ABOUT: WHAT WE DO
A Letter from Our Founder
Doreen Granpeesheh, PhD, BCBA-D
CARD Founder and Executive Director
In 1978, I met a young boy with autism named Corey. His gentle nature, exceptional
memory and desire to interact touched my heart. The positive impact of the therapy
he received inspired me to start the Center for Autism and Related Disorders, Inc.
(CARD) in 1990. At CARD, we truly believe that recovery is possible and we develop
our programs with that in mind.
The CARD I and CARD II programs include comprehensive and cutting-edge curricula
that can be tailored to the specific needs of individuals from birth to 21 years
of age. These programs help children learn to communicate, develop friendships,
and lead happy, healthy lives.
CARD Specialized Outpatient Services (SOS) provides assistance with specific areas
of concern for a family and develops and implements strategies to diminish problem
behaviors and teach necessary skills.
None of these life-changing programs would be what they are without the work of
our exceptional staff which includes PhDs, licensed psychologists, speech and language
pathologists, masters-level supervisors, social workers, Board Certified Behavior
Analysts, and marriage and family therapists. They are truly committed to helping
all of our children achieve their fullest potential.
I hope this publication will answer some of your questions about CARD and in doing
so give you optimism that success and recovery are possible.
ABOUT: THE CARD APPROACH
Focused on Measurable Results Since 1990
Applied Behavior Analysis
Behavior Analysis is the science of behavior. Applied behavior analysis ( ABA )
is the process of systematically applying interventions based upon the principles
of learning theory to improve socially significant behaviors to a meaningful degree
(Baer, Wolf & Risley, 1968/1987; Sulzer-Azaroff & Mayer, 1991). Specifically,
ABA refers to a systematic approach to the assessment and evaluation of behavior
and the application of interventions that alter behavior. Over the past 30 years,
several thousand published research studies have documented the effectiveness of
ABA across a wide range of:
Populations (children and adults with mental illness, developmental
disabilities, and learning disorders)
Interventionists (parents, teachers, and staff)
Settings (schools, homes, institutions, group homes, hospitals,
and business offices), and
Behaviors (language; social, academic, leisure, and functional
life skills,self-injury, and stereotyped behaviors)
Reliable Measurements — Objective Evaluation
ABA is an objective discipline focused on the reliable measurement and objective
evaluation of observable behavior. Programs based upon ABA methodologies are grounded
in the well-established principles of learning and operant conditioning, as influenced
by the works of researchers, such as Edward L. Thorndike and B.F. Skinner. The use
of single case experimental design to evaluate the effectiveness of individualized
interventions is an essential component of ABA programs. This process includes the
following components which outline a reliable and accountable approach to behavior
change (Sulzer-Azaroff & Mayer, 1991):
- Selection of interfering behavior or behavioral skill deficit
- Identification of goals and objectives
- Establishment of a method of measuring target behaviors
- Evaluation of the current levels of performance (baseline)
- Design and implementation of the interventions that teach new skills and/or reduce
- Continuous measurement of target behaviors to determine the effectiveness of the
- Ongoing evaluation of the effectiveness of the intervention, with modifications
made as necessary to maintain and/or increase both the effectiveness and the efficiency
of the intervention
ABA generally focuses on the process of behavior change with respect to the development
of adaptive, prosocial behavior and the reduction of maladaptive behavior. Specific
"socially significant behaviors" include academics, communication, social skills
and adaptive living skills. For example, ABA methods can be used to:
- Teach new skills (e.g. the socially significant behaviors listed above)
- Generalize or transfer behavior from one situation to another (e.g., from communicating
with caregivers in the home, to interacting with classmates at school)
- Modify conditions under which interfering behaviors occur (e.g., changing the learning
environment so as to foster attention to the instructor)
- Reduce inappropriate behaviors (e.g., self injury or stereotypy)
Treatment approaches grounded in ABA are now considered to be at the forefront of
therapeutic and educational interventions for children with autism. In general,
this behavioral framework utilizes manipulation of antecedents and consequences
of behavior to teach new skills and eliminate maladaptive and excessive behaviors.
The Discrete Trial is a particular ABA teaching strategy which enables the learner
to acquire complex skills and behaviors by first mastering the subcomponents of
the targeted skill. For example, if one wishes to teach a child to request a desired
interaction, as in "I want to play," one might first teach subcomponents of this
skill, such as the individual sounds comprising each word of the request or labeling
enjoyable leisure activities as "play." By utilizing teaching techniques based on
the principles of behavior analysis, the learner is gradually able to complete all
subcomponent skills independently. Once the individual components are acquired,
they are linked together to enable mastery of the targeted complex and functional
skill. This methodology is highly effective in teaching basic communication, play,
motor, and daily living skills.
