Assessment of the efficacy of a program to improve the social communication and behavior of young children with autism spectrum disorders

The effectiveness of early intensive interventions for Autism Spectrum Disorder (ASD) is now well-established, but there continues to be great interindividual variability in treatment response. The purpose of this systematic review is to identify putative predictors of response to two different approaches in behavioral treatment: Early Intensive Behavioral Interventions (EIBI) and the Early Start Denver Model (ESDM). Both are based upon the foundations of Applied Behavioral Analysis (ABA), but the former is more structured and therapist-driven, while the latter is more naturalistic and child-driven. Four databases (EmBase, PubMed, Scopus and WebOfScience) were systematically screened, and an additional search was conducted in the reference lists of relevant articles. Studies were selected if participants were children with ASD aged 12-48 months at intake, receiving either EIBI or ESDM treatment. For each putative predictor, p-values from different studies were combined using Fisher's method. Thirteen studies reporting on EIBI and eleven on ESDM met the inclusion criteria. A higher IQ at intake represents the strongest predictor of positive response to EIBI, while a set of social cognitive skills, including intention to communicate, receptive and expressive language, and attention to faces, most consistently predict response to ESDM. Although more research will be necessary to reach definitive conclusions, these findings begin to shed some light on patient characteristics that are predictive of preferential response to EIBI and ESDM, and may provide clinically useful information to begin personalizing treatment.

Autism spectrum disorder is a neurodevelopmental disorder with a rising prevalence disorder. This high-cost/high-burden condition needs evidence-based behavioral treatments that are able to reduce the impact of symptoms on children’s functioning. This retrospective chart review study compared the impact of different types of early interventions on toddlers diagnosed with an autism spectrum disorder developmental profile. Analyses were conducted on 90 subjects (mean = 27.76 months, range 18–44 months; M:F = 4.29:1), of which 36 children underwent the usual treatment, 13 children underwent an intervention based on early intensive behavioral intervention (EIBI) and 41 children received the Early Start Denver Model, for one year, with the same weekly frequency of about 6 h a week. A significant decrease in the severity of autism symptoms was observed for all children when looking at the Ados-2 severity score (average difference = 3.05, SD = 0.71, p = < 0.001) and the Ados-2 social subscale (average difference = 2.87, SD = 0.59, p < 0.001). Otherwise, for most of the Griffiths subscales, we found a significant improvement only for those children who underwent the Early Start Denver Model intervention (General Quotient average difference = 14.47, SD = 3.22, corrected p < 0.001). Analyzing the influence of age on the investigated scores, we found a significant association with the Eye–hand Coordination Quotient (p = 0.003), Performance Quotient (p = 0.042) and General Quotient (p = 0.006). In all these domains, a mild negative correlation with age was observed, as measured by the Pearson’s correlation coefficient (r = −0.32, p = 0.002; r = −0.21, p = 0.044; r = −0.25, p = 0.019, respectively), suggesting less severe developmental skills at the start of treatment for older children. Our results are consistent with the literature that underlines the importance of early intervention, since prompt diagnosis can reduce the severity of autism symptoms; nevertheless, in toddlers, our study demonstrated that an intervention model based on naturalistic developmental behavioral principles such as the Early Start Denver Model is more effective on children’s developmental profile. Further studies are required to assess the extent of effectiveness of different early intervention models in community settings.

