Reducing Maladaptive Behaviors in Preschool-Aged Children with Autism Spectrum Disorder Using the Early Start Denver Model

Elizabeth Fulton,Rudi ÄŒrnÄec,Valsamma Eapen,Amelia Walter,Sally Rogers

doi:10.3389/fped.2014.00040

Abstract

The presence of maladaptive behaviors in young people with autism spectrum disorder (ASD) can significantly limit engagement in treatment programs, as well as compromise future educational and vocational opportunities. This study aimed to explore whether the Early Start Denver Model (ESDM) treatment approach reduced maladaptive behaviors in preschool-aged children with ASD in a community-based long day care setting. The level of maladaptive behavior of 38 children with ASD was rated using an observation-based measure on three occasions during the intervention: on entry, 12 weeks post-entry, and on exit (post-intervention) over an average treatment duration of 11.8 months. Significant reductions were found in children’s maladaptive behaviors over the course of the intervention, with 68% of children showing a treatment response by 12 weeks and 79% on exit. This change was accompanied by improvement in children’s overall developmental level as assessed by the Mullen scales of early learning, but not by significant changes on the Vineland Adaptive Behavior Scales-II or Social Communication Questionnaire. Replication with a larger sample, control conditions, and additional measures of maladaptive behavior is necessary in order to determine the specific factors underlying these improvements; however, the findings of the present study suggest that the ESDM program may be effective in improving not only core developmental domains, but also decreasing maladaptive behaviors in preschool-aged children with ASD.

Highlights

Autism spectrum disorder (ASD) is a life-long neurodevelopmental disorder characterized by impairments in social interaction and communication, and restricted, repetitive patterns of behavior, activities, or interests [1]
Children with ASD frequently engage in maladaptive behaviors such as aggression, self-injurious behavior, and stereotyped behaviors [7]
While the genesis of these maladaptive behaviors is thought principally to reside in communication and social skills difficulties, there is some uncertainty in the literature as to whether maladaptive behaviors are best managed via direct behavioral intervention; via treatments targeted primarily at improving pro-social and communicative skills; or via a combination approach

Summary

Introduction

Autism spectrum disorder (ASD) is a life-long neurodevelopmental disorder characterized by impairments in social interaction and communication, and restricted, repetitive patterns of behavior, activities, or interests [1]. Autism spectrum disorder is recognized as a major public health concern because of its early onset, life-long persistence, and high levels of associated impairment [4]. This impairment is attributable to the core symptoms of ASD, and to the range of co-existing conditions that individuals with ASD often experience, including emotional and behavioral problems, sleep, feeding and eating problems, sensory sensitivities, learning and intellectual disabilities, as well as co-morbid health and mental health diagnoses [5]. 70.9% of children with ASD had experienced a period of severe temper tantrums and, for 60% of these children, tantrums occurred on a daily basis and were a constant (rather than episodic) problem during the period in which they were present [7]

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