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Infants and Toddlers With Autism Spectrum Disorder: Early Identification and Early Intervention
Abstract
The increased prevalence of autism spectrum disorder (ASD) and its detection during the first 3 years of life have substantial relevance for early intervention. The purpose of this article is to summarize current scientific and policy information on early identification and early intervention for infants and toddlers with ASD and their families. Following a brief overview that provides basic information about ASD, the authors discuss early warning signs of the disorder and available screening and diagnostic tools. Finally, they highlight focused intervention practices and comprehensive treatment models appropriate for infants and toddlers with ASD, as well as issues affecting the delivery of effective early intervention services to children and families.
... Prevalencia autizmu na Slovensku zatiaľ nie je známa, ale odhaduje sa, že bude rovnaká ako v iných krajinách, a to 1 -2 % z celkovej populácie. Ďalej je známe, že u chlapcov je výskyt tejto poruchy vyšší ako u dievčat, a to v pomere 4:1 (Boyd et al. 2010;Hnilicová, Ostatníková 2018 Podľa MKCH-10 (2021) sú PAS charakterizované ako kvalitatívne zhoršenie v troch oblastiach, a to konkrétne v oblasti recipročnej sociálnej interakcie, v komunikácii a v obmedzených, stereotypných opakujúcich sa repertoárov záujmov a aktivít. Toto klasifikovanie sa mení už v novšej verzii MKCH-11 (2018), ktorá nadobudne účinnosť v roku 2022. ...
... storočia propagovali Thorndike (1905), Pavlov (1927), Watson (1930 a Skinner (1953) (Simpson 2005 Intervenciu je možné chápať ako intenzívnu formu edukácie detí zameranú na zlepšenie zručností v oblastiach ako je komunikácia, hra, sociálne zručnosti a iné (Perry, Condillac 2003;Granpeesheh et al. 2009a;Klintwall, Eikeseth 2014;Maštenová 2016). Maurice (1996) Každý z týchto modelov alebo prístupov bol publikovaný v mnohých štúdiách, ktoré potvrdzujú ich efektivitu pri práci s deťmi s poruchami autistického spektra (Lovaas 1987;McEachin et al. 1993;Carr, Firth 2005;Corsello 2005;Healy at al. 2008;Vismara, Rogers 2008;Boyd et al. 2010;Dawson et al. 2010;Eikeseth et al. 2012;Rogers et al. 2012;Larsson 2013;DeSouza et al. 2017 a iné). EIBI model vyvinutý Lovaasom (1981, 2003 bol pravdepodobne najvýznamnejším vstupom do metodológie behaviorálnych intervencií, ktorú už niekoľko rokov používajú odborníci v oblasti behaviorálnej analýzy (Carr, Firth 2005;Corsello 2005 (Lovaas 1987;McEachin et al. 1993;Corsello 2005;Larsoon, Wright 2011;Smith, Eikeseth 2011 (Barbera, Rasmussen 2007). ...
Vedecká monografia sa sústreďuje na aplikovanie princípov
a metód aplikovanej behaviorálnej analýzy pri vzdelávaní detí s poruchami
autistického spektra. Naším cieľom je overiť efektívnosť behaviorálnych
procedúr v rámci behaviorálno-intervenčného prístupu – verbálne správanie
v procese rozvíjania komunikačnej kompetencie detí s poruchami autistického
spektra v predškolskom veku, čo následne môže podporiť aj rozvoj ich
sociálnych zručností a eliminovať prejavy problémového správania. Výskumný
súbor budú tvoriť deti rôzneho veku od 2 do 7 rokov s diagnózou alebo
potvrdeným podozrením na poruchu autistického spektra, ktorým budú
behaviorálne intervencie poskytované v rôznej intenzite od 3 do 12 hodín
týždenne. Realizovaný výskum bude mať kvantitatívny charakter a bude
prebiehať formou jednoprípadových experimentálnych štúdií.
