A few months back an article appeared in the journal Pediatrics: Neonatal Jaundice, Autism, and Other Disorders of Psychological Development. It’s one of those articles I meant to blog and just never got around to.
Here’s the abstract:
Objectives The goals were to study the association between neonatal jaundice and disorders of psychological development in a national, population-based cohort and to study whether gestational age, parity, and season of birth influenced that association.
Methods A population-based, follow-up study of all children born alive in Denmark between 1994 and 2004 (N = 733 826) was performed, with data collected from 4 national registers. Survival analysis was used to calculate hazard ratios (HRs).
Results Exposure to jaundice in neonates was associated with increased risk of disorders of psychological development for children born at term. The excess risk of developing a disorder in the spectrum of psychological development disorders after exposure to jaundice as a neonate was between 56% (HR: 1.56 [95% confidence interval [CI]: 1.05–2.30]) and 88% (HR: 1.88 [95% CI: 1.17–3.02]). The excess risk of infantile autism was 67% (HR: 1.67 [95% CI: 1.03–2.71]). This risk for infantile autism was higher if the child was conceived by a parous woman (HR: 2.71 [95% CI: 1.57–4.66]) or was born between October and March (HR: 2.21 [95% CI: 1.24–3.94]). The risk for infantile autism disappeared if the child was conceived by a primiparous woman (HR: 0.58 [95% CI: 0.18–1.83]) or was born between April and September (HR: 1.02 [95% CI: 0.41–2.50]). Similar risk patterns were found for the whole spectrum of autistic disorders.
Conclusions Neonatal jaundice in children born at term is associated with disorders of psychological development. Parity and season of birth seem to play important roles.
This week, three response letters were published in Pediatrics. These originally appeared as online letters:
Effects of perinatal asphyxia plus bilirubin?
Jaundice-Autism Link Unconvincing
and
neonatal jaundice: should we go crazy?
The first article (Effects of perinatal asphyxia plus bilirubin) was supportive, ending with:
Thank you for publishing the report by Maimberg et al., which will hopefully help direct research on perinatal brain vulnerability as an important area of investigation
The second article, as you might guess, was not. “Jaundice-Autism Link Unconvincing”. This was written by Thomas B Newman and Lisa Croen. Lisa Croen has previously published on biliruben (the substance which causes jaundice). They present a number of confounders which should be considered. They also note the potential problems with an incomplete study:
Raising concerns about the danger of jaundice could lead parents or clinicians to treat jaundice more aggressively. However, the Danish study also lacks any information on phototherapy. Thus, if the association is real, it could be due to phototherapy, rather than to the jaundice itself, in which case frightening families about jaundice could lead to an increase in treatment, which would be particularly counter-productive.
The third response notes “In this regard, it should be quoted the paper by Croen at al, who studied neonatal bilirubin levels (although the presence of haemolytic diseases was unspecified) in relation with autism spectrum disorders and did not find any association”. Yes, that’s the same Croen as in the second response. There was no association in those data and that previous study.
Another online letter is even more direct: Neonatal Jaundice Does Not Cause Autism.
In the Response from authors, we see that the authors have performed a reanalysis:
Sir, it has come to our attention that table 3 in our paper (1) only includes patients treated in somatic Danish hospitals identified in the Danish National Hospital Register. If we also add the patients diagnosed with autism spectrum disorders (ASD) at the mental hospitals only (n=6171), the revised figures will look like this:
Association between neonatal jaundice and autism spectrum disorders (F84.0-F84.9):
All;
Crude HR=1.29, adjusted HR=1.07 (0.94-1.21)
Term=>37 weeks;
Crude HR=1.23, adjusted HR=1.06 (0.90-1.25)
Preterm< 37 weeks;
Crude HR=1.17,adjusted HR=1.05 (0.83-1.32)
As seen in the new analysis (including children from the mental hospital only)the association between jaundice and autism is substantially attenuated after adjustments which make us doubt the causal nature of our observation. If the association is causal it apparently only involves the more severe cases reaching the somatic hospital. Our findings are in line with what has been reported from Sweden (2) using a similar case mix. It is likely that our study and the Swedish study are confounded by co- morbidity.
“which make us doubt the causal nature of our observation.”.
I’m rather glad I didn’t blog this at the time. This looks like the science community working to self-correct itself.
Left Brain Right Brain 
“This looks like the science community working to self-correct itself.”
As it should. I have always thought, as a humble layperson, that such correction is a defining element of scientific discourse. Any hypothesis or theory is open to future corrections.
If neonatal jaundice causes autism, then why is Joey the autistic one, and not Andy, who had severe jaundice?
Hi Sullivan –
That’s weird. I was also thinking about writing something about this. I think I read the jaundice paper, and what I liked about it was that it seemed to have biological underpinnings that made sense; i.e., increased oxidative stress and or known associations with brain formation problems in animal models.
Anyway, thanks for posting this, I saw the notice land in pubmed but didn’t have time to go hunting for it.
– pD
Thanks for doing this summary post.
My eldest has autism, and had bad jaundice, and phototherapy for it in hospital. Before I’d even heard of the observed correlation between autism and jaundice, I’d wondered whether the sensory deprivation of being under-lights – eyes covered, blocked from sound etc – had something to do with his condition (just the usual desperate mother searching for answers).
When I was preggers with number two the midwife showed me all the data at that point about any link between autism and jaundice, since I’d asked her about any known risk-factors associated with pregnancy and birth. After all that reading I was left with the impression that there was no convincing evidence of a link, and that where it looked possible, it was unclear whether it was because of the jaundice, or the treatment. It still affected my emotional state though when my second got jaundice too, though his jaundice was not as bad as my first-born.
Because I didn’t want my second boy to go through the same sensory-deprivation that made me upset with number one, I did everything I could at home to get the levels down – breastfeeding like crazy, lots of sun, etc. I managed to keep him out of hospital, barely. He doesn’t have autism, but I still haven’t seen any evidence that makes me think there’s a credible link anyway.
