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A Case Study in the Misrepresentation of AppliedBehavior Analysis in Autism: The Gernsbacher Lectures

Edward K. MorrisUniversity of Kansas

I know that most men, including those at ease with problems of the greatest complexity, canseldom accept the simplest and most obvious truth if it be such as would oblige them to admitthe falsity of conclusions which they have proudly taught to others, and which they have woven,thread by thread, into the fabrics of their life. (Tolstoy, 1894)

This article presents a case study in the misrepresentation of applied behavior analysis for autismbased on Morton Ann Gernsbacher’s presentation of a lecture titled ‘‘The Science of Autism:Beyond the Myths and Misconceptions.’’ Her misrepresentations involve the characterization ofapplied behavior analysis, descriptions of practice guidelines, reviews of the treatment literature,presentations of the clinical trials research, and conclusions about those trials (e.g., children’simprovements are due to development, not applied behavior analysis). The article also reviewsapplied behavior analysis’ professional endorsements and research support, and addresses issuesin professional conduct. It ends by noting the deleterious effects that misrepresenting anyresearch on autism (e.g., biological, developmental, behavioral) have on our understanding andtreating it in a transdisciplinary context.

Key words: autism, applied behavior analysis, misrepresentation, research methodology,ethics

This manuscript is unconventional.I did not write it for publication, butfor students at the University ofKansas (KU), colleagues and ac-quaintances on and off campus,families of children with autism,1

and ultimately for those children. Ialso wrote it for myself, both as aprofessional and as a person. Profes-sionally, I was obliged to respond torecent misrepresentations of appliedbehavior analysis in autism. Person-ally, I was aggravated enough that Ithought that writing the manuscriptmight prove cathartic. In the end,though, the catharsis was more intel-lectual than emotional. I learned agreat deal about autism research andtreatment, and am now better ableto address their misrepresentation.This sense of intellectual satisfaction,however, did not fully overcome myaggravation, but so be it.

INTRODUCTION

At the invitation of KU’s Depart-ment of Psychology, Morton AnnGernsbacher (University of Wiscon-sin) gave its Fern Forman Lecture onSeptember 27, 2007. It was titled

I thank many colleagues for indulging mymany questions about autism and its treat-ment and for their constructive comments onthe manuscript’s earlier drafts. I acknowledgethem by including their fine work in myreference section.

Correspondence may be sent to the authorat the Department of Applied BehavioralScience, 4020 Dole Center for Human Devel-opment, University of Kansas, 1000 Sunny-side Avenue, Lawrence, Kansas 66045 (e-mail:[email protected]).

1 According to the American Psychiatric Asso-ciation’s (2000) Diagnostic and Statistical Man-ual of Mental Disorders, autism is a neurode-velopmental disorder whose core features areimpairments in communication (e.g., lack ofspoken language) and social interactions (e.g.,lack of social or emotional reciprocity) andrestricted, repetitive, and stereotyped patternsof behavior, interests, or activities (e.g., rituals,self-stimulation) (p. 75). These features areoften associated with other conditions thatvary from severe to mild within and acrossindividuals (e.g., mental retardation, chronicaberrant behavior). Autism also falls within

the broader diagnosis of the autism spectrumdisorders, which include autism, Aspergersyndrome, and pervasive developmental disor-der not otherwise specified.

The Behavior Analyst 2009, 32, 205–240 No. 1 (Spring)

205

‘‘The Science of Autism: Beyond theMyths and Misconceptions.’’ Gerns-bacher is an award-winning educator,a well-funded and well-publishedresearcher, and the 2006–2007 presi-dent of the Association for Psycho-logical Science (APS). Her research ison cognitive mechanisms hypothe-sized to underlie language compre-hension (e.g., Traxler & Gernsbacher,2006). When her son, Drew, wasdiagnosed with autism at the age of2 years in the spring of 1998, shebecame ‘‘motivated by personal pas-sion’’ to address autism, too, inparticular, why children with autismdo not speak (www.Gernsbacherlab.org). Since then, she has become anactive researcher and professionalspeaker in this and related areas, aswell as a public advocate for therights of individuals with autism (e.g.,Dawson, Mottron, & Gernsbacher,2008; Gernsbacher, 2007a, 2007b;Gernsbacher, Sauer, Geye, Schwei-gert, & Goldsmith, 2008). At KU, herlecture (a paid public lecture) filled a990-seat on-campus auditorium large-ly, it appeared, with students earningcourse credit. In addition, it wassimulcast to 200 more students andcommunity members at KU’s Ed-wards Campus in Kansas City. Forthe record, Gernsbacher had givenfour previous invited lectures by thesame title at (a) a September, 2005,colloquium at Washington Universi-ty, (b) the August, 2006, conference onBrain Development and Learning:Making Sense of the Science (Vancou-ver, British Columbia, Canada), (c)the February, 2007, meeting of theSoutheastern Psychological Associa-tion, as a William James DistinguishedLecturer (New Orleans), and (d) theApril, 2007, John S. Kendall LectureSeries at Gustavus Adolphus College(St. Peter, Minnesota).

In her lecture, Gernsbacher ad-dressed several assumptions aboutautism’s diagnosis and etiology, forinstance, that it is epidemic (Maugh,1999); that it was once caused byemotionally cold ‘‘refrigerator moth-

ers’’ (Bettleheim, 1967); and that it istoday caused by childhood measles-mumps-rubella vaccinations (Kirby,2005). Emphasizing the importanceof rigorous research methods andexperimental designs, she concludedfrom her review of the literature,some of it her own research, thatthese assumptions were myths andmisconceptions (see, e.g., Gernsba-cher, Dawson, & Goldsmith, 2005;Gernsbacher, Dissanayake, et al.,2005). In the final section of herlecture, she addressed autism inter-vention and therapy, specifically theassumption that applied behavioranalysis is an effective treatment.Before addressing her review ofthis literature and her conclusions,though, I put applied behavior analy-sis in a broader disciplinary frame-work and then in a local and historicalcontext. This material is intended, inpart, as a scholarly resource, so it is atad academic.

Applied Behavior Analysis

Applied behavior analysis is morethan intervention and therapy. It is asubdiscipline of the field of behavioranalysis (J. Moore & Cooper, 2003;see The Behavior Analyst; www.abaintenational.org; www.behavior.org). The field comprises (a) a naturalscience of behavior (i.e., basic behav-ioral principles and processes; e.g.,reinforcement, shaping; see Catania,2007; Journal of the ExperimentalAnalysis of Behavior), (b) relatedconceptual commitments (i.e., philos-ophy of science; e.g., naturalism,empiricism; see J. Moore, 2008; TheBehavior Analyst), and (c) appliedresearch on problems of societalimportance and means for ameliorat-ing them (Cooper, Heron, & Heward,2007; Journal of Applied BehaviorAnalysis [JABA]; Behavior Analysisin Practice). For concise overviews,see Michael (1985) and Reese (1986).

Although applied behavior analy-sis arose at several U.S. and Canadi-an sites in the late 1950s and early

206 EDWARD K. MORRIS

1960s (Kazdin, 1978), its first institu-tional base was KU’s Department ofHuman Development and FamilyLife (established 1965), now theDepartment of Applied BehavioralScience (ABS; established 2004). Thisis where ABA’s flagship journal(JABA) was founded (Wolf, 1993),the subdiscipline’s basic dimensionswere first articulated (Baer, Wolf, &Risley, 1968), and some of its earliestinnovative programs of research wereundertaken. These include the Juni-per Gardens Children’s Project foryouth, school, and community devel-opment (Hall, Schiefelbusch, Green-wood, & Hoyt, 2006) and Achieve-ment Place for juvenile offenders (i.e.,the Teaching Family Model; Wolf,Kirigin, Fixsen, Blase, & Brauk-mann, 1995), both of them in collab-oration with the Bureau of ChildResearch, now the Schiefelbusch In-stitute for Life Span Studies (Schie-felbsuch & Schroeder, 2006; see Baer,1993a; Goodall, 1972).2

Applied behavior analysis involvesan integration of research and appli-cation, including use-inspired basicresearch (i.e., basic research in theinterests of application; e.g., stimuluscontrol of stereotyped behavior;Doughty, Anderson, Doughty, Wil-liams, & Saunders, 2007), discoveryresearch (i.e., research on unplannedfindings; e.g., on the overjustificationeffect; Roane, Fisher, & McDon-ough, 2003), and translational re-search (i.e., the translation of basicresearch into practice; e.g., reinforcer

magnitude and delay; Lerman, Ad-dison, & Kodak, 2006). In themain, however, ABA addresses atyp-ical behavior (e.g., stereotypy; Reeve,Reeve, Townsend, & Poulson, 2007),methods for its assessment and anal-ysis (e.g., functional assessment andanalysis; R. H. Thompson & Iwata,2007), behavior-change procedures(e.g., desensitization for phobias; Ric-ciardi, Luiselli, & Camare, 2006), pack-ages of behavior-change procedures(e.g., self-management; peer-mediatedtreatments; Stahmer & Schreibman,1992), and comprehensive programsof treatment (e.g., early intensive behav-ioral interventions; T. Smith, Groen,& Wynn, 2000).

Applied behavior analysis alsoranges across several domains (Lui-selli, Russo, Christian, & Wilczynski,2008), for instance, (a) from individ-ual procedures for specific behaviorto comprehensive programs for prob-lems in daily living (e.g., Iwata,Zarcone, Vollmer, & Smith, 1994;McClannahan & Krantz, 1994), (b)from inpatient to on-site servicedelivery (e.g., Hagopian, Fisher, Sul-livan, Acquisto, & LeBlanc, 1998;Nordquist & Wahler, 1973), and (c)from staff training to organizationalbehavioral management (e.g., Mc-Clannahan & Krantz, 1993; J. W.Moore & Fisher, 2007; Sturmey,2008; see Cuvo & Vallelunga, 2007).Finally, the field’s interventions are,ideally, research, too, in that clinicaldecisions are data based (e.g., whento alter or amend them). In fact,the ethical guidelines of the Behav-ior Analysis Certification BoardH(BACB) require data-based decisionmaking (see Bailey & Burch, 2005,pp. 104–106, 212–214).

Gernsbacher’s Review and Conclusions

Gernsbacher did not review allthe applied behavior-analytic re-search in autism. That would havebeen too great a task. Over 750articles were published between 1960and 1995 (DeMyer, Hingtgen, &

2 As for my potential conflicts of interest, Iam the ABS department chairperson. Howev-er, although I have published applied researchand reviews (e.g., Altus & Morris, 2004;Atwater & Morris, 1988; Morris & Brauk-mann, 1987) and am a Board-Certified Be-havior Analyst, I am not an applied behavioranalyst. My interests lie largely in history andtheory (e.g., Morris, 1992, 2003; Morris,Altus, & Smith, 2005). As a result, I am notdeeply attuned to applied behavior analysis’severy nuance in science and practice, especiallyin autism, so I apologize to my appliedcolleagues if I am clumsy or insensitive inrepresenting their field.

THE GERNSBACHER LECTURES 207

Jackson, 1981; Matson, Benavidez,Compton, Paclawskyj, & Baglio,1996) and hundreds more since then.They appear in JABA, other appliedbehavioral science journals (e.g., Be-havioral Interventions), and journalsin related fields (e.g., American Jour-nal on Mental Retardation, Journal ofConsulting and Clinical Psychology).What Gernsbacher reviewed was asubset of the comprehensive programsfor early intensive behavioral inter-ventions (ABA-EIBI) that she referredto as ‘‘the Lovaas-style of behavioraltreatment.’’3 Based on her review, sheconcluded that the effectiveness ofapplied behavior analysis for autismwas another myth and misconceptionand that the gains made duringtreatment were due to the children’s‘‘development,’’ not to ABA-EIBI.

These conclusions upset some au-dience members. A parent of anadolescent with autism, for whomapplied behavior analysis had dra-matically improved their lives, askedme what he should use instead. AnABS major bemoaned that her courseof study was apparently for naught.A faculty member criticized Gerns-

bacher for overlooking the extensiveliterature on which Lovaas-styleABA-EIBI is based. This criticism,though, was not fully justified.Gernsbacher had to be selective inher review, given the size of theliterature, the breadth of her audi-ence, and the interests of time.