... Heyer (2021) distinguishes between mere integration and full inclusion by highlighting that meaningful inclusion requires all students' full and equal participation, irrespective of ability or impairment. Inclusive (not merely integrative) ECEC settings are typically high-quality learning environments (Boyd et al. 2010;Strain and Bovey 2011). International research from the last thirty years has consistently demonstrated the potential of high-quality ECEC environments to enhance outcomes for all children, in particular those with additional learning, development and care needs (Barton and Smith 2015;Buysse et al. 1999;Buysse and Hollingsworth 2009;Guralnick 2001Guralnick , 2020Hestenes et al. 2008;Love, Meckstroth, and Sprachman 1997;Lundqvist, Westling, and Siljehag 2016;Walker, Lansey, and Kurth 2021). ...
... Critically, these findings include outcomes for young children with SEND. High-quality teacher-student interactions are important for all students, especially for young students (kindergarten) with SEND (Boyd et al. 2010). Students with SEND learning in inclusive environments score higher on assessments of language ability than those learning in segregated (or 'integrated') environments (Rafferty, Piscitelli, and Boettcher 2003). ...
The Bulgarian Government has made a commitment to inclusive early childhood education and care (ECEC) systems for children with special educational needs and disabilities (SEND). High-quality ECEC settings are more inclusive and responsive to children's individual learning needs. In partnership with UNICEF, the Ministry for Education established a pilot project, ‘Together from Kindergarten’, to enhance quality and support early childhood settings in creating and maintaining quality conditions that support all children's right to access and participate in ECEC. As part of this project, the ECERS-3 was used as a broad measure to explore quality across 40 kindergarten settings. Evidence suggests that despite the positive attitudes of ECEC teachers towards inclusion, the quality of the kindergartens was low, with particular challenges concerning teacher–child interactions and individualised learning supports. The study offers important insights into how ECEC settings in Bulgaria can enhance quality to develop conditions that support children with SEND to participate in mainstream ECEC provision.
... This content aligns with recommended developmentally appropriate practices and promotes family self-efficacy and capacity building (Division for Early Childhood [DEC], 2014;NAEYC, 2020). Parent-mediated interventions for children with autism involve parents through different intervention approaches (Boyd et al., 2010;Shalev et al., 2020). For instance, Zhou and colleagues (2018) implemented the Early Start Denver Model, which combines a developmental, naturalistic approach with a behavioral intervention. ...
Social turn taking, a preverbal social communication competency often difficult for young children with autism, may be foundational to joint attention when included as a component of interventions for children with autism. In this study, social turn-taking was promoted through a parent mediated learning approach to intervention in a telehealth setting. Following a mixed-methods design, the present study explored the results of this new intervention model for a toddler with autism. The study also sought to understand any changes in the parent-child relationship because of the intervention. Findings indicate that the intervention supported the child’s social communication competencies, including social turn-taking, joint attention, and facial focusing. Qualitative data revealed improvements in the parent-child relationship. These preliminary results lend support for promoting social turn-taking in interventions for children with autism, as well as for following developmental, parent-driven approaches to intervention. Studies with larger sample sizes are needed to understand these findings further. Implications for practice and research in early intervention are presented.
... Autism spectrum disorder (ASD) is a complex disorder with no clear etiology. Although genetics is the most frequent factor implied in several studies, numerous prenatal and perinatal exposures and interaction have been implicated as risk factors [1][2][3]. One potentially modifiable risk factor is maternal immune activation during pregnancy [4,5], that can be initiated by maternal oral infections such as gingivitis and periodontitis [6,7]. ...
Background
To evaluate if treating maternal periodontal disease, a pro-inflammatory condition, during pregnancy (intervention) compared to after pregnancy (control) reduces the likelihood of offspring screening positive for autism spectrum disorder (ASD).
Methods
In a follow-up study to the MOTOR randomized trial, we compared rates of positive screens on the Modified Checklist for Autism in Toddlers (M-CHAT) among n = 306 two-year-old toddlers and correlated findings to maternal and cord blood pro-inflammatory interleukin-6 (IL-6).
Results
Toddlers in the intervention group had decreased risk of a positive M-CHAT screen (adjusted RR = 0.53, 95% CI 0.29–0.99). Toddlers screening positive compared to negative had higher mean IL-6 in cord blood (1.58 ± 1.14 vs. 1.09 ± 0.72 p = 0.001) and maternal IL-6 change from baseline (1.30 ± 0.61 vs 0.96 ± 0.62 p = 0.03).
