Early intervention can improve core symptoms of ASD in young children: Study

Kennedy Krieger InstituteDec 17 2010

In a study recently published in the Journal of Child Psychology and Psychiatry (Epub ahead of print), researchers from the Kennedy Krieger Institute found that early intervention can improve the core symptoms of autism spectrum disorders (ASD) in very young children. This is the first randomized clinical trial measuring how a group-based early intervention model impacts social development in toddlers with ASD. The most significant improvements were found in how the children connected and socialized with others, a defining stumbling block for children with autism.

The development of group-based, empirically-validated intervention models is critical to increasing access to autism services for toddlers because they are more easily and affordably replicated than intensive one-on-one intervention models. Group-based interventions also offer children with autism more opportunities for social interaction. Because early social development is a major predictor of outcomes for children with ASD, the researchers at Kennedy Krieger aimed to improve social and communication skills through a comprehensive, behavioral intervention program targeting social development.

"We placed a heavy focus on the ability of toddlers to pay attention to other people's actions and communication behaviors and prepare them to respond and initiate with others in socially appropriate ways," said Rebecca Landa, PhD, CCC-SLP, lead study author and director of Kennedy Krieger's Center for Autism and Related Disorders. "This is critically important because it opens the door to ongoing learning opportunities for toddlers with ASD. When toddlers are attuned to people, people are more motivated to stay engaged with them. Additionally, children learn through imitating others. The ability to connect with peers through imitation can open the door to acceptance and being chosen as a playmate in the classroom or on the playground, for example."

Participants included two groups of 24 toddlers with ASD, ages 21 to 33 months, who received identical intervention for six months. However, one group received a greater number of orchestrated opportunities for social engagement. Social improvements were measured by:
•Changes in socially engaged imitation: imitating others' actions while indicating their social connectedness through eye contact
•Initiating joint attention: gaining others' attention for the purely social purpose of sharing - showing something, giving something
•Affect sharing: sharing emotions with others through facial expressions paired with eye contact, expressed as simply as the child looking at you and smiling.

Researchers found that intervention led to improvements in both groups. However, the most significant finding was that the children who received more of the socially-directed intervention developed greater socially engaged imitation, which increased from 17 percent of imitated acts being paired with eye contact to 42 percent. This skill was generalized, or carried over into "real life" outside the classroom, and maintained through the six-month follow-up. Similar improvements were observed in the group for initiation of joint attention (pointing out things of interest, showing and giving for social purposes) and shared positive affect (smiling paired with eye contact). Specifically, how frequently toddlers initiated joint attention more than tripled from pre- to post- treatment, and the shared positive affect more than doubled. Overall, the children receiving the socially-directed intervention made 10 months of non-verbal cognitive gains in only six months time when compared to the other group.

The second most significant finding was that toddlers in both groups made improvements in expressive language (spoken language), with the greatest gains occurring during the time that the intervention was occurring. This indicates that the improvement was due to the intervention.

Researchers are hopeful that the group-based socially-directed early intervention model can achieve similar social skills gains in older children. Kennedy Krieger researchers have applied for funding to adapt the intervention for preschoolers.