In a head-to-head comparison with the kind of care most autistic youngsters receive, a program of intensive training aimed at autistic toddlers as young as a year old demonstrated better results in boosting IQ levels, communication skills and adaptive behavior.
The study, published in the journal Pediatrics and released Monday, was the first clinical trial to demonstrate the effectiveness of a "comprehensive developmental behavioral intervention" for the very young with autism. In it, 24 children between 18 and 30 months diagnosed with autism received 20 hours a week of training from University of Washington clinicians. The training was aimed at teaching children verbal and nonverbal communications skills within the context of a warm, close teacher-student relationship. A comparison group of 24 toddlers diagnosed with autism got care typically available to such kids in U.S. communities.
Encouraging the expression of positive emotions, promoting eye contact and rewarding social interaction were at the heart of the teaching strategies, said lead author Geraldine Dawson, a University of North Carolina psychologist and chairwoman of the scientific advisory committee of the patient-advocacy group Autism Speaks. The kids' parents got specialized training to use the teaching strategies that teachers used, including paying attention and responding to the child's cues.
After a year, the IQs of toddlers in the special intervention program rose an average of 15.4 points compared with an increase of 4.4 points for those in customary post-diagnosis care. By the second year, the intervention group's IQs rose by 17.6 points, compared with 7 points for the comparison group. Researchers chalk up much of this to major advances in the language-expression and comprehension of the kids in the intervention group. Parents rated their childrens' daily living skills, socialization and motor skills at one and two years: Those receiving the experimental intervention made significant gains, and those receiving typical community care fell significantly behind.
Kids who got the special program were more likely to have their diagnosis changed from autism to pervasive developmental disorder than were those who did not get the intervention, the study also found.
At a time when physicians are being urged to screen children by 18 to 24 months for signs of autism, it is urgent that parents and physicians have an effective program that is designed to intervene immediately after a diagnosis, Dawson said. The program demonstrated effective in this study can be used to treat children 12 months to 48 months, she added.
The next steps will be to see how long the benefits of the early intervention last: Dawson said her team has just finished following the children involved in this study for two years after the program ended. And a new, larger clinical trial will test the early-intervention program at several sites, including the University of Michigan, University of North Carolina and UC Davis' MIND Institute.