Conclusions
Treating periodontal disease during pregnancy reduced risk of a positive ASD screen. M-CHAT positivity was associated with increased IL-6 in maternal and cord blood.
Clinical trial
Trial Registration numbers: Clinicaltrials.gov NCT03423836.
... Early intervention (EI) services are critical for improving long-term learning outcomes for children with autism spectrum disorder (ASD). Interventions for ASD initiated at earlier ages improves children's cognition, language, behavior, and development (Boyd et al., 2010;Bradshaw et al., 2015;Rogers, 1996). Caregiver-mediated interventions are gaining widespread recognition as an effective and feasible approach to EI for young children with ASD (Green et al., 2015;Kasari et al., 2014;Pickard et al., 2016). ...
Programmatic cost assessment of clinical interventions can inform future dissemination and implementation efforts. We conducted a randomized trial of Project ImPACT (Improving Parents As Communication Teachers) in which community early intervention (EI) providers coached caregivers in techniques to improve young children’s social communication skills. We estimated implementation and intervention costs while demonstrating an application of Time-Driven Activity-Based Costing (TDABC). We defined Project ImPACT implementation and intervention as processes that can be broken down successively into a set of procedures. We created process maps for both implementation and intervention delivery. We determined resource use and costs, per unit procedure in the first year of the program, from a payer perspective. We estimated total implementation cost per clinician and per site, intervention cost per child, and provided estimates of total hours spent and associated costs for implementation strategies, intervention activities and their detailed procedures. Total implementation cost was $43,509 per clinic and $14,503 per clinician. Clinician time (60%) and coach time (12%) were the most expensive personnel resources. Implementation coordination and monitoring (47%), ongoing consultation (26%) and clinician training (19%) comprised most of the implementation cost, followed by fidelity assessment (7%), and stakeholder engagement (1%). Per-child intervention costs were $2619 and $9650, respectively, at a dose of one hour per week and four hours per week Project ImPACT. Clinician and clinic leader time accounted for 98% of per child intervention costs. Highest cost intervention activity was ImPACT delivery to parents (89%) followed by assessment for child’s ImPACT eligibility (10%). The findings can be used to inform funding and policy decision-making to enhance early intervention options for young children with autism. Uncompensated time costs of clinicians are large which raises practical and ethical concerns and should be considered in planning of implementation initiatives. In program budgeting, decisionmakers should anticipate resource needs for coordination and monitoring activities. TDABC may encourage researchers to assess costs more systematically, relying on process mapping and gathering prospective data on resource use and costs concurrently with their collection of other trial data.
... Difficulties in gaze regulation and all such anticipatory gestures (Landa et al., 2007) which should develop within the first 6 months of life, through playing routines as well as through feeding (Boyd et al., 2010;Brisson et al., 2012) It is very important to follow the development of non-verbal forms of communication including fine motor acts such as pointing, as well as gross motor acts such as head turning for looking because gestural development is closely linked to language development (Iverson and Goldin-Meadow, 2005). Infants' early rhythmic arm movements appeared to peak around the same time they began to babble (Erson and Wozniak, 2007). ...
A baby’s first year of life is a time of immense development and cerebral plasticity. Following today’s research and clinical observation, the period of the first year of life provides a new challenge inasmuch it is presently clear that it is possible to identify developmental anomalies in this window of time. Effecting early screening procedures could prove very useful, especially where we find genetic vulnerabilities in brothers and sisters of autistic subjects. Interventions of this kind, already practiced by some Public Health systems, can mean taking early action and primary protective measures with significant impacts not only on the subjects (babies and family members) concerned, but also on the public purse. It is, therefore, essential to provide for specific professionalized procedures for psychologists, pediatricians and neuropsychologists to be introduced through personnel highly specialized in interventions during the first year of life.