I probably should have put all that in a post of my own, rather than as a comment here, sorry about the length, just felt like sharing my story 🙂
[Harold L Dohertysay]…as a humble layperson, that such correction is a defining element of scientific discourse. Any hypothesis or theory is open to future corrections.
sadly many “scientist” will not correct…eg, proof ABA is effective long term…
perhaps a view of a respected PhD physicist and friend (associate of nobel prize winner, Schalow) may provide a perspective:
[quote] Physical scientists are not welcome in the world of the would-be scientists in psychology, psychiatry and medicine, except as naive clowns who invent or produce all manner of new diagnostic and treatment equipment, nuclear tracers etc., which are then used by MD’s who are given the credit for the advances by the press and public.
Look at the prescription drug problem. MD’s almost to a man (or woman?PC!!) dole out dangerous poorly tested chemicals hawked by pharmaceutical companies via marketing agents who have no “scientific” credentials and who “educate” the MD with slick brochures and “free samples” to try on unsuspecting patients.
They give elderly people a panoply of drugs without the slightest knowledge of their interactions, and with minimal follow-up. They push “laser” stuff without knowing anything about the operation of the basic equipment beyond which buttons to push on the front panel.
They order lots of xrays without any knowledge of the cummulative damage of even “soft” xrays, and when challenged, will mouth some non sequitur such as “you would get more exposure on a flight to New York” (usually a falsehood.)
Worst of all are behavioral psychologists and charlatan psychiatrists. The former apply all manner of behavior modification systems to people with innate neurological anomalies without a hope of benefit to anyone (except their own earnings). The latter use powerful drugs to control behavior without proper monitoring, and in institutions to control patients with minimal staff.
The biosciences in the past four decades have accounted for 99% of the fraudulent research reports. Underpaid chemists, physicists and biologists working in labs run by senior professors, often MD’s but not always, fudged or outright created date sets to publish results and totally unjustified conclusions.
Psychologists use statistical methods that require large samples to calculate standard deviations and error bars from sets of as few as ten subjects.
but don’t expect the pseudo scientists to pay any attention, since many of them do not understand observational science as applied to human beings, who are not robots and do not obey fixed laws of behavior.[unquote]
apologies for repeat of comments at other threads…but perhaps worship at the altar of science should be RE-considered…
stanley seigler
@ A&O My Autisitc son didn’t have jaundice. He was born ASD. I know plenty of people, most of whom have kids, and a large portion had some level of jaundice. None are ASD. If there was a link between the two I would be most surprised.
@Stanley, I don’t know what your problem with ABA is exactly, but for those of us who have seen it help our children your derogatory comments are insulting and insensitive. If you don’t like it don’t use it. Simple.
As for the above quote, it’s overly cynical and a touch paranoid to me.
Yes, Sharon… I have a problem with Stanley’s quote – every time he feels the need to post it. I’ve seen it a few times. And – whilst one must respect Schawlaw’s achievement in being awarded a Nobel Prize – it does not follow that he had anything to say on disciplines outside of his domain.
As for his beef with ABA, then if he is referring to Lovaas’ variant and the claims made on its behalf, well … I find myself siding with Stanley there. More modern studies have found the behavioural interventions to be less effective than Lovaas’ group was claiming (shows what having such a small and non-randomised sample can do, doesn’t it?). This is not to say that behavioural interventions are useless (they are not… to be honest, I’m not convinced they are used enough – at least in forms that Skinner would have had in mind)… but one has to bear in mind all the contributors to good outcomes (which necessarily include how one defines a good outcome!).
As a mathematics teacher, I have used task analysis and discrete trial training techniques with students – with reasonable success. And as a psychologist I’ve been happy to recommend functional behavioural assessment as a good way to collect very important information that – whilst not directly answering questions – will at least provide the basis for asking the sorts of questions we need to be asking.
But what Lovaas was doing was so desperately unethical. Michelle Dawson has covered this issue far more eloquently than I could ever be bothered to do. I refer readers on to her site.
@David, how Lovaas practiced and how ABA is taught today are quite different. The fundamental principle applies but the aversives in particular are no longer used, at least with my service provider. I can’t help feel that to dismiss ABA based on the original method rather than the contemporary one is somewhat misleading. But each to their own.
Ive seen ABA be effective with my son in a short time and with limited hours. It may not be the best approach for every child but it is for mine so far. I am familiar with Michelle Dawsons view. It does not however change mine. I have taken issue with the occasional suggestion or viewpoint of our therapists and have addressed those accordingly. But have to say overall I have been impressed by their compassion, knowledge and skill.
Hello friends –
Does anyone have a copy of the original paper available? If so, what is the N value for number of children with autism in the original study?
I ask because either the original numbers should have shouted problem in the first study, or the new numbers might not be as meaningful. The original study included every child born in Denmark, 733,826. If we accept ~ 1% prevalance, that is 7300 children with autism [I know the prevalance numbers are shaky, but they are what we have]. Now, the authors say that there were an additional 6171 people with autism!
Did the original paper have a prevelance of autism in the .1% range? If so, someone should have been clever enough to find this horde of autism, the overwhelming majority of autism, before bothering to submit to Pediatrics, and I’d think the peer reviewers would have found this curious. I dunno.
Any thoughts?
– pD
– pD
Sharon:
“David, how Lovaas practiced and how ABA is taught today are quite different. The fundamental principle applies but the aversives in particular are no longer used, at least with my service provider. I can’t help feel that to dismiss ABA based on the original method rather than the contemporary one is somewhat misleading. But each to their own.”
This is what I mean, actually. Behaviour analysis has indeed moved on from Lovaas’ totally screwed up idea of what it actually is. Having looked into the way that Lovaas did it and what Skinner was saying about it himself … I’m not convinced that Lovaas’ version was in fact proper behaviour analysis.
“Ive seen ABA be effective with my son in a short time and with limited hours. It may not be the best approach for every child but it is for mine so far. I am familiar with Michelle Dawsons view. It does not however change mine. I have taken issue with the occasional suggestion or viewpoint of our therapists and have addressed those accordingly. But have to say overall I have been impressed by their compassion, knowledge and skill.”
I’d actually assert that – done correctly – it has a lot to offer anybody, really. Just not how Lovaas did it. I’ve used many techniques that have been validated by that means, and found them much more effect and humane that the usual sort of things used in, say, bringing up a child.
It’s a teaching method, not something for turning an autistic in into a non-autistic one. Lovaas was wrong, and he gave the application of behaviour analysis a bad name because of his screwed up idea of it. He was a psychoanalyst till he died. Skinner was actually very humane … educational rather than clinical in orientation. Huge difference. Lovaas didn’t get that; the smarter ones in the modern ABA crowd know that difference.
