Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model

Autism Speaks, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA.
PEDIATRICS (Impact Factor: 5.47). 11/2009; 125(1):e17-23. DOI: 10.1542/peds.2009-0958
Source: PubMed


To conduct a randomized, controlled trial to evaluate the efficacy of the Early Start Denver Model (ESDM), a comprehensive developmental behavioral intervention, for improving outcomes of toddlers diagnosed with autism spectrum disorder (ASD).
Forty-eight children diagnosed with ASD between 18 and 30 months of age were randomly assigned to 1 of 2 groups: (1) ESDM intervention, which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents for 2 years; or (2) referral to community providers for intervention commonly available in the community.
Compared with children who received community-intervention, children who received ESDM showed significant improvements in IQ, adaptive behavior, and autism diagnosis. Two years after entering intervention, the ESDM group on average improved 17.6 standard score points (1 SD: 15 points) compared with 7.0 points in the comparison group relative to baseline scores. The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children. In contrast, over the 2-year span, the comparison group showed greater delays in adaptive behavior. Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder, not otherwise specified, than the comparison group.
This is the first randomized, controlled trial to demonstrate the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis. Results of this study underscore the importance of early detection of and intervention in autism.

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    • "Early detection of Autism Spectrum Disorders (ASD) has been an important field for research in autism, especially after the publication of studies showing that early intervention and treatment of ASD symptoms are associated with better outcome [1] [2]. "

    Full-text · Article · Jan 2016
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    • "Behavioral interventions are increasingly acknowledged as an effective way of working with, and educating, individuals with autism. There is evidence for the effectiveness of early intensive behavioural interventions (EIBI) (Dawson et al., 2010; Eldevik et al., 2012), and of comprehensive ABA based intervention for older children in home (Eldevik et al., 2009) and school settings (Grindle et al., 2012). However, whilst many have benefitted from behavioral interventions, individual child outcomes vary (Howlin et al., 2009; Remington et al., 2007; Whiteford, Blacklock, & Perry, 2012) and this is the case within, as well as across studies. "
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    ABSTRACT: With an increase in large scale Applied Behavior Analysis (ABA) services for children with autism, the need to define and measure quality is essential. Staff competence is key and identifying and measuring this accurately is critical. ABA service providers typically measure competence by direct observation, video analysis, and written examination. However, apart from the York Measure of Quality of Intensive Behavioural Intervention (YMQI) there is an interesting lack of direct links between defining competencies and developing assessment tools. In this study we used three measures of competencies developed from the UK ABA Autism Education Competence Framework Level 1. Along with the YMQI we assessed their construct validity by comparing the performance of two groups of tutors working in a school for children with autism ("experienced" vs. "inexperienced") and performance of the "inexperienced" group at baseline (T1) and following one year of competence based training (T2). Results revealed that the more experienced group in both the between group and longitudinal comparisons achieved higher scores supporting the construct validity of the measures. There were few associations between the different methods of assessing competence, suggesting that no measure should be used in isolation if competence is to be comprehensively assessed.
    Full-text · Article · Dec 2015 · Research in Autism Spectrum Disorders
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    • "In addition to child factors, particular components of individual, comprehensive ABA could be ''active ingredients'' that produce favorable outcomes (Kasari, 2002), although few of these have been directly tested. Potential important components include amount of supervision (e.g.,Magiati et al., 2011), treatment ''dose'' (Eldevik et al., 2009;Granpeesheh et al., 2009;Sheinkopf & Siegel, 1998;Smith et al., 2015), and parental involvement (Smith, 2010). Finally, despite varying opinions about the method and content of individual, comprehensive ABA (e.g., the optimal mix of structured and child-led intervention strategies, the most useful skills to target in intervention), systematic comparisons are currently unavailable. "
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    ABSTRACT: This evidence base update examines the level of empirical support for interventions for children with autism spectrum disorder (ASD) younger than 5 years old. It focuses on research published since a previous review in this journal (Rogers & Vismara, 2008119. Rogers, S. J. & Vismara, L. A. (2008). Evidence-based comprehensive treatments for early autism. Journal of Clinical Child & Adolescent Psychology, 37, 8–38. doi:10.1080/15374410701817808[Taylor & Francis Online], [PubMed], [Web of Science ®]View all references). We identified psychological or behavioral interventions that had been manualized and evaluated in either (a) experimental or quasi-experimental group studies or (b) systematic reviews of single-subject studies. We extracted data from all studies that met these criteria and were published after the previous review. Interventions were categorized across two dimensions. First, primary theoretical principles included applied behavior analysis (ABA), developmental social-pragmatic (DSP), or both. Second, practice elements included scope (comprehensive or focused), modality (individual intervention with the child, parent training, or classrooms), and intervention targets (e.g., spoken language or alternative and augmentative communication). We classified two interventions as well-established (individual, comprehensive ABA and teacher-implemented, focused ABA + DSP), 3 as probably efficacious (individual, focused ABA for augmentative and alternative communication; individual, focused ABA + DSP; and focused DSP parent training), and 5 as possibly efficacious (individual, comprehensive ABA + DSP; comprehensive ABA classrooms; focused ABA for spoken communication; focused ABA parent training; and teacher-implemented, focused DSP). The evidence base for ASD interventions has grown substantially since 2008. An increasing number of interventions have some empirical support; others are emerging as potentially efficacious. Priorities for future research include improving outcome measures, developing interventions for understudied ASD symptoms (e.g., repetitive behaviors), pinpointing mechanisms of action in interventions, and adapting interventions for implementation with fidelity by community providers.
    Preview · Article · Nov 2015 · Journal of Clinical Child & Adolescent Psychology
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