... Stoga se inkluzivni programi/kurikulumi u ranom i predškolskom sustavu odgoja i obrazovanja trebaju aktivno usmjeriti na educiranje svih roditelja i zajednice kako bi se povećala svijest i znanje o odgojnoobrazovnim potrebama djece s teškoćama, a time i smanjila zabluda o inkluzivnom odgoju i obrazovanju (Nah & Lee, 2016). Analizom svjetskih istraživanja, prema autorima Mathwasa i Sibanda (2021), nekadašnja iskustva praktičara i ranih interferencija za stvarnu identifikaciju i probir djece s teškoćama u razvoju za osmišljavanje prihvatljive kvalitete odgoja i obrazovanja, zasjenila su istraživanja povezana s odgojem i obrazovanjem u ranom djetinjstvu, koja ukazuju na učinkovitost predškolskog odgoja i obrazovanja na socijalno i kognitivno napredovanje sve djece (Boyd, Odom, Humphreys, & Sam, 2010;Camilli, Vargas, Ryan, & Barnett, 2010;Dunst & Trivette, 2009;Gavaldá & Qinyi, 2012;Kaminski & Powell-Smith, 2017). Naime, analize ukazuju na važnost aktivne uključenosti roditelja u živote djece, jer su istraživanja dokazala da se problemi različitosti najprije i najbolje rješavaju u obitelji (Carrillo, 2008). ...
Problems of practice, in order to make business as optimal as possible, often require us to determine a location that is connected to three or four given destinations by communications of the total minimum length. That there is an answer to this challenge, we owe gratitude to the remarkable book: “What is Mathematics” ?, (An Elementary Approach to Ideas and Methods) – “What is Mathematics” (Elementary Approach to Ideas and Methods), by Richard Courant and Herbert Robbins - Richard Courant and Herbert Robins, which in one part actualizes the work of Jakob Steiner, a Swiss mathematician. We owe a special momentum and new contributions to the solutions to this problem to the emergence of Informatics, which, thanks to the unprecedented development of its hardware and software components, easily and accurately solves the challenge for more than four destinations. The aim of this paper is to solve complex problems with a better approach and ways of solving tasks so that students can improve their quality through development.
... Stoga se inkluzivni programi/kurikulumi u ranom i predškolskom sustavu odgoja i obrazovanja trebaju aktivno usmjeriti na educiranje svih roditelja i zajednice kako bi se povećala svijest i znanje o odgojnoobrazovnim potrebama djece s teškoćama, a time i smanjila zabluda o inkluzivnom odgoju i obrazovanju (Nah & Lee, 2016). Analizom svjetskih istraživanja, prema autorima Mathwasa i Sibanda (2021), nekadašnja iskustva praktičara i ranih interferencija za stvarnu identifikaciju i probir djece s teškoćama u razvoju za osmišljavanje prihvatljive kvalitete odgoja i obrazovanja, zasjenila su istraživanja povezana s odgojem i obrazovanjem u ranom djetinjstvu, koja ukazuju na učinkovitost predškolskog odgoja i obrazovanja na socijalno i kognitivno napredovanje sve djece (Boyd, Odom, Humphreys, & Sam, 2010;Camilli, Vargas, Ryan, & Barnett, 2010;Dunst & Trivette, 2009;Gavaldá & Qinyi, 2012;Kaminski & Powell-Smith, 2017). Naime, analize ukazuju na važnost aktivne uključenosti roditelja u živote djece, jer su istraživanja dokazala da se problemi različitosti najprije i najbolje rješavaju u obitelji (Carrillo, 2008). ...
Društvene mreže kao snažan medij omogućavaju dvosmjernu komunikaciju ipojavu influencera sa značajnim utjecajem na druge ljude, posebice djecu i mlade u vrijeme njihovog intenzivnog razvoja. Influenceri svoje djelovanje ostvaruju konceptima parasocijalne povezanosti i identifikacije želja kao i influence marketingom. Medijske ličnosti danas preuzimaju jednu od socijalizacijskih uloga u odgoju te je iz tog razloga jedna od važnih uloga roditelja pomoći djeci u „odgoju za medije“ kako bi minimizirali manipulaciju djecom i njihovo uvođenje u neki iluzorni svijet koji im se prezentira kao „suvremena neminovnost“. Jedan od ciljeva istraživanja bio je problemu utjecaja influencera pristupiti s pedagoškog stajališta budući ovakav način ispitivanja na nacionalnom i širem planu izostaje. Putem posebno kreiranog anketnog upitnika ispitalo se mišljenje učenika 7. i 8. razreda (N = 51) osnovnih škola i njihovih roditelja (N = 26) o spoznajama influencerskog utjecaja i mogućih posljedica na djecu. Istraživanje je provedeno u 5 riječkih osnovnih škola. Rezultati pokazuju snažan influencerski utjecaj među učeničkom populacijom koji se ostvaruje kroz fenomene parasocijalne povezanosti, identifikacije želja i influence marketinga. Istovremeno roditelji pokazuju neinformiranost o problemu, nepoznavanje utjecaja influencera na djecu, dok neki ne uviđaju negativne utjecaje ili su prema problemu indiferentni. Istraživanje ukazuje na potrebu poticanja intenzivne komunikacije roditelja i djece o medijskom sadržaju i medijskim ličnostima kako bi se djecu osposobilo za kritički odnos prema njima. Istraživanje otvara i niz drugih istraživačkih pitanja na koje bi pedagogijska znanost trebala odgovoriti, a prvenstveno kreirati suvremene načine educiranja i osnaživanja roditeljskih odgojnih kompetencija posebice iz područja medijske pismenosti.