&lt;p&gt;Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by difficulties in social communication and the presence of restricted or repetitive behaviours or interests. There is evidence to suggest that early intervention (EI) can lead to improved outcomes for children with ASD. Inclusive preschool-based delivery of EI appears to satisfy current legal and best-practice recommendations around the delivery of EI for young children with ASD. It may also offer several potential benefits including cost-effectiveness, efficiency and opportunities for children with ASD to learn from their peers. The Early Start Denver Model (ESDM) is a promising naturalistic behavioural developmental intervention for young children with ASD aged between 12 and 60 months. The ESDM can be delivered to children in a group-based format and several studies have demonstrated its effectiveness when delivered for 15 to 25 hours per week in designated ESDM preschools with low child–teacher ratios. However, the preschools involved in these studies may not be representative of the typical preschool setting for many communities. Thus, more research is needed to determine the effectiveness of this intervention when delivered under conditions that more closely reflect the typical real-world preschool setting. In the present thesis, two studies with multiple probe across participants designs, each involving three preschool children with ASD, examined the feasibility and effectiveness of the use of the ESDM in an inclusive preschool setting. Specifically, Study 1 evaluated the effectiveness of a modified version of ESDM therapy delivered by a certified therapist and Study 2 evaluated (a) the effectiveness of a brief ESDM coaching programme, and (b) the effectiveness of a modified version of ESDM therapy delivered by preschool teachers. For both studies, the intervention was delivered in regular community preschools and no major changes were made to the typical preschool environments or routines. Effectiveness was assessed by measuring improvements in child active participation, vocal/verbal communication and imitation, and, for Study 2, teachers’ fidelity of implementation of ESDM techniques. Teachers’ perceptions of the acceptability and effectiveness of the intervention were also assessed via a questionnaire and in-depth interviews. In Study 1, an outside certified therapist delivered 3 hours per week of ESDM to three children with ASD over an 8- to 10-week period. Participants showed improvement in active participation, imitation and either intentional vocalisations or spontaneous functional utterances. These results were generally maintained at follow-up. For Study 2, a brief coaching programme was used to train three preschool teachers to use the ESDM with a child with ASD who attended the inclusive preschools where they worked. Teachers improved in their use of the ESDM strategies and children demonstrated improved levels of active participation but results for child imitation and communication were mixed. Teachers also found the intervention to be acceptable and effective. Together, the results from these studies provide preliminary support for the feasibility and effectiveness of the ESDM when delivered in real-world inclusive preschool settings. More research is needed to determine the most effective approach to delivering EI for ASD in an inclusive preschool setting. It may also be valuable to evaluate the extent to which gains made by children and teachers during intervention generalise to other people and/or settings.&lt;/p&gt;

&lt;p&gt;Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by difficulties in social communication and the presence of restricted or repetitive behaviours or interests. There is evidence to suggest that early intervention (EI) can lead to improved outcomes for children with ASD. Inclusive preschool-based delivery of EI appears to satisfy current legal and best-practice recommendations around the delivery of EI for young children with ASD. It may also offer several potential benefits including cost-effectiveness, efficiency and opportunities for children with ASD to learn from their peers. The Early Start Denver Model (ESDM) is a promising naturalistic behavioural developmental intervention for young children with ASD aged between 12 and 60 months. The ESDM can be delivered to children in a group-based format and several studies have demonstrated its effectiveness when delivered for 15 to 25 hours per week in designated ESDM preschools with low child–teacher ratios. However, the preschools involved in these studies may not be representative of the typical preschool setting for many communities. Thus, more research is needed to determine the effectiveness of this intervention when delivered under conditions that more closely reflect the typical real-world preschool setting. In the present thesis, two studies with multiple probe across participants designs, each involving three preschool children with ASD, examined the feasibility and effectiveness of the use of the ESDM in an inclusive preschool setting. Specifically, Study 1 evaluated the effectiveness of a modified version of ESDM therapy delivered by a certified therapist and Study 2 evaluated (a) the effectiveness of a brief ESDM coaching programme, and (b) the effectiveness of a modified version of ESDM therapy delivered by preschool teachers. For both studies, the intervention was delivered in regular community preschools and no major changes were made to the typical preschool environments or routines. Effectiveness was assessed by measuring improvements in child active participation, vocal/verbal communication and imitation, and, for Study 2, teachers’ fidelity of implementation of ESDM techniques. Teachers’ perceptions of the acceptability and effectiveness of the intervention were also assessed via a questionnaire and in-depth interviews. In Study 1, an outside certified therapist delivered 3 hours per week of ESDM to three children with ASD over an 8- to 10-week period. Participants showed improvement in active participation, imitation and either intentional vocalisations or spontaneous functional utterances. These results were generally maintained at follow-up. For Study 2, a brief coaching programme was used to train three preschool teachers to use the ESDM with a child with ASD who attended the inclusive preschools where they worked. Teachers improved in their use of the ESDM strategies and children demonstrated improved levels of active participation but results for child imitation and communication were mixed. Teachers also found the intervention to be acceptable and effective. Together, the results from these studies provide preliminary support for the feasibility and effectiveness of the ESDM when delivered in real-world inclusive preschool settings. More research is needed to determine the most effective approach to delivering EI for ASD in an inclusive preschool setting. It may also be valuable to evaluate the extent to which gains made by children and teachers during intervention generalise to other people and/or settings.&lt;/p&gt;

