Two-Year Outcomes for Children With Autism After the Cessation of Early Intensive Behavioral Intervention A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders. Early intervention in 208 Swedish preschoolers with autism spectrum disorder. A prospective naturalistic study. Effectiveness of a novel community-based early intervention model for children with autistic spectrum disorder. Low intensity behavioral treatment supplementing preschool services for young children with autism spectrum disorders and severe to mild intellectual disability. A randomised controlled trial of an iPad‐based application to complement early behavioural intervention in Autism Spectrum Disorder Intensive Behavioral Treatment at School for 4- to 7-Year-Old Children with Autism A Pilot Study of Parent Training in Young Children with Autism Spectrum Disorders and Disruptive Behavior Early intensive behavioral intervention: outcomes for children with autism and their parents after two years. Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model Impact of Cognitive Behavioral Therapy on Observed Autism Symptom Severity During School Recess: A Preliminary Randomized, Controlled Trial An Evaluation of a Mobile Application Designed to Teach Receptive Language Skills to Children with Autism Spectrum Disorder Behavioral parent training to address sleep disturbances in young children with autism spectrum disorder: a pilot trial. The effect of cognitive-behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: a randomized, controlled trial. A randomized, placebo controlled trial of omega-3 fatty acids in the treatment of young children with autism Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: a randomized trial. A randomized controlled trial of cognitive-behavioral therapy versus treatment as usual for adolescents with autism spectrum disorders and comorbid anxiety.
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 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 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 The Nova Scotia  early intensive behavior intervention model -NS EIBI ( Bryson et al. , 2007 ) for children with autistic spectrum disorders was design ed to be feasible and sustainable in community setting s. It combines parent training and naturalistic one-to-one behavior intervention employing Pivotal Response Treatment - PRT ( R. Koegel & Koegel , 2006 ) . We followed 45 children ( 33 males , mean baseline age = 50 months ) for 12months . Mean gains of 14.9 and 19.5 months were observed on expressive and receptive language measures , respectively , for children with an IQ of 50 or more at baseline versus 6.1 and 8.4 months for children with IQs less than 50 . Behavior problems decreased significantly over the 1-year treatment for both groups , but autism symptoms decreased only for those with an IQ of 50 or more This study evaluated the effectiveness of low intensity behavioral treatment ( on average 6.5h per week ) supplementing preschool services in 3 - 6-year-old children with autism spectrum disorder and severe to mild intellectual disability . Treatment was implemented in preschools ( i.e. , daycare centers ) and a discrete trial teaching approach was used . Twelve children in the treatment group were compared to 22 children receiving regular intervention .  At pre-treatment , both groups did not differ on chronological age , developmental age , diagnosis and level of adaptive skills . Eight months into treatment , children receiving behavioral treatment displayed significantly higher developmental ages and made more gains in adaptive skills than children from the control group . No significant differences between groups were found on autistic symptom severity and emotional and behavioral problems 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 study was design ed to evaluate 1 year of intensive treatment for 4- to 7-year-old children with autism . An independent clinician assigned children to either  behavioral treatment  ( n = 13 ) or eclectic treatment  ( n = 12 ) . Assignment was based on availability of personnel to supervise treatment and was not influenced by child characteristics or family preference . The two treatment groups received similar amounts of treatment ( M = 28.52 hours per week at the child ’s school ) . Children in the behavioral treatment group made significantly larger gains on st and ardized tests than did children in the eclectic treatment group . Results suggest that some 4- to 7-year-olds may make large gains with  intensive behavioral treatment  , that such treatment can be successfully implemented in school setting s , and that specific aspects of behavioral treatment ( not just its intensity ) may account for favorable outcomes 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 ) An intervention group ( n=23 ) of preschool children with autism was identified on the basis of parent preference for early intensive behavioral intervention  and a comparison group ( n=21 ) identified as receiving treatment as usual .  