Early Intensive Behavioral Interventions (EIBI) are behavioral interventions that are widely used in the management of individuals with ASD. They are based on the Applied Behavior Analysis (ABA) model and, historically, they have relied on the Lovaas model (1981, 1987).
The foundation of the program developed by Ivar Lovaas is that a behavioral intervention can build positive behaviors and suppress unwanted ones. According to Lovaas, the younger the child, the more effective the generalized learning opportunity will be. This program uses the principles of operant conditioning: positive behaviors are reinforced while negative or aggressive behaviors are ignored (historically, these negative behaviours could have been punished using aversives but this has been criticized and is no longer used, Dixon et al., 2012). The reinforcers are external to the tasks being taught and pre-selected by the adult.
The main behavioral technique used in the Lovaas program is Discrete Trial Training (DTT), which consists of (Doehring, 2001) :
Progressively, the therapeutic team makes the tasks more complex. The goal of the program is to allow the child to progressively develop skills related to autonomy, receptive language, verbal and non-verbal imitation and to establish the basis for play. A key aspect of this program is teaching the child imitation skills. Once taught, imitation is used as a learning tool. As soon as the child has acquired certain skills, the goal is to help the child generalize these skills at home and then in a school setting.
Because many researchers were concerned that the highly-structured and adult-led environment proposed in the Lovaas program could result in an over-reliance on adults' prompts and limit children's ability to generalize learned skills to news contexts, both researchers and clinicians have worked to improve and expand the Lovaas program (Schreibman et al., 2015).
Influenced by the work of developmental psychologists, new EIBIs have placed more emphasis on child motivation. In these new approaches, the adult gives the child more control over the choice of materials and the initiative for interactions. Reinforcers are natural, that is, they are directly related to the success of the task. A wider range of responses is accepted and attempts, not only successes, are rewarded.
As in the Lovaas program, these new approaches encompass the fundamentals of ABA methodology (such as DTT), take a comprehensive approach to skills development, and maintain a quite structured environment to facilitate initiative. A prominent example of EIBI inspired by these new approaches is the early start Denver model (ESDM).
Currently, the critical components of EIBI involve the use of:
As it could be expected, the meta-analyses assessing the efficacy of EIBI included in this database focus on trials conducted among very young children with important cognitive difficulties. Despite differences in inclusion criteria across meta-analyses (e.g., some meta-analyses of EIBIs require that the duration of the intervention per week should exceed 10 hours per week, others 20 hours per week), all meta-analyses include clinical trials with a very long average duration (> 12 months) and with a very high average intensity (> 20 hours per week). In the database, the meta-analyses of EIBI included trials that srictly follow the Lovaas model as well as more naturalistic approaches (e.g., ESDM).