Impact of the ESDM on the development of children with ASD in a European French-speaking population: First results of the intervention implementation

Autism Spectrum Disorder (ASD) affects multiple developmental domains, and early intervention is critical for optimizing long-term outcomes. Early intensive behavioral and developmental interventions (EIBIs/EDIs), including Applied Behavior Analysis (ABA), the Early Start Denver Model (ESDM), and Pivotal Response Training (PRT), have emerged as key evidence-based strategies. This narrative review aims to evaluate the effectiveness of these interventions on cognitive, language, adaptive, and social outcomes in children under seven years of age, drawing from both primary studies and systematic reviews.Findings from meta-analyses and primary studies indicate that EIBIs and naturalistic developmental behavioral interventions (NDBIs) are associated with significant improvements in IQ (gains of 9-15 points) and language development. However, effects on core autism symptoms are more variable. Parent-mediated and lower-intensity intervention models show promise in maintaining effectiveness while improving accessibility. Despite these encouraging outcomes, variability in study designs, outcome measures, and individual responses highlights the need for more personalized approaches.The key gaps include limited long-term follow-up, inconsistent symptom reduction, and disparities in access. Future research should prioritize precision medicine frameworks, adaptive intervention models, and culturally responsive implementation strategies to enhance equity and maximize developmental potential for children with ASD.

Early intensive intervention has been shown to significantly affect the development of children with autism spectrum disorder. However, the costly implementation of such interventions limits their wide dissemination in the community. This study examined an integration of the Early Start Denver Model into community preschool programs for children with autism spectrum disorder in Israel. Four community preschools implemented the preschool-based Early Start Denver Model and four implemented a multidisciplinary developmental intervention which is widely applied in Israeli community autism spectrum disorder preschools. Fifty-one children (aged 33–57 months) participated in the study. Twenty-six attended the preschool-based Early Start Denver Model preschools and twenty-five attended the multidisciplinary developmental intervention settings. Groups were comparable on age, developmental functioning, and socio-economic status. Compared to the multidisciplinary developmental intervention group, children in the preschool-based Early Start Denver Model treatment made greater gains on blinded measures of overall cognitive development, receptive and expressive language skills, as well as on parent- and teacher-reported adaptive communication and socialization abilities. In the preschool-based Early Start Denver Model group, children with lower symptom severity, higher adaptive functioning, and receptive language abilities at pre-treatment showed greater improvement. This study documents the successful integration of an Early Start Denver Model intervention into pre-existing community preschools, underlining the importance of disseminating evidence-based early intervention in community settings.Lay Early intensive intervention has been shown to significantly affect the development of children with Autism. However, the costly implementation of such interventions limits their wide dissemination in the community. This study examined an integration of a research-supported early intensive intervention model called the Early Start Denver Model into community preschool programs for children with Autism in Israel. Four community preschools implemented the preschool-based Early Start Denver Model and four implemented the existing multidisciplinary developmental intervention which is widely applied in Israeli community preschools for children with autism. Fifty-one children (aged 33–57 months) participated in the study. Twenty-six attended the preschool-based Early Start Denver Model preschools and twenty-five attended the multidisciplinary developmental intervention preschools. Before the intervention began, groups were comparable on children’s age and developmental functioning and on families’ socio-economic status. Results showed that, compared to the multidisciplinary developmental intervention group, children in the preschool-based Early Start Denver Model treatment group made greater gains on measures of overall cognitive development, language skills, as well as on parent- and teacher-reported adaptive communication and socialization abilities. Children who had lower autism symptom severity, higher adaptive functioning and better language understanding abilities before taking part in the preschool-based Early Start Denver Model program showed greater improvements following it. This study documents the successful implementation of an intensive early intervention program in pre-existing community preschools, underlining the importance of the integration of research-supported intervention programs into community settings.

