Elsevier

Brain Research

Volume 1380, 22 March 2011, Pages 229-239
Brain Research

Review
Toward a technology of treatment individualization for young children with autism spectrum disorders

https://doi.org/10.1016/j.brainres.2010.09.043Get rights and content

Abstract

Although the etiology of autism spectrum disorders (ASD) and early development of the ASD are not yet well understood, recent research in the field of autism has heavily emphasized the importance of early intervention (i.e. treatment before the age of 4 years). Currently, several methods have been demonstrated to be efficacious with some children however no treatment completely ameliorates the symptoms of ASD or works for all children with the disorder. The heterogeneity and developmental nature of the disorder make it unlikely that one specific treatment will be best for all children, or will work for any one child throughout his or her educational career. Thus, this paper examines early research validating different technologies for individualizing treatment. A discussion of current research on pre-treatment characteristics associated with differential outcomes in treatment, including child, family, and practitioner variables; and how specific intervention techniques address each of those pre-treatment characteristics is provided. The ultimate goal of this line of research is to enable practitioners to prospectively tailor treatments to specific children and increase the overall rate of positives outcomes for children with autism. Research that furthers understanding of how to match clients with efficacious treatments will decrease the outcome variability that characterizes early intervention research at present, and provide for the most efficient allocation of resources during the critical early intervention time-period. This type of research is in its infancy, but is imperative if we are to determine a priori which treatment method will be most effective for a specific child.

Research highlights

► Treatment for autism spectrum disorders (ASD) must be highly individualized due to the heterogeneity of the disorder. ► Well-designed programs that have systematically combined evidence-based interventions report good outcomes. ► Specific methods of combining evidence-based practices have not been examined scientifically. ► Research is needed that helps match child, parent and system characteristics with efficacious treatments to decrease outcome variability.

Section snippets

Introduction to psychosocial intervention for children with autism spectrum disorders (ASD)

Although the etiology of ASD and early development of the disorder are not yet well understood, recent research in the field of autism has heavily emphasized the importance of early intervention (i.e. treatment before the age of 4 years). This emphasis may be attributed in part to results of treatment studies suggesting substantial gains may be achieved when treatment is provided at a very early age (National Research Council, 2001). Although children with ASD may face significant limitations

Integration of strategies

Some researchers believe that combining treatments in a systematic way may be the most appropriate way to individualize intervention (e.g., Iovannone et al., 2003, Rogers and Vismara, 2008, Schreibman, 2000, Siegel, 1996), as the exclusive use of one treatment method may ignore important aspects of social, emotional, communicative or pre-academic development. Early studies indicate that combining methods is a promising avenue to pursue (e.g., Dawson et al., 2010, Stahmer and Ingersoll, 2004),

Combining strategies within and between activities

Some researchers integrate strategies within activities, during different activities and/or based on the level of support a student requires in order to learn. For example, a program might begin with a high level of structure and remove supports as children no longer need them. Alternatively, other programs begin with the use of the most naturalistic strategies and increase structure if a child does not progress. An example of this is the Alexa's PLAYC inclusion program (formerly Children's

Individualization based on service setting and system

Another decision that needs to be made when determining individualization of intervention for children with ASD is the intervention setting. Although researchers and educators alike typically agree that children with ASD benefit from early identification and intervention services, disagreement arises regarding the appropriate setting for early intervention (e.g., in-home or inclusion programming). In addition, most intervention researchers recognize the importance of social integration for

Individualization based on child characteristics

Because of the wide heterogeneity of treatment outcomes in children with ASD, a number of studies have identified child characteristics associated with positive developmental and treatment gains. Developmental studies have used cross-sectional and longitudinal study designs to identify early child variables associated with later child outcomes in general and also in relation to response to a specific intervention. Early language ability and cognitive ability have emerged as the strongest

Individualization based on family characteristics

In addition to child characteristics, it is also important to consider the characteristics of the child's caregivers. Active parent involvement in intervention is a recommend component of effective intervention for this population (Breiner and Beck, 1984, Ingersoll and Dvortcsak, 2006, National Research Council, 2001, Singh et al., 2006). Yet the field is just beginning to examine how family variables interact with treatment effectiveness. The effects of ethnicity, culture, marital status,

Conclusions and future research

While positive results have been reported for many treatment methods, there are no ASD treatments that currently meet criteria for well-established or probably efficacious, empirically supported treatment (Lonigan et al., 1998). Additionally, due to the heterogeneity and developmental nature of the disorder, it is unlikely that one specific treatment will emerge as the treatment of choice for all children. Currently, researchers and clinicians must use their judgment and training to choose the

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