As for my reaction to her conclu-sions, I was stunned. However, I wasstunned not so much by her conclu-sions per se. I had heard them beforein antiscience rhetoric about autism’setiology and treatment, as well as insentiment against applied behavioranalysis in general (e.g., Meyer &Evans, 1993; www.AutCom.org; www.autistics.org; see ‘‘Is ABA the OnlyWay?’’ at http://www.autismnz. org.nz/articlesDetail.php?id523; contra.Baer, 2005: Eikeseth, 2001; Green,1999; J. E. Jacobson, Foxx, & Mulick,2004; Leaf, McEachin, & Taubman,2008; Lovaas, 2002, pp. 287–407; T.Thompson, 2007a, pp. 187–203; ingeneral, see Offit, 2008).

Sentiment against applied behavioranalysis is not, of course, necessarilyantiscience. No matter what Gerns-bacher’s sentiments may be, herachievements are anything but anti-science. What stunned me, then, washow she reached her conclusions: Sheinaccurately represented research re-views, wrongly characterized appliedbehavior-analytic interventions, mis-leadingly appealed to history, inac-curately conveyed research designs,selectively omitted research results,and incorrectly interpreted interven-tion outcomes. Although misrepre-sentations are often only a minornuisance in science, they can haveharmful consequences, which I be-lieve hers did (and do), both locallyand more broadly.

The local consequences includedmisinforming KU’s community mem-bers about ABA-EIBI; hundreds ofKU students about a science ofbehavior and its application; currentand prospective ABS majors about acourse of study at KU (and careers);and KU staff, faculty, and adminis-

3 Equating applied behavior analysis withany one intervention, for example, withLovaas-style ABA-EIBI or, more narrowly,with discrete-trial training (DTT), is a con-ceptual error. Lovaas’s is just one of severalABA-EIBI programs, of applied behavior-analytic programs in general, and of programsbased in the science of behavior (Luiselli et al.,2008; T. Thompson, 2007a, pp. 43–46; see,e.g., Koegel & Koegel, 2006; Schreibman,2000; Strain, McGee, & Kohler, 2001). In fact,the number of applied behavior-analyticprograms is huge, limited only by the permu-tations on the number of basic behavioralprinciples (e.g., reinforcement, stimulus con-trol), behavioral processes (e.g., chaining,shaping), behavior-change procedures (e.g.,activity schedules), and packages of behavior-change procedures (e.g., verbal behavior inter-ventions), all constrained, of course, by ethicalconsiderations (see Green, 1999; Hayes, Hayes,Moore, & Ghezzi, 1994). Finally, althoughLovaas-style ABA-EIBI is today’s best evi-dence-based treatment for autism, it may not bethe best treatment. That remains an empiricalquestion. It is also not likely the last besttreatment. Science, both basic and applied, is aprocess; it evolves (see T. Thompson, 2008).


trators about scholarship in a depart-ment renowned for its research inapplied behavior analysis. The broad-er consequences include Gernsba-cher’s probable influence on behav-ioral, social, and cognitive scientistswho teach, conduct research, andprovide services in autism; fundingagencies and foundations who setpriorities and allocate resources forautism research and applications; andstate and federal agencies that setstandards for autism services andfunding. She has standing and staturein most, if not all, of these venues: inAPS, of course, but also in theAmerican Association for the Ad-vancement of Science (AAAS), whereshe is a psychology section member atlarge, and in the National ScienceFoundation (NSF), where she is onthe Advisory Committee for the So-cial, Behavioral, and Economic Sci-ences. Although Gernsbacher surelygained these highly respected positionsby conducting first-rate science, thehallmarks of her science were largelyabsent in this section of her lecture.

In Response

In what follows, I respond toGernsbacher’s misrepresentations, butremain agnostic, yet curious, abouttheir source or sources. No matterwhat, though, misrepresentations re-main misrepresentations. In address-ing them, I reproduce this section ofher lecture below,4 inserting bracketed

material to provide context and conti-nuity. Then, where they occur, Iaddress the misrepresentations. Forthe sake of brevity, such as it is, Irestrict my comments to her lectureand note her ABA-EIBI-related pub-lications only in passing (e.g., M.Dawson et al., 2008; Gernsbacher,2003). As a result, I do not addressimportant issues in autism researchand application that she did not cover,for instance, the incomplete reportingof treatment variables in research(Lechago & Carr, in press; see Kazdin& Nock, 2003), among them, therapistcompetence (Shook & Favell, 1996),treatment intensity (Graff, Green, &Libby, 1998), and treatment fidelity orintegrity (Wolery & Garfinkle, 2002). Ialso set aside the literatures on treat-ment effects on brain structure (G.Dawson, 2008; T. Thompson, 2007b),autism recovery and its mechanisms(Helt et al., 2008), and ABA-EIBI’slong-term costs and benefits (Chasson,Harris, & Neely, 2007; J. W. Jacobson& Mulick, 2000).

My response may give offense toGernsbacher, but none is intended. Iam concerned about scientific com-munication and reasoning, not abouta person or persons. Indeed, mycomments are made in the spirit ofthe behavior-analytic maxim: ‘‘Theorganism is always right.’’ It is notalways right, of course, in a moral orfactual sense, but it is ‘‘right’’ in thesense that behavior is a lawful subjectmatter for a science unto its own. Inthat science, behavior is a function ofthe organism’s biology, its environ-ment, and the history of their trans-actions in which organisms become

4 The text was transcribed from KU’sInstructional Development and Support’sdigital recording of Gernsbacher’s lecture forKU’s Department of Psychology. The sectionon applied behavior analysis runs from aboutthe 48- to the 55-min mark. I acquired a URLof it from David S. Holmes, a KU professor ofpsychology, who introduced Gernsbacher.When I asked him if I could forward it tostudents and friends, he responded, ‘‘You candistribute the URL to anyone who is interest-ed. In fact, I want to encourage you to do thatas widely as possible’’ (D. S. Holmes, personale-mail communication, November 27, 2007).The URL is http://merlin.cc.ku.edu:8080/asxgen/ids/holmes/autismlecture.wmv. As for

Holmes’s perspective on ABA-EIBI, his intro-ductory psychology review of it is dated(Holmes, 2008, pp. 368–370); it associatesABA-EIBI with aversive control that has notbeen used in decades; and it is not supportedby any citations to any literature. Given itscontent, though, it is seemingly based onLovaas et al. (1973), Lovaas (1987), andarticles on the late 1980s aversives controversyin behavior analysis (e.g., Johnston, 1991;Sherman, 1991).


individuals.5 Unfortunately, Englishgrammar is not neutral in this matter.Its agent-action syntax implicatesorganisms as the agents of theiractions (Hineline, 1980, 2003). As aresult, in acquiring English, we ac-quire a philosophy of mind woventhread-by-thread unconsciously intothe fabric of our lives. This philoso-phy is both inimical to a science ofbehavior qua behavior (e.g., mind–body dualism; Koestler, 1967; C. R.Rogers & Skinner, 1956) and a basisfor counter-Enlightenment, postmod-ern critiques of it (e.g., humanistic,revelatory; Krutch, 1954; Rand,1982). Its press (that science’s press)is worse than that for evolution inKansas (Frank, 2004). This syntax mayalso make my comments appear adhominem and bereft of compassion forGernsbacher as a parent of a child withautism. Where this occurs, I apologize(see Skinner, 1972, 1975). ABA-EIBI’scritics are always right, too.

AUTISM INTERVENTIONAND THERAPY

I now turn to Gernbacher’s lecture.I begin where she began on autismintervention and therapy:

Finally, since I’m starting to talk aboutintervention and therapy, I am going to goto the last section of my talk and that is theempirical evidence for claims such as this:‘‘There is little doubt that early interventionbased on the principles and practices ofapplied behavior analysis can produce large,comprehensive, lasting, and meaningful im-provements in many important domains for alarge proportion of children with autism.’’ Asyou might know, the author is referring towhat is known as the Lovaas-style of behav-ioral treatment for autistic children.

At this point, I offer a seeminglytrivial observation, for which I begthe reader’s indulgence. As I noted, Iam curious about the sources ofGernsbacher’s misrepresentations.One means of discerning them is toaddress them all, no matter howseemingly innocuous, to see if anypatterns emerge. I begin with firstinstances.

Improvements in Children with Autism

The quotation above about ‘‘im-provements … for a large proportionof children’’ was taken out of context.Its author, Gina Green (1996), qual-ified it in her next sentence: ‘‘Forsome, those improvements canamount to … completely normalintellectual, social, academic, com-municative, and adaptive function-ing’’ (p. 38). ‘‘Some’’ children is not‘‘a large proportion of children.’’Quoting material out of context isnot inherently misleading, of course.Moreover, Gernsbacher could notquote ad infinitum; she had to beselective. In any event, the conse-quence was probably negligible be-cause ABA-EIBI’s effectiveness hasbeen overstated by some of its advo-cates, too (Green, 1999; Herbert,Sharp, & Gaudiano, 2002). Manycritics of these overstatements, how-ever, also support ABA, as in, ‘‘ABAis one of the most—if not the most—promising interventions for child-hood autism’’ (Herbert & Brandsma,2001, p. 49). For an overview ofapplied behavior analysis in autism,see Harris and Weiss (2007).

Lovaas-Style ABA-EIBI Treatmentfor Autistic Children

The first ABA research on childrenwith autism was published in 1964 byWolf, Risley, and Mees.6 The firstsystematic report of Lovaas-style

5 I do not mean to perpetuate the nature–nurture dichotomy, that is, the false dichoto-my between nature and nurture as indepen-dent variables, even if they putatively interact.Among the best contemporary alternatives tothe dichotomy is developmental systems the-ory (Gottlieb, 1998; D. S. Moore, 2001;Oyama, 2000; see Midgley & Morris, 1992;Schneider, 2003, 2007).

6 DeMyer and Ferster (1962) were arguablythe first to apply the principles of operantconditioning to the socially important behav-


ABA-EIBI was published in 1973by Lovaas, Koegel, Simmons, andLong. The first report of a compre-hensive ABA-EIBI program waspublished in 1985 by Fenske, Za-lenski, Krantz, and McClannahan.And, the first clinical trial of Lovaas-style ABA-EIBI was published in1987 by Lovaas (see also Celiberti,Alessandri, Fong, & Weiss, 1993;Maurice, Green, & Luce, 1996).

In that trial, the experimentalgroup (n 5 19; chronological age 52 years 11 months) received 2 years of40 hr per week of one-on-one in-home ABA-EIBI from their parentsand staff members from the UCLAYoung Autism Project. The primarycontrol group was a treatment com-parison control group (n 5 19;chronological age 5 3 years 5months) that received fewer than10 hr per week of ABA-EIBI pluscommunity treatment (e.g., specialeducation). This controlled for mat-urational effects—or what Gernsba-cher called ‘‘development’’—over thecourse of the study; any such effectswould presumably have been thesame in both groups. A matchedsecondary control group (n 5 21;chronological age 5 3 years 6months) was drawn largely from thesame population and received com-munity treatment. This controlled forselection bias and permitted a com-parison between ABA-EIBI andtreatment as usual (Freeman, Ritvo,Needleman, & Yokota, 1985).

Lovaas (1987) did not randomlyassign his participants to the experi-mental and control groups, as he hadplanned, because of ‘‘parent protestand ethical considerations’’ (p. 4;Lovaas, 2002, pp. 388–389). Instead,he assigned them on the basis of staff

availability for the experimentalgroup. This is an accepted practicein clinical research, especially if thetreatment and control groups can bematched a priori or are equivalent onpretreatment measures (Baer, 1993b;Eikeseth, 2001; Kazdin, 1992). InLovaas’s case, his groups were statis-tically equivalent on 19 of 20 pre-treatment measures, among them,their IQs, which were 53 and 46,respectively (McEachin, Smith, &Lovaas, 1993). After treatment, theexperimental group had significantlyhigher IQs than the control groups(83 vs. 52 and 58) and a significantlyhigher probability of passing firstgrade in regular education class-rooms (9 of 19 vs. 1 of 40). The 9participants who passed first gradehad a mean IQ of 107 and wereconsidered to be ‘‘recovered.’’ In afollow-up study, the experimentalgroup was found to have maintainedthese and other gains (e.g., in adap-tive behavior; McEachin et al.).

