Distinct Patterns of Cognitive Outcome in Young Children With Autism Spectrum Disorder Receiving the Early Start Denver Model

Abstract

Evidence-based, early intervention significantly improves developmental outcome in young children with autism. Nonetheless, there is high interindividual heterogeneity in developmental trajectories during the therapy. It is established that starting intervention as early as possible results in better developmental outcomes. But except for younger age at start, there is no clear consensus about behavioral characteristics that could provide a reliable individual prediction of a child's developmental outcome after receiving an early intervention. In this study, we analyze developmental trajectories of preschoolers with autism who received 2 years of intervention using the Early Start Denver Model (ESDM) approach in Geneva, Switzerland in an individual setting (n = 55, aged 28.7 ± 5.1 months with a range of 15–42). Our aim was to identify early predictors of response to intervention. We applied a cluster analysis to distinguish between 3 groups based on their cognitive level at intake, and rates of cognitive change over the course of intervention. The first group of children only had a mild cognitive delay at intake and nearly no cognitive delay by the end of intervention (Higher Cognitive at baseline: HC). The children in the two other groups all presented with severe cognitive delay at baseline. However, they had two very different patterns of response to intervention. The majority significantly improved developmental scores over the course of intervention (Optimal Responders: OptR) whereas a minority of children showed only modest improvement (Minimal Responders: MinR). Further analyses showed that children who ended up having an optimal 2-year intervention outcome (OptR) were characterized by higher adaptive functioning at baseline combined with rapid developmental improvement during the first 6 months of intervention. Inversely, less significant progress by the sixth month of intervention was associated with a less optimal response to treatment (MinR).

Differential Predictors of Response to Early Start Denver Model vs. Early Intensive Behavioral Intervention in Young Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

“…Eleven studies on ESDM reporting predictors of outcome were selected. Four articles focused on one-group pre–post-test studies [ 51 , 93 , 94 , 95 ] and one was an observational retrospective study [ 96 ]. Three studies were randomized controlled trials (RCTs) [ 22 , 23 , 97 ].…”

“…Four studies included patients with ASD diagnosed according to DSM-5 criteria [ 23 , 95 , 96 , 97 , 98 , 99 , 100 ], whereas one study used DSM-IV criteria for Autistic Disorder or PDD-NOS [ 22 ]. All studies administered ADOS or ADOS-2 to confirm the diagnosis.…”

“…Main patient exclusion criteria in selected studies were severe medical conditions other than ASD [ 22 , 23 , 95 , 98 , 100 ], neurological disorders [ 51 , 95 , 96 , 100 ], genetic syndromes [ 51 , 95 , 96 ] and significant vision, hearing, motor, or physical impairment [ 22 , 23 , 51 , 96 , 98 , 100 ]. Two studies [ 22 , 23 ] excluded children with a Developmental Quotient (DQ) below 35 on MSEL; children born at a gestational age of less than 34 months; and children not yet walking.…”

“…All eleven studies implemented ESDM according to the Rogers and Dawson [ 19 ] manual. Seven studies [ 22 , 23 , 94 , 95 , 96 , 99 , 100 ] delivered individualized ESDM sessions, three [ 93 , 97 , 98 ] delivered group-setting ESDM, while Contaldo and Colleagues [ 51 ] provided two hours of individualized and two hours of group ESDM sessions per week. Children received, on average, 13 h/week of ESDM (range: 3–20) for an overall mean duration of 15 months (range: 10–24).…”

“…Cognitive abilities were assessed using the MSEL in all studies except three [ 51 , 96 , 100 ], which administered, respectively, the Bayley Scales of Infant Development-Third Edition (Bayley-III) [ 101 ] and the Wechsler Preschool and Primary Scale of Intelligence-Third Edition (WPPSI-III) [ 102 ], the Gesell Developmental Scale (GDS) [ 103 ] and the Griffith Mental Development Scales (GMDS) [ 104 ], which was also administered by Vivanti et al [ 97 ]. One study [ 95 ] assessed children’s cognition, motor and adaptive skills through the Psychoeducational Profile-Third Edition (PEP—3) [ 105 ] ADOS-2 or ADOS were used by all studies to assess autism severity. One study [ 51 ] also employed the Childhood Autism Rating Scale (CARS) [ 106 ].…”