Autism intervention Early research Lovaas established the Young Autism Project clinic at UCLA in 1962, where he began his research, authored training manuals, and recorded tapes of him and his graduate students implementing
errorless learning—based on
operant conditioning and what was then referred to as
behavior modification—to instruct autistic children. Lovaas later coined the term "
discrete trial training" to describe the procedure, which was used to teach listener responding, eye contact, fine and gross motor imitation, receptive and expressive language, academic, and a variety of other skills. In an errorless discrete trial, the child sits at a table across from the therapist who provides an instruction (i.e., "do this", "look at me", "point to", etc.), followed by a prompt, then the child's response, and a stimulus reinforcer. The prompts are later discontinued once the child demonstrates proficiency. During this time, Lovaas and colleagues also employed physical aversives (punishment), such as electric shocks and slaps, to decrease aggressive and self-injurious behavior, as well as verbal reprimands if the child answered incorrectly or engaged in
self-stimulatory behavior.
1987 study In 1987, Lovaas published a study which demonstrated that, following 40 hours a week of treatment, nine of the 19 autistic children developed typical
spoken language, increased
IQs by 30 points on average, and were placed in regular classrooms. A 1993 follow-up study found that eight maintained their gains and were "indistinguishable from their typically developing peers", scoring in the normal range of social and emotional functioning. His studies were limited because Lovaas did not
randomize the participants or treatment groups. This produced a
quasi-experiment in which he was able to control the assignment of children to treatment groups. Lovaas' manipulation of the study in this way may have been responsible for the observed effects. The true efficacy of his method cannot be determined since his studies cannot be repeated for ethical reasons. A 1998 study subsequently recommended that EIBI programs be regarded with skepticism.
Literature reviews According to a 2007 review study in
Pediatrics, "The effectiveness of [EIBI] in [autism spectrum disorder] has been well-documented through 5 decades of research by using single-subject methodology and in controlled studies... in university and community settings." It further stated, "Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups." However, the study also recommended to later generalize the child's skills with more
naturalistic ABA-based procedures, such as incidental teaching and
pivotal response treatment, so their progress is maintained. Another review in 2008 described DTT as a "'well-established' psychosocial intervention for improving the intellectual performance of young children with autism spectrum disorders..." Three years later, it was found that the intervention is effective for some, but "the literature is limited by methodological concerns" due to there being small sample sizes and very few studies that used random assignment, and a 2018 Cochrane review subsequently indicated low-quality evidence to support this method. Nonetheless, a meta-analysis in the same journal database concludes how some recent research is beginning to suggest that because of the heterology of ASD, there are a wide range of different learning styles and that it is the children with lower
receptive language skills who acquire
spoken language from Lovaas' treatment. In 2023, a multi-site randomized control trial study of 164 participants indicated similar findings.
UCLA Feminine Boy Project In 1974, Lovaas and
George Rekers released the first in a series of papers associated with the Feminine Boy Project, a collective academic effort to formally develop conversion therapy (which consists of various discredited and abusive treatments intended to alter someone's sexual orientation, gender identity or gender expression to fit societal norms). The paper described the use of operant conditioning to force Kirk Murphy (then a four-year-old boy who was behaving in a traditionally
feminine way) to behave in a
gender-conforming manner. Lovaas and Rekers said in the paper that they hoped experimenting on Murphy would help them develop a method to prevent "adult
transsexualism or similar adult
sex-role deviation." Murphy died by suicide in 2003; some members of his family attributed the suicide to the trauma that he endured during the study. Despite one of the subsequent papers (which Lovaas did not co-author) concluding that the conditioning Murphy was subjected to changed his
sexual orientation from
gay to
heterosexual, his sister rejected that conclusion and claimed that Murphy "was conditioned to say that." After reviewing Murphy's journal entries, his sister described how he feared disclosing he was gay due to his father
spanking him for playing with dolls and exhibiting other gender non-conforming behaviors. Murphy's brother stated, "I saw my brother's whole back side bruised so badly one time, my dad should have gone to jail for it." In October 2020, the
Journal of Applied Behavior Analysis (JABA) issued an expression of concern about the Rekers and Lovaas paper, which they had originally published. In the expression of concern, the journal editors acknowledged that the study would have violated ethical standards if conducted at the time of writing, but claimed they chose not to rescind the paper because they did not believe the study violated the ethical standards of its time. In a note accompanying the expression of concern, the journal's editors said that the study did psychological harm to Murphy and his family, but claimed that his suicide could not be causally linked to the study. The editors also said that the study did harm to the
LGBTQ+ community by falsely validating the efficacy of conversion therapy, and stated that conversion therapy was not representative of the field of ABA as a whole. JABA's justification for not retracting the paper was rejected by some members of academia, including Arthur Kaplan, who founded the medical ethics division at the
New York University Grossman School of Medicine, and Austin Johnson, the director of the school psychology program at the
University of California, Riverside's Graduate School of Education. Johnson stated, "Rekers and Lovaas abused Kirk Murphy, a cisgender gay man who ultimately committed suicide in 2003. The words used and actions described in Rekers and Lovaas are abusive and shameful. They did not have value in 1974. They do not have value now. To comply with editorial guidelines and basic human decency, JABA must retract this paper." Johnson also pointed out that the treatment of Murphy had been contemporaneously labeled unethical by some of Lovaas' peers, including ABA researcher
Donald M. Baer, and that the
American Psychiatric Association had already depathologized homosexuality at the time the paper was published. == Awards and accolades ==