@David, I can’t help think you are being unfair to Lovaas. I suppose this is not the thread for the discussion. But will add the therapist who oversees my sons therapy trained with Lovaas (Jura Tender).
Sharon: “David, I can’t help think you are being unfair to Lovaas. I suppose this is not the thread for the discussion. But will add the therapist who oversees my sons therapy trained with Lovaas (Jura Tender).”
Obviously, that one didn’t pick up his bad habits. But really, he actually did not understand behaviour analysis properly if he could conceive of it as a means for ‘building a person’ rather than as a means for making learning more effective. Do remember that this was Lovaas’ aim. As an autistic person, that idea appals me. As a psychologist, it horrifies me.
This is not to say, as I have said previously, that I think that all ABA is done like he did it (with the aversives and all… remember, Matthew Israel sees himself as doing a similar thing, and all based on what he learned from Skinner… and neither of them seemed to have really learned much from Skinner at all).
Based on my readings about Skinner, I honestly do not think that he would be in favour of what Lovaas and Israel have been doing with his ideas.
@Sharon, we were with Jura as well for a few years (NZ has finally started graduating their own BCBAs so we are with a local one now). Amazing progress and no aversives.
The first major Lovaas study and the several papers it produced are simply not relevant at all now. It used totally different methods to those used today. ‘Recovery’ was defined as no longer meeting criteria for a diagnosis, but people on both (or all) sides use the word differently (IIRC Lovaas later regretted using the word). So there are no grounds at all for claiming anything about modern EIBI from the first Lovaas study – Lovaas’ big contribution for which he deserves credit was to show that autistic children could learn and achieve well beyond traditional expectations.
Lovaas did not follow Skinner’s concept of Applied Behavior Analysis at all, Skinner did not believe in using aversives. He considered that there were always undesirable side-effects, that it taught the use of violence, and that it only suppressed behavior temporarily in the presence of the therapist. Lovaas and others (like Matthew Israel) accepted Skinner’s reasoning, but reasoned that if the temporary suppression of unwanted behavior allows the learning of a desired behavior, then it could be justified in some circumstances. But EIBI evolved along more traditional Behavior Analytic lines, and just isn’t comparable to the first iteration. (Matthew Israel is another interesting story)
Michelle Dawson is flogging a dead horse with her unending postmortem of the first study. At that time, many schools were using corporal punishment we would consider barbaric today (shuddering as I recall images of a nun with an extended car aerial whipping my knuckles for playing the wrong piano keys).
You can criticize Lovaas for his use of aversives, his having taken on Rekers as a student, his shonky statistics, and so on – but Lovaas saw potential in kids previously considered hopeless cases. He inspired research into how to teach kids with ASD. So don’t throw the baby out with the bathwater.
As for the phototherapy confound in the jaundice study – that would be a big can of worms. Isn’t one of the biomed theories to do with ASD being caused by Vitamin D deficiency? UV rays destroy folic acid, but make Vit D.
“Lovaas saw potential in kids previously considered hopeless cases.”
Wrong.
He saw an empty shell inside which to build a person.
He had an attitude that set autistic people as not fully human.
He worked – at least for a long time – on the basis that aversives were part of the ‘treatment’… and – given the rate of ‘recovery’ he claimed and then the effectivenesses claimed by later authors – it’s clear that aversives were essential to his way of working.
There’s plenty to despise Lovaas for. And Matthew Israel…
“Lovaas and others (like Matthew Israel) accepted Skinner’s reasoning, but reasoned that if the temporary suppression of unwanted behavior allows the learning of a desired behavior, then it could be justified in some circumstances.”
So it’s justified to slap a child on the ear as a means to ‘temporarily suppress unwanted behaviour so that the child can learn a more desired one’?
Because I flat out do not accept that it is. Punishment is – scientifically speaking – useless. Ethically speaking – is is wrong.
“Michelle Dawson is flogging a dead horse with her unending postmortem of the first study.”
I disagree. She is pointing out that those claims made then could only have been made on the basis of how Lovaas did it. Those claims are still the ones used when ABA-based ‘treatments’ are being suggested, despite the fact that later EIBI publications have claimed lesser – but much more honest – effectiveness, but without the use of aversives.
For me, the thing is about Lovaas’ attitude towards autistic people, and the idea that we could even be empty shells for someone to build a person in… and, also, there is a lot wrong with the whole study that Lovaas did: no random assignment, no blinding at all, and an important error- that he did not compare 10, 20 and 40 hours per week of all three major types of therapy at the time. Sorry, but all that really grates with me. Both as a psychologist and as an autistic person. I will refrain from commenting on Matthew Israel. I have nothing positive to say about him and his practices.
“(shuddering as I recall images of a nun with an extended car aerial whipping my knuckles for playing the wrong piano keys)”
Odd. When I was at school in the 1970s, I can’t remember once getting corporal punishment for any infractions. At least, not from the teachers. ‘Fellow’ pupils were a different matter and that is an issue of bullying, using violence as a means of trying to control someone’s behaviour.
I wonder where they learned that from. Certainly wasn’t from anyone who truly understood behaviour or reinforcements or how to use the latter to change the first.
[DNA say] Lovaas so desperately unethical. Michelle Dawson has covered this issue far more eloquently than I could ever be bothered to do. I refer readers on to her site.
tho seldom agree with DNA…but have to agree here, ms dawson is eloquent…eg, “ABA goes nowhere without its unique vapour trail of adjectives like ‘scientifically-proven’ and ‘medically-necessary’.”
[McD say] Michelle Dawson is flogging a dead horse with her unending postmortem of the first study.”
perhaps a dead horse needs flogging…many still fail to see the THE MISBEHAVIOUR OF BEHAVIOURISTS.
[sharon say] But have to say overall I have been impressed by their [guess ABAers] compassion, knowledge and skill.
compassion, knowledge and skill…”the greatest of these is compassion…w/o compassion the others become as sounding brass or a tinkling cymbal…”
and damn, find myself AGAIN agreeing with DNA : “I’d actually assert that – done correctly – it [ABA] has a lot to offer anybody, really.”
