Talk:Discrete trial training

New citation

I for the life of me can not find the PMID for the Jennifer Elder citation. Pubmed has the journal and the person, but does not appear to have the article abstract itself. WLU 19:01, 23 July 2007 (UTC)

Move

I'm going to move the page to Lovaas technique - the current page name is out of keeping with WP:NAME. WLU (talk) 19:55, 24 March 2008 (UTC)

Lovaas technique

"Lovaas is a form of treatment guided by applied behavior analysis..."

"Lovaas was developed by O. Ivar Lovaas based on research performed by Lovaas and his assistants."

Are these recently made changes correct? I've never seen a research article in a journal refer to the Lovaas approach as simply "Lovaas". It's usually called the "Lovaas method," "Lovaas therapy," "Lovaas approach," or "EIBI". NighthawkJ (talk) 03:25, 26 March 2008 (UTC)

The article refers to the name Lovaas but never includes his entire name, nor has any hyperlinks to the Wikipedia article on Ole Ivar Lovaas. The first reference to "Lovaas" is in all caps, which would lead the naive reader to assume it's an acronym.drone5 (talk) 19:33, 7 January 2009 (UTC)

Recent reliable reviews

Someone with more time than I should rip out some of the lower-quality material here and rewrite it based on the following recent high-quality reviews instead:

• Howlin P, Magiati I, Charman T (2009). "Systematic review of early intensive behavioral interventions for children with autism". Am J Intellect Dev Disabil. 114 (1): 23–41. doi:10.1352/2009.114:23;nd41. PMID 19143460.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Reichow B, Wolery M (2009). "Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA Young Autism Project model". J Autism Dev Disord. 31 (1): 23–41. doi:10.1007/s10803-008-0596-0. PMID 18535894.
• Spreckley M, Boyd R (2008). "Efficacy of applied behavioral intervention in preschool children with autism for improving cognitive, language, and adaptive behavior: a systematic review and meta-analysis". J Pediatr. doi:10.1016/j.jpeds.2008.09.012. PMID 18950798.

Eubulides (talk) 20:27, 16 January 2009 (UTC)

Intelligence Citations Bibliography for Articles Related to IQ Testing

I see the article mentions IQ testing of children who were treated with the Lovaas technique. I have posted a bibliography of Intelligence Citations for the use of all Wikipedians who have occasion to edit articles on human intelligence and related issues. I happen to have circulating access to a huge academic research library at a university with an active research program in those issues (and to another library that is one of the ten largest public library systems in the United States) and have been researching these issues since 1989. You are welcome to use these citations for your own research and to suggest new sources to me by comments on that page. -- WeijiBaikeBianji (talk) 23:14, 2 July 2010 (UTC)

Speech/language use by people with autism

The article says, "As many as 25% of individuals with autism have no functional speech, the remainder typically display pronounced phonological and grammatical deficits in addition to a limited vocabulary.[6]" This seems very unlikely to be accurate from the current perspective that "autism" includes "Asperger's syndrome" and "high-functioning autism." Asbletera (talk) 00:33, 13 April 2015 (UTC)

circular link in cost of care section

The link to EIBI in the Cost section should probably be removed because the similar existing EIBI page name is just a redirect to this article. Apologies for not knowing enough wiki jargon to say that more clearly. ;-) Claudia (talk) 15:37, 18 December 2016 (UTC)

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Straw poll - merge?

Should this article content be merged to Ivar Lovaas where (per WP:NOPAGE) it might make more sense. Alexbrn (talk) 07:03, 11 October 2019 (UTC)

• No. I will make the BLP even more difficult to edit. Since there seems to be substantial disagreement about both detail and the basic question of effectiveness, it would be easier to deal with objectively keeping it here--and, if anything , removing some of the duplication from the bio. If he were the only one practicing it I might say differently, but he's not. (this is not my usual subject area--I came here from ANI) DGG ( talk ) 04:45, 13 October 2019 (UTC)
• No because one is about the psychologist who is a well-known researcher on the teaching methodology and the other is on the methodology itself which is being used by a number of other behavior analysts. ATC ^{. Talk} 19:03, 22 August 2020 (UTC)

Effectiveness

There is decades of research on DTT (mainly single-subject designs, but even some comparison studies, and three randomized control trials, though not the largest in sample size) that proves it to be effective, as outlined by the Surgeon General (1999; see pages 163-164 here: https://profiles.nlm.nih.gov/spotlight/nn/catalog/nlm:nlmuid-101584932X128-doc), National Research Council (2001), and American Academy of Pediatrics (2007), the latter of which also indicated it to be more effective than traditional speech therapy (see here: https://pediatrics.aappublications.org/content/120/5/1162 and https://pubmed.ncbi.nlm.nih.gov/30009626/). The Lovaas (1987) study did have some methodological limitations in that it was a quasi-experimental study (regardless, the Surgeon General called it "well-designed"), yet the results were reproduced in the American Journal on Mental Retardation in 2005 using a randomized control trial (https://pubmed.ncbi.nlm.nih.gov/16212446/), which showed 48% (Lovaas (1987) reported 47%) were the best outcome kids in terms of typical language, social, adaptive, and IQ scores, as well as successful mainstreaming into first grade (the first RCT replicated study in 2000 didn't reproduce such results because it was only done for 25 hours per week (see here: https://pubmed.ncbi.nlm.nih.gov/10934569/) whereas the 2005 study was 35 hours and the original 1987 study was 40).

Nonetheless, one study published in the Journal of Autism and Developmental Disabillities in 2013 (https://pubmed.ncbi.nlm.nih.gov/22733301/) showed that while children with ASD who have lower receptive language skills (aka the ones who get distracted and don't respond from naturalistic Mand (request) training) only learn speech from DTT, those with higher receptive language skills learn speech more rapidly from the less intensive, naturalistic play-based form of ABA (see natural language procedures and pivotal response treatment). More recent randomized comparison studies (the second of which was rather large in sample size) are even revealing that the vast majority on the autism spectrum have higher receptive language skills since they are learning speech faster from the naturalistic, play-based form of ABA (i.e., see: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194254/ and https://pediatrics.aappublications.org/content/144/3/e20190178). So, I don't know why there are some on here arguing against DTT's effectiveness as it is still an evidence-based practice like are all other ABA-based methodologies. ATC ^{. Talk} 19:22, 22 August 2020 (UTC)

User:ATC: According the Cochran (which is the highest quality source), evidence of the efficacy of this method is "low", and risk of bias is "high". That's not very good for an intervention that has decades of research behind it. Since there seems to be some disagreement between sources, we need to pay extra attention to the WP:MEDRS guidelines. In particular, the American journal of mental retardation is not Medline indexed. I'm going to go ahead and trim the sources that clearly fail MEDRS, including sources that are not reviews and the non-Medline indexed journals. Then we can continue this discussion with MEDRS sources. --66.244.121.212 (talk) 00:54, 26 August 2020 (UTC)

That's fine to trim down to the studies that meet WP:MEDRS guidelines. To add though, in a reliable 2007 review by Pediatrics—the official journal of the American Academy of Pediatrics, they state (https://pediatrics.aappublications.org/content/120/5/1162): "The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings. 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..."

User:Eubuildes sourced other reliable studies in an older section on this talk page in 2009, particularly:

• Howlin P, Magiati I, Charman T (2009). "Systematic review of early intensive behavioral interventions for children with autism". Am J Intellect Dev Disabil. 114 (1): 23–41. doi:10.1352/2009.114:23;nd41. PMID 19143460.{{cite journal}}: CS1 maint: multiple names: authors list (link): "At group level, EIBI resulted in improved outcomes (primarily measured by IQ) compared to comparison groups... This review provides evidence for the effectiveness of EIBI for some, but not all, preschool children with autism."
• Reichow B, Wolery M (2009). "Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA Young Autism Project model". J Autism Dev Disord. 31 (1): 23–41. doi:10.1007/s10803-008-0596-0. PMID 18535894.: "The findings suggest EIBI is an effective treatment, on average, for children with autism."

According a 2008 review study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943764/) in the Journal of Clinical Child & Adolescent Psychology, it states: "The only comparative study (Eikeseth et al., 2002) to examine effects of Lovaas's treatment compared to another approach—an eclectic treatment package delivered with comparable intensity—demonstrated statistically significant differences in change scores in favor of Lovaas's treatment. Given the strength of the findings from the four best-designed, controlled studies—Lovaas (1987); Smith, Lovaas, and Lovaas (2002); Eikeseth et al. (2002); and Cohen et al. (2006) (Eikeseth's and Cohen's studies also involved comparison with alternative treatments)—this treatment meets both Chambless et al. (1998) and Chambless et al. (1996) criteria as a “well-established” psychosocial intervention for improving the intellectual performance of young children with autism spectrum disorders, based on the significant increase in IQ reported in these four studies compared to control groups." ATC ^{. Talk} 02:27, 26 August 2020 (UTC)

User:ATC: I have major issues with the two sources you have cited. The first is not so much supportive as a mixed review, and even the second is only suggestive. Both are over ten years old, well outside the five year timeline recommended by WP:MEDRS for controversial issues. When the only study published in the last five years is a Cochrane review, we should be using that. Additionally, it is not proper to claim that the efficacy of the method has been demonstrated when it has not been demonstrated, only to follow that statement up with the contradictory review by Cochrane. --68.45.46.177 (talk) 23:55, 27 August 2020 (UTC)

This 1998 source you re-added to the O. Ivar Lovaas article is 22 years old. That goes against WP:MEDRS, and therefore, the 1998 study has no relevance to be sourced so I replaced it with the Cochrane review but I still don't think calling it "ineffective" based on this one review by Cochrane (2018) is as reliable as the review by Pediatrics and many other reviews that show it to be an effective intervention over the past several years. ATC ^{. Talk} 03:22, 28 August 2020 (UTC)

User:ATC: The claim made by the 1998 article (that supporters of this method regularly ignore evidence it doesn't work) is not a health claim, and is therefore not bound by MEDRS sourcing guidelines like the five year rule. However, the article was published in a medline indexed journal and there is no evidence that things have changed since 1998. The debunked 1987 study is still regularly promoted as proof that the method works, even here on Wikipedia by characters like User:ErikLovaas. This misinformation campaign is still going strong. With regards to these other studies you mention, were they published in the last five years? If you have such studies, you haven't shown them. But still it wouldn't matter-- Wikipedia regards no source as equal in reliability to a Cochran review published in the last five years. --66.244.121.212 (talk) 04:29, 28 August 2020 (UTC)

I further examined the Cochrane (2018) review and it states that it’s a “well-established treatment for autism”, there is “evidence” that it’s effective in increasing IQ, adapative functioning, and receptive and expressive language despite it pointing it out that there are some research design limitations and there needs to be larger sample sizes. You read that review wrong and I will be adding that info in this article and the Ivar Lovaas article later after I get out of work in a few hours. ATC ^{. Talk} 16:21, 28 August 2020 (UTC)

User:ATC: The review does say that there is evidence-- which is weak and at a high risk of bias. As for being established, this means that it is in use, not that it works. To say that the Cochrane review "found evidence" that this method works is to completely misrepresent the contents of the paper. I also see that you are still using non-MEDRS sources to push your views (even though I have asked you five times not to), including case studies and reviews that are more than five years old. --66.244.121.212 (talk) 22:29, 28 August 2020 (UTC)

Agree best to stick with recent high quality reviews. Once we agree on that we can than discuss how best to summarize them. Doc James (talk · contribs · email) 16:57, 31 August 2020 (UTC)

Hello again, ATC; it is always great to hear from you. I appreciate and respect your dedication to this suite of articles, and watching your growth as an editor has been inspiring. Thanks for asking me to respond, considering our long activity on these articles.

First, I would agree with IP 66 regarding the usefulness of the older studies cited by Eubulides. We have not seen an editor on the pages of Wikipedia who understands autism and the research on the topic as well as Eubulides did, but he has now unfortunately been gone for ten years, and it is likely that many things he once cited are no longer accurate or updated. When we get newer information, we should reflect it. Some times this may mean we need to delete outdated information in articles that becomes WP:UNDUE based on current knowledge. I agree with IP 66 on the lessened requirement for MEDRS compliance when reporting on historical statements (in other articles). I disagree that Cochrane is "the highest quality source" (although Wikipedia has tried to present it as such, with bias, because of a collaboration that exists between Cochrane and Wikipedia); Cochrane is among the high quality sources, but it does not stand alone in some special category above all other reviews.

So, we need to figure out what is current and to be presented as a balance of all sources. And we should be able to stick to high quality sources, because there are enough of them, even if we have to use older reviews because there are not enough newer reviews.

The article says now:

DTT is based on over fifty years research that shows it to be effective in enhancing communication and adaptive skills, as well as IQ scores for children with autism. However, these studies are of low quality research design and there is need for larger sample sizes.

The sources for the first sentence are from 2007, 2009, and 2008—all very dated. The sources from the second statement are from 2008 and 2018. That 2008 study said, "The effects of discrete trial learning are inconsistent across studies", and "There is limited and inconclusive evidence for various combinations of discrete trial training", and "The evidence seems to provide some support for discrete trial training in terms of motor and functional skills but not for communication skills". So, it appears that it was known in 2008 that there was not strong evidence for the method; that gives us some historical perspective. Based on that and the new 2018 review, our first sentence may be too strongly appearing to endorse this method with puffery and peacock terms.

The 2018 review says:

The results provide weak evidence that EIBI improves adaptive behavior and autism symptom severity. Analyses of our secondary outcomes also provide weak evidence that EIBI improves IQ, expressive and receptive language, everyday communication skills, everyday social competence, daily living skills, and problem behavior for this population. We rated the quality of the evidence as low to very low using the GRADE system (Guyatt 2008), which means that more research could very well change the effect estimate and our confidence that it is precise; therefore results should be considered with caution.