Prospect i ve assessment was undertaken before treatment , after 1 year of treatment , and again after 2 years . Groups did not differ on assessment s at baseline but after 2 years , robust differences favoring intensive behavioral intervention were observed on measures of intelligence , language , daily living skills , positive social behavior , and a statistical measure of best outcome for individual children . Measures of parental well-being , obtained at the same three time points , produced no evidence that behavioral intervention created increased problems for either mothers or fathers of children receiving it 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 This study compared cognitive behavioral therapy ( CBT ) and treatment-as-usual ( TAU ) in terms of effects on observed social communication-related autism symptom severity during unstructured play time at school for children with autism spectrum disorders ( ASD ) . Thirteen children with ASD ( 7–11 years old ) were r and omly assigned to 32 sessions of CBT or community-based psychosocial treatment ( TAU ) for 16 weeks . The CBT program is based on the memory retrieval competition model and emphasizes the development of perspective-taking through guided behavioral experimentation supplemented with reflective Socratic discussion and supported by parent training and school consultation to promote generalization of social communication and emotion regulation skills . Trained observers blind to treatment condition observed each child during recess on two separate days at baseline and again at posttreatment , using a structured behavioral observation system that generates frequency scores for observed social communication-related autism symptoms .  CBT outperformed TAU at posttreatment on the frequency of self-isolation , the proportion of time spent with peers , the frequency of positive or appropriate interaction with peers , and the frequency of positive or appropriate peer responses to the target child ( d effect size range 1.34–1.62 ) . On average , children in CBT were engaged in positive or appropriate social interaction with peers in 68.6 % of observed intervals at posttreatment , compared to 25 % of intervals for children in TAU . Further investigation of this intervention modality with larger sample s and follow-up assessment s is warranted The current study evaluated the effectiveness of a mobile application , Camp Discovery , design ed to teach receptive language skills to children with autism spectrum disorder based on the principles of applied behavior analysis . Participants ( N = 28 ) were r and omly assigned to an immediate-treatment or a delayed-treatment control group . The treatment group made significant gains , p < .001 , M = 58.1 , SE = 7.54 , following 4 weeks of interaction with the application as compared to the control group , M = 8.4 , SE = 2.13 . Secondary analyses revealed significant gains in the control group after using the application and maintenance of acquired skills in the treatment group after application usage was discontinued . Findings suggest that the application effectively teaches the targeted skills OBJECTIVES A large percentage of children with autism spectrum disorders ( ASD ) have bedtime and sleep disturbances . However , the treatment of these disturbances has been understudied . The purpose of our study was to develop a manualized behavioral parent training ( BPT ) program for parents of young children with ASD and sleep disturbances  and to test the feasibility , fidelity , and initial efficacy of the treatment in a small r and omized controlled trial ( RCT ) . PARTICIPANTS AND METHODS Parents of a sample of 40 young children diagnosed with ASD with an average age of 3.5years were enrolled in our study . Participants were r and omized to either the BPT program group or a comparison group who were given nonsleep-related parent education . Each participant was individually administered a 5-session program delivered over the 8-week study . Outcome measures of feasibility , fidelity , and efficacy were collected at weeks 4 and 8 after the baseline time point . Children 's sleep was assessed by parent report and objective ly by actigraphy . RESULTS Of the 20 participants in each group , data were available for 15 participants r and omized to BPT and 18 participants r and omized to the comparison condition . Results supported the feasibility of the manualized parent training program and the comparison program . Treatment fidelity was high for both groups . The BPT program group significantly improved more than the comparison group based on the primary sleep outcome of parent report . There were no objective changes in sleep detected by actigraphy . CONCLUSIONS Our study is one of few RCTs of a BPT program to specifically target sleep disturbances in a well-characterized sample of young children with ASD and to demonstrate the feasibility of the approach . Initial efficacy favored the BPT program over the comparison group and suggested that this manualized parent training approach is worthy of further examination of the efficacy within a larger RCT OBJECTIVE To examine the efficacy of a modular cognitive-behavioral therapy ( CBT ) protocol relative to treatment as usual ( TAU ) among children with high-functioning autism spectrum disorders ( ASD ) and clinical ly significant anxiety .  