Autism Spectrum Disorder (ASD) is a condition characterized by significant changes in social, communicative, and behavioral development, requiring specialized and early therapeutic interventions. Among the approaches that have stood out in the scientific literature, the Early Start Denver Model (ESDM) emerges as an evidence-based proposal, integrating principles of child development, applied behavior analysis, and naturalistic practices. Psychology plays a central role in this context, by understanding the specific needs of child development and articulating intervention strategies that enhance the cognitive, social and communicative skills of children with ASD. This study aimed to analyze the efficacy of ESDM in the development of children with ASD, especially those who are without a confirmed diagnosis or awaiting specialized treatment. To this end, a descriptive research was carried out, with a qualitative approach, through a bibliographic review in national and international databases, such as PePSIC, SciELO and PubMed, as well as institutional repositories and government data. The methodological choice is justified by the need to gather and synthesize the existing evidence on the effects of ESDM in different contexts, expanding the understanding of the model's applicability in different realities. The results showed that early intervention with ESDM promotes significant benefits for the overall development of children with ASD, even when applied in low-intensity contexts, such as school and family environments. Among the gains observed are the improvement of expressive and receptive language, advances in cognition, adaptive behavior and social interaction, as well as the reduction in the severity of symptoms characteristic of the autism spectrum. Such findings corroborate the importance of public policies that favor early diagnosis and the offer of specialized treatments, reinforcing the role of Psychology in the design of therapeutic practices that respect the specificities of child development. It is concluded that ESDM is an effective tool in the context of early intervention, being fundamental to minimize the impacts of ASD and promote the quality of life of children and their families. It is also recommended that additional studies be carried out in Brazil, in order to strengthen the national empirical base and expand access to evidence-based practices in the field of Developmental Psychology.

Background: Early comprehensive treatment models (CTMs) have been developed as effective treatments for children with autism spectrum disorder (ASD). Numerous studies have suggested that CTMs can improve short-term outcomes, but little is known about precise outcome information in childhood. The current meta-analysis reviewed studies reporting broader outcomes in children with ASD who had ever participated in a CTM and examined the predictors of developmental gains.Methods: We searched eight databases up to June 13, 2019, for relevant trials and natural experiments. Longitudinal studies were selected if they investigated the outcomes of CTMs. Two meta-analyses were undertaken to provide a summary estimate of change in treatment outcomes and to evaluate the effect of CTMs; one used the standardized mean change between the pretest and posttest, and the other was a classical meta-analysis. Stratified and random-effects meta-regression analyses were performed to search for outcome differences among studies.Results: Eighteen intervention studies (involving 495 children with ASD) met all the inclusion criteria: 12 used early intensive behavioral intervention (EIBI), and two used the Early Start Denver Model (ESDM). Outcomes were categorized into three parts: cognitive, language and behavioral (e.g., adaptive functioning and symptomatology). Overall, most children with ASD who had ever participated in an early CTM made gains in many areas of functioning, especially in terms of symptom- and language-related outcomes. Stratified analyses indicated that the ESDM displayed the largest effect on IQ improvement (ES = 1.37, 95% CI: 0.95 to 1.80), while EIBI was more effective for symptom reduction (ES = −1.27, 95% CI: −1.96 to −0.58). Further, meta-regression suggested that interventions with parent involvement, higher intensity, and longer treatment hours yielded greater improvements in IQ and social adaptive functioning, respectively.Conclusion: The results demonstrate a positive association between CTMs and better prognosis in childhood, especially regarding symptoms, and language. However, most extant research involves small, non-randomized studies, preventing definitive conclusions from being drawn. Clearly, the outcomes of children with ASD are still far from normal, especially with respect to adaptive functioning, and the four mediating variables pertaining to treatment elements can affect their gains, including approach, implementer, intensity, and total treatment hours.Systematic Review Registration: [www.crd.york.ac.uk/PROSPERO], identifier [CRD42019146859].