In describing Lovaas-style ABA-EIBI, Gernsbacher continued, ‘‘asillustrated in the intro to this 1980sfilm.’’ The film was Behavioral Treat-ment of Autistic Children (E. Ander-son, Aller, & Lovaas, 1988), whichreviewed and followed up on Lovaaset al. (1973) and Lovaas (1987). Its15-s introduction showed a therapistand a child sitting at a table acrossfrom each other engaged in DTT.DTT is one of many technologiesthat has evolved from ABA research(T. Smith, 2001; Tarbox & Naj-dowski, 2008), but none of them ismeant to be applied in a cookie-cutter fashion. Ideally, applicationsare individualized, taking into ac-count developmental and individualdifferences (Schreibman, 2000), aswell as differences in families andsettings (on values, see e.g., Wolf,1978).

DTT ranges along a continuumfrom more to less structured trialsand from massed to distributed trials.Highly structured and massed DTTmay consist of a therapist’s request or

ior of children with autism, but they failed toaddress so many of the defining dimensions ofapplied behavior analysis (e.g., behavioral,analytic, and technological; see Baer et al.,1968) that it probably does not warrant beingcalled applied behavior analysis.


instruction (e.g., to imitate a vocal ornonvocal model), a child’s response(e.g., imitation), and a therapist’sconsequence (e.g., ‘‘yes,’’ ‘‘no,’’ hugs).The film’s introduction shows the endof one such trial, in which thetherapist says, ‘‘Oh, good boy; that’sgood’’ and leans in for a kiss. In thenext trial, the therapist says ‘‘Sit up;get doll a drink,’’ the child gives thedoll a drink, and the therapist says thechild’s name and ‘‘very nice.’’ In thenext trial, the therapist says ‘‘Kissdoll,’’ but the child again gives thedoll a drink, and the therapist says‘‘No, kiss doll,’’ which ends that trialand begins another.

When possible, DTT moves frommore to less structure and frommassed to distributed trials, that is,to those that are more naturalistic(e.g., incidental teaching; see Allen &Cowan, 2008). Incidental teaching isalso an applied behavior-analytictechnology (Hart & Risley, 1975; seeMcGee, Krantz, & McClannahan,1985), as well as DTT: Therapistsset toys aside, children request them,and therapists provide them if re-quested correctly (or else are prompt-ed). Structured and massed DTT isused to build the basic linguistic,social, and academic repertoires nec-essary for moving to less structured,more distributed DTT, which thenbuilds repertoires necessary for func-tioning more fully in everyday life(e.g., functional communication, so-cial reciprocity, and self-guidance;Leaf & McEachin, 1999; Lovaas,1981, 2002; T. Smith, 2001). WhereABA-EIBI begins on this continuumand how quickly it moves towardmore naturalistic procedures dependon children’s developmental and in-dividual differences and their rates ofprogress (see R. R. Anderson, Taras,& Cannon, 1996), not on develop-mental norms and theories, the latterof which remain largely unfounded.7

As for the film, Gernsbacher couldnot have played its full 43 min. Shehad to be selective again. However,the segment she played was notrepresentative. It showed only struc-tured, massed DTT, not the childrenlater in social play and conversationas teenagers with peers without au-tism (and indistinguishable fromthem). In Gernsbacher’s defense, no15-s segment could have fairly repre-sented the film. Thus, any suchsegment would merit a disclaimer,but none was provided. She contin-ued,

I truly cannot underestimate how muchattention this style of intervention has re-ceived. As just one metric, the Clinical PracticeGuideline, distributed by the New York StateDepartment of Public Health recommendsthat virtually no other intervention be con-

7 In observing that therapists sometimesdraw eclectically from the behavior-analyticand developmental perspectives, Lovaas

(1981) pointed out that important differencesbetween them need to be recognized because,‘‘each involves certain risks that can beassumed to affect a student’s progress. Thebehavioral approach runs the risk of failing toteach prerequisite behaviors in its concernswith teaching age-appropriate skills as rapidlyas possible. In defense of the behavioralapproach, it may be argued that this problemis picked up when the data show the student’slack of progress; attempts are then made todetermine what additional behaviors need tobe taught and to teach them. The develop-mental approach involves a much moreserious risk. In attempting to stimulate mat-urational changes indirectly through proce-dures of often dubious scientific validity, itruns the risk of spending so much time onprerequisite behaviors (or ‘readiness’ skills)that age-appropriate behaviors are nevertaught, nor do the emerge spontaneously.‘Developing,’ in the sense of acquiring newbehaviors without direct instruction, is thething that developmentally disabled childrenare least able to do, whether ‘stimulated’ ornot. Further, the lack of socially significantprogress may not be noticed and addressedbecause the developmental position does notinclude a strong emphasis on data-baseddecision making’’ (p. 225). Lovaas ended onan ecumenical note, though. He expected thatthe education of ‘‘developmentally disabledpersons’’ would become more effective be-cause ‘‘A blending of developmental andbehavioral educational approaches, at leastto some degree, seems likely, with thestrengths of each approach contributing toan integrated curriculum’’ (p. 233).


ducted with young autistic children except forthat one style of intervention [ABA-EIBI]because other interventions like speech thera-py or physical therapy would take precioustime away from the necessary treatmentsupposedly needed for that style of interven-tion. But what do the data show? Are there, asstated on the Surgeon General’s Web site,‘‘thirty years of research’’ demonstrating ‘‘theefficacy of applied behavioral methods inreducing inappropriate behavior and in in-creasing communication, learning, and appro-priate social behavior’’? [Gernsbacher, 2003,p. 20; the quoted material is from the U.S.Surgeon General’s Web site: www. surgeon-general.gov/library/mentalhealth/chapter3/sec6.html]

The New York State Department ofHealth Clinical Practice Guideline

In mentioning only the New YorkState Department of Health’s (notPublic Health’s) (NYSDH, 1999a,1999b, 1999c) Clinical Practice Guide-line (Guideline)8 and the U.S. SurgeonGeneral’s Mental Health Report(1999), Gernsbacher omitted ABA-EIBI’s endorsement by other acade-mies, institutes, and councils at thetime of her lecture, among them, theAmerican Academy of Pediatrics(2001), the National Institute of Men-tal Health (2007), the National Re-search Council (2001), California’sCollaborative Work Group on AutismSpectrum Disorders (1997), Maine’sTask Force Report for Administratorsof Services for Children with Disa-bilities (1999), and other state reports

and guidelines (e.g., Alaska, Ver-mont). Again, time constraints mayhave kept her from mentioning these,which was fair, as long as her omis-sions were not systematically biased.

The claims. Turning to her claimthat the NYSDH recommended that‘‘virtually no other intervention beconducted with young autistic chil-dren except for that one style ofintervention [ABA-EIBI],’’ I couldnot find this in the Guideline. So,perhaps it was an interpretation. Forinstance, although applied behavioranalysis was just one of seven ‘‘expe-riential approaches’’ the NYSDHreviewed, it was the only one thatwas recommended as a primarytreatment. This was not, however, arecommendation for Lovaas-styleABA-EIBI. The NYSDH (1999b)recommended only that the ‘‘princi-ples of applied behavior analysis andbehavior intervention strategies beincluded as important elements inany intervention program for youngchildren with autism’’ (p. 33).

As for the claim that the NYSDHrecommended that no other interven-tions be conducted because they‘‘would take precious time away fromthe necessary treatment supposedlyneeded for [ABA-EIBI],’’ this wassimilar to Gernsbacher’s (2003) as-sertion that the Guideline recom-mended that ‘‘some interventionsnot even be included in a child’stherapeutic program because thoseinterventions might take time awayfrom an intervention that had beenscientifically proven’’ (p. 20). Notonly did I fail to find this in theGuideline, but the Guideline contra-dicts it. It notes that applied behavioranalysis ‘‘may also incorporate someelements of other approaches, such asdevelopmental and cognitive ap-proaches’’ (NYSDH, 1999a, chap. 4,p. 14) and cites this as an advantage(p. 24), although some advocates ofABA-EIBI and treatment efficacywould disagree because those ap-proaches generally lack empirical

8 For some background on the NYSDHGuideline, here is part of its preface: ‘‘In 1996,a multi-year effort was initiated by the NewYork State Department of Health (DOH) todevelop clinical practice guidelines to supportthe efforts of the statewide Early InterventionProgram. As lead agency for the EarlyIntervention Program in New York State,the DOH is committed to ensuring that theEarly Intervention Program provides consis-tent, high-quality, cost-effective, and appro-priate services that result in measurableoutcomes for eligible children and theirfamilies. This guideline is a tool to help assurethat infants and young children with disabil-ities receive early intervention services consis-tent with their individual needs, resources,priorities, and the concerns of their families’’(NYSDH, 1999a, p. xi).


support (e.g., Green, 1996; Lilienfeld,2007).

The closest the NYSDH (1999a)comes to Gernsbacher’s claim is indescribing another experiential ap-proach: the developmental, individualdifference, relationship (DIR) modelalso known as floor time (chap. 4,pp. 55–70). DIR seeks to alleviate thesymptoms of autism as a psychiatricdisorder by enhancing affective par-ent–child relations through child-ledplay and interactive motor, sensory,and spatial activities, taking thechildren’s developmental level intoaccount. In particular, it recom-mends that therapists and parentsspend six to ten 20- to 30-minsessions per day on the floor ‘‘work-ing on the child’s ability for affective-based interactions’’ (NYSDH, 1999c,p. 153). DIR, however, seems littlemore than a program of intensivefree-operant differential reinforce-ment of desired behaviors throughsuccessive approximations (i.e., shap-ing), along with some incidentalteaching. The NYSDH, however,found no empirical support for it inthe only study published at the time (achart-review study; Greenspan & Wie-der, 1997) and thus did not recom-mend it as a primary treatment.Furthermore, the NYSDH (1999a)cautioned that DIR ‘‘may interferewith an intensive behavioral educa-tional program unless steps are takento coordinate the two’’ and that, beingintensive itself, DIR ‘‘may take timeaway from interventions that havebeen shown to be effective’’ (chap. 4,p. 56). These cautions were not ad-monitions against using ABA-EIBI.

If the source of Gernsbacher’sclaim was not in the Guideline, thenit presumably lay elsewhere. In her2003 article, she attributed the fol-lowing to Behavior Analysts, Inc.:‘‘Diverting attention, even for a briefperiod of time, away from treatmentmethods that have been scientificallyproven to be effective is a disserviceand can have serious consequences’’(p. 20; see www.behavioranalysis.org/

level2/EvaluatingTreatmentEffective-ness.htm). Behavior Analysts, Inc.,however, was silent about ABA-EIBI;it was only offering a general precau-tion. So, too, was Green (1996), inarguing for using the most effectivetreatments (ABA-EIBI or not) asopposed to less effective or ineffectiveones. Lilienfeld (2007) refers to theharm caused by the latter as ‘‘oppor-tunity costs.’’ These include ‘‘lost timeand the energy and the effort expend-ed in seeking out interventions thatare not beneficial’’ (p. 57), to whichthe benefits lost by delaying treatmentneed to be added.

As for Gernsbacher’s claim thatthe NYSDH recommended against‘‘speech therapy or physical thera-py,’’ I also could not find this in theGuideline. Moreover, Behavior Ana-lysts, Inc. recommends otherwise. Itsanswer to a frequently asked question(‘‘How does speech therapy fit intoyour approach?’’) was this: ‘‘Ourprogram supervisors determine whenspeech (or other) therapy wouldbenefit the child and make theappropriate referral. In fact, we offerspeech therapy at some of our centersand clinics.’’ The book in whichGreen’s (1996) chapter appeared alsocontradicts the claim: It contains achapter on how to incorporatespeech-language therapy into appliedbehavior analysis (Parker, 1996). AsT. Thompson (2007a) has noted,

An experienced speech therapist can beinvaluable in developing effective treatmentmethods that should be used by all therapistsand teachers as well as the child’s parents. …Many children with ASD have subtle percep-tual-motor coordination problems, which canbe addressed by occupational therapists.(pp. 42–43; see also Koenig & Gerenser, 2006)

By this, Thompson meant therapistswho provide evidence-based treat-ments that are integrated with ABA-EIBI, not empirically unsupportedpull-out services.

