Early Autism Intervention Research Articles

Autism Early Intervention - Progress, Steps Backward, and the Reconciliation of Conflicting Narratives.

We review recent research on interventions, services and supports for children on the autism spectrum, examining both advancements and setbacks. Progress has included an increase in quantity and rigor of intervention science, as well as a broadening of disciplines and perspectives engaged in the examination of early interventions, including their effectiveness, social validity and the contextual determinants of implementation outcomes. Setbacks have included the decrease in research involving children on the autism spectrum who have co-occurring profound intellectual disability, minimal or no spoken language, and who require constant assistance with daily living activities. This trend is alarming because it contributes to the marginalization and unmet needs of children who need intervention the most. Additionally, access to early intervention services is unequal and complicated by the misalignment of policy with the evolving evidence base in the field. The recent growth in the depth and breadth of knowledge related to autism early intervention means that policies, practices, advocacy efforts and research directions can be grounded on a more comprehensive evidence base and societal appraisal of autism. Nevertheless, these indisputable markers of success co-exist with conflicting narratives that hinder the establishment of a cohesive agenda to tackle inequities experienced by marginalized subgroups. Reconciliation of conflicting narratives requires a nuanced and compassionate appraisal of sources of tensions and heterogeneity of needs within the autism spectrum.

Profiles of nonverbal skills used by young pre-verbal children with autism on the ADOS-2: Relation to screening disposition and outcomes.

Autistic individuals exhibit differences in their use and understanding of nonverbal communication; however, individual patterns of nonverbal strengths and challenges vary significantly. This heterogeneity can complicate the diagnostic and screening processes and can result in delayed or missed diagnoses. In this study, we characterize various profiles of nonverbal communication skills among 215 pre-verbal children with autism (Mage = 36.27 months, range = 18-70) and explore how these profiles are related to screening outcomes, diagnostic certainty, and developmental and behavioral features. We conducted a latent class analysis of nine items assessing nonverbal communication skills from the Toddler Module and Module 1 of the Autism Diagnostic Observation Schedule, 2nd Edition. Five nonverbal profiles were identified that differentiated children based on the form, function, and frequency of their nonverbal communication skills. Furthermore, screening outcomes and clinician certainty in autism diagnosis varied by nonverbal profile. False negative screening outcomes based on parent report were highest for children who used a range of nonverbal skills but with limited frequency or consistency. Clinicians, on the other hand, tended to have high certainty in an autism diagnosis for children with this profile, and instead rated their lowest certainty in diagnosing children who demonstrated consistent integration of eye contact with their nonverbal communication. The profiles identified in this study could be clinically useful in helping to identify children at highest likelihood of being overlooked during the screening or diagnostic processes, providing an opportunity to improve early identification and intervention for autism.

The Role of Pathways Early Autism Intervention in Improving Social Skills and Respeto for Young Hispanic Autistic Children.

We know very little about Hispanic autistic children's response to intervention as, historically, Hispanic children are underrepresented in intervention studies. Pathways parent-mediated early autism intervention is one of the few naturalistic developmental behavioral interventions (NDBIs) that is contextually and linguistically responsive to Hispanic families. However, some child-centered NDBI strategies do not align with the Hispanic caregiving value of respeto. A child exhibiting respeto demonstrates affiliative obedience by displaying deference and respect toward adults. Furthermore, theories of the ontogeny of cultural learning suggest that certain levels of social development may be necessary to learn cultural values. The current study investigates (1) the relationship between Hispanic autistic children's social skills and affiliative obedience and (2) the efficacy of Pathways in improving affiliative obedience in Hispanic children. This quasi-experimental design study used preexisting standardized test data and video recordings from 26 Hispanic participants who took part in a previous Pathways efficacy study. Recordings were coded for affiliative obedience and social connectedness. Residual change variables were used to measure progress from baseline to post-intervention, and correlation and hierarchical regression analyses were conducted to analyze the data. We found significant positive correlations between social skills and children's affiliative obedience for baseline and change variables. In addition, we found Pathways had a significant medium-large magnitude effect on change in affiliative obedience skills. This study highlights the benefits of NDBI interventions that advance social development in autistic children and support Hispanic parents in enculturating their children in the value of respeto.

