Clinical outcomes of an early intervention program for preschool children with Autism Spectrum Disorder in a community group setting.
Open accessAbstract
BACKGROUND: Available evidence indicates that early intervention programs, such as the Early Start Denver Model (ESDM), can positively affect key outcomes for children with Autism Spectrum Disorder (ASD). However, programs involving resource intensive one-to-one clinical intervention are not readily available or deliverable in the community, resulting in many children with ASD missing out on evidence-based intervention during their early and most critical preschool years. This study evaluated the effectiveness of the ESDM for preschool-aged children with ASD using a predominantly group-based intervention in a community child care setting. METHODS: Participants were 26 children (21 male) with ASD with a mean age of 49.6 months. The ESDM, a comprehensive early intervention program that integrates applied behaviour analysis with developmental and relationship-based approaches, was delivered by trained therapists during the child's attendance at a child care centre for preschool-aged children with ASD. Children received 15-20 hours of group-based, and one hour of one-to-one, ESDM intervention per week. The average intervention period was ten months. Outcome measures were administered pre- and post-intervention, and comprised a developmental assessment - the Mullen Scales of Early Learning (MSEL); and two parent-report questionnaires - the Social Communication Questionnaire (SCQ) and Vineland Adaptive Behaviours Scales-Second Edition (VABS-II). RESULTS: Statistically significant post-intervention improvements were found in children's performance on the visual reception, receptive language and expressive language domains of the MSEL in addition to their overall intellectual functioning, as assessed by standardised developmental quotients. Parents reported significant increases in their child's receptive communication and motor skills on the VABS-II, and a significant decrease in autism-specific features on the SCQ. These effects were of around medium size, and appeared to be in excess of what may have been expected due to maturation. Nonetheless, these results need to be confirmed in a controlled study. CONCLUSIONS: This study suggests community dissemination of the ESDM using predominantly group-based intervention may be an effective intervention. Making the ESDM accessible to the wider ASD community in child care settings has the potential for significant clinical and economic benefits. Further studies are indicated in this area, including those with younger children, and which incorporate a control group and standardised ASD assessments. TRIAL REGISTRATION: This trial is registered with the Australian New Zealand Clinical Trials Registry: Registry number ACTRN12612000461897.
AI snapshot
Written from the paper’s full text.
TL;DR
In a pre-post community study, 26 preschool-aged children with ASD received the Early Start Denver Model (ESDM) mainly in a group child-care setting and showed significant improvements in several developmental, adaptive, and autism-symptom measures. The authors conclude this delivery model may be effective and feasible, but call for controlled confirmation.
Key findings
- Significant post-intervention gains were found on the MSEL for overall developmental quotient (36.8 to 46.7, p<0.001, d=0.47), Visual Reception (35.9 to 51.5, p=0.001, d=0.63), Receptive Language (27.6 to 38.7, p<0.001, d=0.48), and Expressive Language (32.6 to 40.7, p=0.001, d=0.40); Fine Motor DQ did not improve significantly (47.9 to 51.3, p=0.28, d=0.14).
- On the VABS-II, significant increases were reported for Receptive Communication (7.6 to 9.3, p=0.005, d=0.49), Gross Motor (9.3 to 11.7, p<0.001, d=0.87), and the Motor Skills domain standard score (66.4 to 73.7, p=0.02, d=0.45).
- SCQ total scores decreased significantly from 18.5 to 15.7 (p=0.04, d=−0.39), and the percentage of children scoring below the clinical cut-off of 15 or more doubled from 21% at Time 1 to 42% at Time 2; parent-reported use of full sentences increased from 52% to 68%.
- The authors note effect sizes were generally lower than those in Dawson et al.’s one-to-one ESDM trial, e.g., overall MSEL d=0.47 versus 0.87 in Dawson et al.
Methods
- Pre-post study of 26 children (21 male) with DSM-IV-TR Autistic Disorder, mean age 49.6 months (SD 6.08, range 36–58 months), attending an Autism Specific Early Learning and Care Centre in metropolitan Sydney, Australia.
- ESDM was delivered by trained therapists during child-care attendance: 15–20 hours per week of group intervention plus 1 hour per week of one-to-one intervention; average time between initial and follow-up assessment was 9.72 months (SD 2.91).
- Outcomes were measured pre- and post-intervention with the MSEL, SCQ, and VABS-II; paired samples t-tests compared scores, with Cohen’s d effect sizes reported.
Limitations
- Stated by the paper: lack of a control group; lack of a standardised observational measure of ASD diagnosis and severity; need for further studies with younger children and follow-up to assess durability.
- Evident from the text: the pre-post design cannot establish that observed improvements were caused by ESDM rather than maturation or other factors; the sample was small (n=26), and there were missing data because some families did not complete measures within required timeframes.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 40 cited sources checked · 0 supported · 0 flagged
- Findingown data
The post-intervention improvements were of around medium size.
“These effects were of around medium size, and appeared to be in excess of what may have been expected due to maturation.”
Quote in the paperSubstantial claim - Findingown data
Parents reported significant increases in their child's receptive communication on the VABS-II.
“Parents reported significant increases in their child’s receptive communication and motor skills on the VABS-II, and a significant decrease in autism-specific features on the SCQ.”
Quote in the paperSubstantial claim - Findingown data
Significant improvement was found in children's performance on the Receptive Language scale of the MSEL, as assessed by standardised DQs.
“Significant improvement was also found in children’s performance on the Visual Reception, Receptive Language and Expressive Language scales of the MSEL, as assessed by standardised DQs.”
Quote in the paperSubstantial claim - Findingown data
Significant improvement was found in children's performance on the Expressive Language scale of the MSEL, as assessed by standardised DQs.
“Significant improvement was also found in children’s performance on the Visual Reception, Receptive Language and Expressive Language scales of the MSEL, as assessed by standardised DQs.”
Quote in the paperSubstantial claim - Findingown data
Parents reported a significant decrease in autism-specific features on the SCQ.
“Parents reported significant increases in their child’s receptive communication and motor skills on the VABS-II, and a significant decrease in autism-specific features on the SCQ.”
Quote in the paperSubstantial claim
- Findingown data
No significant increase was found in children's DQ on the Fine Motor scale.
“No significant increase was found in children’s DQ on the Fine Motor scale.”
Quote in the paperNot a substantial claim - Findingown data
Significant improvement was found in children's performance on the Visual Reception scale of the MSEL, as assessed by standardised DQs.
“Significant improvement was also found in children’s performance on the Visual Reception, Receptive Language and Expressive Language scales of the MSEL, as assessed by standardised DQs.”
Quote in the paperSubstantial claim - Findingown data
Parents reported significant increases in their child's motor skills on the VABS-II.
“Parents reported significant increases in their child’s receptive communication and motor skills on the VABS-II, and a significant decrease in autism-specific features on the SCQ.”
Quote in the paperSubstantial claim - Findingown data
There was a significant increase in children's mean overall DQ from pre- to post-intervention.
“There was a significant increase in children’s mean overall DQ, a standardised index of their overall intellectual functioning, from pre- to-post-intervention.”
Quote in the paperSubstantial claim - Findingown data
The effect size for the increase in overall DQ was Cohen's d = .47.
“The size of this effect was Cohen’s d = .47, which is approaching medium size.”
Quote in the paperSubstantial claim - Findingown data
The development of children in the present study remained well below age-based expectations after intervention.
“While the development of children in the present study remained well below age-based expectations after intervention, there was evidence that some ground had been recovered over the course of the intervention that may suggest a change in developmental trajectory.”
Quote in the paperSubstantial claim - Findingown data
Significant increases were found in children's standard scores on the Motor Skills domain of the VABS-II from pre- to post-intervention.
“Significant increases were found in children’s standard scores on the Receptive Communication and Gross Motor sub-domains, in addition to the Motor Skills domain, of the VABS-II from pre- to post-intervention (see Table 1).”
Quote in the paperSubstantial claim - Findingown data
The percentage of children reported to be using full sentences, as assessed by a specific item on the SCQ, increased from 52% at Time 1 to 68% at Time 2.
“In addition, the percentage of children who were reported to be using full sentences, as assessed by a specific item on the SCQ, increased from 52% at Time 1 to 68% at Time 2.”