This is all I could find about thesource of Gernsbacher’s claim that‘‘virtually no other intervention [than


ABA-EIBI] be conducted.’’ If asource does exist, she should havecited it and then distinguished betweenquoting from it and provid-ing an interpretation of it, so thatthe audience could have respondedeffectively to her claim. She continued,

[What do the data show?] Well, to answer thatquestion, we can go back to the New YorkState Guideline books because, in formulatingtheir guidelines, they conducted a thoroughliterature review. They found 232 articles thatreported using behavioral and educationalapproaches in children with autism and thesearticles were systematically screened and fivearticles reporting four studies were found thatmet established criteria. So, of the 232 articles,they found in their exhaustive literaturereview, only five articles met their ownstandards [see also Gernsbacher, 2003, p. 20].And, these are the people who believe that this[ABA-EIBI] is a very scientifically supportedintervention.

Gernsbacher’s description of theNYSDH’s literature review elidedso many details that it misrepre-sented the ABA-EIBI research. TheNYSDH’s (1999a) goal was to ‘‘iden-tify relevant scientific articles thatmight contain evidence about inter-vention methods for young childrenwith autism’’ (Appendix B, p. 3; seeNoyes-Grosser et al., 2005). To iden-tify them, its reviewers searched the1980–1998 MEDLINE, PsychINFO,and ERIC databases under autism,infantile autism, and autistic childrenand read the abstracts of all the articlesfor those ‘‘that might contain evidenceabout intervention’’ and then ob-tained those articles. These were the232 articles the NYSDH screened inits search of reports of original data onintensive behavioral treatment (seebelow).

Several consequences arise fromeliding these and other details. First,in asking, ‘‘What do the data show?’’Gernsbacher was asking, rhetorically,what the 232 articles that reported‘‘using behavioral and educationalapproaches’’ showed about ‘‘the effi-cacy of applied behavioral methods.’’This implied that the 232 articleswere applied behavior-analytic arti-

cles, but this misrepresented theGuideline on three counts: (a) Thekeywords in the NYSDH’s (1999a)search were ‘‘behavior therapy, be-havior modification, psychotherapy,psychoanalytic therapy, psychothera-peutic techniques, instructional pro-grams, and special education’’ (Ap-pendix B, pp. 4–5). Psychoanalytictherapy is not applied behavior anal-ysis. (b) Not all the 232 articlesreported using behavioral and educa-tional approaches. Many of themwere descriptions of interventions,literature reviews, theoretical articles,and commentaries and critiques. (c)Of the behavior-analytic reports ofresearch, most of them used within-subject replication (single-subject) de-signs to evaluate the effects of indi-vidual interventions for discrete be-haviors (e.g., MacDuff, Krantz, &McClannahan, 1993). These were notABA-EIBI or the comprehensiveprograms of research the NYSDHwas selecting for.

Second, the claim that only fiveof the 232 articles ‘‘met establishedcriteria’’ for ABA-EIBI confusedthe criteria. Of the 232 articles theNYSDH screened, a subset of ‘‘arti-cles meeting criteria’’ (NYSDH,1999a, Appendix B, p. 4) ‘‘was se-lected for more in-depth review if[they] appeared to contain originaldata about [a] … treatment methodfor autism’’ (NYSDH, 1999a, chap.1, p. 9). The articles also had tomeet ‘‘general criteria’’ (e.g., includeparticipant age; NYSDH, 1999a,chap. 1, p. 16) and ‘‘additional cri-teria’’ (e.g., evaluate functional out-comes; NYSDH, 1999a, chap. 1, p.17). Among these articles, thosethat reported intensive behavioraland educational programs had to‘‘involve [the] systematic use of be-havioral teaching techniques andintervention procedures, intensivedirect instruction by the therapist,and extensive parent training andsupport’’ (NYSDH, 1999c, p. 229).

Given these criteria, eight of the232 articles were selected for in-


depth review, all of them control-group studies. These were Birnbrauerand Leach (1993), Koegel, Bimbela,and Schreibman (1996), Layton(1988), Lovaas (1987), McEachin etal. (1993), Ozonoff and Cathcart(1998), Sheinkopf and Siegel (1998),and T. Smith, Eikeseth, Klevstrand,and Lovaas (1997) (see NYSDH,1999c, p. 57). From these, theNYSDH selected the articles thatprovided evidence for efficacy onthe basis of several methodologi-cal criteria (e.g., controlled trials;NYSDH, 1999a, Appendix B, p. 4;1999c, p. 229). These were the fivearticles reporting four studies thatmet what Gernsbacher referred to asthe ‘‘established criteria,’’ all of themLovaas-style ABA-EIBI studies: Birn-brauer and Leach (1993), Lovaas(1987), McEachin et al. (1993), Shein-kopf and Siegel (1998), and T. Smith etal. (1997) (see NYSDH, 1999a, chap.4, pp. 17–21; Appendix 7, pp. 7–11).Thus, in the end, four of the sevenstudies (67%) the NYSDH reviewedin depth and four of the four (100%)ABA-EIBI studies met its criteria forefficacy, not five out of the 232(2.2%), as implied. In eliding thedistinctions among what theNYSDH searched and screened andthe ‘‘articles meeting criteria’’ for in-depth review and those that met thecriteria for efficacy, Gernsbachermisrepresented the quantity andquality of the ABA-EIBI researchand the efficacy of applied behavior-analytic treatment overall. She con-tinued,

However, as even the New York StateGuideline notes [what follows is a quotationfrom the Guideline], ‘‘None of the four studiesthat met criteria for efficacy used randomassignment of the children to the groups, suchas to the group receiving intensive behavioralintervention versus the group receiving acomparison intervention’’ (see NYSDH,1999a, chap. 4, p. 22). And, I believe everyonewho has studied behavioral research realizeshow absolutely critical it is to randomly assignparticipants to the treatment versus thecontrol. For example, I could say, ‘‘Ah, I’mgoing to give out new iPhones tonight and I’m

going to do it, you know, randomly. In fact,I’m going to give the first ten people sittingright over there my iPhones.’’ I think those ofyou up there [in the balcony] would get a littlemiffed, right? [She paused for the answer,‘‘Yes.’’] I would, too. Random assignment isabsolutely critical. It is what enables you todraw scientifically supported conclusions.

Random assignment is indeed impor-tant, a point I address shortly, butfirst I note that Gernsbacher’s claimthat none of the four studies metwhat she called the NYSDH’s ‘‘es-tablished criteria,’’ ‘‘own standards,’’or ‘‘criterion for efficacy’’ was mis-leading. The four studies did meet theNYSDH’s criteria for assigning par-ticipants to groups because theNYSDH had two criteria: The stud-ies had to ‘‘assign subjects to groupseither randomly or [italics added]using a method that did not appearto significantly bias the results’’(NYSDH, 1999a, chap. 1, p. 17;1999c, p. 199; e.g., Lovaas, 1987).The studies thus met the NYSDH’seither–or criterion and thus its crite-ria overall.

Misrepresenting ABA-EIBI Research I

Gernsbacher continued,

But, of the four studies that were mentionedfrom this review, the first two weren’t evenexperiments [Sheinkopf & Siegel, 1998; T.Smith et al., 1997]. In fact, they were justrecord reports, where we go back in time andwe say, ‘‘This person has a 4.0. Let’s see if sheate pasta every night her freshman year.’’

The claim that Sheinkopf and Siegel(1998) and T. Smith et al. (1997)‘‘weren’t even experiments’’ and‘‘were just record reports’’ misrepre-sented them, but then much dependson the meaning of ‘‘experiment.’’ Itdiffers across the sciences. In thesocial sciences, control-group designscompare (a) the effects of a conditionfor one group of participants to (b)its absence (or another condition) foranother group, after which the statis-tical significance of any differences intheir correlated outcomes is inferred.In the natural sciences, within-subject


and within-group replication designsare more the norm (T. Thompson,1984). In these, experimental condi-tions are systematically applied, re-moved, and replicated within individ-uals or groups, with the differencesbetween them displayed in graphs (onthe greater use of graphs in ‘‘harder’’vs. ‘‘softer’’ psychology, see L. D.Smith, Best, Stubbs, Archibald, &Roberson-Nay, 2002). This is also theapplied behavior-analytic approach(Johnston & Pennypacker, 2009; Sid-man, 1960), which is increasinglyappreciated in clinical psychology(Barlow & Nock, 2009; Borckardt etal., 2008). For its use in autismresearch, see Wacker, Berg, andHarding (2008). I am not taking sidesin this matter, just noting thatexperiment has a range of meanings.

In any event, although Sheinkopfand Siegel (1998) and T. Smith et al.(1997) were not planned experiments,they were not ‘‘just record reports’’ ofa relation between treatment and itsoutcome. They were record reportsthat used treatment comparison con-trol groups, another point Gernsba-cher omitted. Sheinkopf and Siegel,for instance, found 11 children in alongitudinal study of autism whoseparents had provided 19 hr per weekof Lovaas-style ABA-EIBI. The au-thors then formed a matched treat-ment comparison control group fromthe same study; its participants hadbeen provided 11 hr per week oftreatment as usual (i.e., school-basedinterventions). Over the course of 18to 20 months, the experimental groupmade a significant 25-point gain inIQ over the control group and had asignificant reduction in symptomseverity. See Lovaas (2002, pp. 399–400), however, for a critique of thestudy. As for T. Smith et al., theycreated an experimental group and atreatment comparison control groupof preschool children with mentalretardation and pervasive develop-mental disorder on the basis ofrecords at the UCLA project andother sites. The experimental group

(n 5 11) had received 30 hr ofLovaas-style ABA-EIBI per week,while the treatment comparison con-trol group had received 10 or fewerhours per week. In the 2 to 3 yearsbetween intake and follow-up, theexperimental group made a signifi-cant 12-point gain in IQ and asignificant gain in expressive speechover the control group. Gernsbachercontinued,

The other two studies were experiments[Birnbrauer & Leach, 1993; Lovaas, 1987;McEachin et al., 1993], but they didn’t includethe critical piece of random assignment.Instead, the participants were assigned toeither the treatment or the control group byfactors such as who lived closer, whose parentswanted them to be in the treatment group,who could pay for some of the treatment, etcetera, et cetera.

As for Gernsbacher’s claims aboutparticipant assignment, first, herclaim that children were assigned onthe basis of ‘‘who lived closer’’ waspresumably a rewording of who livedtoo far away, but this rarely oc-curred. Lovaas (1987) assigned only2 of his 38 children to the controlgroup ‘‘because they lived furtheraway from UCLA than a 1-hr drive,which made sufficient staffing un-available to those clients’’ (p. 4) And,although Birnbrauer and Leach(1993) excluded three families be-cause they ‘‘lived too far away’’(p. 64), the families were excludedfrom both the experimental and thecontrol groups. Second, her claimthat children were assigned on thebasis of ‘‘whose parents wanted themto be in the treatment group’’ waspresumably a rewording of ‘‘parentprotest,’’ but is not true. This wouldhave yielded groups that likely dif-fered in parental involvement intreatment (e.g., effort, motivation),which is why the children wereassigned on the basis of therapistavailability. Third, I found nothingto support the claim that childrenwere assigned on the basis of ‘‘whocould pay for some of the treatment.’’Rewording, overstating, and misstat-


ing research methodology are boundto misrepresent it.

As for the findings of these studies,I have already reviewed Lovaas(1987) and McEachin et al. (1993)and so here only describe Birnbrauerand Leach (1993). They provided19 hr per week of ABA-EIBI to 9children with autism and pervasivedevelopmental disorder; the controlgroup was comprised of 5 childrenwho received unknown treatment.Although the groups were similar atpretreatment, the experimental groupmade more gains after 2 years thanthe control group on standardizedand descriptive measures of intelli-gence, language, personality, andadaptive functioning. However, nostatistical analyses were conducted.