Discrete Trial Teaching (DTT)
Initially, ABA programs for children with autism utilized only Discrete Trial Teaching
(DTT) and the curriculum focused on teaching basic skills as noted above. However,
ABA programs, such as the program implemented at CARD, continue to evolve, placing
greater emphasis on the generalization and spontaneity of skills learned. As patients
progress and develop more complex social skills, the strict DTT approach gives way
to treatments that include other components. Specifically, there are a number of
weaknesses with DTT, including the fact the DTT is primarily teacher initiated,
that typically the reinforcers used to increase appropriate behavior are typically
unrelated to the target response, and rote responding can often occur. Moreover,
deficits in areas, such as"emotional understanding," "perspective taking," and other
executive functions, such as problem-solving skills, must also be addressed, and
the DTT approach is not the most efficient means to do so. Although the DTT methodology
is an integral part of ABA-based programs, other teaching strategies based on the
principles of behavior analysis, such as Natural Environment Training (NET), may
be used to address these more complex skills. NET specifically addresses the above-mentioned
weaknesses of DTT in that all skills are taught in a more natural environment in
a more "playful manner." Moreover, the reinforcers used to increase appropriate
responding are always directly related to the task (e.g., a child is taught to say
the word for a preferred item such as a "car" and as a reinforcer is given access
to the car contingent on making the correct response). NET is just one example of
the different teaching strategies used in a comprehensive ABA-based program. Other
approaches that are not typically included in strict DTT include errorless teaching
procedures and Fluency-Based Instruction. At CARD, all appropriate teaching approaches
based on the well-grounded principles of applied behavior analysis are utilized.
Introducing Skills®, the new, invaluable web tool for treating autism!
Providers of ABA-based services must consider many factors in order to provide effective
intervention programs. Skills offers professionals everything they need to design
and manage a customized treatment program for every child. Fully comprehensive assessment
and curricula (including lessons targeting complex behavior, such as perspective
taking or Theory of Mind) are combined with detailed data-tracking capabilities
and other features to enable ABA professionals to maximize treatment effectiveness
and provide services to more children while saving time and money.
References Baer, D., Wolf, M., & Risley, R. (1968). Some
current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis
, 1, 91 - 97.
Baer, D., Wolf, M., & Risley, R. (1987). Some still-current dimensions of applied
behavior analysis. Journal of Applied Behavior Analysis , 20, 313 - 327.
Sulzer-Azaroff, B. & Mayer, R. (1991). Behavior analysis for lasting change
. Fort Worth, TX : Holt, Reinhart & Winston, Inc.
ABOUT: OUR HISTORY
The Center for Autism & Related Disorders was established in 1990 by Dr.
Dr. Doreen studied autism treatment for 12 years under the direction of renowned
autism treatment scientist Dr. Ivar Lovaas at the University of California, Los
Angeles. Dr. Lovaas discovered that intensive early intervention using applied behavior
analysis treatment yielded a 47 percent recovery rate among
children with autism who participated in his study.
Building off these findings, Dr. Doreen and her associates authored a treatment
curriculum for children diagnosed with autism now known as the CARD Treatment Approach
and opened the first CARD office in Los Angeles, California, in 1990. Dr. Doreen
continued to train hundreds of therapists and supervisors on this methodology and
has successfully treated and recovered tens of thousands of children. Today, CARD
has 19 offices in the United States, one office in Sydney, Australia and one office
in Auckland, New Zealand. In addition, CARD provides parent/therapist training and
consultation worldwide through its workshop-model services.
CARD is committed to remaining at the forefront of research on
ABA-based methods of autism assessment and treatment. In August 2009, CARD researchers
published the first-ever study to document recovery in a large group of children
with autism. "Retrospective Analysis of Clinical Records in 38 Cases of Recovery
from Autism," published in the Annals of Clinical Psychiatry, earned CARD's Executive
Director, Doreen Granpeesheh, PhD, BCBA-D, the prestigious American Academy of Clinical
Psychiatrists 2011 George Winokur Research Award.