[sharon say] I don’t know what your [stanley] problem with ABA is exactly
i dont “exactly” have a problem with ABA as practiced by compassionate therapists. i do “exactly” have a problem with the promotional science used to ‘scientifically-prove’ ABA…tho/and;
as mentioned here, probably too often, my daughter (at 3-4) was taught ABA (eg, to button) at UCLA by a lovaas disciple…at 45, she cant button (among other things)…and;
i quit asking for studies that prove long term success of ABA…anyone provide a link IDing a classic kanner (lo functioning, hate the term) autistic person…now a contented 40 yo thanks to ABA…
there is a dire need to define autism degrees on the spectrum…hi-lo-med (whatever)…and the programs that work for the degrees/classifications…so much/many apple/oranges discussions.
nothing to do with thread subject…just responding to comments…why so hard to keep on subject…apologies!
stanley seigler
“tho seldom agree with DNA…but have to agree here, ms dawson is eloquent”
*nods respectfully towards Stanley Seigler*
“i dont ‘exactly’ have a problem with ABA as practiced by compassionate therapists. i do ‘exactly’ have a problem with the promotional science used to ‘scientifically-prove’ ABA…”
I’d like to point out to Stanley here that science can indeed be practised compassionately: compassion and science are not mutual exclusives. What I mean is that science does not have to be a cold, heartless endeavour. Indeed, it shouldn’t be such a thing at all. The purpose of science is to allow us to not get caught up emotionally in something to the point where we cannot see where we are either wrong or right. I am, of course, very much into scientific approaches, because I want anything that gets used with autistic people (of whatever autism specis) to be demonstrated effective and to be demonstrated as humane/ethical. That goes as much for medical interventions as as it does for psychological & educational ones. Because it is wrong to waste people’s time and effort on things that really serve no purpose for the person with whom it is supposed to be being used.
ABA, as done by Lovaas, had so many issues of poor research about it that it is clear that any hope offered by what he was doing is clearly false. As Stanley knows, I have the same opinion about FC (although I am not against finding ways to help those who are non-orative to communicate; I just want to be certain about the communication coming from the person it’s supposed to be coming from… because that is what is supposed to happen). I have the same sort of opinion about the use of methylphenidate and fenfluramine in ADHD and autism respectively, because of habituation risks (and other biomedical concerns too). It’s the abuse of medication that I have an issue with.
“there is a dire need to define autism degrees on the spectrum…hi-lo-med (whatever)…and the programs that work for the degrees/classifications…so much/many apple/oranges discussions.”
I’m kinda of the same mind. Assessment should be absolutely geared to behaviour in terms of what someone can or cannot do, and how well they can do it. Intellectual ability is generally gauged via behavioural output anyway, so there has to be some room in an assessment for that too (non-verbal tests of intellectual ability are of some use here). Also, how the person responds to his/her environment and people in it. And then a diagnosis of what the person’s needs are in relation to becoming able to function reasonably interdependently with that environment and those in it.
We have to keep emotions out of the process so that they don’t cloud our vision and lead us down a wrong path because we want to believe that it’s the right one. But it doesn’t mean that – when we finally discover something that us useful (and ethically so) – we cannot enjoy the results of our hard work. We should enjoy them. It should lead to a wonderful feeling of joy and happiness for all involved in the process when we get the science right and are able to predict how useful something is going to be for a person whose needs we design it to meet (be it a process or an augmentative communication device or whatever). Science should never be about losing the sense of joy and satisfaction of doing one’s job well on the technical, ethical and personal levels. But it does require us to leave our ‘feelings about things’ to the end, and to concentrate on the tasks at hand without our emotions leading us the wrong way.
Science is wonderful, and it is essential for understanding how the universe and everything in it works; and our needs to understand these phenomena depend on the sort of involvement we each have with parts of that universe. FWIW, although I think that Schawlow’s opinion of psychologists as scientists is pretty much wrong, I think it is incumbent upon us psychologists to be as accurate in our measurement and our theory-building as our counterparts the physicists are in theirs (I trained ultimately in psychology, true; but it is physics that provided the impetus to do that, and it is physics and mathematics that I ultimately understood psychological phenomena through). So, I can maybe see a wee bit where Stanley comes from in quoting Schawlow, although I don’t agree with Schawlow. Even now, we have a large lack of real science in the practise of psychology, and that is just plain poor! We do indeed need to sharpen up how scientific we are…
“i quit asking for studies that prove long term success of ABA…anyone provide a link IDing a classic kanner (lo functioning, hate the term) autistic person…now a contented 40 yo thanks to ABA…”
Case in point.
Much depends on what we define as satisfactory outcomes. ABA isn’t going to make an autistic person non-autistic; but it can be used to at least teach some things. Those things that can’t be taught successfully can always be done by others. The important thing is what would lead to an improvement in the quality of life of the person for whom we are asked to do our work.
To Stanley specifically:
“why so hard to keep on subject…apologies!”
Because that’s how conversation goes … it is never linear… no apologies required (at least, from my perspective).
[DNA say]…that’s how conversation goes…it is never linear…no apologies required (at least, from my perspective).
thanks. but shouldn’t there be some connection to jaundice? probably not:)
[DNA say] Stanley comes from in quoting Schawlow, although I don’t agree with Schawlow
another apology…sorry if I mislead. I was NOT quoting schawlow, but a mutual friend (father of twin boys w/ classic kanner autism). Further;
i did not bring up either my friend (w/ whom i agree) or schawlow as experts in anything but their chosen field. AND as very bright parents (for 30 some years) of autistic boys who FCed…
brought them up as persons who would not be so “easily tricked” and used “observable science” in proving their sons’ ability…btw tho not as bright dont think i am easily tricked either.
[DNA say] compassion and science are not mutual exclusives
didn’t mean imply otherwise. NOTE: I used ms dawson’s term, “promotional science (PS)”. Science is beautiful…especially when practiced with compassion.
PS gives science a bad name. sad, it is practiced all too often…to prove/disprove whatever is being promoted/discredited for questionable motives…and many don’t always know the difference…none so blind as…
stanley seigler
“PS gives science a bad name. sad, it is practiced all too often…to prove/disprove whatever is being promoted/discredited for questionable motives…and many don’t always know the difference…none so blind as…”
Ah. That sort of science… yes indeed, it DOES discredit proper science. agree with that. Science tries to find out what works and what doesn’t. Does this by testing hypotheses. If the hypothesis cannot be supported, it is rejected. If the alternative hypothesis cannot be supported, then it is rejected. And that is what science is about… not proving anything or disproving it. It’s about finding out what works and what doesn’t.
