Long-Term Outcomes of Early Intervention in 6-Year-Old Children With Autism Spectrum Disorder

Abstract

Objective We prospectively examine evidence for the sustained effects of early intervention based on a follow-up study of 39 children with ASD who began participation in a randomized clinical trial testing the effectiveness of the Early Start Denver Model (ESDM) at age 18–30 months. The intervention, conducted at a high level of intensity in-home for 2 years, showed evidence of efficacy immediately posttreatment. Method This group of children was assessed at age 6, two years after the intervention ended, across multiple domains of functioning by clinicians naïve to previous intervention group status. Results The ESDM group, on average, maintained gains made in early intervention during the 2-year follow-up period in overall intellectual ability, adaptive behavior, symptom severity, and challenging behavior. No group differences in core autism symptoms were found immediately posttreatment; however, two years later, the ESDM group demonstrated improved core autism symptoms and adaptive behavior as compared with the community-intervention-as-usual (COM) group. The two groups were not significantly different in terms of intellectual functioning at age 6. The two groups received equivalent intervention hours during the original study, but the ESDM group received fewer hours during the follow-up period. Conclusion These results provide evidence that gains from early intensive intervention are maintained 2 years later. Notably, core autism symptoms improved in the ESDM group over the follow-up period relative to the COM group. This improvement occurred at the same time the ESDM group received significantly fewer services. This is the first study to examine the role of early ESDM behavioral intervention initiated below 30 months of age in altering the longer term developmental course of autism.

Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial

“…As such, our results extend the findings from the smaller study of Estes and colleagues, with a shorter follow-up period of 2 years 11 that suggested follow-up effects on autism symptoms. Notably, the PACT intervention is substantially less time intensive than is Estes and colleagues intervention (ESDM) in terms of therapist treatment hours.…”

“…Estes and colleagues reported an effect on parent-rated adaptive function during their 2 year follow-up 11 . Our measures designed to address this aspect of autism were blinded teacher-rating of adaptive function in school, and non-blinded reports by parents of child adaptive function, peer relationships, and prosocial behavior.…”

“…This trial of ESDM was the basis for one of two longer-term follow-up studies of autism symptoms to have been attempted so far. ADOS assessment was done at a mean age of 6 years, 2 years after the end of the intervention 11 . In individuals who were followed up, the investigators reported significantly greater symptom reduction in intervention participants (n=21) than in regular care participants (n=18), although inferences from these findings were limited by the small sample size and lack of intention-to-treat analysis.…”

Sociodemographic Disparities in Intervention Service Utilization in Families of Children with Autism Spectrum Disorder

“…ASD has a heterogeneous etiology, and current research has not yet identified a specific biological treatment for the core symptoms of ASD. At present, the evidence-based treatments for core ASD symptoms in young children supported by research are early intensive behavioral intervention (EIBI) (Remington et al 2007) programs that are based on the principles of Applied Behavior Analysis (ABA), such as Discrete Trial Teaching (Smith 2001), Pivotal Response Treatment (Smith and Iadarola 2015), the Early Start Denver Model (Dawson et al 2010; Estes et al 2015), and others (Schreibman and Stahmer 2014). …”

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

“…Early identification and intervention are popular, although not revolutionary, topics (Ulrich, 2010) and have been identified as beneficial to the overall development of children with ASD (Bradshaw, Steiner, Gengoux, & Koegel, 2014;Eldevik et al, 2009;Estes, 2015). This research into the early identification of and intervention with children with ASD has drawn more attention to the motor-skills development of children with ASD (Lloyd et al, 2013) and led to the recommendation that motor-skill deficits be included in the diagnosis process (Flanagan, Landa, Bhat, & Bauman, 2012;Liu, 2012;Teitelbaum, Teitelbaum, Nye, Fryman, & Maurer, 1998).…”