There are Gains, But can we Tell for Whom and Why? Predictors of Treatment Response Following Group Early Start Denver Model Intervention in Preschool - Aged Children with Autism Spectrum Disorder

Abstract

There is significant variability in treatment outcomes across different interventions for Autism Spectrum Disorder (ASD) and between individuals receiving the same intervention. This is likely related to the considerable phenotypic variability in ASD, which is posited to arise from a developmental cascade whereby a primary deficit in attention to social stimuli leads ultimately to widespread and diverse behavioural and functional difficulties.Purpose: To provide data on predictors of treatment outcome in a cohort of preschool -aged children with ASD receiving a group Early Start Denver Model (ESDM) intervention.Methodology: Forty-nine children (mean age 52 months) with ASD receiving group ESDM over 10 months were assessed pre -and post-intervention for ASD symptoms, developmental level, and adaptive functioning; together with measures of parental stress and coping.Results: Lower initial ASD symptomatology, particularly higher social affect and play skills, and younger age at entry to intervention predicted better outcomes. Conclusion:Reflective of hypotheses from the developmental cascade theory, younger age at entry predicted treatment gains, supporting efforts to include children in comprehensive treatment promptly. Moreover, greater initial social impairments led to relatively poorer outcomes, potentially suggesting that children with greater social affect difficulties may require a higher dose, or modified intervention, to that used in this study.

Is Earlier Better? The Relationship between Age When Starting Early Intervention and Outcomes for Children with Autism Spectrum Disorder: A Selective Review

“…In this case, there was a nonsignificant trend for earlier age of entry to EI to predict faster growth rates. Eapen et al (2016) [ 49 ]: this study examined predictors of outcome in preschool children ( N = 49) aged 3 to 5years when starting approximately 10 months of Early Start Denver Model (ESDM) group intervention. A linear regression controlled for baseline IQ, autism severity, and adaptive behavior.…”

“…Only three of the studies included another environmental variable besides treatment as a predictor. Both Rogers et al [ 57 ] and Eapen et al [ 49 ] included a proximal parental variable reflecting treatment fidelity (e.g., how effectively the mother learned and used the interaction style that was taught during intervention) and it was found to influence the outcome positively. Itzchak and Zachor (2011) [ 63 ] found that the more distal variables of maternal age and education were significant predictors.…”

Exploring possible predictors and moderators of an executive function training for children with an autism spectrum disorder

“…Given the small amount of research on EF training for children with ASD, we included predictors/modifiers based on findings of other (intervention) studies in children with ASD. Therefore, we studied IQ (Smith et al, 2015), autism symptoms (Eapen et al, 2016), and EF (Pellicano, 2010) as possible predictors/modifiers. Moreover, we included reward sensitivity (Dawson et al, 2001) and ToM (Pellicano, 2010) as possible predictors/ modifiers, as children with ASD seem to have difficulties in these areas.…”

Divide and Conquer: Clustering Patients With Autism by Gene Expression Profiles Using Machine Learning Algorithms

“…Further, the diagnostic criteria for ASD have been continuously revised through different editions of the Diagnostic and Statistical Manual for Mental Disorders (DSM), particularly the substantial changes in the 5th edition (DSM 5) where the wide range of clinical presentations have been brought together under a single ASD diagnostic entity [1]. The current diagnostic system lacks an evidence-based approach and we urgently require a scienti c approach to understanding which interventions are likely to be the most effective for which child with ASD [2]. Accumulating evidence has shown that no pharmaceutical treatments have thus far been conclusively found to substantially reduce core symptoms of ASD [3].…”