Clinical assessment of autism in high-risk 18-month-olds Two to Ten Years: Developmental Trajectories of Joint Attention in Children With ASD Who Received Targeted Social Communication Interventions Early intervention in 208 Swedish preschoolers with autism spectrum disorder. A prospective naturalistic study. A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders. A Pilot Study of Parent Training in Young Children with Autism Spectrum Disorders and Disruptive Behavior An Intervention for Sensory Difficulties in Children with Autism: A Randomized Trial Autism from 2 to 9 years of age. Improvement in Social Competence Using a Randomized Trial of a Theatre Intervention for Children with Autism Spectrum Disorder A randomised controlled trial of an iPad‐based application to complement early behavioural intervention in Autism Spectrum Disorder Developmental Profiles of Infants and Toddlers with Autism Spectrum Disorders Identified Prospectively in a Community-Based Setting Two-Year Outcomes for Children With Autism After the Cessation of Early Intensive Behavioral Intervention Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model Development and Initial Validation of a Parent Report Measure of the Behavioral Development of Infants at Risk for Autism Spectrum Disorders Language outcome in autism: randomized comparison of joint attention and play interventions. Outcome at 7 years of children diagnosed with autism at age 2: predictive validity of assessments conducted at 2 and 3 years of age and pattern of symptom change over time. Effectiveness of the parent-mediated intervention for children with autism spectrum disorder in south Asia in India and Pakistan (PASS): a randomised controlled trial. Early identification and intervention in autism spectrum disorders: Some progress but not as much as we hoped
Earlier intervention improves outcomes for children with autism spectrum disorders ( ASDs ) , but existing identification tools are at the limits of st and ardization with 18-month-olds . We assessed potential behavioural markers of ASD at 18 months in a high-risk cohort of infant siblings of children with ASD . Prospect i ve data were collected using the Autism Diagnostic Observation Schedule ( ADOS ) and Autism Observation Scale for Infants ( AOSI ) on 155 infant siblings and 73 low-risk controls at 18 months . Infants were classified into three groups ( ASD sibs , non-ASD sibs , controls ) based on blind best-estimate diagnosis at age 3 . Fisher 's exact tests , followed by discriminant function analyses , revealed that the majority of informative ADOS items came from the social and behavioural domains , and AOSI items measuring behavioural reactivity and motor control contributed additional information . Findings highlight the importance of considering not only social-communication deficits , but also basic dimensions of temperament including state regulation and motor control when assessing toddlers with suspected ASD This study follows 40 children who were participants in a r and omized controlled early intervention trial ( Kasari et al. ) from early childhood ( 2–5 years of age ) to elementary school age ( 8–10 years ) . To fully utilize the available longitudinal data , the general linear mixed model was the primary analytical approach . The growth trajectories of joint attention skills ( pointing , coordinated joint looking , and showing ) and expressive language outcomes in these children were estimated based on five time points during the measurement period . The children were grouped by diagnosis at the last follow‐up ( autism , autism spectrum disorder ( ASD ) , no diagnosis ) and by their original treatment group assignment ( joint attention , symbolic play , control ) , and differences between these groups were evaluated . Results showed that joint attention skills of coordinated joint looking and showing increased over time , and pointing to share interest increased over the first year measured and decreased thereafter . These trajectories were influenced by both original treatment assignment and diagnostic status at follow‐up . In addition , a cross‐lagged panel analysis revealed a causal relationship between early pointing and later language development . This study highlights the longitudinal and developmental importance of measures of early core deficits in autism , and suggests that both treatment and ASD symptomatology may influence growth in these skills over time . Autism Res 2014 , 7 : 207–215 . © 2014 International Society for Autism Research , Wiley Periodicals , Early intervention has been reported to improve outcome in children with autism spectrum disorders ( ASDs ) . Several studies in the field have been r and omized controlled trials ( RCTs ) . The aim of this study was to assess ASD outcome in a large naturalistic study . Two hundred and eight children , aged 20 - 54 months , with a clinical diagnosis of ASD were given intervention and monitored prospect ively in a naturalistic fashion over a period of 2 years . The toddlers were considered representative of all but the most severely multiple disabled preschool children with ASD in Stockholm county . They fell into three cognitive subgroups : one with learning disability , one with developmental delay , and one with normal intellectual functioning . Data on intervention type and intensity were gathered prospect ively in a systematic fashion . Intervention was classified into intensive applied behaviour analysis ( ABA ) and non-intensive , targeted interventions , also based on ABA principles . Children were comprehensively assessed by a research team before the onset of intervention , and then , again , 2 years later . Change in Vinel and adaptive behaviour scales composite scores from intake ( T1 ) to leaving the study ( T2 ) was set as the primary outcome variable . The research team remained blind to the type and intensity of interventions provided . One hundred and ninety-eight ( 95 % ) of the original sample s stayed in the study throughout the whole 2-year period and 192 children had a complete Vinel and composite score results both at T1 and T2 . Vinel and composite scores increased over the 2-year period . This increase was accounted for by the subgroup with normal cognitive functioning . There was no significant difference between the intensive and non-intensive groups . Individual variation was considerable , but no child in the study was " problem-free " at follow-up . Our data do not support that children with ASD generally benefit more from the most intensive ABA intervention programs than from less intensive interventions or targeted interventions based on ABA BACKGROUND This prospect i ve study compared outcome for pre-school children with autism spectrum disorders ( ASD ) receiving autism-specific nursery provision or home-based Early Intensive Behavioural Interventions ( EIBI ) in a community setting . METHODS Forty-four 23- to 53-month-old children with ASD participated ( 28 in EIBI home-based programmes ; 16 in autism-specific nurseries ) . Cognitive , language , play , adaptive behaviour skills and severity of autism were assessed at intake and 2 years later . RESULTS Both groups showed improvements in age equivalent scores but st and ard scores changed little over time . At follow-up , there were no significant group differences in cognitive ability , language , play or severity of autism . The only difference approaching significance ( p = .06 ) , in favour of the EIBI group , was for Vinel and Daily Living Skills st and ard scores . However , there were large individual differences in progress , with intake IQ and language level best predicting overall progress . CONCLUSIONS Home-based EIBI , as implemented in the community , and autism-specific nursery provision produced comparable outcomes after two years of intervention Guidance on effective interventions for disruptive behavior in young children with autism spectrum disorders ( ASDs ) is limited . We present feasibility and initial efficacy data on a structured parent training program for 16 children ( ages 3–6 ) with ASD and disruptive behavior . The 6-month intervention included 11 Core and up to 2 Optional sessions . The program was acceptable to parents as evidence d by an attendance rate of 84 % for Core sessions . Fourteen of 16 families completed the treatment . An independent clinician rated 14 of 16 subjects as much improved or very much improved at Week 24 . Using last observation carried forward , the parent-rated Aberrant Behavior Checklist-Irritability subscale decreased 54 % from 16.00 ( SD = 9.21 ) to 7.38 ( SD = 6.15 ) This study evaluated a manualized intervention for sensory difficulties for children with autism , ages 4–8 years , using a r and omized trial design . Diagnosis of autism was confirmed using gold st and ard measures . Results show that the children in the treatment group ( n = 17 ) who received 30 sessions of the occupational therapy intervention scored significantly higher ( p = 0.003 , d = 1.2 ) on Goal Attainment Scales ( primary outcome ) , and also scored significantly better on measures of caregiver assistance in self-care ( p = 0.008 d = 0.9 ) and socialization ( p = 0.04 , d = 0.7 ) than the Usual Care control group ( n = 15 ) . The study shows high rigor in its measurement of treatment fidelity and use of a manualized protocol , and provides support for the use of this intervention for children with autism . Findings are discussed in terms of their implication s for practice and future research CONTEXT Autism represents an unusual pattern of development beginning in the infant and toddler years . OBJECTIVES To examine the stability of  autism spectrum diagnoses made at ages 2 through 9 years and identify features that predicted later diagnosis . DESIGN Prospect i ve study of diagnostic classifications from st and ardized instruments including a parent interview  ( Autism Diagnostic Interview-Revised [ ADI-R ] ) , an observational scale ( Pre-Linguistic Autism Diagnostic Observation Schedule/Autism Diagnostic Observation Schedule [ ADOS ] ) , and independent clinical diagnoses made at ages 2 and 9 years compared with a clinical research team 's criterion st and ard diagnoses . SETTING Three inception cohorts : consecutive referrals for autism assessment to ( 1 ) state-funded community autism centers , ( 2 ) a private university autism clinic , and ( 3 ) case controls with developmental delay from community