BackgroundEvidence for early intensive behavioural interventions (EIBI) by therapists as an effective treatment for children with an Autism Spectrum Disorder (ASD) is growing. High-intensity and sustained delivery of quality EIBI is expensive. The TOBY (Therapy Outcomes by You) Playpad is an App-based platform delivering EIBI to facilitate learning for young children with ASD, while enabling parents to become co-therapists. Intervention targets include increasing joint attention, imitation and communication of children with ASD. The primary aim of the study presented in this protocol is to determine the effectiveness of the TOBY App in reducing ASD symptoms when used as a complement to conventional EIBI. The secondary aim is to examine parental attributes as a result of TOBY App use.Methods and designChildren aged less than 4;3 years diagnosed with ASD and parents will be recruited into this single-blind, randomised controlled trial using a pragmatic approach. Eligible participants will be randomised to the treatment group ‘TOBY therapy + therapy as usual’ or, the control group ‘therapy as usual’ for six months. The treatment will be provided by the TOBY App and parent where a combination of learning environments such as on-iPad child only (solo), partner (with parent) and off-iPad – Natural Environment (with parent) Tasks will be implemented. Parents in the treatment group will participate in a TOBY training workshop. Treatment fidelity will be monitored via an App-based reporting system and parent diaries. The primary outcome measure is the Autism Treatment Evaluation Checklist. The secondary outcome measures involve diagnostics, functional and developmental assessments, including parent questionnaires at baseline (T0), three months (T1) and six months (T2).DiscussionThis trial will determine the effectiveness of the TOBY App as a therapeutic complement to other early interventions children with ASD receive. The trial will also determine the feasibility of a parent delivered early intervention using the iPad as an educational platform, and assess the impact of the TOBY App on parents’ self-efficacy and empowerment in an effort to reduce children’s ASD symptoms. The outcomes of this trial may have EIBI services implications for newly diagnosed children with ASD and parents.Trial registration ACTRN12614000738628 retrospectively registered on 1st of July, 2014. UTN: U1111-1158-6423.

Early intensive behavioral intervention (EIBI) is one of the most widely used treatments for children with autism spectrum disorder (ASD). The purpose of this Campbell systematic review was to examine the research on EIBI. We found a total of five studies that compared EIBI to generic special education services for children with ASD in schools. Only one study randomly assigned children to a treatment or comparison group, which is considered the ‘gold standard’ for research. The other four studies used parent preference to assign children to groups. We examined and compared the results of all five studies. A total of 203 children (all were younger than six years old when they started treatment) were included in the five studies. We found that children receiving the EIBI treatment performed better than children in the comparison groups after about two years of treatment on tests of adaptive behavior (behaviors that increase independence and the ability to adapt to one's environment), intelligence, social skills, communication and language, autism symptoms, and quality of life. The evidence supports the use of EIBI for some children with ASD. However, the quality of this evidence is low as only a small number of children were involved in the studies and only one study randomly assigned children to groups. Abstract 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 systematically review the evidence for the effectiveness of EIBI in increasing the functional behaviors and skills of young children with ASD. SEARCH METHODS We searched the following databases on 22 November 2011: CENTRAL (2011 Issue 4), MEDLINE (1948 to November Week 2, 2011), EMBASE (1980 to Week 46, 2011), PsycINFO (1806 to November Week 3, 2011), CINAHL (1937 to current), ERIC (1966 to current), Sociological Abstracts (1952 to current), Social Science Citation Index (1970 to current), WorldCat, metaRegister of Controlled Trials, and Networked Digital Library of Theses and Dissertations. We also searched the reference lists of published papers. SELECTION CRITERIA Randomized control trials (RCTs), quasi‐randomized control trials, or clinical control trials (CCTs) in which EIBI was compared to a no‐treatment or treatment‐as‐usual control condition. Participants must have been less than six years of age at treatment onset and assigned to their study condition prior to commencing treatment. DATA COLLECTION AND ANALYSIS Two authors independently selected and appraised studies for inclusion and assessed the risk of bias in each included study. All outcome data were continuous, from which standardized mean difference effect sizes with small sample correction were calculated. We conducted random‐effects meta‐analysis where possible, which means we assumed individual studies would provide different estimates of treatment effects. MAIN RESULTS One RCT and four CCTs with a total of 203 participants were included. Reliance on synthesis from four CCTs limits the evidential base and this should be borne in mind when interpreting the results. All studies used a treatment‐as‐usual comparison group. We synthesized the results of the four CCTs using a random‐effects model of meta‐analysis of the standardized mean differences. Positive effects in favor of the EIBI treatment group were found for all outcomes. The mean effect size for adaptive behavior was g = 0.69 (95% CI 0.38 to 1.01; P &lt; 0.0001). The mean effect size for IQ was g = 0.76 (95% CI 0.40 to 1.11; P &lt; 0.0001). Three measures of communication and language skills all showed results in favor of EIBI: expressive language g = 0.50 (95% CI 0.05 to 0.95; P = 0.03), receptive language g = 0.57 (95% CI 0.20 to 0.94; P = .03), and daily communication skills g = 0.74 (95% CI 0.30 to 1.18; P = 0.0009). The mean effect size for socialization was g = 0.42 (95% CI 0.11 to 0.73; P = 0.0008), and for daily living skills was g = 0.55 (95% CI 0.24 to 0.87; P = 0.0005). Additional descriptive analyses of other aspects related to quality of life and psychopathology are presented. However, due to the inclusion of non‐randomized studies, there is a high risk of bias and the overall quality of evidence was rated as ‘low’ using the GRADE system, which rates the quality of evidence from meta‐analyses to determine recommendations for practice. AUTHORS' CONCLUSIONS There is some evidence that EIBI is an effective behavioral treatment for some children with ASD. However, the current state of the evidence is limited because of the reliance on data from non‐randomized studies (CCTs) due to the lack of RCTs. Additional studies using RCT research designs are needed to make stronger conclusions about the effects of EIBI for children with ASD.

