An Open Letter From O. Ivar Lovaas
The letter reproduced below is a discussion by Dr. Lovaas regarding
what is considered an appropriate therapeutic intervention for children
November 3, 1993
To Whom It May Concern:
This letter is intended to address the question of what constitutes an
appropriate therapeutic intervention for a child diagnosed as autistic.
A consensus has emerged among scientific researchers and practitioners that
appropriate (not ideal) treatment contains the following elements (e.g.,
Simeonnson, Olley, and Rosenthal, 1987):
1. A behavioral emphasis: This involves not only imposing structure and
rewarding appropriate behaviors when they occur, but also applying some more
technical interventions such as conducting discrete trials, producing shifts
in stimulus control, establishing discriminations between SD's and S-deltas,
and so forth (Koegel and Koegel, 1988).
2. Family participation: Parents and other family members should participate
actively in teaching their child. Without such participations, gains made in
professional settings such as special education programs, clinics, or
hospitals rarely lead to improved functioning in the home. (Bartak, 1978;
Lovaas, Koegel, Simmons, and Long, 1973).
3. One-to-one instruction: For approximately the first six months of
treatment, instruction should be one-to-one rather than in a group because
autistic children at this stage learn only in one-to-one situations (Koegel,
Rincover, and Egel, 1982). This training need not be adminstered by degreed
professionals, but can be just as effective if delivered by people who have
been thorougly trained in the behavioral treatment of autistic children,
such as undergraduate students or family members (Lovaas and Smith, 1988).
4. Integration: When a child is ready to enter a group situation, the group
should be as "normal" or "average" as possible. Autistic children perform
much better when integrated with normal children than when placed with other
autistic children (Strain, 1983). In the presence of other autistic
children, any social behavior that they may have developed usually
disappears within minutes (Lovaas and Smith, 1988), presumably because it is
not reciprocated. Mere exposure to normal children, however, is not
sufficient. The autistic children require explicit instruction from trained
tutors on how to interact with their peers (Strain, 1983).
5. Comprehensiveness: Autistic children initially need to be taught
virtually everything. They have few appropriate behaviors, and new behaviors
have to be taught one by one. This is because teaching one behavior rarely
leads to the emergence of other behaviors that were not directly taught
(Lovaas and Smith, 1988). For example, teaching language skills does not
immediately lead to the emergence of other language skills, such as
6. Intensity: Perhaps as a corollary for the need for comprehensiveness, an
intervention requires a very large number of hours, about 40 hours a week
(Lovaas and Smith, 1988). Ten hours a week is inadequate (Lovaas and Smith,
1988), as is twenty hours (Anderson, Avery, Dipietro, Edwards, and
Christian, 1987). The majority of the 40 hours, at least during the first
six months of the intervention, should consist of remediating speech and
language deficits (Lovaas, 1977). Later, this time may be divided between
promoting peer integration and continuing to remediate speech and language
I hope this information is helpful. If you have any questions, please do not
hesitate to contact me.
Ivar Lovaas, Ph.D.
Professor of Psychology
Director, Clinic for the Behavioral Treatment of Children
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Bartak, L. (1978). "Educational approaches". In M. Rutter and E. Schopler
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Settings (pp. 41-65).
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generalization and follow-up measures on autistic children in behavior
therapy." Journal of Applied Behavior Analysis, 6, 131-166.
Lovaas, O.I., and Smith, T. (1988). "Intensive behavioral treatment for
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Clinical Child Psychology, Volume 11 (pp. 285-324). New York: Plenum.
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(Eds.), The Effectiveness of Early Intervention for At-Risk and Handicapped
Children (pp. 275-296). New York: Plenum.
Strain, P.S. (1983). "Generalization of autistic children's social behavior
change: Effects of developmentally integrated and segregated settings."
Analysis and Intervention in Developmental Disabilities, 3, 23-34.