For toddlers with autism, more intervention hours are not necessarily
better

Date:
October 19, 2020
Source:
University of California - Davis Health
Summary:
Two prominent early intervention models for toddlers with autism
show a very similar impact, whether delivered at 15-hours or
25-hours per week intensities, a study has found.



FULL STORY ==========================================================================
A multisite study led by UC Davis Health found that two prominent early intervention models for autism had a similar impact. The researchers
compared developmental and symptom improvements in toddlers with autism
who received one year of one-on-one intervention sessions using either
the Early Intensive Behavioral Intervention (EIBI) or Early Start Denver
Model (ESDM). They found that the effect did not differ significantly
whether delivered at 15-hours or 25-hours per week.


========================================================================== "When parents receive the first diagnosis, they typically ask: What kind
of treatment should I seek and for how many hours per week?" said Sally
J. Rogers, professor emeritus of psychiatry and behavioral sciences at
the UC Davis MIND Institute and lead author on the study. "As clinicians,
we had no data from well-controlled experimental studies to answer these questions. This study is the first to ask these questions experimentally." Their study, published in the Journal of the American Academy of Child
and Adolescent Psychiatry, found that neither the type of intervention
nor the intensity of delivery led to significant differences in the
children's rate of progress.

EIBI and ESDM interventions for autism The two interventions vary
considerably in their delivery style and underlying theories. EIBI
is based on applied behavior analysis and uses simple, structured
instructions to teach the children. ESDM is naturalistic and based on developmental and behavioral sciences with an interactive style embedded
in everyday activities, both play and typical routines.

Previous studies have documented that both treatment types can result
in significant child gains in language understanding and use, learning
rates, and cognitive and adaptive skills. However, recommendations for
a specific number of hours per week of treatment have been based on
assumptions rather than high- quality experimental evidence.



==========================================================================
"We designed the trial to provide objective answers about the effect of
initial child characteristics, treatment styles and treatment intensities
on the child's progress over time," Rogers said. "We assessed this
progress by measuring key developmental and symptom indicators."
Researchers enrolled 87 toddlers with autism (between the ages of 12
and 30 months) from three university sites. Based on their age and
development level, the children were randomly assigned to one of four intervention groups: 15 or 25 hours of ESDM; 15 or 25 hours of EIBI.

The researchers delivered one year of one-on-one interventions in homes
and childcare settings. They also provided caregiver coaching to the
families through two 1.5-hour sessions per month. According to Rogers,
the ESDM and EIBI treatments were delivered at the highest quality.

"Therapists followed the treatment manuals and maintained high fidelity to
the principles of each treatment. They also received frequent supervision
and coached parents to use the interventions and to generalize child
skills from therapy into everyday activities at home and in the
community," Rogers said.

The children received four clinic assessments from the time of enrollment,
at six-month intervals. Therapists assessed progress daily and updated
the intervention frequently to meet children's changing developmental
and behavioral needs.



==========================================================================
More intervention hours not necessarily better The researchers found
that neither style nor intensity of intervention had a differing effect
overall on the study's four outcome measures: children's progress in
receptive language, expressive communication, nonverbal ability and
autism symptom change. They also found that the treatment providers
in both models used the models flexibly to meet individual children's
needs. Both models tended to provide greater structure and practice for children who needed it, and more child choice and naturalistic teaching
for children who were ready for it.

"Parents may find it reassuring that even within highly specified
treatment approaches like these two, therapists still adjust to individual child needs." The initial severity of developmental delay and autism
symptom severity did not influence the impact of treatment style or
intensity on any of the outcomes.

The current findings apply only to the toddler-aged children who were
studied.

They need to be validated through replication. The study approach also
needs to be applied to older children to understand their responses to
these differing treatments and intensities.

Funding for the study came from National Institute of Child Health
and Human Development (NICHD) (R01 MH100030), as part of the Autism
Centers of Excellence (ACE) Treatment Network, and from the MIND
Institute Intellectual and Developmental Disabilities Research Center
U54 HD079125. Clinicaltrials.gov identifier NCT02272192.

Co-authors on the study are Marie Rocha of UC Davis MIND Institute; Paul
Yoder, Zachary Warren, Lisa Wallace and Elizabeth Gardner of Vanderbilt University; Annette Estes, Jeff Munson and Jessica Greenson of University
of Washington; John McEachin of Autism Partnership Foundation; Geraldine
Dawson of Duke University; Catherine Sugar, Gerhard Hellemann and Fiona
Whelan of University of California Los Angeles.


========================================================================== Story Source: Materials provided by
University_of_California_-_Davis_Health. Note: Content may be edited
for style and length.


========================================================================== Journal Reference:
1. Sally J. Rogers, Paul Yoder, Annette Estes, Zachary Warren, John
McEachin, Jeff Munson, Marie Rocha, Jessica Greenson, Lisa Wallace,
Elizabeth Gardner, Geraldine Dawson, Catherine A. Sugar, Gerhard
Hellemann, Fiona Whelan. A Multisite Randomized Controlled Trial
Comparing the Effects of Intervention Intensity and Intervention
Style on Outcomes for Young Children With Autism. Journal of the
American Academy of Child & Adolescent Psychiatry, 2020; DOI:
10.1016/j.jaac.2020.06.013 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/10/201019133644.htm

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