquisition of basic language is achieved.
What are the benefits?
There have been numerous articles and critiques written on this topic over the last 20 years and many arguments as to the validity of Lovaas' findings.
The treatment is extremely long and intensive and can therefore prove to be very expensive. However, a growing number of parents have used this method and have been pleased with the results.
In recent years there has been renewed interest in the Lovaas method following the publication of Let Me Hear Your Voice, Catherine Maurice's moving account of her use of the Lovaas approach with her two children.