For pre-2000 applied behavior-analytic research Gernsbacher didnot review, see S. R. Anderson,Avery, DiPietro, Edwards, and Chris-tian (1987), Fenske et al. (1985),Handleman, Harris, Celierti, Lille-heht, and Tomchek (1991), Harris,Handleman, Gordon, Kristoff, andFuentes (1991), Harris, Handleman,Kristoff, Bass, and Gordon (1990),Hoyson, Jamieson, and Strain (1984),Perry, Cohen, and DeCarlo (1995),and Weiss (1999). For literature re-views, see S. J. Rogers (1998) andMatson et al. (1996).

Experimental Control

Gernsbacher continued, ‘‘Well, theNew York State Guideline says it’sbeen argued that the [nonrandom]method for group assignment proba-bly did not bias the results [NYSDH,1999a, chap. 4, p. 22; see Gernsba-cher, 2003, p. 21].’’ The Guideline didnot argue that nonrandom assign-ment will not bias results. It onlydescribed the outcome of nonrandomassignment in these studies: ‘‘In allcases the authors analyzed the pre-treatment … data to see if the groupswere equivalent in important vari-ables. Most of the authors concludedthat such analyses found no system-

atic bias in the assignment of subjectsto the intervention or comparisongroup’’ (NYSDH, 1999a, chap. 4,p. 22). Furthermore, the NYSDH(1999a) noted that ‘‘all studiesshowed similar and consistent re-sults’’ (chap. 4, p. 24). This does notmean that no biases existed, only thatno (or few) biases were found amongthe important variables; that is, thevariables were balanced acrossgroups.

Other critics have also noted thepossibility of bias on pretreatmentmeasures, as well as the use ofnonequivalent pretest–posttest mea-sures and weak assessment measures(e.g., Foxx, 1993; Gresham & Mac-Millan, 1997; Kazdin, 1993; Munday,1993; Schopler, Short, & Mezibov,1989). This is not perfect science.These criticisms, though, have beensubject to counter-criticisms (e.g.,changes in pretest–posttest languageskills, for instance, may require differ-ent measures; Eikeseth, 2001; Lovaas,1993; Lovaas, Smith, & McEachin,1989; McEachin et al., 1993; T. Smith& Lovaas, 1997; T. Smith, McEachin,& Lovaas, 1993), the counter-criti-cisms to counter-counter-criticisms(e.g., Gresham & MacMillan, 1998)and the counter-counter-criticisms tocounter-counter-counter-criticisms(e.g., Lovaas, 2002, pp. 387–407)—science red in tooth and claw.

Nevertheless, Gernsbacher’s criti-cism of the foregoing studies for notusing random assignment has obvi-ous merit. However, it is not asstraightforward as it seems (S. J.Rogers & Vismara, 2008, p. 30).First, although the American Psy-chological Association (APA, 2002a)states that ‘‘Randomized controlledexperiments … are the most effectiveway to rule out threats to internalvalidity in a single experiment’’(p. 1054), it notes that the experi-ments remain subject to threats ofexternal and construct validity andneed replication.

Second, random assignment is butone component of randomized con-


trolled trials (RCTs). The gold stan-dard requires double-blind (or triple-blind) placebo control groups inwhich the experimenters, partici-pants, therapists, evaluators, andstatisticians do not know whichparticipants are assigned to whichgroup. Even then, it does not guar-antee that statistically significanttreatments are clinically significant.

Third, even when random assign-ment is planned for or used, practicalproblems ensue. (a) The treatment’sintensity often makes it discriminablefrom control groups, which allowsfamilies to distinguish ABA-EIBIfrom other treatments (J. E. Jacob-son, 2000). (b) Parents will protestthe random assignment of theirchildren to experimental and controlgroups, and withdraw them fromresearch if assigned to the latter. (c)Given the empirical evidence forABA-EIBI, institutional reviewboards and parents will balk at theethics of assigning children to controlgroups. And (d), because of ABA-EIBI’s intensity, experimental groupsare often so small that randomassignment can, by chance, creategroups unbalanced on variables thatare critical to the outcome (e.g.,language, age, IQ; see Reichow &Wolery, in press).

Fourth, the claim that randomassignment is absolutely critical maybe overly conservative if, failing thatstandard, public health initiatives aredelayed and treatments are withheldat irreversible risk to individuals andpopulations. For instance, given thestandard of random assignment, noproof exists that smoking causes lungcancer in humans, yet a convergenceof evidence was sufficient for theSurgeon General to take actionregarding it.

In the end, scientific conclusionsare supported by a range and con-vergence of methods, with logicallypermissible conclusions nested hier-archically within them (see T. Smithet al., 2006). Among the methods,randomization is a means for assign-

ing participants to groups, not an endin itself. It does not guarantee unbi-ased assignment, except in the longrun. Presumably, methods such asLovaas’s, could assign participants inan unbiased manner. Bias is anempirical matter (Baer, 1993b).

Appeals to History

Referring to what the NYSDH(1999a) argued about group assign-ment, Gernsbacher continued, ‘‘Myacademic great-grandfather [WilhelmWundt] would be rolling over in hisgrave.’’ (In her introduction, shementioned tracing her academic lin-eage back to Wundt who is ‘‘typicallycredited with establishing the firstexperimental psychology laboratory,and who therefore earned the statusof father of experimental psycholo-gy’’; see Boring, 1950, pp. 316–347.)

Appeals to history can be perilous.First, in this case, most doctorates ofpsychology can trace their lineageback to either Wundt (1832–1920) orWilliam James (1842–1910), soGernsbacher’s appeal to Wundt wasrhetorical, not scholarly. Second,using history to justify apparentlywinning traditions (e.g., cognitivism),as opposed to apparently losingtraditions (e.g., behaviorism), is abreach of historiographical methodcalled presentism (Samelson, 1974;Stocking, 1965; see Furumoto, 1989).Third, citing Wundt on participantassignment was misleading. Althoughhe likely knew of John Stuart Mill’s(1843) ‘‘method of differences,’’ hewas not expert in group designs. Hisresearch was mainly case studies ofindividuals who reported their intro-spectively observed experiences (e.g.,mental elements and processes;Wundt, 1874/1904), studies that donot meet the standards of within-individual replication designs (e.g.,Kennedy, 2005; Sidman, 1960).Moreover, his participants were ahighly trained, nonrandom sampleof the adult population. Wundt’sresearch program died for methodo-


logical reasons: often poor reliabilitywithin studies and, more often, poorreplicability across laboratories (Bor-ing, 1950).

Research Review: Separating Factfrom Fiction


And, in fact, [Wundt] would probably havedrawn the same conclusions as those drawn inan article titled, ‘‘Separating Fact fromFiction in the Etiology and Treatment ofAutism’’ [Herbert et al., 2002]. This articlestates that ‘‘Methodological weaknesses of theexisting studies severely limit the conclusionthat can be drawn about their efficacy.’’[p. 35; see Gernsbacher, 2003, p. 21]

This quotation from Herbert et al.(2002) inaccurately portrayed theirconclusions about ABA-EIBI. First,they addressed ABA-EIBI in a sec-tion titled ‘‘Promising Treatments forAutism’’ (pp. 33–38), in which ABA-EIBI was a ‘‘fact,’’ not ‘‘fiction.’’Second, although ABA-EIBI re-search has mainly used nonrandomassignment, Herbert et al. concludedthat ‘‘the intervention programs …are based on sound theories, aresupported by at least some controlledresearch, and clearly warrant furtherinvestigation’’ (p. 33). Third, afterreviewing the ABA-EIBI research,Herbert et al. wrote, ‘‘Taken togeth-er, the literature on ABA programsclearly suggest that such interven-tions are promising’’ (p. 35). Gerns-bacher, however, quoted the nextsentence as their conclusion: ‘‘Meth-odological weaknesses of the existingstudies [however] severely limit theconclusions that can be drawn[about] their efficacy.’’ Fourth, al-though Herbert et al. admonished theproponents of ABA-EIBI for theiruncritical advocacy, they concluded,‘‘Clearly, ABA does not possess mostof the features of pseudoscience thattypify many of the highly dubioustreatments for autism. ABA pro-grams are based on well-establishedtheories of learning and emphasizethe value of scientific methods in

evaluating treatment effects’’ (p. 35;for critiques of pseudoscience inautism, see J. E. Jacobson et al.,2004; Offit, 2008).

Evidence for the OtherExperiential Approaches

Although the NYSDH (1999a,1999b, 1999c) and Herbert et al.(2002) noted limitations in theABA-EIBI research, they also point-ed out that the treatment was evi-dence based, which was more thanthey said of the other approaches,none of which they recommended asprimary interventions. Among thosethe Guideline reviewed were DIR,sensory integration therapy, touchtherapy, auditory integration thera-py, facilitated communication (FC),and medical and diet therapies. Her-bert et al. addressed these and otherapproaches under ‘‘QuestionableTreatments for Autism’’: sensorymotor therapies (e.g., FC, sensoryintegration training); psychotherapies(e.g., psychoanalysis, holding thera-py), and biological treatments (e.g.,secretin, gluten- and casein-free diets,Vitamin B6). Of these, the NYSDH(1999a) and Herbert et al. were mostcritical of FC (see Biklen, 1990,1993). As Herbert et al. described it,

Facilitated communication (FC) is a methoddesigned to assist individuals with autism andrelated disabilities to communicate throughthe use of a typewriter, keyboard, or similardevice. The technique involves a trained‘‘facilitator’’ holding the disabled person’shand, arm, or shoulder while the latterapparently types messages on the keyboarddevice. The basic rationale behind FC is thatpersons with autism suffer from a neurologicalimpairment called apraxia, which interfereswith purposeful motoric functioning. (p. 28;see also NYSDH, 1999a, chap. 4, p. 64;1999b, p. 43)

In its literature search, the NYSDH(1999a) screened 11 FC articles, noneof which met its criteria for an in-depth review (NYSDH, 1999c,p. 245; see also Herbert et al.,pp. 27–28). Of FC, the NYSDH(1999c) commented,


In studies of facilitated communication usedin older children with autism, the messagestyped by the children are often far beyondtheir capabilities as evidenced by their behav-ior or language. Studies of facilitated commu-nication suggest that communication thatexceeds baseline levels for a subject originatesfrom the facilitator rather than the child. Useof facilitated communication has brought up anumber of ethical and legal issues. There havebeen cases where messages produced withfacilitated communication have caused emo-tional distress to parents or have led toaccusations of abuse that resulted in legalproceedings [see also Herbert et al., pp. 28, 38;and the Public Broadcasting Service’s Front-line report at video.google.com/videoplay?docid53439467496200920717]. Recommenda-tions: Because of the lack of evidence forefficacy and possible harms of using facilitatedcommunication, it is strongly recommendedthat facilitated communication not be used asan intervention method in young children withautism. (p. 160; see also the American Acad-emy of Pediatrics, 2001; APA’s 1994 resolu-tion on FC at http//www.apa.org/divisions/div33/fcpolicy.html; J. W. Jacobson, Mulick,& Schwartz, 1995; Lilienfeld, 2007; Offit,2008, pp. 6–13)

In critiquing FC, Herbert et al.properly distinguished it from aug-mentative and alternative forms ofcommunication (e.g., keyboards andpicture exchange systems; see Bondy& Frost, 1994; Reichle, York, &Sigafoos, 1991). Children with autismoften benefit from such technologiesand may need hands-on help inmastering them, but the content oftheir communication is their own, notthe facilitators’.

