Abstract
Background:
Time is of the essence in treating autism spectrum disorders (ASD). Intensive and effective therapies can advance acquisition of adaptive and communication skills during the lag time until entry into a pre-school program.
Objective:
To jump start treatment in very young toddlers with ASD and good cognitive potential, therapeutic modifications of the Early Start Denver Model (ESDM) were examined.
Method:
The changes involved more intensive cooperative treatments, with two different therapists (“hybrid”), reinforcing behavioral manipulations with the children. The intensified therapies were to maximize gains over shorter periods of time, dictated by limitations of resources.
Results:
Thirty children (mean age 24 m., average duration 4.1 m.) improved on their goal attainment scale (GAS) ratings on nearly all functional measures, (p<0.001). Of 23 ADOS scores, 19 improved, the average pre-treatment ADOS score was 17.7 (SD 3.4) and post-treatment 13.3 (SD 5.34). The correlation between GAS and ADOS score improvement was significant (R=0.67, p<0.001).
Conclusion:
The acceleration in social communication and adaptive skill gains in the treatment of very young children using modifications in treatment therapies already in wide- scale use, indicates the as-yet untapped treatment potential for many young children with ASD.
Acknowledgments
We wish to thank Ms. Pnina Lilos for her help with the statistical analysis. The study was presented at the following conferences: 14th World Congress of the World Association for Infant Mental Health, Edinburgh, Scotland, June 2014. Tenth Bi-annual National Conference of Israel Child Development Centers, Jerusalem, Israel, September 2014.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: None declared.
References
1. Centers for Disease Control and Prevention. Prevalence of autism spectrum disorder among children aged 8 years – Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010. Morbidity and Mortality Weekly Report March 28, 2014. Surveillance Summaries 2014;63:1–21.Search in Google Scholar
2. Dawson G, Osterling J. Early intervention in autism: effectiveness and common elements of current approaches. In: Guralnick MJ, editor. Effectiveness of early intervention: second generation research. Baltimore, MD: Paul Brookes, 1997:307.Search in Google Scholar
3. Myers SM, Johnson CP, American academy of pediatrics council on children with disabilities. Management of children with autism spectrum disorders. Pediatrics 2007;120:1162–82.10.1542/peds.2007-2362Search in Google Scholar
4. Volkmar F, Cook EH Jr., Pomeroy J, Realmuto G, Tanquay P. Practice parameters for the assessment and treatment of children, adolescents, and adults with autism and other pervasive developmental disorders. American Academy of Child and Adolescent Psychiatry Working Group on Quality Issues. J Am Acad Child Adolesc Psychiatry 1999;38 (Suppl 12):32S–54S.10.1016/S0890-8567(99)80003-3Search in Google Scholar
5. Reichow B, Doehring P, Cicchetti DV, Volkmar FR, editors. Evidence-based practices and treatments for children with autism, XVIII. New York: Springer, 2011:408.10.1007/978-1-4419-6975-0Search in Google Scholar
6. Rubin E, Prizant B, Laurent A, Wetherby A. Social Communication, Emotional Regulation and Transactional Support (SCERTS). In: Goldstein S, Naglieri J, editors. Intervention for autism spectrum disorders. New York: Springer Science, 2012.Search in Google Scholar
7. Aman MG, McDougle CJ, Scahill L, Handen B, Arnold LE, Johnson C, et al. Medication and parent training in children with pervasive developmental disorders and serious behavior problems: results from a randomized clinical trial. J Am Acad Child Adolesc Psychiatry 2009;48:1143–54.10.1097/CHI.0b013e3181bfd669Search in Google Scholar PubMed PubMed Central
8. Arick J, Loos L, Falco R, Krug D, editors. The STAR program: strategies for teaching based on autism research. Austin: Pro-Ed, 2005.Search in Google Scholar
9. Mesibov GB, Shea V, Schopler E, editors. The TEACCH approach to autism spectrum disorders. New York: Springer, 2005.10.1007/978-0-306-48647-0Search in Google Scholar
10. Prizant BM, Wetherby AM, Rubin E, Laurent AC. The SCERTS model: a transactional, family-centered approach to enhancing communication and socioemotional abilities of children with autism spectrum disorder. Infants Young Child 2003;16: 296–316.10.1097/00001163-200310000-00004Search in Google Scholar
11. Maglione MA, Gans D, Das L, Timbie J, Kasari C, for the Technical Expert Panel, and HRSA Autism Intervention Research – Behavioral (AIR-B) Network. Nonmedical interventions for children with ASD: recommended guidelines and further research needs. Pediatrics 2012;130 (Suppl 2):S169–78.10.1542/peds.2012-0900OSearch in Google Scholar PubMed