Quote in the paperNot a substantial claim - Findingown data
Significant increases were found in children's standard scores on the Gross Motor sub-domain of the VABS-II from pre- to post-intervention.
“Significant increases were found in children’s standard scores on the Receptive Communication and Gross Motor sub-domains, in addition to the Motor Skills domain, of the VABS-II from pre- to post-intervention (see Table 1).”
Quote in the paperSubstantial claim - Findingown data
The percentage of children who scored below the clinical cut-off of 15 or more on the SCQ doubled from 21% at Time 1 to 42% at Time 2.
“The percentage of children who scored below the clinical cut-off of 15 or more on the SCQ doubled from 21% at Time 1 to 42% at Time 2.”
Quote in the paperSubstantial claim - Findingown data
There was a significant decrease in children's total SCQ scores from pre- to post-intervention, indicative of a decrease in autism-specific features.
“There was a significant decrease in children’s total SCQ scores, indicative of a decrease in autism-specific features, from pre- to post-intervention (see Table 1).”
Quote in the paperSubstantial claim - Findingown data
Significant increases were found in children's standard scores on the Receptive Communication sub-domain of the VABS-II from pre- to post-intervention.
“Significant increases were found in children’s standard scores on the Receptive Communication and Gross Motor sub-domains, in addition to the Motor Skills domain, of the VABS-II from pre- to post-intervention (see Table 1).”
Quote in the paperSubstantial claim - Premisecitation
Evidence for the efficacy of the ESDM has been found among children aged less than 30 months.
“While evidence for the efficacy of the ESDM has been found among children aged less than 30 months [13]”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Dawson G: Randomized, controlled trial of an intervention for toddlers with autism: the early start Denver model. Pediatrics. 2010, 125 (1): e17-e23. 10.1542/peds.2009-0958. source
Not checked in the free run.
- Study design and conductcitation
A sample of 26 was sufficient to provide experimental power >0.8, with alpha at 0.05 using a pre-post design.
“In this regard, a sample of 26 was sufficient to provide experimental power >0.8, with alpha at 0.05 using a pre-post design.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Dawson G: Randomized, controlled trial of an intervention for toddlers with autism: the early start Denver model. Pediatrics. 2010, 125 (1): e17-e23. 10.1542/peds.2009-0958. source
Not checked in the free run.
- Premisecitation
Some effectiveness studies of EIBI in preschool settings have generally adopted a one-to-one approach.
“Some of these effectiveness studies have explored EIBI in preschool settings, although these have generally adopted a one-to-one approach (e.g., [19-23]).”
Quote in the paperSubstantial claim0 of 5 sources checked- cites [19] Magiati I, Charman T, Howlin P: A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders. J Child Psychol Psychiatry. 2007, 48 (8): 803-812. 10.1111/j.1469-7610.2007.01756.x. source
Not checked in the free run.
- cites [20] Eikeseth S: Intensive behavioral treatment at school for 4- to 7-year-old children with autism. A 1-year comparison controlled study. Behav Modif. 2002, 26 (1): 49-68. 10.1177/0145445502026001004. source
Not checked in the free run.
- cites [21] Howard JS: A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Res Dev Disabil. 2005, 26 (4): 359-383. 10.1016/j.ridd.2004.09.005. source
Not checked in the free run.
- cites [22] Eldevik S: Outcomes of behavioral intervention for children with autism in mainstream pre-school settings. J Autism Dev Disord. 2012, 42 (2): 210-220. 10.1007/s10803-011-1234-9. source
Not checked in the free run.
- cites [23] Perry A: Effectiveness of intensive behavioral intervention in a large, community-based program. Research in Autism Spectrum Disorders. 2008, 2 (4): 621-642. 10.1016/j.rasd.2008.01.002. source
Not checked in the free run.
- Interpretationreasoning
The observed effects appeared to be in excess of what may have been expected due to maturation.
“These effects were of around medium size, and appeared to be in excess of what may have been expected due to maturation.”
Quote in the paperSubstantial claim - Study design and conductreasoning
Comparing change in DQ score over time may help to control for the effects of development and maturation.
“Thus, comparing change in DQ score over time may help to control for the effects of development and maturation.”
Quote in the paperSubstantial claim - Study design and conductown data
The average correlation between pre- and post-scores for variables reported was r = .79.
“Dunlap et al. argued that when pre-post scores are highly correlated, as was the case in this study (average correlation for variables reported was r = .79), correction for the correlation results in a significant over-estimate of the true effect size [31].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [31] Dunlap WP, Cortina JM, Vaslow JB, Burke MJ: Meta-analysis of experiments with matched groups or repeated measures designs. Psychol Methods. 1996, 1 (2): 170-177. source
Not checked in the free run.
- Premisecitation
The results of the previous ESDM trial indicate large effect sizes.
“The results of the previous ESDM trial [13], which used the same dependent measures as utilised in the current design, indicate large effect sizes.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Dawson G: Randomized, controlled trial of an intervention for toddlers with autism: the early start Denver model. Pediatrics. 2010, 125 (1): e17-e23. 10.1542/peds.2009-0958. source
Not checked in the free run.
- Premisecitation
The only comprehensive EIBI program available for children aged less than 30 months that has been empirically evaluated is the Early Start Denver Model (ESDM).
“However, the only comprehensive EIBI program available for children aged less than 30 months that has been empirically evaluated is the Early Start Denver Model (ESDM: [13]).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [13] Dawson G: Randomized, controlled trial of an intervention for toddlers with autism: the early start Denver model. Pediatrics. 2010, 125 (1): e17-e23. 10.1542/peds.2009-0958. source
Not checked in the free run.
- Premisecitation
Magiati et al. reported a two-year follow-up of 16 preschoolers treated with an eclectic range of EIBIs in autism specific nurseries with staff-to-child ratios ranging from 1:1 to 1:3.3.
“One exception was Magiati et al. [19] who reported a two-year follow-up of 16 preschoolers treated with an eclectic range of EIBIs in autism specific nurseries with staff-to-child ratios ranging from 1:1 to 1:3.3.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [19] Magiati I, Charman T, Howlin P: A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders. J Child Psychol Psychiatry. 2007, 48 (8): 803-812. 10.1111/j.1469-7610.2007.01756.x. source
Not checked in the free run.
- Premisecitation
In the first randomised controlled trial of the ESDM, there was a separate parent training module.
“There was also a separate parent training module.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [13] Dawson G: Randomized, controlled trial of an intervention for toddlers with autism: the early start Denver model. Pediatrics. 2010, 125 (1): e17-e23. 10.1542/peds.2009-0958. source
Not checked in the free run.
- Interpretationown data
Community dissemination of the ESDM using predominantly group-based intervention may be an effective intervention.
“This study suggests community dissemination of the ESDM using predominantly group-based intervention may be an effective intervention.”
Quote in the paperSubstantial claim- Rests on an assumption: The observed pre-post improvements are attributable to the ESDM intervention rather than to maturation or other concurrent factors.
- Rests on an assumption: The sample of 26 preschool children with ASD attending an ASELCC is representative of the wider population of preschool children with ASD in community settings.
- Rests on an assumption: No other interventions or therapies were received by the children during the study period.
- Rests on an assumption: The missing data did not bias the results.
- Rests on an assumption: The ESDM curriculum can be delivered in a group setting without losing its efficacy.
- Interpretationreasoning
The significant cognitive improvements found among children in the present sample suggest treatment, rather than maturation, effects.
“In this regard, the significant cognitive improvements found among children in the present sample are promising, and suggest treatment, rather than maturation, effects.”
Quote in the paperSubstantial claim - Interpretationown data
Overall, the findings of the current study were not as strong as Dawson et al.'s.
“Overall, our findings weren't as strong as Dawson et al.’s, and this is in keeping with the existing evidence that one-to-one intervention starting at the youngest possible age offers the best opportunity for improving outcomes in children with ASD.”
Quote in the paperSubstantial claim - Premisecitation
The children in the current study had more severe developmental delay than those in the Dawson et al. sample (MSEL composite scores <0.1 percentile compared to approximately 0.5 percentile).
“and had more severe developmental delay (MSEL composite scores <0.1 percentile compared to approximately 0.5 percentile).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Dawson G: Randomized, controlled trial of an intervention for toddlers with autism: the early start Denver model. Pediatrics. 2010, 125 (1): e17-e23. 10.1542/peds.2009-0958. source
Not checked in the free run.
