Autism research controversy: a response to Howard et al.'s (2005) defenders.

Two years ago Jane Howard and colleagues published their quasi-experimental study "A comparison of intensive behavior analytic and eclectic treatments for young children with autism" (Howard, Sparkman, Cohen, Green, & Stanislaw, 2005). A year later my paper (Schoneberger, 2006)-which, in part, raised some serious questions about the methodology of their study--appeared in this journal. Since it publication, my paper has received a number of positive appraisals--some from local public school employees, some from members of local agencies serving special needs children (e.g., Valley Mountain Regional Center, an agency which played a role in Howard et al.'s research), and some from other professionals across the nation. As an example of the latter, consider the comments of Andy Bondy, a prominent behavior analyst and co-founder of the Picture Exchange Communication System (PECS). With regard to the issue of "how to best describe" Howard et al.'s methodology and results, Bondy found my paper (2006) "astute and helpful" (personal communication, September 27, 2006). However, others have attempted to counter my criticisms. Specifically, this journal recently published two letters to the editor offering spirited defenses of Howard et al. (2005): one by the researchers themselves (Howard, Sparkman, Cohen, Green, & Stanislaw, 2007) and the other by Tristram Smith (2007). Further, this current issue contains a third letter (Wright, 2007) which also offers a defense of Howard et al. In what follows I respond to all three letters, beginning with the more substantive of the three (Smith, 2007), and then concluding with Howard et al. (2007) and Wright (2007).

Response to Smith (2007)

Drawing largely on a paper by Tristram Smith and colleagues (Smith, Groen, & Wynn, 2000), my paper (2007) identified three guidelines to be followed by studies assessing the treatment efficacy of behavior analytic approaches to young children with autism. These guidelines are: "(1) random assignment of participants to treatment conditions; (2) use of uniform assessment protocols across all participants; and (3) documentation of sufficient methodological detail to allow for independent replication" (Schoneberger, 2006, p. 208). Further, in my paper I reported Tristram Smith's (personal communication, July 25, 2005) critical commentary on Howard et al.'s (2005) study; namely, that the study's "limitations" included (a) its use of nonrandom assignment and (b) its providing "limited information about the interventions." The logical implications of Smith's criticisms are that Howard et al. (2005) failed to adhere to the first and third guidelines.

In his letter to the editor defending Howard et al.'s (2005) study, Smith (2007) does not dispute the accuracy of my citations of his personal communication to me. However, Smith (2007) does assert that "this characterization of our correspondence is quite one-sided and misleading" (p.146), apparently because I did not include his favorable comments about Howard et al.'s study that were contained in his personal correspondence to me. Indeed, in my paper I did not report Smith's statement to me that Howard et al.'s study "is a very useful contribution to the literature." Further, I did not include his comments that "the groups appear fairly comparable prior to treatment, and the comprehensive assessments and use of independent examiners are strengths. Also, the results are impressive" (T. Smith, personal communication, July 25, 2005). Thus, to the charge that my characterization of his correspondence was "one-sided" I plead guilty with an explanation. However, I disagree that I was thereby misleading. Consider the following explanations of my "guilty" plea.

In selectively quoting Smith's correspondence with me, I was arguing for a particular point of view. So, of course it was one-sided. Smith's criticizing me for being one-sided is like criticizing a participant in a formal debate for being one-sided. Isn't that the point of a debate? I was not attempting to characterize the totality of Smith's responses to the Howard et al. study. Had I been claiming to be attempting that, then I would agree that my selective quotations were misleading. But I was not, so my quotes were not. Rather, by quoting Smith, as well as other sources, I was arguing that Howard et al.'s results should be questioned because of the study's methodological weaknesses. Such selective quotation in mounting an argument is part of the "bread and butter" of scholarly discourse. Indeed, Smith himself is "guilty" of this. For example, consider the following from Smith (2007, p. 146):

   Although Schoneberger (2006) enumerates the potential problems with
   non-random assignment, he does not mention that a design with
   matched groups (as in the Howard et al., 2005 study) is generally
   considered to be the next best approach (Cook & Campbell, 1979).
   Howard et al.'s use of this design (2005) is justified because
   random assignment was not possible.

