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Long-Term Outcomes of Early Intervention in 6-Year-Old Children With Autism Spectrum Disorder

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Objective

We prospectively examined evidence for the sustained effects of early intervention based on a follow-up study of 39 children with ASD who began participation in a randomized clinical trial testing the effectiveness of the Early Start Denver Model (ESDM) at age 18 to 30 months. The intervention, conducted at a high level of intensity in-home for 2 years, showed evidence of efficacy immediately posttreatment.

Method

This group of children was assessed at age 6 years, 2 years after the intervention ended, across multiple domains of functioning by clinicians naive to previous intervention group status.

Results

The ESDM group, on average, maintained gains made in early intervention during the 2-year follow-up period in overall intellectual ability, adaptive behavior, symptom severity, and challenging behavior. No group differences in core autism symptoms were found immediately posttreatment; however, 2 years later, the ESDM group demonstrated improved core autism symptoms and adaptive behavior as compared with the community-intervention-as-usual (COM) group. The 2 groups were not significantly different in terms of intellectual functioning at age 6 years. Both groups received equivalent intervention hours during the original study, but the ESDM group received fewer hours during the follow-up period.

Conclusion

These results provide evidence that gains from early intensive intervention are maintained 2 years later. Notably, core autism symptoms improved in the ESDM group over the follow-up period relative to the COM group. This improvement occurred at the same time that the ESDM group received significantly fewer services. This is the first study to examine the role of early ESDM behavioral intervention initiated at less than 30 months of age in altering the longer-term developmental course of autism.

Section snippets

Participants

A total of 39 children who participated in an RCT of early intensive intervention at the University of Washington were assessed at age 6 years. The original RCT study sample consisted of 48 children diagnosed with an ASD at age 18 to 30 months and randomized into 2 groups (ESDM, n = 24; COM, n = 24) stratified by developmental quotient and sex. Research diagnosis of ASD at baseline was based on direct assessment by expert clinicians with the Autism Diagnostic Interview–Revised (ADI-R),13 Autism

Developmental Outcomes After Early Intervention

For all IQ and Vineland domains, there was a significant main effect of time, demonstrating continued improvement in intellectual and adaptive functioning for both treatment groups. There were no significant treatment group effects or a treatment group-by-time interaction for the IQ variables. The ESDM group’s composite and nonverbal IQ scores remained 10 points higher at age-6; however, the treatment group effect fell short of significance (p = .063 and .051, respectively). A nonsignificant

Discussion

The current study prospectively examined evidence for the sustained effects of early intensive behavioral intervention initiated between 18 and 30 months of age for children with ASD at age 6. Children in the ESDM group maintained the gains that they had made in early intervention 2 years later in all areas, including intellectual ability, adaptive behavior, autism symptoms, and challenging behaviors. This provides direct evidence that these children did not exhibit a developmental regression,

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    Clinical guidance is available at the end of this article.

    This research was supported by grants from the National Institute of Mental Health, the National Institute of Child Health and Human Development (U19HD34565, P50HD066782, R01HD-55741), and the National Institute of Mental Health (U54MH066399).

    Dr. Munson served as the statistical expert for this research.

    The authors thank the children and parents who participated in this study and Lena Tsui, MS, of the University of Washington Autism Center, for her devotion to keeping in touch with these children and parents.

    Disclosure: Dr. Estes has received grant or research funding from the Simons Foundation, the National Institutes of Health, the National Institute of Mental Health, and the Autism Speaks Foundation. Dr. Rogers has received royalty payments and material fees related to the Early Start Denver Model (ESDM). She has also received occasional honoraria from Guilford Press for ESDM materials. She is a co-author of two books on early intervention: The Early Start Denver Model for Young Children With Autism: Promoting Language, Learning, and Engagement and An Early Start for Your Child With Autism, from which she has received royalties (Guilford Press). Dr. Dawson is a co-author of two books on early intervention: The Early Start Denver Model for Young Children With Autism: Promoting Language, Learning, and Engagement and An Early Start for Your Child With Autism, from which she has received royalties (Guilford Press). Drs. Munson, Greenson, and Winter report no biomedical financial interests or potential conflicts of interest.

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