The Effectiveness of Early Intervention on Children with Autism

By Danielle Aycardi

This issue of NASET’s Early Intervention series was written by Danielle Aycardi. The focus is to evaluate the effectiveness of early intervention on children on the Autism Spectrum Disorder (ASD). Early intervention (EI) is defined as intervention implemented as soon as the disability is first identified, with the aim of reducing the impact of disability for the individual, their family, and the wider community (Productivity Commission, 2011). Studies have shown that early intervention has a significant positive impact on students with ASD. This literature review provides evidence of the effectiveness of early interventions when used with children on the Autism spectrum.  In addition, the review focuses on the developmental and social skills improvement during early intervention. 

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Abstract

The purpose of this literature review is to evaluate the effectiveness of early intervention on children on the Autism Spectrum Disorder (ASD). Early intervention (EI) is defined as intervention implemented as soon as the disability is first identified, with the aim of reducing the impact of disability for the individual, their family, and the wider community (Productivity Commission, 2011). Studies have shown that early intervention has a significant positive impact on students with ASD. This literature review provides evidence of the effectiveness of early interventions when used with children on the Autism spectrum.  In addition, the review focuses on the developmental and social skills improvement during early intervention.

Keywords: early intervention, Autism, Autism Spectrum Disorder, ASD, early intervention, EI

The Effectiveness of Early Intervention on Children with Autism: Literature Review

Autism spectrum disorder (ASD) is a neurological disorder that affects communication, social skills, and behaviors and can present in early childhood (American Psychiatric Association, 2013). 1 in 4 children are identified with Autism Spectrum Disorder according to the Center for Disease Control (Maenner MJ, 2016). Children with ASD can have delays in communication and difficulty forming social relationships. Early indications of ASD can appear within the first 2 years in a child’s life. 

Once a child is diagnosed many parents or caregivers choose to have their child participate in early interventions (EI). EI is an intervention that is implemented as soon as the disability is first identified. This is to reduce the impact of the disability for the individual, the family and the community (Productivity Commission, 2011). EI is provided during early childhood and relies on early detection of ASD (American Psychiatric Association, 2013). There is strong evidence supporting early intervention and the positive outcomes for children with ASD. The benefits for children with ASD receiving EI are improvement of language development, cognitive functioning, and adaptive behavior (Reichow 2012; Smith and Iadarola, 2015).

There are different early intervention approaches that can be used for children on the spectrum. These include behavior-based intervention, which focus on the application of learning theory to foster skill development. Another EI is developmental interventions, which involve supporting children’s development and their social relationships (Prior et al. 2011). Now some models include both behavior and developmental interventions, one model is Early Start Denver Model (ESDM). This model is designed for children 12 to 60 months and facilitates social engagement, active learning and aims to minimize the impact of ASD on children by targeting deficits in attention, imitation, language delays, play skills and social interaction (Rogers et al. 2012). Finally, family based intervention is also used with children with ASD. This intervention focuses on parent education to reduce parent stress and increase social interactions (H.M. Kuhaneck, S. Madonna, A. Novak, and E. Pearson, 2015).

Early Start Denver Model

Early Start Denver Model is designed for children between the ages of 12 to 60 months. It focuses on social engagement and active learning. One study conducted by Vinen, Clark, Paynter and Dissanayake (2017) followed children with ASD that received ESDM intervention and compared them to a group of children between age 6 and 9, who received other forms of community-based intervention. Participants were 31 children with ASD, who received community based Early Start Denver Model intervention at Autism Specific Early Learning Care Centre (ASELCC) and 28 children who received other forms of community based intervention from the AEIOU foundation (AEIOU). Both groups were previously receiving interventions at least 1 year prior to the study. The ESDM group used ESDM principles and strategies to focus on individual learning objectives within group activities. The goals were implemented using classroom routines that offered opportunities for interactions between children and staff during play activities and small group instruction. The comparison group received an individualized plan for intervention based on their strengths and needs. The AEIOU center had four learning areas that guided teaching goals; social and emotional, language and communication, physical and cognitive. Treatment and Education of Autistic and Communication Handicapped Children (TEACCH) strategies, which are structured teach/work sessions were used at AEIOU centers. The results of the study were that both groups of students, whether they received ESDM intervention or other forms of community based intervention had improved considerably in their cognitive functions.

