Abstract
The goal of early autism screening is earlier treatment. We pilot-tested a 12-week, low-intensity treatment with seven symptomatic infants ages 7–15 months. Parents mastered the intervention and maintained skills after treatment ended. Four comparison groups were matched from a study of infant siblings. The treated group of infants was significantly more symptomatic than most of the comparison groups at 9 months of age but was significantly less symptomatic than the two most affected groups between 18 and 36 months. At 36 months, the treated group had much lower rates of both ASD and DQs under 70 than a similarly symptomatic group who did not enroll in the treatment study. It appears feasible to identify and enroll symptomatic infants in parent-implemented intervention before 12 months, and the pilot study outcomes are promising, but testing the treatment’s efficacy awaits a randomized trial.
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References
American Psychiatric Association (Ed.). (2000). Diagnostic and statistical manual-IV-TR. Washington, DC: American Psychiatric Publishing Incorporated.
Barrera, M. E., Doucet, D. A., & Kitching, K. J. (1990). Early home intervention and socio-emotional development of preterm infants. Infant Mental Health Journal, 11(2), 142–157.
Brooks-Gunn, J., Liaw, F. R., & Klebanov, P. K. (1992). Effects of early intervention on cognitive function of low birth weight preterm infants. The Journal of Pediatrics, 120(3), 350–359.
Bryson, S. E., Zwaigenbaum, L., Brian, J., Roberts, W., Szatmari, P., Rombough, V., et al. (2007). A prospective case series of high-risk infants who developed autism. Journal of Autism and Developmental Disorders, 37(1), 12–24.
Bryson, S. E., Zwaigenbaum, L., McDermott, C., Rombough, V., & Brian, J. (2008). The autism observation scale for infants: Scale development and reliability data. Journal of Autism and Developmental Disorders, 38(4), 731–738.
Carter, A. S., Messinger, D. S., Stone, W. L., Celimli, S., Nahmias, A. S., & Yoder, P. (2011). A randomized controlled trial of Hanen’s ‘More Than Words’ in toddlers with early autism symptoms. Journal of Child Psychology and Psychiatry, 52(7), 741–752.
Chapman, R. S. (2000). Children’s language learning: An interactionist perspective. Journal of Child Psychology and Psychiatry, 41(1), 33–54.
Charlop-Christy, M. H., & Carpenter, M. H. (2000). Modified incidental teaching sessions: A procedure for parents to increase spontaneous speech in their children with autism. Journal of Positive Behavior Interventions, 2(2), 98–112.
Davis, N. O., Kuhn, J. C., & Carter, A. S. (2006). Children’s problem behaviors and self-efficacy among mothers of toddlers with autism. The moderating role of working alliance. Poster presentation, International Meeting of Autism Researchers; Montreal.
Dawson, G., Osterling, J., Rinaldi, J., Carver, L., & McPartland, J. (2001). Brief report: Recognition memory and stimulus-reward associations: Indirect support for the role of ventromedial prefrontal dysfunction in autism. Journal of Autism and Developmental Disorders, 31(3), 337–341.
Dawson, G., Rogers, S., Munson, J., et al. (2010). Randomized controlled trial of the Early Start Denver Model: A developmental behavioral intervention for toddlers with autism: Effects on IQ, adaptive behavior, and autism diagnosis. Pediatrics, 125(1), e17–e23.
Dietz, C., Swinkels, S., van Daalen, E., van Engeland, H., & Buitelaar, J. K. (2006). Screening for autistic spectrum disorder in children aged 14–15 months. II: Population screening with the Early Screening of Autistic Traits Questionnaire (ESAT). Design and general findings. Journal of Autism and Developmental Disorders, 36(6), 713–722.
Diggle, T., McConachie, H. R., & Randle, V. R. L. (2002). Parent-mediated early intervention for young children with autism spectrum disorder. The Cochrane Database of Systematic Reviews, 2. doi:10.1002/14651858.CD003496.
Ference, J., & Curtin, S. (2013). Attention to lexical stress and early vocabulary growth in 5-month-olds at risk for autism spectrum disorder. Journal of Experimental Child Psychology, 116(4), 891–903.
Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(5), 693–705.
Green, J., Wan, M. W., Guiraud, J., Holsgrove, S., McNally, J., Slonims, V., et al. (2013). Intervention for infants at risk of developing autism: A case series. Journal of Autism and Developmental Disorders, 43(11), 2502–2514.
Hanft, B. E., Rush, D. D., & Shelden, M. L. (2003). Coaching families and colleagues in early childhood. Baltimore, MD: Brookes.
Harris, S. L., Wolchik, S. A., & Weitz, S. (1981). The acquisition of language skills by autistic children: Can parents do the job? Journal of Autism and Developmental Disorders, 11(4), 373–384.
