Comparing the 1‐year impact of preschool autism intervention programs in two Canadian provinces

Abstract

Autism spectrum disorder (ASD) is associated with early differences in children's social interactions, communication, and play/interests. In many countries, considerable resources are invested in early intensive behavioral intervention (EIBI) programs for children with ASD, which aim to build adaptive skills and prevent or treat problem behavior. However, these programs vary widely in structure and delivery. Research evidence supports the efficacy of EIBI, but large knowledge gaps remain about the effectiveness of publicly funded EIBI programs. With policy‐makers as formal research partners, we compared children's progress over 1 year in public preschool programs in adjacent Canadian provinces, New Brunswick (NB) and Nova Scotia (NS). In NB, children received up to 20 hr/week of comprehensive EIBI in a publicly funded, privately provided program. In NS, children received up to 15 hr/week of Pivotal Response Treatment and Positive Behavior Support delivered through the publicly funded healthcare system. In this observational parallel cohort study, we collected parent‐reported data on 298 NB preschoolers (76.5% boys) and 221 NS preschoolers (86.9% boys) at EIBI start and 1 year later. Multilevel analysis revealed significant differences at baseline: NS children were older, with lower adaptive functioning and more severe ASD symptoms than NB children. Despite these pre‐treatment differences that favor NB, children in both provinces showed similar adaptive functioning gains and reductions of maladaptive behavior. No changes were seen in mean ASD symptom severity in either province over time. Results highlight the value of evaluating interventions in their implementation contexts, and have important implications for devising optimal ASD policy. Autism Research 2019, 12: 667–681. © 2019 International Society for Autism Research,Wiley Periodicals, Inc. Lay Summary We need to know more about the impact of different forms of early intensive behavioral intervention (EIBI) for young children with autism spectrum disorder (ASD). We showed that preschoolers with ASD gained important skills while in public EIBI programs in two Canadian provinces. We also saw that differences in how EIBI programs are structured and characteristics of children who are served may affect outcomes. For these reasons, policy making requires evidence that fits the local context.

Preschool autism services: A tale of two Canadian provinces and the implications for policy

“…We found striking differences between the cohorts of children entering their respective provincial EI programs (9). Children in NB were younger, with milder ASD symptoms, fewer behaviour problems, and higher levels of adaptive behaviour.…”

“…Children in NB were younger, with milder ASD symptoms, fewer behaviour problems, and higher levels of adaptive behaviour. Despite this NB profile, which is typically associated with greater intervention gains, children in both provinces gained adaptive skills at the same average rate during 1 year of EI, with both groups showing small but significant mean increases (9). That is, the NB group had a beginning advantage but both groups improved significantly and at the same rate.…”

“…Differences are likely due partly to wait-times, but also influenced by policies regarding who may diagnose ASD and what criteria are used (14). That is, the rigour of diagnostic assessments may determine the numbers of children with the diagnosis who are eligible for ASD-specific services (9). In some provinces/territories, an ASD diagnosis confers eligibility for public ASD services only if specific guidelines are followed (e.g., BC has guidelines and maintains a registry of approved providers), whereas others accept all ASD diagnoses from physicians or psychologists (e.g., NB, ON).…”

“…Data were gathered from families, service providers, and funders in both provinces. Smith et al (9) described NB and NS EI programs and 1-year child outcomes; Tsiplova et al (10) contrasted resource use and costs of ASD services across sectors for NB and NS families and public payers. (See information briefs and video at Autism Research Centre.)…”

The implementation of reciprocal imitation training in a Part C early intervention setting: A stepped‐wedge pragmatic trial

“…Despite the existence of several NDBIs and their emphasis on naturalistic settings, very few have been examined and adapted for use in community‐based settings where they may increase access and reduce common delays to ASD‐specialized treatment for a broader segment of the population (Nahmias et al, 2019; Stahmer et al, 2005; Wise et al, 2010). The few studies that have examined NDBIs in preschool settings have found that they improved key child outcomes (Kaale et al, 2012; Sinai‐Gavrilov et al, 2020; Smith et al, 2019). A recent pilot study by Stahmer et al (2020) is the first to examine an NDBI (i.e., Project IMPACT; Ingersoll & Dvortcsak, 2010) with community‐based early intervention providers and found promising results for improving parent–child interactions.…”