Clinical outcomes of an early intervention program for preschool children with Autism Spectrum Disorder in a community group setting

Abstract

BackgroundAvailable evidence indicates that early intervention programs, such as the Early Start Denver Model (ESDM), can positively affect key outcomes for children with Autism Spectrum Disorder (ASD). However, programs involving resource intensive one-to-one clinical intervention are not readily available or deliverable in the community, resulting in many children with ASD missing out on evidence-based intervention during their early and most critical preschool years. This study evaluated the effectiveness of the ESDM for preschool-aged children with ASD using a predominantly group-based intervention in a community child care setting.MethodsParticipants were 26 children (21 male) with ASD with a mean age of 49.6 months. The ESDM, a comprehensive early intervention program that integrates applied behaviour analysis with developmental and relationship-based approaches, was delivered by trained therapists during the child’s attendance at a child care centre for preschool-aged children with ASD. Children received 15–20 hours of group-based, and one hour of one-to-one, ESDM intervention per week. The average intervention period was ten months. Outcome measures were administered pre- and post-intervention, and comprised a developmental assessment - the Mullen Scales of Early Learning (MSEL); and two parent-report questionnaires - the Social Communication Questionnaire (SCQ) and Vineland Adaptive Behaviours Scales–Second Edition (VABS-II).ResultsStatistically significant post-intervention improvements were found in children’s performance on the visual reception, receptive language and expressive language domains of the MSEL in addition to their overall intellectual functioning, as assessed by standardised developmental quotients. Parents reported significant increases in their child’s receptive communication and motor skills on the VABS-II, and a significant decrease in autism-specific features on the SCQ. These effects were of around medium size, and appeared to be in excess of what may have been expected due to maturation. Nonetheless, these results need to be confirmed in a controlled study.ConclusionsThis study suggests community dissemination of the ESDM using predominantly group-based intervention may be an effective intervention. Making the ESDM accessible to the wider ASD community in child care settings has the potential for significant clinical and economic benefits. Further studies are indicated in this area, including those with younger children, and which incorporate a control group and standardised ASD assessments.Trial registrationThis trial is registered with the Australian New Zealand Clinical Trials Registry: Registry number ACTRN12612000461897.

Effectiveness and Feasibility of the Early Start Denver Model Implemented in a Group-Based Community Childcare Setting

“…Given the critical relevance of early cognitive and language skills for long-term outcomes in ASD (Howlin et al 2009, the ESDM program appears to be a promising approach for pre-schoolers with ASD not only in the context of 1:1 delivery (as documented by Dawson et al 2010) but also in community-based group settings. Results of our controlled study are also consistent with those reported in Eapen et al (2013) and Vivanti et al (2013), providing further support for the usefulness of this approach in the context of group-based community settings. Further research is needed to replicate and extend the results presented here and to analyse the cost-effectiveness of this program in the short and long term.…”

“…Moreover, two recent studies offer preliminary evidence of favourable outcomes following delivery of the ESDM in a group-setting (Eapen et al 2013;Vivanti et al 2013). To date, however, no controlled study has investigated the effectiveness of the ESDM in the context of community-based provision.…”

Assessing Functional Impairment in Siblings Living With Children With Disability

“…1,2 The advance of portable technology and the change in social philosophy and legislation to promote caring for children with disability in the home over institutionalization have been instrumental in doubling the number of children with disability being cared for in the home over the past 50 years. 3,4 These achievements are celebrated but accompanied by increased caregiving burden by all members of a household with a child with disability.…”

There are Gains, But can we Tell for Whom and Why? Predictors of Treatment Response Following Group Early Start Denver Model Intervention in Preschool - Aged Children with Autism Spectrum Disorder

“…Some researchers have suggested that there are likely many 'autisms' with different underlying biological processes and developmental pathways [3]. In this regard, considerable genetic and clinical heterogeneity has been suggested with significant variations both in the etiological underpinnings and in the manifestations of the condition [4,5]. However, consistent with Kanner's original description, the core features include social and communication deficits as well as an 'insistence on sameness' [6].…”

“…In a previous publication, clinical outcomes of ESDM intervention in a subsample of 26 children were presented [4]. The current study involved a larger sample and focused on predictors of treatment response.…”