I don't find a lot of other newer reviews, but that could be because so many different names are used for this method. If there are newer reviews, perhaps you are aware of them and can provide them? Without more sources, my suggested wording would be something along the lines of:

There is inconsistent, low-quality evidence supporting DTT. Many years of research state that DTT is effective in enhancing communication and adaptive skills, as well as IQ scores for children with autism; a 2008 review states that there is "some support for discrete trial training in terms of motor and functional skills but not for communication skills". A 2018 review indicates there is weak evidence that the method "improves IQ, expressive and receptive language, everyday communication skills, everyday social competence, daily living skills, and problem behavior", but that these results should be interpreted cautiously because of the low quality of the evidence.

References

I've left off the "need for larger sample sizes" because it's true for just about everything. I've left off the "50 years" because it is puffery. Then, in terms of how to summarize this to the lead, I suggest something like: "There is inconsistent and low quality evidence supporting DTT." SandyGeorgia (Talk) 22:33, 31 August 2020 (UTC)

User:SandyGeorgia: Thank you very much for your well thought out input. I am the IP you mentioned, now returned as an account. Your opinions have been very useful, but there is still one more thing I would like to have your opinion on. This study finds that supporters of the methods overstate the evidence in favor of it, and regularly deny that such evidence has methodological flaws. The study is from 1998, but this is clearly still going on. Since claims of ignoring evidence are not health claims, MEDRS guidelines like the five year rule may not apply. Additionally, there is still evidence that this is going on to this very day. I think we should include a statement about how supporters of the study tend to overstate the evidence. --Wikiman2718 (talk) 22:45, 31 August 2020 (UTC)

Hi, Wikiman ... I am so glad you registered an account, as that makes communication so much easier! And welcome to Wikipedia; we are in desperate need of people to update autism content, since we lost Eubulides a full decade ago!

I can't endorse the idea of using a 1998 review to make statements of that nature. IF supporters are still doing that today, we should find at least a 2008, 2010, 2015, etc review saying that. If it is "clearly still going on", we should be able to find something a bit more recent that says that. I haven't read the entire Cochrane review, but you may find something along those lines in there that could be useful? Alternately, MEDRS compliance is reduced in Society and culture (see WP:MEDMOS), so you might find a laypress source that mentions the trend, and if it is a quality source (eg, New York Times), we could cite something to Society and cultural trends. Other than that, does the rest of my suggested wording suffice? 23:50, 31 August 2020 (UTC)

User:SandyGeorgia: Hey! Sorry about the confusion. I'm not actually a new user, but I'm sure you know that by now. Here is a Medline indexed review from 2006 that shows it is still going on, and here is a primary source from 2013 where the Lovaas Institute tries to claim that their method is proven. I know that they are still doing this because the current director of the Lovaas institute (Eric Lovaas) sometimes shows up on Wikipeida and tries to write that in his father's page. I have even heard this claim of "proof" in real life by a well-meaning mother who was trying to help her autistic son. It's a pretty common myth. Other than that, I'm pretty much in alignment with your position. I would like the article to say that the the quality of evidence is low, but proponents oven misrepresent the method as being "proven". --Wikiman2718 (talk) 00:24, 1 September 2020 (UTC)

I'm caught up now; seems I missed a step. "Still going on" is not satisfied with a 14-year-old review, and we can't draw our own conclusions from a primary non-independent source. I suggest it is more productive to work on the wording from the high quality sources we have, or to find other high quality recent sources. The way you have phrased what you "want" the article to say sounds like you want to push a certain POV. SandyGeorgia (Talk) 00:49, 1 September 2020 (UTC)

User:SandyGeorgia: I did one last dig and I pulled up a paper from 2017 This one says: " Once considered to be "scientifically proven", the efficacy of these approaches has been called into question in the last decade due to poor-quality data, small effects, low cost-efficiency, and the evolution of ethical and societal standards." This may be the angle we should use. I'll keep digging for more relevant stuff. --Wikiman2718 (talk) 00:59, 1 September 2020 (UTC)

@Alexbrn: what do you think of that source for the content proposed? It reads to me like on opinion piece; unsure if we should use it here, or how. SandyGeorgia (Talk) 02:57, 1 September 2020 (UTC)

User:SandyGeorgia: I don't mean to be rude, but its really not appropriate to analyze the sources in that way. It's a Medline indexed review from 2017, and it's not contradicted by any source of similar standing. It's also backed up by articles of equal quality from 1998 and 2008. How many of these things do they have to pump out before it's good enough for Wikipedia? It looks to me like they only get around to republishing this result about once per decade. Given these three reviews, plus Cochrane, I think it's time to declare that source which over-represent the evidence are advocating for a fringe viewpoint. --Wikiman2718 (talk) 03:06, 1 September 2020 (UTC)

Wikiman2718, I am noticing in these discussions that your AGF-ometer needs repair. The source you provided is not showing as flagged as a review for me on PubMed, but I am not getting along well with the new version of Pubmed, so I asked Alexbrn. I am unclear what they changed so that the type of article is not always flagged anymore, and this particular article reads like what is typically flagged as "Commentary" or "Editorial". And further, it is always appropriate for editors to come to consensus on how to use sources and how much weight to give them. Your response is not helpful in moving the discussion forward. What I did find more useful in that source was not its own conclusions/opinions, but what it stated about other entities, including links to papers and pages from those other entities, and I would like the opinion of an experienced editor about how we might best use the source. That is, an editor who will answer from a policy position rather than a sarcastic one, about which parts of the source we should use, how and where, and how much weight to give it, and others. ALWAYS matters for editor consensus. We very well may come to consensus that the older reviews are now fringe, but we just as well may come to consensus that a strong POV is being pushed here. Because the Cochrane review doesn't say what you want it to say, either. My suggestion is collaborative discussion rather than accusations and sarcasm: I, for one, have no pony in this race. SandyGeorgia (Talk) 03:41, 1 September 2020 (UTC)

Sandy, I fail to see how my last edit did not assume good faith towards you, but AGF should go both ways. I have shown no hostility to you. You say that the Cochrane review "doesn't say what I want it to say", but it clearly says that the evidence is "weak" and "at high risk of bias". This is my stance, also. Additionally, we have some sources that suggest there may be some fringe pushing going on from within the field. This is also relevant. It is one thing to consider whether or not the 2017 source is a review, but it is against guidelines to argue against a source because it reads like an opinion. We should be considering its status as a review, rather than how it reads. --Wikiman2718 (talk) 03:52, 1 September 2020 (UTC)

Your post expressed that others were trying to keep out your viewpoint rather than discuss and understand the sources ("How many of these things do they have to pump out before it's good enough for Wikipedia?"). You say the source you gave is a review: I told you I am not seeing how you came to that conclusion, while acknowledging that I am not getting along with the new way that PubMed flags articles, and in this case I'm not certain. That's where you're failing to AGF. And review or not, editors still come to consensus on how to use these conflicting sources, which are best sources, and how much weight to give to each.

Now, back on content: This is what you said you want the article to say:I would like the article to say that the the quality of evidence is low, but proponents oven misrepresent the method as being "proven". We know the quality is low/weak; that is established in multiple sources, and in the version I proposed above. It's pretty standard for many topics, and particularly within autism. Yet .. We don't have any source saying that proponents are promoting a fringe view. You want this article to say there is "fringe pushing going on from within the field", but you don't seem to have a source that says that. That, in Wikispeak, means you, too, may harbor a strong POV; you seem to have a strong view that this article should say more than what sources say.

Once/if we hear from Alexbrn, I will be happy to propose a merged version of a) what I proposed above, plus b) ATC's new review (below), plus c) your source saying that, "Once considered to be 'scientifically proven', the efficacy of these approaches has been called into question in the last decade due to poor-quality data, small effects, low cost-efficiency, and the evolution of ethical and societal standards." But all of those listed defects calling the efficacy into question are standard stuff for how medical knowledge changes and advances. Proposing text should get us a result quicker than throwing about accusations such as those at ANI and SPI. I will not get to this tomorrow, as I have a six-hour drive, and medical appt's the following day. SandyGeorgia (Talk) 04:18, 1 September 2020 (UTC)

Hi SandyGeorgia, glad to hear from you and thanks for your input! It states here in this other recent 2018 literature review [1] that “Greater improvement in IQ and adaptive behaviour is associated with greater intervention intensity (≥ 36 h per week)... About 19–30% of children receiving EIBI (vs 8.7% of controls) exhibit gains in IQ beyond that expected, due to random fluctuations in IQ performance (Eldevik et al., 2009; Eldevik et al., 2012). These children, likely to reach age-expected IQ and/or adaptive functioning during the study, met Sallows and Graupner’s (2005) criteria for rapid learning (Eldevik et al., 2009). Sallows and Graupner (2005) cautioned that even rapid learners may show uneven rates of development across developmental domains, such as improving more in the cognitive than social domain. Based on a meta-analysis, ~20% of children receiving EIBI (vs 5% of controls) exhibit reliable gains in adaptive behaviour (Eldevik et al., 2009)... EIBI, usually delivered in a 1:1 instructional format, is an effective intervention approach for many children. The comprehensive skill sets targeted by EIBI may contribute to cognitive gains.” ATC ^{. Talk} 03:18, 1 September 2020 (UTC)

Yes, but the devil is in the detail :) They also conclude that there are limitations in the research: Considerably more high quality research, particularly with large sample sizes, is needed ... In the meantime, NDBI, EIBI/ABA, and aided AAC interventions are efficacious. So, as in my proposed text, it is inconsistent, with low-quality evidence. We could add this to the supportive reviews, but Wikiman2718 wants these views declared "fringe"; for that, I am as yet unconvinced. Neither "side" has a strong case here; I hoped that my proposed text met in the middle. SandyGeorgia (Talk) 03:49, 1 September 2020 (UTC)

Sometimes, to meet in the middle makes WP:FALSEBALANCE. When we have studies that find that one side is misrepresenting the evidence, it may not be appropriate to meet in the middle. It looks like this study returned a somewhat similar result to the others-- the evidence is weak, inconsistent, and at risk of bias. --Wikiman2718 (talk) 04:03, 1 September 2020 (UTC)

We've already ceded that the evidence is low/weak/inconsistent. You have not provided a source that "one side is misrepresenting the evidence", which is quite different from routine methodological issues. I will propose text when I have time, probably in a few days, unless Alexbrn weighs in before then. SandyGeorgia (Talk) 04:21, 1 September 2020 (UTC)

In fact, I did show such a source. The 1998 study found that "Based on rebuttals to criticisms of their program, the EIP authors seem unwilling to admit any methodological flaws in the sampling, design, and analysis of data of the EIP." You asked for evidence that this was still going on, and I showed you the studies from 2006 and 2017 that found that it was never actually proven like supporters said it was. Those two studies didn't explicitly advocate that the data was being intentionally misrepresented, only that it was wrong. But either way, there is clear evidence of bad science here. --Wikiman2718 (talk) 04:31, 1 September 2020 (UTC)

References

Yes, we've got those points. We agree then that we can't pretend "fringe" or "intent"; just evolving science and improving knowledge? If we agree on that, then we should be a good way towards proposed text, as I outlined above. I won't be proposing use of 1998 or 2006 sources, though. SandyGeorgia (Talk) 05:07, 1 September 2020 (UTC)

I can settle for that. I personally think that there is intent, but the sources which show that are not as good as those for the weaker argument of "bad science". I would settle for including some text about how the method used to be represented as "proven" by proponents, but is now known not to be. We don't have to imply malfeasance. We should also acknowledge that there are ethical issues at hand (per the 2017 study), and that there have been no studies on how this method effects quality of life (per Cochrane). We should also remove the image that claims to demonstrate increase in IQ, as this increase in not well supported by evidence. --Wikiman2718 (talk) 07:23, 1 September 2020 (UTC)

• PMID 28181042 is classified by PUBMED as a review, though as a single-author narrative review it's a comparatively weak source. I have long purged this suite of articles from my watchlist, but as I recall there was a push to have this area classified as FRINGE at FT/N which didn't get very far. While it may be fair to think many interventions in this space are generally discredited, Wikipedia needs to be careful not to tip over into WP:RGW-ism (and of course this stuff is meat and drink for sensational stories in the popular press). This is a topic area where WP:TONE's recommendation that language be "used in a businesslike manner" is usefully borne in mind, I think. Alexbrn (talk) 06:44, 1 September 2020 (UTC); amended 14:30, 1 September 2020 (UTC)

• Thanks so much, Alexbrn. If I can trouble you with (only :) three more things. Since PubMed changed its format, I don't always see the Review flag. Where do you see a classification as this as a review on their new system? Second, User:Eyoungstrom, a psych professor, has impressed upon me that not all good psych journals are indexed; do you agree? He says that psych topics may often use non-Pubmed-indexed journals. Not sure I feel comfortable with that. Third, if I propose some text, working in everything usable that both "sides" want above, will you watchlist to review it? I would appreciate more eyes because of the controversy. RGWism would have Wikipedia fixing all of the dated science; not our job. We just need to summarize, and recognize areas of controversy. I probably can't get to this for a few more days. Best, SandyGeorgia (Talk) 07:16, 1 September 2020 (UTC)

• @SandyGeorgia: Yes, the new PUBMED format is a pain. In this case I had my habitual search filter in effect (Reviews and Systematic Reviews) and when I searched for the journal title, this journal still showed up with a note this filter was in effect. Surely there must be a better way though? I'm not sure about PUBMED-indexing: if a source was discussing something like proposed intervention efficacy I would like to feel confident it was high-quality - but I'm not familiar with the world of psychology sourcing! I have now watchlisted this article and will be happy to help if I can ... Alexbrn (talk) 07:31, 1 September 2020 (UTC)
• (add) I've been digging around to see if we can broaden the sourcing here, and found from NICE this 2016 clinical guideline (from Scotland) to give us a strong MEDRS. It has a nice overview of the topic space of intensive behavioural intervention for autism, and while issuing a caveat about proper training, has a recommendation that DTS "be considered". So maybe this intervention is not quite so discredited as I thought it might be, in the best sources. Alexbrn (talk) 09:19, 1 September 2020 (UTC)
• (add) Sorry, but it seems I wrong about PMID 28181042 being a review. If we look at the actual PUBMED record[2] PUBMED only categorize this as a "journal article", and in print the journal itself calls it an "original contribution". So it's not a review, more of an opinion piece. The PUBMED search filter seems not to be returning expected results, so cannot be relied on (as I did). I would be wary of using this source when we have much better. Alexbrn (talk) 14:30, 1 September 2020 (UTC)

Fringe?

