The Importance and Effectiveness of Cross-Setting Complementary Staff and Parent Mediated Early Intensive Behavioral Intervention for Young Children with ASD

Background:  

Comprehensive treatment that start early and bases on the principles of ABA substantially improve outcomes in children with autism spectrum disorders. Research suggest that EIBI need to be delivered in many of the child’s daily environments to provide differential learning opportunities. Therefore, one of the most critical elements of including natural environments is the generalization of skills across settings and persons (Matson & Smith, 2008).

Objectives:  

The current study investigated the effect of EIBI in preschoolers with ASD on standardized tests of severity in autism core symptoms (ADOS), developmental performance (GMDS-ER 2-8), adaptive behavior (VABS-II), language skills (CDI) and change in child’s problem behaviors.

Methods:

12 children with ASD (10M:2F), range 26-71 month (M = 46.6 month, SD = 16.4), received a complementary staff- and parent-mediated EIBI treatment based on ABA-VB principles of 25 h/week in centre-based one-to-one (structured) and play room sessions (quasi naturalistic) and 14 h/week in home (naturalistic) (ABA-VB-group). Cross-setting treatment has been done in a 1 week centre – 3 weeks home rhythm for 12 month with a initial 3 week parent training period, to accomplish maintenance and generalization of skills acquired at the clinical setting in a natural environment of the children (Fava & Strauss, 2011). The ABA-VB group was compared with 10 children with ASD (9M:1F), range 28-66 month (M = 43.7 month, SD = 12.5) that received Eclectic interventions for 16 h/week (psicomotricity, speech therapy, music therapy and uncontrolled in-home ABA). All children followed initial 6 month of the full 12 month treatment. Statistical analysis have been performed using R software. Mean scores before and after the therapy have been compared using paired T-tests.

Results:  

After the initial 6 month, a independent examination of a child psychiatrist revealed that there was a significant decrease in ADOS scores in the ABA-VB-group (total: p<.001; communication: p<.05, social interaction: p<.01) and GMDS-ER 2-8 scores show a significant improvement of developmental state (QS: p<.01) as well as the CDI language skills scores (comprehension: p.<01, speaks: p.<05) while the eclectic group did not show any significant change. VABS-II scores increased significantly in both the ABA-VB-group (p<.01) and the eclectic group (p<.01). Furthermore, within the ABA-VB group problem behaviors decreased significantly (aggressive behavior p<.001, stereotypes p<.001 and dysfunctional behavior p<.0001).

Conclusions:  

Our results point to effectiveness of a staff- and parent mediated EIBI program based on ABA-VB for children with ASD for reducing symptom severity and problem behaviors as well as improving the development state, adaptive behaviors and language skills. These finding highlight the importance of generalization across setting and persons and focalize the attention on verbal behavior and incidental teaching for improving functional behavior in various environments that result in reduced problem behaviors and increased language skills. As adaptive behaviors do significantly improve in both study groups, the results will be discussed to specify potential factors that facilitate the generalization of such skills and to help professionals and parents in their program application to maximize EIBI efforts.