Early Intervention for Young Children with Autism Spectrum Disorder by Russell Lang Terry B. Hancock & Nirbhay N. Singh

Author:Russell Lang, Terry B. Hancock & Nirbhay N. Singh
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Recommendations for Future Research

The existing body of ESDM research demonstrates that it is an effective treatment approach for young children with ASD, leading to significant developmental growth in children’s cognition, language, social abilities, and adaptive functioning. These changes are observed both on an individual level and in group comparisons. There is also support for the training procedures for both therapist and parent models, demonstrating that both groups are able to learn the ESDM techniques and implement them with high fidelity. Despite these impressive results, there are several areas where additional research is likely to be particularly fruitful.

The first is in determining which treatments are most effective for which children, a current research need the field of intervention science as a whole (Trembath & Vivanti, 2014). This question cannot fully be answered without directly comparing two treatment programs that are both manualized (standardized), and delivered with the same quality and intensity. A large, multi-site randomized controlled trial is currently underway that will address this issue by comparing ESDM to a manualized discrete trial training program, which are also being evaluated at two intensity levels: 15 h per week versus 25 h per week.

The second area of research n eed is in comparing the outcome s of children in low-intensity ESDM (generally parent-implemented) models to the strong results observed in therapist-delivered formats (Dawson et al., 2010, 2012; Vivanti et al., 2014). While the results of several parent-implemented ESDM trials demonstrate significant gains in children’s language, social communication, and developmental functioning, whether these gains are as strong as those obtained in intensive therapist-delivered ESDM formats is an open research question. There is initial evidence that P-ESDM is at least as effective as some high-intensity non-ESDM community treatment models (Rogers, Estes, et al., 2012). However, whether it is appropriate to expect parents to be the main provider of early intensive services is an important question for public policy. This question is directly related to the more general need for wider dissemination of evidence-based practices and for studies comparing the effectiveness of well-controlled, university-based studies with the real-world demands and limitations of the community setting. Even within established systems, many families experience issues of limited access due to long waiting lists or because intensive behavioral interventions are simply unavailable. Dissemination science will need to address these issues within both established systems and much more broadly in communities across the world where government-supported infrastructure does not exist and dissemination must be directly to families, without an intervening professional. A major focus of ESDM research going forward will be in developing and evaluating wider dissemination of this efficacious treatment.

Finally, the results from the pilot study of infant intervention are quite exciting, and suggest that intervening as soon as symptoms begin to appear may have particularly strong effects in reducing symptom severity and diagnostic rates and improving functional outcomes. This possibility has significant implications for public policy in terms of both screening, resource allocation, and the potential to significantly reduce the long-term costs associated with autism-related impairments (Ganz, 2015; Peters-Scheffer, Didden, Korzilius, & Matson, 2012).

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