Home > Science > 5|25: Celebrating Five Years of Autism Science Day 24: Early Intervention for Toddlers with Autism Spectrum Disorders

5|25: Celebrating Five Years of Autism Science Day 24: Early Intervention for Toddlers with Autism Spectrum Disorders

In honor of the anniversary of Autism Speaks’ founding on Feb 25, for the next 25 days we will be sharing stories about the many significant scientific advances that have occurred during our first five years together. Our 24th item, Early Intervention for Toddlers with Autism Spectrum Disorders, is from Autism Speaks’ Top 10 Autism Research Events of 2009. 

Although previous studies have found that early intervention can be helpful for preschool-aged children, interventions for children who are toddlers are just now being tested. As 2009 came to a close, the results were unveiled for the first controlled study of an intensive early intervention appropriate for children with ASD who are less than 2½ years of age. Published in Pediatrics, results of this study showed that a novel early intervention program was effective for improving IQ, language ability, and adaptive behavior in children as young as 18 months.

The intervention, called the Early Start Denver Model, combines applied behavioral analysis (ABA) teaching methods with developmental ‘relationship-based’ approaches, thereby blending the rigor of ABA with play-based routines that focus on building a relationship with the child. Children in the study were separated into two groups, one that received 20 hours a week of the intervention – two two-hour sessions five days a week – from University of Washington specialists. They also received five hours a week of parent-delivered therapy. Children in the second group were referred to community-based programs for therapy. Researchers closely monitored the progress of both groups.

At the beginning of the study there was no difference in functioning between the two groups. At the conclusion of the study, the IQs of the children in the intervention group had improved by an average of close to 18 points, compared to only 7 points in the comparison group. The intervention group also had a nearly 19-point improvement in receptive language (listening and understanding) compared to approximately 10 points in the control group. Whereas only one child in the community-based intervention group had an improved diagnosis, seven of the children in the intervention group had enough improvement in overall skills to warrant a change in diagnosis from autism to the milder condition known as ‘pervasive developmental disorder not otherwise specified.’

While the youngest children in the study were 18 months old, this particular intervention is designed to be appropriate for children with ASD as young as 12 months of age. Given that the American Academy of Pediatrics recommends that all 18- and 24- month-old children be screened for ASD, it is crucial that we are able to offer parents effective therapies for children within this age range. This new study strongly affirms the positive outcomes of early intervention and the need for the earliest possible start.

Did you know?: To encourage research in early intervention, at the end of 2006 Autism Speaks funded a set of multi-site randomized trials to investigate the efficacy of different early intervention techniques in toddlers who show early signs of autism. From this effort a Toddler Treatment Network (TTN) was born to establish the groundwork for collaborative studies that can incorporate different aspects of these various intervention approaches.  The TTN investigators have also been collecting and sharing information on a variety of best practices, including how to build partnerships with local communities. Importantly, all studies are testing interventions that can be implemented outside the clinic, with the aim of decreasing the time between parent’s first concern and initiation of treatment.

  1. May 7, 2010 at 9:06 pm

    The Slow But Certain Dismantling of NYS Early Intervention:
    An Open Letter To Governor David Patterson and Our New York State Legislators

    We are extremely concerned that Early Intervention is slowly but certainly being dismantled in the State of New York. I am Leslie Grubler and I represent the United New York Early Intervention Providers. Currently, we have members throughout New York State, from Montauk Point to Niagara Falls and are increasing membership exponentially daily. We are rapidly enrolling independent contractor/ EI Providers who are SLP’s, PT’s, OT’s, Special Educators/ABA Therapists, Vision Therapists, Psychologists, Social Workers, Nutritionists, parents and grandparents (the largest voting block in the state of New York), Pediatricians, Attorneys, and Compensation Analysts.

    While we are by majority the providers of service not the stake-holders, WE ARE those that face the children daily; WE ARE the foundation of NYS Early Intervention; WE ARE a group of highly educated professionals; WE ARE in essence the most productive part of NYS Early Intervention.

    Commissioner Daines’ regulatory directive, an action that has averted democratic legislative consideration, has significantly reduced the reimbursement rate to EI Program therapists and, thereby, has created for us the following challenges:

    1. The directive ignores the efficacy of home-based services in favor of center-based services (who along with service coordination will benefit from Commissioner Daines’ mandate). Home based therapy is essential to “Family as Partners”, a central mandate of Early Intervention which stresses that children are to be treated in their own home and family environments. The directive makes it likely that more and more parents and grandparents will soon be expected to place their 0-3 child with developmental disabilities on a school bus to engage in a classroom setting in which parent contact is limited at best and excessive caseloads of providers prevail.

    Research overwhelmingly shows that with home-based care in the child’s natural environment, parents and extended family are trained to help their own children achieve effective, consistent and efficient progress.

    Families of children with special needs are often dealing with the devastation of raising a child with special needs and overwhelmed. There is a strong bond that develops within the home environment between the EI provider and the grandparent/parent/caregiver that cannot be replicated within the center-based setting. This bond contributes to the parent/caregiver’s ability to follow thru on suggestions, techniques provided by each EI provider, and thus contributes to the progress each child makes

    The essence of Early Intervention is home-based care. Commissioner Daine’s directive moves Early Intervention away from the home.