Early intensive behavioral and developmental interventions for young children with autism spectrum disorders (ASDs) may enhance developmental outcomes. To systematically review evidence regarding such interventions for children aged 12 and younger with ASDs. We searched Medline, PsycINFO, and ERIC (Education Resources Information Center) from 2000 to May 2010. Two reviewers independently assessed studies against predetermined inclusion/exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes and assigned overall quality and strength-of-evidence ratings using predetermined criteria. Thirty-four unique studies met inclusion criteria. Seventeen studies were case series; 2 were randomized controlled trials. We rated 1 study as good quality, 10 as fair quality, and 23 as poor quality. The strength of the evidence overall ranged from insufficient to low. Studies of University of California Los Angeles/Lovaas-based interventions and variants reported clinically significant gains in language and cognitive skills in some children, as did 1 randomized controlled trial of an early intensive developmental intervention approach (the Early Start Denver Model). Specific parent-training approaches yielded gains in short-term language function and some challenging behaviors. Data suggest that subgroups of children displayed more prominent gains across studies, but participant characteristics associated with greater gains are not well understood. Studies of Lovaas-based approaches and early intensive behavioral intervention variants and the Early Start Denver Model resulted in some improvements in cognitive performance, language skills, and adaptive behavior skills in some young children with ASDs, although the literature is limited by methodologic concerns.

Early intensive behavioural intervention (EIBI) for children with autism spectrum disorder (ASD) is often delivered using a community model. Behaviour modification experts train and supervise non-experts (e.g. preschool personnel) to teach children according to applied behaviour analysis principles in their natural environment. Several factors predict EIBI outcomes in ASD, for example, knowledge of EIBI and EIBI allegiance among trainers. The aim of the present study was to survey levels of knowledge about and allegiance towards EIBI. Formal knowledge of EIBI and EIBI allegiance was surveyed in supervised preschool staff conducting EIBI (n = 33), preschool staff not involved in EIBI (n = 26), behaviour modification experts (n = 60), school staff (n = 25) and parents of children with ASD (n = 150) [N = 294]. A 27-item (15 knowledge and 12 allegiance questions) online questionnaire was collected. Supervised preschool staff conducting EIBI had more knowledge than preschool staff not using EIBI, but they were not more allegiant. Compared with behaviour modification experts, the supervised EIBI preschool staff group showed markedly less knowledge and allegiance. Findings indicate potential for improvement regarding formal knowledge levels of preschool staff delivering EIBI to children with ASD in real-world settings. In addition, fostering EIBI allegiance might be prioritized when teaching EIBI among non-experts. Broadly increased EIBI knowledge levels among all preschool teachers should be achieved by adding behaviour modification techniques to common university curricula in preschool education. Allegiance of preschool personnel might be accomplished by EIBI supervisors meeting skepticism in practice with conveyance of evidence-based principles and discussions of ethical issues.