The Relationship Between Burnout and Job Satisfaction among Autism Early Intervention Centre Teachers

The Relationship Between Burnout and Job Satisfaction among Autism Early Intervention Centre Teachers

자폐 조기중재의 부모 코칭에 대한 사례 연구

This case study explores the factors that may influence the parent coaching fidelity and intervention fidelity in a parent-implemented intervention within the context of early intervention for autism. Drawing from Stahmer et al.’s (2020) research, the study involved one early intervention provider, two parents, and two toddlers either diagnosed with or at a high likelihood of autism. Video behavior coding was used as the primary method for data collection, focusing on (1) the duration spent on each coaching strategy, (2) the frequency of feedback types, and (3) the frequency of toddlers’ behaviors that were challenging to address. The study data, parent coaching fidelity, and intervention fidelity outcomes were analyzed and compared, and implications and recommendations for early intervention settings were summarized based on the results. The discussion focuses on the importance of adopting the implementation science framework for promoting effective parent coaching and parent-implemented intervention practices, the significance of support for early intervention providers and families, the need for factor analysis in studies with larger sample sizes to facilitate more statistically meaningful outcomes, and the importance of implementing cultural adaptation processes when introducing evidence-based parent-implemented intervention programs from other countries to South Korea.

Evidence-b(i)ased practice: Selective and inadequate reporting in early childhood autism intervention research.

When researchers fail to report their findings or only report some of their findings, it can make it difficult for clinicians to provide effective intervention recommendations. However, no one has examined whether this is a problem in studies of early childhood autism interventions. We studied how researchers that study early childhood autism interventions report their findings. We found that most researchers did not register their studies when they were supposed to (before the start of the study), and that many researchers did not provide all of the needed information in the registration. We also found that researchers frequently did not publish their findings when their studies were complete. When we looked at published reports, we found that many of the studies did not report enough information, and that many studies were reported differently from their registrations, suggesting that researchers were selectively reporting positive outcomes and ignoring or misrepresenting less positive outcomes. Because we found so much evidence that researchers are failing to report their findings quickly and correctly, we suggested some practical changes to make it better.

Interdisciplinary Competencies for Implementing NDBIs With Young Children With Autism and Other Social Communication Challenges

Over the past decade, a newer class of interventions has emerged specifically designed for young children with or at high likelihood of autism, which are called Naturalistic Developmental Behavioral Interventions (NDBIs). NDBIs are particularly well-suited as a discipline agnostic, primary intervention for young children with autism and other social communication challenges; however, community providers from multiple disciplinary backgrounds who serve these children typically do not develop competencies in areas crucial for effectively implementing NDBI. The goal of this commentary is to: (a) describe the interdisciplinary competencies needed to deliver NDBIs effectively and (b) provide recommendations for moving the field of early intervention for autism and social communication delays forward. Resources for building these competencies for providers at the pre- and in-service level are also provided.

Remote Intensive Intervention for Young Children on the Autism Spectrum During COVID-19: the Experience of Caregivers and Service Providers

ObjectivesCommunity-based early autism intervention programs in Geneva, Switzerland, converted their in-person services to a telehealth format during the COVID-19 home confinement period. The current study was aimed at measuring the engagement and satisfaction of service providers and caregivers as they experienced telehealth services for the first time and at monitoring child progress.MethodsForty-five families from diverse backgrounds and their 45 service providers had daily videoconferencing sessions of primarily parent-mediated intervention. Satisfaction questionnaires were completed at three time points over a 2-month period. Session frequency and program participation were recorded. Caregiver and service provider’s answers were compared. Results were also analyzed by family annual income. Child progress was monitored using the Early Start Denver Model Curriculum Checklist.ResultsCaregivers and service providers maintained high levels of participation and satisfaction throughout the telehealth service period and appreciated how the telehealth format allowed them to meet more frequently. Lower-income families tended to be more unanimously positive about the services when compared with mid- and high-income families. We found significant group differences in service providers’ and caregivers’ perceptions of each other’s comfort level with the remote sessions. Child progress followed a pattern of continued significant improvement across most developmental domains during the telehealth service period.ConclusionsThese findings underscore the potential of telehealth as a promising and appreciated approach for delivering intensive early autism interventions in community settings. Further research is needed to determine optimal session frequency for remote parent-mediated intervention and to determine ways to make telehealth services more accessible for low-income families.

