Outcomes of Community-Based Inclusion Programming for Toddlers with ASD

Background: While research suggests that children with autism benefit from inclusive programming, these types of intervention programs are rare and minimal research has examined outcomes for these programs. In a study of a community-based inclusion program for children 18- to 36-months of age, Stahmer and Ingersoll (2004) reported outcomes for a group of 20 children. The reported IQ gains were similar to those reported in research studies of young children with ASD in both intensive one-to-one treatment programs and inclusion programs. Both standardized and functional measures indicated significant gains.
Objectives: To examine the standardized cognitive, communicative, and adaptive outcomes, as well as functional communication and social outcomes of children attending a community toddler inclusion program using mixed methods of intervention and to examine predictors of positive outcomes.
Methods: The current study used a quasi-experimental design to analyze the outcomes of 93 young children with ASD in the same inclusive toddler program. Children were tested at entry and exit to the program using a battery of standardized assessments as well as functional checklists. Data for children enrolled in the program for at least 5 months (M = 8 months) were examined using analyses of variance. In addition, regression analyses were used to examine possible predictors of positive outcome.
Results: There were statistically significant increases from entry to exit in developmental quotient, adaptive behavior, expressive and receptive communication standard scores and significant decreases in disruptive behavior. Twenty-five percent of children exited the program with IQs in the typical range (>85) and another 30% in the borderline range (70-84).  Examination of functional assessments indicated that at entry 30% of children had no communication skills, while only 9% had phrase speech and 8% were commenting.  At exit, only 10% of children were not using language to communicate, 20% used single words, 30% had phrase speech and 25% were using commenting and other forms of reciprocal communication. At entry, 25% of children had no functional play, while only 2% were engaging in even simple forms of pretend play. At exit, over half of the children were engaging in pretend play.  Approximately 50% of children exited the program with a diagnosis of autistic disorder and 36% exited with a diagnosis of PDD-NOS. A step-wise linear regression indicated that number of months in the program, and standardized expressive and receptive communication scores significantly predicted developmental level at exit.
Conclusions: Inclusion programming for toddlers with autism using a systematic combination of intervention strategies can lead to significant improvement in both standardized assessments and functional behaviors. Community agencies can successfully implement effective programming for toddlers with autism. Extended time in the program and early communication skills may be predictive of outcome.