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Supporting Children with Autism Spectrum Disorder at Primary School: Are the Promises of Early Intervention Maintained?

  • Autism Spectrum (A Richdale, Section Editor)
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Abstract

Early and intensive intervention (EI) for children with autism spectrum disorder (ASD) is considered to be “best practice” to reduce the symptoms of autism and maximize the outcome for children’s functioning. Many studies have established the effectiveness of, particularly, early intensive behavioral intervention, and in some cases improvements have been impressive, with children moving off the autism spectrum. However, very few long-term follow-up studies have been conducted to determine if the progress seen as a result of EI has been maintained as children with ASD continue through school. Eight long-term follow-up studies published between 1993 and 2014 are reviewed. The researchers reported that although most children had made progress in many areas as measured by standardized assessments, children in some studies had regressed. Significant difficulties in autism symptomatology, behavior, and social skills remained at follow-up for many children across studies. It appears that ongoing, uninterrupted intervention after the conclusion of early intervention is necessary to ensure gains made in EI are maintained. However, because of numerous methodological issues in the studies, these conclusions cannot be definitive, and additional longitudinal research is called for.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Centers for Disease Control. Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2010. Morb Mortal Wkly Rep. 2014;63(SS02):1–21.

    Google Scholar 

  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington: Author; 2013.

    Book  Google Scholar 

  3. Kim JA, Szatmari P, Bryson S, Streiner D, Wilson F. The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism. 2000;4:117–32. doi:https://doi.org/10.1177/1362361300004002002.

    Article  Google Scholar 

  4. National Research Council. Educating children with autism. Washington: National Academy of Sciences; 2001.

    Google Scholar 

  5. Lovaas IO. Behavioral treatment and normal educational and intellectual functioning in young autistic children. J Consult Clin Psychol. 1987;55:3–9. doi:https://doi.org/10.1037/0022-006X.55.1.3.

    Article  PubMed  CAS  Google Scholar 

  6. Schopler E, Short A, Mesibov G. Relation of behavioral treatment to “normal functioning”: comment on Lovaas. J Consult Clin Psychol. 1989;57:162–4. doi:https://doi.org/10.1037/0022-006X.57.1.162.

    Article  PubMed  CAS  Google Scholar 

  7. Gresham FM, MacMillan DL. Autistic recovery? An analysis and critique of the empirical evidence on the Early Intervention Project. Behav Disord. 1997;22:185–201.

    Article  Google Scholar 

  8. Gresham FM, MacMillan DL. Early Intervention Project: can its claims be substantiated and its effects replicated? J Autism Dev Disord. 1998;28(1):5–13. doi:https://doi.org/10.1023/A:1026002717402.

    Article  PubMed  CAS  Google Scholar 

  9. Reichow B. Overview of meta-analyses on early intensive behavioral intervention for young children with autism spectrum disorders. J Autism Dev Disord. 2012;42:512–20. doi:https://doi.org/10.1007/s10803-011-1218-9.

    Article  PubMed  Google Scholar 

  10. Eikeseth S, Klintwall L, Jahr E, Karlsson P. Outcome for children with autism receiving early and intensive behavioral intervention in mainstream preschool and kindergarten settings. Res Autism Spectr Disord. 2012;6:829–35. doi:https://doi.org/10.1016/j.rasd.2011.09.002.

    Article  Google Scholar 

  11. Sallows G, Graupner T. Intensive behavioral treatment for children with autism: four-year outcome and predictors. Am J Ment Retard. 2005;110:417–38. doi:https://doi.org/10.1352/0895-8017(2005)110[417:IBTFCW]2.0.CO;2.

    Article  PubMed  Google Scholar 

  12. Goin-Kochel RP, Myers BJ, Hendricks DR. Early responsiveness to intensive behavioural intervention predicts outcomes among preschool children with autism. Int J Disabil Dev Ed. 2007;54:151–75. doi:https://doi.org/10.1080/10349120701330404.

    Article  Google Scholar 

  13. Vivanti G, Paynter J, Duncan E, Fothergill H, Dissnayake C, Rogers SJ. Effectiveness and feasibility of the Early Start Denver Model implemented in a group-based community childcare setting. J Autism Dev Disord. 2014;44:3140–53. doi:https://doi.org/10.1007/s10803-014-2168-9.

    Article  PubMed  Google Scholar 

  14. Zachor D, Ben-Itzhak E. Treatment approach, autism severity and intervention outcomes in young children. Res Autism Spectr Disord. 2010;4:425–32. doi:https://doi.org/10.1016/j.rasd.2009.10.013.

    Article  Google Scholar 

  15. Perry A, Cummings A, Geier J, Freeman NL, Hughes S, LaRose L, et al. Effectiveness of intensive behavioral intervention in a large, community-based program. Res Autism Spectr Disord. 2008;2:621–42. doi:https://doi.org/10.1016/j.rasd.2008.01.002.

