Transcript of BBC Coverage
of Autism in
"A ten year study into possible links
between autism and environmental
pollutants and vaccinations is now
under way. Meanwhile the case
load continues to swell.
With ABA, the treatment of
choice, costing $50,000 per
child, per year, the budget for special needs is already
For more articles on disabilities and special ed visit
Apple Valley, California, in the heart of the desert.
ROBERT SMITH: You walk out here,
you don't see street lights, you see stars. Here, it is
different. Colder in the winter, hotter in summer.
WATSON: It's an every day trip for
glass fitter Robert Smith.
SMITH: You can put glass into
anything that moves - from shower doors to store
fronts, cars. I've yet to do an airplane, but I have done
WATSON: But his journey over the
past 30 years has been something of a miracle. At
the age of two he was diagnosed
with severe autism.
VIDEO FOOTAGE: Hi, Bobby, how are
WATSON: This is Robert, aged three.
He refuses to make eye contact, a key sign of
autism. He appears cut off from
the outside world. He is preoccupied with
repetitive play, characteristic of autistic children and
he has no speech.
This is the first time mother and son have seen these
GENIA SMITH: It's pretty crazy. But
we made it.
WATSON: Back in those days, what
problems did Robert have?
GENIA SMITH: He would rock himself
and hit his head against the wall, repeatedly. I
began to hear some
children with autism would wear helmets, to prevent brain
damage or whatever. So I kept him out of the crib
as much as I could. He had
other behaviors. Moving his head back and forth with his
hand in front of his
face. Making a croaking noise.
WATSON: Repetitive behavior?
GENIA: Yeah, he would sit and do
it, do it.
ROBERT: I don't remember half of
it. To me it seemed like a place where I was
going to do things. It was
almost like school, you know. It doesn't register
much, I don't remember feeling
any different. It was just a stage in
LEIGH: Do that. Yeah! That's what
I'm looking for! Do this. Yeah!
WATSON: This is the therapy
technique that cured Robert. It's now practiced across
MILA AMERINE-DICKENS: Leigh is
teaching Luke to imitate and perfect imitation skills. She gives
a cue, Luke
responds and she provides positive reinforcement.
LEIGH: Do this. Yeah! Thank you.
WATSON: Tasks are broken down into
simple components. Success is rewarded with
praise, such as chips or a
drink. It's known as Applied Behavioral
Analysis or ABA.
AMERINE-DICKENS: We've had a lot of
success stories. Success ranges from children just
learning to talk to children
now in third to seventh grade, independently
without assistance. They're in regular ed without help.
WATSON: The hills above Los Angeles
is the home to the man who pioneered ABA for
autistic children. For 40 years
psychologist Dr Ivar Lovaas has developed
the approach at the University of California.
SR IVAR LOVAAS: Imitation is a
major learning strategy. Half the kids learn to imitate
vocal sounds, like
"mama," "papa." Then "mommy, daddy", and then slowly you
make it more complicated. It's like an
accelerated curve. You take a long time
to get to the first sound
imitation, then they shoot up like this. So,
say, "What's your name?" and they can say "Adam."
WATSON: In 1987 Lovaas published
the results of research on a group of 19, mostly
from around Los Angeles, who'd
received 40 hours intensive ABA.
LOVAAS: At the age of seven, 47% of
them scored within the normal range, or the
typical range on IQ tests and
were in first grade unassisted. We tested
them again when they were 13,
as adolescents. The best outcome group
maintained again which surprised me. I
thought it really meant in those first years
that we had them in treatment
they learn how to learn.
NEWS REEL: Marty, touch your nose.
WATSON: The ABA team at the
university of California had to swim against the tide.
Many of Lovaas' rivals believed
autism was created by a cold mother-child
relationship, and as such was treatable with Freudian
now discredited but some researchers still argue against
intensive ABA. This
is the alternative, the
classroom based approach. Ivy and Jared spend all
day in class together with other autistic
TEACHER: Catch the spider.
WATSON: Along time rival of Lovaas
believes this is the best model. He says that
40-hours of intensive one- on-one
therapy can actually be damaging.
DR EDWARD RITVO: Children with
autism need other things be sides one-on-one relationships.
They need to play and to be
kids. They need social reinforcement. I've
seen kids who have been placed
in this treatment 40, 50 hours a week,
day after day, week after week, and
they lose out on the part of their personality
that could develop and become
WATSON: Now Lovaas says the
technique is not effective unless have you something
like 30 or 40 hours intensive
ABA per week. What do you say to that?
RITVO: With two or three hours a
day, four or five times a week, we seem to reach
the maximum effectiveness.
LOVAAS: There are no data to
suggest that two or three hours a day is effective.
