Early Intervention May Help Autistic Toddlers

Study Finds Comprehensive Home-Based Program Improves IQ, Language, Social Ability

From the WebMD Archives

Nov. 30, 2009 -- A new, home-based program for toddlers with autism spectrum disorder (ASD) that combines behavioral change techniques in a playful environment boosted the children's IQ, language ability, and social interaction skills more than a community-based program, according to a new study.

The home-based program included up to 20 hours a week of therapist intervention, plus the intervention of parents, who were taught the same skills.

''This intervention is designed to be appropriate for children as young as 12 months of age," says study researcher Geraldine Dawson, PhD, chief science officer of Autism Speaks, a science and advocacy organization. She conducted the research while a professor of psychology and director of the University of Washington's Autism Center, Seattle.

''We found that after two years the children who received the intervention had made significant gains in their IQ, their language ability, their adaptive behavior, and their social interaction," Dawson tells WebMD.

The IQ of children in the new home-based program -- called the Early Start Denver Model -- rose on average about 18 points after two years, she says. The IQ of the children in the community-based comparison group increased seven points.

''When you see an IQ gain that is this large, the child is much more likely to be able to enter a regular classroom and develop friendships," Dawson says.

The study is published online in the journal Pediatrics.

Intervention in Young Children

Early intervention for children with autism, a developmental disorder estimated to affect one in 150 or more U.S. children, has been evaluated for years. More than 20 years ago, a report of early behavioral intervention found that nearly half the children given the intervention could be mainstreamed into regular classrooms and had IQ gains.

But experts still disagree about whether early intervention makes a long-term difference in autism, which is marked by impairments in communication and socialization, and repetitive, disruptive behavior.

The new study is believed to be the first scientific study that looked at intervening in children so young. "Our entire group was under 2 and a half," says Sally Rogers, PhD, professor of psychiatry, University of California Davis MIND Institute, who developed the intervention with Dawson.

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The intervention combines an established approach known as applied behavioral analysis (teaching children new behaviors and changing harmful ones by repetition and practice) with relationship-based techniques presented in a playful manner that interests the child. "When you are working with very young children, it makes sense you would use a more play-based approach," Dawson says.

For instance, a session might include playing with balls, with the therapist tossing them into a bucket, repeating the word ball, and inviting the child to mimic her.

The researchers evaluated 48 children diagnosed with ASD at 18-30 months old, randomly assigning them to the intervention group or referring them to community-based programs. The children had either autistic disorder or pervasive developmental disorder, not otherwise specified (PDD NOS), a milder condition in which some features of autism are identified. At the end, two years later, just three had dropped out of the study.

The goal was to tap into the so-called ''plasticity'' of the young brain and capitalize on the learning potential of the children, thus limiting the damaging effects of autism.

Those in the early-start model averaged about 15.2 hours a week with the therapist, although 20 were made available. Parents logged, on average, another 16.3 hours a week and the kids got about 5.2 hours in other therapies, such as speech therapy.

Children in the comparison group got an average of 9.1 hours of individual therapy and 9.3 hours weekly of group interventions.

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Improvements in Language Skills

After two years, the researchers found a 17.6-point boost in IQ in the intervention group, compared to a 7-point increase in the comparison group.

Most of the IQ boost, they found, seems linked with improvements in language -- receptive and expressive. For instance, the intervention group had increased nearly 19 points on receptive language skills -- understanding language -- compared to a 12-point improvement in the community group.

In the early-intervention group, seven children's diagnoses improved -- from autism to PDD NOS; just one child in the community group had a milder diagnosis after two years. (But two children in the early-intervention group and five in the comparison group progressed from PDD NOS to autism.)

The early-intervention group showed steady development in what's known as adaptive behaviors (such as social functioning), but the comparison group showed declines.

The researchers are now continuing studies to see if the results can be duplicated, Dawson says. "In the future, we hope to be working with even younger children."

Second Opinion

The new research results are "impressive,'' says Laura Schreibman, PhD, a distinguished professor in the department of psychology, University of California, San Diego, and a veteran autism researcher, because the study was conducted in a scientific manner, comparing two treatments head to head without the evaluators knowing which treatment the child was getting.

''We have long known that we are likely to achieve greater gains with younger children, but this point now takes on more significance as we are increasingly able to identify and diagnose very young children -- for example toddlers," Schreibman says.

The results, she says, are promising and hopeful. "Hope is something the families of these children often find in short supply," she says.

WebMD Health News Reviewed by Louise Chang, MD on November 30, 2009

Sources

SOURCES:

Geraldine Dawson, PhD, chief science officer, Autism Speaks.

Sally Rogers, PhD, professor of psychiatry, University of California Davis MIND Institute.

Dawson, G. Pediatrics, Nov. 30, 2009 online.

Laura Schreibman, PhD, distinguished professor, psychology, University of California, San Diego, La Jolla.

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