The amount and quality of language-related interactions young children experience is related to their later development. The field has developed strategies to address this need, but in practice, parents rarely use them consistently or with high levels of fidelity. Given the need to modify such interventions so that they are used consistently and with fidelity, the purpose of this study was to evaluate whether text messaging used as an enhancement to the Promoting Communication Tools for Advancing Language in Kids (PC TALK) intervention would result in improvements in parent engagement in a home visiting program, parent fidelity of use of the Promoting Communication (PC) strategies, and child language outcomes. Standard analyses of differences associated with group assignment to text messaging versus a control group did not reveal differences in outcomes; however, secondary analyses within the text messaging group were conducted to determine whether unplanned variations in the number of text messages sent were related to parent engagement, parent strategy use, and consequently, child language outcomes. A greater number of PC strategy-focused text messages and the total number of text messages sent were associated with increases in parent engagement and parent fidelity of implementation of the PC strategies. Text messaging had an indirect effect on child communication outcomes via parent fidelity. Social validity data and implications for practice from these findings are discussed.
A variety of strategies have been used to help children with autism acquire functional communication skills. The Picture Exchange Communication System (PECS) is a unique communication training program that was developed as a means of circumventing some shortcomings associatd with these strategies. A description of the steps within PECS is provided. Long-term group data have indicated that a large proportion of children started on PECS as preschoolers acquire speech. Individual and group data supporting the use of PECS are provided.
In an effort to move incidental teaching research to practical applications for toddlers with autism, a comprehensive early intervention model was developed for use in the natural environments of a childcare center and children's homes. Based on the premise that social readiness will best be achieved by providing early social learning opportunities, the center based component of the model targets the developmental needs of an inclusive group of children with and without autism. The home based component involves parents of children with autism as key participants in their children's learning and prepares them to be effective advocates in their children's futures. The curriculum addresses what it is that toddlers need to learn, what environmental arrangements provide the most powerful teaching opportunities, and how teachers and parents can most effectively teach children to progress at their optimum pace. Outcome data are presented that documents an impact on the language and social behavior of participating toddlers with autism. Two of the more controversial Walden curriculum components are discussed. Current impediments to system change are considered in the hope that appropriate and effective early intervention may become available to all children with autism.
We evaluated an intervention package for teaching generative sociodramatic play activities to a young boy with an autism spectrum disorder. In Phase 1, the boy learned computer activity schedules that featured embedded video models of what to say and do. A 3 × 3 instructional matrix defined 9 activities to be performed involving combinations of 3 figurines and 3 actions. In Phase 2, the boy learned to use notebook schedules with pictures cuing sequences of different play activities. Phase 3 clarified and expanded the skills learned so far: Across 3 new instructional matrices, the boy learned 3 of the 9 activities within each matrix using video-enhanced computer schedules. For every activity taught directly, nearly 2 additional activities also occurred. The results recommend video-enhanced activity schedules to teach sociodramatic play and the use of matrix training to program for generative learning outcomes.