To get an authoritative take on the specific question of whether this is fringe or not, I consulted (in hard copy):

• Scherr JF, Kryszak EM, Mulick JA (2019). "Chapter 3: Autism Spectrum". In Hupp S (ed.). Pseudoscience in Child and Adolescent Psychotherapy. Cambridge University Press. p. 28-49. ISBN 978-1-316-62695-5.

and while it identifies some concepts as pseudoscience (e.g. Cold mothers & Facilitated communication), the field of ABA – of which DTT is part – is explicitly not one of them. To quote:

Applied behavior analysis (ABA) has well-established success and has documented its effectiveness in treating individuals with ASD for more than 50 years

The authors quote Richard M. Foxx [3]:

ABA has no place in any discussion of fads or pseudoscientific, dubious, or controversial and politically correct treatments other than to epitomize what constitutes effective and ethical treatment of individuals with ASD.

I trust this puts the fringe question firmly to bed. Alexbrn (talk) 09:39, 1 September 2020 (UTC)

It may not matter, as we appear to be in the middle of reaching a compromise, but the field of ABA is most certainly not fringe. However, it does have fringe elements. For example, early attempts at gay conversion therapy came out of that field and are now debunked. Some still use them. The JRC's GED treatment also came out of that field. It was being used long after it was debunked, and never really had good evidence to support it in the first place. That didn't stop the center from claiming that it was a highly effective proven treatment with "no side effects". The question is not whether ABA is fringe, but of whether this particular ABA intervention (EIBI) has a group of fringe supporters that routinely deny evidence that it is unproven, and promote it as proven anyway. My stance is that it does. --Wikiman2718 (talk) 13:19, 1 September 2020 (UTC)

Many medical treatments have been misapplied at one time or another; that does not necessarily reflect on the treatment itself, but on those perpetrating the misapplication. In general, it is best to find what the WP:BESTSOURCES say and summarize that dispassionately, rather than to approach the topic with a stance. The good sources I am looking at on this topic do not mention the "JRC" or "GED treatment" (which seem to be something controversial in America, a land of many weirdnesses). Alexbrn (talk) 13:36, 1 September 2020 (UTC)

I discussed above, I have already shown three such sources. Let’s not repeat old discussions. —Wikiman2718 (talk) 14:34, 1 September 2020 (UTC)

Not sure which 3 you mean. I'd say the two really good MEDRS sources we have so far are the Cochrane Review and the Scottish National Clinical Guideline. It would be good to find more of that quality. Alexbrn (talk) 14:41, 1 September 2020 (UTC)

User:Wikiman2718, SandyGeorgia already pointed out that 1998 study is long outdated, the 2006 review you just purposed she made clear is old as well, and she and Alexbrn mentioned that 2017 review study reads more like an opinion piece. And you seem to want this article and the Ole Ivar Lovaas article to write towards your “POV” and to use unreliable media sources (i.e., Life Magazine, Forbes, Mother Jones, Guardian, Neurodiversity.com, etc.) to justify your claims for the latter Wikipedia article as well. ATC ^{. Talk} 16:07, 1 September 2020 (UTC)

User talk:ATC: That statement is about 10% accurate. I have tried at Talk:Ole Ivar Lovaas to explain these things to you so many times that I just don't see how once more will help. --Wikiman2718 (talk) 00:08, 3 September 2020 (UTC)

User:Alexbrn: Are we also going to cite the 2019 Cambridge University Press review you provided, in addition to the Cochrane Review and the Scottish National Clinical Guideline? Further, I’m not quite sure how “fringe” is being used here, but should we incorporate SandyGeorgia’s initially purposed wording or write that DTT is an evidence-based practice? How would you purpose the wording of the article if different from SandyGeorgia’s? ATC ^{. Talk} 17:49, 1 September 2020 (UTC)

User:SandyGeorgia and User:Alexbrn: By the way, I just found these two studies: 2019 Journal of Autism & Developmental Disorders [4] that states: "Early intensive behavioral and developmental interventions, such as applied behavior analysis treatment addressed in this Medical Progress, have shown benefits in some children with ASD" and 2016 Journal of Pediatrics [5]: "The evidence for the long-term effectiveness of applied behavior analysis (ABA) in the treatment of autism spectrum disorder (ASD) is vast (Foxx 2016). Individuals with ASD have been educated and treated using ABA for more than five decades (Ferster and DeMyer 1961, 1962; Lovaas et al. 1965; Wolf et al. 1964). Ten years ago, there were more than 1000 peer-reviewed scientific articles documenting ABA successes in autism (Foxx 2008), and that number has grown exponentially since (Volkmar 2015). Specific ABA interventions are considered evidence-based practices (EBPs) in autism (National Autism Center 2015; Peters-Scheffer et al. 2011; Schreibman et al. 2015; Smith 2001, 2013; Wong et al. 2015) and have been socially validated (Callahan et al. 2008, 2017). ... (for example, while using established EBPs such as DTT and functional analysis)..." ATC ^{. Talk} 02:18, 2 September 2020 (UTC)

@ATC: Right, so the citations for those sources are:

• Callahan K, Foxx RM, Swierczynski A, Aerts X, Mehta S, McComb ME, Nichols SM, Segal G, Donald A, Sharma R (September 2019). "Behavioral Artistry: Examining the Relationship Between the Interpersonal Skills and Effective Practice Repertoires of Applied Behavior Analysis Practitioners". J Autism Dev Disord (Review). 49 (9): 3557–3570. doi:10.1007/s10803-019-04082-1. PMC 6707962. PMID 31127484.
• Roane HS, Fisher WW, Carr JE (August 2016). "Applied Behavior Analysis as Treatment for Autism Spectrum Disorder". J. Pediatr. (Review). 175: 27–32. doi:10.1016/j.jpeds.2016.04.023. PMID 27179552.

On the face of it, they look the Hoare source looks useful! Alexbrn (talk) 05:41, 2 September 2020 (UTC); amended 23:15, 3 September 2020 (UTC)

Alexbrn I'm trying to read through and sort what we have ... how do you conclude that Callahan is a review? Back after dinner, SandyGeorgia (Talk) 23:02, 3 September 2020 (UTC)

By mistake! Looking at the record[6] I see it is not so categorized. I have amended my comment, sorry! Alexbrn (talk) 23:20, 3 September 2020 (UTC)

User:Alexbrn: ABA is not the same as EIBI. Please try not conflate the two. And let's not try to bring the national policy of Scotland into play here-- that cherrypicking and it's utterly ridiculous . --Wikiman2718 (talk) 03:24, 2 September 2020 (UTC)

I'm not proposing to conflate anything, although I'm seeing different sources categorize the concepts in this area differently and think we may need to discuss that. The Scottish document is a recent national clinical guideline (i.e. topmost MEDRS) and makes a specific recommendation with regard to DTT, so is completely apt for this article. Alexbrn (talk) 04:19, 2 September 2020 (UTC)

Actually, you did just propose exactly that when you said those articles about ABA put the fringe question "firmly to bed". As for the Scottish thing, can you show that other countries are making similar recommendations? Because if you can't, I stand by my claim of cherry-picking. --Wikiman2718 (talk) 21:56, 2 September 2020 (UTC)

Yes, the fringe question is settled in RS, as this entire field is explicitly not fringe. This has previously been discussed/decided at WP:FT/N also, so it's probably time to drop that particular WP:STICK. As to cherry picking, that means being selective of content within the same source (see WP:CHERRYPICKING). Scotland's source is good for reporting Scotland's guidance. A national guideline is an important, good quality source: see WP:MEDORG. We don't say we can't report on the FDA unless we find "other countries" than America with the same position. It would however be good to find other national guidelines in this area. Do any such exist? The goal in this source-gathering phase is simply to find the WP:BESTSOURCES, not to try a spin a result a priori. Alexbrn (talk) 02:44, 3 September 2020 (UTC)

Are you claiming that gay conversion is not fringe? Because that was aba. Are you claiming that the GED was not fringe? Because that was ABA. Claiming that a DTT cannot be fringe because it arose from ABA is like claiming that cold fusion cannot be fringe because it arose from physics. --Wikiman2718 (talk) 02:57, 3 September 2020 (UTC)

I'm pointing out what the source says. Its considerations are specific to autism. DTT is synonymous with ABA, according to Spreat (as we cite). Alexbrn (talk) 03:13, 3 September 2020 (UTC)

You mean the source that says "Applied behavior analysis (ABA) has well-established success and has documented its effectiveness in treating individuals with ASD for more than 50 years"? Because that is exactly the kind of promotional claim that I have previously shown is not true. --Wikiman2718 (talk) 03:19, 3 September 2020 (UTC)

The goal at the moment is to gather sources, not prejudge what they say. It appears so far there is a degree of alignment in agreeing this can be a beneficial intervention, though a spectrum of confidence about how strong the evidence is. Are there any more sources we've missed? - I've been searching for book sources ... Alexbrn (talk) 03:34, 3 September 2020 (UTC)

Medical textbooks aren't worth as much in a rapidly changing field. We all know how good they are at staying up too date. Given your recent statement that DTT is synonymous with ABA for autism (which I am inclined to agree with) I need some more time to dig. Then we can look at the sources one-by-one and consider what each of them is good for. Let it be known that the fringe argument is still alive. --Wikiman2718 (talk) 22:22, 3 September 2020 (UTC)

Hey User:Alexbrn, I just wanted to point out that a common misconception is that ABA is synonymous with DTT (pivotal response treatment is another evidence-based form of ABA used as an autism early intervention as well). DTT is one form of ABA commonly used as an autism early intervention but ABA is just the application of B.F. Skinner’s behavior analysis/radical behaviorism (most of which uses operant conditioning techniques but includes respondent as well) to change behavior and to understand the reasons for that change so that source made an error. Although the professional practice of behavior analysis is most widely used as a treatment for autism, ABA is researched and shown to be effective in a broad array of other subfields, i.e., applied animal behavior, organizational behavior management, voucher-based contingency management for substance abuse, pediatric feeding therapy, schoolwide positive behavior support, contact desensitization for phobias, counseling (clinical behavior analysis), behavioral gerontology, and much more! ATC ^{. Talk} 16:21, 3 September 2020 (UTC)

As I mentioned above, the sources seem to be inconsistent, with the 2012 Spreat source explicitly saying ABA is an alternative name for DTT. Maybe this is something that changed over time, or is just not settled. Maybe it's an example of synecdoche. Still, Wikipedia probably needs to decide how to categorize things - the way the Cochrane article defines things seems very clear - in my understanding they say ABA is a broad field, and DTT (from that field) is a technique within the multi-part treatment regime of EIBI. Alexbrn (talk) 16:33, 3 September 2020 (UTC)

break

Just found another recent reliable source:

Hyman SL, Levy SE, Myers SM (January 2020). "Identification, evaluation, and management of children with autism spectrum disorder". Pediatrics (Clinical Report). 145 (1). doi:10.1542/peds.2019-3447. "Most evidence-based treatment models are based on principles of ABA... ABA interventions vary from highly structured adult-directed approaches (eg, discrete trial training or instruction, verbal behavior applications, and others) to interventions in natural environments that may be child led and implemented in the context of play activities or daily routines and activities and are altered on the basis of the child’s skill development (eg, pivotal response training, reciprocal imitation training, and others). To determine what intervention is most appropriate, the behavioral clinician works with the family and child to determine which skills to target for development and maintenance and what goals are appropriate... A comprehensive ABA approach for younger children, also known as early intensive behavioral intervention, is supported by a few randomized controlled trials (RCTs) and a substantial single-subject literature. When only RCTs are considered, few interventions have sufficient evidence to be endorsed either for children younger than 12 years or for adolescents. Children younger than 12 years receiving more hours per week of ABA were found to be more likely to achieve the individualized goals identified in their programs. In retrospective studies, more intense ABA therapy was associated with achieving optimal developmental outcomes." ATC ^{. Talk} 21:59, 2 September 2020 (UTC)

"When only RCTs are considered, few interventions have sufficient evidence to be endorsed" --Wikiman2718 (talk) 22:44, 2 September 2020 (UTC)

User:SandyGeorgia and User:Alexbrn, while it's important to source and reflect on the Cochrane Review, I think we should explain the reason it said the evidence is low-quality (very few RCTs, small sample sizes—which, on average, the largest sample sizes were between 10 and 19 in the experimental group) and that was the criteria they were judging it on despite the years of research showing it to be effective in reliable peer-reviewed journals. Further, I think a discussion should be brought on the talk page of WP:MEDRS reflecting upon this review study (below) with regard to the effectiveness of non-drug treatments, particularly clinical and educational interventions, where RCTs shouldn't necessarily be the dominant focus of reliable sources on Wikipedia if the intervention (i.e., EIBI/DTT, etc.) is published in a number of peer-reviewed journals that show it to be effective and the studies were designed based on the scientific method and through precise, accurate data collection. Because you do also need to design the study different ways to test different variables, and from what I have read on WP:MEDRS, they seem to write that RCTs are favored. ATC ^{. Talk} 00:25, 3 September 2020 (UTC)

Keenan M, Dillenburger K (2011). "When all you have is a hammer …: RCTs and hegemony in science". Research in Autism Spectrum Disorders (Review). 5 (1): 1–13. doi:10.1016/j.rasd.2010.02.003.

