A Pilot Study of a Culturally Adapted Early Intervention for Young Children With Autism Spectrum Disorders in China

Xu, Yang; Yang, Jian; Jing, Yao; Chen, Jun; Zhuang, Xiangxiang; Wang, Wenxiang; Zhang, Xiaoli; Lee, Gabrielle T.

doi:10.1177/1053815117748408

Cited by 28 publications

(21 citation statements)

References 41 publications

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“…Only four programs (C. Liu et al, 2015; Xu et al, 2018; Zhou et al, 2018; Zou et al, 2005) met the criteria in using evidence-based intervention models (Figure 3(b)). Most included programs targeted multiple objectives or goals.…”

Section: Resultsmentioning

confidence: 99%

“…The outcome assessors were blind to group status in only 3 out of the 16 studies (Shum et al, 2019; V. Wong & Kwan, 2010; Xu et al, 2018). Two studies were rated as “high risk” either because they used only self-report instruments (Ji et al, 2014) or the author was presented as the outcome assessor (P.…”

Section: Resultsmentioning

confidence: 99%

“…mainland China, Hong Kong, and Taiwan) in the past decade (e.g. Shum et al, 2019; Xu et al, 2018). To the best of our knowledge, no systematic review or meta-analysis has synthesized evidence on the quality of PMIs in Greater China.…”

Section: Introductionmentioning

confidence: 99%

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A systematic review and meta-analysis of parent-mediated intervention for children and adolescents with autism spectrum disorder in mainland China, Hong Kong, and Taiwan

Liu

Hsieh

Chen

2020

Autism

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Parent-mediated intervention is a prominent approach to supplementing service insufficiency for the population with autism spectrum disorder, yet individuals from low-resource areas are largely under-represented among participants in the global parent-mediated intervention research. This systematic review and meta-analysis is the first to inspect the overall effects and research quality of parent-mediated interventions in mainland China, Hong Kong, and Taiwan. A total of 21 parent-mediated interventions were included in systematic review, and among them, 12 randomized controlled trials representing 964 children were analyzed in meta-synthesis. Overall, results of meta-analysis showed favorable effects of parent-mediated interventions with standardized mean difference ranging from 0.63 (social competence) to 1.00 (symptom severity) and averaged 0.76 across domains. However, the results should be interpreted with caution due to poor evidence quality as assessed in GRADE ratings. In terms of methodological quality, QualSyst evaluation showed that more than half (14/21) of the included studies were below satisfactory. Identified programs lack the capacity to be further disseminated in the Chinese societies due to the absence of solid theoretical foundations, the negligence of implementation outcomes, and the inadequacy of sophisticated cultural adaptations. This review reinforces the need for promotion and improvement of parent-mediated interventions in low-resource context (PROSPERO: CRD42019138723). Lay abstract The ideal dosage for early intensive interventions for autism spectrum disorder has been suggested to be at least 25-hour per week to reach optimal effects. However, insufficient service use and unmet needs among families with children with autism spectrum disorder are frequently reported worldwide. Helping parents to develop strategies for interaction and management of behavior through parent training has been demonstrated to be a prominent way to supplementing service insufficiency for autism spectrum disorder, which is particularly crucial in less-resourced areas. This review included 21 parent-mediated intervention programs conducted in China, the most populated developing country. Among them, we were able to combine outcome information from 12 randomized controlled trials to increase confidence in the results. We also rated the quality of methodology and evidence for all included studies, which was taken into account in making conclusions. The included programs varied in the content, length, and delivery method of trainings. Although targeting different training outcomes, the majority of the studies aimed to help parents be more competent and responsive during interactions with their child in order to decrease symptom severity. Overall, results showed sufficient evidence that parent training did improve child outcomes as intended. However, the quality of more than half (14/21) of the included studies were below satisfactory. Identified programs lack the capacity to be further transported in the Chinese societies due to the lack of solid theoretical foundations, implementation manuals, and appropriate cultural adaptations. This review reinforces the need for promotion and improvement of parent-mediated interventions in low-resource context.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A systematic review and meta-analysis of parent-mediated intervention for children and adolescents with autism spectrum disorder in mainland China, Hong Kong, and Taiwan

Liu

Hsieh

Chen

2020

Autism

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“…Several studies have demonstrated the efficacy of a lowintensity ESDM, which provided less frequent and shorter sessions, and a shorter duration of the intervention [10][11][12][13]. The length of each session and the duration of ESDM intervention were as follows: three hours per week for 15 months by Devescovi et al [13], five hours per week for two months by Xu et al [11], six hours per week for six months by Colombi et al [12], and eight hours per week for six months by Lin et al [10]. Taken together, our ESDM intervention might be defined as a low-intensity ESDM in terms of density and length.…”