- Interpretationown data
There was evidence that some ground had been recovered over the course of the intervention that may suggest a change in developmental trajectory.
“While the development of children in the present study remained well below age-based expectations after intervention, there was evidence that some ground had been recovered over the course of the intervention that may suggest a change in developmental trajectory.”
Quote in the paperSubstantial claim - Premisecitation
Without intervention, ASD symptoms are generally thought to be stable over time, particularly where symptoms are at the more severe end of the spectrum.
“Without intervention, ASD symptoms are generally thought to be stable over time, particularly where symptoms are at the more severe end of the spectrum [34]”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [34] Kleinman JM: Diagnostic stability in very young children with autism spectrum disorders. J Autism Dev Disord. 2008, 38 (4): 606-615. 10.1007/s10803-007-0427-8. source
Not checked in the free run.
- Interpretationown data
There are benefits to a less intensive intervention with older children in resource constrained environments.
“However, our findings suggest that there are benefits to a less intensive intervention with older children in resource constrained environments.”
Quote in the paperSubstantial claim - Interpretationreasoning
The cognitive improvements observed from pre- to post-testing are unlikely to arise as a result of maturation.
“Thus, extrapolating from the current literature and given the fact that the participants in the present study had Autistic Disorder, high levels of ASD symptoms and low baseline IQ scores (<0.1 percentile), it appears that the cognitive improvements observed from pre- to post-testing are unlikely to arise as a result of maturation.”
Quote in the paperSubstantial claim - Interpretationcitation
The changes to SCQ and VABS-II scores are attributable to treatment rather than maturational effects.
“Similarly, we would contend that the changes to SCQ and VABS-II scores are attributable to treatment rather than maturational effects for two main reasons: 1) Without intervention, ASD symptoms are generally thought to be stable over time, particularly where symptoms are at the more severe end of the spectrum [34]; and 2) The SCQ and VABS-II have acceptable test-retest reliability, suggesting that”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [34] Kleinman JM: Diagnostic stability in very young children with autism spectrum disorders. J Autism Dev Disord. 2008, 38 (4): 606-615. 10.1007/s10803-007-0427-8. source
Not checked in the free run.
- Rests on an assumption: The SCQ and VABS-II have acceptable test-retest reliability.
- Interpretationcitation
The ESDM may be effective when delivered in a group setting with preschool-aged children, with a relatively minimal one-to-one component.
“In addition to contributing to earlier evidence about the benefits of the ESDM as an efficacious early intervention for toddlers with ASD, our findings also indicate that the ESDM may be effective when delivered in a group setting with preschool-aged children, with a relatively minimal one-to-one component, a finding consistent with the results of Vivanti et al. [15].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [15] Vivanti G: Brief Report: Predictors of Outcomes in the Early Start Denver Model Delivered in a Group Setting. J Autism Dev Disord. 2012, Epub ahead of print retrieved December 11 2012, from http://link.springer.com/article/10.1007%2Fs10803-012-1705-7?LI=true#
Not checked in the free run.
- Premisecitation
For children with more severe presentations, regression is a common course.
“Indeed, for children with more severe presentations, regression is a common course [33].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [33] Begovac I: Longitudinal studies of IQ stability in children with childhood autism - literature survey. Psychiatr Danub. 2009, 21 (3): 310-319.
Not checked in the free run.
- Premisecitation
Kleinman et al. did not report notable changes in MSEL scores in a sample of 46 children with Autistic disorder assessed between 16-35 months and again between 42-82 months.
“Similarly, Kleinman et al. [34] did not report notable changes in MSEL scores in a sample of 46 children with Autistic disorder who were first assessed between 16 and 35 months and again between 42 and 82 months, an age range analogous to that used in the present study.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [34] Kleinman JM: Diagnostic stability in very young children with autism spectrum disorders. J Autism Dev Disord. 2008, 38 (4): 606-615. 10.1007/s10803-007-0427-8. source
Not checked in the free run.
- Premisecitation
The children in the current study were older than those in the Dawson et al. sample at the commencement of the intervention (mean age 49.6 months vs 23.9 months).
“the children in the current study were older than those in the Dawson et al. sample at the commencement of the intervention (mean age of 49.6 months compared to 23.9 months)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Dawson G: Randomized, controlled trial of an intervention for toddlers with autism: the early start Denver model. Pediatrics. 2010, 125 (1): e17-e23. 10.1542/peds.2009-0958. source
Not checked in the free run.
- Study design and conductnone given
The lack of a standardised observational measure of ASD diagnosis and severity is a limitation of the study.
“Limitations of this study, such as the lack of a control group and lack of a standardised observational measure of ASD diagnosis and severity, need to be kept in mind while interpreting the significance of these results, and further research addressing these issues is warranted.”
Quote in the paperNot a substantial claim - Premisecitation
In a review of 23 longitudinal studies of IQ stability in children with ASD receiving therapy, the clear majority found IQ to be stable over time.
“For example, in a review of 23 longitudinal studies of IQ stability in children with ASD, all of whom were receiving therapy, Begovac et al. reported that the clear majority of studies found IQ to be stable over time [33].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [33] Begovac I: Longitudinal studies of IQ stability in children with childhood autism - literature survey. Psychiatr Danub. 2009, 21 (3): 310-319.
Not checked in the free run.
- Study design and conductown data
Due to the lack of a control group, it is difficult to establish a direct link between the observed improvements and the ESDM intervention.
“Due to the lack of a control group in the present study, it is difficult to establish a direct link between the observed improvements and the ESDM intervention.”
Quote in the paperSubstantial claim - Interpretationcitation
The observed gains, or a substantial proportion of them, are unlikely to be due to maturational or other effects.
“While it could be argued that the observed gains, or a substantial proportion of the observed gains, were due to maturational or other effects, we would contend that this is improbable for several reasons.”
Quote in the paperSubstantial claim
- May combine two claims. 10
- Classified as probably not a substantial claim. 15
May combine two claims.
FindingcitationThe Cohen's d effect size for overall MSEL developmental quotient was 0.47 in the current study, compared to 0.87 in Dawson et al.
“For example, the Cohen’s d effect size for overall MSEL developmental quotient was 0.47 in the current study, as compared to 0.87 in Dawson et al. [13].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Dawson G: Randomized, controlled trial of an intervention for toddlers with autism: the early start Denver model. Pediatrics. 2010, 125 (1): e17-e23. 10.1542/peds.2009-0958. source
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductnone givenAll interventions were delivered by therapists formally trained in the ESDM by accredited trainers.
“All interventions were delivered by therapists formally trained in the ESDM by accredited trainers.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataNo families withdrew from the study during the course of the intervention.
“No families withdrew from the study during the course of the intervention; however, there were some instances of missing data due to families not completing measures within the necessary timeframes.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationSeveral meta-analyses have concluded that Early Intensive Behavioural Intervention (EIBI), incorporating the principles of applied behaviour analysis (ABA), is the treatment of choice for young children with ASD.
“Several meta-analyses conducted in recent years have tended to conclude that Early Intensive Behavioural Intervention (EIBI), incorporating the principles of applied behaviour analysis (ABA), is the treatment of choice for young children with ASD (cf. [8,9]).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [8] Reichow B: Overview of meta-analyses on early intensive behavioral intervention for young children with autism spectrum disorders. J Autism Dev Disord. 2012, 42 (4): 512-520. 10.1007/s10803-011-1218-9. source
Not checked in the free run.
- cites [9] Vismara LA, Rogers SJ: Behavioral treatments in autism spectrum disorder: what do we know?. Annu Rev Clin Psychol. 2010, 6: 447-468. 10.1146/annurev.clinpsy.121208.131151. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe VABS-II has well-established strong psychometric properties.
“The VABS-II has well-established strong psychometric properties [29].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [29] Sparrow S, Cicchetti D, Balla D: Vineland adaptive behavior scales. 2005, Minneapolis, MN: Pearson Assessment, 2
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe SCQ has robust psychometric properties.
“The SCQ has robust psychometric properties [26-28].”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [26] Chandler S: Validation of the social communication questionnaire in a population cohort of children with autism spectrum disorders. J Am Acad Child Adolesc Psychiatry. 2007, 46 (10): 1324-1332. 10.1097/chi.0b013e31812f7d8d. source
Not checked in the free run.