So basically, the evidence is low quality (and at high risk of bias). This is with fifty years of research. Are these people incapable of designing a good study? Because it seems like if they were, they would have done it already. --Wikiman2718 (talk) 02:05, 3 September 2020 (UTC)

Throughout the early 2000s, the controlled comparison studies conducted were supposed to be randomized but IDEA only funded 25 hours per week at the time, so the families had a choice: to pay the remaining 40 hours by taking part in the experimental group or be involved in non-ABA based eclectic treatments in the control group, and each of those studies showed that DTT outperformed non-ABA based eclectic treatment. That's why there have only been 3 RCTs (all of which showed the kids made substantial progress in their language, IQ, adaptive functioning, etc.) because it's so expensive that many school districts refuse to pay. Although IDEA recently started funding up to 40 hours per week, families would still have to pay for an attorney to win a law suit against their school district to receive such services from the US Department of Education, so the insurance companies are now funding EIBI services. ATC ^{. Talk} 02:25, 3 September 2020 (UTC)

That explains why there's not good evidence, but it doesn't help your case. It also fails to explain why they (used to) go around claiming that it was "proven" when it's not. --Wikiman2718 (talk) 02:30, 3 September 2020 (UTC)

It's evidence-based because each of those study's results section shows through the data collection that DTT (and other ABA interventions) works (even though sensory integration training states that it works through dozens of RCTs, the results section is not based on accurate data collection; rather, they are based on parent opinions that it works, which makes those studies on sensory integration training unethical). ATC ^{. Talk} 02:36, 3 September 2020 (UTC)

Once again, a reminder to please stay on topic and focus on content, so that we can more quickly determine what sources we want to use and what the text will say. I have a couple of things still to finish up, and then plan to come over here to summarize the potential sources. If we can agree on sources first, we can move on to developing text from those sources. Statements like So basically, the evidence is low quality (and at high risk of bias). This is with fifty years of research. Are these people incapable of designing a good study? Because it seems like if they were, they would have done it already. and That explains why there's not good evidence, but it doesn't help your case. It also fails to explain why they (used to) go around claiming that it was "proven" when it's not. do absolutely nothing to further the construction of text here on a consensus-based model, and are unproductive and unhelpful. We have already established that evidence is low quality; beating dead horses and inserting sarcastic personal opinions only fills the talk page unnecessarily, making it harder to engage. When I try to catch up here, will I have to read through volumes of unconstructive commentary? Please focus on sources. I should be able to get back in here soon, and hopefully our next step will be to focus in on what sources we will use. I see another emerging issue is the scope of this article; since ABA has its own article, it is my opinion that we should stay strictly focused here on DTT as a subset. Am I wrong? SandyGeorgia (Talk) 18:37, 3 September 2020 (UTC)

I think you're right - but we need be clear in the lede that, for the purposes of this article, we are describing DTT as a specific technique within the field of ABA, because some sources appear to use the term more loosely. Alexbrn (talk) 18:41, 3 September 2020 (UTC)

User talk:SandyGeorgia: Those statements do push the argument forward when consensus is defines as the aggregate of reliable sources. And please follow your own advice of discussing sources, not editor behavior. --Wikiman2718 (talk) 22:35, 3 September 2020 (UTC)

I have found this 2015 literature review update of Rogers & Vismara (2008)'s review that I think we can add for historical context:

Smith T, Iadarola S (October 2, 2015). "Evidence-base update for autism spectrum disorder". Journal of Clinical Child and Adolescent Psychology (Review). 44 (6): 897–922.: "As already mentioned, Rogers and Vismara (2008) classified the Lovaas model as a well-established treatment. Four subsequent quasi-experimental studies on this model met our criteria for inclusion in Table 4 (Eikeseth, Klintwall, Jahr, & Karlsson, 2012; Eikeseth, Smith, Jahr, & Eldevik, 2007; Eldevik, Hastings, Jahr, & Hughes, 2012; Peters-Scheffer, Didden, Mulders, & Korzilius, 2010). One study (Eikeseth et al., 2007) was a follow-up of a report reviewed by Rogers and Vismara (Eikeseth, Smith, Jahr, & Eldevik, 2002). All studies indicated that the Lovaas model has large effects on IQ, adaptive behavior, or both (Table 4)... Of concern, however, the only study that examined changes in ASD symptoms and problem behavior (Peters-Scheffer et al., 2010) found that EIBI had little effect on functioning in these domains. In addition, all of the findings from recent studies must be viewed with caution because they were obtained in quasi-experimental rather than experimental studies... At the time of the previous review (Rogers & Vismara, 2008), most group studies centered on a single treatment, the UCLA/Lovaas model of individual, comprehensive ABA. This intervention continues to have stronger empirical support than other comprehensive treatments." ATC ^{. Talk} 16:45, 8 September 2020 (UTC)

Scope

I attempted a hatnote here to define the scope of this article, but I suspect it can be improved. SandyGeorgia (Talk) 20:47, 3 September 2020 (UTC)

Actually, that's a point of controversy. Alexbrn claimed that discrete trial training is synonymous with ABA for autism, which may be true. We should discuss that here. --Wikiman2718 (talk) 22:24, 3 September 2020 (UTC)

That's why I started a separate section here; as I understood it, Alex asked that we clearly define the scope. Perhaps I misunderstood. SandyGeorgia (Talk) 22:25, 3 September 2020 (UTC)

Yes, the sources aren't aligned, so we must be clear how we are using the terms, to avoid confusion. Alexbrn (talk) 22:29, 3 September 2020 (UTC)

I see now. It looks like some sources claim that they are equivalent, and others not so much. This is a real headache. I guess that best thing to do now is to just start listing them. --Wikiman2718 (talk) 22:30, 3 September 2020 (UTC)

I suggest that the best thing to do is to make sure this article is focused exclusively on DTT, because we have an ABA article. More importantly, the dispute resolution skills learned-- or not learned-- here can then be transferred to improving broader articles. Start small. I'm checking that our sources actually discuss DTT specifically. If others disagree with this approach, we should settle this before we start trying to hammer out text. I've got to break for dinner. SandyGeorgia (Talk) 23:09, 3 September 2020 (UTC)

That would be a reasonable solution. That way, Wikipedia can discuss both DDT (in it's narrowest sense) and broader ABA. But if we do this we should probably discuss in the article that some sources consider them synonymous, and we should also add a hat-note. Thanks again for helping us reach consensus. --Wikiman2718 (talk) 23:49, 3 September 2020 (UTC)

It says write here in the APA Division of Behavior Analysis:

"Behavior analysis is a natural science that seeks to understand the behavior of individuals and to apply this understanding in a wide range of settings... Applied behavior analysis has played an especially prominent role in many areas, including:

The treatment of individuals with intellectual and developmental disabilities, not only by helping people achieve greater independence, but also by developing practical techniques for the humane care of people using positive reinforcement.

Effective and supportive behavior management in classrooms.

Data-driven approaches to instruction.

Contingency management in the treatment of substance abuse.

Acceptance and Commitment Therapy (ACT).

Organizational behavior management.

Behavioral approaches to occupational safety.

Humane practices in caring for companion animals as well as animals in zoos and laboratory settings.

The study of the behavioral effects of environmental contaminants."

[7] and the APA Handbook of Behavior Analysis writes: "Behavior Analysis emerged from the nonhuman laboratories of B. F. Skinner, Fred Keller, Nate Schoenfeld, Murray Sidman, James Dinsmoor, Richard Herrnstein, Nate Azrin, and others... By the 1960s, behavior analysts began translating these principles into interventions for institutionalized humans characterized by impoverished repertoires of adaptive behavior. When these interventions proved successful in replacing problem- with adaptive-behavior, the field of Applied Behavior Analysis was born. Over the last 50 years the field of behavior analysis has grown substantially both in the number of practicing behavior analysts and the range of behavior to which behavioral principles have been applied. Today the laboratory study of basic principles of behavior continues to expand our understanding of behavior and to inform the treatment of disorders ranging from autism to substance abuse." [see here: https://www.apa.org/pubs/books/4311509].

ABA is also called Behavioral Engineering (it derived from this study in Skinner's journal, the Journal of Experimental Analysis of Behavior, where the researchers developed a token economy in a psychiatric hospital for adults with psychotic form of schizophrenia and children with mental retardation; see here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1403907/). And according to Mace (1994) in the Journal of ABA: "Beyond behavior modification: A return to behavior analysis... Before applied behavior analysts had a methodology to identify the conditions maintaining aberrant behavior, the reinforcement histories that gave rise to current behavior-environment interactions were largely ignored. Instead, existing repertoires were established and new ones altered by superimposing reinforcement contingencies, punishment contingencies, or both, onto the current environmental contingencies or unknown processes that maintained aberrant behavior. The approach was generically known as behavior modification." [see here: https://psycnet.apa.org/record/1995-06587-001]; Pelios, Morren, Tesch, & Axelrod in that same journal wrote "Behavior modification was an early approach that emphasized how powerful reinforcement and punishment contingencies can change behavior regardless of its causes. Applied behavior analysis was an approach that emphasized the analysis of functional relations between behavior and its causes (Mace, 1994)." [8]; and Mace & Critchfield wrote in 2010 in the Journal of the Experimental Analysis of Behavior [9]: "We briefly summarize...the foundation for the field of behavior modification.... Modification of psychotic and various aggressive, disruptive and otherwise undesirable behaviors was accomplished through the use of [presumed] differential reinforcement procedures used with and without extinction. ...the basic and applied sectors of behavior analysis were disconnected in the late 1970s and early 1980s (Mace, 1994)... ABA changed abruptly in the mid-1980s... Known collectively as functional analysis methodologies, these procedures shifted the focus of ABA research to determining the factors that maintain undesirable behavior and using this information to promote replacement behaviors that serve the same function (e.g., see Pelios, Morren, Tesch, & Axelrod, 1999)..." The major shift between behavior modification to what is now called ABA is that we now use functional behavior assessments and by using these assessments, we're more likely to use reinforcement and less likely to use aversives. ABA is to be contrasted with cognitive behavior therapy on theory: behavior analysis is based on Skinner's radical behaviorism where thoughts and feelings are private events, which are more behavior to later be explained, whereas CBT is based on the theory that thoughts and feelings are the antecedents that cause behavior, but overlaps considerably with the clinical behavior analysis subform of ABA. So, there is no question that DTT is a subform of—not a synonym with—ABA. ATC ^{. Talk} 00:08, 4 September 2020 (UTC)

OK, so I think that means we are all in agreement that we are focusing here on the subset? Or am I misunderstanding? If my understanding is correct, is the hatnote now at the top of the article correct? We should also keep in mind that Early intensive behavioral intervention redirects to this article. SandyGeorgia (Talk) 00:15, 4 September 2020 (UTC)

Yes, it is (the New York State Department of Health had made definition and category errors like that in 1999 as well, calling ABA and DTT the same thing when they're not). Looks great, Sandy! :) ATC ^{. Talk} 00:17, 4 September 2020 (UTC)

I agree too. --Wikiman2718 (talk) 00:19, 4 September 2020 (UTC)

Great; once we hear from Alex, I'll add a list of what sources we have so far, with the idea that we will decide on sources before we move forward to crafting text. Just a note: I've been swamped all week, and am very tired, so if I miss something, unintentional ... SandyGeorgia (Talk) 00:21, 4 September 2020 (UTC)

This article has had problems for years. It can wait a few more days. Please keep contributing, but if you need a break just tell us and we can put this on pause. --Wikiman2718 (talk) 00:24, 4 September 2020 (UTC)

I'm actually beginning to see light at the end of the tunnel, which is not another oncoming train. Just feel I need to explain my delays :) SandyGeorgia (Talk) 00:27, 4 September 2020 (UTC)

That's an improvement, but having started pulling at this thread I think we need to continue. I am not sure that EIBI should redirect here, because according to our Cochrane source EIBI is something, the "origins" of which are just "linked to" the Lovaas model. Discrete trial training is only part one within EIBI, a three-part programme. If you look at the search strategies the Cochrane authors used (see Appendix 1), they did not search for any "Discrete" or "DTT" etc. keywords, but did search for "ABA" and "Lovaas" and so on.

So I don't think we can use the Cochrane source for DTT specifically, as that would be to make a whole/part elision.

I'm also beginning to think that EIBI is the main topic here and although DTT (part of EIBI) is a discrete component of EIBI, and so a discrete topic, per WP:NOPAGE it would make most sense to discuss both things in the same article. The article text we write could then be explicit about whether it was referring to the whole EIBI programme, or just the DTT technique. To do this we would need to rename this article "Early intensive behavioral intervention", reorganize it to have a top-level subsection for "Discrete trial training", and then redirect Discrete trial training to that section.

