Are Toddlers with Autism Spectrum Disorders Receiving the Recommended Hours of Early Intervention Services?

Background: The United States’ (U.S.) National Research Council (2001) and American Academy of Pediatrics (2007) recommend that children diagnosed with ASD receive 25 hours of intensive services per week. Treatment recommendations and delivery of early intervention (EI) services for toddlers with ASD vary regionally.  Few studies have examined whether the services children receive are consistent with recommendations.

Objectives: To describe the age of diagnosis and the amount of intensive EI services in toddlers with ASD.

Methods: A cohort of 162 toddlers with ASD and their parents participated in a longitudinal study of developmental outcomes and service delivery. Diagnosis was confirmed with the Autism Diagnostic Observation Scales (ADOS) and Autism Diagnostic Interview (ADI). Assessments of child development and parental well-being were conducted annually. Detailed information about service delivery was collected through interviews bi-annually.

Results: The cohort consisted of 36 girls and 126 boys in a region of the U.S. that is well-funded to provide services for toddlers with ASD. At initial assessment, mean age was 28 months, with an average age of diagnosis 24 months.  Average age of initiation of services was 18 months while intensive, autism-specific services began at 24 months. At initial assessment, children received an average of 11.83 hours/week of combined EI and intensive services (range: 0-32.5 hours per week). Six months later, children who were under 36 months received an average of 19.56 hours/week through EI services while children over 36 months received an average of 25.85 hours/week through preschool programming.  

Conclusions: On average, children under 36 months of age were not receiving the recommended hours of services for ASD. However, by the time they entered preschool, the average child was receiving the recommended hours of services. Even in a well-funded region of the U.S., children were not receiving adequate services through the EI system.