Family Centered Intervention

Family centered intervention is a family-centered approach which uses play and parent education. The single subject study conducted by Park, Yean Park, Yoo, and Han (2020) researches the effects of family-centered early intervention on the quality of social interaction, social interaction skills in infants with indications of Autism. The intervention program provided home environment modification, play video recording and training, task and feedback, related information training, and question and answer. The study consisted of three participants suspected of ASD ages 24 and 36 months. The Modified Checklist for Autism in Toddlers, Revised, with Follow up was used to evaluate the screening and risk factor of the participants. The Evaluation of Social Interaction Second Edition was used to assess the quality of social interactions. The scores from the M-CHAT-R/F range from 0-20. The participants were then placed in three groups; low-risk group (0-2 points), the middle risk group (3-7 points) and high-risk group (8 – 20 points). There were four phases to the intervention program. During the intervention phase parent education and training was provided 12 times over 6 weeks.

The study used the family based intervention to improve the social interaction skills of infants with suspected ASD. After the 6 weeks of intervention all participants showed improvement in looks, gestures, and speech. The social quality of all participants also improved and the risk factors for all three participants was significantly decreased. The results of the study show that family-centered interventions are effective in improving social interactions and communication.

Behavior Based Intervention

Early intensive behavioral intervention (EIBI) is an intervention model based on applied behavior analysis (ABA) that focuses on the acquisition of behaviors in practical, social and cognitive domains, which encourages the child’s academic and social integration. The purpose of the study conducted by Rivard, Morin, Mello, Terroux and Mercier (2019) was to study the effectiveness of early intensive behavioral intervention. The study assessed thirty-two children ages, 21 boys and 11 girls between 3 years and 1 month to 4 years and 11 months over a period of three years. These children received low-to moderate EIBI, which is between 10 to 20 hours of intervention over a one-year period. The goal of the study was to document IQ, adaptive behavior (AB) and severity of autism symptoms (AS) in children who participated in EIBI at a community based rehabilitation center for 1 year and received one to one intervention with an ABA therapist each week.

Three tests were administered during this study. The Gilliam Autism Rating Scale- Second Edition (GARS-2; Gilliam 2006) was administered to measure the severity of autism symptoms. This test produces three types of scores; autism quotient which ranges from 69 – 131, a level of low to severe and very low to very high. Another test that was administered was intellectual functioning and was determined using the Wechsler Preschool and Primary Scale of Intelligence- Third Edition (WPPSI-III; Wechsler, 2002). The WPPSI-II) is broken into categories; Verbal intellectual quotient (verbal IQ or VIQ), performance IQ (PIQ), full scale IQ (FSIQ) and the General Language Composite (GLC). The final test that was administered was the Adaptive Behavior Assessment System – II (ABAS-II). This is used to measure adaptive behavior in various areas of daily life. Participants were followed up every 12 months for a total of four visits. The results of this study show that children with ASD who received low-to-moderate EIBI showed improvements of intellectual functioning. They also showed gains in terms of autism severity. However, once EIBI stopped the growth was not maintained. This showed the need for continuous EIBI over the course of time.

In conclusion, in the articles that were reviewed indicated that early intervention has a positive impact of children with ASD. EI can benefit children in the areas of adaptive behavior, cognitive abilities, social skills and communication. The type of intervention did not seem to change the positive outcomes of the EI. It is noted that whether it was a community based program or a family-centered intervention all the children has increases in all areas they were tested in. It is important to further research the components of intervention and how they can impact children over longer periods of time. As mentioned previously, a study found that once EI had stopped the severity of behaviors and any previous gains had decreased. (Starr et al., 2016). This shows that EI works as a continuous program and changes with the needs of the children as they age and develop.  I believe that some of the studies did not have a large test population or did not conduct the study long enough and this may have impacted the results. The study conducted by Payne, Trembath and Lane (2018) show that early intervention is not uniformed and consists of subgroup of participants. This study suggests that further studies need to be conducted in order to identify factors that contribute to the gains, high or low in individual children.

References

Chanti F. Waters, Mila Amerine Dickens, Sally W. Thurston, Xiang Lu, and Tristram Smith (2020) Sustainability of Early Intensive Behavioral Intervention for Children With Autism Spectrum Disorder in a Community Setting

Zoe Vinen, Megan Clark, Jessica Paynter and Cheryl Dissanayake (2017) School Age Outcomes of Children with Autism Spectrum Disorder Who Received Community- Based Early Interventions, Journal of Autism and Developmental Disorders

Melina Rivard, Marjorie Morin, Catherine Mello, Amelie Terroux, and Celine Mercier (2019) Follow-Up of Children with Autism Spectrum Disorder 1 Year After Early Behavioral Intervention

Ho Il Park, Hae Yean Park, Eunoung Yoo, and Areum Han (2020) Impact of Family-Centered Early Intervention in Infants with Autism Spectrum Disorder: A Single-Subject Design, American Journal of Occupational Therapy

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, APA Press, Washington, DC, 5^th edition, 2013

J. Paynter, D. Trembath, & A. Lane (2018) Differential outcome subgroups in children with autism spectrum disorder attending early intervention, Journal of Intellectual Disability Research