Researchers have shown for the first time that if a child is
diagnosed with autism as early as 18 months of age, offering the
toddler age-appropriate, effective therapy can lead to raised IQ levels
and improved language skills and behavior.
"Early intervention
can be very effective for toddlers with autism," says Geraldine Dawson,
chief science officer of the advocacy group Autism Speaks, and one of
the two lead authors of a study published Monday in the journal
Pediatrics.
Since 2007, pediatricians have been told to screen
18-month-old children for autism. But what the next step is when such a
young child is diagnosed has not been clear.
"It's crucial, if
we're going to offer screening at such a young age, that we can offer
an intervention, and now we know we have methods that are effective,"
says Dawson.
She adds, "This is the first controlled trial in children under the age of two-and-a-half."
While
Dawson was at the University of Washington, she and co-study author
Sally Rogers from the University of California-Davis M.I.N.D. Institute
devised the trial involving 48 children with autism.
All the
children in the trial were between 1 1/2 and 2 1/2 years old at the
beginning of the study. Half of the children were given community-based
interventions or therapies and the other half were enrolled in a
20-hour per week intervention program called "Early Start Denver Model"
(ESDM), developed by Rogers.
The goal of this research was to determine how much the debilitating effects of autism can be prevented or reduced.
ESDM was designed to address the needs of toddlers with autism
as young as 12 months old, and it is delivered by trained therapists
and their parents in a very natural setting -- the child's own home --
with children sitting on the floor and playing, rather than having a
more adult-directed therapy.
"It's a very pleasing kind of
therapy, kids are happy. It is play, and it can happen everywhere,"
Rogers explains. Dawson adds that this type of intervention builds on a
fun, positive relationship with the therapist. This is a contrast to
traditional Applied Behavioral Analysis (ABA), which is delivered at a
desk, with the child sitting next to the teacher or therapist, who
breaks down complex tasks into small components and then gives tangible
reinforcements.
At the end of two years, all of the children
showed improvements. But children in the ESDM group had increased their
IQ by nearly 18 points -- 10 points higher than the children getting
the standard autism therapy offered in the community. Scores for
listening and understanding as well as motor skills and self-care
skills were all higher in the ESDM group.
"Many of the children had virtually caught up to the typical kids their age," says Dawson.
Rogers says parents can pick up the ESDM therapy methods quite easily.
"They can learn this within six hours of working with therapists," she says.
Then parents can use the skills in everyday settings, not just during specific therapy sessions.
The
study's authors also noted that the children in the ESDM group required
only 15 hours of weekly intervention with a therapist, compared with
the usual 40 recommended hours. This can have a significant economic
impact on families. In 2006, a Harvard study estimated the lifelong
cost of care for person with autism is more than $3 million.
Children
with autism can have one of several complex neurological disorders,
which lead to social impairments, communication difficulties and
restrictive and repetitive behaviors. While the cause of autism in not
yet known -- genetics and environmental triggers are believed to play a
role -- the benefits of early intervention have been shown to reduce
disruptive behaviors and teach the child skills that will lead to
greater independence as he or she gets older.
There is no known
cure for autism. The researchers of this study are quick to point out
this they didn't cure any children, either. The subjects of the study
still have autism, although it may be in a milder form.
In 2007,
the American Academy of Pediatrics recommended that all children be
screened for autism at the ages of 18 months and 24 months. A report
published in their journal, Pediatrics, that year said that several
studies showed that the Denver model was an effective treatment, but
that "controlled studies are lacking" to prove its efficacy. This new
study does just that. Researchers and advocacy groups alike stress
treatments need to be scientifically verified before they can be
recommended on a large scale.
"This is a good-news story" says Dr. Fred Volkmar, director of Yale University's Child Study Center and an autism expert.
"Quite
often the [autism] field is splintered," says Brenda Smith Myles, also
an autism expert and spokeswoman for the Autism Society of America. "I
think on this topic, you will see a lot of cohesiveness."
Volkmar
says this is a "well-done study, an important study." He says it shows
that by effectively intervening at this young age, it is possible to
prevent some of the early problems autism causes.
Rogers
acknowledges that this study is only the first step. "Every piece of
science needs to be replicated before it becomes fact, so we are
currently doing a replication study," she said.
For more information on how to recognizes autism, EDMS and other possible therapies, go to
http://www.autismspeaks.org/ and
http://www.ucdmc.ucdavis.edu/mindinstitute/.