I am pleased to be able to oer comments about this manuscript. It represents an attempt to disseminate interim data on the response of a group of young children with autism to home-based early intensive behavioral intervention (EIBI) using treatment formats based on those of the UCLA Young Autism Project (Lovaas, 1987). It diers from other independent reports following up on the intriguing possibility that home-based EIBI can produce the astonishing developmental gains described by Lovaas (1987), in that there is no comparison to a non-treatment or non-behavioral treatment contrast group (Birnbrauer & Leach, 1993;Sheinkopf & Siegel, 1998), but it represents a report of data suggesting that very rapid and meaningful gains can be observed in adaptive behavior in the context of EIBI under the auspices of yet another independent investigator. This information is of great interest to parents searching for appropriate services, and to policy makers, teachers, and administrators who want to serve the needs of aected children but might fear the consequences of committing substantial resources to a novel service format in the current ยฎscal and advocacy climate (Autism National Committee, 1995).
Having said this, however, I feel adamant that because of its relevance to the aspirations of parents, and the concerns of responsible professionals, the paper should be revised before it is published. Needed revisions involve greater speciยฎcation of the methods and more qualiยฎcation of the conclusions. I will cover my concerns in roughly the same order as they arose in reading the manuscript, and I will give reasons for recommended changes where they may not be readily apparent.
The intervention described is expensive. Estimates range from $30,000 in urban areas to $60,000 in metropolitan areas per child per year. Such expense can only be justiยฎed by a large dierential response to treatment. A small number of studies have supported the possibility of such a large response. From