Early diagnosis and Early Start Denver Model intervention in autism spectrum disorders delivered in an Italian Public Health System service

Abstract

BackgroundEarly diagnosis combined with an early intervention program, such as the Early Start Denver Model (ESDM), can positively influence the early natural history of autism spectrum disorders. This study evaluated the effectiveness of an early ESDM-inspired intervention, in a small group of toddlers, delivered at low intensity by the Italian Public Health System.MethodsTwenty-one toddlers at risk for autism spectrum disorders, aged 20–36 months, received 3 hours/wk of one-to-one ESDM-inspired intervention by trained therapists, combined with parents’ and teachers’ active engagement in ecological implementation of treatment. The mean duration of treatment was 15 months. Cognitive and communication skills, as well as severity of autism symptoms, were assessed by using standardized measures at pre-intervention (Time 0 [T0]; mean age =27 months) and post-intervention (Time 1 [T1]; mean age =42 months).ResultsChildren made statistically significant improvements in the language and cognitive domains, as demonstrated by a series of nonparametric Wilcoxon tests for paired data. Regarding severity of autism symptoms, younger age at diagnosis was positively associated with greater improvement at post-assessment.ConclusionOur results are consistent with the literature that underlines the importance of early diagnosis and early intervention, since prompt diagnosis can reduce the severity of autism symptoms and improve cognitive and language skills in younger children. Particularly in toddlers, it seems that an intervention model based on the ESDM principles, involving the active engagement of parents and nursery school teachers, may be effective even when the individual treatment is delivered at low intensity. Furthermore, our study supports the adaptation and the positive impact of the ESDM entirely sustained by the Italian Public Health System.

Effects of Parent‐Implemented Early Start Denver Model Intervention on Chinese Toddlers with Autism Spectrum Disorder: A Non‐Randomized Controlled Trial

“…The positive effect of ESDM has been documented by previous studies [Dawson et al, ; Vismara, Young, & Rogers, ; Rogers et al, ; Vivanti et al, ; Devescovi et al, ; Vivanti, Dissanayake, & Victorian, ; Waddington, van der Meer, & Sigafoos, ; Touzet et al, ]. Reports from the first randomized controlled trial [Dawson et al, ] indicated that ESDM intervention delivered by therapists for 2 years improved cognitive, linguistic, and adaptive behavior and also reduced severity of symptoms of ASD toddlers compared with community interventions, and the gains were maintained 2 years later [Estes et al, ].…”

“…Thus, 12‐week period might be not enough for parents to implement the intervention with sufficient intensity and quality [Rogers et al, ]. A retrospective study in Italy [Devescovi et al, ] demonstrated that 3‐hr/week ESDM intervention with monthly meeting among professionals, parents and teachers improved language and cognition of children with ASD. The results also supported that higher‐intensity P‐ESDM intervention for longer duration helped enhance developmental outcomes of ASD toddlers.…”

“…Even after high‐intensity ESDM intervention (20 hr/week for 2 years) delivered by trained therapists, toddlers still did not gain significant improvement in ADOS severity score [Dawson et al, ]. However, Devescovi et al [] indicated that although no significant difference was found in the entire group between pre‐ and post‐interventions, most toddlers younger than 27 months at baseline got reduced ADOS severity score after ESDM intervention. A logistic analysis further supported that younger age at the beginning of intervention was positively related to greater improvement in ASD severity (OR = 15, P = 0.028).…”

Current Challenges in Early Intervention for Children with Autism Spectrum Disorder (ASD): A Narrative Review

“…In countries outside the United States, when available, intervention starts on average at the same time (Devescovi et al, 2016). Additionally, the majority of children with ASD in lowand middle-income countries have no access to evidence based interventions (Divan, 2017).…”

Rani Skrining Na Autizam U Primarnoj Pedijatrijskoj Službi

“…Nađeno je statistički značajno poboljšanje u domenu razvoja jezika i kognicije. Kada su u pitanju simptomi autizma, poboljšanje je bilo utoliko veće ukoliko je uzrast bio mlađi u vrijeme postavljanja dijagnoze (12).…”