    2. Commissioner Daines, in his memo dated March 24, reduced reimbursement rates to Early Intervention Programs by 10%. The Early Intervention programs immediately enacted this change. Many passed on the entire cut to providers/independent contractors. Additionally, the majority of Early Intervention administrators have passed this reimbursement rate reduction not as a 10% decrease but in some cases as high as 17% — to the exclusion of any other programmatic changes or pay decreases of staff or administration. Can you and the programs that you trust to manage Early Intervention in all parts of the state — can you not find other ways to reduce costs? Are there no original and/or creative thinkers amongst you that are unafraid to approach a challenge from potentially a different angle?

    A 10% decrease is tragic. A 20% decrease is disastrous. How would YOU and YOUR FAMILIES cope with an income reduction this dramatic? How are each of our members coping? Our single parents? Our single independent contractors with no health insurance or retirement programs?

    3. As Early Intervention independent contractors, WE face the children and their parents, WE push progress, WE are the front line, the most productive members of the New York Early Intervention Team. WE are the change agents. Why were we unfairly targeted? because we are not organized? because our fields are overwhelming female rather than male?

    4. The reductions imposed will not benefit the state…and will not benefit our children. If the neural plasticity of children 0-3 with development disabilities is not accessed during this biological critical period, many of these children with disabilities will not progress. We have seen many children progress through our work in EI — children who had been evaluated initially as low functioning have graduated to kindergartens for typically developing children. Surprising? not to us — this is a regular and daily occurrence.

    5. a. Early Intervention Agencies frequently require that we attend mandatory meetings without pay — oftentimes to address their own changes in policy or procedure and also to address changes in Early Intervention Guidelines. In the past, we have attended; however, the rate decrease imposed by many Early Intervention Programs has required that we seek other opportunities including additional cases which now limit our availability. .

    b. Early Intervention Agencies require that we complete progress notes every three months – in the past this has been said to be included in our fee. Since many of us will likely be forced to take on increased caseloads (more children, longer work days, weekend work, and longer hours) we are being placed in a position where our availability is limited as noted. Additionally, our rates are supposed to cover communicating with other team members, creating adaptive equipment, attending CPSE meetings (in the best interest of the child), attending IFSP meetings (in the best interest of the child), in addition to other QA responsibilities. Is it no wonder that we have consistently asked for an increase in Provider rates – and yet we are met with a decrease.

    c. Early Intervention Agencies are presenting and initiating unfair contracts and are requiring us to sign prior to releasing our paychecks — for services that have already been provided. Does this reflect the current definition of an Independent Contractor?

    d. Early Intervention Provider rates have not increased since 1995. The cost of living has increased including gas prices, car insurance, and materials. Three years ago, across the state, several areas including Nassau County , saw increases to the duration of sessions from 30 minutes to 45 minutes – no increase in rates were offered. For many, this is a second rate decrease.

    6. Proposed Rule Making dated April 7th will not increase employment opportunities in the numbers of home-based independent providers. The recommendation is made that ABA/Teacher Assistants can replace ABA therapists in the instruction of children with autism. These children need to receive ABA intervention by NYS Licensed; ABA- trained and certified special educators. The belief that teacher assistants can fulfill this role is fantasy and reflects the desire to cut costs at all expense – mostly at the expense of children with autism and their families. These children with autism are amongst the most difficult children to reach – and we need trained, qualified, experienced and seasoned professionals to work with them and their families.

    We believe that your efforts to replace qualified ABA professionals with “assistants” is only the tip of the iceberg. If you have impacted ABA therapists in this way, who is next? Early Intervention home-based therapy will consist of unqualified, inexperienced, assistants who will be unable to motivate progress and be incapable of fostering the type of change that Early Intervention has been known to provide — all to achieve cost effectiveness and profitability. Our children are our future whether they are my children, yours, or our neighbors. This change will not only effect the children but their families and, in essence, the future of our state since our “human resources” will be compromised.

    Seek alternatives to this dismantling of Early Intervention. Impact programs or administrators that do not effect the children with developmental disabilities and their families.

    7. Proposed Rule Making dated April 7th also attempts to decrease eligibility for children with expressive language delays seemingly even those with severe expressive disorders like apraxia. Additionally, new constraints are introduced that may severely limit eligibility of children in Early Intervention after 6 months. Therapeutic intervention is a process – and each child is unique. There can be no cookie cutter approach here. The child must be considered holistically. The state’s efforts with respect to the Proposed Rule-Making are short-sighted and will result in burdening our special education system further as the children age.
    In summary, it is our hope that our efforts to preserve and protect Early Intervention are supported by you. We look forward to a resolution that will benefit all those involved in Early Intervention and, in particular, the children who receive Early Intervention Services and their families. I look forward to your reply. Feel free to contact me should you have any questions.


    Leslie Grubler MA, CCC-SLP, TSHH
    United New York Early Intervention Providers

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