The easy thing is to say,
"Oh no, your child needs... is to be stressed now,
only need two or three hours a day and then play with
other kids." They don't learn
anything by being with other kids. We know that for a fact.
You put a class in a
normal class, if he doesn't learn the basic skills he
will stay the same.
WATSON: ABA is not for everyone.
Standards of treatment can vary. Jared's parents
tried it at home with a team of
therapists. Their son made little
JASON ELKIN: The things you hoped
to see such as increased eye contact, more self
aggression, we were not seeing. That he was
non-responsive when it came to that treatment. Truly it
was after we took
the somewhat unusual step of wiring his room with video
to watch the therapy
that we were aghast at what we
THERAPIST: Clap your hands. I don't
like. I don't like that. Clap your hands.
WATSON: Jared cries as he fails and
fails again Lovaas' own data shows that a
minority of children don't
respond, even to the best ABA and much depends
on the quality of the therapy.
THERAPIST: You need to listen.
Stand up. When I say stand up, you stand up.
WATSON: Dr Lovaas acknowledges that
the majority of therapists fall short of his
standards. His critics argue
that ABA is overused and overhyped. Despite
the controversy, there is a
growing body of evidence in California
that early intervention does work
actually work if it's intensive and early enough.
question is what the state believes is the best way
forward. I have
come to meet the man in charge of the
$1.8 billion budget for autism.
California's Department of Developmental Services enjoys a big
budget for disabilities guaranteed
under state law. The state's most senior
psychologist says he is ready to embrace a
radical new policy on ABA.
DR RON HUFF: ABA definitely works.
It probably has more science behind than any other
approach. I think every child
should be given the opportunity to find out
whether or not that child can respond to ABA. Now,
WATSON: That's significant. That's
a big financial resource?
HUFF: It is. It is, but we are
looking at a lifetime of developmental problems
if the child does not receive.
WATSON: The situation in California
is very different from in Britain. Here state
politicians seem willing to
back ABA despite the huge costs. The costs
will be vast. Here, there is an
epidemic of autism. Numbers up are
300% over the
last decade. The crucial question is why. According to an
official California study. The
number of causes diagnosed was consistent between
200 and 300 a year in the
1970s. The numbers climbed sharply and
the 1980s. Today, more than 3,000 cases a year are being
are only two possible reasons for. This either some
unknown environmental trigger is
creating an increase or the rising
numbers are a by product of better
RITVO: Instead of autistic kids
slipping through the cracks, they're getting all
the gravy now. It is very
advantageous to have their kid labeled autistic
because they get a nice teacher and ABA and all goodies
from the school system. Autism
is well funded as a disease now, thank God.
WATSON: You think that
re-categorization could account for 100% of this massive
WATSON: Russell is one of 18,000
autistic children in California today.
RICK ROLLENS: Who is the best?
RUSSELL ROLLENS: I am.
ROLLENS: You had better believe it.
WATSON: Swimming is one of the few
skills Russell has learnt since he was
diagnosed autistic aged two.
ROLLENS: You experienced clearly a
feeling of death and remorse in your family when
you see someone that you love
more than life itself disappear before your
WATSON: Like many parents, Rick is
convinced that Russell was damaged by a series
of vaccinations. He
strongly rejects the idea that the epidemic of autism can
be entirely explained by poor diagnosis in the past
because numbers have rose over
the last few years.
ROLLENS: Missing child with autism
is like missing a train wreck. For us now to now
think that somehow we have
better identified a child who can't talk, who
has repetitive behavior. Who
makes no eye contact. Who is self-
involved and in
many cases self-abusive just defies logic.
WATSON: Is it credible that such a
massive rise in numbers can be put down solely
to changing diagnostic
HUFF: I don't think can you. I
think we would be foolish attribute that rise
simply to one single factor. If we
are intelligent, I think we are doing
this the intelligent way, we are looking at all of those
issues. If it is determined that an
environmental link is there, we are going to see a lot
more of this before we can correct
that. Because we have been contributing
things to the environment for many, many years. I don't
know if we can
clean that up.
WATSON: A ten year study into
possible links between autism and environmental
pollutants and vaccinations is
now under way. Meanwhile the case load
continues to swell. With ABA, the treatment of choice, costing
$50,000 per child, per year,
the budget for special needs is already stretched.
LOVAAS: If the child was not
treated then the child would be in an institutional
setting and protected care for
40 years or 50 years. Normal life
expectancy are 60 or 70 years. That
costs the state $30,000 a year. You
multiply that with 50 and you are
coming into millions of dollars.
WATSON: Back in the desert Robert
Smith prepares for the night shift. He was one
of nine children to
completely overcome their autism in Dr Ivar Lovaas 1970s
research study. Now he makes $50,000 a year as
a glazier. The same as a year's
worth of ABA. California is able to back ABA for every autistic
child. The hope is many more