Thoughts? Alexbrn (talk) 07:37, 4 September 2020 (UTC)

Continued below in Talk:Discrete trial training#Page Move; I suspect three of us are on the same page, but we need to hear from ATC. SandyGeorgia (Talk) 13:44, 4 September 2020 (UTC)

Aversives

User:ATC: Some versions of this method still do use aversives, such as at the Judge Rotenberg Center. --66.244.121.212 (talk) 22:31, 28 August 2020 (UTC)

The New York Times [see here: https://www.nytimes.com/2020/03/06/us/electric-shock-fda-ban.html] reported that the FDA permanently banned the aversives in March 2020, so the JRC no longer uses them. ATC ^{. Talk} 01:04, 29 August 2020 (UTC)

User:ATC: FDA banned the use of electric shocks-- They still use aversives. --66.244.121.212 (talk) 01:11, 29 August 2020 (UTC)

User:ATC: I notice that you have recently changed the article to claim that this method no longer uses aversives. I have to wonder why you did that, as I linked you to Judge Rotenberg Center, which contains proof that that's not true. Did you read it? The article also claims that the method has always relied primarily on positive re-inforcement. This claim is also sketchy, as it is as the exact same claim is regularly made by sympathizers of the Judge Rotenberg Center even though it has been refuted. --66.244.121.212 (talk) 05:09, 29 August 2020 (UTC)

There are no sources to justify your claims that JRC used or still uses other aversives other than the electric shocks (which the FDA banned this past March). ATC ^{. Talk} 20:49, 30 August 2020 (UTC)

Again, that is just not true. You will find those sources easily and abundantly if you do even a brief skim of the article. --Wikiman2718 (talk) 20:51, 30 August 2020 (UTC)

In terms of finishing up this section (before tackling the larger issues above), we don't write an article about a specific technique that is or may be widely used around one individual Center, that may or may not be off-track. And saying these sources are easily found is less helpful than providing MEDRS sources you would like to incorporate. So, to improve what is in the article, let's come up with some MEDRS-compliant sources. I would not be averse to using the New York Times (even though it's a laysource) to mention that the US FDA banned electric shocks. SandyGeorgia (Talk) 21:01, 3 September 2020 (UTC)

Actually, MEDRS only applies to health claims, and not to claims about how medicine is practiced. For example, if we wanted to say that aversives were effective/ineffective in modifying behavior, that would be a health claim bound by MEDRS. But just saying that they are used is not a health claim, and can be sourced as usual. The use of aversives is not confined to the JRC-- for example, ABA International endorses them. But we can get around to this after we have first settled the issue of efficacy. --Wikiman2718 (talk) 01:41, 4 September 2020 (UTC)

As one of the original architects of MEDRS, I'm aware of how to apply it. Whenever we have MEDRS-compliant sources, they are preferable to the laypress (which often gets it wrong). Although any RS can be used in theory for non-health claims, in all topics, we always prefer the highest quality sources. I am also aware that all of our content on Wikipedia about ABA is being skewed towards that of one outlet-- the JRC-- which is UNDUE. SandyGeorgia (Talk) 13:41, 4 September 2020 (UTC)

Yes. I've been re-visiting this suite of articles and at times it seems there's been a competition to see how many times the JRC and the words "cattle prod" can be used - with some decidedly iffy sourcing. I've attempted to remove that kind of thing from this article, as a start ... Alexbrn (talk) 13:48, 4 September 2020 (UTC)

User:Alexbrn: Please do not bring those false claims of iffy sourcing to this page too-- and please do learn the difference between a source and a file hosting service. As for how the JRC applied here, it is proof by example. This article makes is seem like aversives are no longer in use, but the existence of the JRC prove that this isn't true. User:SandyGeorgia: While I would like to produce a MEDRS source for the continued use of aversives, that may be hard to do because an FDA report that I read found that they have been studied very little in high-quality scientific literature. Real scientists, it seems, just don't do these king of experiments. We may have to go with ordinary sources on this one, which should be fine since we're not making health claims. --Wikiman2718 (talk) 22:51, 4 September 2020 (UTC)

It's important when we write about a topic that we properly reflect what high-quality sources are saying about it. If instead we write content that does not correspond to the content of such sources, it skews Wikipedia and is a violation of NPOV, which is a core, non-negotiable policy. Any "proof by example" would need to be something proved in good RS. If it's just an editor's personal wheeze, then there is a policy that prohibits its inclusion. Alexbrn (talk) 04:39, 5 September 2020 (UTC)

1) This article implies that aversives are not longer used.

2) Aversives are still used at the Judge Rotenberg Center.

3) Therefore, this article implies a false claim.

QED -- Wikiman2718 (talk) 15:21, 5 September 2020 (UTC)

Well, if your novel reading of the "implication", and the JRC, and this general topic get juxtaposed in some good sources, point them out and it may be possible to use them. It's important we discuss the topic in the same way that good sources are, since that is the purpose of an encyclopedia (not to WP:RGW). Alexbrn (talk) 15:34, 5 September 2020 (UTC)

1) The article reads: "While the therapy has always relied principally on positive reinforcement of preferred behavior, Lovaas's original technique also included the use of aversives, such as striking, shouting, or using electrical shocks. These procedures have been widely abandoned: in 2012 the use of electric shocks was described as being inconsistent with contemporary practice."

2) Here is such an article as you have requested. This article discusses the JRC in the broader context of the controversy on aversives. It also discretits the claim that the therapy has always relied principally on positive reinforcement, as Lovaas is quoted in it as saying: “These people are so used to pain that they can adapt to almost any kind of aversive you give them.”

3) It is not "righting great wrongs" to correct inaccurate content in the encyclopedia.

--Wikiman2718 (talk) 15:44, 5 September 2020 (UTC)

"Widely abandoned" does not mean "never used". And a 2007 article is not useful for informing us about a position dated as 2012. Alexbrn (talk) 15:51, 5 September 2020 (UTC)

The 2012 claim is that technique has always relied on positive reinforcement. Always here dates back to 1960. When Lovaas said “These people are so used to pain that they can adapt to almost any kind of aversive you give them,” he made it clear that that's not true. A reader could easily read this article and think that aversives are no longer in use. It is a total whitewash. --Wikiman2718 (talk) 16:04, 5 September 2020 (UTC)

"Principally relied" does not mean "relied". Language matters. From what I've seen in the sources aversives were always seen as a "last resort" and this statement accords with that. More sourcing and expansion on this point would be good, true. Alexbrn (talk) 16:11, 5 September 2020 (UTC)

The claim that aversives were only used as a "last resort" is identical to claims made by the JRC, and both have been debunked. These articles show that Lovaas shocked kids for things like dazing off during a reading lesson, and to make them show affection. Both of these articles are supportive of his work, and not attacking him. The JRC's identical claim has been debunked in multiple state reports and by the FDA. Again, I feel the need to reiterate that this article is a total whitewash. --Wikiman2718 (talk) 16:24, 5 September 2020 (UTC)

We need to avoid tawdry/sensational sources, or over-emphasizing what one possibly-off-the-rails American outfit is up to. Some WP:MEDRS on this topic will likely give us the level-headed, profressional WP:TONE we seek. I am searching ... Alexbrn (talk) 16:30, 5 September 2020 (UTC)

Are you claiming that those newspapers just made it all up? What about the FDA and those state investigations? You would need a source for that. Please don't ignore evidence, and please do not whitewash. And we can do with out those sarcastic edit summaries. --Wikiman2718 (talk) 16:35, 5 September 2020 (UTC)

I'm searching for the WP:BESTSOURCES about the topic as a whole, rather than seeking out sensational coverage in the popular press, to push a pre-decided stance. Reflecting high-quality sources on this topic will help us achieve WP:NPOV. Alexbrn (talk) 16:42, 5 September 2020 (UTC)

Well, you keep seeking. Be sure to tell us if you find them. And cut it out with those sarcastic edit summaries. --Wikiman2718 (talk) 16:48, 5 September 2020 (UTC)

Summary of findings: It has been two days, and neither Alexbrn or anyone else has come up with one of these WP:BESTSOURCES to contradict the findings of the newspaper articles. The above thread shows that the article, as it stands, is inaccurate. In particular, the claim that this therapy has always relied "mostly on positive reinforement" is entirely inconsistent with Lovaas' statement that “These people are so used to pain that they can adapt to almost any kind of aversive you give them”. Additionally, aversives were not used as a "last resort" to stop self-harming behavior (which the FDA is opposed to), but for things like the suppression of stemming and to force displays of affection. Additionally, aversives are still in use. The exact frequency and severity of their use remains to be established, but this should be done with reliable sources, not this whitewash by Spreat. --Wikiman2718 (talk) 01:36, 8 September 2020 (UTC)

It was already fixed with the Spreat (2012) source, which is high-quality. But it could stand to be expanded maybe. That source, coincidentally, does used the word "relied": it says the UCLA Autism Project "generally relied on primary reinforcers (such as food) in an effort to circumvent the limitations of social reinforcers ... ". We have no need to go digging around in old lay press when we have decent sources discussing this - though it would be even better to have something more recent than 2012 to confirm the current state of things. I would oppose any reversion to low-quality sourcing. Alexbrn (talk) 05:44, 8 September 2020 (UTC)

Also, this was already well summarized at Alexbrn (talk) 15:51, 5 September 2020 (UTC): I agree we don't need to use poorer sources, and we don't write articles around one example. SandyGeorgia (Talk) 06:14, 8 September 2020 (UTC)

However, searching more I have actually found a source which does briefly allude to the Judge Rotenberg Center as an example of a place where aversives unfortunately didn't (as it puts it) "go out of style" and, since this is decent RS, it would now seem due to mention in our article. I've done this: see what you think.

• Waltz M (2013). Autism: A Social and Medical History. Palgrave Macmillan. p. 97. ISBN 978-1-349-35819-9.

While the article is much improved from its earlier form, I still have some comments. Firstly, withholding food so that is can later be used as a reward is most certainly not positive reinforcement. As you can see from the article, this form of "positive reinforcement" can sometimes result in death. The claim that this intervention "has always relied principally on positive reinforcement" is just not consistent with the available evidence. --Wikiman2718 (talk) 11:42, 8 September 2020 (UTC)

Alexbrn: I see that you have located a paper textbook that describes the 1985 death by starvation of a 19 year-old woman at the JRC. Even through there have been six deaths at the center, the article only describes three, as I have been unable to find references to all of them online. If you could use your access to that paper textbook to upgrade the article, that would be very useful to the encyclopedia. --Wikiman2718 (talk) 12:13, 8 September 2020 (UTC)

In general our approach should be to find what good sources say about this topic (EIBI/ABA/DTT) and then summarize them, rather than to have predecided things which we then try to find sources for. (That is a guaranteed route to POV/RGW problems, as is evidenced at the Judge Rotenberg Center article with its advocacy blogs and marginal primary texts as sources.) I and others have made this point several times now. Two sources call the withholding of food "positive reinforcement" which seems odd but there you – it's psychology jargon. I don't think we don't use the term in the article here. Alexbrn (talk) 12:40, 8 September 2020 (UTC)

A few things:

1) Our general approach is to find out what good sources say and then summarize them. The key word here is "good". If a sources makes claims that are clearly not true and which are contradicted by other sources of repute, it can hardly be classified as good. The withholding of food is not a positive intervention, as should be obvious to everyone. People don’t die from positive interventions. But if you want a top source that says that, check out this state report.

2) Please stop calling the JRC article POV without evidence. It draws most of its claims from state reports, while relying on news articles for backup. It also contains a few sources from advocacy websites that are generally considered reliable.

3) I would still appreciate if you would use your access to that paper text the improve the encyclopedia by adding info about the death by starvation here. I would do it myself, but since you are the only one who has access to that textbook, you may be the only one who can. —Wikiman2718 (talk) 16:42, 8 September 2020 (UTC)

Now that I have actually read the Pediatrics article to which this claim is attributed, I can tell you that at no point does it characterize the intervention an "mostly positive". I am extremely disappointed that you misrepresented the contents of the article in this way, but somehow not surprised. Since this claim is unsourced (and contradicted by other reliable sources) I have taken the liberty to remove it. --Wikiman2718 (talk) 01:54, 14 September 2020 (UTC)

• SandyGeorgia: Firstly, thank you very much for removing that image. I had tried several times to remove it myself, but with no success. However, I have one issue with your edits. I noticed that you moved the discussion on aversives to the history section, and the that article now states outright in the lede that aversives are no longer in use. As the above discussion shows, there is clear evidence that aversives are still in use (at least in some places), so I think we should undo this. --Wikiman2718 (talk) 20:53, 14 September 2020 (UTC)

Wikiman2718: You have no valid sources (other than unreliable magazine and news articles) to justify your claims that aversives are still used because they are not. I'm done explaining these sources to you. ATC ^{. Talk} 01:53, 15 September 2020 (UTC)

That is just not how it works. Please read the above thread to learn more. Wikiman2718 (talk) 02:00, 15 September 2020 (UTC)

Page Move

Continued from Talk:Discrete trial training#Scope

We seem to have consensus that DTT is a technique used in EIBI interventions, and that EIBI is in turn a family of ABA-based interventions within the broader field of applied behavioral analysis for autism. Since this page mostly discusses EIBI, not DTT, I propose that we change its name to Early Intensive Behaviour Intervention. --Wikiman2718 (talk) 00:54, 4 September 2020 (UTC)

Yes, but without losing the DTT "topic": see my comment in the "Scope" section above. Alexbrn (talk) 08:12, 4 September 2020 (UTC)

That sounds logical, as long as we understand then that this article needs significant expansion, as there are many kinds of EIBI. Would like to hear from ATC on this. Holding off then on moving forward until this is resolved. SandyGeorgia (Talk) 13:38, 4 September 2020 (UTC)

I originally replied now during my lunch break but accidentally lost all the text I wrote via cell phone. But EIBI refers to under the age of 5; for older kids (and even adults) with ASD, it’s just called ABA, or more specifically, discrete trials. Will explain further in a few hours when I get out of work. ATC ^{. Talk} 16:46, 4 September 2020 (UTC)

A well-known behavior analyst I briefly spoke with on an ABA Facebook group page a few years ago told me that behavioral (which is an adjective) does not necessarily mean behavior analysis or behavior change (i.e., as discussed in the ABA grad school textbook by Cooper, et al (2007/2018)) and that some of those recent literature reviews on early intensive behavioral intervention included non-behavior analytic interventions such as the early start denver model, which combines the denver model (developmental play therapy) with pivotal response treatment and positive behavior support, but I know Tristram Smith (a former graduate student of Lovaas' and was a highly published researcher at the University of Rochester until his death a few years ago), categorized the ESDM as a "developmental social pragmatic" approach in one of his literature reviews.

