Implementing Evidence-Based Intervention for Young Children with Autism

Background:

The Early Start Denver Model (ESDM, Dawson et. al, 2010) demonstrated the effectiveness of early intervention in young children with autism, improving cognitive and adaptive outcomes, as well as lessening the severity of autism symptoms.  However, there are gaps within Early Intervention and preschool services for implementing family-centered, comprehensive, evidence-based intervention.  Currently in Illinois, there are significant barriers to accessing comprehensive evidence-based treatments for youngsters with ASD. 

Objectives:

Our goal was to develop parent-professional intervention called Busy Bees and to evaluate its impact on child development and family well being in children between the ages of 24 and 36 months of age.

Methods:

We developed a comprehensive treatment program that integrates two early childhood evidence-based approaches, the ESDM and the SCERTS Models (Prizant, B., Wetherby, A., et. al., 2006).  The ESDM approach includes a multidisciplinary team that implements developmental goals across domains, focuses on interpersonal engagement, develops strong imitation skills, and emphasizes both verbal and non-verbal communication development.  The SCERTS model provides more defined social and language goals, including the use of Picture Exchange Communication System (PECS) and training goals for the communicative partner.

We recruited 15 children with ASD who were enrolled in Busy Bees and compared them with 15 children with ASD who received traditional Early Intervention services.  In Illinois, these are home-based individual services that include separate sessions of speech, occupational and developmental therapies.

At baseline and at follow up (4-6 months after start of intervention) our developmental measures included the Mullen Scales of Early Learning, the Vineland Adaptive Behavior Scales-II, and the Brief Infant Toddler Social-Emotional Assessmen (BITSEA).  We also measured parental  competency,  family life impairment, and adult well being  using the Parenting Sense of Competence Scale (Gibaud-Wallston and Wandersman L. P., 1978), the Family Life Impairment Scale (Briggs-Gowen, M. and Carter, A., 2010) and SF-12 (short form).  We compared pre and post intervention scores of those in Busy Bees with those in the traditional early intervention plan comparison group.

Baseline data was compared between groups using nonparametric tests as appropriate.  Assessment scores for all children were converted to yield a developmental quotient and change in developmental quotients over time was compared between groups using unpaired t-tests. Wilcox Rank sum tests were used for ordinal data of parental competency, family life impairment, and adult well being. Statistical significance was defined as p < .05.

Results:

Preliminary results have demonstrated improvements in children’s overall level of adaptive and cognitive competencies.  Importantly, there were significant gains in parent sense of competency and decreased family life impairments due to the ASD diagnosis.  We also identified barriers to enrollment, as well as, community supports the families experienced as helpful.

Conclusions:

We have demonstrated the feasibility in an urban setting with scarce resources an effective early intervention, evidence-based program that is comprehensive, family-centered, and multidisciplinary.  We will discuss both facilitators and barriers to sustaining this model in the current fiscal environment.