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Promising early intervention for children with autism.

Posted Dec 25 2009 10:07pm

This morning I received a press release about early results of a very large multi-site clinical trials of an early intervention program for autism. The trials are being conducted at the MIND institute (UC Davis) and the University of Washington, and here at the University of Michigan. I have not been able to get access to the article as it is not in the Dec 1 issue of Pediatrics. Hopefully I’ll get a copy later today and will post a review by Wednesday. Meanwhile here is a copy of the official press release:

Early intervention for toddlers with autism
highly effective, study finds
Significant gains seen in IQ, communication and social interaction

(Seattle, Nov. 30, 2009) – A novel early intervention program for very young children with autism – some as young as 18 months – is effective for improving IQ, language ability, and social interaction, a comprehensive new study has found.

“This is the first controlled study of an intensive early intervention that is appropriate for children with autism who are less than 2½ years of age. Given that the American Academy of Pediatrics recommends that all 18- and 24-month-old children be screened for autism, it is crucial that we can offer parents effective therapies for children in this age range,” said Geraldine Dawson, Ph.D., chief science officer of Autism Speaks and the study’s lead author. “By starting as soon as the toddler is diagnosed, we hope to maximize the positive impact of the intervention.”

The study, published online today in the journal Pediatrics, examined an intervention called the Early Start Denver Model, which combines applied behavioral analysis (ABA) teaching methods with developmental ‘relationship-based’ approaches. This approach was novel because it blended the rigor of ABA with play-based routines that focused on building a relationship with the child. While the youngest children in the study were 18 months old, the intervention is designed to be appropriate for children with autism as young as 12 months of age. Although previous studies have found that early intervention can be helpful for preschool-aged children, interventions for children who are toddlers are just now being tested. Autism is a lifelong neurodevelopmental disorder characterized by repetitive behaviors and impairment in verbal communication and social interaction. It is reported to affect one in 100 children in the United States.

“Infant brains are quite malleable so with this therapy we’re trying to capitalize on the potential of learning that an infant brain has in order to limit autism’s deleterious effects, to help children lead better lives,” said Sally Rogers, a professor of psychiatry and behavioral sciences, a study co-author and a researcher at the UC Davis MIND Institute in Sacramento, Calif. Rogers and Dawson developed the intervention.

The five-year study took place at the University of Washington (UW) in Seattle and was led by Dawson, then a professor of psychology and director of the university’s Autism Center, in partnership with Rogers. It involved therapy for 48 diverse, 18- to 30-month-old children with autism and no other health problems. Milani Smith, who oversees the UW Autism Center’s clinical programs, provided day-to-day oversight.

The children were separated into two groups, one that received 20 hours a week of the intervention – two two-hour sessions five days a week – from UW specialists. They also received five hours a week of parent-delivered therapy. Children in the second group were referred to community-based programs for therapy. Both groups’ progress was monitored by UW researchers. At the beginning of the study there was no substantial difference in functioning between the two groups.

At the conclusion of the study, the IQs of the children in the intervention group had improved by an average of approximately 18 points, compared to a little more than four points in the comparison group. The intervention group also had a nearly 18-point improvement in receptive language (listening and understanding) compared to approximately 10 points in the comparison group. Seven of the children in the intervention group had enough improvement in overall skills to warrant a change in diagnosis from autism to the milder condition known as ‘pervasive developmental disorder not otherwise specified,’ or PDD-NOS. Only one child in the community-based intervention group had an improved diagnosis.

“We believe that the ESDM group made much more progress because it involved carefully structured teaching and a relationship-based approach to learning with many, many learning opportunities embedded in the play,” Rogers said.

“Parental involvement and use of these strategies at home during routine and daily activities are likely important ingredients of the success of the outcomes and their child’s progress. The study strongly affirms the positive outcomes of early intervention and the need for the earliest possible start,” Dawson said.

In this study, the intervention was provided in a toddler’s natural environment (their home) and delivered by trained therapists and parents who received instruction and training as part of the model.

“Parents and therapists both carried out the intervention toward individualized goals for each child, and worked collaboratively to improve how the children were responding socially, playing with toys, and communicating,” said Milani Smith, associate director of the UW Autism Center and a study co-author. “Parents are taught strategies for capturing their children’s attention and promoting communication. By using these strategies throughout the day, the children were offered many opportunities to learn to interact with others.”

Other study authors include Jeffrey Munson, Jamie Winter, Jessica Greenson, and Jennifer Varley, all of UW Autism Center or the department of psychiatry and behavioral sciences, and Amy Donaldson of the department of speech and hearing science, Portland State University, Portland, Ore.

The study was funded by a grant from the National Institute of Mental Health (NIMH). NIMH has also funded a multi-site trial of the Early Start Denver Model which is currently being conducted at the University of Washington, the UC Davis MIND Institute and the University of Michigan.

About Autism Speaks
Autism Speaks is the nation’s largest autism science and advocacy organization, dedicated to funding research into the causes, prevention, treatments and a cure for autism; increasing awareness of autism spectrum disorders; and advocating for the needs of individuals with autism and their families. Autism Speaks funds more than $30 million each year in new autism research, in addition to supporting the Autism Treatment Network, Autism Genetic Resource Exchange, Autism Clinical Trials Network, Autism Tissue Program and a range of other scientific and medical programs. To learn more about Autism Speaks, please visit www.autismspeaks.org.

About UC Davis MIND Institute
The UC Davis MIND (Medical Investigation of Neurodevelopmental Disorders) Institute, in Sacramento, Calif., was founded in 1998 as a unique interdisciplinary research center where parents, community leaders, researchers, clinicians and volunteers work together toward a common goal: researching causes, treatments and eventual preventions and cures for neurodevelopmental disorders. In addition to autism, the MIND Institute has major research efforts in fragile X syndrome, Tourette syndrome, chromosome 22q11.2 deletion syndrome and ADHD. More information about the institute is available on the web at http://www.mindinstitute.org.

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