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Comparative Effectiveness Review of Intensive Behavioral Intervention for Treatment of Autism Spectrum Disorder

March 13, 2019

Health Problem: Autism spectrum disorder (ASD) is a neurodevelopmental condition, which presents in childhood and is characterized by persistent deficits in social communication and social interaction; restricted, repetitive patterns of behavior, interests, or activities; and clinically significant impairment in social, occupational, or other important areas of current functioning. The estimated prevalence of ASD in 2014 was 1 in 59 among children 8 years of age.

Technology Description: Intensive behavioral intervention (IBI) involves highly structured teaching techniques that are administered on an individual basis by a trained therapist, paraprofessional, and/or parent 15 to 40 hours per week for 2 to 3 years. This comprehensive treatment incorporates several different principles and procedures of applied behavior analysis (ABA) to create new behavioral patterns and to decrease maladaptive behaviors.

Controversy: IBI has been criticized for being expensive, more effective for some children than others, and optimal parameters not yet identified (e.g., appropriate dose of therapy, intervention techniques used, optimal training and supervision of therapists). ABA therapy has also been criticized for its emphasis on repetition of behaviors that may not generalize well to other situations, as well as for an emphasis on reducing behaviors that are viewed as abnormal (e.g., stereotypical self-stimulatory behavior) rather than acknowledging the neurodiversity and needs of individual children.

Key Questions:

  • Is IBI effective for improving behavioral, intellectual, or academic outcomes in children with ASD?
  • How do IBI programs compare with intensive eclectic therapies or nonintensive school-based therapies for improvement of behavioral, intellectual, or academic outcomes in children with ASD?
  • Are IBI programs safe?
  • Have definitive patient selection criteria been established for IBI programs for treatment of children with ASD?