Misrepresenting the ABA-EIBIResearch II


However, skip ahead to 2007 and there arenow two studies of Lovaas-style ABA inter-vention that did employ the ever so importantrandom assignment [Sallows & Graupner,2005; T. Smith, Groen, & Wynn, 2000]. And,you’re probably curious: What do thosestudies show? In one study [T. Smith, Groen,& Wynn], there was a slight but nonsignificantadvantage for the autistic children. [Gernsba-cher presented two figures of treatment gainsgraphed from intake to follow-up for expres-sive and receptive language. The lines in the

figures were labeled the ‘‘ABA’’ and ‘‘Con-trol.’’] 9

T. Smith, Groen, and Wynn (2000).This was the first independent repli-cation of Lovaas’s (1987) ABA-EIBIstudy. Gernsbacher’s description ofit, though, contained serious omis-sions and misrepresentations. First,her claim that ‘‘there was a slight butnonsignificant advantage for the au-tistic children’’ has two meanings,neither of them accurate. (a) Thereference to ‘‘the autistic children’’was seemingly to the experimentalgroup, which implies that the controlgroup was composed of childrenwithout autism, but it was not. Bothgroups were drawn from the samepopulation. (b) The reference mighthave been to the autism subgroups inthe experimental and control groupswhose gains were less than those ofthe pervasive developmental disordersubgroup, but they were still greater(and more frequently greater) thanthose of the control group.

Second, the control group in herfigures was a treatment comparisoncontrol group, not a no-treatmentcontrol group, which the audiencemembers (and I) had expected andwhich her conclusion would require:that the children’s gains were due totheir development. This does notmean that T. Smith, Groen, andWynn’s (2000) methods were impec-cable; they were not (e.g., they usedone-tailed instead of two-tailed testsof significance; M. A. Gernsbacher,personal communication, December1, 2007). However, critical reviewsshould describe research accuratelyenough that audiences can drawcorrect conclusions about them. Forthe record, T. Smith, Groen, andWynn’s control group was composed

9 I thank Gernsbacher for sending me thefigures she constructed from T. Smith, Groen,and Wynn’s (2000) and from Sallows andGraupner’s (2005) results and for her addi-tional comments on the ABA-EIBI research(M. A. Gernsbacher, personal communica-tion, December 1, 2007).


of children (a) whose parents weretrained and supported in providingABA-EIBI for 5 hr per week for 3 to9 months, (b) whose parents wereasked to provide this treatment for anadditional 5 hr per week during thosemonths, and (c) who were enrolled in10 to 15 hr per week of specialeducation. The experimental groupreceived about 25 hr of ABA-EIBIper week for 2 to 3 years.

Third, in claiming that ‘‘there wasa slight but nonsignificant advantagefor the autistic children,’’ Gernsba-cher selectively reported T. Smith,Groen, and Wynn’s (2000) findings.She reported only the nonsignificantdifferences between the experimentaland the control groups on the mea-sures of expressive and receptivelanguage, omitting the differencesthat favored the experimental group:(a) significantly higher IQs (e.g., 16vs. 0 points) and Merrill-Palmer de-velopmental ages (+42.7 vs. +27.3),(b) significantly less restrictive schoolplacements, and (c) higher academicachievement scores (75.7 vs. 58.0 onthe Wechsler Individual AchievementTest).

Fourth, she failed to note that boththe experimental and the controlgroups made gains from intake tofollow-up. The former made gains onseven of the nine standardized mea-sures (e.g., .300% on the Merrill-Palmer), and the latter made gains onfour of them (e.g., .200% on theMerrill-Palmer). The findings, howev-er, were not subjected to statisticalanalysis, so we do not know if theywere significant. Even if they were,without a no-treatment control group,we would not know if the gains weredue to treatment or development.

Gernsbacher’s omission of T.Smith, Groen, and Wynn’s (2000)significant findings was not due toher lack of familiarity with them.When the study was published, sheread it carefully enough to find anerror in its calculation of the statisti-cal differences in the two langu-age measures. The calculation was

wrong; there were no differences (T.Smith, personal e-mail communica-tion, October 5, 2007; see Errata,2001). She was also familiar enoughwith the findings to report thesignificant results in her 2003 article.In her lecture, she continued,

‘‘In the other study [Sallows & Graupner,2005], there was a slight but nonsignificantadvantage for the control children. And thiswas after 40 hours a week of a minimum of 2years of intensive therapy, which is a bitdepressing.’’ (For this, Gernsbacher presentedfigures, labels, and measures that were thesame as T. Smith, Groen, & Wynn’s, 2000,except for the data, of course.)

Sallows and Graupner (2005). Thisstudy was the second independentreplication of Lovaas (1987), albeit apartial replication because the inter-vention included other treatments(e.g., pivotal response training; Koe-gel & Koegel, 2006). Here, Gernsba-cher’s description contained the sameomissions and misrepresentations.First, what she and Sallows andGraupner called a ‘‘control group’’was not a no-treatment control groupbut rather a treatment comparisoncontrol group. It was composed ofchildren whose parents chose thenumber of ABA-EIBI hours theyreceived each week (31 to 32 hr),but who had less in-home staffsupervision than the experimentalgroup. The latter received 37 to39 hr per week of ABA-EIBI, notmuch more than the control group.Second, the claim that ‘‘there was aslight but nonsignificant advantagefor the control children’’ was morefalse than true. On the one hand, thecontrol group had slight but nonsig-nificant advantages in expressive andreceptive language and four otheroutcomes. On the other hand, theexperimental group had slight butnonsignificant advantages on sevenoutcomes. Thus, the experimentalgroup had a seven to six advantageacross the outcomes. Third, Gerns-bacher selectively reported Sallowsand Graupner’s findings: She failed


to note that, when combined, theABA-EIBI experimental and controlgroups made significant gains oneight of the 13 posttreatment mea-sures (e.g., 25 IQ points). Again,though, without a no-treatment con-trol group, the gains could have beendue to development.

Summary. In summarizing T.Smith, Groen, and Wynn’s (2000)and Sallows and Graupner’s (2005)findings, Gernsbacher said, ‘‘Onestudy showed a non-significant ad-vantage to the treatment [T. Smith,Groen, & Wynn, 2000], but the otherstudy showed a nonsignificant ad-vantage to the control group [Sallows& Graupner, 2005], meaning it’s awash.’’ It’s a wash’’ misrepresentedthe studies in ways just described. Italso dismissed other post-1999 ABA-EIBI studies, albeit none of themrandomized controlled trials. Theseinclude control-group studies (e.g.,Howard, Sparkman, Cohen, Green,& Stanislaw, 2005), two of whichused Lovaas-style ABA-EIBI (e.g.,Cohen, Amerine-Dickens, & Smith,2006; Eikeseth, Smith, Jahr, & Elde-vick, 2002, 2007); pretest–posttestgroup comparisons (e.g., Stahmer &Ingersoll, 2004); single-subject studies(e.g., Green, Brennan, & Fein, 2002),one of which used Lovaas’s methods(i.e., T. Smith, Buch, & Gamby,2000); case studies (e.g., Butter,Mulick, & Metz, 2006); and retro-spective analyses (e.g., Boyd & Cor-ley, 2001; Luiselli, Cannon, Ellis, &Sisson, 2000), at least two of whichused Lovaas’s methods (i.e., Bibby,Eikeseth, Martin, Mudford, &Reeves, 2001; Eldevik, Eikeseth,Jahr, & Smith, 2006). For compari-sons of ABA-EIBI to community-based treatments, see Cohen et al.(2006), Eikeseth et al. (2002, 2007),and Howard et al. (2005), some ofwhose control groups (e.g., time-intensive eclectic, public-school-based interventions) regressed onmany outcome measures. Notwith-standing the appeal of individualizedover more standardized interven-

tions, the eclectic application ofnon-evidence-based treatments needsto be questioned (S. J. Rogers &Vismara, 2008).

For post-1999 reviews of the liter-ature, see Campbell (2003), Eikeseth(2009), Goldstein (2002), Helt et al.(2008), Horner, Carr, Strain, Todd,and Reed (2002), McConnell (2002),Odom et al. (2003), Odom and Strain(2002), Reichow and Wolery (inpress), S. J. Rogers and Vismara(2008), and Schreibman (2000). Heltet al. concluded this about the effectsof interventions on the likelihood ofrecovery from autism:

Almost no controlled studies directly compareoutcomes between behavioral vs. other thera-pies (e.g., developmental stimulation, Denverdevelopmental model, ‘‘floor time’’) or with‘‘biomedical’’ treatments. Therefore no defin-itive statements can be made about whichtreatments can produce recovery in thegreatest number of children. However, al-though it cannot be stated categorically thatbehavioral intervention is necessary for recov-ery, the majority of the studies that reportactual recovery used behavioral techniques,alone or in combination with other therapies,for some or all of the children, and therapiesthat include behavioral methods are the mostempirically validated. In addition to the well-described learning principles that governbehavior therapy, competent behavioral ther-apy requires a highly affective, emotionallypositive set of interactions that promote thereward value of social interactions and moreor less continuous social engagement, espe-cially in very young children. (p. 350)

Those learning principles may alsoexplain why effective therapy works,whether it is behavioral or not. Thelatter may work for behavioral rea-sons without our knowing it.

Treatment or Development

[In concluding her review of Smith, Groen,and Wynn (2000) and Sallows and Graupner(2005), Gernsbacher noted that the studieswere not really a wash]: But, you know, I’m anoptimist by nature, in addition to being acurious person, and I like to look at these dataa little differently [i.e., a Sallows and Graup-ner figure]. And when I look at these data, Isay, you know what, these data might notshow us that that particular style of early


intervention is dramatically more effectivethan control [usually a less intensive versionof the same treatment, but often not muchless]. But these data show us something veryimportant and that is that autistic childrendevelop. In fact, it doesn’t appear from thesedata to matter whether they’re in the controlgroup or the intensive treatment group.Autistic children develop. And you see thatpattern in these data as well [i.e., one of her T.Smith, Groen, & Wynn (2000) figures].

Gernsbacher’s claim that the chil-dren’s gains were due to their devel-opment was empirically and logicallyunfounded. For it to be true, thecontrol groups would have to havebeen no-treatment control groupsthat had made similar gains, but nosuch groups existed, although, byimplication, she suggested they did.Gernsbacher’s claim was also incon-sistent with the methodological rigorshe promoted in her lecture. Criticalreviews that emphasize methodolog-ical standards ought not violate theirown standards. This calls into ques-tion not only their logic but also theirintegrity and impartiality. Unfound-ed conclusions may also imply con-sequences that do not necessarilyfollow, as in this case.

First, if development explained thechildren’s gains, then Gernsbacher’saudience should have assumed thatchildren with autism needed no treat-ment at all. This, however, overlooksindividual differences in diagnosisand developmental outcome. In au-tism, most outcomes are gravelysuboptimal (Johnson, Myers, & theCouncil on Children with Disabili-ties, American Academy of Pediat-rics, 2007; T. Smith, 1999; Volkmar,Lord, Bailey, Schultz, & Klin, 2004),and the need for treatment is obvious(Green, 1996; Myers, Johnson, & theCouncil on Children with Disabili-ties, American Academy of Pediat-rics, 2007). In fact, if left untreated,few children with autism spontane-ously recover (Helt et al., 2008). Mostof them require intensive servicesand, as adults, institutionalization,both of which are ultimately moreexpensive than ABA-EIBI (Bilstedt,

Gillberg, & Gillberg, 2005; Howlin,2005; Howlin, Goode, Hutton, &Rutter, 2004). Second, if develop-ment rather than ABA-EIBI ex-plained the children’s gains, then theaudience should have assumed thatchildren with autism do not respondto ABA-EIBI. In study after study,however, ABA-EIBI demonstratessignificant gains. Third, if develop-ment explained the children’s gains,then the audience should have as-sumed that the gains were geneticallyprogrammed and unalterable by anyintervention, but this is neither sup-ported by the literature (T. Thomp-son, 2007a) nor consistent with recentadvances in developmental science(e.g., G. Dawson, 2008; see D. S.Moore, 2001; Oyama, 2000). Gerns-bacher continued,

So, lastly, let me just leave you with the questionof how can we, as parents and teachers andsociety and members of this lovely audiencetonight, how can we foster that development,even through adulthood? And, how can weimprove the lives of all autistic citizens? And forthat message, I want to turn to a brief video thatmy son has made that I think you are going toenjoy and probably will not mind stayinganother six-ish minutes [actually, about10 minutes], so let me get that going.

