Early intervention for toddlers with autism highly effective, study finds

"This is the first controlled study of an intensive early intervention that is appropriate for children with autism who are less than 2 1/2 years of age. Given that the American Academy of Pediatrics recommends that all 18- and 24-month-old children be screened for autism, it is crucial that we can offer parents effective therapies for children in this age range," said Geraldine Dawson, chief science officer of Autism Speaks and the study's lead author. "By starting as soon as the toddler is diagnosed, we hope to maximize the positive impact of the intervention."

The study, published online in the journal Pediatrics, examined an intervention called the Early Start Denver Model, which combines applied behavioral analysis teaching methods with developmental relationship-based approaches. This approach was novel because it blended the rigor of applied behavioral analysis with play-based routines that focused on building a relationship with the child. While the youngest children in the study were 18 months old, the intervention is designed to be appropriate for children as young as 12 months of age with autism. Although previous studies have found that early intervention can be helpful for preschool-aged children, interventions for children who are toddlers are just now being tested. Autism is a lifelong neurodevelopmental disorder characterized by repetitive behaviors and impairment in verbal communication and social interaction. It is reported to affect one in 100 children in the United States.

"Infant brains are quite malleable so with this therapy we're trying to capitalize on the potential of learning that an infant brain has in order to limit autism's deleterious effects, to help children lead better lives," said Sally Rogers, a professor of psychiatry and behavioral sciences, a study co-author and a researcher at the University of California, Davis, MIND Institute in Sacramento, Calif.

The five-year study took place at the University of Washington Seattle and was led by Dawson, then a professor of psychology and director of the university's Autism Center, in partnership with Rogers. It involved therapy for 48 18- to 30-month-old children with autism and no other health problems. Milani Smith, who oversees the UW Autism Center's clinical programs, provided day-to-day oversight.

The children were separated into two groups, one that received 20 hours a week of the intervention -- two two-hour sessions five days a week -- from UW specialists. 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 by UW researchers. At the beginning of the study there was no substantial difference in functioning between the two groups.

At the conclusion of the study, 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 to 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. Only one child in the community-based intervention group had an improved diagnosis.

"We believe that the intervention group made much more progress because it involved carefully structured teaching and a relationship-based approach to learning with many, many learning opportunities embedded in the play," Rogers said.

"Parental involvement and use of these strategies at home during routine and daily activities are likely important ingredients of the success of the outcomes and their child's progress. The study strongly affirms the positive outcomes of early intervention and the need for the earliest possible start," Dawson said.

In this study, the intervention was provided in a toddler's natural environment (the home) 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," said Smith, associate director of the UW Autism Center and a study co-author. "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."

Other study authors include Jeffrey Munson, Jamie Winter, Jessica Greenson, and Jennifer Varley, all of UW Autism Center or the department of psychiatry and behavioral sciences, and Amy Donaldson of the department of speech and hearing science, Portland State University, Portland, Ore.

The study was funded by a grant from the National Institute of Mental Health. The Institute has also funded a multi-site trial of the Early Start Denver Model that is currently being conducted at the University of Washington, UC Davis and the University of Michigan.