Early Social Interaction Project for Toddlers with Autism Spectrum: Effects On Social Communication, Developmental Level, Adaptive Behavior, and Autism Symptoms

Background: The AAP recommends that all children be screened for ASD at 18-24 months, making the need for evidence-based interventions for toddlers with ASD a priority. The Early Social Interaction Project (ESI) is a parent-implemented intervention that is a cost-effective approach to achieve the intensity needed for toddlers with ASD by teaching parents to embed naturalistic behavioral strategies within everyday activities.

Objectives:  The major objective of this randomized controlled trial was to compare two parent intervention conditions for 9 months: 1) a parent-implemented intervention (PII) offered in 3 weekly sessions for 6 months and 2 weekly sessions for 3 months to teach parents how to embed strategies to support social communication skills for 25 hours a week within everyday activities; and 2) an information, education and support group (IES) offered weekly.

Methods: A crossover design was used with all dyads receiving 9 months of each condition. Pairs of children matched on pretreatment nonverbal developmental level were randomly assigned to first treatment condition. The effects of initial treatment condition for 82 children with ASD enrolled at 18-20 months are reported. Effectiveness of PII and IES was compared on measures of social communication (CSBS), developmental level (Mullen), adaptive behavior (Vineland), and autism symptoms (ADOS).  

Results:  Comparisons indicated baseline equivalency of condition groups on all outcome variables. After 9 months of intervention, children in both conditions showed significant improvement on all 3 composites and 7 clusters of the CSBS but children in PII made significantly greater gains than IES on the social composite (timeXcondition: F(69)=7.00, p=.01) and the communication cluster (F(69)=8.12, p=.006), with a trend toward greater gains for the PII group on the emotion and words clusters (F(69)=3.75, p=.057; F(69)=3.31, p=.073). On the Mullen, children in both conditions showed significant improvements in T-scores on receptive and expressive language scales but children in PII showed significantly greater gains in receptive language (F(68)=5.49, p=.02). Children in both conditions showed no significant change in visual reception but showed a significant decrease in fine motor. On the Vineland, children in both conditions showed significant improvements in communication but children in PII showed significantly greater gains (F(68)=4.97, p=.03). Children in PII showed no significant change in social but children in IES showed a significant decrease (F(32)=5.93, p=.02). Children in both conditions showed no significant change in daily living and showed a significant decrease in motor. On the ADOS, children in both conditions showed a significant decrease in symptom severity on social affect and no significant change in restricted, repetitive behavior.

Conclusions: Taken together these findings support the effectiveness of ESI, a cost-effective, community-viable intervention. Children in both conditions showed significant improvements on social communication and language but PII demonstrated significantly greater efficacy on some measures of social communication and receptive language. These findings are particularly important in light of the lack of main effects of other parent-implemented interventions for toddlers. These findings will be discussed in relation to other parent- and clinician-implemented interventions, with consideration to how autism can worsen in this time period without intensive intervention.