Written with intelligence and creativ-ity, the video made the importantpoint that individual differences arenot necessarily deficits. Agreed.When the video ended, Gernsbacherconcluded,

And, given how late it is, I think I will just putup the last slide that gives you places to go ifyou want any more of my work [e.g., www.Gernsbacherlab.org] and also places to go ifyou want to see any more of my son’s films,which is his YouTube account [psych.wis-c.edu/lang/drew/New/drew.html].10 Thankyou so much. You have been a great audiencetonight. I appreciate it. [She allowed no timefor questions.]

10 Presumably posing as ‘‘DeeDeeMom,’’Gernsbacher has posted images from Drew’svideo on YouTube (www.youtube.com/profile?user5DeedeeMom). See also ‘‘D’sAutism Society Presentation, November2006,’’ in which Drew, I presume, then age


DISCUSSION

In summary, Gernsbacher (a) drewmethodologically unfounded conclu-sions about the outcome of ABA-EIBI research, (b) described nonsig-nificant findings to the exclusion ofsignificant ones, (c) failed to identifycontrol groups as other than no-treatment control groups, (d) mis-characterized a research review aswholly critical of ABA-EIBI, (e)appealed to psychology’s history onmisleading points, (f) described par-ticipant assignment criteria that didnot exist, and (g) made unfoundedclaims about professional guidelines.She also omitted significant materialthroughout. These misrepresenta-tions and omissions increased infrequency and significance over thissection of her lecture and wereuniformly biased against ABA-EIBI.11 I shall not belabor thesepoints; I have already done that.Instead, I update the literature, ad-dress some issues concerning profes-sional conduct, and conclude.

Further Endorsement and Research

ABA-EIBI is endorsed by manyacademies, councils, institutes, andagencies, whereas other treatmentsreceive little, if any, support or, likeFC, are found to be harmful. In fact,a few weeks after Gernsbacher’slecture, the American Academy ofPediatrics (AAP) published a revisionof its 2001 recommendations aboutthe management of children withautism (Myers et al., 2007). In 2001,it referenced the applied behavior-analytic literature, but in 2007, itreviewed the literature and conclud-ed, ‘‘The effectiveness of ABA-basedintervention in ASDs has been welldocumented through 5 decades ofresearch using single-subject method-ology and in controlled studies ofcomprehensive early intensive behav-ioral intervention programs in uni-versity and community settings’’(p. 1164). In turn, the AAP wascritical of ‘‘complementary and alter-native medicine,’’ including FC,which was ‘‘not a valid treatmentfor ASD’’ (Myers et al., 2007,p. 1173). As S. J. Rogers and Vis-mara (2008) point out, according toChambliss et al.’s (1996, 1998) crite-ria for identifying empirically vali-dated therapies, Lovaas-style ABA-EIBI is the only ‘‘well-establishedpsychosocial intervention for improv-ing the intellectual performance ofyoung children with autism spectrumdisorders’’ (p. 25; see Chambliss &Hollon, 1998).

Overall, ABA-EIBI has subjecteditself to far more empirical self-scrutiny in published peer-refereedjournals than any other comprehen-sive program of intervention (Eike-seth, 2009; Helt et al., 2008; Myers etal., 2007; S. J. Rogers & Vismara,2008). In fact, soon after Gernsba-cher’s lecture, two more articlesprovided further support, albeit with-out random assignment. In England,Remington et al. (2007) compared atreatment group (n 5 23) that hadreceived 26 hr per week of in-home

11 The pattern reflects what cognitive psy-chologists call a confirmation bias (Evans,Barston, & Pollard, 1983; Lord, Ross, &Lepper, 1979; Mahoney, 1977; Wason, 1960;see also the Tolstoy, 1894, quotation at thebeginning of this article). In critical reviews ofresearch, confirmation bias may be found intendencies to misrepresent the literature inways that credit or discredit a particularposition or sentiment. In the context of the‘‘autism wars,’’ Catherine Maurice (2005a), amother of two children with autism, com-mented on this: ‘‘I think I was naive about thewillingness of people who have a vestedinterest in something to change their minds.Whether it’s a question of income, status inthe field, or the fear of saying ‘I was wrong,’people just have had a hard time changingtheir views about anything. For the purveyorsof therapeutic nurseries, play therapy, rela-tionship therapy, or any other model on whichthey had built their reputations, it was just toomuch to admit that behavioral interventionwas actually capable of taking children withautism farther that had ever been possiblebefore’’ (p. 35).

10, offered engaging and sophisticated an-swers to questions about having autism (www.youtube.com/watch ?v5cJK4S vQ3s4A).


ABA-EIBI to a publicly fundedtreatment comparison control group(n 5 21). The groups did not differ inpretreatment, but after 2 years, thetreatment group had made significantgains over the control group onmeasures of intelligence (e.g., 24 IQpoints), language, daily living skills,and positive social behavior. In Isra-el, Zachor, Ben-Itschak, Rabinovich,and Lahat (2007) compared a treat-ment group (n 5 20) that received35 hr per week of center-based ABA(e.g., DTT, incidental teaching),along with speech and occupationaltherapy, to a matched treatmentcomparison control group (n 5 19)that received eclectic center-basedtreatment (e.g., DIR). After a year,the ABA treatment group had madesignificant gains on measures ofintelligence and core autism deficits(e.g., communicative and social in-teractions), whereas the controlgroup made only a gain in socialinteractions, but with a smaller effectsize. Research continues apace.12

Professional Conduct

Not only did Gernsbacher’s lecturehave deleterious consequences at KUand in the local community, it alsoraised questions concerning profes-sional conduct. Professional conductis, of course, a touchy subject, one onwhich reasonable people will dis-agree. Scientists and practitioners,for instance, disagree about theinterpretation of research designs,

methods, results, clinical guidelines,reviews, and applications. Rarely,though, are they harmed by thesedisagreements in their own and relat-ed fields; indeed, the disagreementsare often an impetus for furtherresearch. However, across the psy-chological sciences (and outsidethem), misrepresentation may raiseissues regarding professional con-duct.

Given that the fundamental ethicaldictum in human research and clini-cal practice is Hippocrates’ ‘‘First, dono harm,’’ the question arises aboutwhether Gernsbacher’s lecture violat-ed that ethic by misrepresentingABA-EIBI to scholars inside andoutside psychology; to students at-tending her lecture for course credit;and to family and community mem-bers possibly looking for clinicaladvice. In research and practice,psychologists are acutely aware ofAPA’s (2002b) Ethical Principles ofPsychologists and Code of Conductbecause state licensing boards, ac-crediting organizations, fundingagencies, and institutional reviewboards routinely apply those princi-ples to their work. In the areas ofcompetence, public statements, andteaching, however, we are less likelyaware of APA’s principles (see Keith-Spiegel, 1994). They are as follows.

Competence. APA’s Standard 2.01on the Boundaries of Competenciesstates, ‘‘Psychologists provide servic-es, teach, and conduct research withpopulations and in areas only withinthe boundaries of their competence,based on their education, training,supervised experience, consultation,study, or professional experience’’(p. 4). For instance, behavioral, so-cial, and cognitive scientists shouldbe wary of offering advice, pro orcon, about clinical treatment toconsumers, especially to vulnerableones, among them the families ofchildren with autism (J. E. Jacobson,2000; T. Thompson, 2007a, pp. 187–203). In Ethics in Plain English, Nagy(2005) elaborates,

12 Magiati, Charman, and Howlin’s (2007)postlecture publication reported no advantagefor Lovaas-style ABA-EIBI over autism-spe-cific nursery school classrooms, and Solomon,Necheles, Ferch, and Bruckman (2007) re-ported on the effectiveness of DIR (seeGreenspan & Wieder, 2006). However, thepoor quality of their research methods,suspect treatment fidelity, and inadequatereporting make any conclusions by Gernsba-cher’s standards debatable at best (see Eike-seth, 2009; Lloyd, Pullen, Tankersley, &Lloyd, 2006). For research that contradictsMagiati et al., see Cohen et al. (2006),Eikeseth et al. (2002, 2007), and Howard etal. (2005).


Your work must be firmly grounded inestablished scientific and professional knowl-edge. Do not make ‘‘factual statements’’ inyour classroom, your consulting office, thecourtroom, on radio or TV, in print, on theInternet, or anywhere, about psychologicalmatters that go beyond supporting facts,unless you use a disclaimer. Resist thetemptation to overgeneralize or oversimplify,regardless of the setting or pressure fromothers. It’s better that your statements are alittle more tentative, but accurate, rather thanflashy and flawed. (p. 57)

Few of us likely violate APA’sstandards for competence, but wemay sometimes engage in the activi-ties Nagy describes: We may over-generalize and simplify our views,both in criticism and advocacy, on avariety of topics in a variety ofvenues. How much harm this causesis difficult to judge, but when mis-representations occur, our colleaguesare often quick to point them out(e.g., see Catania, 1991, on Mahoney,1989; Morris, 1993, on Meyer &Evans, 1993; Wolf, 1991, on Proctor& Weeks, 1990; see Todd & Morris,1992).

Public statements. APA’s Standard5.01 on the Avoidance of False orDeceptive Statements states, ‘‘Psy-chologists do not knowingly makepublic statements that are false,deceptive, or fraudulent concerningtheir research, practice, or other workactivities or those of persons ororganizations with which they areaffiliated. [These] include but are notlimited to … lectures and public oralpresentations’’ (p. 8). With respect toRCTs, the Consolidated Standards ofReporting Trials note that reportingthem inadequately ‘‘borders on un-ethical practice when biased resultsreceive false credibility’’ (Moher,Schultz, & Altman, 2001, p. 1191).Ethical practices include the ‘‘precisereporting of the interventions intend-ed for each group’’ (p. 1192). Al-though this standard concerns thesubmission of RTC manuscripts forpublication, the ethical reasoningbehind it applies to public statementsabout research methods in general.

Teaching. APA’s Standard 7.03bon Accuracy in Teaching states,‘‘When engaged in teaching or train-ing, psychologists present psycholog-ical information accurately’’ (p. 10).Fisher (2003) elaborates, ‘‘Standard7.03b reflects the pedagogical obliga-tion of psychologists to share withstudents their scholarly judgment andexpertise along with the right ofstudents to receive an accurate rep-resentation of the subject matterenabling them to evaluate where aprofessor’s views fit within the largerdiscipline’’ (p. 138). Nagy (2005) cau-tions, ‘‘Do not exaggerate, minimize,spin, or otherwise distort or bend thefacts to suit your opinion or bias’’(p. 182; see Keith-Spiegel, Whitley,Balogh, Perkins, & Wittig, 2003). Iexpect we rarely violate APA’s stan-dard for teaching, but we maysometimes exaggerate or minimizethe facts to suit our sentiments.

In ‘‘Ethics and the PersuasiveEnterprise of Teaching Psychology,’’Friedrich and Douglass (1998) speakto this point directly. They argue thatwe should not only make balancedpresentations (Matthews, 1991), butthat we should also be aware of howour ‘‘instructional persuasion’’ mayaffect students’ beliefs. Beliefs are notonly a function of research, but alsoof how we present the research. Forstudents to act effectively on it, wemust not only avoid misrepresentingit, but also avoid false assumptions,rhetorical tactics, and insincere‘‘cues’’ (e.g., perceived but falsecaring). On this point Friedrich andDouglass recommend,

Not only should instructors help studentsweigh special bias or opinion in sourcematerials, they should also make availablefor scrutiny their own positions and opinionswhen pertinent. The object … is not toindoctrinate students but rather to encouragethem to see the affective, personal dimensionto knowledge and to develop in them the habitof critical consideration of all sources. By thesame justification, instructors should discloseto students their classroom, or public, persua-sion agendas. (pp. 555–556)


Conclusion. Whether or not Gerns-bacher’s lecture violated APA’s eth-ical standards is open to interpreta-tion. I, myself, take no stance. As thestandards for competence are written,the answer is no. As for the standardson public statements, everything de-pends on ‘‘not knowingly,’’ as in notknowingly made false or deceptivestatements about research and appli-cation. As for the standards onaccuracy in teaching, their violationmay also depend on ‘‘not knowing-ly,’’ as in not knowingly presentedinaccurate information; however,APA does not qualify this standardwith ‘‘not knowingly.’’

