Review Looks at Early Intensive Intervention for Autism Spectrum Disorders

April 18, 2011

  http://pediatrics.aappublications.org/cgi/content/abstract/peds.2011-0426v1

There is not yet adequate evidence to pinpoint specific behavioral intervention approaches that are the most effective for individual children with ASD [autism spectrum disorder]," state the authors of an article published in Pediatrics online on April 4, 2011. ASDs are characterized by impairments in social interaction, behavior, and communication. Findings published by Lovaas in 1987 suggested that with intensive intervention using applied behavioral analysis, some children with ASDs may experience a degree of improvement. That report initiated a growing body of research. Results of individual studies have suggested that some children who receive intensive autism-specialized intervention services at young ages may show larger gains in terms of cognitive and adaptive functioning and early educational attainment than children who do not receive such services.

Subsequent research has focused on social communication and behavioral impairments and has used highly structured approaches, developmental approaches that deliver interventions within natural contexts, and integrative approaches. However, there is still no global consensus on what treatment strategies are most effective for children with ASDs.

Children frequently receive combinations of interventions that may include behavioral, education, and medical therapies as well as allied health and complementary approaches. As results of studies on behavioral interventions that present a range of outcomes for different subgroups of children continue to be published, it is important to summarize the evidence so that parents and other caregivers can make informed decisions for specific children. The article presents findings from a systematic review of the evidence on the effectiveness of early intensive behavioral and developmental interventions for children ages 2 to 12 with ASDs and for children under age 2 at risk for ASD. 

The analysis included studies published in English from January 2000 to May 2010. The researchers considered interventions to be early intensive behavioral and developmental if their approach was primarily behavioral and if they were comprehensive (targeted multiple areas of functioning). Studies were further classified into one of three categories:

(1) University of California, Los Angeles (UCLA)/Lovaas-based interventions and approaches that are often termed early intensive behavioral interventions (EIBIs) in the literature;

(2) comprehensive interventions for children younger than age 2; and

(3) parent-training protocols. Among 4,120 articles located for the full review, 38 (comprising 34 unique studies) met study inclusion criteria and addressed early intensive behavioral and developmental interventions. The analysis summarized characteristics of study populations and interventions and used descriptive statistics to report study outcomes.

 The authors found that:

 * UCLA/Lovaas-based intervention and EIBI variant studies have revealed positive shifts in language, adaptive, cognitive, and educational outcomes, but confidence (strength of evidence) in that effect is low because of the need for confirmatory research, a lack of high-quality randomized controlled trials (RCTs), and no studies that have directly compared effects of promising manualized interventions (those with published treatment manuals). 

* The evidence base for interventions for very young children, including the Early Start Denver Model (ESDM), is insufficient; there has been only one RCT, although results of this study were positive and the study warrants replication. 

* The evidence for parent training interventions is insufficient; the few available studies used interventions that varied from study to study. Furthermore, outcomes assessed in these studies were frequently short-term, indirect (intermediate) measures. 

The authors conclude that "the combined research on UCLA/Lovaas-based interventions and the ESDM suggests a benefit of early intensive approaches for some children that should continue to be studied."

 Warren Z, McPheeters ML, Sathe N, et al. 2011. A systematic review of early intensive intervention for autism spectrum disorders. Pediatrics [published online on April 4, 2011]. Abstract available at http://pediatrics.aappublications.org/cgi/content/abstract/peds.2011-0426v1.

Readers: The review is a component of an Agency for Healthcare Research and Quality-commissioned comparative-effectiveness review of therapies for children with ASDs that was conducted by the Vanderbilt Evidence-Based Practice Center. The full report is available at http://www.effectivehealthcare.ahrq.gov/ehc/products/106/656/CER26_Autism_Report_04-14-2011.pdf.

 

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