@David N. Andrews M. Ed., C. P. S. E.
I largely disagree with your one-eyed view of Lovaas, (note: I’m not just blurting out “Wrong” with no explanation). His basic philosophy was that so-called ‘mental illness’ should not relieve a person of responsibility for their actions. Also, you have missed my point. I don’t defend Lovaas original methods, or the odd stupid statement he made when trying to explain his work (which can all be balanced by positive humane statements he made at other times during his very long career – we could trade Lovaas quotes endlessly). But I do appreciate that he was one of a small number of pioneers of research on how to teach autistic children, at a time when many of them were destined for institutions.
Do you also have a bee in your bonnet over Leo Kanner, who blamed Refrigerator Mothers for their autistic children? Kanner framed that theory, Bettelheim just picked it up and ran with it. Do we negate the contribution Kanner made because he caused immense pain to parents and recommended separating autistic children from their ‘inadequate parents’? Like Kanner, Lovaas was a product of his era, and the then predominant state of their respective fields of study. I also think you have conflated Lovaas with the generic blank-slate behaviorist strawman that appears in first-year psychology texts, and pop-psych books.
DNA said: “So it’s justified to slap a child on the ear as a means to ‘temporarily suppress unwanted behaviour so that the child can learn a more desired one’?”
I was describing the behavioral view of punishment, and the rationale used by Lovaas and Israel. Not condoning punishment at all. As you noted, punishment is not very effective, and it is wrong. Recently NZ removed the right of parents to use physical punishment; all the behavior analysts I know supported this very contentious legislation. Meanwhile, parents by the thousand signed a petition to repeal the amendment and have the right to beat their own children. I found it quite sickening.
DNA said: “I disagree. She is pointing out that those claims made then could only have been made on the basis of how Lovaas did it. Those claims are still the ones used when ABA-based ‘treatments’ are being suggested, despite the fact that later EIBI publications have claimed lesser – but much more honest – effectiveness, but without the use of aversives.”
You ‘disagree’ then restate my point? I don’t believe that Lovaas 1987 (and earlier work) should be included in reviews of EIBI, any more than Kanner’s theory on the cause of autism should be included in discussion of causes and triggers. Subsequent research has looked at the comparisons you criticize Lovaas for not investigating – follow up some of the references from the review I link to below if you are really interested.
Also DNA, could you please explain what you meant by “three major types of therapy at the time”.
Here is a technical review of ABA interventions for ASD that does not include Lovaas’ study at all. The review found strong evidence of beneficial effects in many skill domains for children with autism (but evidence for Aspergers was not available), and that beneficial effects generalized beyond the learning context, and were maintained after the intervention. It only considered studies up to 2007; higher quality studies of behavioral interventions are being published every year.
http://www.educationcounts.govt.nz/publications/special_education/61210/1
If you went to a school that didn’t use corporal punishment, then you were lucky.
Many others weren’t and still aren’t: http://www.time.com/time/nation/article/0,8599,1915820,00.html
The aversives Lovaas used in the 1987 study were: “[a] loud “no” and occasional slap on the thigh contingent on self-stimulatory, aggressive, and non-compliant behavior”, which is a hell of a lot less than I was given by my mother and teachers for the same behaviors.
As an AS adult, I think that EIBI would have been of limited value to me as a child – but social skills and self management training would have been of very useful. I am still tremendously resentful of the often excessive physical punishment I received for what we now know to have been AS behaviors, and also for my mother’s attempt to have me placed in a mental hospital ‘just for the school holidays’ when I was about 11 years old. I was extremely fortunate that my father’s family accepted my behavior as pretty much normal (for that side of the family – my parents divorced when I was very young).
Without the oversight of my father’s family, I dread to think of what ‘treatment’ I may have ended up with, so I am very sympathetic to AS skepticism and mistrust of EIBI. But, as the mother of a very high-needs autistic child, who used to be a non-verbal, self-injurious, randomly destructive, screaming-in-frustration, poo-smearing, repeat runaway, I am very glad that EIBI was available when we needed it.
“Do you also have a bee in your bonnet over Leo Kanner, who blamed Refrigerator Mothers for their autistic children? Kanner framed that theory, Bettelheim just picked it up and ran with it.”
I could have, but that RM theory was something that came out of his capitulation to his psychiatric peers at the time; he had the guts to admit being wrong (which makes him a better man than Bettelheim and – probably – Lovaas… I have no evidence that Lovaas ever apologised for his ‘errors of judgment’ – as I’m sure you’d have me see them).
“Like Kanner, Lovaas was a product of his era, and the then predominant state of their respective fields of study. I also think you have conflated Lovaas with the generic blank-slate behaviorist strawman that appears in first-year psychology texts, and pop-psych books.”
Actually, the psych texts I read as an undergraduate praised Lovaas. It was later on, during my postgraduate training in psychology that I found out the nastier stuff about his ‘therapy’.
“The aversives Lovaas used in the 1987 study were: “[a] loud “no” and occasional slap on the thigh contingent on self-stimulatory, aggressive, and non-compliant behavior”, which is a hell of a lot less than I was given by my mother and teachers for the same behaviors.”
And a lot of electrical shocks were administered using a similar device to that used by Matthew Israel … which I read about (in a pro-Lovaas article) about how Lovaas taught autistic kids to read. And why should self-stimulatory behaviours lead to punishment anyway?
“Also DNA, could you please explain what you meant by ‘three major types of therapy at the time’.”
Umm … at the time, there were the main three types: there was behavioural, humanistic and psychoanalytic – in many variants, admittedly. But they were not all tested in the Lovaas study – which means that he had no clue as to whether just ‘anything for 40hrs a week’ might have some potential as a therapy. Lovaas was bloody sloppy.
“But, as the mother of a very high-needs autistic child, who used to be a non-verbal, self-injurious, randomly destructive, screaming-in-frustration, poo-smearing, repeat runaway, I am very glad that EIBI was available when we needed it.”