- cites [27] Skuse DH, Mandy WPL, Scourfield J: Measuring autistic traits: heritability, reliability and validity of the social and communication disorders checklist. Br J Psychiatry. 2005, 187 (6): 568-572. 10.1192/bjp.187.6.568. source
Not checked in the free run.
- cites [28] Snow AV, Lecavalier L: Sensitivity and specificity of the modified checklist for autism in toddlers and the social communication questionnaire in preschoolers suspected of having pervasive developmental disorders. Autism. 2008, 12 (6): 627-644. 10.1177/1362361308097116. source
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationSuperior outcomes are associated with entry into EIBI at the earliest possible age.
“The literature indicates that superior outcomes are associated with entry into EIBI at the earliest possible age [10,11].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [10] Granpeesheh D, Tarbox J, Dixon DR: Applied behavior analytic interventions for children with autism: a description and review of treatment research. Ann Clin Psychiatry. 2009, 21 (3): 162-173.
Not checked in the free run.
- cites [11] Wallace KS, Rogers SJ: Intervening in infancy: implications for autism spectrum disorders. J Child Psychol Psychiatry. 2010, 51 (12): 1300-1320. 10.1111/j.1469-7610.2010.02308.x. source
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationVivanti et al. reported significant developmental gains following one year of group-based ESDM in preschool-aged children.
“Vivanti et al. reported significant developmental gains following the intervention, with skills in functional use of objects, goal understanding and imitation predicting positive response to treatment [15].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [15] Vivanti G: Brief Report: Predictors of Outcomes in the Early Start Denver Model Delivered in a Group Setting. J Autism Dev Disord. 2012, Epub ahead of print retrieved December 11 2012, from http://link.springer.com/article/10.1007%2Fs10803-012-1705-7?LI=true#
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenNone of the participants were receiving an EIBI outside of the ESDM intervention offered as part of the study.
“None of the participants were receiving an EIBI outside of the ESDM intervention offered as part of the study.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationPreliminary data are available for the efficacy of the Denver model, with reports of positive outcomes in cognitive, social, language and play skills, as well as a reduction in ASD symptomatology, in children with ASD.
“Preliminary data are already available for the efficacy of the Denver model [16,17] with reports of positive outcomes in cognitive, social, language and play skills, as well as a reduction in ASD symptomatology, in children with ASD.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [16] Rogers SJ, Lewis HAL: An effective Day treatment model for young children with pervasive developmental disorders. J Am Acad Child Adolesc Psychiatry. 1989, 28 (2): 207-214. 10.1097/00004583-198903000-00010. source
Not checked in the free run.
- cites [17] Rogers SJ, Ozonoff S, Maslin-Cole C: A comparative study of attachment behavior in young children with autism or other psychiatric disorders. J Am Acad Child Adolesc Psychiatry. 1991, 30 (3): 483-488. 10.1097/00004583-199105000-00021. source
Not checked in the free run.
May combine two claims.
PremisecitationStudies exploring the effectiveness of EIBI interventions, such as ABA, in community settings have produced generally favourable results, although effect sizes reported are typically smaller than in clinic-based efficacy studies.
“Studies exploring the effectiveness of EIBI interventions, such as ABA, in community settings have produced generally favourable results [18], although effect sizes reported are typically smaller than in clinic-based efficacy studies.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [18] Eikeseth S: Outcome for children with autism receiving early and intensive behavioral intervention in mainstream preschool and kindergarten settings. Research in Autism Spectrum Disorders. 2012, 6 (2): 829-835. 10.1016/j.rasd.2011.09.002. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe ESDM is a manualised, comprehensive play-based intervention that integrates ABA with developmental and relationship-based approaches.
“The ESDM is a manualised, comprehensive play-based intervention that integrates ABA with developmental and relationship-based approaches [14].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [14] Rogers S, Dawson G: Early start Denver model for young children with autism. 2009, New York: Guilford Press
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThere were some instances of missing data due to families not completing measures within the necessary timeframes.
“No families withdrew from the study during the course of the intervention; however, there were some instances of missing data due to families not completing measures within the necessary timeframes.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationThe first and only randomised controlled trial of the ESDM demonstrated significant gains in visual processing and improvements in language abilities, with subsequent gains in IQ and adaptive behaviours, among children receiving the ESDM.
“The first and only randomised controlled trial of the ESDM demonstrated significant gains in visual processing and improvements in language abilities, with subsequent gains in IQ and adaptive behaviours, among children receiving the ESDM [13].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Dawson G: Randomized, controlled trial of an intervention for toddlers with autism: the early start Denver model. Pediatrics. 2010, 125 (1): e17-e23. 10.1542/peds.2009-0958. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe one-to-one sessions were conducted by a consistent key worker.
“The one-to-one sessions were conducted by a consistent key worker.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationIn the first randomised controlled trial of the ESDM, the intervention was provided by trained therapists and children received 20 hours per week of one-to-one ESDM intervention in a University clinic setting.
“In that study, the intervention was provided by trained therapists and children received 20 hours per week of one-to-one ESDM intervention in a University clinic setting.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Dawson G: Randomized, controlled trial of an intervention for toddlers with autism: the early start Denver model. Pediatrics. 2010, 125 (1): e17-e23. 10.1542/peds.2009-0958. source
Not checked in the free run.
May combine two claims.
PremisecitationThe Rogers and Lewis study of 31 children (mean age 45 months) using the Denver Model with a staff-to-child ratio of 1:2 and groups of six found significant improvement in play skills and reduction in autism symptoms.
“The Rogers and Lewis [16] study of 31 children (mean age 45 months), which employed a staff-to-child ratio of 1:2 with children treated in groups of six using the Denver Model, found significant improvement in play skills and reduction in autism symptoms.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [16] Rogers SJ, Lewis HAL: An effective Day treatment model for young children with pervasive developmental disorders. J Am Acad Child Adolesc Psychiatry. 1989, 28 (2): 207-214. 10.1097/00004583-198903000-00010. source
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
PremisecitationIn Magiati et al., children improved in their mental age scores but IQ standard scores were unaffected after treatment.
“While children improved in their mental age scores in that study, IQ standard scores were unaffected after treatment.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [19] Magiati I, Charman T, Howlin P: A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders. J Child Psychol Psychiatry. 2007, 48 (8): 803-812. 10.1111/j.1469-7610.2007.01756.x. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn Vivanti et al., skills in functional use of objects, goal understanding and imitation predicted positive response to treatment.
“Vivanti et al. reported significant developmental gains following the intervention, with skills in functional use of objects, goal understanding and imitation predicting positive response to treatment [15].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [15] Vivanti G: Brief Report: Predictors of Outcomes in the Early Start Denver Model Delivered in a Group Setting. J Autism Dev Disord. 2012, Epub ahead of print retrieved December 11 2012, from http://link.springer.com/article/10.1007%2Fs10803-012-1705-7?LI=true#
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductcitationCohen's d scores were calculated using the pooled standard deviation uncorrected for the correlation between pre- and post-scores.
“Following the recommendations of Dunlap et al. [31], and in order to provide a conservative estimate of the size of observed effects, Cohen’s d scores were calculated using the pooled standard deviation uncorrected for the correlation between pre- and post-scores.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [31] Dunlap WP, Cortina JM, Vaslow JB, Burke MJ: Meta-analysis of experiments with matched groups or repeated measures designs. Psychol Methods. 1996, 1 (2): 170-177. source
Not checked in the free run.
May combine two claims.
Interpretationown dataThe findings provide a strong suggestion of the feasibility and effectiveness of the ESDM in a less costly, more sustainable, group-based child care program for children with ASD in the community.
“Our findings of significant clinical improvements from the delivery of the ESDM in a less costly, more sustainable, group-based child care program provide a strong suggestion of the feasibility and effectiveness of this empirically validated treatment approach for children with ASD in the community during their critical early years of development.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe pre-post results did not involve comparison with a control group.
“It is to be noted these are pre-post results that did not involve comparison with a control group.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataPreschool-aged children with ASD receiving the ESDM intervention in a group format showed statistically and clinically significant gains on a range of clinical outcomes, particularly in receptive language and communication.
