Children with autism show considerable gains with early intervention
■ Intensive therapy increased IQ and language for children as young as 18 months, according to a new study.
By Tanya Albert Henry — Posted Dec. 22, 2009
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Children with autism spectrum disorder can see significant improvement in IQ, language and adaptive behavior when they receive comprehensive developmental behavioral intervention before age 2½, a new study shows.
Young children who received this more intensive intervention on average increased their IQs 17.6 points after two years. Called the Early Start Denver Model, the therapy model involves parents and therapists working with children on improving communication, social skills and other skills. Sessions are provided in the child's home rather than in an office setting.
Toddlers who received help commonly available in their communities, usually in an office setting without the more intense parental involvement, averaged a 7-point increase, according to the study published online Nov. 30 by Pediatrics (link).
"This is the first controlled study of an intensive early intervention that is appropriate for children with autism who are less than 2½ 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 study lead author Geraldine Dawson, PhD, chief science officer of Autism Speaks, the nation's largest autism science and advocacy organization.
"By starting as soon as the toddler is diagnosed, we hope to maximize the positive impact of the intervention."
The Denver model, designed to be used with children as young as 12 months, integrates applied behavior analysis with developmental and relationship-based approaches. The study, funded by the National Institute of Mental Health, assigned 48 children ages 18 months to 30 months who had autism and no other health problems to one of two groups.
Toddlers in the more comprehensive group received yearly assessments, 20 hours a week of intervention from University of Washington clinicians, therapy and parent training for five or more hours a week, and community services that parents selected. Children in the community-based intervention group received yearly assessments, with intervention recommendations and referrals for intervention from commonly available community providers in the Seattle region.
At the end of two years:
- Children who received the more comprehensive therapy improved receptive and expressive language 18.9 and 12.1 points, respectively, on the Mullen Scales of Early Learning versus 10.2 and 4.0 points for children who didn't get the additional therapy.
- Toddlers in the comprehensive group showed better outcomes for adaptive behavior, making them more able to turn around unconstructive or disruptive behavior. Their scores stayed even on the Vineland Adaptive Behavior Scales, while children who didn't receive the Denver model intervention saw an average 11.2-point decline over their pre-study levels.
- Children from the comprehensive group were more likely to see improved diagnoses: 30% of those receiving the more intensive therapy had their diagnosis changed from autistic disorder to the less severe pervasive developmental disorder. This improvement occurred for 5% of those receiving the community-based therapy.
"The results of this study suggest that the [Denver model], an intervention approach that uses teaching strategies of [applied behavior analysis] that are delivered within an affectively rich, relationship-focused context, can be effective for improving outcomes of young children with autism," the study's authors wrote. "Parents' use of these strategies at home during their daily activities likely was an important ingredient of its success."