Trust me, our child is autistic, and still has a lot of difficulties (even with a diagnosis of AS), and we have used a lot of behaviour analytic techniques… discrete trial, behaviour shaping, Premack and so on. But without the aversives that Lovaas’ 1987 study must have relied on to get that ‘47% recovery rate’ … unless, of course, his research was just so damn sloppy that it’s too hard to disentangle the problems that might have led to such a high rate – one that has never been replicated.
Don’t get me wrong… I have no problem with behaviour analysis. I prefer it much more than psychoanalysis. But I’m not the fan of Lovaas that I could have become had I believed what I’d read in undergraduate texts that looked at his work in a very simplistic way.
We’re never going to agree on Lovaas. I have my reasons for the way I feel about him, largely related to his ideas that one has to build a person inside an autistic child, and to his use of aversives … although this is mere antipathy compared to my feelings about Matthew Israel.
“Here is a technical review of ABA interventions for ASD that does not include Lovaas’ study at all. The review found strong evidence of beneficial effects in many skill domains for children with autism (but evidence for Aspergers was not available), and that beneficial effects generalized beyond the learning context, and were maintained after the intervention. It only considered studies up to 2007; higher quality studies of behavioral interventions are being published every year.”
Look … please… I do not need converting to the appreciation of behavioural techniques. I like them, and I use them. But Lovaas wasn’t even a behaviourist: he was a psychoanalyst using a paradigm that he really didn’t understand the implications of. Behaviour analytic techniques are very good as learning technologies. Absolutely. But as a means of making a person become something that they are not… forget that! That’s not what they are for.
We’re always going to disagree. This is stalemate. We should end this here.
Not much to add the ABA discussion, others have already made many of the points I would (tips hat toward David, Sharon, and McD).
But adding a few comments broadly:
“At that time, many schools were using corporal punishment we would consider barbaric today”
And that is a highly relevant point. During the time span Lovaas and associates were using physical aversives, regular ed kids were also being spanked in California in the schools. The culture toward it was different.
“I’d like to point out to Stanley here that science can indeed be practised compassionately”
Yes, but our sense of what is “compassionately” evolves. Who knows how our current actions will be seen in a generation? I am not arguing that we can behave obviously unethically right now. I am arguing that our sense of social ethics changes over time. Carl Sagan wrote about this very phenomenon ‘The Demon Haunted World’.
One of my good friends helped conduct physical aversive research in the 70s. When the culture shifted he let it go. That person and I have discussed the matter several times and I have never once heard him say we should go back to it. That places him way above veteran teachers I know who sigh at a child’s misbehavior and say we should “bring back the paddle”.
“He saw an empty shell inside which to build a person.”
He said he saw autistic children as a “virtual tabula rasa”. So I agree, but he had a lengthy career and he wasn’t always consistent on this matter. On other occasions it sure sounds like he saw autistic children as having a lack of adaptive behavior, which is different than a virtual tabula rasa. Also, his conversations with Michelle are incredibly fascinating to me. He seemed to grasp autism (or at least eccentricity) as a broad phenotype, one that has contributed meaningfully to culture and society.
I don’t dislike Lovaas any more than I hate dislike teachers who used spanking in the 70s. In fact I admire some of the things Lovaas did. I like how he wasn’t over concerned with diagnosis. This would be unconscionable today with the aggregation of real knowledge about autism. But his work was conducted in the 60s and 70s. One psychologist would say “autism” and the next would see the same child and say “childhood schizophrenic”.
Case in point; the book “One Child” details an American severe special education classroom in 1974. There is a 6 year old non-verbal girl with “Childhood Schizophrenia”. She is dumnfoundingly obviously autistic. Yet, the author goes on to detail all of her unmistakably schizophrenic behavior. Confirmation bias methinks.
“i quit asking for studies that prove long term success of ABA…anyone provide a link IDing a classic kanner (lo functioning, hate the term) autistic person…now a contented 40 yo thanks to ABA”
There was a study following up on Lovaas’ original study participants in 1993 by McEachin et al. The participants maintained their advances.
“Not much to add the ABA discussion, others have already made many of the points I would (tips hat toward David, Sharon, and McD).”
Actually, Interverbal is one of the behaviour analytic practitioners with whom I have had a number of interesting and enlightening conversations over the years, and found myself embracing the field more and more, as long as interventions are ethical. On this (and much else) I don’t feel I have any argument with Interverbal.
I should sleep. Got a lecture to present tomorrow afternoon, in Finnish, about 45km away from where I live. Had to learn all my science stuff in Finnish (not my native language).
[stanley say] i quit asking for studies that prove long term success of ABA…anyone provide a link IDing a classic kanner (lo functioning, hate the term) autistic person…now a contented 40 yo thanks to ABA…
[Interverbal say] There was a study following up on Lovaas’ original study participants in 1993 by McEachin et al. The participants maintained their advances
thanks, not sure this is the ref study…but the only one i found: http://findarticles.com/p/articles/mi_6884/is_1_7/ai_n28460870/
and/but its the CYA statements in it and many studies that cause concerns…eg, from the study:
“In addition to the impact of variables such as intensity, setting, or coordinator, research indicates that there may be other factors that are significantly related to outcome.”
and i know it’s impossible to find a cure/program/whatever that “scientifically” gurantees success…so scientists/salesmen should stop using soft science to prove/disprove programs…ms dawson should continue to beat the dead horse…
in my daughter case: probably was just getting older (maturing)…ie, other factors…skills gained thru ABA have been lost…however she is a relatively more content adult…reduced off wall behavior.
point (my opine): autism psychology cause/cure/programs is soft science…
“observational science” and “first do no harm” (by using or denying programs) should apply in spades…as;
[DNA say]It’s about finding out what works and what doesn’t.”…
for the individual.
stanley seigler
Thanks David,
Get some rest. I hope your lecture goes well.
@stanley seigler, the study is here:
http://www.ncbi.nlm.nih.gov/pubmed/8427693
You may also be interested in:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686987/
Hi Stanley,
McD beat me to the punch in providing the article citation.
“and i know it’s impossible to find a cure/program/whatever that “scientifically” gurantees success…so scientists/salesmen should stop using soft science to prove/disprove programs…ms dawson should continue to beat the dead horse”
(shrugs) I spent years discussing/debating Michelle on the TMotB board. She and others can beat on Lovaas (1987) all they want, provided they are accurately using science/history to do so.
