Long-term Outcomes of Toddlers With Autism Spectrum Disorders Exposed to Short-term Intervention

Abstract

OBJECTIVES: To examine long-term outcomes of toddlers with autism spectrum disorder (ASD) who received a 6-month early intervention at age 2.METHODS: Forty-eight toddlers diagnosed with an ASD received a 6-month evidence-based intervention. Cognitive (IQ) and communication ability, as well as severity of autism symptoms, were assessed by using standardized measures at preintervention (Time 1 [T1]; mean [M] age = 27 months), postintervention (T2; M age = 35 months), short-term follow-up (T3; M age = 41 months), and long-term followup (T4; M age = 72 months). RESULTS:From pre-to postintervention, significant gains in IQ and Vineland Communication domain standard scores as well as a reduction in ASD severity were achieved (all P , .01). Between T2 and T3, the 6-month period immediately after completion of the intervention, IQ and Communication scores stabilized and ASD severity increased significantly (P , .05). During the long-term follow-up period (T3-T4), IQ and Communication scores significantly increased again, but ASD severity increased significantly as well (all P , .05). For overall trajectory (T1-T4), robust gains were observed for both IQ and communication; ASD severity did not change. CONCLUSIONS:Findings highlight the potential for positive long-term outcomes in toddlers with ASD. Additional research is needed to understand the relation between early exposure to uninterrupted intervention and developmental gains, and whether initial reduction in ASD symptom severity can be sustained through targeted intervention. Pediatrics 2012;130:S186-S190 Mounting empirical evidence suggests evidence-based early intervention for children with autism spectrum disorders (ASDs) is associated with cognitive, language, and/or social gains 1-8 ; however, little is known about the durability of such gains after transition from early intervention into the preschool and elementary educational years. Research surrounding sustainability of intervention effects has clinical, economic, and quality-of-life implications. Four published reports have followed 2-or 3-year-olds with ASD for at least 6 months after completion of an early intervention program. In 2 studies, 2-year-olds who received short-term intervention showed sustained social, 4,5 language, 4 and nonverbal cognitive 4 gains through a 6-4 to 12-month 5 followup period. Two other studies reported on longer-term outcomes of 2-and 3-year-olds exposed to a 2-year comprehensive intervention. 6,7 Kovshoff and colleagues 6 reported that IQ, but not Vineland Adaptive Behavior Composite (VABC), 9 increased during receipt of 1:1 applied behavior analysis (ABA) intervention. No IQ or VABC gains were observed from pre-to postintervention in the comparison group receiving public special education. 8 During the postintervention follow-up period, no increases in IQ or VABC scores occurred in either group. 6,8 Outcomes were particularly unfavorable for children in the ABA group whose preintervention IQ was low, as their IQ scores declined significantly during follow-up. 6 Fi...

Parent-Implemented Social Intervention for Toddlers With Autism: An RCT

“…Improvements in core social deficits have been demonstrated in only a few other treatment studies. 23,24 Although both groups worsened on motor standard scores, it is important to note that motor skills were high at baseline, with the average score within normal limits.…”

“…In a cliniciandelivered 2-year RCT of the Early Start Denver Model, 20 significant effects were reported on child outcomes of developmental level and adaptive behavior but not on autism symptoms. In another 6-month RCT of an interpersonal synchrony supplement to classroom-based comprehensive intervention, 24,25 shortand long-term effects were reported on social communication, developmental level, and adaptive functioning. Autism symptoms improved during treatment, but improvements were not sustained.…”

“…22,23,27 The 1 treatment offered at home found differential effects on expressive language. 29 Factors that may contribute to lack of effects of parent-implemented interventions on child outcomes include limited number of sessions (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), length (3-12 months), and clinic-based interventions, which may not support generalization.…”

Life Course Health Development in Autism Spectrum Disorders

“…There is emerging evidence that young children with ASD who received early intervention sustained social, language, and/or nonverbal cognitive gains through a 6-37-month follow-up period (e.g., Kasari et al 2010;Landa et al 2011;Landa and Kalb 2012). For instance, Landa and Kalb (2012) examined outcomes in 2-year-old toddlers enrolled in a 6-month nursery school-based intervention immediately following intervention (M age = 35 months), at short-term (M age = 41 months) and long-term follow-up (M age = 72 months; 37 months after children completed intervention). At long-term follow-up, they found gains in IQ and communication; however, increases were not evenly distributed across the different time points.…”

A Mixed-Methods Analysis of the Effects of a Fundamental Motor Skills Intervention for Children with Autism Spectrum Disorder

“…Recent research has started to demonstrate the importance of building motor skills (Cattuzzo et al, 2016;Logan et al, 2015) and the role motor development plays in other developmental processes for children with ASD (Bedford et al, 2016;Landa & Kalb, 2012). Further, recent research has demonstrated that the development of motor skills for children with ASD is delayed in comparison to peers, starting at an early age (Lloyd et al, 2013) and continuing into adolescence (Staples & Reid, 2010).…”