Johnson-Martin, N. M., Jens, K. G., Attermeier, S. M., & Hacker, B. (1991). The Carolina curriculum for infants and toddlers with special needs (2nd ed.). Baltimore: Brookes.
Kasari, C., Gulsrud, A. C., Wong, C., Kwon, S., & Locke, J. (2010). Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. Journal of Autism and Developmental Disorders, 40(9), 1045–1056.
Koegel, R. L., Bimbela, A., & Schreibman, L. (1996). Collateral effects of parent training on family interactions. Journal of Autism and Developmental Disorders, 26(3), 347–359.
Koegel, R. L., Glahn, T. J., & Nieminen, G. S. (1978). Generalization of parent-training results. Journal of Applied Behavior Analysis, 11(1), 95–109.
Landa, R. J., Gross, A. L., Stuart, E. A., & Bauman, M. (2012). Latent class analysis of early developmental trajectory in baby siblings of children with autism. Journal of Child Psychology and Psychiatry, 53(9), 986–996.
Laski, K. E., Charlop, M. H., & Schreibman, L. (1988). Training parents to use the natural language paradigm to increase their autistic children’s speech. Journal of Applied Behavior Analysis, 21(4), 391–400.
Lloyd-Fox, S., Blasi, A., Elwell, C. E., Charman, T., Murphy, D., & Johnson, M. H. (2013). Reduced neural sensitivity to social stimuli in infants at risk for autism. Proceedings of the Royal Society B: Biological Sciences, 280(1758), 20123026.
Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Levanthal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic. A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.
Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55(1), 3.
McEachin, J. J., Smith, T., & Lovaas, O. I. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal of Mental Retardation, 97, 359–372.
Messinger, D., Young, G. S., Ozonoff, S., Dobkins, K., Carter, A., Zwaigenbaum, L., et al. (2013). Beyond autism: A baby siblings research consortium study of high-risk children at three years of age. Journal of the American Academy of Child and Adolescent Psychiatry, 52(3), 300–308.
Mullen, E. (1995). The mullen scales of early learning. Circle Pines, MN: American Guidance.
Mundy, P., & Crowson, M. (1997). Joint attention and early social communication: Implications for research on intervention with autism. Journal of Autism and Developmental Disorders, 27(6), 653–676.
Ozonoff, S., Iosif, A. M., Baguio, F., Cook, I. C., Hill, M. M., Hutman, T., et al. (2010). A prospective study of the emergence of early behavioral signs of autism. Journal of the American Academy of Child and Adolescent Psychiatry, 49(3), 256–266.
Ozonoff, S., Young, G. S., Belding, A., Hill, M., Hill, A., Hutman, T., et al. (2014). The broader autism phenotype in infancy: When does it emerge? Journal of the American Academy of Child and Adolescent Psychiatry, 53, 398–407. PMCID: in progress.
Ozonoff, S., Young, G. S., Goldring, S., Greiss-Hess, L., Herrera, A. M., Steele, J., et al. (2008). Gross motor development, movement abnormalities, and early identification of autism. Journal of Autism and Developmental Disorders, 38(4), 644–656.
Pan, B. A., Rowe, M. L., Singer, J. D., & Snow, C. E. (2005). Maternal correlates of growth in toddler vocabulary production in low-income families. Child Development, 76(4), 763–782.
Resnick, M. B., Armstrong, S., & Carter, R. L. (1988). Developmental intervention program for high-risk premature infants: Effects on development and parent-infant interactions. Journal of Developmental and Behavioral Pediatrics, 9(2), 73–78.
Rogers, S. J., & Dawson, G. (2010). The Early Start Denver Model for young children with autism: Promoting language, learning, and engagement. NY: Guilford.
Rogers, S. J., Dawson, G., & Vismara, L. (2012a). An early start for your child with autism: Using everyday activities to help kids connect, communicate and learn. NY: Guilford.
Rogers, S. J., Estes, A., Lord, C., Vismara, L., Winter, J., Fitzpatrick, A., et al. (2012b). Effects of a brief Early Start Denver model (ESDM)-based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 51(10), 1052–1065.
Rogers, S. J., & Vismara, L. (2014). Interventions for infants and toddlers at risk for autism spectrum disorder. In F. Volkmar, S. J. Rogers, R. Pelphry, & K. Paul (Eds.), Handbook of autism and developmental disorders (4th ed., pp. 739–769). Hoboken, NJ: Wiley.
Rogers, S. J., Vismara, L., & Wagner, A. (2012). Infant start fidelity. University of California, Davis. Unpublished material.
Ross, G. S. (1984). Home intervention for premature infants of low-income families. American Journal of Orthopsychiatry, 54(2), 263–270.