I dislike it though when people argue that Lovaas (1987) was the first example of ABA research in the field of autism. And that the method preceded the research. I dislike this… because it is untrue. Read the references in Lovaas (1987).
Click to access Lovaas-1987.pdf
Also, read the long list of references I quote below, keeping in mind that I cherry picked only those articles that included punishment and that helped make my point.
http://interverbal.blogspot.com/2006/02/less-punishing-world-contradictions-in.html
“point (my opine): autism psychology cause/cure/programs is soft science”
I would be very interested in seeing an operational tool to sort out hard vs. soft science that you would be willing to share.
@Interverbal, just checked out your blog. You have compiled an excellent resource, Thanks heaps.
Stanley: “‘[DNA say]It’s about finding out what works and what doesn’t’…
for the individual.”
Which is why – if done properly – a behavioural approach is actually a good one; reinforcers can be an intensely personal issue … what might reinforce behaviour in one person may well run it into extinction in someone else, or at least be experienced as a punishment.
Time-out rooms (total misnomer, really) are a good example of this: to many kids, this would be a punishment by isolation (rather than true time out), but for an autistic kid it might actually be something that would reinforce problem behaviour (if the kid is sent there for engaging in problem behaviour… which would be the usual reason for using such a room).
Indeed – the individual needs aspect of autism makes a behavioural approach probably better than any single other approach; behavioural as part of a combined approach – even better.
Just my – possibly jumbled – thoughts on a Thursday morning after a poor night’s sleep.
I disagree David. Time-out rooms have an important place in any school. They are dead useful for storing boxes, supplies, and stacked tables and desks.
@Interverbal….
Bugger :S
I’d forgotten about that! Maybe they have some use after all….
thanks Interverbal and McD for links
[Interverbal say] I would be very interested in seeing an operational tool to sort out hard vs. soft science that you would be willing to share.
not sure of the question…but;
in my world, perhaps no one else’s: physics hard…and 90 years later HARD science is still proveing parts of general/special relativity.
psychology soft, as much art (different playing field than hard) as science…so i (as are other at the empty chairs and tables) am skeptical (nothing to do with lovaas) of soft scientific proof that programs work or don’t…of course;
there are beautiful (not sarcastic), friends, behavioral artists who conclude: “Thus, behavioral treatment ‘may’ produce long-lasting and significant gains for ‘many’ young children with autism.”…i agree.
may/many the operative words…perhaps didn’t read in detail but believe avg age of subjects was 11.5… http:/www.ncbi.nlm.nih.gov/pubmed/8427693…not very long term…buttbut better than a polk in the eye.
also consider tolstoy (thanks McD) that some/many: “can seldom accept the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have proudly taught to others”.
[DNA say] a behavioural approach probably better than any single other approach; behavioural as part of a combined approach – even better.
even better “yet still”: a compassionate therapist/friend who assumes competence, intelligent, and the innate ability many/most have to learn w/o formal education.
sad so few get these so deserved friends/programs/exposures in their lives.
stanley seigler
ps. the “stanley” link is not me (McD March 10th, 4:44:20)
“even better “yet still”: a compassionate therapist/friend who assumes competence, intelligent, and the innate ability many/most have to learn w/o formal education.”
Not totally sure on that. But I’ll say that there is definitely a need for any professional to be compassionate; this doesn’t mean that they should be very emotional, but they should be aware of what the practice of their profession will do (in terms of effects on people’s lives). Some level of training is necessary, so that they can determine whether what they are doing is working or not. But definitely compassion is necessary.
Hi Stanley,
“not sure of the question…but”
What I was looking for originally, was a way to tell what is hard vs. soft science; in your opinion. However, I believe I now better understand your views and respectfully withdrawal my request.
“there are beautiful (not sarcastic), friends, behavioral artists who conclude”
“even better “yet still”: a compassionate therapist/friend who assumes competence, intelligent, and the innate ability many/most have to learn w/o formal education.”
Based on the two quotes above and other comments, I think I finally understand your view (which you are very welcome to correct). You view psychology and related fields as pseudo-science. You contrast this with physics which you see as hard or actual science. As opposed to continuing to work in what someone like myself would label as autism science, you would prefer us to develop educational methods based on ethos and principals, such as are provided in your quote above.
I suspect that our views on education in general and autism in particular (or even how we establish basic facts about autism) are wildly different. I thank you for answering my questions and I have no further questions or comments for you.
[Interverbal say] “I suspect that our views on education in general and autism in particular (or even how we establish basic facts about autism) are wildly different.”
“Probably not”.
believe skinner said, “if it works, it’s good”…i do not draw a line in the scientific sand…my concern is when “basic facts” (hard/soft aside) are established to promote profits/ego vice truth.
we should know the difference; “first do no harm”; and repeating, know when we are dealing with those to whom tolstoy referred…
those that: “…can seldom accept the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have proudly taught to others”. (thanks McD…I hit the like button again)
thanks for the second thoughts.
stanley seigler
Stanley: “believe skinner said, if it works, it’s good’…i do not draw a line in the scientific sand…my concern is when ‘basic facts’ (hard/soft aside) are established to promote profits/ego vice truth.”
Not sure how or even if Skinner said exactly that but if he did, I think he’d have a very scientific approach to finding out if something works and, if it does, then how it might be working. Your point about ‘first, do no harm’ is the starting point for any sort of investigation of that sort. My opinion is that science is important for finding these things out.
I would absolutely say that following the scientific method will, if done ethically and compassionately, enable researchers and practitioners to abide well by that premise – the one you quote from the Hippocratic oath. If it isn’t followed, then the likelihood is that people will be harmed.
The scientific evidence is in on FC, like it is on the Rorschach, and on Rapid Prompting (at least to some extent), and many other things… including Lovaas’ variant of behaviour analytic therapy (although I’d prefer to call it a serious deviation from it). Behaviour analysts these days are more ethical on the whole, and can do their jobs without the inherent prejudice that Lovaas evidently brought to the field.
If Interverbal is correct in saying that “you would prefer us to develop educational methods based on ethos and principles”, then I agree with that approach, but I cannot see it being much use without subjecting it all to scientific inquiry. Because that way is really how we get the data that tell us if something works; because if it works, it’s good. Yes?
