Service System and Cognitive Outcomes for Young Children with Autism Spectrum Disorder in a Rural Area of Taiwan

Background: Chiayi is a rural county located in southwestern Taiwan, the early intervention (EI) service system for autism spectrum disorder (ASD) was possible underserved. Thereby, the effectiveness of its early intervention (EI) service system for autism spectrum disorder (ASD) should be studied in detail.

Objectives: The first aim of the present study was to survey the unitization of EI sources for families in the Chiayi area. The current survey was conducted via a monthly telephone call to avoid parental recall bias. The types and amount of EI received over 1.5 years in children who had ASD and developmental delays (DD) within a narrow age range of 24 to 36 months initially would be assessed. The second purpose of the study was to investigate an association between EI and subgroups of high and low/moderate learners in both ASD and DD groups, and to elucidate how the factors of initial cognitive function and EI impact on the consequent outcomes.

Methods: Seventy-one children of ASD (n = 35) and developmental delay (DD, n = 36) aged 2.5 (time 1, T1) were referred from the only one EI Reporting and Referral Center in Chiayi and followed at ages 4 years old. Cognitive abilities were evaluated using the Mullen Scales of Early Learning (Mullen, 1995) Diagnosis was verified with ADI-R, ADOS, and clinical diagnoses for ASD with DSM-5.

 

Results: The results showed that, regarding EI services utilization, the total hours per week which these children received were relatively low and varied. Second, while separating the high or low/moderate learner subgroups in the ASD and DD groups, it was found that, after controlling the baseline scores, the children in the higher learner group improved significantly in all of the domains and ELS in MSEL in both the ASD and DD groups. However, only in the DD group, the regular preschool experience and the parental SES could contribute to the improvement of scores.

Conclusions: The current study demonstrated that young children with ASD and DD living in a rural area of Taiwan receive limited and lower quality services. Although the initial data showed that both children with ASD and DD could improve on all of the domains of cognitive function, the children with ASD seem to require more autism-specific services to improve their development in a rural area. Some suggestions are provided to the government, medical, educational and social welfare systems in the future.