I also read in one of Smith's other studies that DTT, which he wrote is technically just a structured teaching approach that uses the three-term operant contingency: antecedent (instruction)-behavior (response)-consequence (reinforcer), and includes precision teaching for classroom instruction with typically developing students or errorless learning for Alzheimer's (but for WP's common sense knowledge guidelines, we should probably just call the article DTT in describing the treatment of autism). Further, Lovaas didn't technically first develop DTT for autism. In his 1977 book The autistic child: Language development through behavior modification, he used the term "errorless learning and trials", now a form of DTT that incorporates prompts and prompt-fading, which was developed by Charles Ferster, a colleague of B.F. Skinner's, who originally applied it with animals before using the technique to teach autistic children speech. Lovaas borrowed the technique from two of his college professors at the University of Washington who were among the founders of the Journal of ABA in 1968 (the same year Lovaas founded the UCLA Young Autism Project), so Lovaas didn't technically first develop the technique; he was just a famous researcher in the field. The reason I mention this is because it might need to be discussed in the body of the article as well that Ferster developed the technique but Lovaas originally coined the term DTT and made it 40 hours per week in his 1987 study. ATC ^{. Talk} 22:01, 4 September 2020 (UTC)

Do you happen to know if DDT is ever used outside of ABA for autism? --Wikiman2718 (talk) 23:03, 4 September 2020 (UTC)

I'm not really sure. I would have to search and see. I know errorless learning has been studied in Alzhiemer's. ATC ^{. Talk} 23:06, 4 September 2020 (UTC)

Does errorless learning use DTT? Because if it does, that changes everything. We would need to move almost all of the info on autism to the aba page and make this one about the technique. --Wikiman2718 (talk) 23:11, 4 September 2020 (UTC)

Looks like a speech therapy journal used errorless learning for aphasia (see here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6195057/), but doesn't discuss DTT.

On the other hand, just found this 2009 study [10] that used the term DTT in the treatment of traumatic brain injury, which states: "This study evaluated the impact of collaborative efforts of grandparents and school professionals in the treatment of Traumatic Brain Injury in a six-year-old boy. The method of treatment was discrete trial training across settings (e.g., home and school) and the change agents were the child’s grandparents, special education teacher, and a teacher assistant. Findings indicated that discrete trial training led to increased academic and adaptive skills... Several teaching strategies have been utilized with children with TBI, but the utilization of a specific applied behavior analysis intervention, such as discrete trial training, is lacking in professional literature on TBI." So, it seems very few studies use the term DTT outside of the early intervention for autism. ATC ^{. Talk} 23:42, 4 September 2020 (UTC)

So it's been studies for lots of things other than autism. But has it been used? That is the question. --Wikiman2718 (talk) 00:15, 5 September 2020 (UTC)

Yes, but the subforms like fluency-based instruction/direct instruction, precision teaching, and errorless learning are the terms usually used instead. ATC ^{. Talk} 00:32, 5 September 2020 (UTC)

Can you show sources that link DDT to these other things? Because if so, then DDT is a technique that is used in autism aba and a ton of other stuff. This is quite different from out initial assessment. The efficacy of DDT in each of these fields will have to be evaluated independently. It is quite possible that it works for some things and not for others. --Wikiman2718 (talk) 00:41, 5 September 2020 (UTC)

No one said that it “doesn’t work”. Low quality evidence means the research design limitations and the criteria some research databases are using on Lovaas therapy is that the studies haven’t been larger than 10-19 kids in the experimental group (gold standard is 40+) and the research literature mainly consists of single subject design studies and some non-randomized comparison studies, but only three of the studies were randomized control trials. Regardless, all showed to be effective. Otherwise, they wouldn’t have been published in peer reviewed journals all these years stating they were effective like they have been. ATC ^{. Talk} 01:31, 5 September 2020 (UTC)

User talk:ATC: I'm not sure how this fits in here. Is your comment in the right spot? If not, please more it to the right one and delete this message. --Wikiman2718 (talk) 01:52, 5 September 2020 (UTC)

But I do think that 2018 Cochrane Review was referring to Lovaas therapy (in terms of the phrasing of early intensive ‘’behavioral’’ intervention) and we might need to have an autism section in the ABA page to include this article (I’d still call it DTT for general understanding but it’s technically listener responding/receptive verbal behavior and rapid motor imitation), natural language procedures, pivotal response treatment, and picture exchange communication system, as well as other subsections for applied animal behavior, consumer behavior analysis, forensic behavior analysis, clinical behavior analysis (which includes voucher-based contingency management, acceptance and commitment therapy, functional analytic psychotherapy, pediatric feeding therapy, and contact desensitization), errorless learning, precision teaching, direct instruction, positive behavior support, and organizational behavior management. I’d also redirect behavioral engineering to the ABA page, and behavior modification to its history section. But I’d have SandyGeorgia or Alex do the merge of the articles if they are on board with this. ATC ^{. Talk} 02:37, 5 September 2020 (UTC)

To add, we should leave habit reversal training, nicotine replacement therapy, community reinforcement approach and family training, behavioral economics, consumer behaviour, behavioral medicine, behavioral pharmacology, and the exposure therapies/desensitization separate pages as they can be implemented from either a cognitive-behavioral (which initially uses cognitive restructuring and emotional regulation) or behavior analytic framework. ATC ^{. Talk} 16:49, 5 September 2020 (UTC)

Hey, ATC! These are all good leads, but you're going to have too show some sources. If you can do that, we can properly define the scope of this article and then get around to improving it. --Wikiman2718 (talk) 16:30, 5 September 2020 (UTC)

I'm not sure where this leaves us. Since EIBI is the broader term, would it not be better to have that article, in place of this one, and explain any of these differences within the article? Or am I missing something else? SandyGeorgia (Talk) 06:16, 8 September 2020 (UTC)

I think that would be the least bad solution. EIBI is a big topic in current RS and as things stand, Wikipedia appears not to cover it. Alexbrn (talk) 06:25, 8 September 2020 (UTC)

But the research literature often considers intensive in EIBI as being 30-40 hours per week of DTT (with some Incidental Teaching on the side) though, and pivotal response treatment (PRT) is 25 hours per week, which is not always considered EIBI in the research literature because of it. So, I think we could just call this article Early Behavior Interventions (EBIs), with the subtypes DTT/EIBI, Incidental Teaching, PRT, and Functional Communication Training (including PECS). I wouldn't be against that. ATC ^{. Talk} 21:06, 8 September 2020 (UTC)

It looks to me like DDT is a technique that is used in a variety of interventions, with EIBI just being the most common application. Since EIBI seems notable by itself, that makes me think that there should be an EIBI article with a DDT subsection. But DDT may also merit its own page. --Wikiman2718 (talk) 21:15, 8 September 2020 (UTC)

That might raise a valid point. This is how the APA dictionary defines DTT: "a defined, limited occasion to engage in some behavior. For example, each trip through a maze by a rat can be considered a discrete trial. Such trials may be contrasted with those in which the behavior in question can occur at any time (see free operant)." https://dictionary.apa.org/discrete-ATC ^{. Talk} 21:44, 8 September 2020 (UTC)

But I would just call this article, EBI (or even Early ABA interventions) since I wouldn’t consider PRT to be “intensive” but still an EBI based on ABA, as are DTT, Incidental Teaching, etc. ATC ^{. Talk} 22:42, 8 September 2020 (UTC)

I’m actually beginning to see the point of changing the name of this article to EIBI because although DTT is the primary teaching unit in Lovaas therapy, it’s always been used in conjunction with Incidental Teaching to generalize after the child becomes more verbal from DTT despite Incidental Teaching not being historically described in Lovaas’ studies. And EIBI tends to be the term used over the years to describe Lovaas therapy in the research literature (PRT exclusively uses Incidental Teaching but is not Lovaas therapy), so it might not be a bad thing to call this article EIBI to describe DTT as the primary teaching unit but also Incidental Teaching. ATC ^{. Talk} 18:43, 12 September 2020 (UTC)

List of sources

Meet MEDDATE and MEDRS

1. Hyman2020 Hyman SL, Levy SE, Myers SM (January 2020). "Identification, evaluation, and management of children with autism spectrum disorder". Pediatrics (Review). 145 (1). doi:10.1542/peds.2019-3447. PMID 31843864.
2. Scherr2019 Scherr JF, Kryszak EM, Mulick JA (2019). "Chapter 3: Autism Spectrum". In Hupp S (ed.). Pseudoscience in Child and Adolescent Psychotherapy. Cambridge University Press. p. 28-49. ISBN 978-1-316-62695-5. Applied behavior analysis (ABA) has well-established success and has documented its effectiveness in treating individuals with ASD for more than 50 years ... ABA has no place in any discussion of fads or pseudoscientific, dubious, or controversial and politically correct treatments other than to epitomize what constitutes effective and ethical treatment of individuals with ASD.
3. Reichow2018 Reichow B, Hume K, Barton EE, Boyd BA (May 2018). "Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD)". The Cochrane Database of Systematic Reviews (Review). 5: CD009260. doi:10.1002/14651858.CD009260.pub3. PMC 6494600. PMID 29742275. The results provide weak evidence that EIBI improves adaptive behavior and autism symptom severity. Analyses of our secondary outcomes also provide weak evidence that EIBI improves IQ, expressive and receptive language, everyday communication skills, everyday social competence, daily living skills, and problem behavior for this population. We rated the quality of the evidence as low to very low using the GRADE system (Guyatt 2008), which means that more research could very well change the effect estimate and our confidence that it is precise; therefore results should be considered with caution.
4. Landa2018 Landa RJ (February 2018). "Efficacy of early interventions for infants and young children with, and at risk for, autism spectrum disorders". Int Rev Psychiatry (Review). 30 (1): 25–39. doi:10.1080/09540261.2018.1432574. PMC 6034700. PMID 29537331.
5. Caron2017 Caron V, Bérubé A, Paquet A (June 2017). "Implementation evaluation of early intensive behavioral intervention programs for children with autism spectrum disorders: A systematic review of studies in the last decade". Eval Program Plann (Review). 62: 1–8. doi:10.1016/j.evalprogplan.2017.01.004. PMID 28189054.
6. Roane2016 Roane HS, Fisher WW, Carr JE (August 2016). "Applied behavior analysis as treatment for autism spectrum disorder". J. Pediatr. (Review). 175: 27–32. doi:10.1016/j.jpeds.2016.04.023. PMID 27179552.
7. Sanchack2016 Sanchack KE, Thomas CA (December 2016). "Autism spectrum disorder: Primary care principles" (PDF). Am Fam Physician (Review). 94 (12): 972–979. PMID 28075089.
8. Scottish2016 "SIGN 145: Assessment, diagnosis and interventions for autism spectrum disorders: A national clinical guideline" (PDF). Scottish Intercollegiate Guidelines Network. 2016. Retrieved September 3, 2020.
9. Smith2015 Smith T, Iadarola S (2015). "Evidence-base update for autism spectrum disorder". J Clin Child Adolesc Psychol (Review). 44 (6): 897–922. doi:10.1080/15374416.2015.1077448. PMID 26430947.

MEDRS but not MEDDATE

1. Howlin P, Magiati I, Charman T (2009). "Systematic review of early intensive behavioral interventions for children with autism". Am J Intellect Dev Disabil (Review). 114 (1): 23–41. doi:10.1352/2009.114:23;nd41. PMID 19143460. At group level, EIBI resulted in improved outcomes (primarily measured by IQ) compared to comparison groups... This review provides evidence for the effectiveness of EIBI for some, but not all, preschool children with autism.{{cite journal}}: CS1 maint: multiple names: authors list (link)
2. Reichow B, Wolery M (2009). "Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA Young Autism Project model". J Autism Dev Disord (Meta-analysis). 31 (1): 23–41. doi:10.1007/s10803-008-0596-0. PMID 18535894. The findings suggest EIBI is an effective treatment, on average, for children with autism.
3. Rogers Rogers SJ, Vismara LA (January 2008). "Evidence-based comprehensive treatments for early autism". Journal of Clinical Child and Adolescent Psychology (Review). 37 (1): 8–38. doi:10.1080/15374410701817808. PMC 2943764. PMID 18444052. The only comparative study (Eikeseth et al., 2002) to examine effects of Lovaas's treatment compared to another approach—an eclectic treatment package delivered with comparable intensity—demonstrated statistically significant differences in change scores in favor of Lovaas's treatment. Given the strength of the findings from the four best-designed, controlled studies—Lovaas (1987); Smith, Lovaas, and Lovaas (2002); Eikeseth et al. (2002); and Cohen et al. (2006) (Eikeseth's and Cohen's studies also involved comparison with alternative treatments)—this treatment meets both Chambless et al. (1998) and Chambless et al. (1996) criteria as a "well-established" psychosocial intervention for improving the intellectual performance of young children with autism spectrum disorders, based on the significant increase in IQ reported in these four studies compared to control groups.
4. PLOS Ospina MB, Krebs Seida J, Clark B, Karkhaneh M, Hartling L, Tjosvold L, Vandermeer B, Smith V (2008). "Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review". PLoS ONE (Review). 3 (11): e3755. doi:10.1371/journal.pone.0003755. PMC 2582449. PMID 19015734. The effects of discrete trial learning are inconsistent across studies ... There is limited and inconclusive evidence for various combinations of discrete trial training ... The evidence seems to provide some support for discrete trial training in terms of motor and functional skills but not for communication skills.{{cite journal}}: CS1 maint: unflagged free DOI (link)
5. Pediatrics Myers SM, Johnson CP (November 2007). "Management of children with autism spectrum disorders". Pediatrics (Review). 120 (5): 1162–1182. doi:10.1542/peds.2007-2362. PMID 17967921. Highly structured comprehensive early intervention programs for children with ASDs, such as the Young Autism Project developed by Lovaas35,41 at the University of California Los Angeles, rely heavily on discrete trial training (DTT) methodology, but this is only one of many techniques used within the realm of ABA. DTT methods are useful in establishing learning readiness by teaching foundation skills such as attention, compliance, imitation, and discrimination learning, as well as a variety of other skills. However, DTT has been criticized because of problems with generalization of learned behaviors to spontaneous use in natural environments and because the highly structured teaching environment is not representative of natural adult-child interactions.
6. Gresham FM, MacMillan DL (February 1998). "Early Intervention Project: can its claims be substantiated and its effects replicated?". J Autism Dev Disord (Review). 28 (1): 5–13. doi:10.1023/a:1026002717402. PMID 9546297.