CARD is equally committed to developing technology to make
autism recovery available to professionals and families around the world. Based
on over 30 years of research on child development and autism, CARD's breakthrough
Web-based tool, Skills®, provides comprehensive skill assessment, individualized
curriculum design, and the ability to track treatment progress with automatically-generated
graphs and clinical timeline charts. Skills™ is designed to teach over 4,000 age-appropriate
skills to children with autism, making it the most in-depth, multidisciplinary system
of its kind in the world.
With a staff of nearly 1,000 worldwide, CARD strives for success and even recovery
for every individual it treats.
ABOUT: OUR FOUNDER
has dedicated thirty years to helping individuals with autism lead healthy, productive
Dr. Doreen Granpeesheh is a world-renowned
clinical psychologist and expert in the field of autism research and therapy. Dr.
Doreen has worked with a wide range of patients – from high-functioning children
with autism to the most challenging individuals whose families have been told to
give up hope. Dr. Doreen has an unparalleled recovery rate, enabling children with
autism to lead independent lives. With a PhD in Psychology from UCLA, Dr. Doreen
is licensed by the medical boards of California, Texas, Virginia, Arizona and is
a Board-Certified Behavior Analyst. She is the 2011 recipient of the American Academy
of Clinical Psychiatrists' prestigious Winokur Award.
Dr. Doreen founded the Center for Autism and Related Disorders, Inc., (CARD) in
1990, the world's largest and most experienced organization effectively treating
children with autism. CARD develops individualized treatment plans utilizing the
principles of applied behavior analysis (ABA), a behavioral treatment approach which
the scientific community has empirically validated. Under Dr. Doreen's leadership,
CARD has seen success with every child over the past 20 years.
Dr. Doreen is also the founder and president of ACT Today! (Autism Care and Treatment
Today!), a national nonprofit organization that grants funding for resources and
treatments to disadvantaged families.
Current and Prior Science, Advisory and Executive Board Positions
- Autism Society of America
- Autism Care and Treatment Today
- US Autism and Asperger Association
- 4-A Healing Foundation
- The Autism File Magazine
- Autism 360 / Medigenesis
- SEARCH Family Autism Resource Center
- Autism Human Rights and Discrimination Initiative
- American Academy of Clinical Psychiatrists Winokur Award (2011)
- Autism Society of America, Wendy F. Miller Professional of the Year Award (2007)
- Parenting Arizona, Raising the Bar Award (2007)
- FOX News, "Vaccines and Autism," January 08, 2011
- Dr. Phil Talk Show, "Coping with Autism," March 08, 2008
- The Doctors Talk Show, "Autism and Latest Treatments," April, 23, 2010
- Time.com, "Can Children Recover from Autism," December 01, 2010
- Medical News Today, "Study Reveals Children Recover from Autism," October 12, 2010
- The Capitol Times, "Study Reveals Children Recover from Autism," October 12, 2010
- The Arizona Republic, "Study Reveals Children Recover from Autism," October 12,
- KPNX –TV, "Study Reveals Children Recover from Autism," October 11, 2010
- KCBS 2, "Study Reveals Children Recover from Autism," October 11, 2010
- Canada Television (CTV), "Latest Treatments for Children with Autism," October 22,
- KCAL 9 / CBS Channel 2, "CARD's 20th Anniversary Gala," September 25, 2010
- FOX's Good Day LA, "Celebrating 20 Years of Autism Innovation," September 22, 2010
- ABC News.com, “Autism Recovery,” December 09, 2009
- KTLA - Los Angeles, "Can Marijuana Cure Autism?," November 09, 2009
- ETV - South Africa, "Challenging Behavior," August 01, 2009
- SAFM - South Africa, "Autism and Challenging Behaviors," August 01, 2009
- PBS – KOCE, "Effective Autism Treatments," February 13, 2009
- Recovered: Journeys Through the Autism Spectrum and Back (2008)
- Best Documentary 2008, Director's Chair Film Festival in Staten Island, New York
- Official Selection in the 2008 Victoria Independent Film Festival in Sebastopol,
- 2009 ReelHeART International Film Festival in Toronto, Canada
Recovery from autism is still a controversial topic and many in the autism field
are still afraid to discuss it. We at CARD have seen recovery for decades and we
make it happen for some of the children that we treat. We are not the only ones.
Treatment providers all over the country who have been doing top-quality ABA treatment
for children with autism, for a minimum of 30 hours per week, for two or more years,
have been recovering children for years. Let me explain exactly what we at CARD
mean when we say a child has recovered from autism. We mean that the child no longer
displays clinically significant impairments related to autism. In other words, there
is nothing left to treat, the child is doing just fine. But it’s not good enough
to just take our word for it, so here is how we measure it.
