Early Intensive Behavioral Intervention (EIBI) is the most recognized method in managing Autism Spectrum Disorders (ASD). Some studies show that EIBI can improve several aspects, such as adaptive behavior, intellectual, social abilities, communication, and life quality.

However, scientific evidence is still limited, so the application of EIBI to autism spectrum disorders still needs to be considered.

The increasing prevalence of Autism Spectrum Disease (ASD) increases the need for evidence-based behavioral therapy to reduce the impact of ASD symptoms. At present, neither curative nor psychopharmacological treatment has been proven effective in treating all symptoms of ASD.

Management of Autism Spectrum Disorders with Early Intensive Behavioral Intervention

Management of ASD

A variety of procedures are carried out to reduce the various symptoms of ASD. Psychopharmacological therapy has not been proven effective in overcoming the symptoms of ASD. The applied behavior analysis (ABA) approach method shows the cognitive, adaptive, and social improvement of children with ASD in the past four decades. EIBI is an implementation of the principles of behavior based on ABA.

Management of therapy for ASD should be started as early as possible (ages 3.5–5 years). The earlier an intervention is carried out, the better the results will be. It is caused by brain plasticity, so it is expected that the gap between ASD children's ability and the level of development that should have been able to be done by children his age is not too far away.

Several studies have also shown positive results in high-intensity behavioral therapy (15-40 weeks) in increasing adaptive behavior, language skills and reduced ASD symptoms and difficult behavior.

The primary purpose of managing autism spectrum disorders is to overcome the most severe symptoms of ASD, namely: communication and social disorders, limited interests, the ability to play, and make imitations. Interventions are carried out in a structured and clear atmosphere.

Early Intensive Behavioral Intervention

EIBI therapy in children with ASD includes all the recommendations above. One therapist for one child, in a structured atmosphere (clinic or home) for 25 hours per week or more. Giving Instructions must be systematic in daily life (class, school, in public places).

EIBI therapy focuses on major ASD disorders and is tailored specifically to each child (e.g., communication and socializing). Also, the approach used is personal, depending on the problematic behavior found. Parents' role is enormous in terms of time management, application, and help in arranging programs.

EIBI therapy is based on the principle of the ABA procedure, which is widely used for autism. The main components are:
  • Provision of the initial stimulus (instruction)
  • Children respond (behavior)
  • Children get the consequences (reinforcement) of their behavior.
  • There are times when children are given help (prompt) to bring up the expected behavioral response.
  • Initial Stimulus (Instructions)

Every child, with or without realizing, will do a certain behavior. However, the most important thing is that the behavior must be following the situation and conditions. For example, a child will mention a car when looking at a car or a vehicle, not suddenly out of context, mentioning a car.

Response (Behavior)
The expected behavioral response target of a child must be clearly defined in the criteria. Correct responses can appear on their own or be assisted (prompt). If the child shows the correct behavioral response, the therapist immediately provides consequences in things he likes (praise, toys, or food).

If the behavioral responses that appear are not appropriate or the child does not respond, the therapist can provide verbal instructions. Next, the child is asked to repeat.

Consequences (Reinforcement)
sequences are the essence of learning. Every child is different; some like praise, food, or certain toys. The therapist's job is to find out which response the child likes best. The trick is to ask parents, observe children from a distance, or provide various alternative consequences.

The consequences are given immediately after the child responds correctly to the stimulus to understand what behavior should be done. The consequences can change according to the situation.

Help (Prompt)
The purpose of assisting is to make it easier for children to respond according to the stimulus. Suppose the child is asked to touch the nose, then help can be given is to hold the child's hand to touch his nose. The hope is that in the future, children can respond without always having to be helped.

Task Analysis
All difficult tasks must be divided into various simple tasks to make it easier to learn. For example, the task of playing a train is divided into arranging parts of a train, assembling parts into trains, then pushing trains to run. Learning to speak can be broken down into learning to pronounce per syllable, then study each type of word, until then arrange one sentence.

Discrete Trial Training
Children with autism spectrum disorders tend to be slower to learn, difficult to focus for long periods, and more difficult to understand abstract concepts. Therefore, process
learning will be easier if the lesson is made short and simple. Each course of study must be evaluated, whether it is successful or not, in measured assessments.

Additionally, children must also be able to apply what they have learned in the circumstances outside the classroom, for example, when playing. The program is declared successful if the child makes it into regular school.

Effectiveness of Early Intensive Behavioral Intervention against Autism Spectrum Disorder

A case-control study examined 35 children who received EIBI and 24 children who received general therapy for one year. The EIBI group showed an increase in adaptive function and decreased autism symptoms.

Fava et al. compared 12 children who underwent EIBI and 10 children who underwent general therapy. The treatment duration per week did not differ significantly, 14 hours per week for the EIBI group, and 12 hours per week for the general group. After six months, the EIBI group showed an intellectual improvement, as well as reduced symptoms of autism and difficult behavior.

A meta-analysis study conducted in Los Angeles showed that there was one study with an outgrowth of the general therapy group, having almost the same or slightly better results than the EIBI group. Meanwhile, four other studies show a significant increase in intellectual and adaptive behavior in the EIBI group.

A study conducted in Rome, Italy, compared 24 children who had EIBI every week and 20 children who had 12 hours of general therapy every week for six months. The intervention group showed better results in language, mental development, and the severity of symptoms. However, the general intervention group achieved more excellent results in adaptive behavior and motor skills socialization.

Another meta-analysis study was conducted on one randomized clinical trial and four randomized clinical trials, which compared EIBI and usual therapy. Besides comparing IQ, symptoms of autism, and adaptive behavior, It also observed language, communication, socializing, and everyday life skills.

The results of this meta-analysis study indeed show that EIBI is superior in all these aspects. However, the scientific evidence is not reliable because the methods used are not optimal, the provision of non-random interventions, and differences in sample characteristics are too far away, creating the risk of bias towards research results.

EIBI Effectiveness and Parent Stress Level
However, other studies have shown that the level of stress in the elderly in the general group is lower than in the intervention group.

EIBI Challenge
One of the challenges of EIBI is the absence of a large scale randomized clinical trial that proves EIBI therapy has a strong scientific basis. This is difficult because the therapy protocol for autism spectrum disorders varies greatly and is tailored to each child's personal needs.

Children with autism spectrum disorders have IQ, adaptive behavior, social abilities, language, and various other characters that are very diverse, so it needs to be examined more specifically what things are suitable for certain individuals.

Various aspects of EIBI also need to be further investigated, including:

- The impact of EIBI on the well-being of parents and the overall quality of life of other family members, because its effects (e.g., stress experienced by parents) influence the child's response to therapy
- Modifications that need to be made to EIBI for groups of ASD children who are not experiencing improvement
- The most efficient and effective age group in giving impact to the brain and behavior
- The minimum duration of therapy needed to provide long-term permanent effects
- Biological markers that can be checked to help evaluate therapy