clinics . PARTICIPANTS At 2 years of age , 192 autism referrals and 22 developmentally delayed case controls ; 172 children seen at 9 years of age . MAIN OUTCOME MEASURES Consensus best-estimate diagnoses at 9 years of age . RESULTS Percentage agreement between best-estimate diagnoses at 2 and 9 years of age was 67 , with a weighted kappa of 0.72 . Diagnostic change was primarily accounted for by movement from pervasive developmental disorder not otherwise specified to autism . Each measure at age 2 years was strongly prognostic for autism at age 9 years , with odds ratios of 6.6 for parent interview , 6.8 for observation , and 12.8 for clinical judgment . Once verbal IQ ( P = .001 ) was taken into account at age 2 years , the ADI-R repetitive domain ( P = .02 ) and the ADOS social ( P = .05 ) and repetitive domains ( P = .005 ) significantly predicted autism at age 9 years . CONCLUSIONS Diagnostic stability at age 9 years was very high for autism at age 2 years and less strong for pervasive developmental disorder not otherwise specified . Judgment of experienced clinicians , trained on st and ard instruments , consistently added to information available from parent interview and st and ardized observation The efficacy of a peer-mediated , theatre-based intervention on social competence  in participants with autism spectrum disorder ( ASD ) was tested . Thirty 8-to-14 year-olds with ASD were r and omly assigned to the treatment ( n = 17 ) or a wait-list control ( n = 13 ) group . Immediately after treatment , group effects were seen on social ability , ( d = .77 ) , communication symptoms ( d = −.86 ) , group play with toys in the company of peers ( d = .77 ) , immediate memory of faces as measured by neuropsychological ( d = .75 ) and ERP methods ( d = .93 ) , delayed memory for faces ( d = .98 ) , and theory of mind ( d = .99 ) . At the 2 month follow-up period , group effects were detected on communication symptoms ( d = .82 ) . The results of this pilot clinical trial provide initial support for the efficacy of the theatre-based intervention BACKGROUND Technology-based interventions for Autism Spectrum Disorder ( ASD ) have proliferated , but few have been evaluated within the context of a r and omised controlled trial ( RCT ) . This RCT evaluated the efficacy of one technology-based early intervention programme ( Therapy Outcomes By You ; TOBY ) in young children with ASD . METHODS TOBY is an app-based learning curriculum design ed for children and parents as a complement to early behavioural intervention . Eighty children ( 16 female ) were recruited to this RCT within 12 months of receiving a diagnosis of ASD ( M age = 3.38 ; SD = 0.69 ) and r and omised to receive either treatment-as-usual ( community-based intervention , n = 39 ) or the TOBY therapy ( at least 20 min/day ) plus treatment-as-usual ( n = 41 ) for a period of 6 months . Outcomes were assessed at 3 and 6 months postbaseline . ( Australian New Zeal and Clinical Trials Registry : ACTRN12614000738628 ; www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?id=365463 ) . RESULTS Children in the TOBY intervention group averaged 19 min/day engaging with the app in the first 3 months , but only 2 min/day during the second 3 months . There was no group difference in scores on the primary outcome , the Autism Treatment Evaluation Checklist , at either the 3- or 6-month follow-up . However , significant improvements at the 6-month follow-up were observed in the TOBY intervention group relative to the treatment-as-usual group on three secondary outcomes : the Fine Motor and Visual Reception subscales of the Mullen Scale of Early Learning and the Total Words Understood scale of the MacArthur-Bates Communicative Development Index . Statistical trends towards improvement in the TOBY intervention group were observed on measures of adaptive function , although these decreased in magnitude from the 3- to 6-month follow-up . CONCLUSIONS This study provides evidence that technology-based interventions may provide a relatively low-cost addition to existing therapist-delivered interventions for children with ASD . However , sustained use of the app over the full 6-month period was a challenge for most families This prospect i ve , longitudinal , study charted the developmental profiles of young children with Autism Spectrum Disorders ( ASD ) identified through routine developmental surveillance . 109 children with Autistic Disorder ( AD ) , ‘ broader ’ ASD , and developmental and /or language delays ( DD/LD ) were assessed using the Mullen Scales of Early Learning ( MSEL ) at 12-months ( n = 10 assessment s ) , 18-months ( n = 45 assessment s ) , and 24-months ( n = 99 assessment s ) . The children with AD performed most poorly , overall , than the ASD and DD/LD groups on the MSEL . Furthermore , the children with AD/ASD displayed an uneven cognitive profile , with poorer performance on verbal ( particularly receptive language ) relative to nonverbal skills . There was also evidence of developmental slowing in verbal skills from 18- to 24-months for children on the spectrum , especially those with AD . Given that the poor receptive , relative to expressive , language profile emerges very early