Toddlers with autism demonstrated significant improvement after intensive intervention by parents rather than clinicians, according to a new study published online in the journal Pediatrics.
"The treatment model shows that parents can learn to support their child's learning in everyday activities, and that this can result in improvements in the child's overall development and specifically in social communication and autism symptoms," said senior author Dr. Catherine Lord, director of the Center for Autism and the Developing Brain, a collaboration between Weill Cornell Medical College, NewYork-Presbyterian Hospital, and Columbia University College of Physicians and Surgeons. "The study supports the importance of including parents in their children's treatment."
Social communication includes eye gaze, facial expressions, gestures, sounds, sharing of emotion, listening, learning to understand words, discovering how to use objects — things that children with autism have difficulty learning.
"The findings are important because this treatment is viable in many communities," said Dr. Amy Wetherby, director of the Autism Institute at Florida State University’s College of Medicine and lead author of the study. "We have early intervention that's federally and state funded. Now we’ve tested a model that any early intervention system should be able to offer to all families of toddlers with autism. It’s affordable, and it’s efficient in terms of clinicians’ time."
Most children are not diagnosed with autism spectrum disorder (ASD) until age 4 — and even later in lower-income, rural and minority families. By contrast, the American Academy of Pediatrics wants every child to be screened at 18 and 24 months of age. Early diagnosis, however, does little good without early intervention.
In recent years, some intervention trials had achieved improved outcomes for children but required an inaccessible amount of time from clinicians. Others that focused on teaching parents found that the parents learned, but the children didn’t show significant gains from the treatment.
The new study outlines the results of a seven-year, randomized controlled trial, in which families of 82 toddlers with ASD who were 18 months old were assigned to one of two nine-month interventions.
The researchers compared the effects of teaching parents in a group once a week and teaching them individually in their homes three times a week for six months, and then twice a week for three more months. Children in both groups improved in their use of words and autism symptoms. But children in the second group improved more on measures of understanding and social communication.
The investigators also taught families to work with their children in their everyday activities, such as meals and snacks, caregiving and family chores, including how to bring their children into a given activity. They taught parents how to take their children to places in their communities such as playgrounds, grocery stores and restaurants.
"We tried to help parents make interactions fun and fruitful learning moments. But we also taught the parents how to push their child — because their child has autism, and we are finding these children at this very critical moment when their brain is more able to learn," Dr. Wetherby said. "If the parent can start early, then we are more likely to change the child’s trajectory of learning for the rest of their life."
Dr. Lord was involved in the development of some of the instruments used in this research and receives royalty income from the sale of those instruments.
A version of this story ran on the Florida State University website.