The Critical Role of Early Intervention in Autism Spectrum Disorders
Autism Spectrum Disorders (ASD) are a grouping of several disorders characterized by social-language deficits and a limited behavioral repertoire. Symptoms of ASD generally become apparent in children by 24 to 36 months, but studies have shown that some children with ASD can be identified as early as 12 to 18 months of age. ASD is also a condition that has shown a dramatic increase in the number of children affected over the past ten years, such that the occurrence has recently been quoted as high as 1:88 children. There are still many unknowns regarding ASD, such as what causes it, but there is one area that has little debate. That is, the early identification and systematic treatment of ASD can have a profound effect on a child’s overall development. There is much research and scientific evidence validating that children with autism have a greater chance for successful outcomes when interventions are started at an early age (before 5 years of age). Recent research has revealed that early intervention can actually help a child with ASD “re-wire” their brain. That is, effective treatment actually changes the way the brain works in these children and can be so powerful that some children lose the diagnosis in later years.
Government statistics show that if we took every child with ASD who is under the age of 5 right now and provided them with a state-of-the-art, clinically validated intervention program, between 25 and 50% of them would be able to move into general education programs by Kindergarten and many others would require significantly reduced levels of intervention throughout their academic years. These numbers cannot be ignored, not only because of what it tells us about our ability to treat ASD, but also because of the clear implications for reducing the amount of dollars we will need to spend on the children in the future.
What is Early Intervention?
While there is not currently a “cure” for autism, the best-known treatment is intensive, effective early intervention based upon scientific principles of learning and development. Early interventions for children with ASD are developmentally and educationally based treatment programs available to children between birth and 5 years of age. The goal is to provide intensive therapeutic interventions that will allow the child to develop skills in all areas affecting his/her overall functioning level. With regard to autism the best early intervention programs focus on teaching the child to attend to relevant stimuli (e.g. those necessary for learning), to imitate others, to use and comprehend language or some form of communication system, to play appropriately with toys, develop reciprocity and to learn to interact in a socially expected manner. When these skills are taught at a young age, a reduction in maladaptive behaviors, such as tantrumming, aggression, self-stimulation (e.g. hand-flapping) and self-injurious behaviors is seen. In addition, early intervention plays a critical role in reducing the need for life-long intervention services.
What makes an effective early intervention program?
As with most educational programming, controversy abounds when discussing what is necessary for early intervention with autistic children. This controversy is not so much about the apparent need for such programs, but rather how the services should be delivered and how often. However, every state that has designed educational “best practices’ for ASD has listed the following characteristics as essential in any early intervention program:
It has been well documented that young children with ASD do not learn in traditional preschool or group settings. They often require individualized, one-on-one teaching to address the uniqueness of their communication, social, behavioral and learning difficulties. The most important factor in designing effective early intervention programs is intensity. Intensity in terms of time, individualization of curriculum and level of structure in the environment. As a general guideline, intervention programs that offer a minimum of 20 hours a week have been found to be effective, although some advocate for between 30 and 40 hours a week of treatment during the preschool years.
- The teaching techniques should be modeled upon research-based methods and curriculum.Data (record keeping) must be kept to monitor the child’s acquisition and generalization of skills.
- A highly supportive teaching environment, including the use of specially trained teachers, assistances and aides.
- Built in strategies for generalization.
- Due to the nature of how autistic children learn, the teaching program must be highly structured, predictable and routine-oriented.
- A functional approach to behavior difficulties must be implemented.
- Parent support and training is mandatory.
- The program should be staffed to provide the necessary support to allow each individual child to progress at his/her own pace.
Curriculum should be behaviorally based and developmentally sequenced. Most empirical evidence supports that use of Applied Behavior Analysis (ABA) teaching techniques (such as Discrete Trail Training and Pivotal Response Training), along with relational interventions and opportunities for incidental learning . Teaching must take place in various environments to ensure generalization and maintenance of newly learned skills. That is, teaching is not limited to the classroom- structured and systematic instruction must take place on the playground, in the hallway, at home and in the community.
Classroom design is also a key to successful intervention programs. Teaching areas need to be structured, organized and distraction-free. They should allow for both intensive one-to-one and small group instruction. A visual schedule, preferably an individual schedule should be available to children at all times. This allows for the children to have predictability in their environment which reduces anxiety, behavior problems and increases attention to task.
Finally, parents must be considered an integral part of their children’s treatment team and parent training and support needs to be built into all intervention programs.
When children with ASD are provided with intensive early intervention that is specifically designed to meet the breadth of their needs, the speed of the child’s overall development can be increased and leads to a better long-term prognosis. Appropriate interventions for children with ASD should begin as early as possible to take advantage of the “window of opportunity” that exists while the child’s brain is still developing and is malleable. Some researchers have put forth the idea of “critical periods” for developing certain skills (such as the ability to use verbal language proficiently) and propose the earlier these skills can be taught, the better chance a child has of fully mastering them.
What should parents do if they have concerns about their child?
The idea that your baby may be developing differently can be overwhelming and frightening. However, the best course of action to take if parents are concerned about their baby’s development is to seek out a diagnostic evaluation as soon as those first concerns arise. Speaking with the child’s pediatrician and specifically laying out the areas which are of most concern will help the doctor make a more informed decision as to whether the child should be further assessed. Parents can request the pediatrician give a developmental screening assessment to determine if the child is behind in critical areas. However, parents are encouraged to consider a highly specialized diagnostic assessment if they are concerned their child’s delays may fall within the autism spectrum. Such diagnostic evaluations can be done through the Regional Center or a private agency.
After a child receives a diagnosis of ASD, parents and professionals wishing to investigate early intervention programs should seek out services for children below the age of 3 from their Regional Center or insurance carrier. Children between 3 and 5 can receive services through their school district or a private preschool, non-public school or treatment center specifically designed for working with children with ASD (e.g. utilizes the best practice methods outlined above).
As the number of children identified with Autism increases at an alarming rate, it is necessary that we focus much of our attention on early identification and effective treatment protocols for these children. We need to look to ensure that all children with ASD receive the best diagnosis and intervention programs possible.
It is never too late to provide intervention for children with ASD, but there is a critical window of opportunity in the years before a child turns 5 that can and must be maximized to allow children to reach their fullest potential. By providing these intensive interventions when children are young and their brains have a higher degree of neuroplasticity, we can lead the way in improving the quality of lives for our children.