Earlier intervention leads to better gains for autistic children

Researchers from Children's Hospital of Philadelphia (CHOP), Florida State University (FSU), and the University of California, Los Angeles (UCLA) have demonstrated that starting intervention coaching parents of autistic toddlers as early as 18 months leads to better gains in language, social communication, and daily living skills.

Their findings were recently published in the journal Autism.

While prior studies provided strong evidence for the benefits of early intervention in autism, many are correlation studies rather than randomized controlled studies that can provide more conclusive results. Additionally, prior research has not demonstrated an ideal age at which to begin interventions.

"Many of us in the autism community say earlier is better, but we actually do not have enough high-quality evidence for that, so a randomized controlled trial like this one helps address that issue," said lead author Whitney Guthrie, PhD, a clinical psychologist with the Department of Child and Adolescent Psychiatry and Behavioral Sciences and the Division of Developmental and Behavioral Pediatrics and researcher at CHOP's Center for Autism Research.

Researchers used the Early Social Interaction (ESI) model, a parent-implemented intervention for toddlers diagnosed with autism that provides a framework to support a child's development in social communication and active engagement. It also is a framework for parents as they receive both group education and individualized coaching to incorporate evidence-based strategies into everyday activities in the family's natural environments.

In this study, families received both group and individual conditions but were randomized as to whether the Individual-ESI intervention coaching began when the toddlers were 18 months old or 27 months old. A total of 82 toddlers and their parents participated in the study, conducted at Florida State University and the University of Michigan.

The study found that children who received individualized ESI coaching earlier showed greater gains in use and understanding of language, social use of communication skills, and self-help skills. Additionally, the findings were specific to the intensive and individualized parent-coaching model, compared with the group-education treatment.

This study provides research findings that show starting just nine months earlier, at 18 months versus 27 months, makes a difference in the child's progress. And that makes sense because this is during a period in which a child's brain is developing the most rapidly, in the first two years of life. That doesn't mean they won't continue to learn later, but by providing these interventions even earlier, they have the greatest chance of having the most impact."

Amy Wetherby, PhD, Director of the Autism Institute at Florida State University

"This program is also not something that is likely to cause harm, and it could help many children, with or without autism," UCLA Professor Catherine Lord, PhD, said. "The intent is to support parents and other caregivers in their everyday interactions, not to replace other possible sources of intervention, including preschool programs and direct therapies."

The research team included Guthrie and co-principal investigators Wetherby and Lord. Guthrie worked with Lord during her undergraduate career at Michigan, then worked with Wetherby during her doctoral program in clinical psychology at FSU. The findings were part of Guthrie's ambitious doctoral dissertation.

This study highlights the importance of the recommendation of the American Academy of Pediatrics that all children are first screened for autism at 18 months, which is critical to get started earlier with intervention, Wetherby said.

Lord hopes the study results "will stimulate discussions among governmental agencies about how to get children into services faster, perhaps by not waiting for formal diagnoses but requiring an eventual diagnosis at some point, and also by providing more and better reimbursed diagnostic services."

Lord also wants frontline workers who might be the first to see the children -;like pediatricians, primary care physicians, speech-language pathologists and occupational therapists-; to be able to admit children into programs.

Guthrie said that while it is important to expand future research to include more children from a wider and more diverse community, the results of this study provide measurable evidence supporting earlier intervention.

"Our findings underscore the importance of a swift referral for evaluation if a child screens positive for autism, or there is any professional or caregiver concern for autism," Guthrie said. "We want to make sure that toddlers don't miss this important window for earlier intervention."

This study was supported by the National Institute of Mental Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. This research was also supported in part by the funding from Autism Speaks and the Simons Foundation.

Journal reference:

Guthrie, W., et al. (2023). The earlier the better: An RCT of treatment timing effects for toddlers on the autism spectrum. Autism. doi.org/10.1177/13623613231159153.


  1. Frank Sterle Frank Sterle Canada says:

    Until I was a half-century old, I didn't know about my own crippling ASD condition. It's still an unofficial [self-]diagnosis due to the large fee charged within our [Canada’s] supposedly universal health-care system; for, within it are important health services/treatments that are universally inaccessible, except for the high-incomed to access in for-profit clinics.

    While low-functioning autism seems to be more recognized and treated, higher-functioning ASD cases are typically left to fend for themselves, except for parents who can finance usually expensive specialized help. … But a physically and mentally sound future should be EVERY child’s fundamental right, especially considering the very troubled world into which they never asked to enter.

    I'm sometimes told, “But you're so smart!” To this I immediately agitatedly reply: "But for every 'gift' I have, there are a corresponding three or four deficits." It's crippling, and on multiple levels!

    As a boy with an undiagnosed autism spectrum disorder [not to mention high sensitivity and resultant also-high ACE score], my primary-school teacher was the first and most formidably abusive authority figure with whom I was terrifyingly trapped.

    I cannot recall her abuse in its entirety, but I’ll nevertheless always remember how she had the immoral audacity — and especially the unethical confidence in avoiding any professional repercussions — to blatantly readily aim and fire her knee towards my groin, as I was backed up against the school hall wall.

    Luckily, she missed her mark, instead hitting the top of my left leg. Though there were other terrible teachers, for me she was uniquely traumatizing, especially when she wore her dark sunglasses when dealing with me. Thus, a school environment can become the autistic child's traumatizer; the trusted educator, the abuser.

    But rather than tell anyone about my ordeal with her and consciously feel victimized, I instead felt some misplaced shame: I was a ‘difficult’ boy, therefore she likely perceived me as somehow ‘deserving it’.

    Perhaps not surprising, I feel that our educators could/should receive mandatory training on children with ASD, especially as the rate of diagnoses greatly increases. There could also be an inclusion in standard high school curriculum of child-development science that would also teach students about the often-debilitating condition (without being overly complicated).

    If nothing else, the curriculum would offer students an idea/clue as to whether they themselves are emotionally/mentally compatible with the immense responsibility and strains of regular, non-ASD-child parenthood.

    From my observations, while low-functioning autism is relatively readily recognized and treated, higher-functioning ASD cases are basically left to fend for themselves [except for parents who can finance usually expensive specialized help].

    It would explain to students how, among other aspects of the condition, people with ASD (including those with higher functioning autism) are often deemed willfully ‘difficult’ and socially incongruent, when in fact such behavior is really not a choice. And how “camouflaging” or “masking,” terms used to describe ASD people pretending to naturally fit into a socially ‘normal’ environment, causes their already high anxiety and depression levels to further increase.

    Of course that exacerbation is reflected in the disproportionately high rate of suicide among ASD people.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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