Sources of Misrepresentation

As for the source or sources ofGernsbacher’s misrepresentations, Ican only conjecture, having just theform and content of her lecture andWeb site (www.gernsbacherlab.org)from which to make inferences abouttheir function. The misrepresenta-tions may have been due to a seriesof unhappy accidents or poor schol-arship, but the latter would have beenuncharacteristic of Gernsbacher as aprofessional.13 They may reflect herseemingly dismissive sentiment to-wards applied behavior analysis,based perhaps in a philosophy ofmind that conflicts with behavioranalysis. They may also have had

conscious or unconscious metacogni-tive origins, for instance, an intent tostrengthen a developmental approachto theory, research, and practice inautism by misrepresenting the hold ofapplied behavior analysis on evi-

13 The professional standards of scientists inpublic advocacy are not always their stan-dards in science (Shermer, 2002). For example,Gernsbacher is associated with autism advo-cacy groups—the Autism National Committee(AutCom) and autistics.org—whose standardsare not scientific by the standards shepromoted. For AutCom, she has publishedan article in its newsletter (Gernsbacher, 2005;see www.autcom.org/pdf/AutcomNLSpring2005.pdf), offered ‘‘support’’ for its 2005 and2006 conferences (e.g., www.autcom.org/pdf/AutcomNLFall2006.pdf), and given a key-note conference address by the same titleas her KU lecture (www.autcom. org/pdf/AutcomNLSpring2006.pdf). In addition, Aut-Com has posted an anti-DTT memorandumthat contains scientifically unsupported asser-tions (e.g., the outcome of DTT is due to

development; see www.autcom.org/articles/DTT.html), an article promoting a non-evidence-based treatment (i.e., DIR; seewww.autcom.org/articles/Behaviorism.html),and a position paper advocating for a harmfulintervention —facilitated communication (www.autcom.org/articles/Poition2.html)—that Gerns-bacher has endorsed in a prepublication bookcommentary (www. reasonable-people.com/advanced-praise.html). AutCom also promotespseudoscience: One of its officers, Gail Gilling-ham Wylie, offers a $1,000 diagnostic andtreatment service using a ‘‘QXCI QuantumXeroid Consciousness Interface EPFX/SCIO.’’This device putatively gathers so-called bioener-getic data from clients to diagnose hundreds ofailments and then treat them, autism included,through feedback, even through subspace,that is, without clients being physically present.This is mere quackery (www.quackwatch.com/01 QuackeryRelatedTopics/Tests/xrroid.html;see Offit, 2008). See Maurice (2005b) for howto distinguish science from pseudoscience inautism treatment and for warning signs of thelatter. See Lerman et al. (2008) on usingbehavior analysis to examine unproven thera-pies in the context of ABA-EIBI.

As for autistics.org, as of December 10,2007, it had posted a reprint of Gernsbacher’s2004 article from the Wisconsin State Jour-nal—‘‘Autistics Need Acceptance, Not Cure’’(see www.autistics.org). This is an importantpiece about individual rights, empowerment,and social justice, but it obscures the fact that,although children with autism deserve accep-tance as individuals, their behavior sometimesdoes not. It requires treatment, lest it severelylimit their freedom for the rest of their lives(Rimland, 1993).

The positions these groups advance areinconsistent with the scientific standardsGernsbacher promoted in her lectures andare ill-suited to an NSF panel member, AAASrepresentative, and past president of APS,whose mission is ‘‘to promote, protect, andadvance the interests of scientifically orientedpsychology in research, application, teaching,and the improvement of human welfare’’(www.psychologicalscience.org/about/). Forautism advocacy groups that promote sci-ence-based interventions, see the Associationfor Science in Autism Treatment (www.asaton-line.org) and Families for Early AutismTreatment (www.feat.org/); see also, the Cam-bridge Center for Behavioral Science (www.behavior.org) and Maurice (2005a).


dence-based treatments, especiallynow that significant competitivefunding is finally available. This,though, would have been an error inlogic: Weakening one approach doesnot strengthen the intellectual con-tent of another, but then, audiencesdo not always reinforce logically.14

Gernsbacher’s misrepresentations mayalso be related to her personal experi-ences with her son; decisions abouttreating his autism; and relations withautism advocacy groups that harborsentiments against applied behavioranalysis and science in general. Thesemay have compromised her objecti-vity in reporting the ABA-EIBI liter-ature.

This may sound patronizing andad hominem. If so, I apologize; it isnot meant to. I am only conjecturingabout the personal, social, and cul-tural sources of ABA-EIBI’s misrep-resentations, which extend far be-yond Gernsbacher’s (see Baer, 2005;J. E. Jacobson et al., 2005; Leaf et al.,2008). In some cases, addressing theirsources might reduce the probabilityof future misrepresentations (Morris,1985; Todd & Morris, 1992). Myconjectures notwithstanding, I havedeep and abiding professional andpersonal compassion for the parentsof children with autism. They arepart of my life. They telephone and e-mail me about services in Kansas,and I fail them as often as not; goodservices are lacking. They consultwith me about how to improve

services, but have had to bandtogether later to found their ownschool. They work with some of mycolleagues, who work with theirchildren, but often on waiting liststhat are too long. They are also myneighbors.

CONCLUSION

Gernsbacher concluded by askinghow we can foster the developmentand improve the lives of persons withautism across the life span. Given anagreement on the meaning of fosterand improve, her question can beanswered empirically through re-search in the biological, behavioral,and developmental sciences. It can beanswered better, though, throughinterdisciplinary research acrossthem. Autism is not an essence thatlies in any one of their subjectmatters. It is a product of thetransactions among biology, the en-vironment, and behavior that occurover the course of biological andbehavioral development and that areunique to each individual (G. Daw-son, 2008). Although research in eachof these sciences controls for factorsin the others, holding those factorsconstant does not thereby privilegethe factors that any one of theminvestigates. Autism does not existoutside the factors in all of thesesciences. As long as research isempirical, discoveries in any one ofthem will ultimately be consistentwith those in the others (Warren,2002).15 Finally, given that our un-derstanding of autism and our abilityto discover effective treatments for itrequire transdisciplinary research,misrepresenting any one of the sci-ences will only impede our overallprogress. Gernsbacher is presumably

14 Given Gernsbacher’s undisclosed associa-tion with antiscience advocacy groups, herpromotion of FC, and her sentiments againstapplied behavior analysis, her conclusionsabout ABA-EIBI may reflect a conflict ofinterest. APA’s Standard 3.06 on Conflict ofInterest is this: ‘‘Psychologists refrain fromtaking on a professional role when personal,scientific, professional, legal, financial, orother interests or relationships could reason-ably be expected to (1) impair their objectivity,competence, or effectiveness in performingtheir functions as psychologists or (2) exposethe person or organization with whom theprofessional relationship exists to harm orexploitation’’ (p. 6).

15 I am surely naive about the ability of datato resolve philosophical and political differ-ences, at least in the short run (see Howard,1999). A case in point is Project FollowThrough, a follow through on the Head Startprograms of the early 1960s. Begun in 1968,the project identified and funded 22 differentearly education programs not just to discover


aware of this. As she noted of a 2006AAAS symposium she organized andchaired, ‘‘With the surge in bothscientists and society turning theirattention toward autism, there comesresponsibility. It behooves us asscientists to distinguish uninformedstereotypes from scientific reality andto move beyond myths and miscon-ceptions’’ (Gernsbacher, 2006, re-trieved December 11, 2007, fromwww.news.wisc.edu/12198).

It also behooves us to distinguishmisrepresentations of ABA-EIBIfrom scientific reality to foster thetransdisciplinary research needed tosolve the problem of autism.

I conclude by returning to myopening. I wrote this response toGernsbacher’s KU lecture for aparent who asked me how he coulddefend the effective use of ABA-EIBIwith his son. They can now go fishingtogether; before, they could not. Iwrote it for the ABS major whoasked for counterarguments to themisrepresentations of ABA-EIBI sothat she could defend her major toher peers in other departments. She isnow a research assistant in a programof use-inspired basic research indevelopmental disabilities. Mainly,though, I wrote it for the families ofchildren with autism and, ultimately,for those children who need anddeserve evidence-based treatments,of which ABA-EIBI so far has thebest support. Unfortunately, manyparents are dissuaded from using it bymisinformed, misguided, or mislead-ing advocates of other approaches.As a result, they often use theseapproaches until they see their chil-

dren’s poor progress. When theybegin using ABA-EIBI to good effect,they speak of their great regret andguilt for not having used it earlier,when their children had the most togain and the most time to make thosegains. The opportunity cost of notusing ABA-EIBI, or any equallyeffective intervention, is that theirchildren will be delayed in achievingtheir full potential or never achieve itat all. As a result, their children willneed more supportive services andinstitutionalization later into theirlives and perhaps for the rest of theirlives at significant personal and socialcosts to them, and financial costs tous all.16 This is a crime.

POSTSCRIPT

On March 28, 2008, Gernsbachergave a lecture by the same title as herKU lecture at the Midwest Confer-ence on Professional Psychology inOwatonna, Minnesota, hosted by thePsychology Department at Minne-sota State University at Mankato.The conference’s goal was ‘‘to pro-mote the dissemination of empiricallyoriented research from a variety ofdisciplines within the field of psy-chology’’ (Society for Teaching ofPsychology Discussion List). I wastold by three colleagues who inde-pendently attended the lecture andwho had either read an earlier draftof this manuscript or viewed theURL of Gernsbacher’s KU lecture,that, minor changes aside (e.g., label-ing the control groups as comparisongroups), she misrepresented ABA-EIBI in the same ways she did atKU. Given that I had sent her a draftof this manuscript at least a monthbefore her Mankato lecture, shewould have knowingly misrepresent-what worked but also to adopt and then fund

the programs that did work, not the others.Although the results demonstrated the clearsuperiority of the two behavior-analytic pro-grams—direct instruction (Englemann & Car-nine, 1982) and behavior analysis (Bushell,1973)—the project funded many models,irrespective of their effectiveness (Carnine,1983, 1984). For a review of the project andhow various stakeholders undermined it, seeWatkins (1988, 1997).

16 Gernsbacher has been fortunate to havehad choices in addressing her son’s develop-mental course. Most parents of children withautism do not. For the barriers and frustra-tions they face in seeking evidence-basedtreatments, see Maurice’s Let Me Hear YourVoice: A Family’s Triumph over Autism (2001;see also Maurice, 2005b; Offit, 2008).


ed ABA-EIBI if she had read it. Shealso presented a paper by the sametitle that addressed, in part, ‘‘DoesABA cure autism’’ at the April, 2008,Web Conference Series on Practicesto Promote Inclusion for People withAutism Across the Lifespan, spon-sored by the Association for theSeverely Handicapped. And, in No-vember, 2008, she offered an on-line course through neurodiversity.com (http://www. neurodiversity.com/autismbasic.html) titled ‘‘Under-standing Autism: Myths and Mis-conceptions’’ (http://144.92.102.54/autism-sample.html) that examined‘‘approaches to remediating behav-iors that are considered autistic’’(Gernsbacher, 2004; see http://www.ls.wisc.edu/L&STODAYv9no2/L&STODAYv9n2p4.pdf, retrieved Feb-ruary 3, 2009). As of February 3,2009, however, the link was broken.

To address her continued misrep-resentations, I consulted one of hercolleagues for advice. She proposedthat I invite Gernsbacher to partici-pate in an APA symposium on theevidence for the efficacy of ABA-EIBI. I also consulted one of thesenior APS administrators, whoagreed. Thus, last summer, I invitedGernsbacher to participate in such asymposium, but she never responded.Finally, I wrote her departmentchairperson to suggest that he coun-sel her against continuing to give thislecture, lest a teacher, therapist, orparent file ethics charges against her,but he never acknowledged my con-cern. At the urging of many col-leagues, this was the point at which Isubmitted this manuscript to TheBehavior Analyst.17 I end with anadmonition and hope:

Let us pay tribute to the courage of childrenwith autism and their families, as they striveevery day to confront the disability with apowerful combination of determination, crea-

tivity, and hope. Let us empower them andrespond to their needs today, so as to makeour societies more accessible, enabling andempowering for all our children tomorrow.(Ban Ki-Moon, United Nations SecretaryGeneral, April 2, 2008, First World AutismDay)

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