    Article  Google Scholar 

  16. Kovshoff H, Hastings RP, Remington B. Two-year outcomes for children with autism after the cessation of early intensive behavioral intervention. Behav Modif. 2011;35:427–50. doi:https://doi.org/10.1177/0145445511405513.

    Article  PubMed  Google Scholar 

  17. Matson JL, Konst MJ. What is the evidence for long term effects of early autism interventions? Res Autism Spectr Disord. 2013;7:475–9. doi:https://doi.org/10.1016/j.rasd.2012.11.005. A recent, brief review of 22 studies on long-term efficacy of EIBI interventions, although many included studies are really post-test, rather than long-term follow-up studies.

  18. Nahmias A, Kase C, Mandell DS. Comparing cognitive outcomes among children with autism spectrum disorders receiving community-based early intervention in one of three placements. Autism. 2012;18:311–20. doi:https://doi.org/10.1177/1362361312467865.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Eikeseth S, Tristram S, Jahr E, Eldevik S. Outcome for children with autism who began intensive behavioral treatment between ages 4 and 7. Behav Modif. 2007;31:264–78. doi:https://doi.org/10.1177/0145445506291396.

    Article  PubMed  Google Scholar 

  20. Akshoomoff N, Stahmer A, Corsello C, Mahrer N. What happens next? Follow-up from the Children’s Toddler School Program. J Posit Behav Interv. 2010;12:245–53. doi:https://doi.org/10.1177/1098300709343724.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Towle P, Vacanti-Shova K, Shah S, Higgins-D'alessandro A. School-aged functioning of children diagnosed with autism spectrum disorder before age three: parent-reported diagnostic, adaptive, medication and school placement outcomes. J Autism Dev Disord. 2014;44:1357–72. doi:https://doi.org/10.1007/s10803-013-1997-2. The most recent study to look at long-term outcomes of EI using chart abstraction. However, it is retrospective.

  22. Starr EM, Martini T, Kuo B-H. Transition to kindergarten for children with autism spectrum disorder: a focus group study with ethnically diverse parents, teachers, and early intervention service providers. Focus Autism Other Dev Disabl. 2014. doi:https://doi.org/10.1177/1088357614532497. Online First.

    Article  Google Scholar 

  23. McEachin J, Smith T, Lovaas IO. Long-term outcome for children with autism who received early intensive behavioral treatment. Am J Ment Retard. 1993;97(4):359–72.

    PubMed  CAS  Google Scholar 

  24. Turner LM, Stone WL, Pozdol Stacie L, Coonrod EE. Follow-up of children with autism spectrum disorders from age 2 to age 9. Autism. 2006;10:243–65. doi:https://doi.org/10.1177/1362361306063296.

    Article  PubMed  Google Scholar 

  25. O'Connor A, Healy O. Long-term post-intensive behavioral intervention outcomes for five children with autism spectrum disorder. Res Autism Spectr Disord. 2010;4:594–604. doi:https://doi.org/10.1016/j.rasd.2009.12.002.

    Article  Google Scholar 

  26. Magiati I, Moss J, Charman T, Howlin P. Patterns of change in children with autism spectrum disorders who received community based comprehensive interventions in their pre-school years: a seven year follow-up study. Res Autism Spectr Disord. 2011;5:1016–27. doi:https://doi.org/10.1016/j.rasd.2010.11.007.

    Article  Google Scholar 

  27. Landa R, Kalb L. Long-term outcomes of toddlers with autism spectrum disorders exposed to short-term intervention. Pediatrics. 2012;130:S186-S90. doi:https://doi.org/10.1542/peds.2012-0900Q. The main interest in this study is because of its use of both sort-and long-term followup measures after only a 6 month EI.

  28. Shattuck PT, Durkin M, Maenner M, Newschaffer C, Mandell DS, Wiggins L, et al. The timing of identification among children with an autism spectrum disorder: findings from a population-based surveillance study. J Acad Child Adolesc Psychiatry. 2009;48:474–83. doi:https://doi.org/10.1097/CHI.0b013e31819b38-48.

    Article  Google Scholar 

  29. Reichow B, Wolery M. Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA Young Autism Project model. J Autism Dev Disord. 2009;39:23–41. doi:https://doi.org/10.1007/s10803-008-0596-0.

    Article  PubMed  Google Scholar 

  30. Burgess A, Gutstein S. Quality of life for people with autism: raising the standard for evaluating successful outcomes. Child Adolesc Mental Health. 2007;12:80–6. doi:https://doi.org/10.1111/j1475-3588.2006.00432.x.

    Article  Google Scholar 

  31. Estes A, Rivera V, Bryan M, Cali P, Dawson G. Discrepancies between academic achievement and intellectual ability in higher-functioning school-aged children with autism spectrum disorder. J Autism Dev Disord. 2011;41:1044–52. doi:https://doi.org/10.1007/s10803-010-1127-3.

    Article  PubMed  Google Scholar 

  32. Keen D, Webster A, Ridley G. How well are children with autism spectrum disorder doing academically at school? An overview of the literature. Autism. Online first, 2015. doi:https://doi.org/10.1177/1362361315580962This study is of interest because of its examination of academic outcomes, an important aspect that needs to be included in studies looking at long-term outcomes of EI.