Improving access to early intervention for autism: findings from a proof-of-principle cascaded task-sharing naturalistic developmental behavioural intervention in South Africa

BackgroundDespite the high number of children living with neurodevelopmental disabilities in sub–Saharan Africa, access to early intervention is almost non-existent. It is therefore important to develop feasible, scalable early autism intervention that can be integrated into systems of care. While Naturalistic Developmental Behavioural Intervention (NDBI) has emerged as an evidence-based intervention approach, implementation gaps exist globally, and task-sharing approaches may address access gaps. In this South African proof-of-principle pilot study, we set out to answer two questions about a 12-session cascaded task-sharing NDBI—whether the approach could be delivered with fidelity, and whether we could identify signals of change in child and caregiver outcomes.MethodsWe utilized a single-arm pre-post design. Fidelity (non-specialists, caregivers), caregiver outcomes (stress, sense of competence), and child outcomes (developmental, adaptive) were measured at baseline (T1) and follow-up (T2). Ten caregiver-child dyads and four non-specialists participated. Pre-to-post summary statistics were presented alongside individual trajectories. Non-parametric Wilcoxon signed rank test for paired samples was used to compare group medians between T1 and T2.ResultsCaregiver implementation fidelity increased in 10/10 participants. Non-specialists demonstrated a significant increase in coaching fidelity (increases in 7/10 dyads). Significant gains were seen on two Griffiths-III subscales (Language/Communication—9/10 improved, Foundations of Learning—10/10 improved) and on the General Developmental Quotient (9/10 improved). Significant gains were also seen on two Vineland Adaptive Behaviour Scales (Third Edition) subscales (Communication—9/10 improved, Socialization—6/10 improved) and in the Adaptive Behaviour Standard Score (9/10 improved). Caregiver sense of competence improved in 7/10 caregivers and caregiver stress in 6/10 caregivers.ConclusionsThis proof-of-principle pilot study of the first cascaded task-sharing NDBI in Sub-Saharan Africa provided fidelity and intervention outcome data which supported the potential of such approaches in low-resource contexts. Larger studies are needed to expand on the evidence-base and answer questions on intervention effectiveness and implementation outcomes.

Urinary aluminium and its association with autism spectrum disorder in urban preschool children in Malaysia.

The presence of aluminium (Al) in the human body may impact brain neurodevelopment and function, and it is thought to contribute to autism spectrum disease (ASD). The main objective of this study was to assess the association between urinary Al and the development of ASD among Malaysian preschool children in the urban city of Kuala Lumpur. This was an unmatched case-control study in which children with ASD were recruited from an autism early intervention center and typically developed (TD) children were recruited from government-run nurseries and preschools. Urine samples were collected at home, assembled temporarily at study locations, and transported to the laboratory within 24 h. The Al concentration in the children's urine samples was determined using inductively coupled plasma mass spectrometry (ICP-MS). A total of 155 preschool children; 81 ASD children and 74 TD children, aged 3 to 6 years, were enlisted in the study. This study demonstrated that ASD children had significantly higher urinary Al levels than TD children (median (interquartile range (IQR): 2.89 (6.77) µg/dL versus 0.96 (2.95) µg/dL) (p<0.001). Higher parental education level, non-Malay ethnicity, male gender, and higher urinary Al level were the significant ASD risk factors (adjusted odds ratio (aOR) >1, p<0.05). A higher urine Al level was discovered to be a significant risk factor for ASD among preschool children in the urban area of Kuala Lumpur, Malaysia.

Knowledge and reported use of evidence-based practices by early intervention professionals working with autistic children in Saudi Arabia

BackgroundThis study examined early intervention professionals’ attitudes towards, knowledge and reported use of evidence-based practices for autistic children in Saudi Arabia. MethodAn online survey was completed by 173 early intervention professionals working directly with autistic children (under the age of six years) in early intervention programs at public and private nursery schools/ day-care centres in all provinces of Saudi Arabia. ResultsParticipants reported greater use of evidence-based practices than emerging and unsupported practices. However, some evidence-based practices (EBPs) were reported to be used infrequently - less than once per week on average. Unsupported practices were also reported to be used more frequently than emerging practices. Participants were more likely to report using EBPs when they had more knowledge of EBPs, they said that they would have a higher level of willingness to use EBPs if it was required by authorities, and the location of their school/centre was a major city. Participants were also more likely to report using emerging practices when they had less knowledge of EBPs and more knowledge of emerging practices. A similar pattern was also found for unsupported practices. The most reported used sources of information on early intervention practices were other teachers, professional development inside the workplace, and general web searches. Research literature was one of the reported least commonly accessed sources of information. ConclusionsThese results add to the scant Saudi literature investigating autism early intervention practices, highlighting the knowledge and reported use by professionals of these practices. The implications of these findings for the facilitation of knowledge transfer into practice are discussed.

Examining Cultural and Linguistic Sensitivity of Pathways Early Autism Intervention with Hispanic Families.

