When it comes to educating children with autism, Mary Hanafin doesn't know what she is talking about, according to Geraldine Leader, Julian Leslie, Kevin Tierney, Olive Healy, Veronica Cullinanand Rita Honan, six leading professionals in applied behaviour analysis.
We are dismayed, but no longer surprised, by the Minister for Education and Science's justification ("Hanafin defends special needs education" - Irish Times, January 31st) for depriving so many children with a diagnosis of autism of the only scientifically validated treatment approach to autism, applied behaviour analysis (ABA), even when the parents are pleading for it.
Specifically, the Minister stated "ABA is a valuable teaching method but only one", and "it only teaches behaviour".
Here is some basic information to remediate the Minister's lack of understanding of this topic.
Applied behaviour analysis has been a science leading to evidence-based practice since its inception in 1968, and not a teaching method as Hanafin repeatedly states. The academic discipline of ABA is taught in universities nationally and internationally. Within the science of ABA, there are at least 500 different teaching methods and procedures based on over 60 years of scientific research.
Confusingly, the Minister states that ABA "only teaches behaviour". We presume she means that ABA-based methods can reduce serious challenging behaviours such as aggression, tantrums and self-injury. The principles of the science (such as positive reinforcement) are used to establish and increase skills that the child with autism does not perform.
In the most widely used ABA-based teaching strategy, every skill that the child with autism does not demonstrate is broken down into small steps and then carefully taught, using one-to-one teaching.
Teaching pre-academic skills (learning to learn), such as attending and imitation, is followed by language skills, which are of course of central importance to development. Daily living skills such as dressing, eating and toileting are also taught, as well as social communication.
Once sufficient progress has been made, the national curriculum is introduced as the child now has the pre-academic skills to access it. This paves the way for moving the child to small group instruction, and a gradual move to mainstream education supported initially by a classroom assistant.
A significant body of research has demonstrated that ABA can result in dramatic improvements for children with autism. If ABA is implemented early and intensively, up to half of children may achieve normal functioning. All children who receive early and intensive behavioural intervention make significant gains and can reach their potential, and this is the treatment of choice for children with autism.
In November 2007, the prestigious medical body the American Academy of Pediatrics published guidance for clinicians in this area. These guidelines, based on reviews of all the current available scientific literature, strongly recommend all the key features of ABA, and, inter alia, note that while ABA is well supported by research, the small number of studies that have compared it with an eclectic approach have found the ABA-based programmes to be significantly more effective.
It is also noted that the widely marketed PECS (picture exchange communication system) and TEAACH (training and education of autistic and related communication handicapped children) approaches include many features of ABA and thus should not be regarded as alternative approaches; in any case there is limited scientific evaluation of these methods.
The Department of Education claims that its approach follows "best practice". Best practice involves being guided by current scientific findings. It is clear that the department is not following best practice as it is ignoring this substantial body of scientific research.
The department also claims that it is following the findings of the 2001 task force. Two members of the task force, Maisie Dooley and Rita Honan (one of the authors of this article), have recently criticised the Minister's interpretation of this report. Dr Honan says she is continually stunned by Ms Hanafin's remarks that there is no "preferred" method for teaching children with autism.
"The unbiased literature reviews and related research of the task- force undoubtedly found that following the method of applied behaviour analysis was by far superior to other approaches. ABA was also consistently advocated by other bodies which had researched this same issue (eg New York, California, Canada)," she says.
Finally, the Minister believes that it is more beneficial to offer a child with autism "a range of methods and not just one method".
It does not follow logically that combining several therapies or methods is likely to be beneficial for young children with autism. Furthermore, children with autism often do not respond well to changes in routines, have substantial attentional difficulties, and learn best when instruction is consistent.
Eclectic intervention necessarily involves multiple transitions per day from one activity or therapy to another, and a great deal of variability in the way intervention is provided.
Thus eclectic approaches are not likely to produce meaningful benefits for children with autism, as has sadly been demonstrated by research to date.
The provision of medical care for children in Ireland is based on scientific knowledge; we think that the provision of education for children with autism is just as important and should also be based on science, not prejudice or inertia.
Dr Geraldine Leader is director of the master's course in ABA at the department of psychology, NUI Galway; Prof Julian Leslie is director of the masters course in ABA at the University of Ulster; Dr Kevin Tierney is director of the doctorate in clinical psychology course in Trinity College, Dublin; Dr Olive Healy is a lecturer in ABA at NUI, Galway; Dr Veronica Cullinan is head of the psychology department at Mary Immaculate College; Prof Rita Honan is director of the MA course in ABA at Trinity College, Dublin.