Recent, but not MEDRS

1. Mottron L (July 2017). "Should we change targets and methods of early intervention in autism, in favor of a strengths-based education?". Eur Child Adolesc Psychiatry. 26 (7): 815–825. doi:10.1007/s00787-017-0955-5. PMC 5489637. PMID 28181042.

Not MEDDATE or MEDRS

1. Eikeseth2 Eikeseth S (2009). "Outcome of comprehensive psycho-educational interventions for young children with autism". Research in Developmental Disabilities. 30 (1): 158–178. CiteSeerX 10.1.1.615.3336. doi:10.1016/j.ridd.2008.02.003. PMID 18385012.
2. Gernsbacher MA (2006). "Is One Style of Early Behavioral Treatment for Autism 'Scientifically Proven?'". J Dev Process. 7: 19–26. PMC 4266398. PMID 25520761.

Discussion of sources

My apologies for my continual delays in returning here due to IRL issues and other pressing Wiki matters. I have pulled together what I hope to be a summary of the sources discussed so far (hope I didn't miss any). If so, please point out the PMID and I will add it above. I've also bolded the named ref or suggested name ref (and will point out how unhelpful it is to have refs named things like "pediatrics" or "PLOS"-- I highly recommend this standardized ref naming format, as it makes it easier to discuss sources, for example, Landa2018).

My view is that with seven nine sources that meet MEDRS and MEDDATE, we should have little or no need to rely on any of the older or marginal sources. Once agreed on sources, it should be easier to adjust text and address the page move. SandyGeorgia (Talk) 17:56, 14 September 2020 (UTC)

Hi Sandy, looks good! However, you missed two other sources that I found:

MEDRS but not MEDDATE (could still be used for historical context since it's only 5 years old)

Smith T, Iadarola S (October 2, 2015). "Evidence-base update for autism spectrum disorder". Journal of Clinical Child and Adolescent Psychology (Review). 44 (6): 897–922. The 2015 literature review update of Rogers & Vismara (2008): "As already mentioned, Rogers and Vismara (2008) classified the Lovaas model as a well-established treatment. Four subsequent quasi-experimental studies on this model met our criteria for inclusion in Table 4 (Eikeseth, Klintwall, Jahr, & Karlsson, 2012; Eikeseth, Smith, Jahr, & Eldevik, 2007; Eldevik, Hastings, Jahr, & Hughes, 2012; Peters-Scheffer, Didden, Mulders, & Korzilius, 2010). One study (Eikeseth et al., 2007) was a follow-up of a report reviewed by Rogers and Vismara (Eikeseth, Smith, Jahr, & Eldevik, 2002). All studies indicated that the Lovaas model has large effects on IQ, adaptive behavior, or both (Table 4)... Of concern, however, the only study that examined changes in ASD symptoms and problem behavior (Peters-Scheffer et al., 2010) found that EIBI had little effect on functioning in these domains. In addition, all of the findings from recent studies must be viewed with caution because they were obtained in quasi-experimental rather than experimental studies... At the time of the previous review (Rogers & Vismara, 2008), most group studies centered on a single treatment, the UCLA/Lovaas model of individual, comprehensive ABA. This intervention continues to have stronger empirical support than other comprehensive treatments."

Meets MEDRS and MEDDATE

Hyman SL, Levy SE, Myers SM (January 2020). "Identification, evaluation, and management of children with autism spectrum disorder". Pediatrics (Clinical Report). 145 (1). doi:10.1542/peds.2019-3447. "Most evidence-based treatment models are based on principles of ABA... ABA interventions vary from highly structured adult-directed approaches (eg, discrete trial training or instruction, verbal behavior applications, and others) to interventions in natural environments that may be child led and implemented in the context of play activities or daily routines and activities and are altered on the basis of the child’s skill development (eg, pivotal response training, reciprocal imitation training, and others). To determine what intervention is most appropriate, the behavioral clinician works with the family and child to determine which skills to target for development and maintenance and what goals are appropriate... A comprehensive ABA approach for younger children, also known as early intensive behavioral intervention, is supported by a few randomized controlled trials (RCTs) and a substantial single-subject literature. When only RCTs are considered, few interventions have sufficient evidence to be endorsed either for children younger than 12 years or for adolescents. Children younger than 12 years receiving more hours per week of ABA were found to be more likely to achieve the individualized goals identified in their programs. In retrospective studies, more intense ABA therapy was associated with achieving optimal developmental outcomes."

ATC ^{. Talk} 21:40, 14 September 2020 (UTC)

Added above they are both recent MEDRS ... especially when compared to the 2009 sources we use now, SandyGeorgia (Talk) 22:12, 14 September 2020 (UTC)

Thank you very much for compiling this list of sources. This is a major step towards reaching consensus on the issue of efficacy. I am in agreement with your assessment of most of these sources, but I would like to challenge two of them.

• Scottish2016: This sources is a statement from the medical authorities of Scotland. MEDRS says: "Statements and information from reputable major medical and scientific bodies may be valuable encyclopedic sources. These bodies include the U.S. National Academies (including the National Academy of Medicine and the United States National Academy of Sciences), the British National Health Service, the U.S. National Institutes of Health and Centers for Disease Control and Prevention, and the World Health Organization." Since the Scottish medical authorities can hardly be considered the sort of "reputable major medical and scientific bodies" of the kind mentioned in the previous passage, I don't think this source should count as MEDRS. It would not be at all unusual for one minor medical body to be behind the times on an issue like this.

• Scherr 2019: This source is a textbook. MEDRS says: "High-quality textbooks can be a good source to start an article, and often include general overviews of a field or subject. However, books generally move slower than journal sources, and are often several years behind the current state of evidence." Since in this case there is rapidly changing evidence, we should avoid sources that might be out of date. This textbook may be good for some things, but we should use journal to decide the issue of efficacy.

I agree that we should use only sources that pass MEDDATE to decide the issue of efficacy. The sources that fail MEDDATE should still be good for making historical claims about how our understanding of the evidence has changed over time. Wikiman2718 (talk) 22:12, 14 September 2020 (UTC)

There has been several studies conducted following that 1998 review study (which is long outdated), and after that time, it has been identified as well-established throughout the research for improving autistic kids' intellectual performance; these literature reviews were published in peer-reviewed journals in 2008 and 2015, and the recent Pediatrics (2020) review said that ABA-based interventions are evidence-based practices and that DTT/EIBI has been associated with optimal outcomes in all areas of development. ATC ^{. Talk} 22:52, 14 September 2020 (UTC)

Right now I'd like to finish deciding which sources are valid, and then we can move on to how to interpret them. It looks like you're a step ahead of us. Let's take it one step at a time. --Wikiman2718 (talk) 23:13, 14 September 2020 (UTC)

My point is the sources that SandyGeorgia listed are the ones we (and Alexbrn) agree on, and as Sandy and Alex pointed out, they meet MEDRS and MEDDATE criteria. ATC ^{. Talk} 23:48, 14 September 2020 (UTC)

I agree that most of them do, but I did challenge two. Let's wait a bit for Sandy to weigh in. I'd rather not build up another giant wall of text here. Wikiman2718 (talk) 00:14, 15 September 2020 (UTC)

Potential new sources

Sandy, just found these two sources that we could possibly add to your list:

"Autism spectrum disorders". World Health Organization (Government document). November 7, 2019. "Evidence-based psychosocial interventions,... such as behavioural treatment and skills training programmes for parents and other caregivers, can reduce difficulties in communication and social behaviour, with a positive impact on the person’s well-being and quality of life."

Gordon JA (April 24, 2019). "Director's messages - Progress and priorities in autism research: It's beginning to feel a lot like springtime". National Institute of Mental Health (Government report). "Treatment-wise, applied behavioral analysis is now widely accepted as an evidence-based therapy for ASD and is a mandated covered service in most states." ATC ^{. Talk} 00:59, 15 September 2020 (UTC)

Having glanced at the two new proposals, it is not clear that the first one is referring to aba, and the second mentions it only in passing. I don't think the quality of these sources matches up with the others, so I'm against adding them to the list. Wikiman2718 (talk) 01:43, 15 September 2020 (UTC)

Hi Sandy, just found this recent 2020 report from the University of North Carolina on evidence-based practices (including DTT and all others interventions based on ABA) as well:

Steinbrenner JR, Hume K, Odom SL, Marin KL, Nowell SW, Tomaszewski B, et al. (2020). "Evidence-based practices for children, youth, and young adults with autism" (PDF). The University of North Carolina at Chapel Hill, Frank Porter Graham Child Development Institute, National Clearinghouse on Autism Evidence and Practice Review Team (Report). ATC ^{. Talk} 23:44, 16 September 2020 (UTC)

I'm not entirely sure what to make of this. I can't find it in PubMed. Has it been subjected to peer review? Wikiman2718 (talk) 01:12, 17 September 2020 (UTC)

• @SandyGeorgia: I have one more source to submit. A 2019 meta-analysis by the American Psychological Association finds that "when effect estimation was limited to RCT designs and to outcomes for which there was no risk of detection bias, no intervention types showed significant effects on any outcome." I think it's time that we move on to evaluating the sources. It is unlikely that anyone will submit a new source for consideration if they have not done so already. Wikiman2718 (talk) 12:30, 4 October 2020 (UTC)
  • Cool. You've quoted the abstract - what does the paper itself say (if anything) about ABA? Alexbrn (talk) 13:31, 4 October 2020 (UTC)
    • "no intervention types showed significant effects on any outcome." Wikiman2718 (talk) 13:44, 4 October 2020 (UTC)
      • Yeah, that's from the abstract, which isn't much use. Does the full paper include a discussion of ABA? How many studies are included in the analysis and what are the main discussion points on that specifically? (since that it the topic of this article). I can't access the full paper so I'm curious to know if/how it's useful ... Alexbrn (talk) 14:10, 4 October 2020 (UTC)
        • The paper does discuss ABA as a whole and several of its subtypes. It seems to be a very complete review of literature. The study is over 100 pages. The study finds that the quality of evidence in favor of these interventions is generally not very good. When considering studies without regard for evidence quality, effect is found, but when considering only RTCs there is not evidence of significant effect on any outcome. Wikiman2718 (talk) 14:43, 4 October 2020 (UTC)

Yay - so I've just got access and from a quick skim it seems to mention DTT and ABA only once. ABA is defined loosely as a combination of 3 things: Discrete Trial Training (DTT), Picture Exchange Communication System (PECS), and Positive Behavioral Supports (PBS). These are all placed within an even broader category of "Behavioral approaches". From the piece's conclusion it seems the criticism hinted at in the abstract is reserved for "TEACCH, sensory-based interventions, animal-assisted interventions, and interventions mediated solely through technology" whereas other approaches have vary degress of encouraging supporting evidence, and some considered firmly proven. I'm not seeing any discussion specifically about DTT/ABA though - so it would seem misleading to apply those criticisms in the abstract to DTT/ABA, based on what I've read - am I missing something? Alexbrn (talk) 15:18, 4 October 2020 (UTC)

The paper includes extensive discussion of ABA using the term "behavioral approaches". They are referring here to ABA per page 10. From page 39: "There were not enough RCTs of behavioral interventions to permit summary effect estimation for any outcome type." Wikiman2718 (talk) 15:24, 4 October 2020 (UTC)

So, for this article on DTT, not that useful? Alexbrn (talk) 15:32, 4 October 2020 (UTC)

DTT is explicitly listed as a behavioral intervention on page 9. Wikiman2718 (talk) 15:34, 4 October 2020 (UTC)

And not discussed again; thus would be difficult to use this source without WP:SYNTHESIS and even then we could only repeat what we already say with more explicit sourcing: roughly "seems to work but the evidence is a bit weak". Alexbrn (talk) 15:42, 4 October 2020 (UTC)

Studies on DTT are included in the broader analysis of studies on behavioral interventions, and high quality studies are found not to exist. This is after fifty years of research. Let's not try to confuse this issue with giant walls of text. Wikiman2718 (talk) 15:50, 4 October 2020 (UTC)

No need for WP:MWOT. But if we try to "reach or imply a conclusion not directly and explicitly supported by the source, we are engaging in original research". This source doesn't do for DTT, but may be usable for broader statements about behavioural approaches and other intervention types (all all types of effectiveness). Alexbrn (talk) 15:59, 4 October 2020 (UTC)

The source makes claims about all behavioral interventions, with DTT explicitly included. Wikiman2718 (talk) 16:03, 4 October 2020 (UTC)

File under: "the source explicitly says apples contain cyanide, and then later that apples are good for you: so cyanide is good for you". This is why we prohibit WP:SYNTHESIS. The source is great for the very many things it does explicitly discuss (I have plans for it!) But DTT ain't one of 'em. Alexbrn (talk) 16:08, 4 October 2020 (UTC)

