The Frankfurt Early Intervention Program for Preschool Children with Autism Spectrum Disorder (FFIP) - First Results on the Two Year Development

Background:  Several studies have shown that early intervention can result in improved development for young children with autism spectrum disorder (ASD). The Frankfurt early intervention program (FFIP) is an individual developmental and behavioral approach with low training intensity (2h/week) and intensive parental involvement which is currently manualized (Teufel et al., in preparation).

Objectives:  The aim of this study was to assess the 2-year outcome of FFIP on autism severity (ADOS), adaptive behavior (VABS), mental age (DQ) and additional psychiatric symptoms (SRS, SCQ, ABC, CBCL) in a pre-/post-study. As the present study lacks a control group, the results of FFIP are compared with the results of the RCT ESDM study (Dawson et al., 2010) which showed similar baseline data in most variables.

Methods:  N = 27 children with ASD (ADOS severity score = 7.3; SD = 1.4), aged M = 55.5 month (SD = 12.2) took part in the 2-year FFIP study. Difference scores of T2-T1 measures were calculated for the variables of interest and the value was compared to H0: μ = 0, i.e., no change. For mental age, the t-test value μ was set to the expected yearly development (7.9 months/year). To compare the study results with the ESDM groups, μ was set to the relevant change value after 2 years reported in the ESDM study.

Results:  The ADOS severity score showed a decline of 0.9 points after 2 years of FFIP which was significantly more than the ESDM control group achieved (t = -3.44; p = .002) and slightly better than the results of the ESDM treatment group (t = -1.98; p = .059). No significant change in VABS-II total standard score was observed, but compared with the ESDM groups this result is significant better than the loose of standard scores the control group showed in the total score (t = 8.3; p < .001) and comparable with the gains of the ESDM treatment group (t = 1.90; p = .070). After two years of FFIP a cognitive development of 23.5 month was observed. This was significantly more than expected (t = 3.80; p = .001). The developmental quotient increased by 8.9 points, showing no difference to the ESDM control group (t = .72; p = .478) and less improvement than the ESDM treatment group (t = -3.33; p = .003).

Conclusions:  This study shows the 2-year development in children who received FFIP. Results on adaptive behavior and autism severity are comparable with the development of children in the ESDM RCT study. This is a conservative comparison, as better therapeutic gains would be expected in the younger ESDM comparison group which received more hours of intervention. Similar to previous reports, variability in outcome was large and the lack of a matched control group is a strong limitation of the study. A randomized-controlled trial needs to be performed to proof its effectivity compared to community-based early intervention programs in Germany.