Autism Spectrum Disorder (ASD) is a life-long developmental disorder, characterized by qualitative impairments in social and communication behaviors, and a restricted range of activities and interests. Latest U.S. incidence estimates are 1:100 live births.
Rapid advances in developmental neuroscience and psychology, neurobiology and genetics have contributed to more optimistic outcomes for many children with ASD and have led to new methods for early detection and more effective treatments.
Optimal treatments, based on the principle of brain plasticity, begin early and target social interaction, language and sensory and motor deficits.
The study attempts to measure the importance of altered interactions between toddlers with newly-diagnosed ASD and the therapeutic environment to optimized social interactive, language, and play functioning.
Method and Subjects
30 Ss (29 M and 1 F), newly diagnosed with high-functioning ASD within the Public Health System, were integrated into a thrice-weekly therapeutic regimen with hybrid speech and occupational therapists, along with consulting psychology and social services personnel, for an average 4 month period before placement in a therapeutic pre-school setting.
Measures of functioning were recorded by independent, blinded observers, and converted into numerical values according to A GOAL ATTAINMENT SCALE GAS (L Rube, McGrew, and M Toland 2012)
Median age at diagnosis was 23 months (range 14-34 months) and the median range at the start of therapy was 25 months (range 15-34 m).
DQ values ranged from 4 in the mildly retarded, 4 borderline and 22 in the average to above average range.
Of 23 children with ADOS pre and post treatment scores, 19 improved, 2 had no change, and 1 worsened.
On specific functional measures, there was significant improvement on the following measures:
The therapeutic interventions (pre vs. post ADOS) were increasingly affective, (P<0.001) using ANOVA with repeated measures.
There was a trend for the child's pre-vs. post ADOS to be associated with DQ (intelligence).
There was no correlation between age of diagnosis or age at start of therapy for improvement of ADOS scores. Hence hybrid therapy is beneficial regardless of age group. It is important to note that there was a relatively small age range in our study.
Paired T tests and Wilcoxon signed ranks test indicated the effectiveness of therapies on all functional measures except voice intonation (p<0.001). These included: eye contact, response to name, gestures, requesting, imitation, contingent play and receptive language.
Short-term hybrid therapy is an effective therapeutic venue for newly diagnosed toddlers with ASD. Besides parental empowerment, indices most amenable to functional improvement, prior to special educational pre-school placement included salient functional and social communication skills.
Long term follow-up is needed to gauge the far reaching utility of very early acute therapeutic intervention. In the short term, children were better equipped to continue to enhance early social and language skill gains upon entry into pre-school settings.