This research aimed to evaluate evidence of Pathways parent-mediated early autism intervention as a culturally and linguistically sensitive intervention (CLSI) for Hispanic families with autistic children. We used Bernal et al.'s ecologically valid (EV) framework to evaluate current practice and Hispanic parents' perceptions of Pathways 1 ½ years after completing the intervention. Both quantitative and qualitative methods were used. Nineteen parents were contacted, of which 11 completed a semi-structured interview about their experience with Pathways. On average, the group that completed the interview was less educated, had more monolingual Spanish speakers, and rated their general experience with the intervention slightly more positively than those who did not agree to complete the interview. A review of Pathways's current practices through the lens of the EV framework suggested that Pathways was a CLSI for Hispanic participants in the domains of context, methods, language, and persons. Parental interviews echoed these strengths. However, Pathways did less well balancing evidence-based intervention strategies for autistic children with the heritage value of respeto. Pathways demonstrated strengths regarding cultural and linguistic sensitivity for Hispanic families with young autistic children. Future work with our community stakeholder group will integrate heritage and majority culture perspectives to strengthen Pathways as a CLSI.

Professional Development and Use of Evidence-Based Practice in Autism Early Intervention

We investigated the experiences of Australian autism early intervention service providers, including the professional development they receive on the job and how they translate research evidence into their practice. Semi-structured interviews were conducted with 15 providers drawn from three locations. Participants described the crucial role of paraprofessionals in early intervention services, and indicated that, within multidisciplinary teams, allied health professionals, and teachers are the ones who select intervention practices and upskill paraprofessionals. Furthermore, participants reported using practices supported by research evidence, but also some emerging and unsupported practices. The use of unsupported practices is examined in light of the daily challenges faced by centers. Results may inform further professional development in early intervention services for children on the autism spectrum, to support the best possible outcomes for this population. The findings highlight the potential need for job-embedded hands-on professional development conducted in real time.

Assessing the quality of care and service trajectories in autism from families’ perspective: Early intervention and interim services

BackgroundFollowing the Evaluation of the Autism Trajectory for Parents – Diagnostic Services (ETAP-1), the ETAP-2 instrument was created to assess the quality of the post-diagnostic phase of the care and service trajectory of families of children with autism. The instrument, based on an integrated care perspective, was developed with the input of multiple stakeholders (parents, service providers, researchers). AimsThis study sought to evaluate the factor structure, reliability, and convergent and discriminant validity of ETAP-2. Methods and proceduresParents (N = 197) of children recently diagnosed with autism (M = 5.1 years) were recruited from an assessment center and organizations providing early behavioral intervention and other supports for autism in the province of Québec, Canada. They completed the ETAP-2 questionnaire along with measures of satisfaction and family quality of life. Outcomes and resultsThe instrument presented a five-construct structure generally consistent with previously identified dimensions of quality, except for three items previously associated with the continuity of the service trajectory. ETAP-2 had excellent internal consistency and demonstrated convergent and discriminant validity with other measures. Conclusions and implicationsETAP-2 is a brief parent-report measure with good psychometric properties. It can assist in gathering information on families’ perception and experiences with early intervention and other post-diagnostic, interim services.

Taking an evidence-based child- and family-centered perspective on early autism intervention.

Taking an evidence-based child- and family-centered perspective on early autism intervention.

Video-Feedback Approach Improves Parental Compliance to Early Behavioral Interventions in Children with Autism Spectrum Disorders during the COVID-19 Pandemic: A Pilot Investigation.

In the field of autism intervention, a large amount of evidence has demonstrated that parent-mediated interventions are effective in promoting a child's learning and parent caring skills. Furthermore, remote delivery treatments are feasible and can represent a promising opportunity to reach families at distance with positive results. Recently, the sudden outbreak of COVID-19 dramatically disrupted intervention services for autism and forced an immediate reorganization of the territory services toward tele-assisted intervention programs, according to professional and local resources. Our study aimed to conduct a retrospective pilot exploratory investigation on parental compliance, participation, and satisfaction in relation to three different telehealth intervention modalities, such as video feedback, live streaming, and psychoeducation, implemented in the context of a public community setting delivering early autism intervention during the COVID-19 emergency. We found that parents who attended video feedback expressed the highest rate of compliance and participation, while parental psychoeducation showed significantly lower compliance and the highest drop-out rate. Regardless of the tele-assistance modality, all the participants expressed satisfaction with the telehealth experience, finding it useful and effective. Potential benefits and advantages of different remote modalities with reference to parent involvement and effectiveness are important aspects to be taken into account and should be further investigated in future studies.