WP:SYNTHESIS is not applicable to talk pages. And I see that your sarcastic edit summaries have returned. Wikiman2718 (talk) 16:22, 4 October 2020 (UTC)

That's not sarcasm, I was agreeing with you (but not your onward implication). Lots of stuff is fine on a Talk page, and I have no objection to your raising this source, it's been useful (as I say) with other articles in mind. So long as we don't try to twist it to be about something it's not (DTT), then all is good. Alexbrn (talk) 16:29, 4 October 2020 (UTC)

Were you also agreeing with me here? It's just so hard for me to tell when you have such a history of making these kind of jabs at me in the edit summaries. As I'm sure you know, gaslighting is against the rules. But anyway, I'm glad that we agree. We can use the source to form conclusions, but will not cite it for these purposes in the article on DTT. We have other sources for that which should serve just as well. Wikiman2718 (talk) 16:41, 4 October 2020 (UTC)

 Not citing it here sounds good. Let's focus on the more directly relevant sources. Alexbrn (talk) 16:51, 4 October 2020 (UTC)

@SandyGeorgia: Could you add this source to the list? Alexbrn and I have agreed that it is relevant, but probably shouldn't be cited in the article on DTT. Wikiman2718 (talk) 16:59, 4 October 2020 (UTC)

On second thought, it would not be synth to say something along the lines of "A 2019 meta-analysis by the American Psychological Association found that when only RCTs were considered, there was no significant evidence to support the use of any behavioral intervention, including DTT." So we might use it in the article, but we probably won't need to. Wikiman2718 (talk) 17:15, 4 October 2020 (UTC)

No because that would be textbook WP:SYNTHESIS, unless there's something in the source saying like "significant evidence" (problematic phrase) and "including DTT" like you want to say. Looks like POV-pushing. Alexbrn (talk) 17:25, 4 October 2020 (UTC)

The source does say those things. And please stop accusing me of POV pushing. You've made it quite clear that you have a POV here, too. Wikiman2718 (talk) 17:40, 4 October 2020 (UTC)

You'll need to give a quotation that "direct and explicitly" supports your proposed text then. Otherwise, a quick check at WP:NORN could be helpful. Alexbrn (talk) 17:46, 4 October 2020 (UTC)

If a study found that that all homeopathic remedies are ineffective, and that treatment X is a homeopathic remedy, we would be able to say that treatment X is ineffective. If we were not, we wouldn't be able to write an encyclopedia. This study finds that "when effect estimation was limited to RCT designs and to outcomes for which there was no risk of detection bias, no intervention types showed significant effects on any outcome." DTT was among the interventions included in this statement. You are trying to impose an overly strict interpretation of WP:SYTH, which if enforced, would make it impossible to write an encyclopedia. Wikiman2718 (talk) 18:09, 4 October 2020 (UTC)

It's perfectly possible to write articles while sticking to the WP:PAGs, and last time I looked our Homeopathy article did just that (in fact, by necessity it has to be ultra-strict because of the intense attention it attracts from those who would skew it). About avoiding synthesis the phrase "directly and explicitly" is crystal clear, and emphasized - in italics - in policy. Quite apart from anything else your novel re-imagining of the source (based on cherry-picked wording) contradicts the conclusion of the article, for which many interventions are adjudged effective and/or proven, even based on RCTs. If you think you can satisfy policy, you'll need to be prepared to defend any use of this source at WP:NORN. Please read the policy:

"A and B, therefore C" is acceptable only if a reliable source has published the same argument in relation to the topic of the article

Alexbrn (talk) 20:14, 4 October 2020 (UTC)

So if we had an article on a new and untested homeopathic preparation, we wouldn't declare it ineffective? Of course we would. Per what synth is not: "Virtually anything can be shoehorned into a broad reading of SYNTH, but the vast majority of it shouldn't be." SYNTH is not an advocacy tool. And you want to accuse me of cherry-picking for quoting the main conclusion of the paper? Please show me the quote where it says that these interventions are "proven" based on RCTs. That would directly contradict the contents of the abstract, so quite frankly, I think you're making stuff up again. Wikiman2718 (talk) 20:36, 4 October 2020 (UTC)

Wikiman2718, RCTs are not the only way to show that a method works or is effective if it’s not a drug treatment and the studies conducted were designed based on the scientific method as outlined in a number of peer-reviewed journals, indicating that all ABA-based interventions (i.e., DTT, pivotal response treatment, PBS, and PECS, etc.) are effective for those with autism and which form of ABA is most effective depends on each child’s learning style (that was even made clear in the 2020 ‘’Pediatrics’’ review that I added to Sandy’s list). And you’re asking for another block request because of how rude you’re being to anyone who goes against ‘’your’’ POV. ATC ^{. Talk} 16:24, 5 October 2020 (UTC)

I accused him of making things up, but he did in fact make things up. He also did that earlier in our discussion when he represented a closed source Pediatrics article as making claims about aversives that is did not make. Please do not threaten me with a block for calling him out on this. Wikiman2718 (talk) 16:50, 5 October 2020 (UTC)

False accusations are Wikiman2718's stock in trade, as is now well known throughout the community. I'm not going to say anything more here since what I've said is sufficient and correct. Alexbrn (talk) 17:01, 5 October 2020 (UTC)

Firstly, User:Atdevel was a sock. I have apologized to ATC for having misidentified him as the master. As for you, Alexbrn, you are required to substantiate your claims with evidence. You have claimed that the the paper says that many interventions are "proven" based on RCTs. This directly contradicts the abstract. You will need to supply more than a snide comment to make that statement stand. Wikiman2718 (talk) 17:49, 5 October 2020 (UTC)

Editors wanting to make edits have an WP:ONUS upon them, also WP:CIR. Alexbrn (talk) 18:09, 5 October 2020 (UTC)

You have the onus to show that the source calls these methods "proven", when it states quite frankly in the abstract that they are not proven. It does not help when you tell me to read the source (which is over 100 pages) just to prove that your claim is made up. I'm sure that if I did, you would just keep on insisting that it's in there. It also does not help to imply that I am incompetent. Wikiman2718 (talk) 18:18, 5 October 2020 (UTC)

After two days of vaccination-induced fever and malaise, I am just catching up here. You were reminded not to raise the socking issue again on Wikipedia, as your claims about ATC were false (I am glad you apologized, and see that it was sincere). I have just read through reams of text added while I was sick, which mostly seem to amount to you misrepresenting the source. There doesn't seem to be consensus here that it is an applicable review useful for this article. SandyGeorgia (Talk) 14:28, 7 October 2020 (UTC)

Sandy: I am sorry to hear that you were sick. Thank you for returning and as always, your presence is this discussion is appreciated. I was told not to raise the issue of that socking incident again, but that was before it had been determined the Atdevel (the accused sock) actually was a sock. And I think that this probably doesn't apply to apologizing to ATC for having misidentified him as the master. So in short, I was being attacked by a sock, but I made the pretty big mistake of getting the master wrong. I have learned a lot from that incident.

As for the source, Alexbrn claims that it says certain behavioral interventions are "proven", or highly supported by RTCs. He refuses to show a quote, telling me instead to read the source (see the edit summary). I do not believe his claim is accurate, as I have done a text search on the article and the word "proven" does not appear in it. If you believe that I am misrepressenting the source, please tell me exactly what is wrong and I will be glad to discuss it with you. Wikiman2718 (talk) 14:54, 7 October 2020 (UTC)

I am still not operating at full capacity; will check in after a few days, when the brain fog passes. SandyGeorgia (Talk) 14:57, 7 October 2020 (UTC)

Not a problem. =) Wikiman2718 (talk) 15:05, 7 October 2020 (UTC)

It beggars belief that anybody reading this article has missed the main discussion points of the conclusion. No the word "proven" is a paraphrase of facts that are attested by evidence as mentioned by the source. Because it seems Wikiman2718 can't or won't read the source for some reason, here is a relevant extract:

The last decade has seen the publication of over 100 group design studies of intervention, including at least 50 RCTs. These studies attest to the fact that access to intervention in early childhood can yield a range of positive outcomes for the children receiving it. NDBIs have emerged as a new intervention category with significant summary effects even when several quality indicators are taken into account. High quality studies also suggest that developmental intervention can improve some core challenges associated with ASD, particularly difficulties in social communication. Traditional behavioral intervention approaches show some evidence of effectiveness, but methodological rigor remains a pressing concern for this body of research. There is little evidence to date, however, to support the effectiveness of several other interventions that are geared towards young children with autism ...

What we're seeing here Wikiman2718 riding yet another bad-faith hobby horse round the park and - yes - misrepresenting the source to boot. And it's wasting everybody's time. Again. In any case, this is still not a relevant source for disscussing DTT. Alexbrn (talk) 15:19, 7 October 2020 (UTC)

Thank you for finally supplying a quote, and not just asking me to read the 100+ page article again. The article discusses three classes of interventions: Behavioral (defined here to be synonymous with ABA), developmental, and NDBI. While it does state some support for NDBI (but does not go so far as to call them proven), its position on behavioral interventions is far less optimistic. While I would like to continue this discussion, I have not found it productive to do so while Sandy is not moderating. Therefore I will do my utmost best not to participate in this discussion until she is back, even if you leave a response. With two of the four editors on break, it is probably best to just put this on hold. Wikiman2718 (talk) 15:44, 7 October 2020 (UTC)

see WP:HOLES. Alexbrn (talk) 15:55, 7 October 2020 (UTC)

I found this 2018 Cochrane review which may be of good use to add to the list; see here: Brignell A, Chenausky KV, Morgan AT, et al. (November 2018). "Communication interventions for autism spectrum disorder in minimally verbal children". Cochrane Database of Systematic Reviews (Meta-Analysis). pp. CD01234. doi:10.1002/14651858.CD012324.pub2. PMC 6516977. PMID 30395694. It pretty much summarizes what learners DTT/Rapid Motor Imitation Antecedent is effective for in terms of teaching spoken language, but there needs to be RCTs with larger sample sizes to show this on a large wide scale. “Given the substantial heterogeneity in ASD and wide range of underpinning factors that may be at play in preventing a child from talking, it is not surprising that children respond differently to different interventions (see Hudry 2017, Trembath 2014 and Vivanti 2014 for further discussion around predictors of treatment response)... For example, Paul 2013 found that children with a receptive language age‐equivalent below 18 months were more likely to do better with the Rapid Motor Imitation Antecedent training, whereas those scoring above 18 months were more likely to do better with Milieu Communication Training.” Milieu Communication Training is a fancy term for Incidental Teaching/Natural Environment Training and pivotal response treatment. ATC ^{. Talk} 22:18, 13 October 2020 (UTC)

Looks like both the Lovaas (1987) study and that 2013 study from the Yale Child Study Center on the different learning styles was replicated this summer using a large randomized control trial of 164 participants. 45% with lower receptive language skills gained typical spoken language from Discrete Trials, while those with higher receptive language skills gained typical spoken language from JASPER (a naturalistic play-based form of ABA). See here: https://onlinelibrary.wiley.com/doi/full/10.1002/aur.2932 We'd need about 5 or 6 more studies before they could make a literature review out of it. ATC ^{. Talk} 20:51, 6 September 2023 (UTC)

Oral motor imitation

I think it might be worth adding in the article that sometimes Errorless Learning/DTT had also incorporated oral motor imitation/tactile prompts for the speech (as Lovaas did; and there is considerable overlap between DTT and speech therapy). Over the years, we find those prompts usually have no effect and are only beneficial if the child is attempting to speak but struggles with phonetics. Speech therapists always had and stills trains behavior analysts how to use them, yet none of the newer training manuals, like Mark Sundberg's Verbal Behavior, provide assessments for it anymore, and there have been no behavior analytic studies on it either. ATC ^{. Talk} 23:30, 4 September 2020 (UTC) September 2020 (UTC)

That was also my assesment of the issue as it came up in the sources I read. Can you think of any more uses for DDT? --Wikiman2718 (talk) 00:13, 5 September 2020 (UTC)

Rapid Motor Imitation/Antecedent (RMIA) is a form of DTT for autism that was first coined in the research literature by speech therapists which consists of fine and gross motor imitation mass trials followed by echoic (vocal imitation) training. It's the same thing as Lovaas therapy (just branded differently). In a randomized control trial published in the Journal of Autism and Developmental Disabillities in 2013 [11], 3 out of the 5 children acquired speech using the approach. ATC ^{. Talk} 00:32, 5 September 2020 (UTC)

Well, OK. That trial is way too small, but if they're actually conducting such studies it could possibly be worth talking about. It would be nice if we could get a reliable result, though. --Wikiman2718 (talk) 00:36, 5 September 2020 (UTC)

I read online a few years ago before Tristram Smith died that he was raising grants with the Kennedy Krieger Institute to reproduce Lovaas therapy using rather large sample sizes. Don’t know the status on it considering he isn’t alive anymore but I’m sure it’s still in the process. The insurance caused a lot of other varying problems in each state so that could affect the status as well (i.e., inadequate training and licensing requirements, long waiting lists, not covering the full 40 hours for the kids who need it, NY limiting the field only to autism, etc.) ATC ^{. Talk} 00:56, 5 September 2020 (UTC)

Exactly how large is this sample size? Past studies have been ~20 people in the treatment group, which is just not enough to get good result. If the planned study was quite large it could be worth mentioning, but only if was quite large. And preferably if it was conducted by an independent organization. --Wikiman2718 (talk) 01:49, 5 September 2020 (UTC)

Many have been conducted by independent researchers and organizations in a variety of locations. ATC ^{. Talk} 02:08, 5 September 2020 (UTC)