METHOD A total of 45 children ( 7 - 11 years of age ) with high-functioning ASD and clinical ly significant anxiety were r and omized to receive 16 sessions of weekly CBT or TAU for an equivalent duration . After screening , assessment s were conducted at baseline , post-treatment , and 3-month follow-up . Raters were blind to treatment condition . RESULTS Youth receiving CBT showed substantial improvement relative to TAU on primary anxiety outcomes . Of 24 children r and omized to the CBT arm , 18 ( 75 % ) were treatment responders , versus only 3 of 21 children ( 14 % ) in the TAU arm . Gains were generally maintained at 3-month follow-up for CBT responders . CONCLUSIONS Relative to usual care , CBT adapted for anxious youth with high-functioning ASD demonstrates large effects in reducing anxiety symptoms . This study contributes to the growing literature supporting adapted CBT approaches for treating anxiety in youth with ASD Background Autism spectrum disorder ( ASD ) is a neurodevelopmental disorder affecting more than 1 % of children . It is characterized by social communication deficits and repetitive behaviors/restricted interests . In the absence of any medications known to improve core symptom domains , parents often use complementary alternative treatments , including omega-3 fatty acid supplements . Methods We conducted a 6-month , r and omized , placebo controlled trial of omega-3 fatty acid supplements ( 1.5 g ) vs placebo in children 2 to 5 years of age with ASD . Primary outcome measures included the autism composite score of the Pervasive Developmental Disorders Behavioral Inventory ( PDDBI ) and the externalizing problems score of the Behavior Assessment System for Children ( BASC-2 ) . Secondary outcome measures included clinical global improvement ( Clinical Global Impression-Improvement ( CGI-I ) ) , adaptive function ( Vinel and Adaptive Behavior Scale ( VABS-II ) ) , and language gains ( Preschool Language Scale ( PLS-4 ) ) , as well as safety . Exploratory analysis investigated potential correlations between changes in cytokine profiles and treatment response . Results Thirty-eight participants were r and omized in a 1:1 fashion . There was no significant difference between groups on the 0- to 24-week change in PDDBI autism composite scores ( p = 0.5 ) . There was a significant group by week interaction on the BASC-2 externalizing problem score , with participants r and omized to the treatment group demonstrating worsening scores ( p = 0.02 ) . There was no statistically significant week by group effect on either adaptive function ( p = 0.09 ) or language ( p = 0.6 ) . Omega-3s were relatively well tolerated . Changes in cytokines during the study did not significantly correlate with treatment response . Conclusions This study does not support high dose supplementation of omega-3 fatty acids in young children with ASD.Trial registration Clinical trials.gov NCT01248728 . Registered 22 November 2010 BACKGROUND Children with high-functioning autism spectrum disorders ( ASD ) are at high risk for developing significant anxiety . Anxiety can adversely impact functioning across school , home and community environments . Cognitive behavioral therapies ( CBT ) are frequently used with success for children with anxiety symptoms . Modified CBT interventions for anxiety in children with ASD have also yielded promising results . METHODS Fifty children with high-functioning ASD and anxiety were r and omizedto group CBT or treatment-as-usual ( TAU ) for 12 weeks . Independent clinical evaluators , blind to condition , completed structured interviews ( Anxiety Disorders Interview Schedule – Parent Version;ADIS-P ) pre- and post-intervention condition . RESULTS Forty-seven children completed either the CBT or TAU condition . Results indicated markedly better outcomes for the CBT group . Significant differences by group were noted in Clinician Severity Ratings , diagnostic status , and clinician ratings of global improvement . In the intent-to-treat sample , 10 of 20 children ( 50 % ) in the CBT group had a clinical ly meaningful positive treatment response , compared to 2 of 23 children ( 8.7 % ) in the TAU group . CONCLUSIONS Initial results from this r and omized , design ed treatment study suggest that agroup CBT intervention specifically developed for children with ASD may be effective in decreasing anxiety . Limitations of this study include small sample size , lack of an attention control group , and use of outcome measures normed with typically developing OBJECTIVE Examine the efficacy of a personalized , modular cognitive-behavioral therapy ( CBT ) protocol among early adolescents with high-functioning autism spectrum disorders ( ASDs ) and co-occurring anxiety relative to treatment as usual ( TAU ) . METHOD Thirty-one children ( 11 - 16 years ) with ASD and clinical ly significant anxiety were r and omly assigned to receive 16 weekly CBT sessions or an equivalent duration of TAU . Participants were assessed by blinded raters at screening , posttreatment , and 1-month follow-up . RESULTS Youth r and omized to CBT demonstrated superior improvement across primary outcomes relative to those receiving TAU . Eleven of 16 adolescents r and omized to CBT were treatment responders , versus 4 of 15 in the TAU condition . Gains were maintained at 1-month follow-up for CBT responders . CONCLUSIONS These data extend findings of the promising effects of CBT in anxious youth with ASD to early adolescents
There is some evidence that EIBI is an effective behavioral treatment for some children with ASD .
BACKGROUND The rising prevalence of autism spectrum disorders ( ASD ) increases the need for evidence -based behavioral treatments to lessen the impact of symptoms on children 's functioning .
At present , there are no curative or psychopharmacological therapies to effectively treat all symptoms of the disorder .
Early intensive behavioral intervention ( EIBI ) , a treatment based on the principles of applied behavior analysis delivered for multiple years at an intensity of 20 to 40 hours per week , is one of the more well-established treatments for ASD .
OBJECTIVES To systematic ally review the evidence for the effectiveness of EIBI in increasing the functional behaviors and skills of young children with ASD .