12. Odom SL, Collet-Klingenberg L, Rogers SJ, Hatton DD. Evidence-based practices in interventions for children and youth with autism spectrum. Preventing School Failure 2010;54:275–82.10.1080/10459881003785506Search in Google Scholar
13. Baranek G. Autism during infancy: a retrospective video analysis of sensory-motor and social behaviors at 9–12 months of age. J Autism Dev Disord 1999;29:213–24.10.1023/A:1023080005650Search in Google Scholar
14. Ghaziuddin M. A family history of Asperger syndrome. J Autism Dev Disord 2005;35:177–82.10.1007/s10803-004-1996-4Search in Google Scholar PubMed
15. Warren Z, McPheeters ML, Sathe N, Foss-Feig JH, Glasser A, Veenstra-VanderWeeke J. A systematic review of early intensive intervention for autism spectrum disorders. Pediatrics 2011;127:e1303–11.10.1542/peds.2011-0426Search in Google Scholar PubMed
16. Dawson G, Rogers S, Munson J, Smith M, Winter J, Greenson J, et al. Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics 2010;125:e17–23.10.1542/peds.2009-0958Search in Google Scholar PubMed PubMed Central
17. Rogers SJ, Dawson G, editors. Early Start Denver Model for young children with autism: promoting language, learning and engagement. New York: Guilford, 2010.Search in Google Scholar
18. Webb SJ, Jones EJ, Kelly J, Dawson G. The motivation for very early intervention for infants at high risk for autism spectrum disorders. Int J Speech Lang Pathol 2014;16:36–42.10.3109/17549507.2013.861018Search in Google Scholar PubMed PubMed Central
19. Vivanti G, Paynter J, Duncan E, Fothergill H, Dissanayake C, Rogers SJ, et al. Effectiveness and feasibility of the Early Start Denver Model implemented in a group-based community childcare setting. J Autism Dev Disord 2014;44:3140–53.10.1007/s10803-014-2168-9Search in Google Scholar PubMed
20. Davidovitch M, Hemo B, Manning-Courtney P, Fombonne E. Prevalence and incidence of autism spectrum disorder in an Israeli population. J Autism Dev Disord 2013;43:785–93.10.1007/s10803-012-1611-zSearch in Google Scholar PubMed
21. Israel Ministry of Social Welfare. Report of rehabilitative day care activities for 2013. Available at: http://www.health.gov.il/DocLib/rehab_kindergarten-2012-13.pdf. Accessed September 2014.Search in Google Scholar
22. National Insurance Institute Services for the Physically Handicapped and Disabled, 2013. Available at: http://www.btl.gov.il/Funds/Services_for_the_Disabled/Pages/. Accessed Sept 2014.Search in Google Scholar
23. Hickman L. Benefits to a “hybrid” occupational therapy program. Special-Ism 2011. Available at: http://Special-ism.com/occupational-therapy-month-occupational-therapy-in-the-real-world/ 2011. Accessed 30 Aug 2014.Search in Google Scholar
24. Ruble L, McGrew J, Toland M. Goal attainment scaling as outcome measurement for randomized controlled trials. J Autism Dev Disord 2012;42:1974–83.10.1007/s10803-012-1446-7Search in Google Scholar PubMed PubMed Central
25. Lord C, Rutter M, DiLavore PC, Risi S, editors. ADOS Manual, 2nd ed. Torrance, CA: Western Psychological Services, 2001.Search in Google Scholar
26. Schopler E, Van Bourgondien M, Wellman G, Love S, editors. Childhood autism rating scale, 2nd ed. San Antonio, TX: Western Psychological Services, 2010.Search in Google Scholar
27. Mullen E, editor. Mullen Scales of Early Learning. San Antonio, TX. Psychological Corporation, 1995.Search in Google Scholar
28. Sparrow S, Cicchetti D, Balla D, editors. Vineland adaptive behavior scales, 2nd ed. San Antonio, TX: Psychological Corporation, 2005.10.1037/t15164-000Search in Google Scholar
29. Robins D, Fein D, Barton M. Modified checklist for autism in toddlers, revised, with follow-up (M-CHAT-R/F)TM. LineageN, 2009.Search in Google Scholar
30. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: American Psychiatric Association, 2013.10.1176/appi.books.9780890425596Search in Google Scholar
31. Dixon WJ, editor. BMDP statistical software. Los Angeles: University of California Press, 1993.Search in Google Scholar
32. Vismara LA, Rogers SJ. Behavioral treatments in autism spectrum disorder: what do we know? Annu Rev Clin Psychol 2010;6:447–68.10.1146/annurev.clinpsy.121208.131151Search in Google Scholar PubMed
33. Vismara LA, Young GS, Rogers SJ. Community dissemination of the early start denver model: implications for science and practice. Topics Early Child Spec Educ 2013;32:223–33.10.1177/0271121411409250Search in Google Scholar
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