Early Intervention

Boyd, B.A., Odom, S.L., Humphreys, B.P., & Sam, A.M. (2010). Infants and toddlers with autism spectrum disorder: Early identification and early intervention. Journal of Early Intervention, 32(2), 75-98.

The prevalence of young children who are identified as having Autism Spectrum Disorder has increased significantly since the mid-1980s. This increase is thought to be due to several contributing factors, including: 1) an increase in early diagnosis, 2) a research base that has identified autism as a spectrum disorder, which has allowed children with milder characteristics to be diagnosed with ASD, 3) an increase in diagnoses of pervasive developmental disorders-not otherwise specified, 4) the appearance of an educational eligibility classification for autism, and 5) an increase in public awareness of autism and the characteristics of autism. These characteristics include impaired social interaction and the inability to develop and maintain social relationships, impaired language and communication development, and the appearance of restrictive and repetitive behaviors. In their review of the current literature, the authors found that early identification of children with autism has increased due to heightened general awareness of warning signs of autism, availability of more effective screening and diagnostic tools, and a greater understanding that a stable diagnosis of autism can be made at around two years of age. The authors indicated that while the increase in early diagnosis is beneficial, it is critical that early diagnosis be coupled with the provision of high quality evidence-based services for children with an early diagnosis of autism and their families. These practices may include a variety of focused intervention practices and comprehensive treatment models. The authors summarize these practices, but they are quick to point out the limitations of the current research base and encourage further research of these practices with infants, toddlers, and younger preschool children. The authors conclude this article by describing that a shift in focus has occurred with regard to assisting young children with autism and their families. In the past, the emphasis was primarily on early identification, now the emphasis is on how to best implement evidence-based practices and provide access to appropriate services when children have received an early diagnosis of ASD. In response to this shift in focus, the authors advocate improvement in the structures and policies that currently govern service delivery for young children with autism.

Friedman, M. & Woods, J. (2012). Caregiver coaching strategies for early intervention providers: Moving toward operational definitions. Infants & Young Children, 25(1), 62-82.

While early intervention (EI) is a family-focused process focused on improving outcomes for children, coaching is a new trend that expands EI to helping improve outcomes for caregivers as well. Coaching does this by increasing caregiver competence and confidence so that caregivers can work on skills throughout the day and in a variety of environments. The authors of this article suggest that early intervention providers may not be aware of how to effectively provide coaching to caregivers. The authors also recommend that early intervention providers consider caregivers as adult learners and apply adult learning principles to improving outcomes and teaching skills. In other words, early interventionists should understand that caregivers learn best when provided with personalized information that is provided in the context of real life situations. Implementation of coaching strategies can be difficult, however, and can vary greatly from professional to professional. In order to understand more about how coaching is implemented, videos from a wide variety of early intervention disciplines and therapy sessions were analyzed. From the videos, coders were able to identify the following distinct strategies of the sessions: conversation and information sharing, observation, demonstrating, direct teaching, guided practice with feedback, caregiver practice with feedback, joint interaction, problem solving and reflection, and child-focused. Providing operational definitions such as these may improve consistency in the application of coaching from provider to provider and session to session, as well as be instrumental in improving professional development standards for early intervention providers, administrators, and the families served through EI.

Matson, J.L. & Konst, M.J. (2013). What is the evidence for long term effects of early autism interventions? Research in Autism Spectrum Disorders, (7), 475-479.

In this review, 22 studies evaluating Early Intensive Behavior Intervention (EIBI) that included follow-up were examined to determine the long-term efficacy of this intervention. EIBI is defined as 20-40 hours of intervention per week for roughly one year. While it is clear in the research that EIBI is superior to any other intervention, only 3 studies followed children and assessed core symptoms of ASD after treatment terminated from 1 year to 9 years later. Other studies included in the review lacked true follow-up data. The majority of questions from the review surrounded type and location of curriculum (home / school), evaluation methods, start, length, and intensity of treatment. While there are many benefits to EIBI, the data does not currently support any claim that EIBI has a long-term benefit. The authors state an urgent need for EIBI-based research with long-term follow-up data.

Rush, D.D., Shelden, M.L., & Hanft, B.E. (2003). Coaching families and colleagues: A process for collaboration in natural settings. Infants & Young Children, 16(1), 33-47.

Coaching is an effective tool for many educational processes and activities, including early intervention. Early intervention has changed dramatically over the years and has moved towards a family-centered process that uses evidence-based practices and is implemented in natural environments. Coaching in early intervention suggests that providers should become collaborative partners with family members and other key professionals, such as child care providers, in order to share knowledge and help teach the child new skills. Through collaboration, family members and caregivers develop the confidence and skills needed to help the child in any environment. Coaching focuses on the exchange of information between the provider and the family members or caregivers and includes: a collaborative and voluntary relationship between providers and learners (family members and caregivers), taking small steps towards a goal, helping the learner master a skill before moving on, providing encouragement, using mutual problem-solving strategies and active reflection processes. While coaching is not a linear process, it does include the following steps: initiation (or the creation of learning opportunities), observation, action (teaching or modeling skills), reflection (or evaluation), and continuation or resolution (continuing to find learner opportunities, moving on to other skills listed in the IFSP, or no longer needs services.) Coaching works best with a primary service provider model. In other words, only one provider is the ‘coach’ throughout this process, although early interventionists are expected to work closely with colleagues in other disciplines through meetings, video-taping, and special seminars.

Strain, P., Schwartz, I., & Barton, E.E. (2011). Providing interventions for young children with Autism Spectrum Disorders: What we still need to accomplish. Journal of Early Intervention, 33, 321.

This study examines the use of public school programs utilizing evidence-based practices to improve outcomes for young children with ASD. A review of previous studies demonstrates that: intervention should begin when ASD is suspected (not diagnosed), interventions should be provided by highly skilled staff in a consistent manner with multiple and embedded learning opportunities using a comprehensive curriculum that includes a functional approach to behavior, and interventions should be implemented alongside typically developing peers and should include family input. Given the changes in the field of ASD, the authors also reviewed meaningful goals and outcomes for children and these often included: functional behaviors, participation-based skills, developmentally appropriate skills, social skills, family input, and generalization and maintenance of skills. The authors suggest that the focus of the next generation should be on training staff members and families, improving quality of life, improving support for families, and finally, continuing to research better methods and interventions for children who are not responding to evidence-based practices.

Wise, M.D., Little, A.A., Holliman, J.B., Wise, P.H., & Wang, C.J. (2010). Can state early intervention programs meet the increased demand of children suspected of having autism spectrum disorders? Journal of Developmental & Behavioral Pediatrics, 31(6), 469-76.

Across the United States, early intervention, or Part C services, have been significantly strained by the increased need for services for infants and toddlers with ASD. At the same time, funding for early intervention in many states has been drastically reduced, impacting services and creating provider shortages among behavioral therapists, speech-language pathologists, and occupational therapists. As healthcare providers increase screening and surveillance of infants and toddlers, more demand has been placed on early intervention programs to provide intensive interventions for those diagnosed with ASD. Each state’s early intervention program is coordinated differently, thus services can be drastically different from state to state. Due to funding issues and provider shortages, most young children in early intervention receive 5 hours of services or less per week and only four states reported that children with ASD receive more than 20 hours a week. The National Research Council suggests 25 hours of behavioral intervention a week, an amount very few children are actually receiving. As a result, the study suggests more resources will be needed to address the provider shortages and to increase the services available for the growing number of infants and toddlers diagnosed with ASD.