Predictors of Treatment Outcome in Young Children with Autism

Abstract

This study examined predictors of developmental outcomes in 17 children diagnosed with autism or PDD-NOS, who received generic treatment over a mean period of 37 months. Pre-treatment evaluations occurred at a mean age of 31 months with follow-up evaluations at a mean age of 69 months. Significantly different developmental trajectories were observed among the participants at follow-up, separating the participants into two distinct groups (high and low outcome). However, groups did not differ significantly in treatment intensity or other outcome prediction measures. Pre-treatment developmental intelligence levels between the two groups approached significance. The results raise questions regarding the effect of treatment intensity and type, family stress factors, and intelligence ability in very early childhood on, outcome.

Can Children with Autism Recover? If So, How?

“…Although this paper did not explicitly discuss optimal outcome or loss of diagnosis, the smaller, high-functioning group showed mean verbal and nonverbal scores within the normal range, and few autism symptoms; many of them would probably have met our current definition for recovery. Gabriels et al (2001) also found two clearly separable developmental trajectories in a group of individuals with ASD who were studied from preschool to school-age. Unlike Stevens et al (2000), however, Gabriels and colleagues found that in both groups, IQ tended to increase across development.…”

“…In addition to the confounding factor that Gabriels et al (2001) suggested, another potential confound could work in the opposite direction: children who make slower progress are sometimes given more intensive treatment, making interpretation of the relationship between progress and treatment intensity very difficult. All of the children in the studies that reported participants with optimal outcome were receiving at least some level of treatment and thus it is possible that the treatment, in combination with the potential for normal levels of cognition, was responsible for their improvements.…”

“…Goldstein (2002) found that verbal imitation, IQ and age, together, strongly predicted language outcome. Gabriels et al (2001), in their study of differential outcome after 3 years of treatment, found that no early characteristics significantly predicted outcome, although initial IQ scores tended to predict outcome. There was a 21-point gap in initial developmental IQ between the children who responded best to intervention as compared to the "low outcome" group; this difference was 51 points at follow-up.…”

“…Examination of the studies mentioned previously in documenting the existence of recovery is not generally informative about treatments received by the most successful children, but there are some clues. Gabriels et al (2001) noted that children in their "high outcome" group received an average of 40.3 more hours per month of intervention. Although this difference was not statistically significant, the authors suggested that it may reflect differential treatment effects in community-based settings in which children with initially higher developmental ability may be given more hours of intervention.…”

How relevant is the framework being used with autism spectrum disorders today?

“…They concluded that PECS may be more effective for children at the pre-request stage and RPMT may be more effective for children with some ability to initiate joint attention. Other studies have investigated parent and environmental predictors of intervention response (Ben Itzchak & Zachor, 2011;Gabriels, Hill, Pierce, Rogers, & Wehner, 2001;Osborne, McHugh, Saunders, & Reed, 2008;Robbins, Dunlap, & Plienis, 1991). This direction is encouraging as it better takes into account the heterogeneity of ASD and allows for intervention to be tailored to needs and abilities, rather than based on a categorical diagnosis.…”