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| International Symposium - Outcomes for Children in the Ontario IBI Program |
| Sunday, May 27, 2007 |
| 9:00 AM–10:20 AM |
| Elizabeth H |
| Area: AUT/CSE; Domain: Applied Research |
| Chair: Adrienne M. Perry (York University) |
| Abstract: This will be a four-part symposium focused on the outcomes of children in the large, publicly-funded Intensive Behavioral Intervention (IBI) program in Ontario, Canada. The Ontario Outcome Study is important to the ABA field more generally as it represents a large community effectiveness study. In the symposium, we will: 1. address the context of effectiveness research (vs. efficacy studies) and describe the methodological strengths and weaknesses of this type of study; 2. present a detailed description of the 332 participants on standardized psychometric measures; 3. present the data on children’s improvement on various measures and the heterogeneity in outcomes that was observed; and 4. examine predictors of progress/outcome in terms of developmental and diagnostic variables as well as program factors such as age at entry to the IBI program and duration of treatment. |
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| Effectiveness Research in IBI: The Context of the Ontario IBI Outcome Study. |
| ANNE CUMMINGS (Central East Preschool Autism Services), Jo-Ann M. Reitzel (Hamilton-Niagara Regional Early Autism Initiative) |
| Abstract: Intensive Behavioural Intervention (IBI) is a specialized form of intervention designed for young children with autism, based on the principles of Applied Behaviour Analysis. IBI is considered “best practice” for young children with autism, based on literature which has demonstrated superior outcomes relative to less intensive intervention, eclectic intervention, and special education. IBI has been publicly funded in Ontario since 2000 and hundreds of children have now received community-based services. This first presentation will contextualize the Ontario IBI Outcome Study in terms of the previous literature on IBI, will make the distinction between Efficacy (can it be shown to work under ideal conditions?) and Effectiveness (does it work in the “real world”?), and will point out some of the strengths and limitations of a community effectiveness study of this nature. The purpose of this study was to examine children's outcomes to date in the Ontario program. The study was designed to address two main questions: 1. Do children show significant improvement? and 2. What factors predict greater improvement? |
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| Developmental and Diagnostic Characteristics of Children in the Ontario IBI Outcome Study. |
| JANIS M. WILLIAMS (Erinoak), Susan Hughes (Pathways for Children and Youth) |
| Abstract: It is important to use valid and reliable measures as well as to present a detailed description of the developmental and diagnostic characteristics of research participants, in order to ascertain the degree of generalizability of results to other samples. This presentation will describe the measures and participants in the Ontario IBI Outcome Study. There were 332 children (276 boys; 56 girls) with pre- and post-IBI psychological assessments. Children’s age at entry into IBI ranged from 20 to 54 months, with a median of about 4 ½ years. The duration of IBI was, on average, 18 months. Clinical diagnoses were: Autistic Disorder (194), PDD-NOS (46), or unspecified ASD (92) with 91% of children scoring beyond the Autism cut off on the Childhood Autism Rating Scale (CARS). Developmental level, based on the Vineland Adaptive Behavior Scales (VABS) and various cognitive measures, varied considerably with mean standard scores in the 50s. Developmental rate (based on VABS Age Equivalents) prior to IBI was .32, indicating children were learning at one-third of a typical rate prior to treatment. The sample was divided into three initial level of functioning groups, based on VABS Standard scores (essentially 60s, 50s, and 40s) for subsequent analyses. |
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| Ontario IBI Outcome Study: Do Children Improve? |
| TOM MANAGHAN (Child Care Resources), Jennifer Dunn Geier (Preschool Autism Program, Eastern Ontario) |
| Abstract: Results for Question 1 indicate that children showed statistically significant and clinically significant reduction in autism symptom severity on the CARS, with many children changing enough to fall into a milder category on this instrument. Cognitive level improved significantly for children, in some cases dramatically so. Further, children gained significantly in developmental skills (increased age equivalents) in all areas of adaptive behaviour. Standard scores, which are corrected for age, also increased significantly, though modestly for most domains examined. There were different patterns in different subgroups, with substantial improvements in the group who were relatively "higher" functioning to begin with. Children's rate of development during IBI was approximately double their rates prior to IBI, and this was true for all three initial rate groupings, i.e., even the lower functioning children doubled their rate of development, as a group. There was considerable heterogeneity in outcome, as would be expected given the population. Children were classified into seven categories of progress/outcome. The majority of children (75%) showed some measurable benefit or improvement during IBI and some children did even achieve average functioning. |
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| Ontario IBI Outcome Study: What Predicts Different Outcomes? |
| LOUISE LAROSE (Private Practice), Nancy Freeman (Surrey Place Centre) |
| Abstract: Results for Question 2 indicate that children's progress/outcome was clearly related to their initial functioning levels, though not totally. As a group, children who were “higher” functioning initially showed better outcomes, but not in every case. Children who were initially medium functioning were, at exit, to be found in every one of the progress/outcome groups, including average functioning. Children who were initially lower functioning also showed a range of progress, though none achieved average functioning. Children who started IBI before age 4 did better than those who started later on all outcome scores. Children who received 2 years or longer duration of IBI did better than those who received a shorter duration of IBI (but they were also younger when they entered). Regression analyses attempting to prioritize the degree of influence of initial level of functioning, age, and duration, showed that initial levels are the strongest determinant, but that they do not account for all the variability (half at most). Age at entry appears to be more predictive than duration of IBI. However, there are clearly other factors (e.g., quality and quantity of intervention, other child factors not measured here) which may account for the unexplained variance. |
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