Sacrey, L. A. R., Bryson, S. E., & Zwaigenbaum, L. (2013). Prospective examination of visual attention during play in infants at high-risk for autism spectrum disorder: A longitudinal study from 6 to 36 months of age. Behavioural Brain Research, 256, 441–450.
Sanz, M. T., & Menendez, J. (1996). A study of the effect of age of onset of treatment on the observed development of Down’s syndrome babies. Early Child Development and Care, 118(1), 93–101.
Sanz-Aparicio, M. T., & Balaña, J. M. (2002). Early language stimulation of Down’s Syndrome babies: A study on the optimum age to begin. Early Child Development and Care, 172(6), 651–656.
Sanz-Aparicio, M. T., & Balaña, J. M. (2003). Early learning in psychomotor training of Down’s syndrome. Early Child Development and Care, 173(2–3), 317–321.
Schreibman, L., & Koegel, R. L. (1997). Fostering self-management: Parent-delivered pivotal response training for children with autistic disorder. In E. D. Hibbs & P. S. Jensen (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice. Washington, DC: American Psychological Association.
Seifer, R., Clark, G. N., & Sameroff, A. J. (1991). Positive effects of interaction coaching on infants with developmental disabilities and their mothers. American Journal on Mental Retardation, 96, 1–11.
Short, A. B. (1984). Short-term treatment outcome using parents as co-therapists for their own autistic children. Journal of Child Psychology and Psychiatry, 25(3), 443–458.
Simpson, J. A., Collins, W. A., Tran, S., & Haydon, K. C. (2007). Attachment and the experience and expression of emotions in romantic relationships: A developmental perspective. Journal of Personality and Social Psychology, 92(2), 355.
Sloper, P., Glenn, S. M., & Cunningham, C. C. (1986). The effect of intensity of training on sensori-motor development in infants with Down’s syndrome. Journal of Mental Deficiency Research, 30(2), 149–162.
Smith, T., Groen, A. D., & Wynn, J. W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal on Mental Retardation, 105, 269–285.
Smith, T., Scahill, L., Dawson, G., Guthrie, D., Lord, C., Odom, S., et al. (2007). Designing research studies on psychosocial interventions in autism. Journal of Autism and Developmental Disorders, 37(2), 354–366.
Steiner, A. M., Gengoux, G. W., Klin, A., & Chawarska, K. (2013). Pivotal response treatment for infants at-risk for autism spectrum disorders: A pilot study. Journal of Autism and Developmental Disorders, 43(1), 91–102.
Tamis-LeMonda, C. S., & Bornstein, M. H. (1994). Specificity in mother-toddler language-play relations across the second year. Developmental Psychology, 30(2), 283.
Tomasello, M. (1992). The social bases of language acquisition. Social Development, 1(1), 67–87.
Vismara, L. A., Colombi, C., & Rogers, S. J. (2009). Can 1 hour per week of therapy lead to lasting changes in young children with autism? Autism: An International Journal, 13(1), 93–115.
Vismara, L. A., Young, G. S., & Rogers, S. J. (2012). Telehealth for expanding the reach of early autism training to parents. Autism Research and Treatment,. doi:10.1155/2012/121878.
Wallace, K. S., & Rogers, S. J. (2010). Intervening in infancy: Implications for autism spectrum disorders. Journal of Child Psychology and Psychiatry, 51(12), 1300–1320.
Wan, M. W., Green, J., Elsabbagh, M., Johnson, M., Charman, T., & Plummer, F. (2013). Quality of interaction between at-risk infants and caregiver at 12–15 months is associated with 3-year autism outcome. Journal of Child Psychology and Psychiatry, 54(7), 763–771.
Wetherby, A., & Prizant, B. (2002). Communication and symbolic behavior scales developmental profile (1st ed.). Baltimore, MD: Paul H. Brookes.
Zwaigenbaum, L., Bryson, S., Rogers, T., Roberts, W., Brian, J., & Szatmari, P. (2005). Behavioral manifestations of autism in the first year of life. International Journal of Developmental Neuroscience, 23(2), 143–152.
Acknowledgments
This project was funded by grants from NICHD/NIMH (R21 HD065275: Rogers R01 MH068398: Ozonoff) and support from Autism Speaks and the John and Marcia Goldman Foundation. The authors would like to acknowledge SoYeon Baik for her assistance with nearly every aspect of the project, Diane Larzelere for her assistance with manuscript preparation, and the children and families who gave of their time to participate in the study.
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Rogers, S.J., Vismara, L., Wagner, A.L. et al. Autism Treatment in the First Year of Life: A Pilot Study of Infant Start, a Parent-Implemented Intervention for Symptomatic Infants. J Autism Dev Disord 44, 2981–2995 (2014). https://doi.org/10.1007/s10803-014-2202-y
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DOI: https://doi.org/10.1007/s10803-014-2202-y