HOW GOOD IS THE EVIDENCE FOR EARLY INTERVENTIONS IN AUTISM

1
HOW GOOD IS THE EVIDENCE FOR EARLY INTERVENTIONS
IN AUTISM

• Can treatment result in recovery from autism?
• Is early intervention effective for children with
  autism
• Which treatments work with which children?

2
Can treatment result in recovery from autism?

• Despite claims most information is

• Anecdotal
• Non-independent
• Short term
• Often exaggerated
• Sometimes untrue

3
Interventions claiming significant effects or
recovery from autism

• Diet/Vitamins
• Intensive behavioural
• Daily Living Therapy
• Psychoanalysis
• Sensory integration
• Options
• Pet therapy
• Holding therapy

• Cranial osteopathy
• Chelation therapy (including magic baths)
• Secretin
• Dissipation of electrical charges

4
Research adequacy of most treatments poor New
York Health Dept review, 1999
5
Conclusions limited New York Helath Review,
1999 Maine review, 2000)

• Strongly discouraged
• facilitated communication secretin
• No advantages not recommended,
• Auditory/sensory integration vitamins, diets
• To be used with caution
• Medication
• No evidence
• most , thus impossible to inform parents/
  professionals whether treatment does, or does
  not, work

6
Early Intensive Behavioral Intervention (EIBI).

• Claims recovery from autism
• Significant increases in IQ (up to 30 points)
• Around 40 of cases indistinguishable from
  normal peers
• However, replication studies more cautious

7
Social skills strategies

• Social scripts
• Structured play
• Social rules
• Self awareness
• Social stories
• Theory of mind

EVIDENCE so far improvements limited to tasks
taught little generalization to new
skills/environments
8
Communication programmes

• TEACCH / Early Bird
• Mostly anecdotal, or small scale.
• Gains reported in child behaviour, parent
  satisfaction, cognitive and language level, some
  generalisation to non-treatment settings

• Small scale RCTS
• Hanen
• Pre-school Autism Communication Treatment (PACT)
  
• Responsive Education Pre-Linguistic Milieu
  Teaching (RPMT))
• Positive impact on language social
  communication not to other skills

9
PECS

• Independent studies (eg Magiati and Howlin)
  indicate improvements in use of PECS not speech
• 2 recent RCTs Increases in initiations and
  requesting using PECS
• No change in speech

10
Which treatments work with which children?

• Early behavioural/educational interventions the
  best option for children with autism -
• But no evidence in favour of any one
• approach
• level of intensity
• degree of structure
• or
• subgroup of children

11
Predictors of outcome in 18 ABA studies
12
Conclusions

• Lack of RCTs remains a major problem in the
  field as a whole.
• Increasing evidence of highly specific response
  of children with autism to interventions
• what you teach is what you get!
• Need to
• Match treatments to individual needs.
• Determine what components of any intervention are
  most effective
• Identify which subgroups of children respond best
• Explore mediators and moderators of treatment
  effectiveness.

13
HOW GOOD IS THE EVIDENCE FOR EARLY INTERVENTIONS
IN AUTISM

• Can treatment result in recovery from autism?
• Is early intervention effective for children with
  autism
• Which treatments work with which children?

No
Yes
???