Several points need to be made here. First, nowhere in the Howard et al. study do its authors report that they used a matching procedure when assigning participants to groups (I will have more to say about this later). Second (and to the issue at hand), Smith (2007) employs a one-sidedness when he cites Cook and Campbell (1979) in support of his claim that "a design with matched groups (as in the Howard et al., 2005 study) is generally considered to be the next best approach" when random assignment is "not possible"(p. 146). To be sure, Cook and Campbell (1979) acknowledge that sometimes problems arise, which make random assignment "not feasible" (p. 344). However, they are also much less tolerant of using such problems to justify nonrandom assignment than Smith's citation of their book suggests. Indeed, Cook and Campbell (1979) caution us against "persons who use these problems to justify their reluctance to randomize"(p. 350) and go to great lengths to provide strategies for making the putatively impossible-i.e., random assignment--possible (see Cook & Campbell, 1979, pp. 346-371). Why didn't Smith also make reference to these passages? Let me hazard a guess: Because, had he done so, he would have weakened his claim that "Howard et al.'s use of this design is justified because random assignment was not possible" (Smith, 2007, p. 146). In arguing his viewpoint, Smith made a one- sided use of Cook and Campbell. But since he was not trying to summarize the totality of Cook and Campbell's views on randomization, he was not (in my opinion) misleading the reader. And neither was I when I selectively quoted Smith's correspondence to me.

Further, Smith's positive comments about Howard et al.'s study do nothing to lessen the import of its limitations identified by him. For example, his opining that the results were "impressive" does not mitigate its methodological weaknesses. Consider the following analogy. Suppose I know that you are looking for a dependable, fuel-efficient car, and you mention a particular model that you are pondering. Suppose I then tell you that, based on a review appearing in a respected consumer's advocate magazine, the car is reportedly a gas guzzler and needs frequent repairs. Would you then have a legitimate grievance against me if you later discovered that I had failed to tell you that the magazine also found that the car in question has an impressive exterior (e.g., a great paint job) and interior (e.g. leather seats)? I think not. Just as the car's "impressive" looks are irrelevant in light of the essential features it lacks (i.e., dependability and fuel efficiency), so too Howard et al.'s impressive results are irrelevant when stacked up against its methodological flaws. These research design flaws raise doubts about the study's results, and thereby militate against the impressiveness of same.

Response to Howard, Sparkman, Cohen, Green, and Stanislaw (2007)

In the opening paragraph of their letter to the editor, Howard and colleagues (Howard et al., 2007) indicate their intention to "correct some misrepresentations" of their study (Howard et al., 2005)- misrepresentations which allegedly appeared in this journal as well as "elsewhere" (Howard et al., 2007, p. 144). In the next paragraph they decry the supposed "dissemination of unfounded statements and insinuations about the study and those involved in it" (p. 144). Unfortunately, the systematic ambiguity which plagued the published account of their study also plagues their letter. By systematic ambiguity, I mean an inexactness (which I assume is unintentional) in their statements at numerous critical points in their writing, making understanding and evaluation difficult. Specifically, in their letter they are vague about whose "misrepresentations" they intend to be countering; further, they do not tell us which statements are "unfounded" nor who has authored the "insinuations." In offering this ambiguous complaint, they appear to be engaging in the very practice they decry; namely, disseminating insinuations--in this case, insinuations directed at those who have critiqued their study.

In their letter, Howard et al. (2007) claim that nonrandom assignment was used in their study "because of serious ethical and practical constraints" and because it would have violated "state and federal laws governing special education placement and procedures" (p. 144). Given the distinct advantages of random assignment, Howard et al (2007) need to be specific here; unfortunately, they are not. However, I shall make some brief comments on their justification--sketchy as it is--for not employing random assignment. Howard et al. (2007) assert that their agency (Therapeutic Pathways) never refused service to a child "as long as there were adequate resources to staff and supervise the program" (p. 144). Of course, like the "therapist availability" criterion used by Lovaas (1987) in assigning participants to conditions (see Smith, Groen, & Wynn, 2000), this represents a potential source of bias. However, it is understandable, given the challenges facing Therapeutic Pathways as an agency serving in the dual, often conflicting roles of being both a business enterprise and a research entity. However, Cook and Campbell (1979) have opined that when resources are insufficient, random assignment--far from being unethical-may well be the ethical course. According to Cook and Campbell (1979), "Random assignment sometimes serves ... as a means of solving the ethical issues that arise when we must distribute valuable but scarce resources" (p. 342). Similarly, Boruch (1997) identifies "a kind of fundamental ethical rule in deciding whether to randomize" (p. 66)--a rule which he believes was first enunciated by Campbell and Stanley (1966). "The rule, simply put, is that when there is an oversupply of eligible recipients for scarce program services, randomized assignment of candidates for the resource is fair"(Boruch, 1997, pp. 66-67).

