Community Interventions for Autism 1998-2003: Did We Meet the Guidelines?

Background: The National Research Council (NRC; 2001) recommends 20-45 hours a week of multidisplinary intervention beginning before the age of three to treat autism. It is important to evaluate how closely interventions received in the community match recommended guidelines.

Objectives: Describe interventions received by children with autism enrolled in a longitudinal study in terms of number of hours and types of interventions received.  Investigate factors predicting the hours of intervention received.  Evaluate whether interventions match NRC guidelines.

Methods: Seventy-five participants with an Autism Spectrum Disorder (ASD) were assessed as part of a longitudinal study.  Participants received diagnostic assessments at ages 3-4 and age 6. Month-by month information on behavioral interventions was collected every 6 months.

Results: Participants received an average of six hours per month of intervention at age 2, 14.08 hours at age 3, and 24.98 hours per month at age 6, below recommended guidelines.  At age 3 the types of interventions received were: 96% preschool or kindergarten, 93% speech therapy, 65% occupational or physical therapy (OT/PT), 41% Applied Behavioral Analysis (ABA), 1.3% individual psychological therapy, and 0% social skills training. By age 6 the percent enrolled in each type of intervention was: 100% preschool or kindergarten, 85% speech therapy, 65% OT/PT, 41% ABA, 10% individual psychological therapy, and 10% social skills training.  Increased symptom scores on the ADOS at age 3-4 were associated with increased hours of intervention from age 3-6 (β = .29, p = .04) over and above initial Mullen DQ.  Sex and initial DSM-IV diagnosis were not significant predictors of hours received. 

Conclusions: In accordance with NRC guidelines, participants received multidisciplinary interventions and all participants had started one intervention by age 3. However, the average hours received fell short of NRC guidelines. Implications of the findings in terms of optimal early intervention will be discussed.