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Early intervention for toddlers with autism highly effective
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A novel early intervention program for very young children with autism — some as young as 18 months — is effective for improving IQ, language ability and social interaction, according to a recently published study.
The study, published in the journal Pediatrics, examined an intervention called the Early Start Denver Model, which combines applied behavioral analysis (ABA) teaching methods with developmental “relationship-based” approaches.
The five-year study took place at the University of Washington in Seattle. It involved therapy for 48 diverse, 18- to 30-month-old children with autism and no other health problems.
The children were separated into two groups, one that received 20 hours a week of intervention (two two-hour sessions five days a week). They also received five hours a week of parent-delivered therapy. Children in the second group were referred to community-based programs for therapy. Both groups’ progress was monitored.
At the beginning of the study, there was no substantial difference in functioning between the two groups. At the conclusion of the study, however, the IQs of the children in the intervention group had improved by an average of approximately 18 points, compared to a little more than four points in the comparison group. The intervention group also had a nearly 18-point improvement in receptive language (listening and understanding) compared with approximately 10 points in the comparison group. Seven of the children in the intervention group had enough improvement in overall skills to warrant a change in diagnosis from autism to the milder condition known as “pervasive developmental disorder not otherwise specified,” or PDD-NOS. Only one child in the community-based intervention group had an improved diagnosis.
In this study, the intervention was provided in a toddler’s natural environment and delivered by trained therapists and parents who received instruction and training as part of the model.
“Parents and therapists both carried out the intervention toward individualized goals for each child, and worked collaboratively to improve how the children were responding socially, playing with toys, and communicating,” Milani Smith, associate director of the University of Washington Autism Center and a study co-author, said in a press release. “Parents are taught strategies for capturing their children’s attention and promoting communication. By using these strategies throughout the day, the children were offered many opportunities to learn to interact with others.”
The study was funded by a grant from the National Institute of Mental Health (NIMH).
For more information:
- Dawson G. Pediatrics. 2010; 125:e17 e23.
- Myers SM, Johnson CP, and the Council on Children with Disabilities. Management of children with autism spectrum disorders. Pediatrics. 2007;120:1162-1182.
- Rogers SJ, Vismara LA. Evidence-based comprehensive treatments for early autism. J Clin Child Adolesc Psychol. 2008;37:8-38.
Intensive, structured educational interventions are the primary means of helping young children with autism spectrum disorders to achieve the social communication competence, emotional and behavioral regulation, and functional adaptive skills necessary for independence. All treatments, including educational interventions, should be based on sound theoretical constructs, rigorous methodologies and objective scientific evidence of efficacy. Although most pediatricians are not experts on the various educational strategies, they are in a position to guide families to empirically supported interventions.
Early intensive intervention programs based on applied behavior analysis (ABA), particularly those based on the Lovaas model, are currently the most well-established, evidence-based treatments for young children with ASDs, although there is wide variability in response to treatment. Developmental and relationship-based models are also widely utilized, although they have been studied less rigorously. This study provides important evidence that the Early Start Denver Model, which integrates ABA with developmental and relationship-based approaches, is an effective intervention for very young children with autism spectrum disorders. There is still much research to be done to determine the comparative effectiveness of various interventions, which variables moderate treatment effects and predict outcomes, and how much improvement can reasonably be expected. The work by Dawson and colleagues exemplifies the type of well-designed trial that has the capacity to significantly advance care for children with autism spectrum disorders.
– Scott M. Myers, MD
Infectious Diseases in Children Editorial Board