Response by Maureen Graves to Dr. Bryna Siegel

Dr. Siegel calls me personally a “loose cannon” who has been “threatening” her for years and suggests I may be “mad” because data do not support the notion that all children need early intensive behavioral intervention. In fact, I agree that children’s needs as well as the quality of available home and school options vary widely, and have assisted in securing a wide variety of services. Most of my clients and I would be very happy if it were not necessary to arrange, fight for, and live with intensive in-home programs. If there were research indicating that these programs made no difference, I would want to know that. While I have very frequently seen clients go from being nonverbal during years of special education to beginning to talk soon after starting intensive applied behavior analysis, I rely on research rather than such “anecdotal” or “clinical” experiences. I expect research to be done honestly and with acceptable statistical techniques. All reputable research has concluded that ABA programs are very helpful, and indeed, the pattern has been that the more intensive programs are and the longer they last, the better the results are. See S.R. Anderson et al., “Intensive Home-based Early Intervention with Autistic Children” (1987); Jay Birnbrauer & David Leach, “The Murdoch Early Intervention Program After 2 Years” (1993); Geraldine Dawson & Julie Osterling, “Early Intervention in Autism,” in The Effectiveness of Early Intervention (1997); Sandra Harris et al., “Changes in Cognitive and Language Functioning of Preschool Children with Autism” (1991); Ivar Lovaas, “Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children” (1987); John McEachin, Tristam Smith & Ivar Lovaas, “Long-Term Outcome for Children with Autism Who Received Early Intensive Behavioral Treatment” (1993); Gregory Olley, Frank Robbins & Marlene Morelli-Robins, “Current Practices in Early Intervention for Children with Autism” (1993); Sally Rogers, “Brief Report: Early Intervention in Autism” (1996); Ruth Simeonsson, Gregory Olley & Susan Rosenthal, “Early Intervention for Children with Autism” (1987). Indeed, Siegel’s own initial work contains one strong and statistically significant association – between treatment length and outcomes.

As for the suggestion that my criticisms are “divisive” and undermine parent confidence in professionals, I am afraid that this is true, and unfortunately that this is necessary. As funding flows to autism research -- through the hard work and strong advocacy of parents and professionals in the field -- it is crucial that this money be spent on things that are likely to produce good results, and not on things that are sure to produce bad ones.

The problems with Siegel’s work have been evident for years. Nonetheless, her work made it through JADD’s internal process, and only with extreme persistence were refutations published – in the letters column. Despite these published refutations, this very work was relied upon by the National Academy of Sciences as its only citation for the proposition that “dose” may not matter: “However, Sheinkopf and Siegel (1998) did not find a dose-response relationship between more than 20 hours of interventions and outcome, in part because children’s skills at entry were such strong predictors of improvement.” Educating Children with Autism (2001), p. 151. The JADD piece established Dr. Siegel as an “authority” on treatment outcomes whose current claims deserve respectful attention. I think that this episode shows that parents and others with a commitment to “whatever works” rather than to specific methodologies need to be involved in ensuring that research that is funded or presented in influential fora is scientifically sound, and not just politically or ideologically useful. Autism professionals vet each other’s research proposals and have friendship and “friend of friend” relationships. They are often very busy with their own research and clinical obligations, and thus feel too busy to referee the work of others as carefully as they need to. (It doesn’t help that there are few professional rewards for careful refereeing.) Some may even be reluctant to be called “loose cannons” who “threaten” others.

As for Dr. Siegel’s suggestion that readers contact lawyers for whom she has testified, I do not doubt that she could be useful as an expert witness in cases in which she decides to get involved. An “expert” who is generally skeptical about an approach, but extremely supportive of its application to a particular case, is an ideal witness, as is one who usually testifies for the “other side.” Unfortunately, whatever occasional good she does on a “retail” level cannot begin to undo the wholesale harm created by pseudo-research which points parents and funding agencies away from the best validated approaches so far.

Maureen Graves