“The findings from the present study suggest that preschool-aged children with ASD receiving the ESDM intervention in a group format showed statistically and clinically significant gains on a range of clinical outcomes, particularly in the areas of receptive language and communication.”
Quote in the paperSubstantial claim
The paper relies on this without support.
The observed pre-post improvements are attributable to the ESDM intervention rather than to maturation or other concurrent factors.
“This study suggests community dissemination of the ESDM using predominantly group-based intervention may be an effective intervention.”
The paper relies on this without support.
The sample of 26 preschool children with ASD attending an ASELCC is representative of the wider population of preschool children with ASD in community settings.
“This study suggests community dissemination of the ESDM using predominantly group-based intervention may be an effective intervention.”
The paper relies on this without support.
No other interventions or therapies were received by the children during the study period.
“None of the participants were receiving an EIBI outside of the ESDM intervention offered as part of the study.”
The paper relies on this without support.
The missing data did not bias the results.
“No families withdrew from the study during the course of the intervention; however, there were some instances of missing data due to families not completing measures within the necessary timeframes.”
The paper relies on this without support.
The ESDM curriculum can be delivered in a group setting without losing its efficacy.
“Other than accommodations to allow translation to the group context, no modifications were made to the ESDM curriculum.”
The paper relies on this without support.
The SCQ and VABS-II have acceptable test-retest reliability.
“The SCQ and VABS-II have acceptable test-retest reliability, suggesting that measurement errors were not a key factor.”
The paper relies on this without support.
The ESDM is designed to enhance the social attention and communicative abilities of young children with ASD, with particular focus on social attention, affect sharing, imitation and joint attention.
“Given that the ESDM is designed to enhance the social attention and communicative abilities of young children with an ASD, with particular focus on the critical skills of social attention, affect sharing, imitation and joint attention, the significant gains made in the respective domains of visual reception and receptive and expressive communication are noteworthy.”
The paper relies on this without support.
One-to-one intervention starting at the youngest possible age offers the best opportunity for improving outcomes in children with ASD.
“this is in keeping with the existing evidence that one-to-one intervention starting at the youngest possible age offers the best opportunity for improving outcomes in children with ASD.”
The paper relies on this without support.
Intervention programs provided within day care and preschool settings offer greater opportunities for generalisation of skills and improvements to school readiness, resulting in easier transition to other education settings following intervention.
“Intervention programs provided within day care and preschool settings offer greater opportunities for generalisation of skills and improvements to school readiness, resulting in easier transition to other education settings following intervention.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
On the basis of evidence linking early treatment to improved outcomes, it is important that children with developmental concerns be evaluated and referred to services as soon as possible.
“On the basis of evidence linking early treatment to improved outcomes (36–39), it is important that children with developmental concerns be evaluated and referred to services as soon as possible.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Adaptive Behaviour Composite effect size differs between tables
MinorTable 1 reports Cohen's d as 0.12 for the current study's Adaptive Behaviour Composite, while Table 2 reports 0.07 for the same outcome.
“| Adaptive Behaviour Composited | 61.9 | 13.9 | 63.6 | 14.4 | −0.9 | 14 | 0.38 | 0.12 |”
“| Adaptive Behaviour Composite | 0.07 | −0.49b |”
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“Consistent with this view, the American Academy of Pediatrics has recommended that children be screened for ASD from around 18 months of age to aid in early intervention efforts [12].”
BackgroundVineland Adaptive Behavior Scales
Sparrow, S. S. (2010) · Springer eBooks · doi:10.1007/978-0-387-79948-3_1602 · Cited by 1,974 · see citing works
Meta-analysis of experiments with matched groups or repeated measures designs
Dunlap, W. P., Cortina, J. M., Vaslow, J. B., & Burke, M. J. (1996) · Psychological Methods · doi:10.1037/1082-989x.1.2.170 · Cited by 1,693 · cited 3× · see citing works
“[31], and in order to provide a conservative estimate of the size of observed effects, Cohen’s d scores were calculated using the pooled standard deviation uncorrected for the correlation between pre- and post-scores.”
BackgroundMethodInfluentialEarly behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder
Dawson, G. (2008) · Development and Psychopathology · doi:10.1017/s0954579408000370 · Cited by 1,138 · cited 2× · see citing works
“Moreover, early intervention in the first years of life offers the best potential for children as brain plasticity is greatest during this period, enabling the establishment and reorganisation of neuronal networks in response to environmental stimulation [5].”
BackgroundMultiple Comparison Procedures: The Practical Solution
Saville, D. J. (1990) · The American Statistician · doi:10.1080/00031305.1990.10475712 · Cited by 638 · cited 3× · see citing works
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InfluentialA comparison of intensive behavior analytic and eclectic treatments for young children with autism
Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H. (2005) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2004.09.005 · Cited by 600 · cited 1× · see citing works
“, [19-23]).”
Reichow, B. (2012) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-011-1218-9 · Cited by 584 · cited 1× · see citing works
“[8,9]).”
Predicting language outcome in infants with autism and pervasive developmental disorder
Charman, T., Baron‐Cohen, S., Swettenham, J., Baird, G., Drew, A., & Cox, A. (2003) · International Journal of Language & Communication Disorders · doi:10.1080/136820310000104830 · Cited by 489 · cited 1× · see citing works
“found that language outcomes were positively associated with early joint attention [32].”
Eikeseth, S., Smith, T., Jahr, E., & Eldevik, S. (2002) · Behavior Modification · doi:10.1177/0145445502026001004 · Cited by 481 · see citing works
CHANDLER, S., CHARMAN, T., BAIRD, G., SIMONOFF, E., LOUCAS, T., MELDRUM, D., SCOTT, M., & PICKLES, A. (2007) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e31812f7d8d · Cited by 410 · cited 1× · see citing works
“The SCQ has robust psychometric properties [26-28].”
Behavioral treatments in autism spectrum disorder: what do we know?
Vismara, L. A., & Rogers, S. J. (2010) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.121208.131151 · Cited by 376 · cited 1× · see citing works
“[8,9]).”
Skuse, D. H., Mandy, W. P. L., & Scourfield, J. (2005) · British Journal of Psychiatry · doi:10.1192/bjp.187.6.568 · Cited by 322 · cited 1× · see citing works
“The SCQ has robust psychometric properties [26-28].”
Makrygianni, M. K., & Reed, P. (2010) · Research in Autism · doi:10.1016/j.rasd.2010.01.014 · Cited by 301 · cited 1× · see citing works
“Such a model suggests the importance of early intervention for ASD, and is supported by studies showing better outcomes with earlier treatment [6,7].”
ResultAn Effective Day Treatment Model for Young Children with Pervasive Developmental Disorders
ROGERS, S. J., & LEWIS, H. (1989) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-198903000-00010 · Cited by 283 · see citing works
Diagnostic Stability in Very Young Children with Autism Spectrum Disorders
Kleinman, J. M., Ventola, P. E., Pandey, J., Verbalis, A. D., Barton, M., Hodgson, S., Green, J., Dumont-Mathieu, T., Robins, D. L., & Fein, D. (2008) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-007-0427-8 · Cited by 272 · cited 2× · see citing works
“[34] did not report notable changes in MSEL scores in a sample of 46 children with Autistic disorder who were first assessed between 16 and 35 months and again between 42 and 82 months, an age range analogous to that used in the present study.”
BackgroundResultMagiati, I., Charman, T., & Howlin, P. (2007) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2007.01756.x · Cited by 263 · cited 1× · see citing works
“[19] who reported a two-year follow-up of 16 preschoolers treated with an eclectic range of EIBIs in autism specific nurseries with staff-to-child ratios ranging from 1:1 to 1:3.”
BackgroundIntervening in infancy: implications for autism spectrum disorders
Wallace, K. S., & Rogers, S. J. (2010) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2010.02308.x · Cited by 221 · cited 1× · see citing works
“The literature indicates that superior outcomes are associated with entry into EIBI at the earliest possible age [10,11].”
BackgroundGuidelines for safe work practices in human and animal medical diagnostic laboratories
Miller, M. J., Astles, R., Baszler, T. V., Chapin, K. C., Carey, R. A., Garcia, L. S., Gray, L. D., Larone, D. H., Pentella, M., Pollock, A., et al. (2012) · Cited by 209 · see citing works
Snow, A. V., & Lecavalier, L. (2008) · Autism · doi:10.1177/1362361308097116 · Cited by 182 · cited 1× · see citing works
“The SCQ has robust psychometric properties [26-28].”
