title: Outcome for Children with Autism who Began Intensive Behavioral Treatment Between Ages 4 and 7 Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial Intensive Behavioral Treatment at School for 4- to 7-Year-Old Children with Autism Early intensive behavioral intervention: outcomes for children with autism and their parents after two years. Early Intensive Behavioral Treatment: Replication of the UCLA Model in a Community Setting A controlled trial of a training course for parents of children with suspected autism spectrum disorder. A pilot study of the effects of a social-pragmatic intervention on the communication and symbolic play of children with autism A new social communication intervention for children with autism: pilot randomised controlled treatment study suggesting effectiveness. Cognitive, behavior and intervention outcome in young children with autism.
abstract: This study extends findings on the effects of intensive applied behavior analytic treatment for children with autism who began treatment at a mean age of 5.5 years . The  behavioral treatment group ( n = 13 , 8 boys ) was compared to an  eclectic treatment group ( n = 12 , 11 boys ) . Assignment to groups was made independently based on the availability of qualified supervisors . Both behavioral and eclectic treatment took place in public kindergartens and elementary schools for typically developing children . At a mean age of 8 years , 2 months , the behavioral treatment group showed larger increases in IQ and adaptive functioning than did the eclectic group . The behavioral treatment group also displayed fewer aberrant behaviors and social problems at follow-up . Results suggest that behavioral treatment was effective for children with autism in the study OBJECTIVE : To conduct a r and omized , controlled trial to evaluate the efficacy of the Early Start Denver Model ( ESDM ) , a comprehensive developmental behavioral intervention , for improving outcomes of toddlers diagnosed with autism spectrum disorder ( ASD ) . METHODS : Forty-eight children diagnosed with ASD between 18 and 30 months of age were r and omly assigned to 1 of 2 groups : ( 1 ) ESDM intervention , which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents for 2 years ; or ( 2 ) referral to community providers for intervention commonly available in the community . RESULTS : Compared with children who received community-intervention , children who received ESDM showed significant improvements in IQ , adaptive behavior , and autism diagnosis . Two years after entering intervention , the ESDM group on average improved 17.6 st and ard score points ( 1 SD : 15 points ) compared with 7.0 points in the comparison group relative to baseline scores . The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children . In contrast , over the 2-year span , the comparison group showed greater delays in adaptive behavior . Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder , not otherwise specified , than the comparison group . CONCLUSIONS : This is the first r and omized , controlled trial to demonstrate the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis . Results of this study underscore the importance of early detection of and intervention in autism Summary Background Results of small trials suggest that early interventions for social communication are effective for the treatment of autism in children . We therefore investigated the efficacy of such an intervention in a larger trial . Methods Children with core autism ( aged 2 years to 4 years and 11 months ) were r and omly assigned in a one-to-one ratio to a parent-mediated communication-focused ( Preschool Autism Communication Trial [ PACT ] ) intervention or treatment as usual at three specialist centres in the UK . Those assigned to PACT were also given treatment as usual . R and omisation was by use of minimisation of probability in the marginal distribution of treatment centre , age ( ≤42 months or > 42 months ) , and autism severity ( Autism Diagnostic Observation Schedule-Generic [ ADOS-G ] algorithm score 12–17 or 18–24 ) . Primary outcome was severity of autism symptoms ( a total score of social communication algorithm items from ADOS-G , higher score indicating greater severity ) at 13 months . Complementary secondary outcomes were measures of parent-child interaction , child language , and adaptive functioning in school . Analysis was by intention to treat . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N58133827 . Results 152 children were recruited . 