Next consider the supposed legal constraints which reportedly discouraged Howard et al. (2005) from employing random assignment. Every special education student is entitled to a free and appropriate education (FAPE). As long as this legal right is respected, it appears there is a lot of room for offering other, voluntary options (e.g., participation in a randomized experiment) as well. Given the well documented history of the use of random assignment in clinical trials of medical interventions involving issues of life-and-death, I suggest that parents, educators, and service providers--in consultation with special education attorneys--could, in good faith, meet all the relevant legal and ethical constraints while conducting randomized clinical trials of the differing approaches to the treatment of autism in young children.

In the published account of their study (Howard et al., 2005), the most serious ambiguity concerns Howard et al.'s account of how participants were "assigned" to groups. Other than telling us that a nonrandom assignment procedure was used in which parental preferences "weighed heavily" (Howard et al., 2005, p. 6), no information was provided in Howard et al. (2005) on the participant assignment procedure. Thankfully, Howard et al.'s (2007) letter has resolved some of this ambiguity. Specifically, in their letter we now learn for the first time that a matching procedure was used. Nowhere in the study (2005) is this stated. In their letter, Howard et al. (2007) inform us that "participants were selected for our study from larger pools of children ... in such a way as to constitute matched treatment and comparison groups"(2007, p. 144). Although this information is clearly helpful, there remains some lingering ambiguity which raises important questions. Matching in quasi-experimental, between-group designs occurs after participants have been assigned to their respective groups. So, the first question is: At what point during the experiment were the subjects matched? Second, was the matching conducted by an individual blind to the individual participants' responses to treatment? Obviously, to reduce the chances of bias, blind matching is important if the matching occurred after initial measures of the dependent variable--or other indicators of responses to treatment--were available.

As previously noted, parental preferences reportedly "weighed heavily" when assigning participants to the treatment conditions. However, another ambiguity inherent in this process concerns what influence the other members of the IEP/IFSP teams had in making these educational placement decisions. Howard et al. (2005) do not tell us. Again, in their letter (2007) they attempt to remove some of this ambiguity. Specifically, they report that the "nonpublic agency" (i.e., Therapeutic Pathways, an agency for which the first and second authors serve as directors) that provided the intensive behavior analytic treatment in the study has "never refused to serve a child with autism who was referred to its ... programs ... as long as there were adequate resources to staff and supervise the programming" (Howard et al, 2007, p. 144). Fair enough. In my paper (Schoneberger, 2006) I never claimed that they had refused serving children referred to them, so I do not take issue with this statement.

Further clarifying the role of the other members of the IEP/IFSP teams, Howard et al. (2007) also assert in their letter that "neither the staff of the nonpublic agency nor any Regional Center staff person ever directed <italics added> a child to be placed in any particular intervention program"(p. 144). This is an important assertion. In their manual "In-home Programs for Young Children with Autism," Therapeutic Pathways (June 1999) states that, "Therapeutic Pathways clinical group has final decision making authority regarding the scope and content of my child's program, including school placement" (p. 2). Based on this statement, in my paper (2006) I concluded that a "reasonable assumption is that Therapeutic Pathways staffers used this power to place in the IBT <i.e., intensive behavior analytic treatment> condition those participants who, in their professional judgment, were more likely to benefit from the program, and to refer the other participants to the other conditions" (Schoneberger, 2006, p. 211). Howard et al. (2007) are now stating that this was not the case. I accept their correction. However, some of the parent advocacy groups serving the same catchment area as Therapeutic Pathways have a different view of the educational placement process used with early intervention autism children.

For example, in their brochure, "Coalition Against the 'EIBT Program Procedures and Guidelines,' the Coalition Against the "4-Way Agreement" (2005) takes a different view. They assert that the decision making process used to determine whether or not a nonpublic agency will serve a child "discriminates against low-functioning autistic children" (unpaginated). They also assert that children who are accepted, but then fail to make adequate progress, are exited from some of the programs. Similar assertions are made by other advocacy groups (e.g., Concerned Parents of Children with Autism, abbreviated "CPCA," personal communication, June 5, 2006). Indeed, the CPCA has called for an independent, fact-finding inquiry into the process by which young children with autism have been educationally placed under auspices of the collaboration between Regional Centers, SELPAs, nonpublic agencies/schools, and parents (CPCA, personal communication, June 5, 2006). In my paper (Schoneberger, 2006) I raised a number of questions about how IEP/IFSP members may have influenced the placement decision in a manner that, though appropriate in their role as fiduciaries, nonetheless yielded selection bias.

