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Working Intensely Early on May Help Autistic Kids

Language, social skills improve with specially designed program, study finds

MONDAY, Nov. 30 (HealthDay News) -- A special, intensive early intervention program for toddlers with autism succeeded in boosting IQ along with children's language and social skills, a new study shows.

"When done in this fashion, many children are able to learn and make remarkable progress," said Geraldine Dawson, lead author of the study, published online Nov. 30 in Pediatrics, and chief science officer of Autism Speaks. "Some of the kids at the end of the study were going into regular preschool and had developed language and friendships with their peers."

All children in the study were 1½ to 2½ years old, but the intervention -- called the Early Start Denver Model -- was designed for children 1 to 5 years of age, Dawson said.

"This is the first time that there's been a randomized controlled study of an intensive early intervention for toddlers," added Dawson, who was a psychology professor and director of the Autism Center at the University of Washington, Seattle, when the study was conducted. "There have been a few studies of short-term strategies that would improve specific skills such as language and social behavior."

The American Academy of Pediatrics now recommends that children be screened as young as 18 months for autism spectrum disorders, a cluster of neurodevelopmental disorders, sometimes called pervasive developmental disorders, involving social and verbal impairments.

However, the age at diagnosis is generally closer to 3 or 4 years, Dawson said, simply because new screening tools are not in widespread use.

"The systems that underlie early social behaviors such as eye contact and babbling come on in the first few months of life so one of the reasons we're trying to move to early diagnosis and early intervention is to be able to intervene at a point when the brain is still developing so we can change the trajectory not only of early development but also of brain development," she explained.

For the study, 48 children, 1½ to 2½ years old, with autism spectrum disorder were assigned either to the new Early Start Denver Model program or were placed in programs typically available in their communities.

The Denver Model "targets all areas of development so it's language, social behavior, motor skills, play, self-help skills, and the intervention is provided by trained paraprofessionals who work with the child one-on-one in the home for two two-hour sessions five days a week," Dawson explained. "Parents are also trained to carry out intervention strategies and to use those strategies in the context of bath time or at the dinner table or even at the playground."

"The strategies in this model are delivered in a very naturalistic, play-based and relationship-focused context rather than sitting the child down at a table and doing drills," she added. "It's just a slow process, sort of a labor of love, teaching kids step by step all these different skills."

Two years later, children in the Denver Model group had improved an average of 17.6 points on a standard scale of early-life learning, compared with a 7-point increase for the comparison group. The Denver Model children also had an average IQ increase of 15.4 points, compared with a 4.4-point increase for the others.

Children participating in the Denver Model program were also more likely to have their diagnosis changed from autism to pervasive developmental disorder, the study found.

A step-by-step manual describing the approach is being published within the next month, Dawson said. The authors are also working on Web-based training materials and other ways to make the model more widely available, she said.

Keith A. Young, vice chairman for research in the psychiatry and behavioral science department at Texas A&M Health Science Center College of Medicine, and chairman of the Tissue Advisory Board at Autism Speaks, described the study as a "critically important paper."

"It sets a benchmark for additional therapies that may come along," Young said. "This treatment was done in a very scientifically rigorous way and I think ... this is going to become the standard for what needs to be done to get these kids to function better." "The magnitude of the learning that took place in the domains that are deficient in people with autism and, in particular, in expressive language and communication were really substantial and brought them up to a level where this is really going to improve their quality of life," he added.

Donna Murray, co-director of the Kelly O'Leary Center for Autism Spectrum Disorders at Cincinnati Children's Hospital Medical Center, said that the study "continues to support the idea that we need to be able to provide more intensive early intervention" for autism spectrum disorders.

"We do know there are studies suggesting that applied behavioral analysis [used in the Denver model] has positive outcomes in children with autism," Murray said. "This is a very nice study to support what we had sort of suspected."

A second study published at the same time in Pediatrics found that the anti-psychotic drug aripiprazole (Abilify) helped quell tantrums, aggression and other forms of irritability in 98 children and adolescents with autism spectrum disorder. The study was funded by Bristol-Myers Squibb and Otsuka Pharmaceutical Co., which develop and market Abilify.

The drug is an antipsychotic more commonly used to treat schizophrenia and the mania associated with bipolar disorder.

More information

The U.S. National Institute of Mental Health has more on autism spectrum disorders.

SOURCES: Geraldine Dawson, Ph.D., chief science officer, Autism Speaks; Donna Murray, Ph.D., co-director, Kelly O'Leary Center for Autism Spectrum Disorders, Cincinnati Children's Hospital Medical Center, Cincinnati; Keith A. Young, Ph.D., vice chairman, research, Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center College of Medicine, Temple, Tex.; Nov. 30, 2009, Pediatrics, online

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