Pragmatic contributions to early vocabulary and social communication in young autistic children with language and cognitive delays

IntroductionThere are limited data on the interrelationships among pragmatic skills and expressive vocabulary and their contribution to later social communication. Understanding these relationships could inform developmental processes and early intervention strategies. This study explored the relationship among pragmatics skills (i.e., communicative intents and responding to parents’ preceding utterances) and concurrent expressive vocabulary as well as the predictive nature of these skills on later social communication in young autistic children with language and cognitive delays. MethodData from 56 autistic children (age 18–57 months) who participated in a larger randomized control trial of Pathways Early Autism Intervention were used in this secondary analysis. Video recordings of pre-intervention (Time 1) parent–child interactions were analyzed for number of different words (NDW; expressive vocabulary), number of different (ND) communicative intents, and response to parents’ preceding utterances. Residual scores from an assessment of social communication were used to measure Time 2 social communication. First-order correlations and hierarchical regression were used for analyses. ResultsAdjusting for age and receptive language, both ND communicative intents and response to parents’ preceding utterances were associated with pre-intervention NDW. Further, adjusting for receptive language age and intervention group, NDW and response to parents’ preceding utterances – but not ND communicative intents—was related to Time 2 social communication. NDW, however, was no longer related to Time 2 social communication skills after accounting for response to parents’ preceding utterances. ConclusionsThis study provides evidence that autistic children with language and cognitive delays use their expressive vocabularies to respond, hence allocating attention to parent speech, a rudimentary form of social orienting. Our results support approaches to intervention that leverage responding as a rudimentary form of social orienting while encouraging more mature forms of social attention (i.e., social orienting to faces and joint attention) within developmentally appropriate activities, such as routines.

Further evaluation of functional analysis screening methods in early autism intervention.

A goal of some functional analysis (FA) variations is to reduce assessment time while still maintaining efficacy. This may be especially important when conducting FAs in early intervention programs, where time is a crucial commodity. To that end, we evaluated a model for using the results of the no-interaction condition as a screening for behavioral function and to guide selection of FA test conditions with 20 participants (22 assessments) aged 3 to 7 years old. We used the no-interaction condition to develop hypotheses for both automatic reinforcement and socially mediated reinforcement. The outcome of the no-interaction condition guided the selection of test conditions for the remainder of the FA. We also incorporated methods from prior FA studies (e.g., divided attention) to modify the test conditions. We obtained differentiated results in 91% of assessments, all within 70 min and, as such, extended evidence that an FA can be completed in little time without sacrificing efficacy.

Cripping vulnerability: A disability bioethics approach to the case of early autism interventions

The relationships between neurodivergent and disabled communities, and healthcare practices, are marked by ambivalence. While there is a history of harmful and discriminatory practices, the clinical encounter also holds beneficial and empowering potential for neurodivergent and disabled people. To address this ambivalence, this paper’s central question is whether and how bioethical decision-making in healthcare settings can become more informed by critical insights from neurodiversity and disability studies. The bioethical debate in Western countries on early interventions for young autistic children will be the case animating my theoretical propositions. I provide a working definition of such a ‘disability approach to bioethics’ and review the obstacles in both mainstream bioethics and disability studies this approach has to overcome. Then, the ethical concept of vulnerability, its feminist reinterpretation, and its potential for disability bioethics are introduced. Instead of using the concept in its traditional, problematic sense, I propose that vulnerability can be reclaimed, or cripped, by neurodiversity and disability movements to do the exact opposite: to trouble the demarcation between the vulnerable and the invulnerable, to stress structural injustices over individual deficits, and to justify solidaristic, empowering interventions over paternalist ones. Finally, this ‘cripped account of vulnerability’ will be applied to the case of early autism intervention.

Early Intervention in Autism Spectrum Disorder

Abstract. Early intervention in autism has become possible with the identification of this disorder at earlier ages, but the scientific production on this subject is still very incipient. The present study aimed to characterize scientific production in Brazil regarding early intervention in the Autism Spectrum Disorder (ASD), resorting to the database of the Capes Journal Platform ( Plataforma de Periódicos Capes). The procedure used for the theoretical search was an integrative literature review. The discussion on the analysis of the review occurred with the inclusion of articles published in Portuguese, between 2001 and 2020, with the keywords: “intervention”, “early” and “autism.” As a result, a total of 83 texts were found. Of this total, 65 articles were published in peer-reviewed journals and made available as an online resource on the Capes Journal Platform. In the next phase of data analysis, we decided to categorize the articles included in the search process ( N = 25), based on the following categories: “autism” (19) and “early autism intervention” (6). A very low percentage of publications related to this topic were identified in the search universe, although an increase in studies has been observed in recent years. Nonetheless, we concluded that the six articles on early intervention agree that the sooner the disorder is diagnosed and the child is stimulated, the greater the effectiveness in the development of communication and language, as well as social interaction.