The passage of the Individuals with Disabilities Education Act of 1990 mandated the provision of interventions for young children with autism spectrum disorders (ASD) under the age of 3 years. Although Strain, McGee, and Kohler (2001) suggested that children with autism benefit from inclusive programming, inclusive early intervention programs are rare. In the current study, the authors used a quasi-experimental design to analyze the outcomes for 20 young children with ASD in an inclusive program for children under age 3. Both outcomes on standardized assessments and functional outcomes were compared at program entry and exit. Significant increases in standard scores were found for the standardized assessments from intake to exit, with 37% of the children functioning in the typical range at exit, compared to 11% at entry. Significant improvements in performance on functional measures were also seen. At intake, 50% of the study participants had no functional communication skills, whereas at exit, 90% used a functional communication system. Social and play behaviors also increased substantially. Use of augmentative communication systems and a combination of research-based programming are discussed.
The applicability of teaching communication replacement behavior for challenging behavior has not been fully recognized by early interventionists Working With young children in their natural environments. This article describes hoW challenging routines for families can be converted into opportunities to teach communication skills and increase participation in family activities. A case description is presented to illustrate hoW routines-based intervention can extend the process and procedures of functional assessment and positive behavior support interventions to ongoing early intervention that facilitates increasingly more sophisticated communication skills. We demonstrate hoW communication skills can be targeted in an individualized fashion first as a replacement behavior serving the same function as the challenging behavior for the child and second to correspond to the interests and concerns of the family and child. This approach offers flexibility in applying a variety of effective intervention strategies Within a family-guided process.
Objective: To estimate changes in the risk of autism and assess the relation of autism to the mumps, measles, and rubella (MMR) vaccine.
Design: Time trend analysis of data from the UK general practice research database (GPRD).
Setting: General practices in the United Kingdom.
Subjects: Children aged 12 years or younger diagnosed with autism 1988-99, with further analysis of boys aged 2 to 5 years born 1988-93.
Main outcome measures: Annual and age specific incidence for first recorded diagnoses of autism (that is, when the diagnosis of autism was first recorded) in the children aged 12 years or younger; annual, birth cohort specific risk of autism diagnosed in the 2 to 5 year old boys; coverage (prevalence) of MMR vaccination in the same birth cohorts.
Results: The incidence of newly diagnosed autism increased sevenfold, from 0.3 per 10 000 person years in 1988 to 2.1 per 10 000 person years in 1999. The peak incidence was among 3 and 4 year olds, and 83% (254/305) of cases were boys. In an annual birth cohort analysis of 114 boys born in 1988-93, the risk of autism in 2 to 5 year old boys increased nearly fourfold over time, from 8 (95% confidence interval 4 to 14) per 10 000 for boys born in 1988 to 29 (20 to 43) per 10 000 for boys born in 1993. For the same annual birth cohorts the prevalence of MMR vaccination was over 95%.
Conclusions: Because the incidence of autism among 2 to 5 year olds increased markedly among boys born in each year separately from 1988 to 1993 while MMR vaccine coverage was over 95% for successive annual birth cohorts, the data provide evidence that no correlation exists between the prevalence of MMR vaccination and the rapid increase in the risk of autism over time. The explanation for the marked increase in risk of the diagnosis of autism in the past decade remains uncertain.
Intervention was implemented with an infant identified at 9 months of age with a behavioral profile consistent with autistic spectrum disorder. The intervention approach, the Early Start Denver model, consisted of a 12-week, 1.5-hr-per-week individualized parent–child education program. Results of this case study demonstrated that the parent acquired multiple teaching tactics that were associated with growth in the infant's social communication behaviors. Improvements were also noted with respect to the severity of behavioral indicators related to autism between 18 and 24 months of age. Findings are discussed in relation to providing an intervention model that may equip parents with the necessary intervention skills to engage, communicate with, and teach their very young children with or at risk for autism.
Over the past feW years, a number of studies have demonstrated the efficacy of combining positive behavior support and family-centered intervention in home settings. Family-centered positive behavior support is often conducted Within the context of natural routines that occur regularly in home or community settings. The purpose of this article is to describe many of the unique challenges and benefits related to assessment, intervention design, and implementation that are inherent in parent—professional collaboration for positive behavior support. This is accomplished through an example of a partnership that resulted in the provision of a variety of visual supports to a young child With autism Who exhibited severe problem behaviors during daily routines.