There are three main pieces to how we measure recovery from autism: 1) the child
scores in the average range or higher on valid standardized tests of intelligence,
language, socialization, and daily living skills, 2) the child is earning passing
grades in a regular education classroom, with no specialized supports, whatsoever,
and 3) the child is evaluated by a medical doctor or psychologist who is an expert
in diagnosing autism, and the clinician’s conclusion is that the child no longer
qualifies for any diagnosis on the autism spectrum.
You may have noticed that we use the word recovery in some of the marking and
public relations materials for CARD and SKILLS and you might be wondering if we
are saying that CARD services or SKILLS are going to recover your child. We are
not saying that, and there is currently no guarantee that any treatment in the world
can recover your child from autism. SKILLS is the best quality multidisciplinary
system in the world for designing and tracking progress in ABA programs. Top-quality
early intensive ABA treatment is what brings about recovery in some portion of children
with autism, so if your team is using SKILLS and your team is doing professional-quality
ABA treatment, starting before the age of 5, with 30 or more hours per week of therapy,
continuing for 2 or more years, your child may have a chance at recovery.
Any scientists reading this might be wondering about the research. Every single
published study on the outcomes of behavioral intervention for children with autism,
that included a control group, that started treatment before the age of 5, implemented
more than 25 hours per week of treatment, and that continued treatment for 2 or
more years, reported that at least some of their participants achieved functioning
in the average range on at least some of their outcome measures. In most of these
studies, some percentage of the children achieved average functioning on all of
the outcomes. More scientifically rigorous research is still needed on recovery
from autism, and it is currently underway here at CARD and at a few other centers,
but the evidence currently available already strongly supports recovery.
Some people acknowledge that children with autism may be able to achieve completely
non-impaired functioning but they must still have autism. But if the child no longer
qualifies for the diagnosis and does not have any challenges left for us to treat
(other than any other typically developing child might), then why do we still need
to burden him with the label? There may well be something still amiss biologically
or physiologically, but if there is no longer any clinically significant impairment
in language, socialization, and stereotyped behavior, then the child no longer has
autism, they have some sort of impaired physiology.
Another issue that needs to be discussed is that, by recovering someone from autism,
we are not removing their unique perspectives on life or their unique personality.
We are simply teaching skills, we are giving tools, we are opening up options. It
is then the child’s choice as to whether or not he wants to take them. We are not
trying to make anyone “normal,” we don’t even believe in normal. We believe in learning
skills that make you stronger and more independent.
Unfortunately right now, the research has not been done yet to allow us to predict
exactly who will recover and who won’t. As long as we are able to start intensive
treatment, and by intensive we mean 30 or more hours per week, before the age of
5 or so, we are shooting for recovery with every child. We know we won’t achieve
it in every case, but the worst possible outcome is that the child learns lots of
useful life skills. The fact that most children will still not recover from autism
doesn’t mean they don’t deserve a shot at getting the best treatment possible and
learning the most they can.
Butter, E. M., Mulick, J. A., Metz, B., et al. (2006). Eight case reports of learning
recovery in children with pervasive developmental disorders after early intervention.
Behavioral Interventions, 21, 227-243.
Fein, D., Barton, M., Eigsti, I., Kelley,E., Naigles, L., Schultz, R., Stevens,
M., Helt, M., Orinstein, A., Rosenthal, M., Troyb, E., &, Tyson, K. (2013). Optimal outcome in individuals with a history of
autism. Journal of Child Psychology and Psychiatry, DOI: 10.1111/jcpp.12037.
Granpeesheh, D. (2008). Recovery from autism: Learning why and how to make it happen more. Autism
Advocate, 50, 54-58.
Granpeesheh, D., Tarbox, J., Dixon, D., Carr, E., & Herbert,
H. (2009). Retrospective Analysis of Clinical Records in 38 Cases of Recovery from
Autism. Annals of Clinical Psychiatry, 21, 195-204.
Helt, M., Kelley, E., Kinsbourne,
M., et al. (2008). Can children with autism recover? If so, how? Neuropsychology
Review, 18, 339-366.
Kelley, E., Naigles, L., & Fein, D. (2010). An in-depth examination
of optimal outcome children with a history of autism spectrum disorders. Research
in Autism Spectrum Disorders, 4, 526–538.