Perhaps Howard and colleagues will join me, CPCA, and other concerned individuals and advocacy groups in asking an independent agency (e.g., the Area 6 Developmental Disabilities Board) to investigate the parent advocacy groups' claims, as well as the questions raised by me, in a manner that assures the confidentiality of those who are questioned. Based on concerns raised by the advocacy groups, here are two critical questions that need to be addressed: (1) Were all parents of young children with autism provided information on all of the educational placement options available? and (2) Did Regional Center and/or SELPA staffers encourage parents to accept particular educational placements while discouraging them from choosing other options? Embracing a variant of the principle of charity (Mackie, 1995), I assume that answering these and other questions will further resolve ambiguities inherent in Howard et al.'s (2005) study, so that the latter can take its place along side other quasi-experimental treatment efficacy studies--setting the stage for subsequent true (i.e., randomized) experiments.

Response to Wright (2007)

As a practicing behavior analyst serving special needs students, I share Ms. Wright's desire to provide these children with effective treatment. Unfortunately, this appears to be where our agreement ends (however, it may hopefully be that one or both of us is simply misunderstanding the other). For example, Ms. Wright reports being "appalled" by my paper (Schoneberger, 2006) apparently because of the "potential negative affects such an article may have on severely disabled children throughout this state." Green (1999) has observed that "the goals of science are not to assume but to test, to seek not to confirm but to disconfirm hunches and beliefs" while pseudoscientific approaches "resist scrutiny and objective testing of their claims by others" (p. 12). I see my paper as an exemplar of the "scrutiny and objective testing" which typifies science. My critique of Howard et al. (2005) is part of the normal, ongoing peer review of research that is intrinsic to any empirical science.

Ms. Wright begins her specific responses to my paper by defending Howard et al.'s (2005) use of nonrandom participant assignment. Since I addressed this issue above, I will add nothing more here. In my paper (2006, pp. 210-211) I entertain two alternative hypotheses that may account for the experimental results reported in Howard et al. (2005). Ms. Wright takes issue with each alternative. My first hypothesis is that perhaps the parents who chose non-EIBT treatment did so because they lacked the motivation to comply with what the EIBT programs require of them--and that this represents a confound challenging treatment efficacy. Wright apparently interprets this as my claiming that these parents "do not care enough about their children to provide them with intensive intervention." I, of course, am not claiming this. Being insufficiently motivated and note caring enough have different meanings. Indeed, the issue of parental motivation is one that the EIBT programs typically address. For example, the document "Guidelines for Early Intensive Behavior Treatment Programs (EIBT) for Children with Autistic Spectrum Disorder (Region 6 Autism Connection, 1999) outlines the procedures employed by the collaborating agencies referring children to Therapeutic Pathways (i.e., the program providing EIBT treatment in Howard et al, 2005) as well as other EIBT programs. This document includes among the "EIBT entrance criteria" that the child's "family environment supports an EIBT program," reflecting the importance of sufficiently motivated parents. Further, Therapeutic Pathway's (1999) manual "In-home Programs for Young Children with Autism" identifies a number of responsibilities which are required of parents as a condition of their children receiving treatment. Failure to live up to these responsibilities can lead to the cessation of treatment.

My second hypothesis--and a second major area of disagreement between Ms. Wright and me-concerns how IEP/IFSP teams make educational placement decisions. Consider the following passage from my paper (2006, p. 211) regarding the role IEP/IFSP team members play in placement decisions:

   As fiduciaries within a federally mandated special education
   process <italics added>, these team members had both a legal and
   ethical responsibility to advocate assigning to the IBT group only
   those children for whom such a placement would be "appropriate"
   based on the child's IEP/IFSP. An "appropriate" placement is one
   which permits the child to "benefit educationally" from the
   instruction (Bateman & Linden, 1992/1998, pp. 143144). So, although
   the parents' choice of treatment conditions may have, according to
   Howard et al., "weighed heavily," the other members of the team
   doubtless used their expertise to influence the eventual decision
   <italics added>.

