Effects of a Family-Based Treatment on the Repetitive Behaviors of Children with Autism

Background: An important issue in autism intervention research is whether interventions truly impact the core deficits that are presumed to mediate abnormal behavior and development in autism.  Recent controlled trials of joint attention and symbolic play interventions have demonstrated that these types of focused interventions can significantly impact core social communication symptoms (Kasari et al., 2006).  To date, focused interventions have not been developed for the other primary symptom area of restricted repetitive behaviors.  Repetitive behaviors in autism significantly peak during the critical early childhood period when rapid neurological change is occurring.  For this reason one can hypothesize that early intervention may be both more effective in terms of immediate impact and also more far-reaching in terms of broader aspects of optimal brain and behavioral development.  While pharmacologic options for treating or managing repetitive behaviors have been identified, their safety and utility with very young children with autism have not been established.  Because of pathogenic and phenomenological similarities between the repetitive behaviors found in Obsessive-Compulsive Disorder (OCD) and those found in autism (Rapoport & Inoff-Germain, 2000), it is reasonable to ask if behavioral treatments for the former disorder can be translated to treat the latter. Exposure response prevention (ERP) is an evidence-based intervention routinely used to treat repetitive behaviors in OCD.         

Objectives: To modify and translate a family based ERP (F-ERP) therapy to treat repetitive behaviors in autism, and examine the effects of the intervention.

Methods: Six participants (ages 2 – 5) diagnosed with an autism spectrum disorder and one of their caregivers participated in the 12-week treatment.  The ADOS was used to confirm diagnosis and participants were screened to ensure severity of repetitive behavior using the PDD-CYBOCS (a psychometrically-valid measure).  Each enrolled caregiver selected two repetitive behaviors to treat, and then participated in weekly, clinic-based sessions.  Caregivers were trained by a therapist using live coaching and modeling.  Single case methodology was used to investigate the effects of F-ERP on repetitive behaviors in autism, as it allows experimental control to be established with small N studies.  Naïve behavioral raters coded intervention sessions post-hoc to examine treatment effects.     

Results: Preliminary descriptive data for 4 of 6 participants show decreasing levels of child repetitive behavior across the 12 week period, and maintenance of treatment gains at a 1 month follow-up home visit.  In addition, the findings are replicated for both therapist- implementation of treatment as well as caregiver-implementation.  At the conference, single subject graphs will be shown for all 6 caregiver-child dyads to convey participant data and effect sizes will be reported.

Conclusions: Evidence-based behavioral treatments for repetitive behaviors in OCD can be modified and translated to treat repetitive behaviors in young children with autism. Preliminary evidence suggests that F-ERP can be used as an early, intensive behavioral intervention to treat the broad range of repetitive behaviors found in autism. In addition, caregivers of children with autism are able to successfully learn the intervention strategies and implement them in the absence of therapist support (i.e. in home vs. clinic).