Section: Esdm Intervention In This Studymentioning

confidence: 99%

The Efficacy of Early Start Denver Model Intervention in Young Children with Autism Spectrum Disorder Within Japan: A Preliminary Study

Tateno¹,

Kumagai²,

Monden³

et al. 2021

J Korean Acad Child Adolesc Psychiatry

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Objectives: Among the many intervention programs for children with autism spectrum disorder (ASD), the Early Start Denver Model (ESDM) is one of the few approaches that has succeeded in demonstrating clinical efficacy in randomized control trials. Here, we investigate the clinical efficacy of ESDM intervention in young children with ASD in a community setting within Japan. Methods: All subjects were children with ASD who received ESDM intervention during the study period. Each ESDM session lasted 75 min and occurred once per week for at least 12 weeks. The outcome measures consisted of the Kyoto Scale of Psychological Development (K-test), Aberrant Behavior Checklist-Japanese version (ABC-J), and the Clinical Global Impression-Severity scale (CGI-S). Results: Twenty-seven subjects (29.4±6.4 months old) received ESDM intervention that lasted for 8.0±2.6 months on average. The score on Language and Social developmental quotient on the K-test increased significantly after the intervention. The total scores on the ABC-J and CGI-S significantly decreased after completion of the ESDM intervention. Conclusion:Our results suggest that ESDM intervention could reduce the severity of distinct clinical features of ASD, such as impairments in social interaction and communication assessed by the K-test, and maladaptive behavior rated by the ABC-J and CGI-S. We believe that the ESDM adapted to each institution might become one of the standard options for children with ASD in Japan.

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“…Three previous studies have examined the effects of low-intensity ESDM programs, with one in China (Xu et al, 2018) and two in Italy (Colombi et al, 2018; Devescovi et al, 2016). Each study showed favorable results: children with ASD improved in cognitive functioning, language, adaptive behaviors, or ASD symptom severity.…”

mentioning

confidence: 99%

Preliminary clinical outcomes of a short-term low-intensity Early Start Denver Model implemented in the Taiwanese public health system

Lin

Chiang

et al. 2020

Autism

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The Early Start Denver Model is an evidence-based, comprehensive naturalistic developmental behavioral intervention. Randomized controlled studies indicate that long-term, high-intensity Early Start Denver Model in home-based settings can positively impact the clinical outcomes of young children with autism spectrum disorder. However, it is difficult to deliver high-intensity early intervention in an under-resourced country such as Taiwan. This study evaluated the effects of implementing the Early Start Denver Model with adaptations (including low intensity, shorter duration, and delivery in general hospitals by multidisciplinary professionals) within the Taiwanese public health system. A pre- and post-intervention study was conducted. Sixteen children with autism spectrum disorder (mean age of 33.5 months) received 6 months of one-on-one Early Start Denver Model intervention (approximately 8 h per week). The children showed significant post-intervention improvements in language and overall cognitive functioning and reduced symptom severity in communication and play. This study suggests that delivering the Early Start Denver Model in community-based hospitals may be an effective intervention, with a wider reach, for young children with autism spectrum disorder in Taiwan. The next steps in Taiwan are to incorporate a control group and assess the long-term effects of the adapted Taiwanese Early Start Denver Model program. Lay Abstract The Early Start Denver Model is a comprehensive naturalistic developmental behavioral intervention for young children with autism spectrum disorder. Rigorous studies indicate that long-term, high-intensity Early Start Denver Model in home-based settings can help young children with autism spectrum disorder have great progress in language, cognitive development, and adaptive skills and reduce overall symptom severity. In accordance with the current limitations in resourcing for early intervention in Taiwan, this study evaluated the effects of implementing the Early Start Denver Model in the Taiwanese public health system with some adaptations, including lower intensity, shorter duration, and delivery in general hospitals. A total of 16 children with autism spectrum disorder, aged between 25 and 46 months, received approximately 8 h per week one-on-one Early Start Denver Model intervention. After 6 months of intervention, the children showed great improvements in language and overall cognitive functioning and reduced symptom severity in communication and play. This study suggests that directly delivering the Early Start Denver Model in community-based hospitals may be an effective intervention, which can make more young children with autism spectrum disorder in Taiwan access the Early Start Denver Model service.

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A Pilot Study of a Culturally Adapted Early Intervention for Young Children With Autism Spectrum Disorders in China

Cited by 28 publications

References 41 publications

A systematic review and meta-analysis of parent-mediated intervention for children and adolescents with autism spectrum disorder in mainland China, Hong Kong, and Taiwan

A systematic review and meta-analysis of parent-mediated intervention for children and adolescents with autism spectrum disorder in mainland China, Hong Kong, and Taiwan

The Efficacy of Early Start Denver Model Intervention in Young Children with Autism Spectrum Disorder Within Japan: A Preliminary Study

Preliminary clinical outcomes of a short-term low-intensity Early Start Denver Model implemented in the Taiwanese public health system

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