In her letter Ms. Wright references my statement (cited above) that other members of the team doubtless use their expertise to influence the final decision. According to Wright, "not only does this statement malign the conduct of Regional Center and school staff, it is contradictory to earlier statements." How does this statement possibly malign these individuals? I have been attending IEP/IFSP meetings for twenty seven years and find member routinely attempting to influence the team's decision. Indeed, this is part of their job. They are expected to function as active participants, not "potted plants." When placement is being discussed, assessment drives the decision making process. Individuals with differing areas of expertise--e.g., teachers, autism specialists, speech/language pathologists, school psychologists, and behavior specialists--present assessment data to the team and make recommendations including, especially, recommendations about placement. Ideally, all team members "weigh in" during the process of deciding upon an appropriate educational placement.

In addition to the charge that the aforementioned statement maligns members of the IEP/IFSP teams, Wright also argues that it contradicts my earlier statements. In the above passage, I assert that IEP/IFSP members have a fiduciary responsibility to advocate intensive behavioral treatment only for those who would benefit educationally from such a placement. The supposed contradiction? For Wright, "given that competently delivered early intensive ABA has been shown to produce substantial benefits for the majority of children who receive it, the staff would be required to advocate for every child with autism" intensive behavioral treatment. In my judgment, this is a non sequitur. Let's assume that the majority of children who receive early intensive, behavioral treatment experience substantial treatment benefits. Part of the reason why EIBT treatment may be effective is that children with autism are carefully screened before being assigned to such treatment. As a result of such screenings, IEP/IFSP teams frequently decide that a child with autism will not benefit--not at present or perhaps never--from EIBT programs such as employed in Howard et al. (2005). For such students, other placement options are appropriate.

For example, the aforementioned "Guidelines for Early Intensive Behavior Treatment Programs (EIBT) for Children with Autistic Spectrum Disorder (Region 6 Autism Connection, 1999) outlines the procedures employed by the collaborating agencies when referring children to EIBT programs. According to these guidelines, the "EIBT entrance criteria" stipulate that "between 48 and 66 months of age child must have been 20 and 25 functional expressive words." Failure to meet these guidelines presumably provides a rationale for recommending non-EIBT placement. In my experience serving children with autism in the same catchment area, other reasons for recommending non-EIBT placement include the presence of (1) excessive self-stimulatory behavior, and/or (2) serious physical aggression, and/or (3) little or no imitative responding. Employing such criteria to recommend non-EIBT placements is generally laudable within the context of an IEP/IFSP process; however, from an experimental perspective, it exemplifies selection bias and thereby threatens the validity of the research outcomes. Those children who meet EIBT entrance criteria are likely to profit from the treatment and show gains in IQ, while those who are enrolled in other placements receive treatment (e.g., self-care skills) which, though appropriate, is often unlikely to produce substantial gains in IQ.

In addition to Ms. Wright's response to my two alternative hypotheses, she raises some additional issues. I shall now respond to four of these further concerns. First, Ms. Wright draws attention to the disclaimer appearing at the end of my paper in which I note that my views are not necessarily those of my employer or my fellow employees. She appears to infer from this that my employer and fellow employees do not question the process or treatments described in Howard et al. (2006). No such inference is justified. The reason I provided this disclaimer is the same reason why I do not write letters of recommendation using stationery with my employer's letterhead: To avoid the inference that my employer (or fellow employees) share my opinions. But by failing to use my employee's letterhead, one is also wrong in inferring that my employer disagrees with my recommendations. The same applies with the disclaimer in my paper (2006). In both cases one should not infer either an endorsement, or a lack of endorsement, of my opinions by my employer or fellow employees.

Second, Ms. Wright responds to my criticizing Howard et al.'s (2005) lack of a uniform assessment protocol. She states that "a knowledgeable evaluator must choose testing instruments based on a child's chronological age, developmental level, and overall functioning, as well as whether the test is normed for children of that age and has been shown to produce valid results with children with autism." I have no argument with this. However, in my paper I argue that, even given the need to use different tests, a much more uniform assessment protocol could have been achieved. Indeed, a case in point is the superior assessment uniformity achieved by Sallows and Graupner (2005; see Schoneberger, 2006, p. 215).