&lt;p&gt;Autism spectrum disorder (ASD) is a pervasive developmental disorder that is characterised by deficits in social communication and restricted and repetitive behaviours, interests and activities. Recent developments in identification techniques mean that many children can be reliably diagnosed with ASD before the age of 2. Early identification creates the opportunity for early intervention. In fact, some research suggests that the earlier a child with ASD receives intervention, the greater the progress he or she is likely to make. Naturalistic developmental behavioural interventions are a relatively recent method of early intervention for children with ASD, which combine elements of previous intervention approaches (behavioural, naturalistic behavioural, and developmental/relationship-focused intervention). One such naturalistic developmental behavioural intervention is the early start Denver model (ESDM), which is designed for children with or at risk for ASD between the ages of 12 and 60 months (5 years). Research suggests that ESDM intervention may improve a range of child outcomes when delivered for at least 15 hours per week over at least 10 months. However, many families may not be able to access or afford such intensive intervention. Therefore, the two studies in this thesis evaluated the effectiveness of two ESDM delivery approaches that required relatively few hours of professional input per week. Specifically, low-intensity therapist delivered ESDM intervention, and ESDM parent training. Study 1 used a multiple probe across participants design to evaluate the effectiveness of 3 hours per week of home-based ESDM therapy for 12 weeks for improving imitation, communication, and engagement for four young children with ASD. It also examined whether children showed increases in these outcomes with their mothers following the intervention. The results of this study suggest that, following the intervention, all four children increased their imitation skills and their engagement with the therapist. In addition three of the children had more functional utterances and one child increased his use of intentional vocalisations. These results were maintained four weeks after intervention and generalised to a lesser degree to each child’s mother. This suggests that low-intensity therapist delivered ESDM intervention may improve outcomes for children with ASD. The results of Studies 1 and 2 suggest that both low-intensity therapist delivered ESDM intervention and ESDM parent training may be promising intervention approaches for young children with ASD. This is particularly encouraging as both approaches involved relatively few hours of professional input per week. In theory, this could increase the number of families who are able to access such intervention. More research is needed to identify the most effective low-intensity ESDM intervention method, or combination of methods.&lt;/p&gt;

&lt;p&gt;Autism spectrum disorder (ASD) is a pervasive developmental disorder that is characterised by deficits in social communication and restricted and repetitive behaviours, interests and activities. Recent developments in identification techniques mean that many children can be reliably diagnosed with ASD before the age of 2. Early identification creates the opportunity for early intervention. In fact, some research suggests that the earlier a child with ASD receives intervention, the greater the progress he or she is likely to make. Naturalistic developmental behavioural interventions are a relatively recent method of early intervention for children with ASD, which combine elements of previous intervention approaches (behavioural, naturalistic behavioural, and developmental/relationship-focused intervention). One such naturalistic developmental behavioural intervention is the early start Denver model (ESDM), which is designed for children with or at risk for ASD between the ages of 12 and 60 months (5 years). Research suggests that ESDM intervention may improve a range of child outcomes when delivered for at least 15 hours per week over at least 10 months. However, many families may not be able to access or afford such intensive intervention. Therefore, the two studies in this thesis evaluated the effectiveness of two ESDM delivery approaches that required relatively few hours of professional input per week. Specifically, low-intensity therapist delivered ESDM intervention, and ESDM parent training. Study 1 used a multiple probe across participants design to evaluate the effectiveness of 3 hours per week of home-based ESDM therapy for 12 weeks for improving imitation, communication, and engagement for four young children with ASD. It also examined whether children showed increases in these outcomes with their mothers following the intervention. The results of this study suggest that, following the intervention, all four children increased their imitation skills and their engagement with the therapist. In addition three of the children had more functional utterances and one child increased his use of intentional vocalisations. These results were maintained four weeks after intervention and generalised to a lesser degree to each child’s mother. This suggests that low-intensity therapist delivered ESDM intervention may improve outcomes for children with ASD. The results of Studies 1 and 2 suggest that both low-intensity therapist delivered ESDM intervention and ESDM parent training may be promising intervention approaches for young children with ASD. This is particularly encouraging as both approaches involved relatively few hours of professional input per week. In theory, this could increase the number of families who are able to access such intervention. More research is needed to identify the most effective low-intensity ESDM intervention method, or combination of methods.&lt;/p&gt;