Moderators of Cognitive Outcomes for Children with Autism Receiving Community-Based Early Intervention in Three Settings

Background:

There is much debate in the literature about the most appropriate early intervention placement for children with autism.  On one hand, autism-specific placements can provide intensive evidence-based care.  On the other hand, inclusion settings provide interaction with typically developing peers, the importance of which is increasingly understood. To date, there is little empirical study of which settings produce the best outcomes and are most appropriate for which children.  

Objectives:

The current study examined the association between early intervention (EI) setting for preschool-aged children with autism and outcomes upon entry into elementary school.  

Methods:

Early intervention records were obtained for 100 children with autism (81 male) who received EI between ages 3 and 5 years and then attended elementary school in kindergarten-through-second-grade autism support classrooms in a large urban school district.   Records contained Evaluation Reports, Developmental Assessment for Young Children (DAYC) scores, and Individualized Education Plans. Children were classified as receiving EI in one of three settings: ASD-only, mixed disabilities, and inclusive.  Cognitive outcomes were assessed using the Differential Abilities Scale (DAS) at the beginning and end of participants’ first year of elementary school.  Potential moderators of interest included Time 1 DAYC Communication and Social-Emotional subtest scores.

Results:

Participants were an average of 38.1 (SD = 7.0) months when assessed for eligibility for entry into EI (Time 1) and 67.2 (SD = 5.6) months when assessed at the beginning of elementary school (Time 2). ASD-only (n=40), mixed-disabilities (n=35), and inclusive (n=25) setting groups did not significantly differ in Time 1 DAYC scores, demographics, or other baseline characteristics, except for Time 1 age and DAYC Communication subtest scores (ps < .05).  Among children who did not floor on the DAYC Communication subtest at Time 1, Time 2 DAS scores of those who received EI in an inclusive setting were significantly higher than for children who attended a mixed disabilities setting (p = .04) and marginally higher than those who attended an ASD-only setting (p = .07).  DAS Time 2 scores of these children who attended a mixed disabilities or ASD-only EI settings did not significantly differ from each other (p = .66).  For children who did not reach the lowest standard score on the DAYC Communication subtest at Time 1, Time 2 DAS scores did not significantly differ from each other by setting (ps > .58).  Among children with lower scores on the DAYC Social-Emotional subtest at Time 1, those in inclusive settings had significantly higher DAS scores than children in ASD-only settings (p = .03) and marginally higher scores than children in mixed disabilities settings (p = .07).  DAS Time 2 scores of these children in ASD-only and mixed disabilities EI settings did not significantly differ from each other (p = .77).  For children with higher initial social-emotional scores, DAS scores did not significantly differ from each other by setting (ps > .13).   

Conclusions:

Preliminary results suggest that inclusive early intervention settings may be particularly beneficial for preschool aged children with autism with fewer social-emotional abilites and/or higher communication skills.