Third, Ms. Wright reports that she does not know what my "agenda" was when I wrote the article, but speculates that it might have been a "personal one." Specifically, she states that "the fact that Mr. Schoneberger provides consultation to some of the eclectic programs referenced in the study seems a likely source of at least some of his obvious personal biases." Several points need to be made here. First, my primary agenda was (and remains) that of promoting effective behavioral treatment by advancing the cause of well-designed experimental studies. Secondly, most of my career (19 out of 27 years) as a behavior analyst has been as an independent contractor and not as employee of the public schools-- so a more likely charge is that I am biased in favor of independent agencies. Specifically, I provided behavioral consultation for years serving: (1) Valley Mountain Regional Center as an independent contractor (i.e., a "vendor") and (2) the public schools, first with my own nonpublic agency, and later as a Senior Behavior Analyst employed by Applied Behavior Consultants (Sacramento, CA), one of the nonpublic agencies/schools which has serviced the same catchment as Therapeutic Pathways.

Fourth, Ms. Wright also appears to question my qualifications for critiquing Howard et al.'s research when she suggests that I may lack research experience. At the risk of engaging in shameless self-promotion, let me set the record straight. As an adjunct faculty member of the psychology department at California State University, Stanislaus, I taught a research methodology course at least once (but almost always twice) a year for 16 years. Indeed, I was initially hired to teach this course by Jane Howard (in her capacity as department chair). Part of my responsibilities included overseeing literally hundreds of student research projects. Further, as a member of the editorial board, I have also routinely served as a reviewer of research articles for the journal The Analysis of Verbal Behavior.

In closing, I thank those tireless individuals who have managed to read my original paper, the three letters in response, and this letter responding in kind. I hope that, personal differences aside, the exchanges have advanced the cause of providing well-designed experimental studies demonstrating efficacious treatment of autism spectrum disorders. These children and their suffering families deserve no less.

Author's Note

Disclaimer: The views expressed here are not necessarily shared by my employer, the Stanislaus County Office of Education (Modesto, CA), nor by my fellow employees.

References

Bateman, B. D., & Linden, M. A. (1992/1998). Better IEPs: How to develop legally correct and educationally useful programs (3rd ed.). Longmont, CO: Sopris West.

Boruch, R. F. (1997). Randomized experiments for planning and evaluation: A practical guide. Thousand Oaks, CA: Sage.

Coalition Against the "4-Way Agreement"(2005). Coalition against the "EIBT program procedures and guidelines. Available: http://www.no4way.org.

Campbell, D. T. & Stanley, J. C. (1966). Experimental and quasi-experimental designs for research. Chicago: Rand McNally.

Cook, T. D. & Campbell, D. T. (1979). Quasi-experimentation: Design and analysis for field settings. Chicago: Rand McNally.

Green, G. (1999). Science and ethics in early intervention for autism. In P. M. Ghezzi, W. L. Williams, and J. E. Carr (Eds.), Autism: Behavior-analytic perspectives (pp. 11-28). Reno, NV: Context Press.

Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359-383.

Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H (2007). Letter to the editor: Correction concerning Howard et al. (2005). Journal of Speech-Language Pathology and Applied Behavior Analysis, 1.4-2.1 (compiled),144-145.

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

Mackie, P. (1995). Principle of charity. In T. Honderich (Ed.), The Oxford companion to philosophy (p. 130). Oxford: Oxford University Press.

Region 6 Autism Connection (1999). Guidelines for early intensive behavior treatment programs (EIBT) for children with autistic spectrum disorder. Stockton, CA: Author.

Sallows, G. O, and Graupner, T. D. (2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors. American Journal of Mental Retardation, 110, 417-438.r

Schoneberger, T. (2006). EIBT research after Lovaas (1987): A tale of two studies. Journal of Speech-Language Pathology and Applied Behavior Analysis, 1, 210-217.

Smith, T. (2007). Letter to the editor: Contributions of Howard and colleagues (2005) to early intensive behavioral treatment. Journal of Speech-Language Pathology and Applied Behavior Analysis, 1.4-2.1 (compiled),146-147. Therapeutic Pathways

Smith, T., Groen, A. D., & Wynn, J. W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal of Mental Retardation, 105, 269-285.

Therapeutic Pathways (June 1999, version 4). In-home program for young children with autism manual.

Wright, D. J. (2007). Letter to the editor: Response to Schoneberger (2006): "EIBT research after Lovaas (1987): A tale of two studies." Journal of Speech-Language Pathology and Applied Behavior Analysis, this issue, ~.

Author Contact Information

Ted Schoneberger, BCBA

Behavioral Intervention Case Manager

Stanislaus County Office of Education

1100 H Street

Modesto, CA

Phone: [phone]

e-mail: [e-mail]