Early Intervention in Autism

Corsello, C (2005).  Infants & Young Children.  An Interdisciplinary Journal of Special Care Practices; Apr-June, 2005 Vol. 18 Issue 2, p74-85, 12p

Purpose: 

Autism is a developmental disorder that was first described by Leo Kanner in 1943, in a classic article that included case studies of 11 children. Since that time, the diagnostic criteria have evolved based on continued observations and research.  When reviewing programs, there are several components to cover, including method of intervention, the format, the setting, who implements the program, and whether it is child- or adult-centered, Within this review, we will first focus on issues relevant to early intervention, followed by a review of programs and empirical support for programs, and suggested next steps with regard to intervention with very young children.

Populations/Participants/Research Subjects:

This review focus on the birth to age 3 groups.  Over the past 10 to 15 years, there has been evidence that children with ASDs can be reliably diagnosed as young as 2 years of age.  One of the largest errors in diagnoses of 2-year-olds referred for autism is under diagnosing children on the basis of clinical impression when their scores on standardized measures are consistent with a diagnosis of Autism. 

Intervention

Two aspects of intervention that are common to most intervention programs designed for ASDs and have empirical support include the intensity of the program and the age at which children should begin intervention.  Dawson and Osterling (1997), based on a review of programs for children with autism,

report that most programs involve 15 to 25 hours of intervention a week. There is also empirical evidence that children who enter programs at younger ages make greater gains than those who enter programs at older ages. These studies generally compare children who are older than 4 or 5 years with those who are younger than 4 or 5 years.  One study comparing children younger than 3 years with those older than 3 years did not find an age difference in improvement, which may suggest those 4 years of age, is young enough to lead to significant gains. A potentially complicating factor is that children tend to make intelligence quotient (IQ) gains regardless of intervention at the younger ages. 

Results and Finding:

There is outcome data available on the program, based on 31 children between 2 and 6 years of age with ASDs. Children demonstrated significant developmental improvements in cognition, language, social/emotional development, perceptual/fine motor development, and gross motor development after 6 to 8 months in the program, after accounting for expected developmental progress. While only 53% of the children had functional speech when they entered the program, 73% had functional speech at follow-up.

Conclusion: 

The available evidence from a variety of programs and studies suggests that early intervention leads to better outcomes. As we have seen, a number of studies demonstrated that children make greater gains when they enter a program at a younger age. It is important to keep in mind that most of the empirical support for the difference in gains is comparing children younger than 4 or S years to children older than 4-5 years of age. The preschool years are still considered "early" when it comes to early intervention

Implication

Screening and the role of the pediatrician have become even more critical as we have recognized the stability of early diagnosis over time and the importance of early intervention. At this point, experts working with children with autism agree that early intervention is critical. There is professional consensus about certain crucial aspects of treatment (intensity, family involvement, and focus on generalization) and empirical evidence for certain intervention strategies. However, there are many programs developed for children with autism that differ in philosophy and a lack of research comparing the various intervention programs. Most of the programs for children with autism that exist are designed for children of preschool age, and not all are widely known or available. While outcome data are published for some of these programs, empirical studies comparing intervention programs are lacking. In this review, existing intervention programs and empirical studies on these programs will be reviewed, with a particular emphasis on the birth to 3 age group.