in life for children with AD/ASD , this cognitive profile may serve as an additional red flag to social attention and communication deficits . Receptive language should therefore be stringently monitored in any developmental surveillance program for autism spectrum disorders in the second year of life Evidence from recent meta-analytic and narrative review suggests that early intensive behavioral intervention ( EIBI ) may improve life chances of preschool children with autism . Unfortunately , there are few data indicating whether early gains are maintained after intervention ceases . The purpose of the present study was to establish the 2-year follow-up outcome for children with autism ( N = 41 ) who had participated in an earlier 2-year controlled comparison of EIBI . Twenty-three children in the intervention group ( 100 % of original sample ) and 18 in the treatment-as-usual comparison group ( 86 % of original sample ) were located and retested . Group differences favoring intervention substantially diluted in this period but varied significantly between subgroups who had received university-supervised and parent-commissioned interventions , favoring the latter . These groups differed in terms of their baseline characteristics and intensity of intervention . Results strongly suggest a need for better characterization of those children who would benefit from more active maintenance programs OBJECTIVE : To conduct a r and omized , controlled trial to evaluate the efficacy of the Early Start Denver Model ( ESDM ) , a comprehensive developmental behavioral intervention , for improving outcomes of toddlers diagnosed with autism spectrum disorder ( ASD ) . METHODS : Forty-eight children diagnosed with ASD between 18 and 30 months of age were r and omly assigned to 1 of 2 groups : ( 1 ) ESDM intervention , which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents for 2 years ; or ( 2 ) referral to community providers for intervention commonly available in the community . RESULTS : Compared with children who received community-intervention , children who received ESDM showed significant improvements in IQ , adaptive behavior , and autism diagnosis . Two years after entering intervention , the ESDM group on average improved 17.6 st and ard score points ( 1 SD : 15 points ) compared with 7.0 points in the comparison group relative to baseline scores . The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children . In contrast , over the 2-year span , the comparison group showed greater delays in adaptive behavior . Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder , not otherwise specified , than the comparison group . CONCLUSIONS : This is the first r and omized , controlled trial to demonstrate the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis . Results of this study underscore the importance of early detection of and intervention in autism We developed and evaluated a new parent report instrument — Parent Observation of Early Markers Scale (POEMS)—to monitor the behavioral development of infants at risk for autism spectrum disorder ( ASD ) because they have older affected siblings . Parents of 108 at-risk infants ( 74 males , 34 females ) completed the POEMS from child age 1–24 months . The POEMS had acceptable psychometric properties and promising predictive validity . Most concerning items were social and communication deficits , and intolerance to waiting . Results provide preliminary evidence that prospect i ve parent report measures can help to detect early ASD symptoms in infants at biological risk . We invite research ers to join us in multi-center studies of the POEMS This study reports results of a r and omized controlled trial aim ed at joint attention ( JA ) and symbolic play ( SP ) in preschool children with autism , with prediction to language outcome 12 months later . Participants were 58 children ( 46 boys ) with autism between 3 and 4 years of age . Children were r and omized to a JA intervention , an SP intervention , or control group . Interventions were conducted 30 min daily for 5 - 6 weeks . Assessment s of JA skills , SP skills , mother-child interactions , and language development were collected at 4 time points : pre- and postintervention and 6 and 12 months postintervention by independent testers . Results indicate that expressive language gains were greater for both treatment groups compared with the control group , and results could not be explained by differences in other interventions in which children participated . For children beginning treatment with the lowest language levels , the JA intervention improved language outcome significantly more than did the SP or control interventions . These findings suggest clinical ly significant benefits of actively treating JA and SP skills in young children with autism OBJECTIVE To examine the predictive validity of symptom severity , cognitive and language measures  taken at ages 2 and 3 years to outcome at age 7 in a sample of children diagnosed with autism at age 2 . METHOD Twenty-six children diagnosed with autism at age 2 were re-assessed at ages 3 and 7 years . At each age  symptom severity , cognitive and language assessment s  were completed . RESULTS The