What are the best approaches to intervention of autism in young children?
Important information about best practices in autism have recently been published by the NYS Department of Health. They have produced a new guideline for early identification, diagnosis and treatment of Autism Spectrum Disorder for children 0-3. The guidelines are "recommendations about best practice based on scientific evidence and expert clinical opinion about the efficacy of various assessment and intervention options and medical management for young children with ASD". They worked with top specialists in the field of autism for several years to come up with these guidelines and the guidelines represent the best approaches to date for the treatment of autism in young children.
While the document is long, the executive summary is very worthwhile reading. It may be found here.
Here are some important take home points that are abstracted from the report.
- Since making an accurate diagnosis of ASD is complex, particularly in children under 3 years of age, it is important that professionals who make the diagnosis have experience and expertise in assessing young children with ASD. This can include Developmental pediatrician, psychologists, psychiatrists, neurologist and pediatricians in primary care who have that extensive experience in the diagnosis of ASD in young children.
- Treatments for ASD should focus on improving core difficulties in social communication and social relationships as well as addressing challenging behaviors and coexisting concerns especially of attention or anxiety.
- A child's comprehensive and intensive early intervention services should be determined on an individual basis. The family need as well as availability, time commitment required for the family, child characteristics (such as cognitive skills and age), and costs need consideration.
- Applied behavioral analytic interventions are considered first line due to the depth of positive outcome data. It is recommended that early behavioral and developmental interventions based on principles of ABA be incorporated as an important element of any intervention approach for young children with autism spectrum disorder. These interventions use research-based procedures and parameters and are based upon basic principles of learning.
- In deciding upon the intensity and duration of intervention for young children with ASD, it is important to recognize that based on available scientific evidence, it is not possible to accurately predict the optimal intensity that will be effective for any given child and family. However, it is recommended that behavioral programs include a minimum of approximately 20 hours per week of individualized intervention. It is recommended that the precise number of hours and duration of behavioral intervention be determined based on a range of child and family characteristics, including severity of autistic symptoms, rate of progress, health considerations, the child's tolerance for the intervention, and family participation. In the recent studies reviewed, effective interventions based on ABA techniques ranged in intensity between 14-28 hours per week. ABA services are available through early intervention but there may be limited certified therapists available. Most insurances also will pay for ABA services if a family wishes to have additional therapy outside of early intervention.
- It is recommended that parent training and education be included as an important component of comprehensive intervention programs for children with ASD.
Treatment for autism is effective for young children and these new guidelines help clarify the best known approaches. These recommendations are new and parents may find that their local service providers and coordinators are not yet following the guidelines closely. However parents are the best change agents and understanding the guidelines will help parents be sure that their children get the best of services.