77 were assigned to PACT ( London [ n=26 ] , Manchester [ n=26 ] , and Newcastle [ n=25 ] ) ; and 75 to treatment as usual ( London [ n=26 ] , Manchester [ n=26 ] , and Newcastle [ n=23 ] ) . At the 13-month endpoint , the severity of symptoms was reduced by 3·9 points ( SD 4·7 ) on the ADOS-G algorithm in the group assigned to PACT , and 2·9 ( 3·9 ) in the group assigned to treatment as usual , representing a between-group effect size of −0·24 ( 95 % CI −0·59 to 0·11 ) , after adjustment for centre , sex , socioeconomic status , age , and verbal and non-verbal abilities . Treatment effect was positive for parental synchronous response to child ( 1·22 , 0·85 to 1·59 ) , child initiations with parent ( 0·41 , 0·08 to 0·74 ) , and for parent-child shared attention ( 0·33 , −0·02 to 0·68 ) . Effects on directly assessed language and adaptive functioning in school were small . Interpretation On the basis of our findings , we can not recommend the addition of the PACT intervention to treatment as usual for the reduction of autism symptoms ; however , a clear benefit was noted for parent-child dyadic social communication . Funding UK Medical Research Council , and UK Department for Children , Schools and Families This study was design ed to evaluate 1 year of intensive treatment for 4- to 7-year-old children with autism . An independent clinician assigned children to either  behavioral treatment  ( n = 13 ) or eclectic treatment  ( n = 12 ) . Assignment was based on availability of personnel to supervise treatment and was not influenced by child characteristics or family preference . The two treatment groups received similar amounts of treatment ( M = 28.52 hours per week at the child ’s school ) . Children in the behavioral treatment group made significantly larger gains on st and ardized tests than did children in the eclectic treatment group . Results suggest that some 4- to 7-year-olds may make large gains with  intensive behavioral treatment  , that such treatment can be successfully implemented in school setting s , and that specific aspects of behavioral treatment ( not just its intensity ) may account for favorable outcomes An intervention group ( n=23 ) of preschool children with autism was identified on the basis of parent preference for early intensive behavioral intervention  and a comparison group ( n=21 ) identified as receiving treatment as usual .  Prospect i ve assessment was undertaken before treatment , after 1 year of treatment , and again after 2 years . Groups did not differ on assessment s at baseline but after 2 years , robust differences favoring intensive behavioral intervention were observed on measures of intelligence , language , daily living skills , positive social behavior , and a statistical measure of best outcome for individual children . Measures of parental well-being , obtained at the same three time points , produced no evidence that behavioral intervention created increased problems for either mothers or fathers of children receiving it ABSTRACT . Although previous studies have shown favorable results with early intensive behavioral treatment ( EIBT ) for children with autism , it remains important to replicate these findings , particularly in community setting s. The authors conducted a 3-year prospect i ve outcome study that compared 2 groups : ( 1 ) 21 children who received 35 to 40 hours per week of EIBT from a community agency that replicated Lovaas ' model of EIBT and ( 2 ) 21 age- and IQ-matched children in special education classes at local public schools . A quasi-experimental design was used , with assignment to groups based on parental preference . Assessment s were conducted by independent examiners for IQ ( Bayley Scales of Infant Development or Wechsler Preschool and Primary Scales of Intelligence ) , language ( Reynell Developmental Language Scales ) , nonverbal skill ( Merrill-Palmer Scale of Mental Tests ) , and adaptive behavior ( Vinel and Adaptive Behavior Scales ) . Analyses of covariance , with baseline scores as covariates and Year 1 - 3 assessment s as repeated measures , revealed that , with treatment , the EIBT group obtained significantly higher IQ ( F = 5.21 , p = .03 ) and adaptive behavior scores ( F = 7.84 , p = .01 ) than did the comparison group . No difference between groups was found in either language comprehension ( F = 3.82 , p = .06 ) or nonverbal skill . Six of the 21 EIBT children were fully included into regular education without assistance at Year 3 , and 11 others were included with support ; in contrast , only 1 comparison child was placed primarily in regular education . Although the study was limited by the nonr and om assignment to groups , it does provide evidence that EIBT can be successfully implemented in a community setting OBJECTIVE To evaluate a training course for parents , design ed to help them underst and autism spectrum disorder and to facilitate social communication with their young child . STUDY DESIGN Controlled trial for 51 children aged 24 to 48 months , whose parents received either immediate intervention or delayed access to the course .  