Little is known about the predictive factors for a positive response to intensive treatment in toddlers with ASD. Recommendations are from reports of clinical improvement after intensive 1:1 therapy. But in clinical practice, we sometimes see children receiving less therapy making progress while children receiving intensive therapy make little progress.
We sought to compare the developmental progress of toddlers with ASD receiving variable hours of treatment.
Seventeen children referred to a developmental clinic for evaluation of a possible or known ASD, ages 26 and 32 months, are followed in this prospective pilot project. All received assessments with the Mullen Scales of Early Learning (MSEL), Autism Diagnostic Observation Schedules (ADOS), Vineland Adaptive Behavior Scales (VABS), the Pervasive Developmental Disorders Behavior Inventory (PDDBI) and play interactions developed for this project. Intensive treatment at 25 hours a week was recommended for all but was not always delivered. Children are evaluated every 6 months for 2 years.
Mean age of the 17 children was 28.8 months. All have completed at least one year follow-up, at an average of 14.6 months after the initial evaluation. Fourteen are boys and 3 are girls. We examined the relation between total hours of 1:1 treatment per week and change scores at the average months of follow-up for the: MSEL, PDDBI, VABS and the play measures. Eight children received > 10 hours of treatment a week and 9 received =>Vineland at follow-up, but children with >/= 10 hours/wk of treatments were rated as having less reduction. No significant change was reported in the Adaptive Behavior Composite in either group.
These preliminary data in a small sample do not support the belief that greater intensity of treatment leads to more clinical improvement in toddlers with ASD. Other factors are important in the response to treatment. Play interactions developed for this project will need further validation but may offer a quick clinical measure for autism symptoms improvement.