Outcomes of a Low-Intensity Early Behavioral Intervention Among Japanese Preschoolers with Autism Spectrum Disorders: A 1-Year Follow-up

Background:

Studies suggest early intensive behavioral intervention (EIBI) can improve cognitive abilities, language, and adaptive behavior of young children with autism spectrum disorders (ASD). However, EIBI is unaffordable in many countries. Although it is essential to implement evidence-based early interventions for children with ASD with varied needs in community settings, evidence whether low-intensity early behavioral interventions (LBI) for ASD children contribute to improved outcomes compared to eclectic treatment-as-usual (TAU) in community settings is not well established.

Objectives:

This study aimed to examine whether LBI implemented in community settings helped to improve DQ and adaptive behavior of children with ASD compared to TAU.

Methods:

Sixty one preschool children diagnosed with ASD were recruited from several universities, private agencies, and regional public centers. After the exclusion of 8 children with a high DQ (DQ >84), the study sample consisted of 53 children: 27 participants (24 male) (mean age: 4.0 years; SD: 1.3; range: 2.1-6.7) receiving LBI (a mean of 3.8 hours per week; SD: 2.5; range: 0.8-8.0) and 26 participants (21 male) (mean age: 3.5 years; SD: 1.0; range: 2.3-5.9) receiving TAU (a mean of 18.2 hours per week; SD: 9.7; range: 0.5-25.3). Standardized tests were administered at baseline (T1) to assess mental age (DQ), adaptive behavior (VABS), ASD symptom severity (PARS), mental health problems, maternal parenting stress and depression, and again, 1 year later (T2). Intervention type, intensity and duration were also monitored after 6 months. There were no differences between groups for age, parental age or education at T1. A paired t-test was used to compare DQ and VABS scores for each group between T1 and T2. DQ at T1 in the TAU group was significantly higher than in the LBI group (t = -2.284 p <.05). Analysis of covariance was used to compare between-group changes in DQ and VABS scores.

Results:

Within the LBI group there was an increase in DQ (t = -2.150; p <.05), Language-Social DQ (t =-3.221; p <.01), and VABS Communication (t = -2.267; p <.05) score, and decreases in VABS Daily Living (t = 2.758; p <.05) and VABS Socialization scores (t = 3.024; p <.01) between T1 and T2. For the TAU group only Language-Social DQ (t = -4.161; p <.01) and VABS Communication (t = -2.665; p <.05) score increased. A between groups comparison revealed a greater increase in DQ in the LBI group than in the TAU group (F = 4.129; p <.05). There were no significant differences in the size of the score change between the groups for Cognitive-Adaptive DQ, Language-Social DQ, or the VABS scores.

Conclusions:

In this prospective observational study, preschool children with ASD receiving LBI, which included varied programs and a lower intensity intervention compared to in previous studies, had a greater improvement in DQ across a 1-year period compared to children receiving TAU, even though the mean intensity of the LBI intervention was less than the TAU intervention. RCTs involving larger samples are now needed to determine the evidence-based efficacy of LBI in community settings.