Outcome was measured 7 months after recruitment in parents ' use of facilitative strategies , stress , adaptation to the child ; and in children 's vocabulary size , behavior problems , and social communication skills . RESULTS Taking into account scores at recruitment , child 's level of ability , diagnostic grouping , and the interval between assessment s , a significant advantage was found for the intervention group in parents ' observed use of facilitative strategies and in children 's vocabulary size . CONCLUSIONS The training course is well received by parents and has a measurable effect on both parents ' and children 's communication skills The acquisition of social communication skills is a major challenge faced by children with autism . This pilot study investigated the effects of the Stronger Families Project , a social-pragmatic intervention , on the communication and symbolic abilities of 16 children aged 2–4 years with autism . St and ardized measures of the child 's communication and symbolic behaviour were conducted by independent observers at a university clinic pre and post-intervention , and parents were interviewed to determine the impact of variables such as maternal stress and competence on the child 's social communication . Changes in some communication and symbolic behaviours occurred following the Stronger Families Project intervention according to parent report . However , improvements based on ratings by independent observers were not significant . Results are discussed in relation to the assessment of changes in the social communication and symbolic play of children with autism following intervention using clinical observation and parent report BACKGROUND Psychosocial treatments are the mainstay of management of autism in the UK but there is a notable lack of a systematic evidence base for their effectiveness . R and omised controlled trial ( RCT ) studies in this area have been rare but are essential because of the developmental heterogeneity of the disorder . We aim ed to test a new theoretically based social communication intervention targeting parental communication in a r and omised design against routine care alone . METHODS The intervention was given in addition to existing care and involved regular monthly therapist contact for 6 months with a further 6 months of 2-monthly consolidation sessions . It aim ed to educate parents and train them in adapted communication tailored to their child 's individual competencies . Twenty-eight children with autism were r and omised between this treatment and routine care alone , stratified for age and baseline severity . Outcome was measured at 12 months from commencement of intervention , using st and ardised instruments . RESULTS All cases studied met full Autism Diagnostic Interview ( ADI ) criteria for classical autism . Treatment and controls had similar routine care during the study period and there were no study dropouts after treatment had started . The active treatment group showed significant improvement compared with controls on the primary outcome measure -- Autism Diagnostic Observation Schedule ( ADOS ) total score , particularly in reciprocal social interaction-- and on secondary measures of expressive language , communicative initiation and parent-child interaction . Suggestive but non-significant results were found in Vinel and Adaptive Behaviour Scales ( Communication Sub-domain ) and ADOS stereotyped and restricted behaviour domain . CONCLUSIONS A R and omised Treatment Trial design of this kind in classical autism is feasible and acceptable to patients . This pilot study suggests significant additional treatment benefits following a targeted ( but relatively non-intensive ) dyadic social communication treatment , when compared with routine care . The study needs replication on larger and independent sample s. It should encourage further RCT design s in this area UNLABELLED The relations between cognition and autism severity , head size and intervention outcome , were examined . Change in cognitive level with intervention was measured in children with autism and compared to children with developmental disabilities ( DD ) . Eighty-one children ( mean age 25.9 months ) with autism ( n=44 ) and DD ( n=37 ) were assessed at pre- and post 1 year of intervention . Cognitive abilities and autism severity were measured by st and ardized tests . Three pre-intervention cognitive level groups : normal ( IQ>90 ) , borderline ( 70<IQ<89 ) and impaired ( 50<IQ<69 ) were examined . The impaired group had more severe autism symptoms than the borderline and the normal cognitive groups . However , following intervention the groups did not differ in the change in core autism symptoms . IQ scores increased significantly more in the autism group than in the DD group . IQ improvements correlated significantly with reduction in autism symptoms and mostly in stereotyped behaviors . CONCLUSIONS Cognitive ability in autism is associated with autism severity . Two distinct subtypes based on cognitive level are identified . However , baseline cognitive level can not predict the progress rate in autism symptoms with intervention . Improvement of social-communicative behaviors and the intensive intervention are related to significant cognitive increments in autism
target: 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 .
background: CONTEXT : Early intensive behavioral and developmental interventions for young children with autism spectrum disorders ( ASDs ) may enhance developmental outcomes .
  OBJECTIVE : To systematic ally review evidence regarding such interventions for children aged 12 and younger with ASDs .