Early intensive behavioral intervention appears beneficial for young children with autism spectrum disorders

Abstract

Reichow B, Barton EE, Boyd BA, Hume K. Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database Syst Rev 2012;10. Among children with autism spectrum disorder, what is the clinical efficacy of early intensive behavioral intervention (EIBI), compared with routine treatment, in lessening the impact of symptoms on children’s functioning? Systematic review of the treatment effect of EIBI. Clinic, school, or home based treatment. Children younger than 6 years of age with autism spectrum disorder. EIBI or treatment-as-usual. Primary outcomes: adaptive behavior, psychopathology (symptom severity), and deterioration on a primary measure (worsening). Secondary outcomes: intelligence, communication and language skills, social competence, and quality of life (for both children with autism spectrum disorder and their caregivers). One randomized controlled trial (RCT) and four non-RCTs with a total of 203 participants were included. All studies used a treatment-as-usual comparison group. The results of the four non-RCTs used 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 (standardized mean difference) = 0.69 (95% CI: 0.38-1.01; P < .0001). The mean effect size for IQ was g = 0.76 (95% CI: 0.40-1.11; P < .0001). Three measures of communication and language skills all showed results in favor of EIBI: expressive language g = 0.50 (95% CI: 0.05-0.95; P = .03), receptive language g = 0.57 (95% CI: 0.20-0.94; P = .03), and daily communication skills g = 0.74 (95% CI: 0.30-1.18; P = .0009). The mean effect size for socialization was g = 0.42 (95% CI: 0.11-0.73; P = .0008), and for daily living skills was g = 0.55 (95% CI: 0.24-0.87; P =.0005). Quality of life and psychopathology effects were variable, depending on how they were measured. There is some evidence that EIBI is an effective behavioral treatment for some children with autism spectrum disorder. However, the current state of the evidence is limited because of the reliance on data from non-randomized control trials 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 autism spectrum disorder.