  33. Brown H, Ouellette-Kuntz H, Hunter D, Kelley E, Cobigo V. Unmet needs of families of school-aged children with an autism spectrum disorder. J Appl Res Intellect Disabil. 2012;25:497–508. doi:https://doi.org/10.1111/j.1468-3148.2012.00692.x.

    Article  PubMed  Google Scholar 

  34. Schulting A, Malone P, Dodge K. The effect of school-based kindergarten transition policies and practices on child academic outcomes. Dev Psychol. 2005;41:860–71. doi:https://doi.org/10.1037/0012-1649.41.6.860.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Forest EJ, Horner RH, Lewis-Palmer T, Todd A. Transitions for young children with autism from preschool to kindergarten. J Posit Behav Interv. 2004;6:103–12. doi:https://doi.org/10.1177/10983007040060020501.

    Article  Google Scholar 

  36. La Paro K, Kraft-Sayre M, Pianta R. Preschool to kindergarten transition activities: involvement and satisfaction of families and teachers. J Res Child Educ. 2003;17:147–58.

    Article  Google Scholar 

  37. Early D, Pianta RC, Taylor LC, Cox MJ. Transition practices: findings from a national survey of kindergarten teachers. Early Childhood Educ J. 2001;28:199–206.

    Article  Google Scholar 

  38. Levy A, Perry A. Transition of children with autism from intensive behavioural intervention programs into the school system. J Dev Disabil. 2008;14(1):1–10. http://www.oadd.org/Published_Issues_142.html.

    Google Scholar 

  39. Walker S, Dunbar S, Meldrum K, Whiteford C, Carrington S, Hand K, et al. The transition to school of children with developmental disabilities: views of parents and teachers. Aust J Early Childhood. 2012;37(3):22–9. http://www.earlychildhoodaustralia.org.au/our-publications/australasian-journal-early-childhood/.

    Article  Google Scholar 

  40. Lilley R. It’s an absolute nightmare: maternal experiences of enrolling children diagnosed with autism in primary school in Sydney. Aust Disabil Soc. 2013;28:514–26. doi:https://doi.org/10.1080/09687599.2012.717882.

    Article  Google Scholar 

  41. Starr E, Foy JB. In parents’ voices: the education of children with autism spectrum disorders. Remedial Spec Educ. 2012;33:207–16. doi:https://doi.org/10.1177/0741932510383161.

    Article  Google Scholar 

  42. Whitaker P. Provision for youngsters with autistic spectrum disorders in mainstream schools: what parents say—and what parents want. Br J Spec Educ. 2007;34:170–8. doi:https://doi.org/10.1111/j.467-8578.2007.00473.x.

    Article  Google Scholar 

  43. Martins M, Harris SL, Handleman JS. Supporting inclusive education. In: Volkmar F, Rogers S, Paul R, Pelphrey K, editors. Handbook of autism and pervasive developmental disorders. 4th ed. Hoboken: John Wiley & Sons; 2014. p. 858–70.

    Google Scholar 

  44. Guldberg K. Educating children on the autism spectrum: preconditions for inclusion and notions of ‘best autism practice’ in the early years. Br J Spec Educ. 2010;37:168–74. doi:https://doi.org/10.1111/j.1467-8578.2010.00482.x.

    Article  Google Scholar 

  45. Batten A, Corbett C, Rosenblatt M, Withers L, Yuille R. Make school make sense: autism and education: the reality for families today. London: National Autistic Society; 2006.

    Google Scholar 

  46. Kasari C, Freeman S, Bauminger N, Alkin M. Parental perspectives on inclusion: effects of autism and Down syndrome. J Autism Dev Disord. 1999;29:297–305. doi:https://doi.org/10.1023/A:1022159302571.

    Article  PubMed  CAS  Google Scholar 

  47. Rubin DB. Estimating the causal effect of treatments in nonrandomized studies. J Educ Psychol. 1974;66:699–701. doi:https://doi.org/10.1037/h0037350.

    Article  Google Scholar 

  48. Holland PW. Statistics and causal inference. J Am Stat Assoc. 1986;81:945–60. doi:https://doi.org/10.2307/2289064.

    Article  Google Scholar 

  49. Imbens GE. The role of the propensity score in estimating dose–response functions. Biometrika. 2000;87:706–10. doi:https://doi.org/10.1093/biomet/87.3.706.

    Article  Google Scholar 

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Correspondence to Elizabeth M. Starr.

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Elizabeth M. Starr, Svetlana Popovic, and Brian P. McCall declare that they have no conflict of interest.

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Starr, E.M., Popovic, S. & McCall, B.P. Supporting Children with Autism Spectrum Disorder at Primary School: Are the Promises of Early Intervention Maintained?. Curr Dev Disord Rep 3, 46–56 (2016). https://doi.org/10.1007/s40474-016-0069-7

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