pattern of autistic symptom severity varied over time by domain . Across time , children moved across diagnostic boundaries both in terms of clinical diagnosis and in terms of instrument diagnosis on the Autism Diagnostic Interview-Revised ( ADI-R ) . On all measures group variability in scores increased with age . Although non-verbal IQ ( NVIQ ) for the group as a whole was stable across the 3 assessment s , this masked considerable individual instability . St and ard assessment s at age 2 did not predict outcome at age 7 even within the same domain of functioning . In contrast , st and ard assessment s at age 3 did predict outcome . However , a measure of rate of non-verbal communicative acts taken from an interactive play-based assessment at age 2 was significantly associated with language , communication and social outcomes at age 7 . CONCLUSIONS The trajectory of autism symptoms over time differed in different domains , suggesting that they may be , at least in part , separable . Variability in language , NVIQ and symptom severity increased over time . Caution is required when interpreting the findings from assessment s of children with autism at age 2 years . At this age measures of rate of non-verbal communication might be more informative than scores on st and ard psychometric tests . Predictive validity of assessment s at age 3 years was greater BACKGROUND Autism spectrum disorder affects more than 5 million children in south Asia . Although early interventions have been used for the treatment of children in high-income countries , no substantive trials have been done of the interventions adapted for use in low-income and middle-income countries ( LMICs ) . We therefore assessed the feasibility and acceptability of the parent-mediated intervention for autism spectrum disorder in south Asia ( PASS ) in India and Pakistan . METHODS A single-blind r and omised trial of the comparison of 12 sessions of PASS ( plus treatment as usual ) with treatment as usual alone delivered by non-specialist health workers was done at two centres in Goa , India , and Rawalpindi , Pakistan . Children aged 2 - 9 years with autism spectrum disorder were r and omly assigned ( 1:1 ) by use of probabilistic minimisation , controlling for treatment centre ( Goa or Rawalpindi ) , age ( < 6 years or ≥6 years ) , and functional impairment ( Vinel and Adaptive Behaviour Scale Composite score < 65 or ≥65 ) . The primary outcome was quality of parent-child interaction on the Dyadic Communication Measure for Autism at 8 months . Analysis was by intention to treat . The study is registered with IS RCT N , number IS RCT N79675498 . FINDINGS From Jan 1 to July 30 , 2013 , 65 children were r and omly allocated , 32 to the PASS group ( 15 in Goa and 17 in Rawalpindi ) and 33 to the treatment-as-usual group ( 15 in Goa and 18 in Rawalpindi ) . 26 ( 81 % ) of 32 participants completed the intervention . After adjustment for minimisation factors and baseline outcome , the primary outcome showed a treatment effect in favour of PASS in parental synchrony ( adjusted mean difference 0·25 [ 95 % CI 0·14 to 0·36 ] ; effect size 1·61 [ 95 % CI 0·90 to 2·32 ] ) and initiation of communication by the child with the parent ( 0·15 [ 0·04 to 0·26 ] ; effect size 0·99 [ 0·29 to 1·68 ] ) , but time in mutual shared attention was reduced ( -0·16 [ -0·26 to -0·05 ] ; effect size -0·70 [ -1·16 to -0·23 ] ) . INTERPRETATION Our results show the feasibility of adapting and task-shifting an intervention used in a high-income context to LMICs . The findings also replicate the positive primary outcome treatment effects of a parent-mediated communication-focused intervention in the original UK Preschool Autism Communication Trial , with one negative effect not reported previously . FUNDING Autism Speaks , USA Abstract Camarata 's ( 2014 ) review summarizes the progress that has been made in the field of early identification and early intervention in autism spectrum disorders ( ASD ) over the past few decades , but also provides a salutary reminder that much still needs to be done . Whilst it is possible to prospect ively identify cases of ASD using screening instruments ; it is critical that those using such screens in clinical practice underst and how to interpret data from published studies and consider how screening information is communicated to parents . After several decades when few r and omized controlled trials of early intervention in ASD were conducted , the last decade has seen an explosion of new studies . Despite initial optimism , as more trials are published they have highlighted the limits of , and challenges to , early intervention in ASD . Given the complex nature of ASD these sobering lessons are perhaps not surprising . Rather than promote despondency , they need to inspire and inform the next decade of clinical research to move the field forward to the benefit of young children with ASD and those who care for them
An increasing number of interventions have some empirical support ; others are emerging as potentially efficacious .
This evidence base up date examines the level of empirical support for interventions for children with autism spectrum disorder ( ASD ) younger than 5 years old .