[DNA say] The scientific evidence is in on FC…
for you maybe…
[jim todd say (2/11):] In any case, I am pleased that at this point we see that pretty much everyone in the discussion has found a way to agree with at least one or two things everyone else has said–including Stanley, whose provisional recommendation of me for preliminary information about FC in a sticky legal case is truly appreciated, and who did have some points to make (although not about me or my students getting rich or applying behavioral techniques in the way Matt [israel, JRC] does.) For an FC discussion, this is a quite remarkable outcome that speaks to the possibility of additional thoughtful analyses of these issues.
http://www.science20.com/countering_psychology_woo_and_science_asds/facilitated_communication_price_too_high_pay-75597#comment-57928
you might want to consider “the possibility of additional thoughtful analyses of these issues” and the tolstoy quote, those that:
“…can seldom accept the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have proudly taught to others”. (sorry for the repeats, but gawd i like it)
and not sure what skinner said either (quote was from a book about not by him)…in any event FC works and is good.
we have been around the FC-bush several times…and i was told to “shut the hell up”…so i will not go around the FC bush again…
hard/soft science issues and others welcome…i am learning a thing or two about “establishing facts”, etc
stanley seigler
@stanleyseigler, I hope you read more than the Tolstoy quote in that paper. but I somehow doubt it.
The words you are putting in Skinner’s mouth sound like a warped version of his framing of positive reinforcement, which goes something like this. If a consequential stimulus increases a behavior, then it is positive reinforcement for that behavior.
So if a kid is disruptive in class, and the teacher slaps the child on the leg (the teacher is intending to punish the child), BUT the slap on the leg produces more disruptive behavior every time it is applied, the slap is actually positive reinforcement for the behavior. If the teacher responds to the child’s disruptive behavior by hugging the child, and the child then stops the disruptive behavior, the hug is actually punishment for that behavior.
Reinforcement or punishment is defined by its effect on behavior. In the example above, a slap was positive reinforcement, while a hug was punishment. I think that is the origin of the Skinner phrase you are looking for – basically if a stimulus increases a behavior then it is positive reinforcement.
“in any event FC works and is good.”
It hasn’t passed the tests that determine whether it works. My ex-wife and I are currently working with the Finnish national autism association to explain to them why blind acceptance of FC (and – for that matter – any method claimed to work with autistic clients; please, don’t think that I’m just like this about FC … I want all such things tested) … is bad.
I can understand why you want it to work and to be good. I’d have a hard time still – with all that I know about doing science – if I was in a situation where my autistic child didn’t speak at all. Personally, it’s Biklen I blame for all this. I certainly cannot blame you. You want the best for your daughter, and I can see that. I want to apologise for how I treated you before: I’d seen you as the ‘enemy’, and the work that I’ve been involved in recently regarding FC and those who promote it from a university background has shown me that you are not. I think you’re wrong in thinking that FC works (and I cannot, based on the science and the research into it, even come close to agreeing with you on that), but I respect you now for at least trying to do something for your child. I was wrong in how I treated you. And, for that, I am sorry.
[McD say] “I hope you read more than the Tolstoy quote in that paper. but I somehow doubt it.”
doubts confirmed…
[DNA say] “I am sorry.”
apologies unnecessary…too old to take anything personally…
such discussions are perhaps necessary in the search for truth…much is lost sometimes in more tactful discussions…but thanks for the kind words…
perhaps one day you will apologize to those who were denied the right to communicate.
stanley seigler
“but thanks for the kind words…”
Welcome.
“perhaps one day you will apologize to those who were denied the right to communicate.”
I don’t need to. I worked in research that was aimed at making communication possible for people who otherwise wouldn’t get to do so. I’d like to see Crossley and Biklen apologise to the many families that FC has placed unnecessarily in to court systems around the world and which have been split on the bases of false allegations made by facilitators … it’s at least as bad to ascribe to someone any communications that are not theirs as it is to deny people a chance to communicate.
I still agree that it is bloody important to put the welfare of the client first in everything we do, and that is what I do. My standards are high – they are based on science because that is exactly how we find out what does or doesn’t work, and oft-times how and why it works. And I stand by science as the arbiter of these issues, since without it, we just end up getting too emotionally messed up and see what we want to see rather than what is there. And despise those people who play on people’s emotions in that way. And to me (and many others) Biklen et al are just that sort of person.
My ex-wife and I are making the recommendation that FC not be outlawed – that would make it go underground (which would lead to even more rubbish being claimed on its behalf) – but that, if it is going to be used, then it should be tested regularly, frequently and thoroughly … and using science. Biklen et al’s portfolio approach is nothing but a guide to doing bad science and as such is telling people how to carry on ascribing to people communications that are not theirs. Biklen et al do not care about this. I do. I want anything that is touted as a means of helping autistic people to go through the same sort of testing. If it fails – be it FC, RP, or whatever – then it is not good because it does not work. That is how science works and that will never change.
I hope one day you’ll see what I mean.
[DNA say] to explain to them why blind acceptance of FC
in my case and daughter’s peers…it’s not blind acceptance…it’s living with it 24/7, for almost 20 years.
[DNA say] it’s at least as bad to ascribe to someone any communications that are not theirs as it is to deny people a chance to communicate.
well not sure as bad…as;
There are some in the field who see no harm in FC even if it’s the facilitator…they see the importance of the bond (daily, routine, interaction) between the friend (facilitator) and the person…and the resulting reduced behavior, improved life quality, issues.
[DNA say] I’d like to see Crossley and Biklen apologise to the many families that FC has placed unnecessarily in to court systems around the world and which have been split on the bases of false allegations made by facilitators
for the now FC-etal is not ready for prime time legal bs
Is your position based on the stupid court system that allows false allegations to be prosecuted unnecessarily even w/wo FC involvement…
Sad you are on the wrong side of history…FC-etal is more and more accepted…I know several who held your position who have changed…eg, a very intelligent person with aspergers who spent time with sue rubin (autism is a world) and is now a believer.
[DNA say] And I stand by science as the arbiter of these issues
maybe better to stand by individuals who communicate with FC-etal and/or bond between facilitator and person.
hate to say this as we have seem to be gaining a mutual respect…but (in my opine) you “do harm” with your anti-FC crusade…why the crusade?
if its the legal considerations issues…let the courts handle it.
stanley seigler
wow, your information about autism causes was so good it will must be helpful to the public.
wow, your information about autism causes was so good it will helpful to the public.