Eikeseth, S., Klintwall, L., Jahr, E., & Karlsson, P. (2012) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2011.09.002 · Cited by 176 · cited 1× · see citing works
“Studies exploring the effectiveness of EIBI interventions, such as ABA, in community settings have produced generally favourable results [18], although effect sizes reported are typically smaller than in clinic-based efficacy studies.”
ResultGranpeesheh, D., Tarbox, J., & Dixon, D. R. (2009) · Annals of Clinical Psychiatry · doi:10.1177/104012370902100304 · Cited by 174 · cited 1× · see citing works
“The literature indicates that superior outcomes are associated with entry into EIBI at the earliest possible age [10,11].”
BackgroundOutcomes of Behavioral Intervention for Children with Autism in Mainstream Pre-School Settings
Eldevik, S., Hastings, R. P., Jahr, E., & Hughes, J. C. (2012) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-011-1234-9 · Cited by 166 · cited 1× · see citing works
“, [19-23]).”
Perry, A., Cummings, A., Geier, J. D., Freeman, N. L., Hughes, S., Managhan, T., Reitzel, J.-A., & Williams, J. (2011) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2010.07.003 · Cited by 144 · cited 1× · see citing works
“Such a model suggests the importance of early intervention for ASD, and is supported by studies showing better outcomes with earlier treatment [6,7].”
ResultEffectiveness of Intensive Behavioral Intervention in a large, community-based program
Perry, A., Cummings, A., Dunn Geier, J., Freeman, N. L., Hughes, S., LaRose, L., Managhan, T., Reitzel, J.-A., & Williams, J. (2008) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2008.01.002 · Cited by 142 · cited 1× · see citing works
“[23], such a conclusion is not consistent with what we know from the literature on outcomes for children with Autism in the past and as reported by several investigators in their control groups.”
ResultBrief Report: Predictors of Outcomes in the Early Start Denver Model Delivered in a Group Setting
Victorian ASELCC Team, Vivanti, G., Dissanayake, C., Zierhut, C., & Rogers, S. J. (2012) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-012-1705-7 · Cited by 134 · see citing works
ROGERS, S. J., OZONOFF, S., & MASLIN-COLE, C. (1991) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199105000-00021 · Cited by 110 · see citing works
Genetic basis of autism: is there a way forward?
Eapen, V. (2011) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e328345927e · Cited by 102 · cited 1× · see citing works
“Building on genetic vulnerability [4], it has been hypothesised that ASD emerges from a developmental cascade in which a deficit in attention to social stimuli leads to impaired interactions with primary caregivers.”
BackgroundSelf-citationEarly start denver model for young children with autism
Xu, X. (2015) · Zhonghua shiyong erke linchuang zazhi · doi:10.3760/cma.j.issn.2095-428x.2015.11.001 · Cited by 81 · cited 2× · see citing works
“The ESDM is a manualised, comprehensive play-based intervention that integrates ABA with developmental and relationshipbased approaches [14].”
BackgroundMethodStability and change of IQ scores in preschool children diagnosed with autistic spectrum disorder
Dietz, C., Willemsen‐Swinkels, S. H. N., Buitelaar, J. K., van Daalen, E., & van Engeland, H. (2007) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-007-0614-3 · Cited by 50 · cited 1× · see citing works
“While it is the case that some studies have found that a proportion of children with ASD show catch-up intellectual development during the preschool years that may not be attributable to intervention effects [35], it appears that this occurs more in children who have less severe Autism symptoms, a diagnosis of PDD-NOS…”
BackgroundLongitudinal studies of IQ stability in children with childhood autism - literature survey.
Begovac, I., Begovac, B., Majić, G., & Vidović, V. (2009) · PubMed · Cited by 31 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Rutter M, Bailey A, Lord C: Social communication questionnaire (SCQ). 2003, Los Angeles, CA: Western Psychological Services
- Sparrow S, Cicchetti D, Balla D: Vineland adaptive behavior scales: (Vineland II), survey interview form/caregiver rating form. 2005, Livonia, MN: Pearson Assessments
Cited by
Sorted by citations
Christensen, D. L., Baio, J., Braun, K. V. N., Bilder, D., Charles, J., Constantino, J. N., Daniels, J., Durkin, M. S., Fitzgerald, R. T., Kurzius-Spencer, M., et al. (2016) · MMWR. Surveillance Summaries · doi:10.15585/mmwr.ss6503a1 · Cited by 1,964 · see citing works
Christensen, D. L., Braun, K. V. N., Baio, J., Bilder, D., Charles, J., Constantino, J. N., Daniels, J., Durkin, M. S., Fitzgerald, R. T., Kurzius-Spencer, M., et al. (2018) · MMWR. Surveillance Summaries · doi:10.15585/mmwr.ss6513a1 · Cited by 587 · see citing works
RetractedChristensen, D., Bilder, D. A., Zahorodny, W. M., Pettygrove, S. D., Durkin, M. S., Fitzgerald, R. T., Rice, C. E., Kurzius‐Spencer, M., Baio, J., & Yeargin‐Allsopp, M. (2015) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000235 · Cited by 389 · see citing works
Systematic review of tools to measure outcomes for young children with autism spectrum disorder
McConachie, H., Parr, J. R., Glod, M., Hanratty, J., Livingstone, N., Oono, I. P., Robalino, S., Baird, G., Beresford, B., Charman, T., et al. (2015) · Health Technology Assessment · doi:10.3310/hta19410 · Cited by 378 · see citing works
Christensen, D. L., Maenner, M. J., Bilder, D., Constantino, J. N., Daniels, J., Durkin, M. S., Fitzgerald, R. T., Kurzius-Spencer, M., Pettygrove, S. D., Robinson, C., et al. (2019) · MMWR. Surveillance Summaries · doi:10.15585/mmwr.ss6802a1 · Cited by 344 · see citing works
Sleep in Children with Autism Spectrum Disorder
Souders, M. C., Jackson, S. Z., Eriksen, W., Sinko, R., Connell, J. E., Kerns, C. M., Schaaf, R. C., & Pinto‐Martin, J. A. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0782-x · Cited by 307 · see citing works
the Victorian ASELCC Team, Vivanti, G., Paynter, J. M., Duncan, E., Fothergill, H., Dissanayake, C., & Rogers, S. J. (2014) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-014-2168-9 · Cited by 240 · see citing works
Outcome for children receiving the Early Start Denver Model before and after 48 months
The Victorian ASELCC Team, Vivanti, G., & Dissanayake, C. (2016) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-016-2777-6 · Cited by 174 · see citing works
Fulton, E. A., Eapen, V., Črnčec, R., Walter, A., & Rogers, S. J. (2014) · Frontiers in Pediatrics · doi:10.3389/fped.2014.00040 · Cited by 137 · see citing works
“(34) investigated the impact of the ESDM on children’s adaptive behavior, no studies of the ESDM to date have focused on the effect of the ESDM on children’s maladaptive behaviors.”
BackgroundResultInfluentialSelf-citationEapen, V., Črnčec, R., Walter, A., & Tay, K. P. (2014) · Autism Research and Treatment · doi:10.1155/2014/160783 · Cited by 124 · see citing works
“While advances in the accurate diagnosis of ASD at increasingly earlier ages have been made, as well as the development of evidence-based early interventions [24, 25], QoL research in ASD is in its infancy.”
BackgroundSelf-citationEffectiveness of the Early Start Denver Model: a Systematic Review
Waddington, H. L., van der Meer, L. A. J., & Sigafoos, J. (2016) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-015-0068-3 · Cited by 124 · see citing works
“Twelve articles reported onmeasures of child behavioral functioning and development (*Dawson et al. 2010; *Eapen et al. 2013; *Estes et al. 2015; *Fulton et al. 2014; *Rogers et al. 2012; *Vismara et al. 2012; *Vismara et al. 2009a, b *Vismara et al. 2013a; *Vismara et al. 2008; *Vivanti et al.…”
BackgroundMethodResultInfluentialJo, H., Schieve, L. A., Rice, C. E., Yeargin-Allsopp, M., Tian, L. H., Blumberg, S. J., Kogan, M. D., & Boyle, C. A. (2015) · Maternal and Child Health Journal · doi:10.1007/s10995-015-1683-4 · Cited by 116 · see citing works
“Previous studies suggest early intervention is associated with improved outcomes [3–6].”
