Tag Archive for 'early intervention'

Parent questionnaire picks up ASD at age one

According to a report published 10 July 2012 in Autism: The International Journal of Research & Practice by Lauren Turner-Brown and her colleagues of the University of North Carolina, their First Year Inventory (FYI) completed by parents when their children were only one year old correctly identified nine children who were later found to have Autism Spectrum Disorders.

Initially almost 1200 parents completed the FYI—a 63-item questionnaire that only requires about 10 minutes to fill out—when their children were 12 months old and agreed to participate in later research; at the time they completed the FYI the researchers had no scales to indicate whether scores indicated risk. At follow-up within 6 months of the the children’s third birthday, almost 700 then completed additional assessments—Social Responsiveness Scale–Preschool Version and the Developmental Concerns Questionnaire. Using these data (which they scored liberally so they wouldn’t miss possible cases), the researchers identified children at risk for developmental disorders.

They invited families of those at risk (as well as a few not-at-risk children so that the psychologists, who were kept naive about the purposes of the assessments, doing the assessments would have a few “ringers” in the group) to visit the research site for additional assessments. Assessments included the Mullen Scales of Early Learning and the Autism Diagnostic Observation Schedule; parents completed a clinical interview, the Vineland Scales of Adaptive Behavior (2nd Edition), and an autism spectrum diagnostic checklist of symptoms according to Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition.

Using these data, the researchers were able to identify the the nine cases of ASD (6 with Autism, 3 with PDDNOS). (Of course, some had been diagnosed in the community.) In addition, they found that over 40 children apparently had been diagnosed or treated for non-ASD developmental problems, and over 80 more children were in a group they called “Developmental Concerns” meaning that “that parents reported some concern or that a professional had noted some concern about the child” (p. 9). In total, that is roughly 18% of their 700 participating children.

“These results indicate that an overwhelming majority of children who screen positive on the FYI indeed experience some delay in development by age three that may warrant early intervention,” Grace Baranek, senior developer of the FYI, said.

Now that Professor Turner-Brown and her colleagues have been able to follow this sample of children into early childhood, they can see how their instrument predicts developmental problems, and they will be able to begin using it more practically. Additional payoff will come as they are able to follow the children into the school years.

Although this research team is focusing on Autism and ASD, it may be that their larger contribution will be the benefits of screening for a wide spectrum of disorders. Early detection and intervention is likely to be beneficial for problems beyond ASD!

Turner-Brown, L. M., Baranek, G. T., Reznick, J. S., Watson, L. R., & Crais, E. R. (2012). The First Year Inventory: A longitudinal follow-up of 12-month-old to 3-year-old children. Autism, 16. Published online before print July 10, 2012. doi: 10.1177/1362361312439633

The UNC Med School’s press release provided the quotes I’ve used here: Questionnaire completed by parents may help identify 1-year-olds at risk for autism. The FYI questionnaire was developed by the Program for Early Autism Research, Leadership & Service (PEARLS) team. One can learn more about the FYI from the PEARLS Web site.

New review of early intervention in Autism from Pediatrics

Zachary Warren and colleagues from Vanderbilt University published a review of 34 studies of early intervention efforts with children who have Autism in Pediatrics in April of 2011. The authors interpret their results as providing tempered supported for the the early intervention methods often described as “UCLA,” “Lovaas–based,” “EIBI,” or the “Early Start Denver Model.” Here is the abstract.

A Systematic Review of Early Intensive Intervention for Autism Spectrum Disorders
Zachary Warren, Melissa L. McPheeters, Nila Sathe, Jennifer H. Foss-Feig, Allison Glasser and Jeremy Veenstra-VanderWeele

CONTEXT: Early intensive behavioral and developmental interventions for young children with autism spectrum disorders (ASDs) may enhance developmental outcomes.

OBJECTIVE: To systematically review evidence regarding such interventions for children aged 12 and younger with ASDs.

METHODS: We searched Medline, PsycINFO, and ERIC (Education Resources Information Center) from 2000 to May 2010. Two reviewers independently assessed studies against predetermined inclusion/ exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes and assigned overall quality and strength-of evidence ratings using predetermined criteria.

RESULTS: Thirty-four unique studies met inclusion criteria. Seventeen studies were case series; 2 were randomized controlled trials. We rated 1 study as good quality, 10 as fair quality, and 23 as poor quality. The strength of the evidence overall ranged from insufficient to low. Studies of University of California Los Angeles/Lovaas–based interventions and variants reported clinically significant gains in language and cognitive skills in some children, as did 1 randomized controlled trial of an early intensive developmental intervention approach (the Early Start Denver Model). Specific parent-training approaches yielded gains in short-term language function and some challenging behaviors. Data suggest that subgroups of children displayed more prominent gains across studies, but participant characteristics associated with greater gains are not well understood.

CONCLUSIONS: Studies of Lovaas-based approaches and early intensive behavioral intervention variants and the Early Start Denver Model resulted in some improvements in cognitive performance, language skills, and adaptive behavior skills in some young children with ASDs, although the literature is limited by methodologic concerns.

Warren, Z., McPheeters, M. L., Sathe, N., Foss-Feig, J. H., Glasser, A., & Veenstra-VaderWeele, J. (2011). A systematic review of early intensive intervention for autism spectrum disorders. Pediatrics, 127, e1303–e1311. Published online Apr 4, 2011; DOI: 10.1542/peds.2011-0426

ESDM benefits toddlers

File this one in “things that work.”

In a smallish-but-well-done study, Geraldine Dawson and colleagues reported in Pediatrics that the Early Start Denver Model (ESDM)—a variant of the behavioral methods that have often been found to be effective—produced salutary benefits for young children with Autism. The children who received the ESDM intervention had significantly greater gains in IQ than those in a community treatment control and their social behavior kept pace with the standards for their non-disabled peers while the social behavior of the community controls declined relative to the standards.

OBJECTIVE 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).
Continue reading ‘ESDM benefits toddlers’