BackgroundSullivan, K. A., Stone, W. L., & Dawson, G. (2014) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2014.07.027 · Cited by 103 · see citing works
Sappok, T., Budczies, J., Dziobek, I., Bölte, S., Došen, A., & Diefenbacher, A. (2013) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-013-1933-5 · Cited by 97 · see citing works
“Thus, an increasing number of intervention programs integrate applied behavior analysis with developmental and relationship-based methods (Eapen et al. 2013; Freitag et al. 2012) and report promising results with respect to adaptive skills, cognition and symptom severity.”
BackgroundAn Evaluation of the Research Evidence on the Early Start Denver Model
Baril, E. M., & Humphreys, B. P. (2017) · Journal of Early Intervention · doi:10.1177/1053815117722618 · Cited by 91 · see citing works
“Of the four studies that took place with children over 36 months of age, children received a combination of both individual and group intervention in two of the studies (Eapen et al., 2013; Fulton et al., 2014).”
BackgroundResultInfluentialAutism Spectrum Disorder Screening Instruments for Very Young Children: A Systematic Review
Towle, P. O., & Patrick, P. A. (2016) · Autism Research and Treatment · doi:10.1155/2016/4624829 · Cited by 83 · see citing works
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“15,16 We are aware that our study has the limitation of being a retrospective analysis that did not include a control group without intervention or other early treatment.”
Gibson, J. L., Pritchard-Rowe, E., & de Lemos, C. (2021) · Autism & Developmental Language Impairments · doi:10.1177/23969415211015840 · Cited by 81 · see citing works
Parenting preschoolers with autism: Socioeconomic influences on wellbeing and sense of competence
Mathew, N. E., Burton, K., Schierbeek, A., Črnčec, R., Walter, A., & Eapen, V. (2019) · World Journal of Psychiatry · doi:10.5498/wjp.v9.i2.30 · Cited by 62 · see citing works
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Early Detection and Intervention of ASD: A European Overview
Magán‐Maganto, M., Bejarano‐Martín, Á., Fernández-Álvarez, C. J., Narzisi, A., Primo, P. G., Kawa, R., de la Paz, M. P., & Canal‐Bedia, R. (2017) · Brain Sciences · doi:10.3390/brainsci7120159 · Cited by 56 · see citing works
“Empirical studies evaluating the effectiveness of the ESDM and the ESDM Parent Delivery version indicate that this model is characterized by a rigorous, structured curriculum that is followed and implemented according to the programme’s guidelines and research findings suggest positive treatment outcomes as children i…”
MethodMcNeill, M., Noyek, S. E., Engeda, E. H., & Fayed, N. (2020) · Quality of Life Research · doi:10.1007/s11136-020-02690-4 · Cited by 50 · see citing works
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Eapen, V., Črnčec, R., & Walter, A. (2013) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2013.00567 · Cited by 50 · see citing works
“…studies have demonstrated that children receiving the Early Start Denver Model (ESDM), a behavioral intervention for children with ASD, showed gains in IQ and adaptive behavior and decreases in ASD-specific symptoms after intervention (Dawson et al., 2010; Eapen et al., 2013; Vivanti et al., 2013).”
ResultSelf-citationWang, Z., Cheong, L. S., Tian, J., & Chen, Q. J. (2021) · International Journal of Developmental Disabilities · doi:10.1080/20473869.2020.1870419 · Cited by 46 · see citing works
“…improvements in autism symptoms or diagnosis (Gao et al. 2020, Xu et al. 2017, Yang 2015, Rogers et al. 2012, Vivanti et al. 2014), cognition (Eapen et al. 2013, Fulton et al. 2014, Rogers et al. 2019, Rogers et al. 2012, Vivanti et al. 2014), social communication (Rogers et al. 2019, Rogers…”
BackgroundChan, G. W. L., & Goh, E. C. L. (2013) · Journal of Social Work Practice · doi:10.1080/02650533.2013.844114 · Cited by 49 · see citing works
“Research studies have shown the importance of early intervention services for CASD and their families (Dawson et al., 2012; Reichow et al., 2012; Eapen et al., 2013).”
BackgroundAssessing Functional Impairment in Siblings Living With Children With Disability
Goudie, A., Havercamp, S. M., Jamieson, B., & Sahr, T. R. (2013) · PEDIATRICS · doi:10.1542/peds.2013-0644 · Cited by 49 · see citing works
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“Therefore, it is unclear how well, or if not at all, ESDM strategies were implemented in the home (Eapen et al., 2013).”
BackgroundResultInfluentialHolzinger, D., Laister, D., Vivanti, G., Barbaresi, W. J., & Fellinger, J. (2019) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000675 · Cited by 41 · see citing works
Can the Early Start Denver Model Be Considered ABA Practice?
Vivanti, G., & Stahmer, A. C. (2020) · Behavior Analysis in Practice · doi:10.1007/s40617-020-00474-3 · Cited by 41 · see citing works
“Fulton, Eapen, Črnčec, Walter, and Rogers (2014) documented that the implementation of this procedure resulted in a substantial reduction of unwanted behaviors in children receiving the ESDM.”
Pre-linguistic Vocal Trajectories at 6–18 Months of Age As Early Markers of Autism
Chericoni, N., Wanderley, D. D. B., Costanzo, V., Diniz-Gonçalves, A., Gille, M. L., Parlato-Oliveira, É., Cohen, D., Apicella, F., Calderoni, S., & Muratori, F. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01595 · Cited by 42 · see citing works
Xu, Y., Yang, J., Jing, Y., Chen, J. R., Zhuang, X., Wang, W., Zhang, X., & Lee, G. T. (2017) · Journal of Early Intervention · doi:10.1177/1053815117748408 · Cited by 40 · see citing works
“This study used CARS, while other studies used Autism Diagnostic Observation Schedule (ADOS; Dawson et al., 2010; Estes et al., 2015; Vivanti et al., 2016; Vivanti et al., 2013; Vivanti et al., 2014) or Social Communication Questionnaire (SCQ; Eapen et al., 2013; Fulton et al., 2014).”
BackgroundMethodResultInfluentialWilson, K. P., & Landa, R. J. (2019) · Frontiers in Education · doi:10.3389/feduc.2019.00027 · Cited by 40 · see citing works
“One major barrier pertains to lack of adequate training to prepare educators to effectively instruct children with ASD (Scheuermann et al., 2003; Loiacono and Allen, 2008; Busby et al., 2012; Eapen et al., 2013).”
BackgroundAdaptive functioning of childhood brain tumor survivors following conformal radiation therapy
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“, direct skills based teaching, computer simulations), established in other clinical populations (mental illness [30], autism [31, 32], traumatic brain injury [33, 34]), may be an area of possible intervention to enhance the quality of life for BT survivors.”
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A Randomized, Community-Based Feasibility Trial of Modified ESDM for Toddlers with Suspected Autism
Mirenda, P., Colozzo, P., Smith, V., Kroc, E., Kalynchuk, K., Rogers, S. J., & Ungar, W. J. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05390-1 · Cited by 35 · see citing works
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“, 2010), community settings (Eapen et al., 2013; Stadnick et al., 2015; Edwards et al., 2019), and school settings (Goods et al.”
BackgroundWergeland, G. J., Posserud, M.-B. R., Fjermestad, K. W., Njarðvík, U., & Öst, L. (2022) · Clinical Psychology Science and Practice · doi:10.1037/cps0000106 · Cited by 30 · see citing works
Garg, P. (2014) · JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH · doi:10.7860/jcdr/2014/8243.4527 · Cited by 31 · see citing works
“A recent uncontrolled study has also demonstrated community dissemination of the ESDM using a group-based intervention as effective [66].”
MethodDevine, D. P. (2013) · Psychopharmacology · doi:10.1007/s00213-013-3279-2 · Cited by 29 · see citing works
The Need for a Developmentally Based Measure of Social Communication Skills
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“Consistently with these results, a number of studies conducted in recent years tended to confirm a positive relationship between early start of the treatment and positive outcome [24, 25].”
ResultRogers, S. J. (2016) · Springer eBooks · doi:10.1007/978-3-319-40904-7_3 · Cited by 28 · see citing works
Gender comparisons in children with ASD entering early intervention
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Social communication deficits and restricted repetitive behavior symptoms in Tourette syndrome
Eapen, V., McPherson, S., Karlov, L., Nicholls, L. E., Črnčec, R., & Mulligan, A. (2019) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s210227 · Cited by 24 · see citing works
Self-citationSchool engagement of children in early grades: Psychometric, and gender comparisons
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“Therefore, ASD has a significant impact on public health and education systems [3].”
BackgroundAldharman, S. S., Al-jabr, K. H., Alharbi, Y. S., Alnajar, N. K., Alkhanani, J. J., Alghamdi, A., Abdellatif, R. A., Allouzi, A., Almallah, A. M., & Jamil, S. F. (2023) · Cureus · doi:10.7759/cureus.38745 · Cited by 30 · see citing works
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“Applied Behaviour Analysis (ABA) is a one-toone intensive approach based on behavioural strategies and targets specific symptoms using reinforcement of adaptive, expected skills [8, 9].”
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Developmental and mental health disorders: Two sides of the same coin
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“For example, children receiving early intervention for Autism have been shown to have an increase in their mean IQ score of 10 points over 12 months in a community setting (Eapen et al., 2013) and 18 points over two years in a clinic setting (Dawson et al.”
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“Early intervention and detection that directly focus its development showed preliminary evidence of potent effects on communication and motor skills (Eapen et al. 2013) or on later language and social abilities (Landa et al. 2011).”
BackgroundAdults with autism spectrum disorder: Updated considerations for healthcare providers
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“41 44 Some versions of applied behavioral therapy, such as the Early Start Denver Model, 45 have been found to be cost-effective and offset some expenses in the care of children with autism, using play-based and relationship-based interventions to promote development across domains while reducing symptoms.”
BackgroundBaillin, F., Lefebvre, A., Pedoux, A., Beauxis, Y., Engemann, D. A., Maruani, A., Amsellem, F., Kelso, J. A. S., Bourgeron, T., Delorme, R., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.510366 · Cited by 30 · see citing works
“Early detection and intervention directly focusing on the development of IS showed preliminary evidence of positive effects on motor and communication skills (42), especially later in both language and social abilities (39).”
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“In this regard, considerable genetic and clinical heterogeneity has been suggested with significant variations both in the etiological underpinnings and in the manifestations of the condition [4,5].”
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“G-ESDM has been evaluated across five studies to date (Eapen et al. 2013, Fulton et al. 2014, Vivanti et al. 2013, 2014, 2019).”
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“Early interventions increase children’s performance in several areas, such as communication abilities, adaptive functioning, facial emotion production, and prosocial behaviors [2,10–13], decrease the severity of the autistic traits [6,14,15], and offer mechanisms for parents in coping with the grief resulting from the…”
BackgroundTeaching choice‐making within activity schedules to children with autism
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Autism: One or many spectrums?
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“The effect size found was of 10 points for the DQ.44 The other study was a pilot study conducted in the principal investigator’s (PI) centre, where children received ESDM 12 hours per week with one therapist for one child, over 9 months, which found an improvement of 11 DQ points at the end of the study.”
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A replication of preference displacement research in children with autism spectrum disorder
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“Consequently, there is no cure for autism [11,13], even if several behavioral and educational programs have been suggested for treatment [4,14].”
BackgroundBrief Report: An Evaluation of an Australian Autism-Specific, Early Intervention Programme.
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“These programs primarily aim to reduce ASD symptomology and improve cognitive ability but if externalizing behaviors are present, positive behavior support principles are utilised (Eapen et al., 2013; French & Kennedy, 2018).”
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Relationships Between Household Income and Functional Independent Behavior for Children With Autism
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“Studies have highlighted that interventions received in early childhood are more effective than later childhood interventions for children with ASD (Dawson et al., 2010; Eapen et al., 2013).”
BackgroundTraining Pediatricians to Implement Autism Screening Tools: a Review of the Literature
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Self-citationAn evaluation of preference stability within MSWO preference assessments for children with autism
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Behavioral therapies for the treatment of autism spectrum disorder: A systematic review
dos Santos, C. L., Barreto, I. I., da Silva, A. C. F., Soriano, J. F. B., Castro, J. D. L. S., Tristão, L. S., & Bernardo, W. M. (2024) · Clinics · doi:10.1016/j.clinsp.2024.100566 · Cited by 8 · see citing works
“Eapen et al. assessed group-based ESDM, while the other authors evaluated individual sessions supplemented with parental follow-up to implement certain homework tasks.”
InfluentialATITUDES E PRÁTICAS PEDAGÓGICAS DE INCLUSÃO PARA O ALUNO COM AUTISMO
Faria, K. T., TEIXEIRA, M. C. T. V., Carreiro, L. R. R., et al. (2018) · Revista Educação Especial · doi:10.5902/1984686x28701 · Cited by 8 · see citing works
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The Mullen scales of early learning: ceiling effects among preschool children
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Factor Structure of the Social Communication Questionnaire in Preschool Aged Autistic Children
Grove, R., Paynter, J. M., Joosten, A. V., Vivanti, G., Dissanayake, C., & Eapen, V. (2019) · Journal of Child and Family Studies · doi:10.1007/s10826-019-01519-0 · Cited by 7 · see citing works
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“…service delivery models: for example, group based programs provide opportunities for peer-to-peer interaction with potential D i s ad v . to develop children ’ s social communication or generalize new skills to real-life situations, particularly in low-resource contexts (Eapen et al., 2013).”
Zhou, H., Li, C., Luo, X., Wu, L., Huang, Y., Zhang, L., Zou, X., Xu, X., Jiang, Y., Yan, W., et al. (2018) · Frontiers in Neurology · doi:10.3389/fneur.2018.00460 · Cited by 6 · see citing works
Early Start DENVER Model: A Meta - analysis
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“According to Eapen et al., (2013), early intervention offers the best treatment during the 12 months of life of the child with ASD since this is where the “brain plasticity” is high.”
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Evidence-Based Treatments in Communication for Children with Autism Spectrum Disorders
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“Children’s developmental skills such as visual reception, fine motor, expressive language, and receptive language are commonly assessed to determine the effectiveness of ASD intervention [26, 27].”
BackgroundLinnsand, P., Nygren, G., Hermansson, J., Gillberg, C., & Carlsson, E. (2024) · Frontiers in Child and Adolescent Psychiatry · doi:10.3389/frcha.2024.1341729 · Cited by 4 · see citing works
“Several studies have demonstrated the ef fi cacy of preschool based ESDM, including improvements in core developmental domains and decreased maladaptive behaviour (27 – 31).”
- Authors
- Eapen, V., Črnčec, R., & Walter, A.
- Affiliations
- South Western Sydney Local Health District (AU)
- UNSW Sydney (AU)
- Corresponding author
- Eapen, Valsamma
- Venue
- BMC Pediatrics
- Published
- 2013-01-07
- Volume
- 13
- Issue
- 1
- Pages
- 3-3
- ISSN
- 1471-2431 (ISSN-L)
- PMC
- PMC3631131
- OpenAlex
- W2123545643
- Semantic Scholar
- 8bd9c0a64f6d5f1e607acda7005e2ea0c8e857b5
- Cited by
- 230
- References
- 37
- Citations by year
- 2026: 10 · 2025: 13 · 2024: 16 · 2023: 18 · 2022: 63 · 2021: 11 · 2020: 13 · 2019: 18 · 2018: 15 · 2017: 12 · 2016: 10 · 2015: 14 · 2014: 10 · 2013: 6 · 2012: 1
- FWCI
- 7.18
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Pediatrics (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- Funders
- Australian Government
- University of New South Wales
- University of California, Davis
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- autism spectrum disorder, Early Start Denver Model, early intervention, preschool children, group intervention, community-based childcare, community dissemination, applied behaviour analysis, language development, adaptive behavior, parent-reported outcomes, Mullen Scales of Early Learning
- MeSH terms
- Behavior Therapy, Child, Child Development Disorders, Pervasive, Child, Preschool, Female, Humans, Male, New South Wales, Treatment Outcome, Early Intervention, Educational
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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